tips and tricks

I will use the example that I encountered recently: a class 2 div 2 case with caries between the central and lateral but this is relevant to caries in any crowded area. Caries tends to be more severe in these areas due to the inaccessibility of cleaning and the culturing of anaerobic environments. Overlap of teeth hinder effective access of toothbrushing and allows a protected environment from the cleansing effect of food movement and saliva. Tight contacts hinder the passing through of floss and calculus buildup further prevents this.  Caries tends to initiate under the contact point and due to their root torque, class 2 div 2 teeth tends to have a long contact point more apical to the ideal position. Therefore caries tends to be positioned closer to the DEJ and more severe in size. Also, upon caries removal, the distance between the cervical restorative margin will be minimal to none. Once I had caries freed this case, the contact point had not been present because the teeth w...

Bitewings are a narrow view into a wider area. Generally, a size 2 film which the majority of dentists will use will show 4-5 teeth in view. This will usually miss the 8s, distal of the 7s and distal of the 3s depending on the anterior posterior positioning of your film. The posterior lateral surface of the tongue will tend to push the film superiorly and anteriorly and the curvature of the mandible will stop the film moving too far forwards. Caries will only present on bitewings when a significant portion of the buccolingual width is involved. Therefore as it is well known, they are useful for diagnosing interproximal caries where the buccolingual width is narrow near the contact point. However, a few things can confuse the interpreter of the radiograph: Occlusal caries is unlikely to show up on a bite wing until large. If you see a radiolucency at the base of a fissure, it is very likely to be carious. Buccal and palatal pit caries show up better as they penetrate into the tooth...

The more time I spend in clinical practice, the more I appreciate the idea that the more information we get off the patient, the better our treatment outcomes. As I begin to ask more questions, I begin to wonder how much I have been missing in the past. I am learning that dentistry alone can't win against an inhospitable oral environment. I spent a good hour with a patient today just digging through their history and trying to uncover the puzzle of his dental disease. I think a good rule is, "Nothing happens for no reason" or to put it another way "If the story isn't adding up then you're probably missing something." I think at university, we were given the tools to uncover these details but weren't taught how to use them. I also think that if you can agree that it is of utmost importance to modify the oral environment prior, during and after treatment, you can agree that we all need to dig a little deeper as to what the patient is doing to themsel...

So I had a brief encounter with a salesman in Harvey Norman today and a few thoughts occurred to me. This is how it went... I was browsing around the laptop and phone section, wasn't looking for anything in particular, just trying to pass the time. I'm dressed as scruffily as possible, t-shirt, shorts and thongs. Try to get past the appearance of a patient. IT MEANS NOTHING. as most people go I do fairly well for myself but I do not dress like it. When someone says they can't afford dentistry it doesn't mean they have no money, it simply means they do not see enough benefit in spending the money they have on what you are offering. When a patient requires comprehensive treatment planning we have a duty to inform them of options we assume is past their means. The right patient with the right motivation will spend much more than you will expect if they think you and your skills are worth the money. A salesman comes and asks if there's anything I need. He smells.....

Haven't had much time to post anything new on this blog but I'm starting to get back in the swing of it, to answer some comments and write some more posts. Have a few interesting topics that I want to write about. It's been a fairly up and down year for me with a lot going on in work and personal life. My colleagues are going through the primary exams right now and I wish them all the best. Unfortunately I dropped the commitment earlier in the year due to some reasons previously discussed. I'm also moving back to Sydney in the next few days smack bang in the middle of the exam schedule. After working rural for so long the big smoke scares me but it will be good to be closer to family especially with the health scares we've had in the past year or so. If anyone is following this blog I hope all is going well on your end. Things change and people change and someone who is great one day can be struggling the next. Just remember, help is always there to those who as...

The temperature of any material hastens its setting and breakdown. Composite resin has the desirable property of being command set with our curing lights so the temperature variations with composite resin are mainly to affect its handling properties. Too cold: Composite that is too cold will be thicker and more crumbly. Arguably this is beneficial to allow you to pack composite against a matrix band to generate a tighter contact that will stay in place while you cure. However the fact that it comes out of the capsules and tubes crumbly ensures that it will be impossible for you to avoid incorporating a void in your restoration. The most crumbly part tends to be right at the nozzle which is also the part exposed to air and likely to dry out over time. This will likely be the part that is placed at the very base of your restoration hence the most important to getting a good seal at the tooth interface. You will find it is very difficult to squeeze cold composite out of a compule so gen...