tips and tricks

http://dental-tidbits.blogspot.com/2014/09/a-thought-about-differentiating-between.html "I had a good demonstration about how to manage a patient with painful teeth where pulp tests are ineffective. This generally means that the pulp is either too calcified to respond or the canal is necrotic or pulpless. In either of these situations, chances are there is some periapical involvement. A PA radiograph of TTP is a good sign of this. Also symptomatic questions are useful with a prolonged, intense dull pain which may wake the patient up at night. A way to approach this would be to get the patient to bite down on a cotton stick saying you're going to test the teeth and you want them to bite down with firm pressure on 3 teeth 1, 2 and 3 and to tell them afterwards which hurt the most 1, 2 or 3." A bit incoherent but I think I know what I was trying to get at. -Pulp tests will give you an idea about the level of response of the nerves in the pulp which is not 1...

I did mention this tip a very long time ago (while still a dental student) but watching my colleagues has reminded me of several pet peeves that I used to be guilty of. Xrays are uncomfortable, we want to therefore do them as quickly but without compromising diagnostic quality. I am not talking about minimising exposure time because there really isn't any difference in comfort between 0.125ms and 0.250ms.What I am referring to is having everything prepared in advance i.e your DA setting up the film holder and film and most importantly positioning the xray tube before you place the film. Most patients find it incredibly uncomfortable to bite down on xray films and it is nerve wracking watching my colleagues place the film and waste an extra ten seconds pulling the xray tube from the wall with the patient writing in front of them Knowing that at any point the patient will give up and open and the xray will be ruined. There are a few things you must do to prepare the patient for th...

http://dental-tidbits.blogspot.com/2014/03/composite-restorations.html 1. Putting a thick layer of flowable doesn't compromise the strength of the restoration due to poor retention form, it is due to the lower filler content. 2. The way you place the composite into the cavity matters as trying to force a large blob of composite into a small cavity will result in voids. Flowable composite can be placed at the base of a cavity and heated composite can be injected into this to minimise voids. You must place the composite precisely and deliberately to reduce shrinkage stress. 3. I stopped using bond on instruments many years ago. It helps to stop instruments sticking but acts as a weak plane in your restoration (lower filler content again) and will lead to staining of your restoration. To avoid material sticking ensure a clean instruments i.e no material cured onto it and you can clean it with alcohol. Gold coated instruments can be used as well. Don't manipulate your material t...

If there was one criticism that was a constant theme from demonstrators throughout uni was my lack of attention to detail. For example, when I restored a tooth in composite I would leave flash and rough areas everywhere and would have no attempt at anatomy. I think this arose due to a few reasons: - I couldn't see what I was doing. I was trying to simultaneously have good posture and see what I was doing. This is impossible, magnification is needed to see what you are doing and do a good job. -I didn't understand what I was trying to achieve in a procedure. I thought a filling was a filling and that a rough filling was the same as a smooth filling as long as it filled the gap that was made after caries removal. I didn't understand that just because the patient is happy with the work doesn't mean that I should be. I wasn't striving for excellence. - I didn't care about what I was doing. I did care about patient outcomes but I didn't see the correlation of...

There are rules for tooth shapes that should be adhered to if you want to create beautiful, natural restorations. These pertain to the shape and dimension of teeth, tooth textures, line angles and negative space (which is defined by embrasures, contact points, gingival margins, incisal edges). There is some wriggle room for creativity within these rules but be sure to adhere to the basic outlines or your restorations will look unnatural. Purposeful aesthetic design of tooth position: -Left and right hand sides of the arch will not be perfectly symmetrical. The central incisors should be as symmetrical as possible but the importance of symmetry lessens the further from the midline you are and minor asymmetry in gingiva and tooth shapes can give a more natural appearance to a certain extent -Upper central incisors are anatomically the widest anterior teeth and as they are perpendicular to the viewer they appear as the widest and most dominant tooth. Therefore imperfections in their d...

As dentists we tend to be problem focused and so have the problem in mind when we analyse a situation. Interpreting xrays is one problem that this attitude can lead us into strife. Since we are teeth focused, we tend to ignore non dental landmarks on a film such as an OPG but forget we are responsible for interpreting everything that is present on any particular radiograph. Similarly, in bitewings and periapical radiographs  we may be giving them a quick scan for obvious pathology and missing subtler aspects such as widening in PDL or bony lesions. During endodontic treatment we may be so focused on the apex that we fail to notice things such as perforations in the coronal aspect or missed canals. Prior to extractions I would suggest that you have an OPG and zoom into the tooth in question and force yourself to stare at it for a good minute to notice the subtler aspects of the treatment to be performed. Often times what appears as conical roots from a distance may be masking an a...

I was assisting a colleague sectioning a bridge the other day and had a few thoughts: -Sectioning a bridge is a procedure done in an attempt to salvage the prosthodontic work. You should never promise that this is possible, only that you will try. In this case, the tooth that was to be extracted was the abutment that was holding on the whole bridge and the remainder of the bridge dislodged showing severe caries and food packing around the other abutments. This needs to be part of your consent process! You will try and preserve the remainder of the bridge and teeth but this may not be possible. If they don't want to proceed knowing this then you don't take the risk. -Tie a floss tight around the part of the bridge that you want to keep. In this case once the bridge section was complete the remainder of the bridge dislodged and fell to the back of the patient's throat. We caught it before it was swallowed but this risk is unnecessary. Tying floss around one of the connecto...