Wednesday, January 18, 2012

Cervical Burnout

Oh my gosh. Are the weeks flying by, or is it just me? It seems like we spoke on Friday and bam! Here it is Wednesday. I hate that my life seems to be going so fast.

I got to play golf this weekend with some buddies. I love golf, but I never get to play. How does this sound? "Honey, I am so glad it is Saturday. I had such a hard week. So, it is 8am now and I have a tee time at 9. I am going to leave now and hit some balls before my round. The round should take about 4 and a half hours, and then afterwards we are going to sit around and have some beers. Expect me around 4pm. And yes, I know you have been with the four kids all week, but I need an avenue to relax."

I don't know about you, but this stuff doesn't fly at the Gammichia house. If I said the above, all my stuff would be on the front lawn when I got home. But I digress. I went on a church retreat and part of it was golf. The weather here is so nice and the golf course was beautiful. I love stuff like that. It is really not about the score but being outside and having a beer and a cigar. Awesome. That is why I want that Shelby Cobra. Then me AND my wife can jump in the car (lock up the kids in the pantry) and enjoy each other and the beautiful weather that central Florida gives us.

Today I want to talk to you about Cervical Burnout. I realize that most of my posts have been about money, and I want to try to get away from that. I realize that most people are dealing with money issues one way or another, and I wanted to talk about things that are current and on the minds of dentists. But too much of one thing can be bad. This is a non-money issue.

I assume most of you that read blogs are more on the high-tech side, which leads me to believe that most of you probably have digital x-rays. Five years ago, when I got digital x-rays, I had to make a decision about which product to go with. We are big Patterson people here and we were already using EagleSoft, so it was kind of natural that we would go with EagleSoft and Schick.

Anyway, that is not what I want to talk about. What I want to talk about is that I find there is a lot of cervical burnout showing up on digital x-rays. One of the issues with digital x-rays is not with seeing a dark spot but deciding what that dark spot is. Most of the time, what I am seeing is virgin teeth next to crowns. If there is a crown, the adjacent tooth has a lot of radiopacities on it. Sometimes I go in there and try to feel something and the contact could be too tight. Now I have this supposed lesion on a tooth that I can't feel. What do I do? It looks like decay, it smells like decay, it is in a prime spot for decay. Is it decay? Most of the time, it is.

Check out #15 MO.

I want to say that I am really good at reading x-rays. I thought this was decay. I appointed him and I got into it, and I didn't see decay. It is tough because sometimes I go into the interproximal and it is two steps. I cut a box and nothing. Then I go deeper than I think and there it is. Or I think the decay is on the straight mesial and it turns out to be on the ML ling angle. So I cut into this thing and I didn't see anything. I went deeper and there wasn't much there. I went a little wider and I started to see what was going on here. IT WASN'T THERE. So I did the best damn filling I could and hoped that I actually took out some decay while drilling this tooth.

Anyone dealing with a lot of cervical burnout on their digital x-rays? Ever go into anything that wasn't there? (For the record, I did this once or twice with film as well.)

And before I forget, the next thing on my list is to get Kodak sensors. I know there are going to be some bridges and it is going to cost a bunch, but I think it is the best image and my patients should have the best.




DC said...

Thanks for the honesty, it's good to see what's not going right that can be improved. Also, thanks for your contribution to the latest edition of ASDA's "Mouth". Keep writing...

gatordmd said...

It's my pleasure....on both things.

Anonymous said...

I did the exact same thing on a patient yesterday! I kept drilling deeper, and nothing!! You keep looking back at the xray as if you've lost your mind. Or maybe the assistant wrote down the wrong tooth and it's really #2!! But I'd rather do it, than worry about it turning into a RCT down the road and trying to explain to the patinet why all of a sudden they need a root canal, when you've been taking xrays regularly! I thought it might be my monitors, but sounds like a common issue.


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