tips and tricks

Wear facets between upper and lower teeth can be a telltale sign of how a patient functions. A few points. Wear facets on cuspal inclines can indicate posterior function in a non axial direction.  Linear wear facets (i.e elongated, not a single spot)  can indicate a slide from first contact in CR to MIP. Large wear facets only indicate wide broad contacts not heavy contacts Worn canines can indicate nocturnal bruxism. Be sure to get the patient to manipulate their jaw to match the wear facets up. Patient who contact in extreme laterotrusion almost inevitably sleep brux. This makes a lot of sens to the if you point it out and it can be a good point to convince them to seek more diagnostics Patients who still have mammelons are unlikely to brux on anterior teeth so either they are trapped in MIP and exhibit more of a clenching habit or the have an anterior open bite relationship.

Again I find the need to remind myself that we are the health professionals and we are responsible for our actions so we should never let anyone else dictate what we do. Don't let the eye rolling of your dental assistant or the begging of the patient force you into a situation that you are uncomfortable with. Of course you should be working for the improvement of health of the people you encounter but not at the risk of your professional ethics or personal values. An example: A patient comes in with a toothache begging you to do something. You take a PA and lo and behold it is a carious lower 8 with divergent roots sitting right next to the IAN. Your options are to send for an opg for a better view of the situation and attempt the extraction yourself or refer off to someone more experienced. In this case I was not confident with the extraction but was won over by the patient's need and the fact that there was a large PA lesion around the mesial roots which (despite logic), I ...

A little while ago I posted on detecting and managing curved roots in premolars. http://dental-tidbits.blogspot.com/2019/06/premolar-extractions.html I recently extracted an upper molar with fairly curved buccal roots. One thing I noticed was the xray exposure happened to obscure the curvature of these roots. One tip I would suggest is to spend adequate time inspecting your preoperative xrays before starting the extraction. This can be before the appointment if the procedure is planned or during waiting for local anaesthesia  to settle in if it is not. Play with the contrast and brightness and sharpness filters if your program has one. Thicker or thinner bone can obscure root features and thin roots can be burnt out by higher exposures. Slowly follow or trace the external boundaries of the root surface to describe the root shape and never underestimate the variability of posterior root forms. The good thing about upper molar roots is that the form is usually quite defined o...

There are many courses set out to improve the way we communicate and speak to patients in an effort to improve rapport, heighten treatment acceptance and deal with anxiety. However these teach you the skills to use your mouth and body to get a message across to others. There doesn't seem to be enough emphasis on "listening skills". I've seen it in my reading, day to day life and practice that listening is the most important skill we can have as a health professional. This is because diagnosis is the first "medical thing" we do and we can't get a good diagnosis without good rapport and we can't get good rapport if we don't listen to the patient. Listening to the patient will almost always determine your treatment plan, affect patient motivations and improve rapport even without looking in their mouth. Too often health professionals have the habit of cutting patients off early and asking closed ended questions that require short sharp answers. e....

I attended Mike's course in Sydney at the end of August and found it a decent set of lectures. Nothing ground breaking as I have explored a little bit into occlusion in the past but it definitely served  to clear up a few misconceptions I had and consolidate a few concepts I was unsure about. There will be recordings available through restoring excellence so I will probably purchase this when it becomes available and make a few posts on occlusion. The good thing about Mike's lectures and philosophies is that it combines multiple points of views from different occlusal schools into a predictable and workable treatment flow. Topics I will be blogging about are things like: splints: designs and uses: ideal occlusal contacts, how to check lab work before it is inserted, concepts of CR, the uses of leaf gauges, how to manage cases taking into account structure, engineering and aesthetics etc.

Just a spot where you can get caught out when clearing dentine removal. Make sure you have removed all enamel overlying the carious dentine and also have a clear DEJ before you switch to a slow speed for carious dentine removal. It is easy to get focussed once you have switched to the slow speed on the depth of the cavity while you risk failing to clear carious dentine at the DEJ. The other day I was preparing a wide, shallow class 1 carious lesions and in the name of "conservative dentistry" I failed to clear some enamel overlying the carious dentine. the slow speed round bur was clearing carious dentine well but there was one "island" of dark tooth that was not being cleared. It was easy enough to recognise by cleaning and drying the tooth and recognising that there was still some translucent material overlying the dentine. Switching back to a high speed diamond to clear this and clear the enamel margins to a clean DEJ allowed me to complete the preparation well...

Root canal systems calcify and dentine undergo scleroses in response to function, ageing and insults to the pulp such as repeated thermal or chemical insults (erosion, caries). As the dentinal tubules close, the ability for fluid movement to stimulate the pulp is reduced. Deposition of secondary and tertiary dentine increases the bulk of avascular tooth structure between the environment and the pulp tissue. This is beneficial for protecting the teeth against further insult but does raise difficulties during diagnosis of dental pain. When we are diagnosing pain we want to identify the odd tooth out e.g if there is a pulpitis we want to identify which tooth has an exaggerated response to stimulus compared to the surrounding teeth or if there is a pulp necrosis we want to see which tooth has no response compared to the surrounding teeth. Dentine sclerosis and pulp recession makes all responses less obvious and can complicate diagnosis. Technically the majority of tests we utilise for ...