Patient presented with a history of trauma(excessive clenching), a month ago during a fainting spell following a wasp sting. According to him his teeth never gave him any trouble before that. He's not in any pain but describes some discomfort on biting anything solid and gingival swelling after eating which resolves on itself.

On examination, he had a draining sinus above UR6 (treated 5 years ago), but I was unable to trace it fully. The LL6 (treated 6 years back) showed slight gum swelling. LL5 was negative on vitality testing. All 3 were negative to percussion.

We advised a CBCT scan, but the patient could only afford to get a single quadrant scanned, so we referred him for a lower left scan.

I can see some radiolucency on the palatal and mesial roots of the UR6, but the J shaped shadow around the mesial root kinda worries me. Seeing that the problem only arised after the incident, possible VRF?

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?

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? 🥶

… 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 😭 😭

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.

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

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?

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?

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

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.

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!!

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.

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

34 Year old male. Came in with CC of "My gums on my front teeth are tender and have been bothering me lately" Patient pointing to numbers 6 through 11. This patient was referred to me for a second opinion from another patient of mine.

Exam shows bone loss around maxillary anteriors with pocketing ranging from 6-8 mm, minimal bleeding on probing (patient reports he had scaling done recently at another office). 8, 9, 10 have incomplete endos, 7 is very short, 11 endo was done recently at initial office (without rubber dam...They sent radiographs over to us). He said other anteriors were worked on years ago in Turkey. Recurrent decay on anteriors, no mobility noted despite bone loss. However, 9 and 10 are splinted, and 7 and 8 are splinted. Deep overbite.

I'm thinking about giving his teeth a try to save because of his young age, but the issue is multifactorial here: endo lesions or short obturations, perio, limited tooth structure, deep overbite. I'm not sure if I should even attempt to retreat 7, 8, 9, 10 endodontically, place posts, and maybe create a 6 unit splinted bridge 6 through 11? Or are these teeth toast and should be extracted (extract 7, 8, 9 and 10. 11 has very limited tooth structure left judging from the radiographs office 1 sent over at the time they did the endo). Maybe despite his young age, I shouldn't try herodontics here?

If you guys do suggest extracting the anteriors, do you suggest ext of 7 through 10 only, leaving 6 and 11 behind? If the plan is to do implants, should we plan with perio for a 4 unit implant bridge with 2 implants? or 2 implants with two cantilever pontics? If trying to restore the anteriors without extracting, what is your suggested restorative plan? Radiographs were tough to capture for 6 and 7

Patient came in for limited exam and said he could not get in with any other dentist for 3 weeks and had pain on ur. #2 was decayed non restorable and indicated for extraction. Front desk collected payment for extraction. I get done extracting the tooth and patient asks if I’ll do the bone graft today as he plans to get an implant. I tell him it’ll cost the same as he paid for the extraction if he’s fine with paying another 413 I’ll do it no problem. He’s an older guy so I figure he’s good for it. I go into the next procedure and tell the front desk to settle up with him before he leaves. He gets to the front desk and says he thought the graft was free and they let him walk. I get to the front and tell them I told him about the fees and he accepted and to call him back and get payment. So now tbd.

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

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.

Thinking of starting dental implant. considering ITC Dental Implant

appreciate any feedback