Friday, May 22, 2009

Confessions

Hi all,

I watched Rocky II with the family last night. Great movie.
Next up on the queue is Rocky III. Clubber Lang you are next. "I pity the fool."
My son Luke is so loving the Rocky series.
Okay, right to it today.
I was confessing what I do to you on Wednesday. I felt so good after I got these things off my chest.
I want to do more. I am just going to come out with it. I treat kids and I have never done a stainless steel crown.
WHAT, DID YOU JUST SAY?!!!
Yeah, I said it. What are you going to do about it?
I love working on kids. I hate stainless steel crown. I don't do them.
Then, you say, how do you do pulps and crowns? Good question.
To answer that question I want to take you back to dental school. Pedo at the University of Florida was like most schools. I am going to teach you how and why we do this. Then I am going to show you how to do this. Then I am going to watch you do this.
Well, I did ONE stainless steel crown in dental school and I don't even think it was on a patient. I think it was on a dentiform. So I get my degree and license and I am somehow suppose to qualified to do this. I went to a lecture on it and guess what? I still didn't feel great at it.
So I started to work on kids in my practice and did what was comfortable. I could do a pulpotomy and then I said to myself, "Self, you are good at fillings. Why don't you just do a big filling and then when you think you are good enough at SSC then you can start doing them?" Sounded good to me. So for the first year or so I did big fillings. Well guess what? I am still not comfortable doing SSC and I am getting better and better at doing big fillings. In fact I love doing them.
I show the parents what this bombed out tooth looked like before we started then I show them what this tooth looks like after and they are so impressed with me (and I am a little impressed with myself too). Oh, and they last.
I know what you are thinking. You are thinking, "No, they don't". Well I am here to tell you that they are lasting. I have been doing it for a long time, about 14 years (I know that is not as long as 28 years) and I can't remember any failures due to breaking of the tooth. I have had failures a couple of years later due to the pulp not working and the tooth has a large abscess under it, but never because of a broken tooth.
Okay, here is a pictorial.
I am just going to do one tooth. I don't remember why but we just did one.
Took all the decay out. Formo for 5 minutes (I have heard of some pediatric dentist that are going away from Formo so I am looking into it) and then IRM. Then a big filling.

Nice. If you double click on it you can see the detail I can put into a primary tooth. I love doing this.
I want to prove to you that it lasts.
I took this tooth out because of natural exfoliation and the MO filling was 5 years old. Not one microleakage spot.
One more.
Anther 5 year old filling. Yes there is decay on this tooth but it is not at the margin of the filling.
Oh and I use SE Bond for all my primary fillings.
I think I will confess one more thing on Monday. Wait Monday is Memorial Day and we have been invited to stay at our friends beach condo (only one thing better than having great friends...and that is great friends with beach condos) for the weekend.
I am going to bring my laptop but I seriously doubt there will be a blog.
Unless it rains.
Have a great weekend.
Remember the people that died so we can do all this.
We can be free, we can worship, we can make money and spend money the way we want.
This is the greatest country and I will definitely take time to think about those men and women this weekend. I beg for you to do the same.
Thanks for reading,
Have a great weekend.
john

9 comments:

Anonymous said...

Unlike my last response, on this I totally agree. I have seen restorations last just fine untl they exfoliate. I dont do SS crowns for the same reason. I even signed up for an AGD course last year because I felt guilty not knowing how to make a good SSC and they ended up removing it from the course due to lack of interest! (I guess my interest didnt count!) I refer maybe 1 child a year to a pediatric DDS and usually they come back with a mouthful of crowns (they needed General anesthetic due to BEH issues). No argument, they work but I think of the $ these poor folks had to shell out and it is a lot! (Our practice is 40% pediatric; didnt plan it that way, just happened). We usually have great luck, even with huge restorations. Because they are not going to be in place for 80 years (the teeth, not the restorations), I feel fine about this option.

patti said...

Eye of the Tiger babyeee...Eye of the Tiger...

Anonymous said...

I agree with you John. I've probably done more SSCs in the last eight years on adults (and,at that, only a handful) than on kids. I think they work very well, but, I admit, I suck at them. You do some very nice restorations, i'm impressed. I will say, though, that I do firmly believe that amalgum is still the standard of card for primary teeth. I don't fault you for doing nice composites on primary teeth, i've just seen too many leaky, ugly composites on kids to simply stick to AMG. Alot of the kids that I see have quite poor OH, and I feel that AMG holds up that much better in a poorly cared-for mouth. If you can do nice composites, and have cooperative kids, my hats off to you, but I choose to stick with AMG with those "squirmy, slobbery, no-attention-span little buggers"...Ha! (I say this with a smile). As an aside, I really enjoy your blog John. It's a breath of fresh air from most of what is said in, and around, dentistry. Even if I don't always agree with you (which is rare), you bring up very honest, interesting things. Have a good weekend.

Dental Santa Clara said...

Looking upon the images of the filling process, it looks great. If only fillings could last for more than five years, this would be a better treatment with patient who visits dentist once a year or never. Though I encourage patients to visit their dentist regularly to maintain their healthy teeth even with fillings.

gatordmd said...

Thank you all for the comments.
I appreciate your thoughts.
I appreciate even more when you say nice things about me.
You know we don't always have to agree. One thing we do have to do is care about our patients. We have to have passion and strive to be the best.
I think we are doing this.
John

Anonymous said...

Oh, and by the way John, I just read a recent article reviewing the effects of Articaine on non-surgical paraethesia. It was in a Journal called TeamWork (April/May 2009), and cited quite a variety of studies and reports of patient problems after dental anesthetic. In a nutshell, it found that Articaine is no more likely to cause paraethesia than any other amide anesthetic. The "conclusion" was that Articaine has been used widely enough worldwide, and for a long enough period of time to have an excellent track record. The most likely culprit of paraesthesia was thought to be trauma due to injection, rather than the solution itself. It attributed the fear of Articaine usage recently to an overly-eager tendancy of the public to go to the courts when any post-operative problems occur (and therefore we erred on the overly-safe side). Anyhow, i'm back on the "Articaine is totally safe" bandwagon again!!!!

jodyleedoc said...

AWESOME ANATOMY on the composite... i always know which fillings are "mine" bc i love doing this too. seems to be a lost art... there are so many "ugly" fillings out there, i totally appreciate when i get a new pt and see anatomy like this.... maginifico! jody l. ross dmd Montclair, NJ

gatordmd said...

Jody,
Finally someone appreciates me.
Thanks for reading.
I hope you are liking the blog as much as you are my anatomy.
And I hope you keep reading.
john

Anonymous said...

How can you perform a pulp treatment without placing a rubberdam?Its almost a crime

Disclaimer

PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.


The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.