PING: NOYB Was: toothache after deep filling

From: W_B (no_one_at_nowhere.net)
Date: 02/27/05 

Date: Sun, 27 Feb 2005 21:54:55 GMT

OK NOYB,

I am gonna be nice, just this once mind you.

Scroll down to read my replies.

On Sun, 27 Feb 2005 14:47:40 -0500, "NOYB" <NOYB@NOYB.COM> wrote:

>
>"W_B" <no_one@nowhere.net> wrote in message
>news:4sc221t9pnhvcd95omq36bi86el7pp578h@4ax.com...
>> On Sat, 26 Feb 2005 17:53:27 -0500, "NOYB" <NOYB@NOYB.COM> wrote:
>>
>>>>>> Talking dentistry here, not ophthalmology.
>>>>>
>>>>>I meant the pulp.
>>>>>
>>>> No kidding.
>>>>
>>>> Ask Mancuso who he went to see when he needed endo.
>>>
>>>Weston Price?
>>>
>>
>> Not him, nor Dr. L Stephen Buchanan.
>>
>> I suspect that your pre-op pulpal health diagnostic
>> skill leaves much to be desired.
>
>I suspect that you're a bit of a Narcissist making a statement like that.
>
>
>>
>> That cracked MOD in #19 with recurrent decay
>> needs a crown, right ?
>
>Perhaps. Is the crack into the dentin? Into the enamel? Down the root.
>
>
>>
>> Nope, it needs an educated evaluation of the pulpal health,
>
>
>Agreed.
>
>> a microscopic evaluation of fracture status,
>
>I suppose you mean after you've accessed the pulpal chamber. If that's the
>case, then I agree.

I can usually tell before I pick up a handpiece.
Matter of fact, can usually tell before the radiograph.
Twenty years of experience and all that....

>
>However, how do you know the crack doesn't stop before the chamber? Perhaps
>the tooth never needed endo in the first place.
>
>
>> and a
>> careful evaluation of the cause, namely parafunction v. caries.
>
>The mode of repair is the same either way.
>

No, actually it is not.
>
>>
>> Crown a tooth like this at your own jeopardy.
>> You will eventually either extract or have RCT done through
>> the crown.
>
>>
>> Either way, the patient views *you* as a inept dentist when
>> your treatment fails.
>
>Not when the treatment options are explained to the patient in advance.
>Sure, you could go and RCT every tooth prior to crowning them. But why? The
>majority of crowned teeth don't need endo. In fact, the majority of teeth
>with cracks in them don't need endo. By taking an asymptomatic tooth with a
>visible crack and doing interceptive endo on it is a means further weakening
>of that tooth.

Your treatment modality concept is completely
out of step with reality.

Once the fracture is present, then endo is needed
(in the symptomatic tooth) before the 'crown prep'.
If you prepare a fractured tooth for a crown, with a
compromised pulp, you will end up doing RCT on
that particular tooth nine times out of ten;
within 5 - 8 mos. of placement.

Most of the SMD regs agree with this.
You must contemplate a constricted pulp before
you prepare any tooth for a crown.

>
>I use endo as a last resort, not a first line of attack. Many times, I'll
>put a patient in a temp crown for several months to see if a tooth become
>symptomatic, and then reeval the pulpal health before final cementation.
>Oftentimes I'll put the permanent crown on with Temp Bond for up to a year
>to see if the pulp will settle down. I give the patient the choice,
>however. And the great majority choose to go with a more conservative
>approach of "wait and see".
>
>
>
>
>
>>
>> Evaluate each particular case carefully;
>> before you perform *any* dental operation.
>>
>
>If you tell Mrs. Jones that she needs a crown, she'll ask if that also means
>that it needs a root canal. The answer for most intelligent and ethical
>dentists should be "Possibly, but usually not".
>
>To jump right into endo is unethical unless you have clear signs of pulpal
>necrosis or irreversible pulpitis.
>

I am sorry to tell you that your pulpal diagnostic skill leaves much
to be desired.
Have never been unethical.
Just have better diagnostic skills than you, and most others.
>
>
>> I gained most of my endodontic experience by bailing
>> out inept operators who created mechanical exposures,
>
>Aren't you special.
>
>How do you know it was a mechanical exposure and not a carious exposure?
>
>
>> didn't anticipate pathologic exposures, and those who
>> crowned teeth without regard for pulpal health.
>
>Well, gee whiz. Someone did a crown on a tooth and it ended up needing a
>root canal afterwards. Stop the presses! But as you know (or should know),
>that's more the exception than the rule.
>

Here is where you are fargin up.

# 19 or 30 with a MODB (or whatever) needs an endodontic
evaluation before you prep it for a crown.
#3 and #14 also deserve a serious consideration.

>> Not to mention those who never took occluding into consideration.

>> So you call it 'pink eye', have heard it called 'the red-dot club'
>> and there are a few others.

>> I say you have poor diagnostic skills.
>
>You've said a lot of things in this post. But just because you said 'em
>doesn't make 'em right.
>

Try again, newby.
Got twenty years and am the young one in this group.

>
>> And probably poor mechanical skills.
>
>LOL. Are you feeling exceptionally insecure today? Or are you always like
>this?
>

Am never insecure.
You wanna come get some ?

>>
>> There are no *mechanical exposures* in my solo practice.
>
>Mine either. So what. If a pulp is exposed, it's with a spoon excavator
>while excavating carious dentin...and the patient knew going in that it was
>likely to happen...but due to financial reasons chose to "try to fill it
>anyhow" before doing endo.

That approach is completely stupid.
If you cannot tell from the radiograph,
then your diagnostic skills Suck.
>
>
>>
>> Gauntlet thrown down noyb, come get some...
>
>What are you talking about? I'm not sure what set you off, but you really
>turned into a prick on this thread.
>
>
I am a prick ?
Sure, I can take that.

You are an inept diagnostician.
Listen and learn newbie dentist.

I have much to teach, as do the regs in SMD.

Don't make enemies of the regular practitioners. 

--
W_B
wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE

Relevant Pages

  • Re: toothache after deep filling
    ... > Nope, it needs an educated evaluation of the pulpal health, ... the tooth never needed endo in the first place. ... > Crown a tooth like this at your own jeopardy. ...
    (sci.med.dentistry)
  • Re: toothache after deep filling
    ... > Nope, it needs an educated evaluation of the pulpal health, ... the tooth never needed endo in the first place. ... > Crown a tooth like this at your own jeopardy. ...
    (sci.med.dentistry)
  • Re: toothache after deep filling
    ... > Nope, it needs an educated evaluation of the pulpal health, ... the tooth never needed endo in the first place. ... > Crown a tooth like this at your own jeopardy. ...
    (sci.med.dentistry)
  • Re: NOYB Was: toothache after deep filling
    ... >>the tooth never needed endo in the first place. ... you could go and RCT every tooth prior to crowning them. ... > you prepare any tooth for a crown. ... > Just have better diagnostic skills than you, ...
    (sci.med.dentistry)
  • Re: Abscess after a new crown
    ... >> Carefully evaluate the pulpal health of any tooth that is scheduled for a ... >have also had multiple patch-ups as well as the major fillings. ... >why I try like hell NOT to crown any non- RCT'd tooth. ...
    (sci.med.dentistry)