Dr. Mommy Dentist

Sunday, May 14, 2006

by the book means nothing...

my first day of dental school we got a huge lecture from one of our profs about ethics in health care, our responsibility to the public, et cetera. this was followed by a speech from another prof (who incidently had it in for canuck and almost failed him in his course, despite the fact that canuck was in the top 10 of our class) who basically told us, "at some point in your career, you will get sued! doesn't mean that the lawsuit will come to fruition, but someone will bring a complaint against you to the office of professional discipline (the royal college of dental surgeons here in ontario) at least once in your lifetime." since then, i've pretty much been petrified and every little thing, right down to that tiny little margin on a crown, is taken within the context of that conversation. don't get me wrong, my dentistry is not soley driven by litigation - i care very much about each of my patients and the quality of my work because morally and ethically i'm obliged to do a good job, and hey, my calling card is pretty much in that patient's mouth and who wants a bad rep? but litigation is always in the back of my mind. that's why i try to do everything pretty much by the book. i try to keep good and accurate records, explain things over and over (and over) again, don't cut corners on procedures, and if i make a mistake, i try to let the patient know immediately and then fix it. all that effort, though, doesn't mean that i always get the outcome i want.

you would think that the "trickier" procedures like molar endo, extractions, crowns, etc. would be more difficult to master and would most likely have post-op complications and keep me up at night thinking about it. so imagine my surprise when about 40% of the resin fillings i've done have post-op sensitivity to biting. in two cases, the sensitivity was so bad it developed into irreversible pulpitis and i had to do root canals, even though the fillings weren't deep at all AND i removed the resins and placed ZOE sedatives. i called my endodontist friend and asked him what the heck was going on, am i doing something wrong, is this normal, and he actually gave me so great insight. apparently, he says that about 1/3 of his business is from composite resin cases run amuck, and that i've done nothing wrong, but he thinks posterior composites are garbage. now, i'm not one of those dentists that runs around and claims that amalgam is toxic and can kill you and rip 'em all out, whatever. there is absolutely NO science behind that twisted logic. i have amalgam in my office and am equipped with the traps and everything, but patients simply don't want silver fillings any more because they are "ugly". so i'm going to try some new things that dr. endo suggested: first, i switched bonding agents from a one step to a two step (the stuff we have now is crap and i never had a problem with the system i used in new york) and second i'm going to use a rubber dam for ALL restorative procedures, not just RCT, so i can get a perfectely dry field and ensure proper bonding. AND i will always give patients the option of amalgam restorations and talk about side effects of composite. and the irony of it all? ZERO post op complications from endo, crown and bridge, and surgical extractions!

so, it's a bummer, but i guess the only way to perfect your trade is to have things go wrong so you can tweak and perfect. but what a blow to the ego sometimes!


  • Have you found using a liner under the resin to be of any help? I've always wondered just how well they really work.

    By Blogger MomEtc., At Wednesday, May 17, 2006  

  • You really need to buy a Cerec, pal.

    Patrick Meaney

    By Blogger Project Bytewing, At Thursday, May 18, 2006  

  • dr.(?) meaney - someday, when i can scrounge up enough cash. but as an associate, i'm kind of at the mercy of what materials my employer has available. and i don't do large composites, if it doesn't look ideal i treatment plan for a crown or onlay. good luck with your house, btw, i just saw your blog...

    dr. m - yeah, i also started using vitribond glass ionomer underneath the restos after i started noticing the problems and that seems to help if you place it on the exposed dentin before etching.

    By Blogger Dr. Mommy, D.D.S., At Thursday, May 18, 2006  

  • GIC liners and incremental cures on large resins seem to substantially help.

    By Blogger Ameloblast, At Friday, July 28, 2006  

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