tips and tricks

 The other day I was called in to see patients in the extraction department as they were running quite far behind schedule. There was one lady who had been waiting about 7 hours since 8am for her extraction. She was a walk in who had presented to ED the day before (a public holiday) with a facial swelling. She was complaining to me that she was very tired as that day she was waiting 14 hours total in the hospital ED. I wanted to say something about how she was waiting less with us than them but then decided it was best not to.  As our time together progressed, she told me more about her ordeal and how she was sitting around while nothing happened, people were walking around, talking and having coffees. She said she waited 3 hours for a CT scan (for the dental pain) which was in a room 5 meters away and when she went in there was nobody waiting. She said she asked staff when her CT scan was going to be and they kept replying they didn't know. She asked if they could check with ...

 Today Tom Giblin was kind enough to let me observe him for a day at his practice. I saw a full mouth case which was in the middle of preps and a few consultations and review appointments. Overall it was quite a relaxed practice and modern and advanced feel to the place. Below are some tips I picked up from the day: When giving a block, give some LA with a short needle at the site and come back with a long needle with an aspirating syringe and the patient won't feel the block as much. -The high speed air turbine is usually better than the red band as you can have some tactile feedback with the loss of torque. The power of the handpiece is relative to the air pressure and this can be turned up to reach the max speed of 400,000 RPM whereas redband handpiece has a max of 200,000 RPM. The only concern with the air pressure is damaging the internal chair lines but he hasn't had an issue with his chair. -When packing cord, soak the cord in astringent but remove the excess by blotting...

 I have recently started using alginate for my upper full denture impressions and zinc oxide eugenol for my lower full denture impressions as per Dr. Findlay Sutton's lectures. I find the alginate superbly accurate as it is hydrophillic and flows very well as well allowing good border moulding at the flanges.  A full lower impression I took today with Zinc oxide eugenol had a large deficiency on the labial flange area as I had insufficiently border moulded with greenstick. This would normally not be an issue as on seating the tray, the excess material would extrude out and fill the sulcus area, however, I had also requested tissue stops which the lab had placed at the 34 and 44 area. This prevented over seating of the tray and actually worked quite well to control the level of thickness of ZOE and to control placement of the tray. However, compared to alginate, as ZOE is much thicker and flows more poorly, my inadequate control of flange length meant that insufficient material...

 Today I spent another day in the upstairs specialist clinics but this time spent my day in the prosthodontic department. This will likely be the last day that I can do this for a while if my teaching job comes through as I will not have any free time to pop in and do so. There was nothing mindblowing but I observed a few patients including some crown preparations, some head and neck cancer patients who had had fibular reconstructions and a hypodontia case who had canine substitutions for lateral incisors. Some things I picked up are below: -     Look at the shank of the bur when you are preparing a tooth for a crown. This will be the reference point for producing parallelism perfectly parallel preps are more appropriate for gold work but porcelain doesn't tend to do so well with parallelism and requires some taper. If your preps are too parallel, take an endo Z bur (tungesten carbide, non end cutting bur) and run it around your prep a couple of times with the non cu...

 Just finished Tom's day 2 of the denture course. We continued with the patient from yesterday with seting up the lower teeth and the upper posterior teeth. We tried the teeth in, took a check bite and then they went through the lab steps for waxing, flasking and injection the acrylic with the Ivocap system. I had some knowledge of the lab steps but it was good to see it done in person. Then in the afternoon he did the insert and because of the accuracy in the previous steps we didn't need any adjustment at that time. The lectures continued on the previous theme with discussing aesthetics, occlusion but due to time constraints he skirted through partial dentures, immediate dentures and missed out on implant retained overdentures.  I think that there was a general disinterest in the room from some of the other dentists about the laboratory side of the course and they were more interested in the clinical side. To me the two go hand in hand and it is vital that we as dentists und...

Today I attended Day 1 of 2 of Tom Giblin's Denture course. It was combined lectures and live patient demonstration. He demonstrated a soft liner material in the patient's existing denture and its use in taking a functional impression which could be used to reline the denture or to pour up a master cast in the process of making a new denture. He showed the impression technique he uses for full dentures: the Massad technique of which there are many videos available online. It involved layering PVS material of different properties in different areas based on what you are trying to achieve. He then demonstrated pouring these up, making a wax rim and setting the 6 upper anterior teeth.  Nothing too ground breaking so far but I would have assumed this would be the case as not much has changed in the fundementals of denture design and construction for many decades. Instead it has reinforced some fundemental principals and got my brain ticking about denture work and questioned certain...

 I was having a chat with one of my new graduate colleagues about one of his full denture cases. He was taking a jaw registration but I noted that his upper model had a deep horizontal divot running across the hard palate area. I was wondering how that had happened but when I saw the ZOE impression, it was apparent that he had not seated the impression fully in the palatal area, tried to reline the impression and again not seating it fully leading to a step in the model.  When using ZOE as an impression material for full upper dentures, the tray is made without spacing so while border moulding with greenstick, the tray is in intimate adaptation to the soft tissues. If the tray is then seated without sufficient pressure, there will be a significant thickness of impression material set onto the tray rather than a thin wash. This makes the previous border moulding step almost redundant and can fail to capture all areas of soft tissue, it will also lead to differential thickness o...

 Today I spent the day observing in the specialist clinics upstairs. I am in a transition period  with my part time private hours and am yet to start a teaching position so I still had the free weekday to do this. In the morning I watched in the OMFS clinic which was mainly post operative reviews and pre-surgical consultations. The students that were rostered to the OMFS rotation got the preference to watch in theatre so I didn't get any exposure there. Some things they mentioned were: - Trauma signs: CSF leak will result in a halo sign i.e the fluid will have blood in the centre and clear CSF around it which resembles a halo -With a vertical ramus fracture, displacement of the bone opening the fracture will be due to the lateral pterygoid and temporalis which pull in different directions whereas the masseter and medial pterygoid will act as a stabiliser  - Titanium jaw plates will generally stay in situ for the rest of the patient's life but can occasionally show through...

 Today I have my first experience with denture soft reline material and I thought I would jot down a few points that I learned. The clinical situation was actually one where I intended to do a lab reline but the patient came late for their appointment and we missed the boat. Being in the public system, the lab was booked out for same day relines for months so I had to think of an alternative option to reach our goals. The patient has had a an immediate upper partial denture for a very long time and the ridge has long since resorbed allowing a large A-P rock of the denture. This is causing severe fremitus on the upper lateral incisor which is the only anterior tooth left. My initial aim was to reline the denture to bring it back to the height where the clasps engage the abutment teeth and by adding the support, hopefully resolve the fremitus allowing us to retain the tooth and then create a new denture.  Ideally, I would have done a hard reline, but the situation was against me...

 Today was my first day at a new private practice job. I am now part time public, part time private and looks like I will be working 1 day a week tutoring at the university clinics starting later in the month. It was a good welcome to the practice and everyone is very accommodating but I have had the same feeling I have had previously when starting a new job: there's a lot that I would want to change here. Mostly there's things that I would want to train the staff about in terms of procedures, clinical workflow assisting but I also have an urge to clean out the massive stockpile of expired goods that are just put in a dusty storage area and left alone.  It is important to realise that there are many dental practices and they will all do things very differently. Most of them will sit within the framework of standards such as guidelines for infection control but some will not and it is each practitioners responsibility to ensure that the standards are upheld to their expectation...