Re: NOYB Was: toothache after deep filling
From: NOYB (NOYB_at_NOYB.COM)
Date: 02/27/05
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Date: Sun, 27 Feb 2005 17:27:18 -0500
"W_B" <no_one@nowhere.net> wrote in message
news:9el421ttbqch56h1bfihoqakg8guraqcak@4ax.com...
>
> 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 disagree. You've demonstrated that if there's any doubt as to the pulpal
health of a tooth, you jump right into endo. I temporize and reevaluate
once I've removed the causative stimuli. Most would argue that my technique
demonstrates a much better diagnostic routine.
>>
>>
>>> 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.
You're assuming that nobody but you evaluates the pulpal health before
working on a tooth. I employ digital radiographs, a Tooth Slooth, and
percussion and thermal testing before cutting. That sure sounds a lot like
"endodontic evaluation" to me.
> #3 and #14 also deserve a serious consideration.
>
Why stop there? I've seen fractures into the nerve and down the root on
plenty of maxillary bicuspids.
>
>>> 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.
So then you're too entrenched in your archaic ways to change.
>
>
>>
>>> 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 ?
I guess I can add immature to the list.
>
>>>
>>> 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.
Horsepoop. A radiograph is a two-dimensional picture of a three-dimensional
object. You can't tell the depth of a buccal pit or class V carious lesion
on a radiograph.
>>
>>
>>>
>>> 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.
If I listened to you, there'd be a couple of hundred extra unnecessary root
canals done each year in my patient's mouths.
>
> I have much to teach, as do the regs in SMD.
I'm sure you do. However, your methods leave a lot to be desired
>
> Don't make enemies of the regular practitioners.
I leave the regular practitioners out of this, and just pick on the "supreme
diagnosticians" like yourself.
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