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News Bulletin : ADA News Bulletin December 2010
44 DECEMBER 2010 clinical hints many promotions like this, and some of the adults visiting the Magic Kingdom will think what they are visiting is not fantasy. EAT YOUR WAY TO HEALTH This is what the some of the food manufacturers in the US and Australia would have you believe is possible, simply by eating their products. Phrases like: 'help regulate your digestive system by helping to reduce long intestinal transit time' is a way of saying 'this is an excellent laxative', but the latter claims a medical effect, and advertisers can't do that without peer- reviewed research. There are plenty of other claims, such as: 'can lower cholesterol 4 per cent in six weeks' and 'aids digestion'. The industry will usually claim that having to justify claims about health benefits using valid research would cost too much. Most consumers would probably say: "if you can't provide evidence to justify the claim, don't make it, just sell the product, and let the consumer decide". GUNFIGHTERS These are the legendary hard men who faced each other in a shoot-out in hundreds of Hollywood cowboy movies. The ABC TV programme 'Stephen Fry in America' had Stephen in a programme (7.30pm 13 IX 09) covering a raid on a marijuana plantation. Stephen was handed a .44 magnum for his own self-protection by the supervising officer. The officer went on to explain that this was the preferred shoot- out weapon, and, traditionally, was loaded with two cartridges. The third chamber contained a rolled-up $20 bill. The theory was that the $20 was to pay for any funeral and burial that might be required. Even more disturbing, your Recorder's son has a graduate student who said recently, that she felt naked without her handgun. She came from Detroit, and there were 600 shooting incidents at her university last year. Enough said. CLINICAL HINTS The ADA and your Compiler do not endorse these hints. 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. Thus no one will know which hint is yours. An abscess on a deciduous molar usually presents as a swelling (gum boil) and is, typically, painful. The pressure partly anaesthetises the surrounding gingiva, and sustained, gentle pressure on a probe inserted into the gingival crevice is usually painless and will elicit drainage. Pain relief is quite rapid, and you can then decide whether to extract, prescribe an antibiotic or wait for resolution before extracting. If it is the second deciduous molar that is abscessed, and the first deciduous molar is mobile, always extract both, or the abscess will recur. Contact with air (oxygen) inhibits the cure of composite resins. It makes sense to use a layer of plastic film (e.g., cut-up freezer bag strips) on the occlusal surface of the resin before moulding the occlusion. Leave it in place when light-curing, which should result in a more fully-cured occlusal surface, because of the oxygen-inhibited resin surface. Most dentists have been in the embarrassing position of inserting a new partial denture and having great difficulty removing it. Strong fingernails under the clasp and strong pressure from the thumb on the tooth surface usually works, but if it doesn't, try this: Hook some dental floss under the clasp or clasps, and apply gentle traction. This can be quite effective, especially if the traction is in a direction (occlusally and bucally) which will flex the clasp(s) away from the undercuts. Patients do not like needles, and if it is possible to avoid their use, you patients will thank you for it. A surface anaesthetic of particular effectiveness is one that uses three components, tetracaine, prilocaine and lignocaine. Not surprisingly, it is called TPL, but the hinter is not sure whether it is available commercially. Use it or similar strong surface anaesthetics 1: around very loose deciduous teeth, 2: in deep carious cavities where the tooth itself isn't sensitive, but the cavity margin is below the gingiva, 3: on fractured tooth fragments which still have attached gingiva. Anent No 1, your Anecdotist created a fraternity (Alpha Omega) in the Pedodontics Clinic at the Eastman Dental Dispensary, circa 1958. You became a member if you removed successfully three deciduous teeth without anaesthesia or instruments, and without the patient crying. Readers may have noticed that pharmacies now stock a range of interdental brushes, which suggests that folk are keeping their teeth when interproximal spaces are large or furcations become accessible. Wonderful, we are winning! But clumsy brush usage or lack of knowledge of the anatomy of the spaces can lead to fracture of the brushes, and sometimes, the need for professional removal assistance. When recommending the use of interproximal brushes, remember that familiarity with the shape of the space is not inborn. You have to show the patient how to insert and activate the interproximal brush. The space is not parallel to the floor, nor is it TEASER Being Christmas, you get two TEASERS. The first is a very common dental equipment item of the early 1900s. What is it for? The second requires a bit of lateral thinking. What is it, and who does it belong to? Please send your comments, clinical hints to: Barrie Gillings, Phone: 02 9144 3787; Fax: 02 9440 9159; e-mail: firstname.lastname@example.org Providers of clinical hints enjoy enhanced social interactions, and sleep more soundly. These are typical examples: J Brownbill, C Daly, R Darcy, J Chiew, M Knapp, E Owen and G Roberts. at right angles to the arch line. You might, yourself, have to do a bit of study before showing them how. Older dentists may recall that one of the requirements for graduating as a dentist required expertise in the placement of gold foil restorations. They were very superior restorations, but required a high level of skill to place them, and a high level of patient acceptance to put up with the trauma of their placement. This hinter still has his SS White gold foil plugger, now many years past its 'use by' date, but still has its uses. He uses his to adapt and seat pre-formed stainless steel bands. For younger dentists unfamiliar with the gold foil plugger, it delivered a short sharp, adjustable blow when pushed against a hard surface. A modern variant is the automatic centre-punch used by machinists. Come to think of it, such a punch would be an effective replacement for the now almost unobtainable gold foil plugger, and at a fraction of the cost.
ADA News Bulletin November 2010
ADA News Bulletin February 2011