tips and tricks

Wow, this marks the 200th post since I started the blog back in 2012. To date this is my longest running project. Yes it has been on and off but it has been a good test of my mental fortitude writing out all these posts. It has been a great way to pass time, solidify knowledge and bounce ideas off the interweb. I've shared the blog with a few close people and the feedback seems positive. It is surprising to me how long this has been running but it has been surprising in a good way. Many things have changed in my dentistry and especially in my life since I started this blog but I can see things moving slowly onwards and upwards. Who knows what the future will bring? Here's to learning, improving and the sharing of knowledge.

In complex rehabilitations cases, the more records that you collect often results in less adjustments on insert. Multiple unis prosthodontics removes the stability of the casts on mounting therefore the bite record is paramount. The protrusive bite becomes necessary to program the condylar angle on a semi adjustable articulator. One of many variations in human anatomy, the condylar angle has implications for guidance of the mandbible in protrusion and laterotrusion from CR. It represents the steepness of the articular eminence that the condyle translates down (Figure 1). Steep condylar angles will result in rapid disclusion of the dentition from CR whereas shallow condylar angles will have quite subtle disclusion. Figure 1: The angle of the articular eminance determines the path of the condyle as it translates forwards. The protrusive bite must not be taken too far forwards as it will give a false reading as the condyle translates over the cusp of the eminence. The protrusive bi...

From Contemporary oral medicine 2019 The management of SB aims mainly to reduce the damage and consequences of SB rather than reducing the muscle activity. Behavioural medicine: Most of these concepts are based on expert opinion and lack long term results. Avoidance of triggers such as cigarettes, caffeine, alcohol and illicit drugs can be beneficial. Habit awareness and reversal techniques for AB will reduce attrition of the dentition. Relaxation techniques, good sleep hygiene and hypnotherapy may be useful for SB and AB.  Oral appliance: First line therapy for SB associated with TMD. Mechanism of action is under unresolved debate. Current evidence suggests that oral appliances decrease SB transiently for the first 2 weeks of wear with SB continuing in the long term. Changes to occlusion may occur as a side effect and may not be tolerate by those with an active gag reflex. The use of maxillary stabilisation splints may increase the AHI and risk for snoring due to reduced to...

We often plan to place rubber dam isolation over multiple teeth that require restoration. This is beneficial for the comfort of the patient, ease of working and longevity of the restorations. However, placement of the rubber dam through the contact point can be hindered by sharp enamel edges or restorations that can cut the rubber dam septa. Also, very tight restorations with overhangs will prevent proper seating of the dam. When you note these conditions and plan to place a rubber dam, at the very least check the contacts with floss. If the floss is shredded or can't penetrate through the contact point then your rubber dam is likely to do the same. Therefore, these restorations need to be recontoured or the preparations done before rubber dam placement. This will save valuable clinical time as recutting a torn rubber dam and difficulty placing the dam will be time consuming.

From Contemporary oral medicine 2019 Signs of SB: -Tooth wear: Erosion most commonly causes excessive tooth wear with attrition following closely. Attrition can be charaterised by flat planes on teeth i.e wear facets, with planar enamel wear and shallow dentine wear with well defined margins in the enamel of incisal edges or with step like areas on the palatal aspects and equivalent facets on all opposing teeth. In contrast, erosion tends to damage dentine more deeply causing cupped lesions and loss of surface anatomy. Bed partner or parent reports of tooth grinding sounds can also be helpful in diagnosis. -Masseter hypertrophy: This is a benign, asymptomatic enlargement of one or both masseter muscles. There is a slight male predominance with an average age of 30 years. -Tongue indentation (Tongue scalloping): This has been associated with bruxism, more commonly clenching. It has been suggested that Tongue indentations may be caused by macroglossia secondary to systemic amyloid...

In our busy lives, our time can seem too precious to do things that are out of our routine. However, when we do volunteer our time for a good cause this makes the effort all the more worthwhile. As dental health professionals we have the privilege to use our minds and unique skill sets on a daily basis to benefit complete strangers. Volunteering can be a fantastic way to utilise these skills and make a positive change in the lives of those less fortunate than ourselves. Volunteering in dentistry can take all sorts of forms and you can participate at any stage in your career. Joining a committee with your professional organisation or university can be a great way to connect with your peers, share your ideas and experiences and contribute to changes in the direction of your profession.  It is a great way to make connections, develop your interpersonal skills and see what issues the wider world of dentistry holds for us. Volunteering organisations exist all over the world that see...

From Contemporary oral medicine 2019 The etiology of SB is largely unknow but current theories hypothesise that SB is centrally mediated probably in the brainstem and has a multifactorial etiology. Sleep arousal is a brief awakening from sleep (3-15s) characterised by increased EEG, autonomic, cardiac and muscular activities without a complete return to consciousness. These normally occur <15 times an hour in response to external or internal stimuli. The association between sleep arousals and RMMA is well estabilished but they shouldn't be considered as the only cause or trigger of SB as they may be the window that allows RMMA during sleep. Additionally, arousals represent the end result of a multitude of physiological events involving the SNS, movement and respiration that may be more to blame. Genetics and familial predisposition: The level of evidence supporting a genetic predisposition to SB is low however there is a high proportion of SB subjects who have a family mem...

When a patient returns complaining of soreness to chew on dentures there are two broad possibilities: -Pain in the teeth supporting or retaining the denture can occur due to tight or ill fitting dentures. You will notice that it is difficult to insert the dentures without pressure. This can cause a similar condition to traumatic occlusion to the periodontium and the patient may complain of a tight feeling in their residual teeth -Pain to soft tissues due to denture contact: Always check the occlusion first! The patient may be contacting more firmly on one side causing uneven pressure and pain on the side they are chewing. They may also have an interference causing into lateral shift MIP. This will cause significant lateral force on the denture and will tend to cause pain on the lower denture that is on the lingual of one side and buccal of the contralateral side. Rather than adjusting the fitting surface of the denture, adjust the occlusion first til there are even bilateral contact...

Just finished the first day of the RACDS orientation course. It started with an introduction and welcome and progressed to a day of lectures including physiology, pathology and cell biology and biochemistry. Definitely had more attendees than I expected, from all over Australia and from overseas too. The lectures were basic but hopefully they'll pick up in interest. ZZZ what a snooze fest. I don't think I've been that bored for a very long time. I think I've been less bored staring at the blank wall in my bedroom. Of course it's boring because it's hard to keep concentration going over a long day but the subject matter is very reminiscent of first and second year basic sciences. It is quite strange going back to basics and studying things that while important do not have a direct clinical relevance to dentistry. I will see how the next couple of weeks go for me. Should probably make more of an effort to socialise more but that's just not me.

Thin gingival biotypes are notorious for their fragility and predisposition to recession. When examining the blood supply to the gingiva it reveals some interesting points. Blood supply to the gingiva occurs mainly through the periosteum however the papillae have a more rich and varied supply. It receives blood flow from the periosteum, periodontal ligament, surrounding tissue and crestal bone. When viewing the crestal bone through a microscope you will notice small arterioles exiting at the crest to supply the soft tissue. Incidentally this is the site that allows intraosseous infiltration without drilling into the bone. Blood supply is the most important consideration when handling soft tissue and techniques about handling and flap design all take this into consideration. Many people when viewed on a CBCT will show inadequate buccal bone coverage with severe dehisence almost to the apex of the tooth. The buccal of a tooth is also the site with the least keratinised and attached tis...

From Contemporary oral medicine 2019 Bruxism is a repetative jaw muscle activity characterised by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. Sleep (SB) and awake (AB) bruxism are separate in their presentation and pathophysiology however they may overlap in some individuals. AB tends to occur in the form of clenching and bracing or thrusting of the mandible. Grinding can be seen but it is milder than that seen in SB unless the patient has a neurological condition. There seems to be a female predilicition with rations M:F between 2:3 and 1:3. AB is associated with stress, depression, addictions, neurological disorders such as Huntington's disease and congitive impairments such as in Rett's syndrome, Down syndrome and ASD. It is also significantly influenced by lifestyle. Management of AB is initially based of the recognition of awake clenching. This may involve lifestyle changes, habit reversal training, relaxation, hypnosis and biofeedba...

Going through the lecture notes I can start to see how this commitment could take up quite a bit of my time. Some subjects have more lecture notes than others and I can see how those with fewer notes are probably the ones that require significant self directed learning. Orientation course is in less than a week. Honestly the more dreadful idea is commuting Sydney public transport in peak hour. Looking forward to the lectures.