Monday, May 4, 2015

Clinical Tips

This time around I want to give you a gift. If I may, I would like to offer some clinical tips that have made my life easier. Many of these may be old news to some of you. But I’m willing to bet that at least one person out there will benefit. Enjoy some of my hard-earned knowledge. If you ever get saved by one of these, just drop me a note. I’d like to hear about it.

Ankylosed teeth: You’ve been there. A mid-teenaged patient is referred to you for extraction of a primary molar. Everyone looks at the tooth and thinks, “I can’t believe it’s still there.”

Do yourself a big favor and tap that tooth with the handle of a mouth mirror. If it sounds hollow you have an ankylosed tooth in front of you. Believe me, you’ll immediately identify that sound.

Now you have a decision to make. Some of you are awesome at extractions. You say to yourself, “Bring it on!”

If you are like me, however, you’d rather refer. I always enjoy the call/letter from the oral surgeon, telling me about the difficult extraction: “How did you see that one coming?”

Multiple anesthetics: Mandibular blocks—admit it; this is the area with your lowest success rate. You get it most of the time, but many times you don’t. I learned this simple trick and it dramatically increased my success rate. Sure, it’s not a 100 percent guarantee, but it will get you much closer to that goal.

In dental school I was taught to administer two carpules of lidocaine. If that didn’t work, you were instructed to administer a third carpule. This does work many times. However, many times it does not.

This is what I do now: I administer one carpule of lidocaine and one carpule of carbocaine. What happens with much more frequency? I hear the patient say, “My whole face feels numb.”

Lower second molars: If you are like me, you cringe at the thought of preparing some second molars. You know which ones I’m talking about. They are SHORT. That upper palatal cusp has ground them down. Eventually that upper ends up cracking that lower.

So I’ve been doing patients a favor. If I see a pointed upper cusp, I contour it. I usually do this if I’m working in that area anyway. Usually I’m doing a filling. Since it’s numb anyway, I contour that cusp. Call it whatever you want—contouring, equilibration, occlusal adjustment, etc. But the result will be that your patient may not need that crown any time soon. Wow, two lives simplified.

Dry socket: I cannot claim credit for this one. I learned this from KISCO’s newsletter. It has saved me several times.

I realize that there are as many dry socket cures as there are dentists. But if you are in a pinch, this one works.

Crush an aspirin and mix it with eugenol (the liquid in that zinc oxide eugenol package). Place the resulting paste in the socket. An amalgam carrier works just fine for this.

I’ve actually had patients call me from my parking lot to tell me that it is already feeling a lot better. Thanks to Dr. Joe Steven, Jr., for that one.

Anyway, I hope this helps. If you have any game-changers, please let me know.

Andy Alas, DDS


Dan said...

Thanks, Andy; Great tips all around. I like the lido/carbo combo, but I prefer carbo first because its less acidic and the patients feel it even less (supposedly). As for the aspirin/eugenol combo, does this cause any aspirin burns? And why aspirin vs ibuprofen?

Andy Alas, D.D.S. said...

Thanks for reading, Dan.

I've never seen aspirin burn with this technique. Great question.

As far as ibuprofen, I've never tried that combination so I couldn't tell you if it would work.



Anonymous said...

I love the helpful hints.

In the times that I am doing a single lower molar, I use the interligament injection. Like the old Ligajet.
I use the newer edition called the Paroject by Septodont.
They are numb almost immediately, they don't get numb on their tongue and just a little on their lip.

If it is an operative procedure they are done in 20-30 min and they don't have to have that numb feeling for hours after.

This has been a big help for me.

Anonymous said...

Many years ago I sometime had difficulty with good inferior block anesthesia; I used a local called "Ravocaine"..that gave m,e better results......which, when no longer available, I decided the effective ingredient may be the higher percentage of epinepherine in Ravocaine. I bagan trying 2% liodocain (green colorfed stopper) 1 to 50,000 epi.; did pretty good. Then I began using red lidocaine*red rubber stopper( --which is 1 to 100,000, followed by a second injection of "green" 1 to 50,000 lidocaine; I use a shotgun approach. Many times the long buccal branch is not where it is supposed to be; I probably inject into 10 different locations on the madible; I also have learned to wait a minimum of 10 minutes, by the clock. I refuse to begin any treatment until 10+ minutes has elapsed; longer seems better. I now use Septocaine followed by green Lidocaine, as that is all I have available. You see, I work now temporarily in a prison, with limited resources. I told administration I would not work there without "green" lidocaine. I have been there for 10 weeks...seen 300 patients using local block anesthesia and NONE have expressed any feeling of pain during different treatments, including difficult surgical extractions. .


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