tips and tricks

 I think it is important to take some time and effort at every stage of your journey to look back at the successes and failures we have encountered. With time the successes may have faded in their effect and the failures may still be haunting you but they are a part of our past nevertheless. For me in dentistry it comes from looking at my clinical records and appreciating how far I have come. Improvement is a continuum and it comes in stages rather than a constant flow. Looking back I can see that there are diagnoses I have missed and procedures I have completed in a substandard way. These are more likely than not to work out fine as the next clinician will come in, judge my work and fix it up the best they can. If not then it isn't the end of the world either way. My mistakes have come at the cost of the patient but as well at the cost of my disappointment in what I have achieved. However the benefits of these mistakes are multiple in that it gives me the insight to ensure that I ...

 I was helping out one of the younger colleagues in the extraction department the other day with a very difficult case. This was one of the times I would say that the tooth was genuinely difficult to anaesthetise due to a hot pulp. In the past I had quite a few cases where I failed to achieve anaesthesia and blamed hot pulps only to realise it was probably my own technique that was inadequate and the excuse was just too convenient. This tooth was a heavily carious upper premolar with a significant curve on the root which bordered the maxillary sinus. The curve was to the mesial which was strange and it seemed to follow the outline of the sinus so we can assume that the expansion of the sinus at the time of tooth formation led the tooth root to curve to the mesial.  Challenges involved in the anaesthesia of this patient were: -Very dense bone: which I noted as we were elevating the tooth. Elevation and forcep movements hardly produced any movement of the tooth which is common w...

 Today I had a situation where I had to heat test some teeth to diagnose where the patient's pain was coming from. The situation was lingering pain from a lower molar elicited by hot and cold stimuli. The cold test was being inconsistent and wasn't reproducing the lingering pain that the patient was describing. I was given a Q tip to carry the cold spray but I find that looser materials such as cotton rolls or cotton pellets are better at carrying the liquid and will retain the cold for longer. It may have been that my method for cold testing wasn't efficient enough at carrying the cold into the tooth. The carrier for cold will warm up quickly once in the mouth and it may not be cold enough to elicit a response from the pulpal nerves. I wasn't getting anywhere so I decided to heat test the pulps. It has probably been about 5 years since I've had to do this but in the odd time that it is used, it is very useful in reproducing their pain. A few methods for heat testin...

The greater palatine artery provides blood supply to the posterior palate. There is accessory supply to much of the head and neck so cutting this artery will not result in any long term issues and it is often ligated. Most arteries in the head and neck can be ligated with no consequences due to the density of accessory supply. Exceptions include the internal carotid artery. Surgery around the palate including upper posterior extractions, periodontal surgery on posterior teeth and palatal graft harvests can affect this artery. The artery is always located at around the anterior-posterior level of the upper 7 at the transition of the vertical and horizontal slope of the palate. Iif you cut the palatal artery: 1. Take a deep breath, don't panic 2. Inject a whole catridge of local anaesthetic at the side of bleed. Will cause temporary haemostasis due to pressure and vasoconstriction 3.  Find the site of the artery by pressing your mirror handle firmly at the expected site. You will...

 This week I had my first experience in a teaching capacity. Earlier in the week I was one of the supervisors in the bachelor of oral health simulation clinics and also as a surprise I was rostered with the dental students in the extraction clinic today. I still have a fair bit to learn about dentistry but it was good to impart some knowledge onto the students. Unfortunately with the lockdown not many of the students were present in the simulation clinics and all the students had experienced significant disruption to their learning schedule and were lacking in variety of experience. In some way it is the duty of a teacher to try and impart their knowledge and experience onto the students but the students have to reciprocate with an open ear and an open mind. I found that some students were willing to listen and learn and they gained quite a bit from our time together but others were content in powering on their own. It is a testament to the wide variety of personalities that we com...

 Today an elderly man dropped off a broken lower full denture which belonged to his wife. She was in a nursing home due to her severe dementia and had thrown her denture on the floor. It had split in half and was a clean break so was definitely repairable. I had a bit of free time and we had some cold cure acrylic in the back lab so I thought I would attempt the repair rather than send it out to our lab as they didn't offer same day work. The steps I followed are below: -Inspect the denture: If the break is clean and there aren't too many pieces then the denture is deemed repairable. With traumatic fractures, the denture usually breaks at the thinnest part of the denture which tends to be down the midline with lower full dentures or at the flanges for upper full dentures. If there is a fracture through the tooth arches it will almost always pass through the contact point and not fracture a tooth in half as this point is a weak spot. Put the pieces together and if they fit toget...

With the hospital on higher restrictions we have shifted to emergency only and I spent a day in the extraction clinic today. I had some successes and some challenges and I will put my thoughts about some particular challenges below: - When a lower molar is heavily carious and the caries on the buccal or lingual is subgingival, it can be difficult to get forceps around the tooth. If you still have one root that has solid buccal and lingual tooth structure i.e the caries is on the distobuccal aspect subgingivally, you may be able to fit a set of lower universal forceps on this good root to try and move the whole tooth. The upside is that you may be able to extract the tooth straightforwardly if the roots are fairly straight or there is bone loss. The downside is that if the caries on the weak root is too extensive, the tooth may section unfavourably and make access difficult. - When you break a root tip you can use an Endo file to remove it when the canal is visible. I had difficult with...