Friday, September 02, 2005

It's Darts Season!

Yes, it's that time again, when I actually dabble in a meaningful activity that may even pass as a hobby. Yes, along with fish 'n chips, pubs and representative democracy, darts is one of our best British imports. There is nothing I enjoy more than standing in the company of a group of darters, consuming ethanol whilst hurling sharp objects. Brilliant!

I play on The Cockney Rejects, based at the Coat of Arms Pub in Portsmouth. We are the Boston Red Sox of our league - Always good enough for 2nd place! Even last year, the Sox threw off their curse, but we remained 2nd in the standings and 2nd in the playoffs. On the positive side, we consumed a lot of beer.

This season, we hope to recover from the loss of longtime team captain, Eden Moe, who, for some crazy reason that had to do with marrying a beautiful British physician, emmigrated to the UK. Eden and his clutch bullseyes will be sorely missed. Also, I'll have no one to shoot me dirty looks when I follow unconventional strategies in my singles matches....

Native Brit Nigel Smith is stepping into the captaincy. Mr. Smith is a master of throwing darts while drawing puffs of his cigarette, which is a clever trick, when you think about how easy it would be to hurl the butt and stab a dart in one's mouth... On the rare occaisions that he misses his mark, one can hear Nigel's characteristic explosion: "WANK-er!"

In the past, the British-ness of the team was bolstered by Roger and Simon; Roger plays on as an alternate, and also runs the pub in his spare time. We have no Callums, Olivers or Liams, however.

Ironically, Andy English is a Yank. Andy and I used to hang out at the same Irish Pub in Columbus, Ohio (Byrne's) but didn't know each other until moving to New Hampshire in '02. Andy plans on missing several weeks of the season this fall, for some crazy reason that has to do with marrying a beautiful American architect, and..... hmmm.... anyone else see a trend here? Anyway, he'll be back; Best Wishes to Andy and Cathryn, however!

Hailing from Dover, Dennis Wiggin and Chuck Schlicter will have to travel to Portsmouth for every game this season. Someone should offer to help with gas... Dennis finished on the leaderboards after coming on strong last season, and we're happy to have Chuck back full time from his educational hiatus of last season.

Joining the Rejects this season, Sean Lyons brings his mad phat Irish dart skills to the team. He was smart enough to get married last year (beautiful/American/therapist, for those keeping track of non-darts stats here...) so he shouldn't miss many matches this season!

We opened with a win this week at the Coat; our opponents threw valiantly, despite being down two players. They thusly forfeited three matches. I thusly only played one of the three matches I was scheduled for. Disappointing, but I won by default. "De, Fault! the two sweetest words in the English language!" according to Homer Simpson. Most notable was the tour de force of a throw by Mr. Wiggin, who had a round of five corks. This means that he hit the "red-eye" twice and also a regular bullseye just for giggles. I've never actually seen that done in competition. I did it once while practicing, with no one around to see.... *sigh*. No sour grapes; congrats to the Big Fella! Roger subbed for Nigel this week, as the latter remains in England on "Holiday," I believe. Although simply out-matched in his singles, rookie Sean acquitted himself very well, contributing to his trio's win in 601 and teaming up with Chuck to win a hard-fought doubles Cricket match.

In other news, the Coat's Soft Taco Special is delightfully spicy, but could use some more shells to help mop up the plethora of tasty goodness served w/ the soft steak. Yum.

Back to dentistry later.....

Wednesday, August 31, 2005

How to Extract Teeth

This is in response to a comment yesterday from Dave L, a first year dental student at UMB in Baltimore. You can check out Dave's site from my sidebar. Dave asks: "we haven't gotten to oral surgery yet I was wondering what is it about extracting teeth that makes it so difficult. I haven't seen a tooth extraction yet, but evidently there's a lot more to know than 'take a pliers and pull'."

Non Dental Types and the Squeamish might want to take a pass here....

Hey, thanks for the comment, Dave. To answer your question: Extractions are not hard, per se. Certain TEETH are hard. Go open your dental anatomy text and compare, say, #3 to #24. The molars, especially uppers, have three roots. If your text is like mine, it should show molars with a variety of roots, from convergent to highly divergent. if there's just one root, no problem, 2 minute extraction. 2 roots is harder. 3 is harder still. NOW pretend that the tooth is super decayed, so there's a minimal of cornal structure to grab on to! THAT was my patient yesterday. And there were two of those.

No, you don't just pull. You "luxate." Think of pulling up a fencepost. "Yanking" won't get you anywhere; you have to wiggle wiggle wiggle. bone is more flexible and less dense than tooth. So you can expand the socket. Then the tooth is ready to come out. If your roots are particulary divergent, you section into 2-3 pieces to remove in parts. If you don't have the access, you have to lay a perio flap (which is the gingival equivalent to peeling a banana) and then drill away the bone holding the tooth in. This is called a surgical extraction. To quote Dr. Hank, "If you're gonna take away bone...take away bone!"

A lot of dentists don't do surgical extractions, or extractions at all. They realize this is unpredicatble. The amount of time spent doing a surgical extraction (especially if you're not super good at it!) would be more economically spent doing a few crowns. So maybe you don't even have the equipment. This is what oral surgeons are for. This is why OSs can get up to $350 per tooth, as well.

Hank and I work in Community Health clinics and our uninsured patients are not super popular with the oral surgeons. So we end up doing a lot of it. We also end up getting pretty good at it; even a bit cocky. Some patient comes in, "Oh, Dr. Smith said I had to see an oral surgeon for that." Five minutes later, you're casually tossing that #16 onto a tray, making a flip remark like, "Congrats; it's a boy!" The patient is stunned. "Why did Dr. Smith think I needed an oral surgeon?" The temptation is to say, "Well, my friend; Dr. Smith is a, conservative practitioner." But we all know sometimes the tooth that looks easy isn't. So be careful of that.

Oh, and Dave - Please call them "forceps" from now on! If you even whisper "pliers" up in the clinic, the 4th years will peg you as the guy to send off in search of an "amalgam shade guide" when you start assisting.... word to the wise - Good luck!

Tuesday, August 30, 2005

Some mornings it just isnt' worth...

...gnawing through the straps...
-Emo Phillips

Good Heavens - a pair of extractions today took me nearly 90 minutes, as much due to difficulty of teeth (14,15) as to the patient whining about how much vicodin she had coming to her afterwards....

The two root canals I had today BOTH branched into accessory canals and other anatomic weirdness... (Hank; when was the last time you got a 13 w/ two??) and that took me forever. Now we're trying to change our computer system so the records are more accurate and so forth.

That's all well and good, but I'm FAST on the "slow" system I've been using for the last 2.5 years....! Well, such is progress. I keep telling the powers that be that the "new" system is going to make some peoples' jobs easier (data entry and collection) and other peoples' jobs harder (the dental department) so as long as they're prepared for decreased efficiency (at least in the short run), I'm ok with it.

Gotta go eat; hey, thanks for all the comments you guys! It really picked me up after a tough day. Also, see my comment to those comments... :) laters.

Monday, August 29, 2005

The Highest Praise....

So I cemented a crown on today, which is a bit unique. Here in Non-Profit Dental World, crowns (bridges, implants, etc) are a bit of a luxury. If someone comes to us and has a boat load of "bombed out" teeth, we can't just go and do root canals and crowns and all that jazz that most of you who are middle aged or older are familiar with, dentally.

It's more cost-effective (and the best use of OUR resources) to fill and save teeth we can, extract teeth we can't and then fabricate a partial denture (usually with a metal frame) to restore function and esthetics to some degree.

Of course, taking a denture out of your mouth to clean at night isn't the best thing with which you can saddle someone. But I can do one for about $340 for folks on the sliding-fee scale. Compared to $2500 or so for a bridge that replaces just ONE tooth, that's a great deal.

However, if someone comes in who ISN'T missing teeth, and, for some reason, has ONE bombed out tooth... Well, you can't say, Oh, sorry, let's extract and put in a partial for one tooth; that's crazy. So we do some root canals and so forth there.

Anyway, I finally finished an upper molar (#3 for dr hank and the rest of you) and cemented it. Everything worked well. No adjustment (insert plug for Captek here!) needed. The young man who is the patient went out to his mom (who paid for it!) and I asked her, Hey, what do you think?

She said, "Well... huh... I'm not even sure what I'm looking at; it looks normal."

I said, "That's RIGHT!" It's not what it looks like; it's what it doesn't look like, which is FAKE. So that's gratifying.

Thanks to Don, Hank and anyone else who's reading - if you're out there, leave a note!

Sunday, August 28, 2005

Almost Famous

The Daily Flos

Last night, at an upscale restaurant in town, we sat next to a pair of sharply dressed, professional-looking women. After a few sips of wine, I glanced at one of them.

With a flash of recognition, she exclaimed, "I know you! You're that fabulous dentist! We heard you speak at J_____'s party."

The party in question was a fundraiser/auction to benefit the non-profit for which I work. I remember working hard to prepare my remarks to be insightful, persuasive and witty.

I don't recall being fabulous, but I'll take what I can get! "That's DR. Fabulous to you, dahling...."

Rejected Dentist Blog Names

John Wayne was born Marion Robert Morrison.

U2 started out as The Virgin Prunes, while REM was originally Buckets of P#$%.

If a certain father who shall remain un-named had had faster X gametes, I believe I would have been Elizabeth.

So in the spirit of whismy (and since it's the weekend) I now present "Rejected Dentist Blog Names."

The Secret Lives of Dentists (already a film as well as a

book by the appropriately named Jane Smiley)

Dentisty Bites

Dentisry Bytes

Chew on This

On the Cusp(id) of Fame

Tooth Wisdom (one of Rachel's favorites of my ideas...)

Brace Yourself!

Mental Floss

The Root of All Evil

Open Wide (disturbingly, but not surprisingly, this is already, film. I will not hyperlink to it, but if you are an "adult" who is into "film databases" there is a "dotcom" where you can....bleah. i feel so dirty already....)

and the other two finalists:

This is Not a Drill

and The Awful Tooth

So, hopefully it's readily apparent that my chosen title is a play on The Daily Kos, which is, however technically pronounced "ose" as in "close," not "oss" as in "floss." But it's too well-known a blog to not play with the name.

Adios, amigos.

This is only a test.

working on tags!

you, jane... chuckle.