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News Bulletin : ADA News Bulletin October 2010
44 OCTOBER 2010 TEASER Fiona Hunter (Carnegie 3163) has submitted two bite- wing radiographs as a TEASER which is sure to activate the perceptive reader. They show a feature not normally seen on the average radiograph. The much sought-after inscribed, pewter, ADA paperweight will be awarded to the reader who identifies the feature and explains its presence. Correct answers accompanied by clinical hints gain a pro-rata statistical advantage. Please send your comments, clinical hints or stories you wish to share with your colleagues to: Barrie Gillings, Phone: 02 9144 3787; Fax: 02 9440 9159; e-mail: firstname.lastname@example.org This column’s particularly creative hints came from the fertile minds of: R Darcy, G Freeman, G Howe, P Klein, M Knapp, J Paterson and J Rourke. PAnDEMOnIUM Your Wordsmith paid scant attention to this word until he read Carl Sagan’s The Demon-Haunted World, subtitle Science as a Candle in the Dark (ISBN 0 7472 5156 8), which discusses witchcraft, the human folly attached thereto, and how scientific thinking has all but eliminated the horrible excesses of burning heretics at the stake. He points out that ‘pandemonium’ is actually Greek for ‘demons everywhere’. The sad thing is that there are places where they still thrive. Witchcraft is still out there. CLInICAL HInTS These hints are not promoted or endorsed by your Columnist or the ADA. Your colleagues submit them because they have found them helpful but it is your decision whether to use them. So if you don’t like a hint, don’t write a letter of complaint, just send in a better hint. You can be anonymous or you can use a pseudonym, and your colleagues won’t tease you because no one can tell which hint is yours. Many dentists give their patients a complimentary toothbrush, and some even include toothpaste. But the cost of toothbrushes has risen considerably over the years, and standard types are around $3–$6 in supermarkets, but considerably more in pharmacies. Fancy ones can cost much more. But in large shopping centres, there are often so-called ‘two-dollar shops’ (e.g., Top Dollar, Reject Shop) which sell brand-name toothbrushes and toothpastes for $1–$3. They do not have a use-by date, and the brand names appear to be genuine. Vibrating toothbrushes are very effective, cost about $8, are excellent value, and some allow you to replace the battery. Alginate impression powders are usually supplied with a scoop for the powder and a measure for the water. Two scoops of powder usually suffice for a mandibular impression, and three for a maxillary impression. The water measure, when full, conventionally provides water for two scoops of powder. But for three scoops of powder, the measure must also be filled to the halfway mark thoughtfully provided by the manufacturer. It can be tedious filling the measure exactly to this mark. Try this: fill the measure more than halfway, then slowly tip the water out until its surface is level with the measure’s lower lip and the upper corner of its base. The measure is now half full. When giving a palatal injection, use a finger to press with increasing force on the injection site for about a minute. Now inject at the site while telling the patient that they will feel pressure for about ten seconds. Before the ten seconds have elapsed, you will have completed the injection and removed the needle, and the patient will still be counting. They usually compliment you on your technique. Maxillary first premolars (14 and 24) often have two roots. Examine the radiograph and decide whether there are two roots. If there are, root fracture is then a possibility or even probability unless the patient is very young and has relatively soft alveolar bone. You can greatly reduce the likelihood of fracture by sectioning the crown so that the two roots are separated, using a long, thin diamond bur. Now reshape one of the two crown sections so that you can grasp it with fine-beak straight forceps, and remove the sectioned crown and its root by gentle rotation. Then remove the second crown/root. It takes a little longer, but not nearly as long as retrieving a fractured root. Occlusal matrices are available from dental suppliers, but you can use readily available plastic film instead. Cling-wrap is too fine, but plastic ziplock bags are made from plastic film of about the correct thickness. Simply cut them into strips of the appropriate shape. You can experiment with thicker film, which can save you time because the extra thickness reduces or even eliminates the need for an occlusal adjustment. When an incisor, most commonly a mandibular incisor, loses most of its bony support through periodontal disease, it is usually extracted. The space can sometimes be filled on a temporary or even semi-permanent basis by splinting just the crown to adjacent teeth, after smoothing the root surface and restoring the pulp chamber. But it can be a trial to hold the tooth crown in the correct position while splinting it. Consider splinting the tooth to its neighbours before extraction. You can then section the root then or at a later, more convenient appointment, and, with care, use an elevator to loosen the root and remove it labially. This sounds difficult, but it can be done. Smoothing the root surface and restoring the pulp chamber can be done after the gingiva has healed. When a Class V cavity extends into the proximal area and hinders your ability to achieve a good contour or to fill the deficiency adequately, fit a Tofflemire or similar matrix band around the tooth, taking care to ensure that the band does extend below the gingival margin in the proximal area of concern. Now cut a window in the band over the centre of the area to be restored, dry the enclosed spaces and inject chemical-cure GIC until the area is completely filled. After setting and band removal, trim any overhangs or excess as usual. clinical hints
ADA News Bulletin September 2010
ADA News Bulletin November 2010