Had a pretty interesting day today at the office. Morning was pretty normal, drill and fill, check hygiene, extract a tooth etc. Nothing too out of the ordinary.
Pretty normal lunch. Trolled around on CP, ate an apple and a handful of wheat thins.
Then the afternoon hit.
I see inmates from the county jail here in town if they have a tooth ache or something, sheriff or deputy will call up and bring them up in shackles and the whole bit. It's not big deal, most of them are just happy to get out of pain and it's not a problem. So dude comes in, my assistant goes in to ask the normal "which tooth is bothering you, let me get an xray, blah blah". I was in the lab doing something so I wasn't really paying attention. She comes in and says "doc, you will need to come look at something" to which I responded "he need a tooth out, which tooth is hurting"?
"All of them". Huh, ok, weird response but lets go check it out. Sure enough, continued meth use pretty much causes things to not go so well intraorally, so he was pretty much decayed out and most teeth were broken off to the gumline (google meth mouth if you want to see it, i'm not messing with photos). Asked if I could extract all 26 teeth he had left in the 30 minute block we had on the schedule for him.
I laughed, said "nah, which one hurts the worst, we'll take that out". He pointed to one, I numbed it up, used an elevator to take it out, about 30 seconds worth of pressure and it was pretty lose. 2 teeth next to it are super mobile and infected (which starts draining as I get this one out, that smelt nice) so I told him he was getting 2 free extractions since he was already numb in that area and they were loose and I was right there, no harm no foul.
It's always fun when we see the inmates, the Sheriff comes up and sits in the room with them all serious, then when I come in the room we talk about hunting or why the Chiefs always break hearts or something.
He breaks down and starts crying thanking me, that he already felt better (if you saw the amount of infection I drained, you'd see why) and asked if he could make an appointment for when he got out. "Sure, how long you think you'll be in this predicament".
"I figure 4 or 5 years, you scheduling ahead that far yet"? Told him nah, just take care of himself and come see me when he gets out.
Next patient is an amish guy (we have a fairly big amish community near us), super nice guy, needs a crown. Asks if he can barter instead of pay, I ask what is in it for me, said he'd bring me a dozen eggs every week for 6 months (they have chicken barns or something) or I could have a quarter of one of the cows they're butchering. Sold, eggs and beef for a crown, sign me up.
Only problem with that is he scheduled an appointment for himself, but brought 4 other family members who all needed work done.
So we had a waiting room full of inmates and Amish this afternoon. Thought that might be a good name of a band or something. [Reply]
I am so overdue for a dentist it's not funny. Last one was around 2015 in Virginia.
Looking for a recommendation from all my doctors but none so far. Wanting one that does sonic cleaning.
I have a broken lower first molar where I had a root canal like 25-30 years ago and it sheared off at the gum line. Looks horrible. Have another 1/4 broken lower back molar and other small chips and crap. They are discolored from cigars.
Originally Posted by DJ's left nut:
Do you judge people that don't floss? Or those that say they do? Because those guys are lying.
Nobody flosses. And dentists essentially sigh when they ask you if you do because they KNOW you don't.
Honestly, I quit asking. It's pretty obvious when I have to do work on people and they have strings of chicken from lunch the day before in there that flossing is an afterthought. [Reply]
Got a lady coming in today that I'm gonna do some extensive crown and bridge/removable partial work on. She'd rather do implants, but due to lack of bone the surgeon doesn't think she's a candidate for them, unless we do some GBR grafting, which even with that it can be pretty difficult.
So I'm gonna do some precision attachments on a couple crowns around edentulous spaces and make partials that "lock" in. It will allow us to do away with any metal clasping, she's fairly vain and doesn't want that.
Then, I had a patient that we had made and upper and lower denture for, ready to deliver. His wife called today and informed us that he had passed and they would like me to go to the funeral home to deliver them so he can have them for the funeral.
I've had some scuba students throughout the years who needed a filling do-over because of trapped air under their current filling. In fact I have a student who will be leaving on a trip in a couple of weeks who I did scuba refresher for who needs to get in and have it done in sort of an emergency fashion, or risk not diving/painful diving.
How does that (air trapped under a filling) happen? [Reply]
Most restorative fillings and such now are composite (white, tooth colored) and are bonded in. There are multiple different bonding systems we use, but for the most part they all use the same steps
First there is an acid etch that etches the enamel rods and prepares them for the bond, then a bonding agent is applied. The bonding agent has to be air dried to blow off the reagent (I can't remember which one or what that is), then UV light cured. THen you place the composite resin in layers and cure each.
If you over dry or under dry the bond you can introduce some air, so that would be my guess as to what the "trapped air" would be?
I've had some issues in the past with patients having post op sensitivity on these, mostly chalk it up to moisture as these are to be placed with no moisture present. Inadequate bond or light cure can cause leakage which leads to sensitivity. But I've never really thought about the air trap stuff. Interesting though. [Reply]