tips and tricks

 I'm continuing the theme of photography and records with this post with a few of the most common photography errors that I have made and learned from, but still make from time to time. These errors may harm the diagnostic quality of the photos. If we are going to the effort of capturing the photos in the first place it is important that we try our best to make them the best quality and as useful as they can be.  I made a post previously about some basic camera settings which may be useful for complete camera newbies: https://dental-tidbits.blogspot.com/2020/04/basics-of-photography.html  Buccal shots should be perpendicular to the teeth   This is one I learned at the Orthoed Minimasters. For orthodontically diagnostic images, the buccal shots must show the canine and molar relationship accurately. This means that the photos should be taken perpendicular to the posterior plane of occlusion. Most commonly, the buccal shots are taken angled from the anterior as we...

This is more of a conceptual post of a thought that popped into my head. Treatment planning is important for sure, but having the discipline and authority to carry out this treatment plan is necessary to make things work. I was discussing futures with a younger family friend who is thinking about his choices for university study or trade. He was discussing his aspirations to be a chiropractor "because he likes cracking backs, can help with pain and if he's good he can make $400k a year." Firstly, I voiced my skepticism but did suggest that he does some proper research into his future but did suggest that with his goals there may be other careers that could fulfill his requirements. avenues such as psychology and physiotherapy are just as involved in rehabilitation, maybe he could broaden his choices to them. We got on a discussion about physiotherapy vs chiropractic fields. This is a long discussion which isn't entirely relevant but his conclusions were interesting....

I was thinking about this question in the car yesterday. Many of our guarantees about dentistry lasting for a number of years or giving warranties comes from our own insecurities about our work. The truth is we don't really know. It lasts as long as it lasts. We can identify risk factors associated with early failure such as wear facets, large masseters, plaque accumulation, erosive wear etc and we can take steps to mitigate these risks. Despite this, dentistry lasts only as long as it lasts and we won't know when it will fail until it finally does. The question can be reversed though to: How long are teeth meant to last? The truth is that patients who require complex dentistry have ruined their natural teeth and their dentistry will fail one day too. It begs the question as to why we are designed with such fatal flaws and why we are in need of repair. The truth is that no design is perfect. Our teeth are only one of many things that wear and breakdown over time. Disease is...

A mockup is a trial run in the mouth of a functional and/or aesthetic restoration. This can be done in a multitude of ways. Small aesthetic restorations, even mockups for bridge pontics can be done freehand. Models can be take and waxed up to their final form. This may be more time and cost effective when multiple teeth need to be restored. A putty stent can then be taken of this waxup and transferred to the mouth with self cure resin e.g temporary crown material. The question is why is this an important step? -It is important to get the patient's approval of the aesthetics before the final restorations are put in place. You can discuss finer points of the patient's aesthetic rehabilitation beforehand but nothing is as effective as a visual representation of the possible appearance of the patient's future smile. The best time to find out what the patient likes or doesn't like or if they have unrealistic expectations is before the final restorations are placed and espec...

Just an incident that manifested today which I'll recount and add my thoughts afterwards: A patient that was seen in emergency by a new graduate colleague about 6 months ago. The patient didn't speak English and the appointment was done through an interpreter service. The patient was complaining about pain in the second quadrant and the only tooth with an issue was the 27 which had a short root canal treatment but no periapical lesion. The diagnosis was difficult because there were multiple teeth tender to percussion and pain wasn't localised to the 27 tooth. Bitewings were taken and periapicals of the first and second quadrant.  No definitive diagnosis was made but, the patient was sent for extraction of the 27 but this didn't eventuate for some reason or another. Fast forward 6 months and the patient has been booked into see me for extraction of the 27 based off the previous referral. The patient says this tooth isn't sore but there is pain in the 4th quadrant. I ...

The more time I spend in clinical practice, the more I appreciate the idea that the more information we get off the patient, the better our treatment outcomes. As I begin to ask more questions, I begin to wonder how much I have been missing in the past. I am learning that dentistry alone can't win against an inhospitable oral environment. I spent a good hour with a patient today just digging through their history and trying to uncover the puzzle of his dental disease. I think a good rule is, "Nothing happens for no reason" or to put it another way "If the story isn't adding up then you're probably missing something." I think at university, we were given the tools to uncover these details but weren't taught how to use them. I also think that if you can agree that it is of utmost importance to modify the oral environment prior, during and after treatment, you can agree that we all need to dig a little deeper as to what the patient is doing to themsel...

Be very careful when managing the occlusion of questionably restorable teeth. The other day I had a strange appointment where I temporised an upper premolar with a deep carious lesion. the remaining cusps were thin but the tooth was an abutment to a partial denture. On checking the occlusion at the end of the appointment the patient bit down hard and there was a god almighty crack. The filling dislodged and the palatal cusp had fractured and was being held on by the palatal gingiva! Obviously there had been a very high spot in this case and all the force of the patient's (significant) bite had gone through the restoration and fractured the undermined cusp. One could argue that this would happen eventually through normal functioning but it did significantly reduce the longevity of the tooth. Before the fracture, she could consider a large cusp capped composite or a crown retrofitted to the partial denture. Both of these options can be considered very difficult or impossible now. W...

Be wary of performing irreversible procedures on patient justified just because they think they won't undergo elective procedures in the future. They could win the lottery the next day and suddenly they have no tooth left to work on. Start conservative and don't jump to irreversible treatment unless there is an overriding reason (they're absolutely sick of the condition of a tooth and want it out/ are going away for a long time and will not have access to a dentist. If their dental issue is a minor inconvenience e.g extra cleaning for food packing, then they can live with it until they are ready to extract or can afford more pricier treatment e.g ortho. Extraction of a lateral instead of a palatally placed canine to stop food packing is preferrable as the canine is harder to extract and will last for life and the canine can be odontoplastied to blend in as a lateral.

Today I had the chance to treatment plan for an elderly gentleman in his 80s. He presented with a 20-30 year old maxillary full denture. It was stained, worn and had a missing 22 tooth. He saw a public clinic about this and they didn't replace the tooth but built up the opposing canine till it was in function with the denture. His lower teeth had a posterior edentulous segment, bilateral lingual tori and arrested caries on multiple teeth. his 45 exhibited some sort of pain on touch. All lower teeth were severely worn. Upper edentulous ridge was good volume and contour The patient was functioning fine with lower posterior teeth missing but upper denture was unsatisfactory. Plan aimed to replace upper denture crown lower canines and 1 first premolar, temporise painful tooth and build up lower incisors in composite. The lower teeth were to be lengthened by increasing the height of the restorations so occlusal/incisal prep was to be minimal if any. Interim appointment schedule: ...