tips and tricks

 Today I had difficulty with the extraction of a lower premolar. It was part of a lower dental clearance and I had removed all the teeth except this one. The lingual, mesial and distal tooth structure was remaining but there was deep caries subgingivally on the buccal. I mobilised the tooth initially by elevating it against the adjacent roots but this purchase point was removed as I wanted to focus on removing the canine as I predicted this would cause me more headaches to remove. The remaining premolar was mobile and I knew it would be easy to remove i I gould get a firm grip on it but due to the deep caries, it kept crumbling when placing the forceps. Due to the angle the caries sheared off, there was no parallel or undercut tooth tissue for the forceps to grip onto. I struggled with this for a while but after a moment of realisation, I just turned the forceps 90 degrees and grabbed onto the tooth on the mesial and distal aspect and made short work of the tooth from there on out....

 Often times when performing a cavity preparation, there will be sensitivity elsewhere in the mouth either due to exposed dentine or caries. This can make the procedure more difficult in patients with rampant caries, recession or generalised wear. Pain relief is important at this time so there are several strategies I use in these situations: 1. Use rubber dam, This will remove the problem entirely, sometimes if the situation is nfavourable, rubber dam may not be possible to use for the entire restoration, but at least short term use of the dam can help get the bulk of the prep out of the way comfortably. 2. Give local anaesthetic in the other areas. You can be hesitant to do this because that isn't the area you are working on but in the end, we give anaesthetic to block nerve conduction percieved as pain so the patient can get through the appointment comfortably. Therefore, if the patient is agreeable, local anaesthetic at the other painful sites can be very useful to achieve this...

 Yesterday I observed one of the OMFS at work remove a sialolith about 8mm diameter from a sublingual duct. He said it was quite rare to see such a large one make it so far distal down the duct. It was almost near the midline so had made it to the exit of the duct but was too large to escape.  The aetiology is a calcification forms in the duct and gathers more calcium and phosphate as it travels down the duct and eventually becomes too large to escape and gets stuck. This stone was quite superficial and so was palpable intraorally. A very superficial mucosal incision was made not directly over the stone as scar tissue would form over the duct exit. He then used curved hemostats to blunt dissect the mucosa off the gland tissue and separate the gland tissue apart until the stone was located in the duct. Prior to the procedure starting he put in quite a lot of anaesthetic, a whole cartridge was put in underneath the stone's position causing quite a bit of swelling to the area. th...