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News Bulletin : ADA News Bulletin August 2011
49 AUGUST 2011 clinical hints TEASER The TEASER is a device given to your Commentator by his children on his 65th birthday. It would be regarded as a collector’s item by those who collect such things. Submit an answer if you think you know what it is. If you don’t know, send in a creatively incorrect answer. Your Complier has surmised that the publication of the names of incorrect respondents has deterred readers from submitting answers. So henceforth, the names of those submitting incorrect answers will NOT be published. As usual, correct answers accompanied by clinical hints get extra named slips in the hat, pro rata, and a better chance of winning, if there are multiple correct answers. The best creatively incorrect answer will be selected by Margaret. The prize is the usual handsome, antiqued metal, inscribed ADA paperweight. If you are a past winner and are still awaiting your inscribed paperweight, the hold-up has been because we have run out of stock, and new supplies are now being processed. Our apologies. You out there have been too smart, and won too many of them. It is rumoured that people who send in stories, clinical hints and teasers are more attractive to members of the opposite sex. Test this supposition by sending in something to: Barrie Gillings, Phone: 02 9144 3787 Fax: 02 9440 9159 e-mail: firstname.lastname@example.org The hints for this month came from the fertile minds of: the ANZAE Team, G Howe, M Knapp, M Maltby, I Martin and N Rock. David Dale, in his book An Australian in America comments on telling jokes which provide ‘maximum gaiety and minimum offence’. First: it is best to tell jokes on your own ethnic group. For example: Who is dumber than a dumb Irishman? A smart Australian. What is an Australian’s idea of being open-minded? Dating a New Zealander. Second: If the joke is about another group, would you be embarrassed to tell it to that group? If so, don’t tell it to anyone. Third: Don’t tell jokes about groups that are really suffering, if you can switch the joke to groups that can look after themselves. Fourth: Some traits are more offensive than others. Jokes about drunkenness, laziness and greed are less offensive than about physical characteristics, personal habits or intelligence. Fifth: If you tell an ethnic joke, make sure it is really funny. An unfunny jibe is an expression of contempt. A funny one may not be. To be really safe, limit your jokes to your wife or husband, as do some professional comedians. Then no one is offended, except, of course, your husband or wife. CLInICAL HInTS Neither your Compiler nor the ADA endorse or promote these hints. Dentists submit them because they have found them helpful, but you decide whether to use them or not. If you object to a hint, don’t write a letter of complaint, simply send in a better hint. You can use a pseudonym, or be anonymous, and no one will know which hint is yours. Rubber dam has been around for over 130 years, the reason being that it makes dentistry safer, easier and better. It is almost obligatory for endodontics. Prior to punching the tooth hole/s, punch an orienting hole on, say, the upper right border. This will guide you in attaching the rubber dam frame. If the dam leaks or there are gaps after fitting it, plug them with OrasealTM putty. There are computer-controlled devices for the injection of anaesthetics, but you can do as well, with care, when injecting the palate. Do so VERY SLOWLY for the first 20-30 seconds. The patient will seldom feel the injection using this slow technique. But they may wonder why you are taking so long, so explain the technique beforehand. If you have difficulty positioning a radiograph film correctly, try using a Snapex holder. This usually makes the job easier for the patient. If they have difficulty positioning the Snapex because of its bulk or poor access, replace it with artery forceps. They are much less bulky, but with the slight disadvantage of an image of the forceps tips on the radiograph. Painless injections require taut mucosa. Use the thumb and forefinger of your free hand to stretch it, and use one or other to stabilise the hub of the syringe. Now, insert the needle a few millimetres and inject a few drops of anaesthetic. Wait ten seconds, then insert the needle to working depth, and inject very, very slowly. You will be rewarded when you patients tell their friends that ‘the needle didn’t hurt at all’. Chloroform is good for softening and then removing the gutta percha from a failing root canal treatment (provided, one hopes, by some other operator). But, there is a problem. It can also dissolve your rubber dam. Take special care to confine it to the cavity, using, say, a small cotton ball to apply it, or a fine tip sucker to remove any excess. Valium is an excellent muscle relaxant and has a role in the symptomatic treatment of myofacial pain or temporo-mandibular joint problems. But some patients perceive it as being highly addictive, or implying that their condition is psychosomatic. Many will also know that its generic name is Diazepam. There is an alternative name: Antenax. This can be prescribed, and its effects explained honestly and objectively, without the accompanying emotional baggage associated with Valium/Diazepam. Always use a rubber dam for cementing post and core restorations. This avoids the risk of the patient inhaling or swallowing the restoration, and also allows you to use sodium hypochlorite or silver fluoride to disinfect the post space, and also prevents salivary contamination during cementation.
ADA News Bulletin July 2011
ADA News Bulletin September 2011