tips and tricks

One thing I am never sure of during an intraligamentary injection is "is the needle tip in the PDL space or in the tissues?"Always use a small gauge needle even if you have a large gauge needle out for a block. A larger gauge needle will be too chunky to predictably fit into the PDL space. The angle of the needle is important and should be pointed towards the tooth surface. If it is inserted quite parallel o the tooth it will tend to sit in the gingival tissues and you will feel back pressure but will only be injecting into tissues with nothing reaching the periapical tissues. You may notice quite profound blaching in the area if you're inecting mainly into the tissues. In a thin biotype, it is quite easy for the needle to deflect away from the tooth and pierce the tissues back into the oral cavity. The best indication of a good needle placement is when you pull back, the needle tip is stuck in the PDL space and it is difficulty to remove. A patient with significant apica...

I had an issue recently with the use of a wooden wedge during a class II restoration in a perio patient. The issue was that when I inserted the wedge on the buccal, due to the patient's loose gingiva, the tip of he wedge moved apically and penetrataed through the lingual papilla. As a wedge is inserted, it will contact the teeth either side. As the angle of the roots taper away from each other, the further the wedge is inserted, the further apically it is forced. In a healthy periodontium, it will contact the gingiva and be foced back upwards. In this perio patient, the buccal papilla didn't provide much resistance which allowed the wedge to seat more apically into the tissues. Due to the interproimal periodontal pocket, the interdental col was exaggerated and so the tip of the wedge was guided downwards into the pocket. As I wasn't careful with the insertion, the wedge entered the tissues and went straight out the other side.  This caused bleeding and made moisture control...

When you are adjusting the dentures to remove overextensions which cause instability or for sore spots, look at the tissues and see how they match up with the denture base. I don't put a lot of trust and faith in indicators such as pressure indicating pase because it is very dependant on the amount you put and the pressure at which you apply the denture to the tissues. If you put a very thick layer on the denture it may not be removed even with significant pressure. If the pressure spot is also quite light, it may not have enough pressure to displace even a thin layer of PIP. The material itself is quite viscous and sticky. Half the time, it will stick to the tissue and be removed from the denture surface. Other times, the viscosity will displace tissue at the sulcus and won't reveal overextensions. A light bodied material won't displace tissue as much and instead will be displaced off the denture revealing pressure spots. Inspecting the tissues is especially important at t...

I wrote this title at the start of the year and couldn't really remember what I was thinking or writing about at the time. The concept of empathy, sympathy and compassion came up again recently though when I was reading through some of the material for the RACDS final examinations. At first glance, the differences between these terms are quite subtle but what they mean for us as practitioners has quite a profound difference. Sympathy is the act of understanding what the other person is feeling i.e recognising their emotions and motivations. Recognition of other's feelings is the basis of our human interaction and is essential in a practitioner's skill-set to get a read for the patient's desires, goals and reasons for seeking treatment. It is really the first step in gaining meaningful information that underpins the whole treatment plan. It is not enough simply to gather objective data about probing depths, carious lesions and restorations. In the end, percieved patholog...