Operative Dentistry

IV sedation can be fun – for the oral surgeon

September 13, 2013 By Trish Walraven 1 Comment

Haven’t you wondered what your patients experience when you send them to your most trusted oral surgeons? Here’s an in-depth video that explains the process of taking out their third molars:

I have to give the Awkward Spaceship sketch comedy group a HUGE thank-you for making this a top-notch, truly hilarious, dental-wanna-see video. I wish I could say I’ve seen a funnier skit or parody about dentistry but no one else even throws a paper ball anywhere close to where you guys throw ’em. So for now I’ll say congratulations and suggest a new challenge for Dentally Challenged:

Offering a smile makeover to someone whose teeth are the LEAST of their problems.

WWII dentistry video

September 3, 2013 By DentalBuzz Staff 3 Comments

What was ideal dentistry like seventy years ago?

Thanks to dentist Dr. Mac Lee of Edna, Texas for bringing this Navy training video to our attention for this edition of TimeWarp Tuesday. You will be both impressed by the way things were done back then and relieved that dentistry has progressed so much since. Even though it’s a bit longer than you’d usually sit through, remember PEARLS! There are pearls here, even in the way, way back times.

Like Smears! They were doing bacterial profiles in 1944! And Check Out That Piece of Autoclave Artwork. That is definitely something that would look good in your practice, and you would have to drive it, like you would a classic auto, not daily, but just BECAUSE. Sure, the new one is faster, but the old is a CLASSIC and you would use it because it’s too cool just to keep it locked up in a museum somewhere.

Be sure to look out for these bitty tids of juice as well:

• Procaine. That looks like some scary stuff to be injecting into people.
• The long exposure time on the radiograph.
• 10 minute sterilization in a water bath? Really?
• The surgery cart and tongs are creepy awesome.
• What the heck kind of toothbrushing technique is that?

With an emphasis of keeping everything super clean, this is probably the most memorable line in the video:

“Never should there be a sign of the last patient.”

We should all hope there’d be no bits of him anywhere afterwards.

Serious tongue action

August 28, 2013 By Trish Walraven 3 Comments

Are you in a state of media overshock after this gratuitous display of tongue-adge on a certain video awards show? No? But it may give you pause to think about all the naughtiness that tongues present to you as a dental clinician on a daily basis.

Most tongues behave themselves very well when you’re working in their realm. It IS the tongue’s kingdom after all; the mouth is where this majestic muscle rules supremely, preventing any dangerous objects from being inhaled or swallowed. However, there are some tongues that simply won’t cooperate, no matter how much you comfort and reassure them. See if you recognize any of these personalities in the tongues you have worked with.

The Stalker

This is a tongue that hangs back, ominously, but sort of follows you a tiny bit, like it’s planning to MURDER you while you’re simply blowing an occlusal surface dry. It is the godfather of tongues, so you had better not refuse its offer of allowing you to LIVE.

The Fist

If you encounter The Fist, you will be lucky to gain power over it. Usually appears when you’re working on an upper posterior tooth. The tongue will ball up and tighten so hard that you cannot wedge anything, not even oxygen itself, between the tooth and the tongue.

The Dive Bomber

You know you’re working with a Dive Bomber tongue when the tip of it continuously pounds you from every direction. It wouldn’t be surprising at all if the patient were actually whistling downward and making the CRRR crash sound with every hit. Your dentistry may feel like the crumbled buildings in Space Invaders by the time this appointment is over.

The Wave

A tongue doing The Wave is bad. Not that it’s doing anything to get in your way, but when the ripple of peristaltic action starts quivering along the rim of the tongue, that usually means that the patient is about a half-second away from a gag and a wretch. Have your high-speed suction available for…um…incidentals.

The Bulldozer

Everyone has had experience with this tongue. It’s one big bully, pushing you around, scooping up the rubber dam clamp and pelting it against the wall before you even consider straightjacketing it with your square of latex. The Bulldozer will warp impression vinyl into a freakshow of “was that a human or an octopus?” when questioned by your lab, and is generally violent towards anything you try to put in the attached patient’s mouth.

The Lover

This tongue is so embarrassing! You’re working along, minding your manners, when it just sort-of slinks up the handle of your mouth mirror and begins pole dancing. Worst of all is seeing this happen to a straight male dentist by an apparently straight male patient who has no idea that his tongue is lovingly caressing the tools. You just. Can’t. Say. Anything. But your assistant will, after the appointment, behind your back. Or worse, to your face.

The Exorcist

I’ve only seen The Exorcist once. Okay, twice, but it was the same patient, and I would have never believed that a tongue could move like that unless I’d seen it with my own eyes. The Exorcist stands up, perfectly straight in the center of the mouth and slowly and continuously rotates in a clockwise direction while you’re cleaning the left side of the mouth, and then stops and begins rotating in the opposite direction when cleaning the other side. The only reason I didn’t call a priest was because the patient’s health history showed she was taking some major antidepressants and schizophrenia medications.

The Puppy Dog

Like a real puppy dog, this tongue is actually kind of cute. It bounces, following you around while you’re touring a patient’s mouth, stopping to sniff while you check the edge of an old amalgam, wagging its tail when you give it a little attention. It’ll even pee on itself if it gets nervous. Yeah, you’ve seen that submandibular salivary gland gleek squirt piddle.

The Cobra

The Cobra should be heeded, but it is more of a display than an actual threat. When a patient’s tongue slowly raises up and looks like a curved shield about to strike, get out your clarinet. It’s time for a little snake charming.

The Victim

This tongue acts like it’s been maimed and waterboarded, cowering in the back of the throat like it’s trying to make itself as small as possible. You actually feel sorry for The Victim, and find yourself trying to convince the patient that you’re not the dentist from The Marathon Man, which can cause some funny looks from the oblivious. One problem with The Victim is that it may end up consoling itself by acting out its former abuse and become The Lover. NOOOOOOOOOO!

And if this is the best tongue-in-cheek humor you’ve EVER READ you need to share it now. Oh that was bad. But share, because the world needs more tongue humor, at least.

Lumadent headlight review

May 30, 2013 By Trish Walraven 14 Comments

Do you know how sometimes, when you get a new piece of equipment, it’s so Shifta La Paradigma that you can’t even THINK about working without it? You get a little anxious about the possibility of it failing and having to go back to the old way of doing things. What do you do?

You get yourself a backup, right? hoping that your original will keep going until FedEx arrives with your precious cardboard salvation. But then you realize that the backup is so Next Generation, your OLD one ends up becoming the backup. And that’s where I am with my Lumadent headlight. I have the old, the new, and opinions about them both, which are the real reasons you’re here. So let’s get to those, shall we?

Opinion #1: It’s Bright, Baby.

Not only is the Lumadent headlight well-focused and a good color, its shadowless light means that more photons are hitting your retinas, therefore the mouth that you’re looking at may be ACTUALLY MORE GROUNDED in reality. If you can’t see something, it’s not there.

Since I haven’t used any other lights except the Lumadent consider this a broad endorsement for headlights over any other sort of overhead illumination. Just about all of them have some sort of knob that will allow you to adjust the intensity, and I find that I rarely turn the Lumadent’s control any more or less than to the halfway position. I’ve learned how to control my head so that the light doesn’t shine in my patient’s eyes (unless I’m gesticulating wildly, then they might see a few blinding streaks) and the super bright just isn’t necessary most of the time. Also included is a flip-up composite filter to keep your accidental light curing to a minimum. I’ve heard some concerns about LEDs damaging user’s eyes over time which is one reason I tend to keep the power down, but don’t seem to have any problems with eyestrain in the two years I’ve been using one. The new model seems to be just as bright and as clear as the older one, so no change in this most important feature.

Opinion #2: Cords are better. And worse.

But mostly better. I’ll explain. The cord replacement is much easier now that the light detaches completely from it. They’ve also switched to a longer initial cord which means that I don’t have to keep a too-long extension hanging around or knotted up in a tie wrap. You’ll notice that the plug-in at the battery has changed to a right-angle which should keep the tension off the cord. I was KILLING my extensions contacts and the light would flicker and just short out and be a huge pain.

What I’m less than thrilled with is the way that the right-angle attaches to the light itself. If you end up with a short in the new cord now, all you do is detach it right there, loupside, leave the light on the loupe, and plug in a new cord. But the cord sticks up at a weird angle and I’m forced to use yet another tiny tie-wrap to keep those wires from getting tangled in my hair and attached close to the frames. The other thing I do like is that the lens is easier to access and clean now that it’s not recessed. It’s the one on the left in this image.

Opinion #3: This battery pack is serious.

My original battery pack served me well and would stay charged for a whole day, but its slick case in a sassy leather pouch clip probably caused the short outs due to occasional detachment problems. Not the clip, just the battery itself would skittle across the floor when I had a “way to go, Grace” moment.

Now that I have two batteries I forget to charge the new silver one, but I have yet to have it clunk out on me and switching back to the black one for backup. Once you go silver….

So this pack is so serious, it’s like Chuck Norris, it has it’s OWN clip built in. A very tough clip. One so tough that if you wear those cute scrubs with the flared legs and the knit waistline you can forget trying to spread the clip enough to get it to attach to your pants. But I adapted by figuring out how to wear it on a waist-level pocket. Now my biggest issue is leaning close to patients and inadvertently turning the light off at the black side switch. I really think it was better on the top when it was red and adjacent to the intensity knob.

Opinion #4: There’s no excuse for not using a headlight.

I’m just going to think I’m better than you if you don’t have one. That’s my throwdown. If you use the excuse that headlights cost too much? Compare the Lumadent with its “better” competitors, it’s so much less expensive, you can buy one for you AND your assistant. And for your higher power loupes, for that matter. What about the problem with wires and bulk? The Lumadent is so lightweight that once you adjust your behavior a little (all I did was to begin wearing a strap on my loupes instead of taking them on and off so that they hang around my neck when I’m not using them) they will become a much easier part of you than having to reach up and adjust a mounted light somewhere over your right shoulder, in space. And patients stop anticipating the bright light and never squint anymore when it’s time to open their mouths. PATIENT ACCEPTANCE IS AMAZING, and in my opinion, the BEST reason why you should get a Lumadent.

This is my parting shot for you, a side view of the Lumadent attached to a pair of Through-The-Lens shielded SandyGrendel loupes with the custom mount that came with the light. See how it sticks up a little too high, and there are two tie-wraps, and a cord management doohickey making this all such a mess?

No? I don’t see it either, actually.

For earlier insights about Lumadent and the company, click here to go to the DentalBuzz original review.

Were these third molars aborted?

May 22, 2013 By Trish Walraven Leave a Comment

It looks like wisdom teeth can be preventable.

Now that you’ve found yourself a little incensed at the inflammatory title of this blog post (sometimes it takes alarm words to grab people’s eyeballs these days!) you’ll realize that the word ABORT actually does apply in this case.

Last month Tufts University School of Dental Medicine announced that there was a correlation between the injection of local anesthesia given to children between the ages of two and six and evidence of missing lower wisdom teeth. In other words, if a child had an IAN block at this age, they were over 4 times more likely to have missing third molar buds when radiographs were taken at least three years later.

At this young age, the cells that will become the third molar are not much larger than the anesthetic needle itself, and the developing tooth bud is quite vulnerable to injury. Dr. Anthony Silvestri, a clinical professor at Tufts University and an author of this study, has also published research to support the trauma theory of wisdom tooth prevention, showing that both diode lasers and electrosurgical energy can stop third molars from developing in rats.

Interestingly enough, I might have been affected by this phenomenon. As a kid I had my share of mandibular blocks as soon as my permanent molars started popping in with occlusal decay, and never developed my lower wisdom teeth. Thank you, Dr. Big-Scary-Hands-But-Really-Nice-Dentist Tom Watson DDS! Thank you for excusing my future visit to the oral surgeon.

You know, if the science behind this prophylactic de-nucleation of third molars gains any momentum, think about the consequences. In the next thirty years out-of-work oral surgeons will be lining up in protest of the loss of their bread and butter business. They’ll be picketing general dentists who perform these euphemisms and call them names like wizzie abortionists or bud killers.

Don’t take a side just yet. At this point the ethics of new research itself are even in question, but if there is a way to inoculate kids against the inconvenience of such minor diseases as chicken pox and shingles, why shouldn’t we at least explore the idea of making third molar extraction an option instead of an inevitability for most people?

And as a hygienist trying to hit production goals, I say, well, there goes my fourth qualifying tooth for quadrant scaling and root planing.

Thanks to these articles for all their information:

TuftsNow: Dental Anesthesia May Interrupt Development of Wisdom Teeth in Children
Nerve Blocks in Children May Destroy Future Molars
Dimensions of Dental Hygiene: Local Anesthesia and Wisdom Teeth Development