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Showing posts from September, 2019

An update on my journey

So I don't really know what I want to write in this post because my mind is scattered so it may be a bit of a ramble on. I'll try and organise my thoughts...I'll dump my thoughts on here and hopefully it sounds cohesive. You don't have to read this post. It's mainly for me to organise myself and figure out where I am heading. Motivation is one of those strange things that is there for you until it's not. Motivation to me is the inner drive that arises when you have a clear goal in your mind worth struggling for.  It's a fickle thing because every day there are distractions that may cause us to stray from the path that we have set for ourselves. There is no inherent malevolence in these distractions, they are what they are. Sometimes these distractions are negative because they cause us to stumble and fall. Sometimes they cause us to stumble and we respond by increasing our resolve to achieving our goal. Sometimes they can be positive and cause us to realis...

My observations of masseter size and bruxism

These are my thoughts and observations when facing a patient with occlusal issues. I am unsure if they have a scientific basis or actually make sense but it will be good to learn a bit more about occlusion at Michael Melker's course in Sydney in August. Taking notes of the size of a patient's muscles of mastication is important in determining the functional demands on their teeth. Like any muscle, continued use results in hypertrophy. It is less obvious in the temporalis as it is located over the temporal fossa that masks the true thickness of the muscle. The masseter is the main elevator muscle of the mandible and will be enlarged in patients who clench and brux.  Correlate masseter size with the patent's risk of sleep apnoea. I have found that the skinny, non class 2 patients with large masseters tend to be awake clenchers. Clenchers will show less wear on their anterior and posterior teeth as the force is mainly vertical though they may display chipped teeth and cra...

Review of an old blog post

Today I had the opportunity to review a previous case: http://dental-tidbits.blogspot.com/2018/08/getting-good-contact-with-large-gics.html http://dental-tidbits.blogspot.com/2019/05/review-of-alternative-technique-for-gics.html The entire GIC debonded a couple of weeks ago about a 11 months after placement when the patient was biting on a mintie. It's not a bad result but still needs management. The idea of the initial GIC placement was as a temporary to monitor the pulp status and the tooth has been otherwise asymptomatic. One might question if it's asymptoamtic due to a receeded pulp or a necrotic pulp. The failure was adhesive with the entire GIC lost save for the vitrebond liner so this was placed back when I was doing more indirect pulp caps. As enough time had passed for pulp review I replaced the restoration in composite. I'm a lot less worried these days about causing pain with wedges. The patient consented to treatment without LA and understands there will ...

An update on primary exams

As my journey through the primary exams continues I have made some choices/realisations: -So far I have scrapped the idea of a second blog with content of the primary exams. It would be a fairly dry read and It will take up time I could be using for actually studying. -The timing of the orientation course is too late in the year. It really only gives time from end of July to end of November to prepare for exams or wait till the next year round. My suggestion would be to find someone who has done the primaries before and get the lecture notes from them so at least you can have a head start of things. -Focussing on study is difficult but not impossible. It is best to remove distractions and structure your study times and breaks well. I have found that working to a timer is useful. have it counting down e.g in 30 minute blocks and every time it goes off you can have a short break. Make sure you stick to these! -Studying hard core and denying yourself reasonable breaks and days off is ...

How to locate subgingival calculus

Subgingival calculus as the name implies is out of sight and therefore can be difficult to locate and clean. In this case, out of sight doesn't mean out of mind as it is our responsibility to locate these deposits and clean the tooth surface during the patient's regular periodontal maintenance visit. Locating these deposits in the first place is the difficulty and this can become much more difficult after debridement has begun due to bleeding of gums. Below are some points on how to identify subgingival calculus. Supragingival calculus tends to be yellower, chalkier and rougher than the surrounding tooth structure. Once you know the proper shape of the tooth and root surface, any deviation is easy to identify as calculus. Drying the tooth will help differentiate the two surfaces. Subgingival calculus is often proximally related to supragingival calculus as the same poor oral hygiene practices that have led to one lead to the other. Areas where subgingival calculus is prese...