!

so i go to canadian tire to get my oil changed on thursday, no biggie, just routine maintenance (did i spell that right???). i go to pick the car up and i'm told that the "boots and shaft" on the front axel is torn and corroded and needs to be replaced. well, okay, that sucks, but my car's 8 years old and hasn't been serviced with anything major since i bought it so. it's a '99 subaru forrester with over 103,000 miles on it and i absolutely love it and am not planning on getting another one anytime soon, do what you gotta do. oh, btw, the power steering fluid needs to be flushed, too. sure, go ahead, what's another $70 on top of the $550 i'm already spending, right? i take the car in today to get all this done and i get another phone call about an hour later. guess what, your brake pads are worn down and out of alignment, and one of the recepticles or whatever you call is is cracked and leaking brake fluid. um, okay, i guess that should be fixed, too, i use the bloody car every day it would probably be a good thing i could stop the car properly, right? how much is this going to run me in total? $1300???? ho-ly shit! damage, it hurts, it hurts!!!

it's so funny, because surveys have pretty much placed dentists and mechanics at the same level of the "trust meter" (which is pretty damn low, as you can guess). so i suppose today i got a taste of what it feels like when someone comes in for a "chipped tooth" or "my filling fell out" and i take a radiograph and whoa, nice PAR, you need a root canal and a post, core and crown and then the jaws drop to the floor. it's going to cost me $2000 to save this tooth? are you kidding me? i was absolutely dumbstruck-flabbergasted at the cost, and i was really torn between are these guys trying to soak me and i should just do what needs to get done and trust the experts? what kind of response would i expect if placed in the same position, as i am every single day i come to work? most people are pretty honest, right? well, as you can guess i went with the latter (gritting my teeth the whole way, but still, it needed to get done). i hope some good karma comes my way now ;-)

a busy few couple of days, past and present

i'm off again today, nice! i have a ton of things to do before my parents come to visit this weekend! i'm very excited because this is the first time my mom will be seeing our house. and what's really cool, we even have real bedroom furniture (which i personally refinished) and a room for them to stay in, the days of the air mattress and futon are so over!

my endo course is on friday and i'm really excited. i have a nice bunch of extracted teeth all accessed and ready to go. i made sure to tell the oral surgeons to give me the wackiest molars they could find, lots of curved and twisted roots since i need the practice. canuck's taking the class with me, what a romantic way to spend an autumn friday afternoon together. and because i really, really love him, i'm even sharing my most prized extracted teeth with him. nothing says love and devotion like the gift of extracted teeth, especially when they're in a a container of javex. i think it will be a good day. i really do enjoy doing root canals (the "sadistic" part of me, as my mom says) and want to get very proficient. i actually was planning on specializing, i still do think about it often, but life, kids, and a house changed things a bit. that's okay, someday when my debt's paid off and i have cash to burn i might go back to school. until then, i'll just focus my attention on getting cookie to poop in the toilet and not in her pants.

case from HELL, why why why???

had a really difficult case last friday that i worked overtime to complete. about two weeks ago, a woman in her late 50's came into the office with a loose bridge 11-12-13-14-15 (pontics in pink). she's had the bridge for about 20 years. the abutments 11 and 13 were completely rotted out so that when the bridge was seated there was about a 5 mm gap between the margin of the crowns and the edge of the tooth, #11 had a periapical lesion and both had caries near the level of the bone and would probably require crown lengthening. #15 was actually in pretty good condition, the only tooth physically holding the bridge in place. she was squeezed into my schedule as an emerg recement, so i had about 15 minutes with her. i scooped out the caries from 11 and 13, cemented the bridge back onto 15 with rely-x (and that was the only tooth holding the damn thing in place) and basically gave her the ideal treatment options. a) extract the teeth and get a partial denture (keeping #15) or b) extract the teeth and get an implant supported bridge. note how the word "extract" is repeated in this conversation. now, she has no insurance and wanted a "quick fix". since so much decay had obliterated #11 and #13 and they could no longer support the exisiting bridge, the only "quick fix" option would be to root canal those teeth, place a post and core, and retrofit the bridge she had, since it was not worth it to make a new one with such poor-guarded prognosed teeth. i knew this was going to be a beast of a case, but i felt obligated to present her with all the options, the good, the bad, and the ugly and i wanted to help her out. i repeatedly told her that this was extremely short term, who knows how long it would last, very limited prognosis, yadda yadda yadda. no, no, please just save the bridge.

so she came back a week later, and lo and behold, the bridge was still on there, wobbling around but permanently cemented to #15. i couldn't remove it with a hemostat, so i had to tap the thing off, took me a bloody half an hour to do so i was almost ready to cut this damn thing off. lo and behold, poor oral hygiene and the gingiva had grown over the root tips. how the hell am i supposed to access these teeth for root canal with all that gum tissue in the way? answer - gingivectomy! of course, this office doesn't have an electrosurge machine, so i performed the gingivectomy old school with a scalpel and fine diamond burs. so much freakin' blood everywhere, it took a galloon of hemodent and multiple papillary epinepherine injections to stop the bleeding to i could proceed with the RCT. and forget about putting a rubber dam on these babies, there was abolutely nothing to grab onto. why why why did i do this to myself? so i instrumented these horribly calcified canals to a #40 file (too small for teeth that size), irrigated with copious NaOCl and EDTA, obturated the teeth (lateral condensation), and managed to squeeze in well fitting titanium posts in both #11 and #13. next, bring on the Ti-Core, pounds of it, and i just went to town. the #13 fit like a glove, but there was so much loss of tooth structure from caries on #11 that i had to fill in the remaining gaps with ti-core, and i even ran out! i had to order more and bring her in to fill in the distal portion of #11. four hours later, the whole shebang was permanently cemented with rely-x and the patient is asymptomatic and pain free, so far the bridge is holding tight and she's eating like a champ but for who knows how long? and here's the thing that really miffed me: i had to charge her for the two root canals, the posts, and the core build-ups (never mind the surprise gingivectomies, those were on the house) which added up to about $1400. she came prepared to pay over $1800 in CASH (estimate error from the front desk) and i was like, if you had that much cash on you, enough to pay for at least IMPLANT SURGERY or a DENTURE, why the hell are you shelling out all this money for treatment that won't last? i mean, i did the best job i possibly could, and i even had a lengthly discussion about this with her and her family (nicely, of course) and i felt so bad i cut her an additional 25% break. what was she thinking? what was i thinking? am i on crack for taking on such a thing? or was i really helping this person out? what will happen when this thing fails? i can't say "i told you so" and i don't know how i can patch this up anymore than i already did. why don't people listen? and why am i such a sucker?