tips and tricks

A few months back I encountered a patient in the public clinics who had had an all on 4 prosthesis placed in the maxilla and mandible a few months prior. Personally, I felt as though he was an incredibly highly strung person and at the state at which I met him I would be hesitant to do any large scale dentistry on. His personality may have been a true reflection of himself or it may have had something to do with the state he was in about his all on 4 treatment. The patient had gone through a few sets of full dentures over quite a number of years and actually didn't mind the dentures too much but his story was that he had come into some money and felt as though he wanted to make some positive changes to his health and transition to a fixed prosthesis. He spent the money he had on this treatment but had recently fallen on harder times due to the pandemic.  The patient percieved nothing but problems from the treatment and reported he had chronic sinusitis since the treatment and belie...

Working in the public acute care clinics means that a lot of the dentistry that I do when I am there is compromised. The goal is to provide relief of pain and to deal with the patient's main complaint in the simplest, quickest way possible simply due to time constraints. Therefore lately I have found that I am using a tofflemire matrix a lot more than I used to. I've previously written about some tips for using Tofflemire matrices: http://dental-tidbits.blogspot.com/2020/01/limitations-of-tofflemire-bands.html http://dental-tidbits.blogspot.com/2021/03/difficult-restorative-appointment.html http://dental-tidbits.blogspot.com/2020/09/a-note-on-tofflemire-matrix-retainers.html http://dental-tidbits.blogspot.com/2019/09/review-of-old-blog-post.html The difficulties I have found with tofflemires is that initially it is very difficult to get a contact with the adjacent tooth and when you can get a contact it is of poor contour and in the wrong location much to close to the adjacent ...

When I have been checking student's work in the simulation clinic, most of them are expecting me to have a look and give my feedback straight away. Instead, what I have found useful is before even looking down at it, asking the following: -What are you up to? -How did you go? (any difficulties?) -How is it?  -What do you need to do to make it better? I find from these questions that there is a spectrum and some students are over confident of their abilities, some have an accurate appraisal of their skills and some lack confidence but are not doing too bad. I think these questions are useful to develop their self critical skills as it is important for them to be self sufficient in appraising their own work. They need to be able to visualise what they want the work to look like and be able to figure out if and why their own work departs from the ideal. Only then will I look at their work and give my feedback.

The other day I had a session as a clinical educator in the university simulation clinic. I was surprised to find when I turned up that I was the only dentist there and the person who normally led the class was on leave. Eventually it fell to me to "lead" the session which just involved announcing what the exercise was for the day and what steps were involved. On reflect it wasn't a spectacular effort but I will definitely be able to do better next time. The topic was class II composites and I had some thoughts about some common things that I explained during the session and some common errors that I noted. Hopefully when I am in this position in the future I would have a bit more of an idea of what I am doing. We were using the V3 matrix system and covered the basics of how to use this system. Some notes on each component: Band, wedge, ring. There are different sizes of matrix band, the coloured plastic markers in the container will tell you which size the band is. When ...

Today I had a very difficult extraction case which I struggled with. I knew it would be from the preoperative xray and by looking at the patient. My recognition of the difficulty of cases is improving but I do find myself looking at most of the extraction cases and judging them as difficult. This is partly a reflection of my wary nature. I think it is useful to analyse the case properly beforehand and recognise the difficulties for the purpose of planning contingencies. I don't think that planning should produce fear of the procedure but instead reinforce that things can go wrong and that when they do you will be prepared for it. It is also useful to recognise when a case may beyond your skills and referral or guidance is warranted. In this case, a lower 6 had curved roots and the patient had a massively thick jaw and tongue. The large tongue is always a difficulty with the administration of a IDN block. Getting the patient to relax their tongue is useful but not always possible. H...

This is a string of photos I took almost two years ago and have been meaning to write about for a while. There were a few things I did wrong and a few lessons I have taken from the case. My memories are a bit sketchy on the exact details of the case but I will do the best I can. -The patient presented to me complaining initially of spontaneous pain to the lower left second molar exacerbated by temperature changes. To me that is sounding like a pulpitis of some sort, leaning towards the irreversible diagnosis clinically.The 37 tooth had a couple of deficiencies on the occlusal and lingual aspects as well as an occlusal amalgam and a mesial crack apparent. -As there was no visible carious lesion I chalked the problem down to the deficiencies in the tooth and patched them up with GIC. I didn't investigate thoroughly into the diagnosis, didn't perform pulp tests or even take an Xray. I am unsure why I didn't do this but possibly it was that the patient was very anxious and I w...