If the number of television commercials for sleep medications is any indication inadequate sleep has become an epidemic. It is estimated that as much as 30% of the adult population suffers from obstructive sleep apnea, which can cause significant medical consequences if left untreated. We have an opportunity when patients come in for routine dental visits to talk with patients about sleep and help them identify if there are reasons for more investigation.
There are a variety of ways I capture bite records for diagnostic models that will be mounted in a seated condylar position. One way to capture these records is with bite registration silicone and either a leaf gauge or a lucia jig. These techniques are fantastic for patients where we need to release muscles or who tighten their muscles as a response to our procedures. One challenge they pose is trimming the records and mounting them to get an accurate representation. Another is that some patients will posture forward during the record. Having multiple techniques in your arsenal will allow you to use the one that is most appropriate and will yield the most accurate results for each individual patient.
Over the last few weeks one of the recurring topics I run into is sinus infections, or more appropriately sinusitis. A patient and I were discussing the recommendations that he had received from his family practitioner regarding his sinus symptoms, and the information was surprising. He had been told that the current thought was not to prescribe antibiotics as they are ineffective. I didn’t make much of it until today sitting in a lecture at the Chicago Midwinter meeting on pharmacology with Dr. Harold Crossley. The lecture turned to the topic of prescribing medication for a sinus infection and here again Dr. Crossley stated that new evidence supported that antibiotics are not effective or needed in most cases of sinusitis.
The past few blogs have focused on utilizing Facebook as a powerful Social Networking tool. Today we are shifting our attention to Twitter. According to a recent article on Twitter.com, they have more than 100 million monthly global actives. And half of their active users log in every day. “55% of our active users are active on mobile. We’ve seen tremendous growth with mobile – about 40% increase quarter over quarter.” Those are big numbers that show that they have a “sticky” base of active users that communicate on a daily basis.
I am a strong believer in patient approved provisionals in cases where we are making esthetic changes to anterior teeth. I have patients back a week or two after placing anterior provisionals. This appointment is designed to review the appearance and get the patients approval prior to sending the case to the lab for fabrication of the final restorations. Additionally we test the phonetics and function. If everything is a go we photograph the patient and take a model of the approved provisionals to send to the technician.
This morning at the Sky Harbor airport in Phoenix I stood inline at Starbuck’s with the owner of Aqualizer as we both headed to Chicago for the Chicago Midwinter Dental Meeting. As you read this post you are either already utilizing Aqualizer’s in your office or you are wondering what I am talking about.
The Aqualizer is a temporary occlusal appliance. It is two water filled cushions connected by a bridge of plastic that allow the device to be placed over the posterior teeth and stay in place. The device provides posterior support that can relieve acute pain from a lateral pterygoid spasm, disc displacement, as well as a traumatic injury to the retrodiscal tissues.
I had a patient in today to complete a quadrant of teeth on the upper right. She did great through the local anesthetic and placement of the Isolite. As we began to work, she raised her left hand to stop us. The cold caused by the water spray and the high volume suction were causing her to experience sensitivity on her lower teeth where she has root exposure. This is a common experience and one I have sought to rectify over the years. I have tried placing a cotton roll in the buccal vestibule by the sensitive teeth. This tends to work for awhile until the cotton roll becomes super wet, or their lip pushes it out.
Patients who have worn teeth can be some of the most disconcerting. Often we are unsure of when to talk to patients about wear and uncertain about how we treat it and how predictable the results are. I believe that some wear is normal. I base this on the fact that I have very few if any patients who are in their seventies or eighties and still have mammelons on their incisors. Wear is a concern when the amount of tooth structure being lost is out pacing the patient’s age.
The last two posts have focused on utilizing shell provisionals during the restoration of an entire arch of teeth. A critical step in the fabrication of any provisional is trimming to perfect the marginal fit and create the proper embrasure form and emergence profiles. Once the provisional has been trimmed the final polish not only creates the esthetics but a smooth surface that optimizes tissue health. For many years I trimmed my provisionals with carbide burs in a straight handpiece.
One sure-fire way to get a shell provisional is to have it fabricated by a laboratory. The first piece of this puzzle is to make sure that the fees you quoted for the case include the extra lab expense for the provisional. The second challenge is depending on how the lab fabricates the provisional you may have adjusting to do in order to seat it over your preps. Often what the lab does is prep a duplicate model to make the shell. Depending on how much they prep and the orientation, the shell may bind on your preps and require internal relief. I utilize a shell technique that we do in the office. It is another process I have trained my assistant to complete. This transfers the lab fee for the shell to an hourly rate for a team member plus expenses.