Saturday, January 31, 2015

Comment Of The Day

Patient: Are you the doctor? That was the most gentle cleaning I've ever had.

Thursday, January 29, 2015

Comment Of The Day

Office Manager: Are you sure you're a doctor? Your handwriting so so legible!

Sunday, January 25, 2015

16 Facts About Sedation In The Dental Office

1. Nitrous oxide sedation was first introduced by Dr. Horace Wells

2. Dr. Niels Bjorn Jorgensen introduced the technique of titrating multiple drugs to induce sedation

3. The boundaries between different levels of sedation are NOT well demarcated

4. When administering drugs for sedation, it is NOT always possible to predict the level of sedation

5. Oral sedation alone or a combination of oral and nitrous oxide/oxygen can achieve minimal sedation

6.  Qualification requirements to provide minimal enteral sedation includes 14 hours of nitrous oxide course, 16 hours of didactic instructions and Basic life Support

7.  Moderate Conscious sedation is when the patient's airway is open with adequate ventilation and responds purposefully to verbal command

8. Deep sedation is when a patient responds only to repeated painful stimulation, airway may need assistance and ventilation may be impaired

9. One disadvantage of oral sedation is the inability to titrate

10. Patient escort is mandatory if oral sedation is considered

11. Patients with acute narrow-angle glaucoma should avoid benzodiazepines

12. Nitrous oxide should NOT be adequate substitute to local anesthesia

13. Nitrous oxide has a disadvantage, low potency. Advantages include titratable and rapid onset and recovery

14. Contraindications to IV sedation in a dental office are by an untrained provider, a pregnant patient and extremely obese patient

15. A review of medical and dental history, base line of vital signs and ASA status are a few of the pre-sedation assessment

16. ASA III and IV are not good candidates for sedation in the general dentist office.


Friday, January 23, 2015

13 Facts About Electronic Cigarettes

1. The first smokeless non-tobacco cigarette device was patented by Herbert A. Gilbert

2. Hon Lik was credited with the first generation e-cog that used a piezoelectric element to vaporize the liquid containing nicotine.

3. All the major cigarette companies like Altria, Reynolds and Lorillard market e-cigarettes now.

4. Most basic cartridges are called cartomizers, these are pre filled with e-liquid and are disposable

5. The liquid nicotine or the 'E-Juice" contained in the cartridge is a solution of propylene glycol or vegetable glycerin, distilled water, artificial flavoring and nicotine.

6. Propylene glycol and vegetable glycerin are flavoring carriers in food products and food coloring.

7. E-liquids commonly come in no nicotine, 6mg, 12mg, 18mg or 24mg

8. E-cigarettes are advertised in magazines, convenience stores, internet web sites and social media networks.

9. According to the Philadelphia's Dept of Public Health in 2010, 40% of adults were aware of e-cigs and 10% of tobacco smokers had used an e-cig recently

10. While awareness is high in the adult population and the most common reasons for using e-cigarettes as stated by consumers are to help with cravings, to use less toxic alternatives to regular cigarettes, avoid relapse and attempt to cut down or quit. E-cigarettes have not been shown to be effective for cessation

11. Use of e-cigarettes does not discourage, and may encourage conventional cigarette use in adolescents.

12. E-cigarette use in the US is currently unregulated by the federal government.

13. To date, 115 adverse events concerning e-cigarettes have been reported including four reports of mouth irritation and/or bleeding gums


Tuesday, January 20, 2015

Maxillary Molar Root Canal - #3

Patient presented with a "toothache" from a failed restoration (filling). 

Periapical reveals decay extending to the pulp. Tx plan: RCT/Crown

Access was fairly straightforward, only found three canals (always look for MB2 canal!)

Final fill. Working length ranged from 20-21mm. 

#21 RCT

Simple, straightforward endo on #21. 

Working length 21.5mm

Filled with apex sealer and gutta percha

Tuesday, January 13, 2015

The Foramen Exits Before The Radiographic Apex 87% Of The Time

Courtesy of Dr. Tony Tran

Canine Endo - #6

Patient presented with no symptoms. Decay was diagnosed visually and radiographically. 
Patient felt pain when the explorer touched the decay.

#6 large distal lesion extending near the pulp. Working length is 25mm using Moritz Root ZX II apex locator.

Obturation with two size 25 gutta percha and apex sealer. 
The canine was prepped for all-ceramic crown.

First Encounter With Second Molar Endo

Elderly gentleman presents with chief complaint "My filling cracked as I was eating on Saturday".

Intra oral exam reveals large cuspal fracture on #13 and #15. Four bite wings and two periodicals are taken. Radiograph reveals caries extending to the pulp.

Recommended treatment plan is root canal, core, crown on #13 and 15.

2 carpules of 2% lido 1:100k to the superior alveolar nerve. Rubber dam placed. #15 access made.
Three canals found: palatal, medial and distal. With limited range of movement, getting the files into the mesial canal was challenging.

Working length: 21mm palatal, 21mm mesial and 20mm distal.

After copious RC Prep and NaOCl, the canals are obturated with gutta percha. 
Core buildup and crown prep in chamfer was also done in the same visit.
Final impressions were taken and a temp was made.

Best Jobs of 2015. Dentist Ranks Top Spot.

I may be biased but the description is spot on. Here's a snippet:

No. 1: Dentist 
In 2014, dentist had a hiatus from being U.S. News' No. 1 job. But it's now back on top, rising from its No. 3 slot in 2014, because it provides a nice blend of factors that make all the difference in the rankings: One, a low unemployment rate of 0.9 percent. Two, decent work-life balance, especially compared to other health care jobs. Three, the take-home pay is simply phenomenal -- in 2013, dentists earned an average salary of $164,570 and a median salary of $146,340. And four, the BLS predicts there will be 23,200 new job openings cropping up at a rate of nearly 16 percent between 2012 and 2022.