In my 23 years of practicing dentistry I have seen the caries rate decline and now I have seen it rise again. When I talk with my patients about nutrition and oral hygiene, one of the things that has changed in the last 5 years is the number of people who consume energy drinks. There are so many of them on the market now that I can’t remember all of the names. When I was young we would drink Mountain Dew if we wanted a surge of energy, the combination of caffeine and sugar did the trick. Some of these new drinks make Mountain Dew seem pretty low-key when you look at the amount of caffeine and sugar.
Every dentist is familiar with tetracycline staining and the damaging effect it has on tooth color and the self-esteem of the patient. I was under the belief that this phenomenon was something that affected my baby boomer patients, and was no longer an ongoing phenomenon, I was wrong. Many of our teenage patients, one of my children included, are being treated for acne with antibiotics in the Tetracycline family.
Some of the most challenging intra-oral photos to master are the mirror shots. The placement of the retractors and the mirror, controlling fog and then aiming and focusing are all part of what makes these photos my favorite to take. In some ways it feels like I am playing the game twister by the time I am ready to press the button and take the photo. With all of this when I then look at the photo and the exposure or color aren’t right I’m frustrated! One of the biggest problems that I have with my mirror shots, especially the occlusal, is that they come out with a bluish tint to them.
An important step in bonding in an IPS e.max ( Lithium Disilicate) restoration is to prepare the intaglio surface of the glass by etching with hydrofluoric acid. The quality of the bond is dependent on the effectiveness of how the glass is etched, so understanding the manufacture recommendations is critical. Lithium Disilicate has very different etching protocols then other porcelain restorations due to it’s unique crystalline structure and chemistry.
Friday I had the pleasure of learning from Dr. Harald Heymann, UNC School of Dentistry professor, at the Society for Color and Appearance in Dentistry meeting in Chicago. Harald spent an hour discussing techniques and scientific information on whitening, and I was taking notes furiously. Whitening is an everyday occurrence in my general practice. We are recommending these services and helping patients with both in office and tray bleaching systems, as well as the many patients who are whitening with OTC products on a regular basis.
When I saw this search phrase in my site analytics it caught my eye, and made me wonder how many assistants, hygienists and even dentists aren’t clear about the micro-mechanical process that has revolutionized dentistry. Without the ability to form a hybrid zone, create adequate bond strengths and prevent micro-leakage we would not be placing posterior composites, porcelain inlays and onlays and many other procedures that seem routine.
Recently I received a series of clinical photographs with a question, “What should I do to close the gingival embrasures?” It’s a common question and comes down to preparation design. We close gingival embrasures (or try to) routinely with direct composite. You all know the routine, you place the composite, do some finishing and then it is time to check with an explorer and floss. Sure enough there is a catch at the gingival, so you get out the mosquito diamond or finishing bur and get to work. Several passes later with your explorer it feels as smooth as silk, you sit back and stare at an open gingival embrasure. Ok, maybe this has never happened to you, it happened to me and it is the same issue our technicians face.
We learned a valuable lesson in the office today, that was humorous and serious all at the same time. We were getting ready to take a final impression for an onlay I had just finished preparing and my assistant was setting out the impression materials as I finished placing cord. I asked her to get out the fast set Flexitime Extreme, as we would be using a triple tray, and for one tooth I don’t need the extended working time of the regular set. I watched as she took the material I requested out of a cabinet and began putting a new mixing tip on the tube.
There are many techniques for capturing a centric relation bite record. I have spent time becoming comfortable with all of them because in different clinical situations, each may be the technique of choice. One of these approaches is to capture the record utilizing a lucia jig. The purpose of the lucia jig is to separate the back teeth, release the elevator muscles, which will then release the lateral pterygoid.
My friend and fellow dental educator Dr. Gary DeWood is famous for saying “Gluma, Every Prep, Every Time”. This accurately represents the way that I use Gluma Desensitizer by Heraeus in my practice. It is a part of every set-up in our office, and I have come to depend on it’s benefits based on my real life experience. The combination of Glutaraldehyde and HEMA work both by killing off bacteria, and sealing the dentinal tubules preventing fluid movement.