party's over, back to work!
so it was a good weekend, weather was little crappy with gray skies and snow, but i went shopping with the sis-in-law and got canuck a nice new shirt from tommy hilfiger, on sale! we went to our best man's house for a superbowl party (go steelers!) but didn't watch much of the game, spent most of the time talking to his wife about labor and childbirth (she was very curious!). we ate well, worked out, and relaxed. perfect.
so, back to work today! i didn't have that many patients scheduled , as it was only my second day, but it was pretty productive. i did two crowns, one with a post and core, one with just a core build-up. the latter was definitely the more annoying of the two - the tooth was fractured and had absolutely nothing left save for a little sliver of enamel - try making a nice looking acrylic temp with that to work with! but i did manage to make a template out of wax so i could make one later on. then as i was making the space to put the post, i noticed that the root canal was filled with a material called thermafill, which had a nice, hard, black plastic rod that i could not remove, so i had to get a little bit creative (something i hate doing when it comes to this stuff, i prefer to stay by the book). while taking the impression, the patient (who was very nice and so relaxed that he fell asleep in the chair) did not completely close onto the tray, thus messing up the bite and necessitating another impression. i worked like mad to make a nice temporary, since the tooth was in a highly visible area, only to find that when i went to try on his denture, which anchored to tooth in question, the blasted denture didn't fit. so, i had to shave down my work of art just so his partial would fit (called retrofitting a crown). so i'm thinking, i hope the lab knows not to make the crown too bulky or i'll have the same trouble with the permanent crown, which would be even worse, and i have the forsight to take an mold of the now well-fitting (albeit ugly) tooth to use as a guide. of course, the now-cemented temp pulls out with the impression material, and i had to recement the bloody thing AGAIN. cripes! it's also hard, because i don't know where anything is still, and i'm getting used to using different materials and i'm like "uh, what do i do with this stuff..." and then feel stupid in front of the patient. but it wasn't all so bad, the patient was very nice and i think he appreciated the time spent for a job well done. dentistry does have moments like that....
cookie wants to play a dora game on the computer. i haven't hung out with her all day, so i am obliged!
so, back to work today! i didn't have that many patients scheduled , as it was only my second day, but it was pretty productive. i did two crowns, one with a post and core, one with just a core build-up. the latter was definitely the more annoying of the two - the tooth was fractured and had absolutely nothing left save for a little sliver of enamel - try making a nice looking acrylic temp with that to work with! but i did manage to make a template out of wax so i could make one later on. then as i was making the space to put the post, i noticed that the root canal was filled with a material called thermafill, which had a nice, hard, black plastic rod that i could not remove, so i had to get a little bit creative (something i hate doing when it comes to this stuff, i prefer to stay by the book). while taking the impression, the patient (who was very nice and so relaxed that he fell asleep in the chair) did not completely close onto the tray, thus messing up the bite and necessitating another impression. i worked like mad to make a nice temporary, since the tooth was in a highly visible area, only to find that when i went to try on his denture, which anchored to tooth in question, the blasted denture didn't fit. so, i had to shave down my work of art just so his partial would fit (called retrofitting a crown). so i'm thinking, i hope the lab knows not to make the crown too bulky or i'll have the same trouble with the permanent crown, which would be even worse, and i have the forsight to take an mold of the now well-fitting (albeit ugly) tooth to use as a guide. of course, the now-cemented temp pulls out with the impression material, and i had to recement the bloody thing AGAIN. cripes! it's also hard, because i don't know where anything is still, and i'm getting used to using different materials and i'm like "uh, what do i do with this stuff..." and then feel stupid in front of the patient. but it wasn't all so bad, the patient was very nice and i think he appreciated the time spent for a job well done. dentistry does have moments like that....
cookie wants to play a dora game on the computer. i haven't hung out with her all day, so i am obliged!
posted by Dr. Mommy, D.D.S. at
7:57 PM
4 Comments:
I'm glad work seems cool and that you are productive and off the streets! Glad the visit home was cool too - sorry I missed you. Try to let me know sooner next time and I will move heaven and earth to make it happen!
Up and down here, as you can imagine.
By
Anonymous, At
Tuesday, February 07, 2006
Glad to hear you're busy, busy! The teeth of the world thank you. Meanwhile, I'm afraid to get my teeth checked here in the UK. One too many Austin Powers movies...
By
Anonymous, At
Wednesday, February 08, 2006
Awww I hate when fiddly things like that happen! Retrofitting crowns and fillings are a pain! Well glad that he was appreciative and I think he could see (through the zzzs he was sawing) that you were working hard for him.
Wow patients over there jump to doing crowns relatively fast. I suppose it could be like that in Sydney too. But here in the country, lots of patients, even after your spiel about how a crown is better, go " I think I'll just have the filling done one more time" So , we get pretty good at build - ups. amazingly they are probably too good as many of them last 10 years or more especially with amalgams.
By
Anonymous, At
Thursday, February 09, 2006
hey dr. rachel. i usually try to push the crowns when i'm in doubt about a tooth's long-term prognosis with a large filling. my clinical and personal experience has been that so many patients come in with large fractured amalgams or composite fillings that have been there for years and i say to myself "hmm, this should have been crowned from the get-go". i also crown all RCT teeth because they become so brittle over time, tho i try to avoid putting a post in whenever possible due to the increased risk of root fracture, especially on upper pre-molars. amalagam cores are fantastic and durable, but there seems to be a whole scare about amalgam in the states that has developed over the past 10 years. people now call them "mercury fillings" and want them removed because "they cause MS" or "i have breathing problems from the leeching mercury" or "they block my meridians" (yes people actually say that). personally, i don't like amalgam as a restorative material, as when they tend to go, they take the whole tooth with them, but if a restoration is there and looking hunky-dorey, then i leave it unless the patient asks to replace it with the tooth colored composite.
as for the jumping to do crowns, patients generally will listen if you convince them that you think it's in their best interest and increases the tooth's long-term good prognosis. the trick is to not let the patient dictate treatment. and if you feel guilty about having them spend the money, as any empathetic individual would, well, you didn't put the caries there to begin with (i have to tell myself this every day, as i sometimes get a little pang when i have to "sell" a crown to someone who doesn't have insurance.)
By
Dr. Mommy, D.D.S., At
Thursday, February 09, 2006
Post a Comment
Subscribe to Post Comments [Atom]
<< Home