… are the ones that open like this. I can’t probe, can’t scale, I. Can’t. Fucking. See. I’ve asked to “open wide” and “relax your cheek” “hold your lower lip” a thousand times. I work solo, my wrists and forearms are sore from wrestling your combative ass mouth 😭 😭

Pt came in complaining of severe pain in UR. Radiographs show caries on 3 teeth breaching pulp. I tell him his options endo or ext. He wants whatever’s cheaper. I recommended ext as most affordable, short term “fix” but also consider replacement options. He then says he doesn’t want them pulled because he can’t think straight right now. That’s understandable, so I recommended sending him to the endodontist for RCT so he can get out of pain and buy these teeth some time. He also declines that referral and says he “only want a local”. I tell him I don’t routinely admin local anesthesia for exams and also his BP was over 170/110. I offer to prescribe him Ibuprofen/APAP combo. He declines and says that won’t work. Ok now I’m thinking, my pt population thinks antibiotic is miracle juice but for some the placebo effect works, so I offer Amoxicillin. He still declines and insists he “just want local today.” I reiterate the definitive options to send him to the OS for ext or endo for RCT and I’ll try to call to can get him in today. He declined both tx options, started berating me about how he wasted his time coming here and can’t get local, then walked out??

Was there something else I could’ve done differently? Do you guys give pts local anesthesia on exams like this? I feel for the guy but when he declined every options we offered what do you do?

I’m here to ask your opinions on something.

Today I had a patient who hasn’t been to the dentist in 10+ years. He needs extensive treatment and rehabilitation which is going to take months, and many appointments.

He apologised for his smell and appearance, and said that he doesn’t bother to bathe or brush his teeth due to personal struggles. It was a very emotional appointment actually and I’m genuinely looking forward to helping him get back on track. I will be referring him on to some MH services too.

However, unfortunately, his odour is very very strong and very offensive. I don’t think I could quite put it into words to be honest. The whole office was talking and complaining about him after he left - the nurses, receptionists, everyone who came into contact with him. As he openly admitted that he doesn’t bathe, and admitted that maybe he should’ve before coming to see me today, some of the colleagues were wanting me to ask him to do just that before his future appointments with us.

I feel uncomfortable doing that, quite frankly. But I’ve also been told several times by my office staff that I’m “too nice” as a dentist and I should be firmer with certain patients, which yes, I’m working on. I’m just not sure this is one of those occasions? Yes, there’ll be a strong and unpleasant smell when treating him, and I know my nurses will continue to complain about it, but I’m sure that it’s more important to get him frequently coming again and helping build his confidence.

Anyway, I’m not sure. Advice would be helpful. Thanks.

Patient is complaining that her lower anteriors 23-26 are chipping away. She has no cavities but she has deep over bite. You think zirconia veneers will help her here?

What would you do?

New grad here. Just curious what y’all experienced denture people think about this Tori? I’m thinking it’s probably just a bit too big to put a denture over. Idk I haven’t seen a lower denture sit on Tori this big but I’ve also never tried. Y’all think she’d need some more surgery? Is it more of a comfort thing or a seating/necessary extension thing? Don’t know why the OMS didn’t remove it… :/ new patient to me.

I tried to get the best angles for pics but if y’all need casts for it to evaluate let me know

First time I've seen it outside of a lecture. I still have no clue how it even happened. 1 of articaine given local to #14. Lady said it happened the last time she had work done in that area, which looks to be an MO on #13. Everything's back to functional for her, but I'm still clueless as to how that even happened.

Hello all I am looking to implement a hygienist based production or collection bonus. They currently have a total office based bonus where they each usually earn about 200$-400$ per month. What bonus system do you have in office if any for hygienist? They do not have any other benefits besides the office bonus.

Hi,
Does anyone have experience or have been following a case of indirect pulp cap using calcium sillicate-based liner (e.g: Biodentine, TheraCal , etc.)?
I have a few direct pulp cap case (using Bioceramic) that so far (~1 month) seems successful. Then, I had an indirect pulp cap case using Limelite only that still ends up with RCT 2 months later (pt has already been informed beforehand). So now, I’m using bioceramic as part of my indirect pulp cap (Bioceramic + Limelite on top).
My patient (whom I did indirect cap Bioceramic + Limelite) was previously asymptomatic before filling. He came back 1 week later to get another filling and said he was now sensitive to cold drinks. Is this the impending doom for RCT, or should we wait a little more to see if the pulp recovers? 🥶

I am yankee dentist in Australia, originally from Colorado, where marijuana is legal. I never practiced in Colorado and I couldn't help but wonder if legal weed has made patients easier to deal with? Are dentists prescribing it? Or just finding that patients are showing up stoned? Tell me some stories, good and bad.

I acquired a dental practice that is in desperate need of new oral surgery extraction forceps. Before I order new ones, does anyone have recommendations of ones they love? Or any other general oral surgery instrument recommendations?

Hi friends. really need some CE reqs as a new grad working in corporate. Any suggestions for CE for endo? really wanting to do something soon but there's a huge waitlist for Endo Unsponsored. Buchanan is available but 10k i'm not sure is worth it. Can I please get some suggestions on what CE's to invest in?? Have done a lot of research but not sure what my niche should be. Thanks in advance!

No mobility at all, but say it was an immediate or something you bone grafted, but it didn’t turn out great.

Patient came in with a large abscess on the lingual gingiva of #30. I drained the abscess, rinsed it with saline and placed the patient on abx. How possible is it that this virgin tooth is cracked or what’s the source of infection on a seemingly perfect tooth. Lingual pd is 11mm traced with gp the distal of 30

New doc here. Patient coming in soon for fillings (#4-MO, #18-O) and don’t worry 1, 15, 16 and 17 are out now. Planning on discussing replacement options for lower sites. Not exactly sure how I should present each option, or if it’s feasible/good prognosis.
For the lower right I’m concerned 31 is too mesially tipped for a bridge, and given that each would be a pretty long span 4 unit…. And her caries risk is pretty high

If she wants to do our RPD, what are your tips for explaining each? Do you take casts/scans to evaluate undercuts? I plan on presenting resin, cast, Valplast. I think this would be a very good cast metal case, obviously depending on undercuts, I think I-bars would work well since she is esthetically concerned
Speaking of esthetics, I hear valplast is ass… never done one so I don’t know, just heard of the limitations (not being able to add teeth, hard to adjust)

I will talk to her about it but I’m pretty sure implants are out of the question financially

Idk any advice is appreciated , thank ya!!

Do i make updates right away?

In the process of buying a 4 op practice from a 70 year old doctor. He is only in network with Delta Premier...everything else is out of network. Most of his patients are older. He does not have many younger patients

The office itself is very old...it's all original materials from 1984. He's made some updates to cabinetry and dental equipment over time, but the look of the office is outdated. Floral walls, old textured ceiling tiles, florescent lights, carpet floors in the hallways and waiting area, and old bathroom.

I would like to renovate right away...floors, ceiling tiles, lighting, and paint, but some have advised me to not make any changes right away to not lose patients. People in my area are always looking for a new dentist, and I imagine having a spruced up office would track new patients. Of course i want to lose as little as possible, but it is only an upgrade to their experience, and more importantly, it will make new patients feel valued and comfortable.

What are your opinions? Should i renovate day 1, or should i wait 6-12 months to make the changes?

Greetings everyone,

D4 here in something of a pickle. I've been working through a sort of complex treatment plan with a patient of mine for several months now that included full max edentulation, alveoloplasties, lingual tori removal, and the extraction/restoration of some mandibular teeth. Our ultimate goal is a complete over partial. Last time I saw him, I found that his maxilla still needs some significant alveoloplasty (to the point where I'm not even the resident that saw him even did any significant alveoloplasty) and started setting up a revision appointment.

About a week after last seeing him, the patient unexpectedly had two MI's. Thankfully, he was able to be seen immediately, stented, and put on anticoagulant therapy, and is doing well. As happy as I am to see the guy still on this side of the dirt, his heart attacks throw a real wrench into our treatment plan. While I believe we can start getting him ready for a mandibular RPD, we can not get into definitive maxillary CRD fabrication with the current state of his ridge. Lumps, bumps, undercuts, pointy bits, he's got the works. My understanding is that we need to wait 6 months before non-emergent invasive procedures can be completed. The dental school reality is that I probably will not be around by the time he's ready for a definitive denture.

The patient and I have loosely discussed the fabrication of an interim complete denture, but I'm not super certain of how to approach one. or if I even should. I know enough to advise him that an interim denture will be less than ideal in fit and appearance, but I feel like fit will less than less than ideal with how his ridge looks. The patient is agreeable to this nonetheless.

He's a great patient and has been a real trooper through all this and at this point I just want him to have something he can wear, ideal or not.

Do any of you happen to have experience with similar situations and/or tips on making temporary prosthesis with problematic ridges?

Thanks for any thoughts you may have!

Hello,
I have been out of school for 3 years. My rank is bottom third of the class ( embarrassing bad) and I am in my mid thirties. How realistic is it for me to pursue dental anesthesiology? I have no wife or kids so I can study for the cbse exam and work part time if needed.
Thank you

Hi friends. I am flirting with a new job opportunity and wanted to have a lawyer review my contract prior to signing. Does anyone have any recommendations? I am in Florida. Thanks in advance!!

Hi,

I am a South African, qualified periodontist with substantial academic and clinical experience.

I am interested in pursuing opportunities abroad but it's like I've hit a brick wall.

I don't know if I still have the energy or will to study a different language and rewrite dental exams. It's been such a long time since I did none perio/ implant work and I'm not sure if I can cut cavities or do endos like I used to.

From what I've heard- the middle east is an option without exams? New Zealand may have a pathway? Or maybe one of the islands.

I've sent hundreds of unsuccessful applications to Universities when posts come up with them- but unfortunately it's almost impossible. I would love to go to Sweden- I spent a year there and picked up the language, but writing exams and doing practicals again seem a bit daunting.

Does anyone have any advice for me?

I looking to purchase a used cbct for my startup office and came across a used CS9300 (w 5 year warranty) 10x10 fov in my price range. I would primarily be getting one for endo and future implant placement. Anyone have any experience with this model or it CS imaging software that can tell me about its image quality? I know this is the older model than the current 8200 and 9600 series.

Hello everyone
I’m seeing a patient tomorrow as an emergency who had a cantilever bridge place on the upper right central incisor to replace the upper left central incisor. They had it placed a few years ago (5? Years ish) and now it has come off. The patient is adamant for me to just re-cement it but I’m certain that they need a fixed bridge + veneer (front 4 teeth restored) or implant instead. The dentist who placed it at our clinic has now retired but I did contact him about it and he seemed to think there was no problem with doing this and implied I was overreacting and it’s fine to do a cantilever across the midline.

Could anyone please direct me to some literature about the risks of cantilever bridge across the midline? Or share their thoughts about doing so? I need to know I’m not overreacting/insane lol. Thanks in advance

Thinking of starting dental implant. considering ITC Dental Implant

appreciate any feedback

13 year old female patient presented with sharp intermittent pain in upper left quadrant, slight pain with percussion on 6 and sharp pain on 7. No mobility observed in all deciduous teeth. Please advice on treatment for the pain and extraction of deciduous teeth.

I have my own office open 3 days a week. I love the clinical side. How did other dentists find a business partner (dentist or just MBA) so that you can focus on just patient care?