tips and tricks

Been fairly busy lately and haven't had time to post anything. Moved from Queensland back home to Sydney. Personally I wouldn't recommend anyone move back in with their parents after years away from home but in the end I really can't complain. Leaving my old position was poignant but I'm getting better and better at letting go of things (not sure if that's good). I've started a new position in the public system in a large hospital and I'm finding there are definite differences between public and private dentistry. Originally I was planing to work part time in the hospital and a day or two privately but they changed my offer in the hospital to full time. I'm unsure what my plan is for the future but I'm just seeing where this takes me for now. Working in a hospital is interesting. I have found: -There are positives and negatives to any job and any job type. Private dentistry has higher potential cash flow but has less predictable patient flow.Pub...

Tofflemire style matrix bands are slowly going out of fashion due to a few limitations and are being replaced by more "in season" contoured sectional matrix bands. Tofflemire matrix bands have a few uses and I find them useful in large buildups including core buildups in some cases as well as in deep subgingival cavities but some limitations preclude their use in modern dentistry: -Tofflemires must be tightened around the tooth to allow a seal at the cervix. This generally draws the band away from the adjacent tooth and makes gaining a tight contact difficult. Use a wooden wedge tightly between the teeth and loosen the band a 1/4 after wedging to assist in a contact. Due to the shape of a tofflemire band, a flat, non anatomic surface is created. This has a contact point very high in close proximity to the marginal ridge. Due to the lack of an occlusal embrasure, it is difficult for floss to flow down between the teeth. -The thickness of material at the marginal ridge is o...

For a long time I struggled to get non rubber dam isolation on the lingual of lower teeth. Overactive or large tongues are a nightmare as saliva will build up and wash over the lower teeth every time the tongue moves.  The aims are to control moisture for bonding procedures and to control the tongue position for access. Rubber dam is probably the best option to gain isolation of lower molars for restorative procedures but barring this there are a few strategies you can employ: -Place cotton rolls under tongue to block saliva from the sublingual and submandibular glands. unfortunately this raises the tongue and moves into the operating field. If you try and force the cotton roll down with the tongue at a rest position the tissue will bounce back and the cotton roll will dislodge. The best way I have found is to try the sublingual area with a saliva ejector or get the patient to swallow, retract the tongue away from the teeth with a mirror and place the cotton roll deep under the ...

When preparing a cavity for restoration, a vital process is to clear the cavity of carious tooth structure. This will ensure there is structurally solid tooth structure available for bonding to prevent loss of vitality, integrity of the restoration, reduced post operative sensitivity and reduce risk of decay progression. I thought I had written a post previously on how to ensure a caries free cavity but I couldn't find it in the search function. There are many methods to identify missed caries which I can write about in the future but I thought it would be more useful to write about areas where I often miss caries. This was extremely frequent straight after graduation and still catches me out. Be extra careful to check these areas before you restore. 1. Class V lesions: For some reason I've had a large amount of these cavities to restore lately. Abrasion lesions tend to be equigingival as the gum receeds to the level of the toothbrush abrasion but sometimes they're supr...

A compilation of little ideas that have popped into my head.  I'll add to it as more come to mind or are suggested by others: A dental degree is a license to learn: Don't be afraid to learn. University teaches us the minimum to allow us the skills to go on and learn how little we know. The "famous" figures in dentistry started where we did. They got to where they are with blood sweat and tears. They will make excellence look easy but there are years of hard work behind them. If you want to get to that level be prepared to put just as much work in and expect disappointment when it doesn't come easily to you. Don't rush through your career, it is a marathon not a sprint. Don't look at your colleagues and compare your own position, everyone develops at their own pace and the grass isn't always greener on the other side. Some people are fast learners and will make more mistakes, some people are slow and cautious. Some people will specialise ear...

I will use the example that I encountered recently: a class 2 div 2 case with caries between the central and lateral but this is relevant to caries in any crowded area. Caries tends to be more severe in these areas due to the inaccessibility of cleaning and the culturing of anaerobic environments. Overlap of teeth hinder effective access of toothbrushing and allows a protected environment from the cleansing effect of food movement and saliva. Tight contacts hinder the passing through of floss and calculus buildup further prevents this.  Caries tends to initiate under the contact point and due to their root torque, class 2 div 2 teeth tends to have a long contact point more apical to the ideal position. Therefore caries tends to be positioned closer to the DEJ and more severe in size. Also, upon caries removal, the distance between the cervical restorative margin will be minimal to none. Once I had caries freed this case, the contact point had not been present because the teeth w...

Bitewings are a narrow view into a wider area. Generally, a size 2 film which the majority of dentists will use will show 4-5 teeth in view. This will usually miss the 8s, distal of the 7s and distal of the 3s depending on the anterior posterior positioning of your film. The posterior lateral surface of the tongue will tend to push the film superiorly and anteriorly and the curvature of the mandible will stop the film moving too far forwards. Caries will only present on bitewings when a significant portion of the buccolingual width is involved. Therefore as it is well known, they are useful for diagnosing interproximal caries where the buccolingual width is narrow near the contact point. However, a few things can confuse the interpreter of the radiograph: Occlusal caries is unlikely to show up on a bite wing until large. If you see a radiolucency at the base of a fissure, it is very likely to be carious. Buccal and palatal pit caries show up better as they penetrate into the tooth...