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News Bulletin : ADA News Bulletin April 2011
48 APRIL 2011 clinical hints a British comedian on TV. He was flying to Hollywood to participate in the film test of a concept. He said: “I was asked the purpose of my visit and I said I was ‘here to shoot a pilot’. I was detained for hours.” AndELAY, AndELAY, ARRIbA ARRIbA‡ Your Orthographer had occasion recently to order some duplicating gel from Dentaurum (Australasia) P/L. He ordered it by telephone at 9.30 am. The product arrived on his doorstep, packed and invoiced, at noon, after a 16 kilometre journey. Is this a record, or are all dental supplies delivered so expeditiously? dEdICATEd RESEARCHERS Some researchers are simply dedicated. Bill Bryson, in his book A Short History of Nearly Everything, notes that Henry Crampton spent from 1906 until his death in 1956 studying the snail genus Partula in Polynesia. If his surroundings were like they were when your Recorder visited Tahiti in 1957, who would blame him?¶ He compiled his results in fastidiously detailed tables, which have probably been studied by perhaps one or as many as three or four keen gastrodopologists. Another dedicated researcher was Alfred Kinsey, who was a keen entomologist. In an expedition lasting two years, he hiked 4,000 kilometres and amassed a collection of 300,000 wasps. That is a lot of wasps! He then transferred his interests to human sexuality, and after 20 years, published Sexual Behaviour in the Human Male and Sexual Behaviour in the Human Female five years later. Both are a good read, if that is your area of interest, but note that many of his experimental subjects were college students, and you know what they are like. CLInICAL HInTS The following hints are not endorsed be the ADA or your Compiler. Dentists submit them because they have found them helpful, but it is your decision whether to use them. If you object to a hint, don’t write a letter of complaint; just send in a better one. You can be anonymous or use a pseudonym. Thus no one knows which hint is yours. When restoring or re-restoring an endodontically-treated tooth, heat out then condense the gutta percha to the level of the alveolar bone, or a little below, then place a well-sealing base of contrasting colour before placing the final restoration. This provides an additional insurance against disturbing the gutta percha. It also assists in identifying root canal direction should the canal require re-treatment. Mandibular anterior teeth sometimes have a cingulum shape which does not allow sufficient grip to retain a rubber dam clamp. But they usually have a significant mesio-distal constriction, which you can use to hold a rubber dam in place with a dental floss ligature. You can extend the dam to the adjoining teeth using the same ligating technique. Note that saliva can accumulate, and a small-tip saliva ejector may be necessary to maintain a dry field. Locating a suspected crack in a multi- cusped or multi-rooted tooth can be difficult. Using a ‘Tooth Sleuth’ or ‘Frac Finder’, you can test individual cusps, which may help you to locate the crack. Experienced oral surgeons will be familiar with this technique, but new graduates may not be aware of it. Always examine the root/s of any tooth you extract. You are looking for evidence that a root tip has been left behind. If so, dry the area and look for the red spot indicating the root canal. Now select a root canal file of the appropriate size, and screw it into the root canal until it jams. The root will usually dislodge with gentle tugging, and if not, grasp the file in artery forceps and resume tugging. If that fails, loosen the tip with a fine-tip straight elevator, and then tug. If that fails, you may need to raise a flap and remove bone, but the aforesaid is much to be preferred. Early types of apex locaters to establish root canal length sometimes gave incorrect readings. Current models employ advanced technology and are much more accurate. If you use them, you will find that you need far fewer diagnostic radiographs. In addition, your patients will suffer much less post-operative pain because the instruments have not gone beyond the root apex. After inserting root canal points to the correct length and fit, cut the occlusal ends to be level with the incisal edge or occlusal plane of the tooth. After applying sealant, re-insert the points to the same level. This is especially helpful with multi- rooted teeth. You will, of course, need to ensure that each point is inserted in its correct canal, but you must do that to make you worthy of your fee. When restoring an endodontically-treated tooth using a resin-bonded composite material, it is wise to seal the gutta percha with glass ionomer cement. This will improve the adherence of the composite and also provides a good seal against leakage. TEASER Some readers have requested easier TEASERS. Here are two which might comply. The first is from an 1886 Claudius Ash catalogue. The second is from a 1924 oral hygiene magazine. Readers are invited to describe the use of the items. If any reader can supply the actual names of the items, it will be miraculous. Your correct answer gets your name on a slip, and if Margaret draws your slip from the hat, you win an inscribed ADA paperweight. You get an extra slip for every clinical hint accompanying your answer. Share your thoughts about dentistry, hobbies and items you think might interest your colleagues. We also need challenging items for TEASERS. Those involved with the recent fires and floods might like to share their experiences. Send items to: Barrie Gillings, Phone: 02 9144 3787; Fax: 02 9440 9159; e-mail: firstname.lastname@example.org Join the creative and ingenious dentists who devise techniques which improve the delivery of dental care, and submit a clinical hint. For this month the hinters were: ANZAE (Victoria) (per E Rebellato), R Adams, R Darcy, M Hayes, M Knapp, I Martin and N Rock. ‡ The catch-cry of Speedy Gonzales, fastest mouse in all Mexico. ¶ But they aren’t anymore!
ADA News Bulletin March 2011
ADA News Bulletin May 2011