Daniel Balaze: September 2007 Archives
We are well aware of the hydro-dynamic theory of tooth sensitivity. The dentin tubules that lie between the enamel [or cementum] and the pulp chamber are filled with fluid. When they are opened [due to a cavity or a dentist] a greater amount of movement of the fluid is created. This movement is created even after the tooth has been filled, because of several reasons, but most often because it wasn't sealed. When this change in pressure is too great, it causes an action potential in the nerve to fire, illiciting a pain response.
Thanks to the advent of etching and bonding, we are able to seal these tubules very predictably. If most dentists are aware of this, why don't we take advantage of it more often? Of course, we have to use bonding agents for successfull composite restorations. What about other operative restorations like inlays, onlays, and amalgam? Should we be taking advantage of it during our crown preparations as well?
Are there contra-indications to using bonding agents with diferent cements? Or, could we bond our crowns in place of using luting agents?
A search of the literature is in order, I believe.
My fellow blogger at http://www.dmdstudent.com/ mentioned briefly that he had ordered some loupes. Now, there are several companies that supply loupes with different designs and quallity of lens, but that's really not important. What is important is that you use them. "Why," you ask? Because you can, because most dentists do [making it a standard of care], and because you want to be better at what you do [we hope].
There are many benefits to using loupes, especially as a dental student. At Case, they were included in our first year instrument kit. They took some time to get used to, but nothing ridiculous. Though, I will say that I wouldn't want anyone working on me the first time they put a pair of loupes on. Using them for waxing, and the sim-lab, even on our sealant rotation helped to visualize exactly what I was doing.
It wasn't long before I wanted to see things even bigger... I would find myself leaning in over the patient trying to get things as close as I could. There was some back pain, and after 20 minutes or so, I'd catch myself leaning in again. Then, at a vendor fair, I tried on a pair of 4.8x loupes. Wow, were things big.
Now, some will say that you should step up from 2.5 to 3.3 to 4.0 to 4.5+... That is too much time spent adjusting, and too much money spent in upgrades. Do it once, and do it big. After spending a year with my new loupes, I am completely satisfied, my posture is better [thanks to a narrow working length], and my work is limited by my hands not my eyes.
Spending a week in Oral Surgery... made me want to pull my teeth out. Maybe it was just the slow week. Maybe it was that I'm not that interested in pulling teeth [I prefer to save them]. Who knows?
There was a few positives, though: Learning how to suture, and practicing anesthesia technique.
Speaking of anesthesia... I now know that the effects of topical anesthetic prior to injection are simply mental. I intentionaly placed the topical two teeth infront of my injection site [only after I tried to proceed without]. After giving the injection I recieved great compliments on my technique "didn't feel a thing, doc". I wanted to tell the patient that it had nothing to do with the placement of the topical, but I felt like that would be similar to telling a 6 year old that Santa doesn't exist.
While I'm working on setting up the design of the site, I decided that I shouldn't wait any longer to start back to my old posting habits.
A patient presented last week into the pediatric clinic expecting a cleaning and sealants. He was an african-american male, age 14. I scaled the minor calculus off of the lingual surfaces of 22-27, finished the prophy, and took four bitewings. Looking at the radiographs, I was suprised to see a sharp bony defect between 19 and 20. Can you guess the diagnosis?
