tips and tricks

So the other day I was rostered in the extraction clinic, my first one of this for the year which means it was the first time extracting teeth other than perio teeth for about 3 months. Below are some thoughts that I had during the day: - I probably broke the roots on about 3 teeth that day and I felt no panic or at least a lot less than if the same thing had happened fresh out of uni. Successful exodontia doesn't involve having straight forward procedures all day every day but requires the skills and knowledge to manage complications and surprises as they come. I dug these roots out with different methods: elevation, root picks and endo files. Some advice I would give to a fresher grad is that you will break plenty of roots, don't be surprised when it happens.  If something happens that you don't expect, step back, take a deep breath and plan out what you will do next. -Most of the appointment is talking, the fastest part is often the extraction itself. 10 minutes of ta...

Today I had  3 restorations side by side that required different methods to restore. There was a 47 with large buccal caries that extended towards the mesial, a 45 with rampant caries that eventually covered the whole MODB, and a similarly carious 43. The oral hygiene was poor and the gingiva was very inflamed with subgingival carious margins. We are transitioning to a full denture.The challenges with each tooth and the restoration method were: -47 subgingival margins, bleeding gingiva, poor access due to a high attachment of the buccinator muscle and hypertrophic masseters pushing the mucosa towards the tooth. For cheek retraction, dry tips could be used to ease handling, The mirror needs to be placed right against the gingiva at the mucobuccal fold and pull downwards and towards the bone not buccally. If you hold the mirror against the buccal mucosa and attempt to retract the cheek the mucosa will fold in and you won't have access to the tooth. Double large cords were placed be...

I'm getting better at standing my ground in situations where my ideas of treatment and the patient's ideas differ. Normally I'm quite flexible in my treatment planning but when the patient wants something that I think is absolutely a bad idea then I think it is important not to budge in your refusal of that treatment. For example a patient not willing to have an unrestorable, infected tooth extracted without promising to fill the gap after. This is in a mouth with poor oral hygiene and half completed endos on the abutment teeth. The patient will go through the stages of acceptance: denial, anger, depression, bargaining and then eventual acceptance. You can actually see the changes in their behaviour as they move through these. They will keep asking if you can do something for them. They will keep coming up with different ideas to get around your suggestion but in the end you have to keep giving them the same message: they have to do what you suggest or they get nothing. I...

The areas where I find it the most difficult to access for cavity preparation are the lingual of the lower molars and the buccal of the upper molars. This is due to the associated structures of the tongue and cheek respectively. Some patient's are easier to work on than others in these areas. you will find that the patients with more weight under the belt will have increased tongue size due to an increase in tongue fat volume. I have already made a post about working in the lingual area: http://dental-tidbits.blogspot.com/2020/01/lingual-isolation.html The buccal area of the upper 7s and 8s often become carious for the same reason that they are difficult to treat: difficult access for cleaning: http://dental-tidbits.blogspot.com/2019/01/plaque-accumulation-on-7s.html Plaque accumulation occurs on these surfaces and the proximity of the cheek traps food particles against this plaque leading to rapidly processing, wide areas of decay. This is why upper 8s are often caved in o...