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Archive for category Child Dental Health

Acid Pumice Microabrasion Revisited: The Scrap Book

Jan 19

Posted by ChrisO'C in Child Dental Health, Conservation, Dental Blog

Ever since I wrote a “guide to using microabrasion in practice” I have been looking for a suitable case to put on the blog. Typically I’d seen 2 which worked great just before the practice got an SLR camera!!!

Well finally I found one and did the 2 week review today. I think the result is pretty good (though I have had better), very minimally invasive, avoids a whole lot of porcelain work and most importantly the patient was made up.

The case was a lady in her late 30’s. She had been offered veneers at every dentist for years but resisted. She came into the practice and didn’t even ask about her front teeth… she was resigned to them looking in a way she hated.Before microabrasion

When you look at the before picture you can see the brown stain which is located at the incisal edge of the upper anterior teeth. This is the best type of stain to attempt micro-abrasion on because the brown tends to come off better although the white chalky stains will also reduce.

This is a common stain pattern on anterior teeth: localised to the incisal edge, upper anterior teeth affected only. The cause is probably that the patient had a trauma on the deciduous precursor and this has damaged the surface of the mineralising enamel. Because of this the stain will be extrinsic (located 0n the outside of the tooth) and should respond well to micro-abrasion.

The treatment was completed over 45 minute appointment in which I isolated with rubber dam and followed the steps described in the guide. I used 12, 5 second applications on the worst effected 11 tooth and stopped at this level because the patient was just starting to get immediatly after microabrasionsome sensitivity. The other teeth had only 10 applications.

You can see from the pictures straight after that the effect is instant but that the teeth still appear a little chalky at this point. The 2 week review pictures are a far truer representation of the colour change.

The patient at review today was no longer having any sensitivity issues (which lasted a few days) and was delighted with the response. I asked her if she would mind writing a short description of the treatment experience and hand it in to the practice as I’m making up a scrap book of cases with which to better inform patients of the treatments I can offer. I’ve also emailed her a little collage of the photos (easy on Picasa), just because it’s nice.

I made a pledge in September that I would start to build up my scrapbook of cases and I have to tell you it has been fairly slow going. Unfortunately I often forget or don’t have time to take pictures in surgery and you have to wait for the right case/patient sometimes. However I’m2 week review finally getting there. I’m now quicker as getting a couple of snaps and more proactive taking photos, sometimes simple work can make a great demonstration case. Also I got started early on so hopefully in a few years I will have a great little library!

If you are like me: a young dentist trying to sell treatments like this. Trying to explain to patients what you can do and how it will look afterwards then I suggest you should think about starting your own scrap book of photos and testimonials, it’s never to early to start. It won’t hurt when your looking for jobs either!

Clinical disclaimer.bmp

All the best

Chris

P.S. Please follow this link if you want more information on using the SLR camera or Microabrasion

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Bilateral ID blocks and dry sockets!

Dec 13

Posted by Zaid in Child Dental Health, Dental Blog, Oral Surgery

I finally decided to bite the bullet and get orthodontic therapy! After an orthodontic assessment I was told I needed to have lower 5’s extracted. The principal at my practice had no qualms about taking them out for me. I flirted with the idea of IV sedation mainly to see what it was like, but it worked out very difficult to organise in regards to escorts etc, besides who knows what I would have said under the influence!zaid for blog

So after the end of a busy day I gingerly jumped into my principals’ chair. He decided to conduct a split mouth mini randomised control trial. One side of my mouth received 4% Articaine ID block and the other had the conventional 2% Lidocaine ID block, I had to guess which side was which. Well it was obvious; the left hand side was Articaine as the top of my ear was feeling numb!

On the Lidocaine side I felt the pushing and a slight twinge at the apex of the tooth. While the articiane side I felt nothing at all, not even the pushing! It was profound anaesthesia and exactly what I would want from an anaesthetic.

So picked up a mirror to make sure the 5’s were taken out and not the 4’s, but the most traumatic part was seeing the mesial surfaces of my 6!

I went home to recover and attempt to eat dinner. Soup was on the cards and even that had it difficulties. The bulk of the anaesthesia wore off 3 hours later, the articaine side left a bit of a cold sensation/tingling on the lower lip for a further 45 minutes to an hour.

zaid vanity

I was relieved to wake up the next morning with no perman

ent nerve damage or any pain from the sockets. So good times……

…. except the horror of getting two dry socket 4 days later. To make things worse it was a weekend and I was in South Wales, the only place where I don’t know any dentists!!

Roll on Monday morning and after weekend of painkillers and attempts of homemade alvogyl remedies, I was finally able to get a chlorhex irrigation and a packing of alvogyl…. 30 minutes later no pain and finally enjoyed a good night sleep!

So conclusions:

  1. In my opinion articaine, is a brilliant aneasthetic, but still not sure if I trust it as an IDB.
  2. Bilateral IDB’s are not that bad, didn’t swallow my tongue … or my dinner!
  3. Extractions aren’t that traumatic, dry sockets are!
  4. The price to pay for vanity!
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Is The Force With You?

Sep 13

Posted by ChrisO'C in Child Dental Health, Dental Blog

Last week at work I was asked by a team member to take out an annoying wisdom tooth. Luckily it was a upper 8 out of occlusion so I manfully stepped up the plate and whipped it out. That was a really tricky tooth (I lied through my teeth) but it’s all about knowing where to put the force and the force is with me.Yoda

Anyway I’d noticed for a while that said person had some brown and white mottling on her central incisors and although you never want to bring it up I’d been fantasising about trying some acid pumice micro-abrasion on them. Thankfully she let me have a go and with only 7 applications on the 11 and 5 on the 21, I was looking down at a whole new smile. I think that my colleague was made up with the result but probably not as much as me. I positively skipped home, happy and proud that I had seen a simple improvement I could make to her aesthetics, managed it in a conservative way and got a great result.

This is my favourite type of dentistry in the whole world. The simple stuff like a little composite to close a gap or whitening, or micro-abrasion which takes a few minutes and makes all the difference. All it requires is for you take a few minutes after making sure the mouth is healthy to take a look at the smile and see if you could make that simple change.

I’m not proud that I did the acid pumice (I’ve put a guide to the technique and how to get the equipment to do it up in the reference section) it’s easy peasy, I am proud that despite working with dentists every day for the last X years it was me who spotted the opportunity to make a simple but huge improvement to my friends teeth.

I’m just saying, keep your eyes pealed because it’s the best feeling a dentist can get!

Chris

P.S. Did I get any photos….NO, am I gutted ….YES

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Obtura and Camera Obscura

Aug 10

Posted by ChrisO'C in Child Dental Health, Dental Blog, Endodontics

I’ll do anythink for a rhyme. Here is your “stupid title” sponsored song from Camera Obscura’s sweet new album, “My maudlin Career”camera

Luckily my career is anything but maudlin at the moment. Today I finally got back to work after the what shall be now formally known as the, “thumb fiasco”. It was so good to be back feeling useful (ish) as I started my new placement on Paediatrics in the hospital.

A couple of learning points too from today after my first treatment session on, “Trauma Clinic”. This afternoon I saw a patient who was being treated for a 21 tooth which had suffered an avulsion and complicated enamel dentine fracture. This was just over a year since the original splint therapy (which had created ankylosis) and 3 monthly dressing with Calcium Hydroxide to create an apical barrier. The tooth had been restored very nicely with composite and after re-accessing the canal I found a lovely calcific barrier formed at 23mm.

To fill it I used Obtura to back fill the whole canal. Obtura heats Gutta percha pellets for those who don’t know and allows you to slowly syringe the material into a canal. As this tooth had a well formed apical barrier I was able to back-fill directly into the canal. You make sure the syringe of the Obtura goes right to the length of the canal, place some slow setting sealer in the canal, then as you syringe you simply allow the force of the GP to push you slowly (and it is slowly) out. It is important to stop periodically to compact the GP with a machtu plugger or something similar to make sure there are no air blows and the material is well compacted then continue until the canal is full, then cross your fingers and radiograph.

I can’t put hospital radiographs on the net but the result was fantastic and it was such an honour to finish the work of several house officers working over a year. It just shows what a dedicated patient and dentists can achieve. That tooth will last for many years looking great and once it gets resorbed the patient will be in a great position for an implant

Here are my learning points:

  • I used to be a bit sceptical that apexification of open apex teeth really worked with calcium hydroxide; I was wrong. Yes it had taken a whole year of diligent dressing changes but there was a very definite barrier. It was actually very firm when touched with a file and I was very confident to fill on it.
  • Apparently if the apexification hasn’t happened in about a year it never will so at that point you should look to place an MTA apical plug. This can be done in one visit with the quick setting MTA pobturaressed to the correct working length then once set (around 30 mins) the MTA is covered in syringed thermal GP (obtura is just one brand). Alternatively the MTA can be placed on one visit with slow setting MTA (which is much easier to control) left for a week with a damp pledget of cotton wool and then a week later, once set, covered in GP.
  • It is easy to say why not use MTA straight away for open apex teeth and I guess I used to wonder why we didn’t. However if you consider how difficult it is to place MTA at the end of a canal without overfilling (even though I appreciate how bio-compatible MTA is) and how easy it was to fill this canal which had achieved apexification and you start to see the logic.

Bear in mind this technique for obturating only works because there is an apical barrier that stops the thermal GP getting extruded. This is not the case in a normal root canal which should be patent and needs an apical barrier forming before thermal GP can be used. I’ll go through this obturation technique later this week for those who like that kind of thing.

Until then, stay classy incidentists :)

P.S just found this really interesting case study on a simillar subject, it is well worth a gander

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Traumatic experience (or not)

Jul 29

Posted by ChrisO'C in Child Dental Health, Dental Blog

When I first started working as a VT, I think one of my worst nightmares was if a dental trauma came in and I couldn’t remember what to do. There are so many trauma guidelines which keep changing that it is easy to forget the correct management.photo_emergency

So one of the first things I did when I started work was to make some notes on trauma to take with me to work just in case.  I also bought a copy of Wellbury’s  “Managing Dental trauma in practice” and had a copy of the latest trauma guidelines in my email inbox.

Guess what… I never worried about it again.

I knew I could never remember all the splint times off by by heart but I did at least put systems in place that I could easily find them out. As a general practitioner you may only see trauma a few times a year  so I think it’s reasonable to have a good working knowledge and the information to hand. However as  I’m just about to start my rotation on paediatrics  in the hospital and I’ve decided I really better try to learn them off by heart hence digging out the old guidelines.

Either way I won’t have that rabit in the headlights nightmare I feared because I’ve identified a possible weakness and put some systems in place to help me. Once you start work your not in an exam anymore so you don’t need to know everything at all times but you should know where to look it up!

If your about to start VT I would suggest you ask yourself what areas are you weak in and decide if  you could write yourself systems to deal with them? I’ll give you a few more examples of things I forget and have written down:

  • Guidelines of when and what age to refer orthodontics and the IOTN sheets
  • Tooth preparation reductions. especially functional bevel
  • Warfarin and anti-coagulation protocol

I’ll try to put some of these on the blog when I get a chance as I really do think they are useful to have at hand. Here are the latest trauma guidelines (from 2007) to help get us started:

Trauma guidelines Permanent teeth

avulsion guidelines

Trauma guidelines primary teeth

Please, please let me know if you have any protocols for things you struggle to remember that you would like to share. We’ll try to get them all up in the reference section asap.

Chris

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