Shout out to college pal Anastasia Tuckness (nee Niefhof).... The following has nothing to do with dentistry!
The talented ladies of Espiral Design have submitted a logo for Portsmouth's Market Square Day. Among 40-50 entries, they were chosen for the Final Four. It is now up to Seacoast newspaper readers and internet denizens to select the winner.
Please VOTE HERE!
I don't think you can vote multiple times from the same computer, BUT if you happen to have a couple at work, it wouldn't hurt to do so from different terminals!
There is a cash reward for winning, but the exposure would be the best thing for a young design company.
Also, you should take the time to appreciate that it is NOT just your typical square logo... I said, "Hey, wouldn't a more squarish...."
"NO. You clearly don't understand contemporary design."
So there ya go.
Vote. Tell your friends to vote.
Saturday, April 29, 2006
Thursday, April 20, 2006
In Response to Don
First of all, the Easter service we attended this church was lovely...the pastor apparently started there in '03, so I was like "ooh, look who's been at his profession LESS time than me?! ha! Hey, kiddo...you old enough to preach?" Sorry, I've been waiting to dish that at someone for four years... But he has an earring, so I thought of Don. Also, he preached from the end of Mark, and was happy to point out that the concluding text (after "and they were afraid") was all added a coupla centuries later. So I thought, wow, that's pretty ballsy.... shooting down the inerrancy thing in the first 2 minutes of your Easter sermon! But he did a great job tying the whole piece together so as to not be detrimental to the Ressurection and the faith as a whole. Kinda cool.
Don says, "This wave of anti-smoking legislation has come as the result of those of us who do not feel we should have to breathe others' smoke saying, "If they want to smoke, fine, but I should not be forced to breathe it.""
True. But you don't have to breathe it. There are tons of non-smoking bars that you're welcome to go to, just as there should be smoking bars for smokers. Most of us aren't so inclined to watch naked women dance, SOooooo we don't go to Club Secrets. (inside Columbus joke; I was sad to see that place go, cuz every time we drove past, Rachel or I would say in a cartoon-like falsetto, "NEEWWWdie bar!".... not unlike Randall in Clerks says it.)
I've gotten to the point, now that I'm "old" that I don't care to watch college kids "dancing" at their "clubs." So I go to other clubs. I feel we should let the market decide. If all the hospitality employees STOP working at those smoking facilities, then they'll go under. If no one patronizes them, same deal. -I- for one would like people to stop attending knee-jerk right-wing fundamentalist "churches" like Rev. Phelps' in Kansas, but I wouldn't suggest legislating against people attending the church of their choice (even if they do espouse hate.)
My point is: are smokers really SO bad, in their limited bar-space left to them that you have to force them outside to freeze in 15 degree weather during the winter? Granted, smoking under those conditions is doubly ironic, as A) you have to have your fingers extended to grip the butt (ha! I said grip the butt...) which makes them colder and B) the nicotine causes peripheral vasoconstriction, thereby making them even COLDer. Funny, ironic, but mean, I think.
Yep, Don...the Cerec machine has been in existence for at least 10 years, I believe; they're on the third generation of it now...or maybe the fourth. Bill Thompson at Grandview Dental has one and my mom has a couple of those crowns.
I didn't hear the NPR on amalgam/composite, but I did read a new mailing from the ADA that sites some new J. of the Am. Med Assoc studies that provide MORE evidence that the mercury therein does nothing to harm kids behavior, learning and cognition and their kidney function. So.
Last thought: How many of you would think it's odd if you went to the dentist, and instead of telling you if you had cavities or not, they said, "Well, we'll look at the xrays later and call you if anything shows up."? just curious.
Don says, "This wave of anti-smoking legislation has come as the result of those of us who do not feel we should have to breathe others' smoke saying, "If they want to smoke, fine, but I should not be forced to breathe it.""
True. But you don't have to breathe it. There are tons of non-smoking bars that you're welcome to go to, just as there should be smoking bars for smokers. Most of us aren't so inclined to watch naked women dance, SOooooo we don't go to Club Secrets. (inside Columbus joke; I was sad to see that place go, cuz every time we drove past, Rachel or I would say in a cartoon-like falsetto, "NEEWWWdie bar!".... not unlike Randall in Clerks says it.)
I've gotten to the point, now that I'm "old" that I don't care to watch college kids "dancing" at their "clubs." So I go to other clubs. I feel we should let the market decide. If all the hospitality employees STOP working at those smoking facilities, then they'll go under. If no one patronizes them, same deal. -I- for one would like people to stop attending knee-jerk right-wing fundamentalist "churches" like Rev. Phelps' in Kansas, but I wouldn't suggest legislating against people attending the church of their choice (even if they do espouse hate.)
My point is: are smokers really SO bad, in their limited bar-space left to them that you have to force them outside to freeze in 15 degree weather during the winter? Granted, smoking under those conditions is doubly ironic, as A) you have to have your fingers extended to grip the butt (ha! I said grip the butt...) which makes them colder and B) the nicotine causes peripheral vasoconstriction, thereby making them even COLDer. Funny, ironic, but mean, I think.
Yep, Don...the Cerec machine has been in existence for at least 10 years, I believe; they're on the third generation of it now...or maybe the fourth. Bill Thompson at Grandview Dental has one and my mom has a couple of those crowns.
I didn't hear the NPR on amalgam/composite, but I did read a new mailing from the ADA that sites some new J. of the Am. Med Assoc studies that provide MORE evidence that the mercury therein does nothing to harm kids behavior, learning and cognition and their kidney function. So.
Last thought: How many of you would think it's odd if you went to the dentist, and instead of telling you if you had cavities or not, they said, "Well, we'll look at the xrays later and call you if anything shows up."? just curious.
Friday, April 14, 2006
Public Health vs. Smokers' Rights?
Soooooo..... It has come to this. After some comments on the last post regarding smoking, I will address this peculiar little issue.
Due to what I call the "situationality" of the issue, I really have no problem with smoking in bars and some restaurants.
Yep. There ya go.
Situationality? Sure. There's situations where otherwise incongruous points of view collide. Example: Howard Dean (whose campaign I labored for mightily back in 2003-4) is a big supporter of gun rights. Situationally. That is to say, the possession of firearms by farmers in Vermont and adolescents in NYC is quite different. The church I attended in Ohio had a few "log cabin Republicans." These were otherwise intelligent, educated folks who voted Republican. OK, the latter description includes my dad...did I mention the Log Cabin folks are GAY? Yup. But, for situational issues, they prefer to side with the party that one would otherwise assume they would not.
So. The anti-public smoking camp says that they are merely looking out for the health of all those poor wretches who are forced to wait tables and sling beers in (*gasp! koff!*) smoke-filled environs. Shouldn't we be protecting them from second-hand smoke as we protect dental assistants from excess radiation? Perhaps, but I have yet to meet such a restaurant/bar employee who isn't a smoker themselves. For heaven's sake, -I- had barely even picked up a cigarette 'til I started waiting tables back in the day. Then you discover you get an extra break to participate in a vice. How much sense does that make? I mean, could you be waiting tables, and then say, "Yo, Jim - Cover my section; I'm gonna run out back and masterbate and pick my nose for five minutes." Yet smokers get breaks when they like.
Thus, I don't buy the "save the employees" argument. I also don't buy the "let's protect the public who wants to dine without gross smoke by their food." If I'm dropping $25 for an entree and $12 for a glass of wine, you better believe I don't want smokers around. If I'm paying $5 for a truck-stop breakfast or I'm just drinking beer and grubbing pub fare, I don't care.
And even if I did - Guess what? There are plenty of smokeless alternatives to go to. I DO recognize this is not the case for dart league, although most players are courteous enough that if someone says, Hey, can you not smoke within 10 feet of me, they'll comply.
Now, New Hampshire (whose House passed and Senate rejected a smoking ban in restaurants) is the Live Free or Die state. I'd be more indulgent of a paternalistic "let's make everyone quit" philosophy if they started...oh, I don't know... Making people wear seatbelts! or motorcycle helmets for cryin' out loud.... How likely are you to die being exposed to second-hand smoke? Possibly more likely than otherwise, sure, but when you compare that to how likely you are to die by not wearing helmets/seatbelts..... Until you've seen those charming photos of ER patients who are scraped off the road or out of their cars you really don't appreciate that.
My feeling is that until we can prevent people from consuming sugary drinks and eating fatty meals, trying to legislate less smoking is foolish. Concentrate on preventing it in high school and providing smokers with resources and support to cut back or quit.
Have at it. :)
Due to what I call the "situationality" of the issue, I really have no problem with smoking in bars and some restaurants.
Yep. There ya go.
Situationality? Sure. There's situations where otherwise incongruous points of view collide. Example: Howard Dean (whose campaign I labored for mightily back in 2003-4) is a big supporter of gun rights. Situationally. That is to say, the possession of firearms by farmers in Vermont and adolescents in NYC is quite different. The church I attended in Ohio had a few "log cabin Republicans." These were otherwise intelligent, educated folks who voted Republican. OK, the latter description includes my dad...did I mention the Log Cabin folks are GAY? Yup. But, for situational issues, they prefer to side with the party that one would otherwise assume they would not.
So. The anti-public smoking camp says that they are merely looking out for the health of all those poor wretches who are forced to wait tables and sling beers in (*gasp! koff!*) smoke-filled environs. Shouldn't we be protecting them from second-hand smoke as we protect dental assistants from excess radiation? Perhaps, but I have yet to meet such a restaurant/bar employee who isn't a smoker themselves. For heaven's sake, -I- had barely even picked up a cigarette 'til I started waiting tables back in the day. Then you discover you get an extra break to participate in a vice. How much sense does that make? I mean, could you be waiting tables, and then say, "Yo, Jim - Cover my section; I'm gonna run out back and masterbate and pick my nose for five minutes." Yet smokers get breaks when they like.
Thus, I don't buy the "save the employees" argument. I also don't buy the "let's protect the public who wants to dine without gross smoke by their food." If I'm dropping $25 for an entree and $12 for a glass of wine, you better believe I don't want smokers around. If I'm paying $5 for a truck-stop breakfast or I'm just drinking beer and grubbing pub fare, I don't care.
And even if I did - Guess what? There are plenty of smokeless alternatives to go to. I DO recognize this is not the case for dart league, although most players are courteous enough that if someone says, Hey, can you not smoke within 10 feet of me, they'll comply.
Now, New Hampshire (whose House passed and Senate rejected a smoking ban in restaurants) is the Live Free or Die state. I'd be more indulgent of a paternalistic "let's make everyone quit" philosophy if they started...oh, I don't know... Making people wear seatbelts! or motorcycle helmets for cryin' out loud.... How likely are you to die being exposed to second-hand smoke? Possibly more likely than otherwise, sure, but when you compare that to how likely you are to die by not wearing helmets/seatbelts..... Until you've seen those charming photos of ER patients who are scraped off the road or out of their cars you really don't appreciate that.
My feeling is that until we can prevent people from consuming sugary drinks and eating fatty meals, trying to legislate less smoking is foolish. Concentrate on preventing it in high school and providing smokers with resources and support to cut back or quit.
Have at it. :)
Wednesday, April 05, 2006
That's DOCTOR Caveman to you, Bub!
The latest from Yahoo News:
9,000 Year-old Dental Drill Found
Somewhere, a bunch of hungry Sullivan-Schein reps are placing eager calls to Pakistan, hoping to make a sale. "Oh, that doctor is BOUND to want the NEWest Kavo handpiece!"
My favorite part of the article is where the anthropologist says, "I showed the pictures to my dentist and he thought they were amazing holes."
To my patients: If you ever want to share "amazing holes" with me, I'd just as soon you not.
Anyway, I know that ancient Native Americans (and perhaps Egyptians?) used to hold their heads over incense to "smoke out" the evil spirits or tooth worms which presumably caused toothaches. It turns out that the herbs in question had hallucinogenic properties or narcotic properties, thereby "curing" the toothache, or at least relieving it for a short time. I'm not sure when hashish was discovered, but it's mentioned in Arabian Nights, so who knows how those people may have relieved pain prior to fillings.
Depending on the age of the patients, too, a minutes worth of drilling, up to 2-3mm, might not be SO bad.
I had a 16-year-old yesterday w/ a small amount of decay on a molar. I said, "OK, let me know if you feel anything; this isn't worth getting numb, but if it bugs you, I can do so." Soooo, being all hepped up on Mountain Dew and such, he didn't say anything. "You OK?" "Yeah." When I was done (maybe 2mm, which is 1/2mm into dentin, and therefore probably sensitive), he says, "Oh, Dude, that, like, hurt the entire time. But I didn't say anything."
Tempted to cite one of my mother's favorite sayings, "So do you want a medal or a chest to pin it on?" I replied, "OK. Nice work, bud."
Days without patient swallowing precious gold restoration: 13!
9,000 Year-old Dental Drill Found
Somewhere, a bunch of hungry Sullivan-Schein reps are placing eager calls to Pakistan, hoping to make a sale. "Oh, that doctor is BOUND to want the NEWest Kavo handpiece!"
My favorite part of the article is where the anthropologist says, "I showed the pictures to my dentist and he thought they were amazing holes."
To my patients: If you ever want to share "amazing holes" with me, I'd just as soon you not.
Anyway, I know that ancient Native Americans (and perhaps Egyptians?) used to hold their heads over incense to "smoke out" the evil spirits or tooth worms which presumably caused toothaches. It turns out that the herbs in question had hallucinogenic properties or narcotic properties, thereby "curing" the toothache, or at least relieving it for a short time. I'm not sure when hashish was discovered, but it's mentioned in Arabian Nights, so who knows how those people may have relieved pain prior to fillings.
Depending on the age of the patients, too, a minutes worth of drilling, up to 2-3mm, might not be SO bad.
I had a 16-year-old yesterday w/ a small amount of decay on a molar. I said, "OK, let me know if you feel anything; this isn't worth getting numb, but if it bugs you, I can do so." Soooo, being all hepped up on Mountain Dew and such, he didn't say anything. "You OK?" "Yeah." When I was done (maybe 2mm, which is 1/2mm into dentin, and therefore probably sensitive), he says, "Oh, Dude, that, like, hurt the entire time. But I didn't say anything."
Tempted to cite one of my mother's favorite sayings, "So do you want a medal or a chest to pin it on?" I replied, "OK. Nice work, bud."
Days without patient swallowing precious gold restoration: 13!
Monday, April 03, 2006
Spitting is better than Swallowing
Fun and games.
Went to ER last week due to Rachel having a Pilonidal cyst (check out pilonidal.org for gory details) - nothing like being asked "Does this look infected to you?" OUTside of work. So that's all better, having had it drained. (Gooey!)
(Aside to Rev. Wallick - now a higher risk of Crohn's, acc to the ER phys. asst - interesting)
Monday there was a bat in the house. Always fun to toddle over to the neighbors (hi Matt!) and say, "Um, yeah, have you got a fish net?" at 11pm.
The most FASCINATING thing to happen to me was an experience with a patient who ate a crown. (actually an onlay, but we won't get into that)
This is a fascinating lady who is a hoot at cocktail parties, I'm sure, but, by her own admission a "pain as a patient." (I did NOT say it; she did....) Anyway, upon trying this crown in, I put cement on it, seated it, had her bite and said, "Stay biting for a few minutes." For SOME odd reason, perhaps it was the nitrous, she elected to OPEN a few seconds later. As she moved her tongue around, and I looked on in horror, I saw the crown (onlay! less retention..duh...) dislodge and float around her pharynx area for a few fateful seconds.
Springing into action, I whipped off the nitrous, pulled her head to the side and encouraged her to cough. "Turn! cough! couch couch! Go aaaugghhkk!" (the latter word is MUCH better when I tell the story in person, as people say, "oh, how was that again?" in a facile attempt to make me go aaaugghhkk again)
She did not aaaugghhkk. She went, "glug...gurrr...ack....GULP!"
Down it went, as I futilely attempted to fish it out with a cotton pliers (dental tweezers to you lay people).
"Oh," she remarked, "a piece of something went down my esophagus!"
Oh, not just a piece, but THE something. After making sure she was breathing ok, I walked out of the room so as to avoid the temptation to either grab her by the throat or bash my own head against the wall in frustration. Certainly I could have been more watchful that she didn't open and sure, I could have had a 2x2 gauze there to catch it if it fell. (although, YOU try to leave gauze adjacent to #2 AND have the patient close and then you'll really see gagging!) Nevertheless, I thought, "Oh dear Lord, I SAID to BITE!"
After returning, I encouraged her to eat plenty of fiber, Metamucil, what have you. We'll get her back in 2 weeks after the lab makes a new restoration. "In the meantime," I said, "you will be pooping out gold. We should all be so lucky."
"What if I get it back?" she asked. Er. You mean....retrieve it....er, AFTER? "Sure!" Well...um....
Actually, I DID recement a lost aka swallowed crown back in school....just ran it through the autoclave, tho I learned that when a patient hands you ANYthing you want to probably have a glove on.
Well, on Monday, she called and reported that after dining sumptuously on Mexican food all weekend, she RECOVERED the restoration. All I could think of was Trent Reznor of Nine Inch Nails singing that one line, "I wear my crown of s---/ upon my liar's chair/ full of broken thoughts/ I cannot repair." (of course, the Johnny Cash version is not only a more powerful song, but he manages to clean it up, "I wear my crown of thorns.")
So, after some sterilization, we cemented the bugger right back into place. Only took 2 hours this time. I was careful.
Adios, amigos.
Went to ER last week due to Rachel having a Pilonidal cyst (check out pilonidal.org for gory details) - nothing like being asked "Does this look infected to you?" OUTside of work. So that's all better, having had it drained. (Gooey!)
(Aside to Rev. Wallick - now a higher risk of Crohn's, acc to the ER phys. asst - interesting)
Monday there was a bat in the house. Always fun to toddle over to the neighbors (hi Matt!) and say, "Um, yeah, have you got a fish net?" at 11pm.
The most FASCINATING thing to happen to me was an experience with a patient who ate a crown. (actually an onlay, but we won't get into that)
This is a fascinating lady who is a hoot at cocktail parties, I'm sure, but, by her own admission a "pain as a patient." (I did NOT say it; she did....) Anyway, upon trying this crown in, I put cement on it, seated it, had her bite and said, "Stay biting for a few minutes." For SOME odd reason, perhaps it was the nitrous, she elected to OPEN a few seconds later. As she moved her tongue around, and I looked on in horror, I saw the crown (onlay! less retention..duh...) dislodge and float around her pharynx area for a few fateful seconds.
Springing into action, I whipped off the nitrous, pulled her head to the side and encouraged her to cough. "Turn! cough! couch couch! Go aaaugghhkk!" (the latter word is MUCH better when I tell the story in person, as people say, "oh, how was that again?" in a facile attempt to make me go aaaugghhkk again)
She did not aaaugghhkk. She went, "glug...gurrr...ack....GULP!"
Down it went, as I futilely attempted to fish it out with a cotton pliers (dental tweezers to you lay people).
"Oh," she remarked, "a piece of something went down my esophagus!"
Oh, not just a piece, but THE something. After making sure she was breathing ok, I walked out of the room so as to avoid the temptation to either grab her by the throat or bash my own head against the wall in frustration. Certainly I could have been more watchful that she didn't open and sure, I could have had a 2x2 gauze there to catch it if it fell. (although, YOU try to leave gauze adjacent to #2 AND have the patient close and then you'll really see gagging!) Nevertheless, I thought, "Oh dear Lord, I SAID to BITE!"
After returning, I encouraged her to eat plenty of fiber, Metamucil, what have you. We'll get her back in 2 weeks after the lab makes a new restoration. "In the meantime," I said, "you will be pooping out gold. We should all be so lucky."
"What if I get it back?" she asked. Er. You mean....retrieve it....er, AFTER? "Sure!" Well...um....
Actually, I DID recement a lost aka swallowed crown back in school....just ran it through the autoclave, tho I learned that when a patient hands you ANYthing you want to probably have a glove on.
Well, on Monday, she called and reported that after dining sumptuously on Mexican food all weekend, she RECOVERED the restoration. All I could think of was Trent Reznor of Nine Inch Nails singing that one line, "I wear my crown of s---/ upon my liar's chair/ full of broken thoughts/ I cannot repair." (of course, the Johnny Cash version is not only a more powerful song, but he manages to clean it up, "I wear my crown of thorns.")
So, after some sterilization, we cemented the bugger right back into place. Only took 2 hours this time. I was careful.
Adios, amigos.
Sunday, March 19, 2006
Madness, I tell you....
Ahh, is there any better time than March Madness season? If there is a better confluence of sports, slacking off, beer and excess, it's gotta be getting out of work at noon and sitting in a sports bar watching four basketball games while drinking Guinness on St Patty's day with a plate of corned beef and cabbage on it's way.
Working in a primarily all-female environment, I find some difficulty relating all this excitement. One of the hygienists, a man (who is SO much cooler than Ben Stiller's Nurse Fokker) keeps me sane. But some women are tricky regardless. I'll come into work all excited about the Olympic figure skating short programs and did anyone watch it? Nope. They were watching American Idol and Dancing with the Stars. Hey, new Pride and Prejudice film out.... who's seen it? No one; they all went to see "Stealth" or "The Hills have Eyes." Sigh.
Currently, however, my pool is being won by our friend Cathryn, who based close decisions on "Do I know anyone there?" Thusly, you have her brilliant predictions of Montana defeating Nevada and Washington squeaking past Illinois to the Sweet 16. With 25 correct picks in the first round, she's 4 up on ESPN's Joe Lunardi and 6 ahead of Sports Illustrated. So hah.
Rachel continues to ride Gonzaga deep into the tournament. I say, "Every year they disappoint you! Why do you keep picking them?" "Well, if I DON'T pick them, then that's the year they'll win it all!" Sheesh. Gonzaga: the abusive ex that you keep hooking up with, even after the relationship is irreversibly flawed.
In other quotes from R: "I think it's good that Kirby goes in the shower, cuz then at least it cleans his butt."
No one likes a cat that's too...er, hefty to reach his own posterior for cleaning.... sigh again.....
Working in a primarily all-female environment, I find some difficulty relating all this excitement. One of the hygienists, a man (who is SO much cooler than Ben Stiller's Nurse Fokker) keeps me sane. But some women are tricky regardless. I'll come into work all excited about the Olympic figure skating short programs and did anyone watch it? Nope. They were watching American Idol and Dancing with the Stars. Hey, new Pride and Prejudice film out.... who's seen it? No one; they all went to see "Stealth" or "The Hills have Eyes." Sigh.
Currently, however, my pool is being won by our friend Cathryn, who based close decisions on "Do I know anyone there?" Thusly, you have her brilliant predictions of Montana defeating Nevada and Washington squeaking past Illinois to the Sweet 16. With 25 correct picks in the first round, she's 4 up on ESPN's Joe Lunardi and 6 ahead of Sports Illustrated. So hah.
Rachel continues to ride Gonzaga deep into the tournament. I say, "Every year they disappoint you! Why do you keep picking them?" "Well, if I DON'T pick them, then that's the year they'll win it all!" Sheesh. Gonzaga: the abusive ex that you keep hooking up with, even after the relationship is irreversibly flawed.
In other quotes from R: "I think it's good that Kirby goes in the shower, cuz then at least it cleans his butt."
No one likes a cat that's too...er, hefty to reach his own posterior for cleaning.... sigh again.....
Sunday, March 12, 2006
Wow...she MUST be bored
At the tail end of the conversation on Southern Ohio, a certain first-time poster called "Rachel" wrote, "Wow...I MUST be bored. :) luv you nate..."
Well, I appreciate the love, but.... Seriously, only the painfully bored would POSSibly read what I have to say! YOU are blessed to be exposed to a consistent stream of charmingly whimsical Nate-isms. You should be more symmpathetic to the vast Nate-less populace that has never had the opportunity to bask in Nate-ness all the time, or harsher still, those who have experienced a brief, shining moment of Nate-aity and then had their Nate from their bosom untimely ripp'd.
(The latter is a shameless "rip off" of MacBeth, Act V, scene viii, in case the phrase resoNates with anyone...)
In other news, check out the progress of Ohio State basketball. Go Bucks. Whoot.
Have you ever wanted an Angora rabbit? I haven't. Rachel thinks they're "cute 'n fluffy." blegh!
check outErnie the English Angora. You have to scroll past Oscar the Pug, which is a freakishly odd pet, but only relative to dogs.
Also, theljc blog is charmingly whimsical and I recommend it to everyone.
off to Brunch!
Well, I appreciate the love, but.... Seriously, only the painfully bored would POSSibly read what I have to say! YOU are blessed to be exposed to a consistent stream of charmingly whimsical Nate-isms. You should be more symmpathetic to the vast Nate-less populace that has never had the opportunity to bask in Nate-ness all the time, or harsher still, those who have experienced a brief, shining moment of Nate-aity and then had their Nate from their bosom untimely ripp'd.
(The latter is a shameless "rip off" of MacBeth, Act V, scene viii, in case the phrase resoNates with anyone...)
In other news, check out the progress of Ohio State basketball. Go Bucks. Whoot.
Have you ever wanted an Angora rabbit? I haven't. Rachel thinks they're "cute 'n fluffy." blegh!
check out
Also, the
off to Brunch!
Tuesday, March 07, 2006
Gasp! Mercury!!
So, a couple weeks ago, the award-winning local daily put this article on the front page.
Pretty standard alarmist stuff. I was mad that although they quoted the directors of local dental societies, who ostensibly represent dentists, they didn't bother going to the trouble to find an actual dentist to discuss this issue. Oh, they found Dr. Fischer, "past president of the International Academy of Oral Medicine and Toxicology." His site, which I won't even justify with a hyperlink (google if you like) discusses the imminent danger not only of silver fillings but of fluoridating the water.
Now here's my deal. If someone asks me not to use silver fillings due to concerns about mercury, I'm OK with that. Better safe than sorry, maybe (even tho', as all dentists know, there's no scientific evidence to support the "silver fillings will hurt/kill you theory). Hey, I personally have an unproven superstition that if you hit the "To Cross" button at the crosswalk an even number of times, it will DEactivate the signal. (On...off...on...off) So I always do it 3-5 times.
But when you get to the anti-fluoridationists, I just get mad. I can respect anti-mercury filling people despite their lack of evidence. But the others.... wow, they feel compelled to lobby against the single most cost-effective public health practice on the planet, thereby primarily harming those who can least afford it: Uninsured children, or kids with non-compliant parents.
The other thing seems to be the way the article is structured. They lead off with all these super-scary mercury facts. THEN, at the END of the article, the opponent of mercury fillings states, "We can’t say it will cause harm, but we know there is no benefit."
We can't say it will cause harm, but.... Kinda specious, in my opinion. The SAME poll they use (Zogby) states that of those patients who actually discuss fillings with their dentists, more than HALF feel that they'd be likely or somewhat likely to go ahead and use silver if necessary. Not reported in the article. Thbbt.
Pretty standard alarmist stuff. I was mad that although they quoted the directors of local dental societies, who ostensibly represent dentists, they didn't bother going to the trouble to find an actual dentist to discuss this issue. Oh, they found Dr. Fischer, "past president of the International Academy of Oral Medicine and Toxicology." His site, which I won't even justify with a hyperlink (google if you like) discusses the imminent danger not only of silver fillings but of fluoridating the water.
Now here's my deal. If someone asks me not to use silver fillings due to concerns about mercury, I'm OK with that. Better safe than sorry, maybe (even tho', as all dentists know, there's no scientific evidence to support the "silver fillings will hurt/kill you theory). Hey, I personally have an unproven superstition that if you hit the "To Cross" button at the crosswalk an even number of times, it will DEactivate the signal. (On...off...on...off) So I always do it 3-5 times.
But when you get to the anti-fluoridationists, I just get mad. I can respect anti-mercury filling people despite their lack of evidence. But the others.... wow, they feel compelled to lobby against the single most cost-effective public health practice on the planet, thereby primarily harming those who can least afford it: Uninsured children, or kids with non-compliant parents.
The other thing seems to be the way the article is structured. They lead off with all these super-scary mercury facts. THEN, at the END of the article, the opponent of mercury fillings states, "We can’t say it will cause harm, but we know there is no benefit."
We can't say it will cause harm, but.... Kinda specious, in my opinion. The SAME poll they use (Zogby) states that of those patients who actually discuss fillings with their dentists, more than HALF feel that they'd be likely or somewhat likely to go ahead and use silver if necessary. Not reported in the article. Thbbt.
Saturday, February 25, 2006
Ah, Southern Ohio....
First off: No lurking! If you are reading and enjoying (or even reading and hating) please leave replies! Otherwise I'm forced to assume no one cares and will be forced to sit around wondering why everyone insists dentists have such a high suicide rate. (not actually true; in recent years we've been surpassed by lawyers...)
This post is almost verbatim copied from a recent email exchange with a dental school colleague who now finds herself working in Southern Ohio. (This is, I'm sure, less stressful to her than finding herself, due to vagaries of surnames, sitting next to ME for four years...heh heh...)
Anyway, thanks to Dr. Janice for her inspiration - I wish her the best of luck in joining the small but significant demographic of "NASCAR-watching Orthodontists!"
As you may recall, I spent 3-4 mos working for
[non profit healthcare agency] in [Appalacian Ohio town]; had some good assistants
from [slightly larger town]... I always remember things from that
practice like:
"Bubby don't much take ta sleepin' without his
Mountain Dew, ya see..."
On back of a truck: sticker featuring Osama bin Laden
saying "F--- you A------." That way, when al Qaida's
leader is tooling around Appalachian Ohio, he will see
that, realize he's an a------ and that he can get
f---ed.
On blackboard inside Waverly restaurant/tavern:
"How's a Pike County divorce like a tornado? answer:
Either way, someone's losing a trailer."
Also noted on backs of trucks (it was eerie thinking that my Toyota was the only one for miles around...)
-Keep honking; I'm re-loading.
-(in the style/font of popular milk industry slogan:) gut deer?
- "Terrorism" - just that, w/ an 'anti' ring around it, like the "no smoking" sign or the Ghost Busters logo.
I saw the latter in a parking lot one day and mused, "Ya know, that really makes me stop and think. Cuz ya know, before I got into dentistry, I was totally going to BE a terrorist! But now...I'm just not so sure..."
Needless to say, I was hardly surprised to find John Ashcroft trailing me around for a few days...
Fond memories - I always referred to the area as a place "with more
guns than teeth."
THAT said, I was always impressed that a lot of young
parents with kids were pretty determined to keep their
offspring from losing all the teeth that THEY had; they kept
their appointments, listened carefully to your
instructions and were profoundly grateful for the
services. If Bubby or Sissy weren't brushing enough,
you can belive mom and dad would be letting 'em have
it on the way out the door....
so there you go.
This post is almost verbatim copied from a recent email exchange with a dental school colleague who now finds herself working in Southern Ohio. (This is, I'm sure, less stressful to her than finding herself, due to vagaries of surnames, sitting next to ME for four years...heh heh...)
Anyway, thanks to Dr. Janice for her inspiration - I wish her the best of luck in joining the small but significant demographic of "NASCAR-watching Orthodontists!"
As you may recall, I spent 3-4 mos working for
[non profit healthcare agency] in [Appalacian Ohio town]; had some good assistants
from [slightly larger town]... I always remember things from that
practice like:
"Bubby don't much take ta sleepin' without his
Mountain Dew, ya see..."
On back of a truck: sticker featuring Osama bin Laden
saying "F--- you A------." That way, when al Qaida's
leader is tooling around Appalachian Ohio, he will see
that, realize he's an a------ and that he can get
f---ed.
On blackboard inside Waverly restaurant/tavern:
"How's a Pike County divorce like a tornado? answer:
Either way, someone's losing a trailer."
Also noted on backs of trucks (it was eerie thinking that my Toyota was the only one for miles around...)
-Keep honking; I'm re-loading.
-(in the style/font of popular milk industry slogan:) gut deer?
- "Terrorism" - just that, w/ an 'anti' ring around it, like the "no smoking" sign or the Ghost Busters logo.
I saw the latter in a parking lot one day and mused, "Ya know, that really makes me stop and think. Cuz ya know, before I got into dentistry, I was totally going to BE a terrorist! But now...I'm just not so sure..."
Needless to say, I was hardly surprised to find John Ashcroft trailing me around for a few days...
Fond memories - I always referred to the area as a place "with more
guns than teeth."
THAT said, I was always impressed that a lot of young
parents with kids were pretty determined to keep their
offspring from losing all the teeth that THEY had; they kept
their appointments, listened carefully to your
instructions and were profoundly grateful for the
services. If Bubby or Sissy weren't brushing enough,
you can belive mom and dad would be letting 'em have
it on the way out the door....
so there you go.
Sunday, February 19, 2006
Serious as Cancer
Friday I spent the afternoon "riding shotgun" with a local oral surgeon. Usually it's fun (for me anyway) to watch someone w/ the skills to shuck out four wisdom teeth in the time it takes me to do one. Today was a little different. He was kind enough to see a patient from the non-profit who we were pretty sure had oral cancer.
The slim, middle aged woman is "between homes," as we say, but had recently started a new job and was pleased to be getting health insurance. Unfortunately, even though she'd noticed the sore in her mouth a year ago, and even though there were resources to assist her in seeing someone, she "put it off because I didn't WANT to know for sure...I was scared."
Increasingly, the difficulty swallowing increased, the pain under her tongue and in her jaw became more severe and frequent, and she finally sought help. The ulcerated, bulging lump ventral to her tongue and the nodular involvement appreciable in the submandibular and cervical areas were hardly subtle. Even the greenest dental student would raise an eyebrow with the symptoms and presentation.
While waiting on the oral surgeon, I made small talk with the patient. We both had family in Ohio. Our places of employment are nearby one another. Yep, it sure is windy today.
The oral surgeon confirmed our suspicions without needing biopsy. "T3 or T4," he said, soberly shaking his head out in the hallway. "I'm sending her to Dr. ---- in Boston. She needs a head and neck surgeon - probably radiation, maybe chemo...."
We returned to his exam room to try to gently tell the patient that we would do what we could to facilitate her treatment. "Can I wait 'til my insurance kicks in?" she asked hopefully. "Two months?" my colleague said incredulously. "Ma'am, I don't want you to wait two weeks. We need you down in Boston next week." He wrote out a script for a strong narcotic so she could sleep at night.
Dr. ---- was in surgery, so the oral surgeon dismissed the patient, promising that his office would call her as soon as they reached the Boston doctor. I shook her hand as compassionately as I good, encouraging her to not hesitate if my agency could do anything to facilitate her transportation or other needs. She left smiling unconvincingly, with a hint of tear in her eye.
It's easy to scoff at people for smoking too much or not seeking care. Harder when the person has a face and a family. I wish she'd come in sooner.
The slim, middle aged woman is "between homes," as we say, but had recently started a new job and was pleased to be getting health insurance. Unfortunately, even though she'd noticed the sore in her mouth a year ago, and even though there were resources to assist her in seeing someone, she "put it off because I didn't WANT to know for sure...I was scared."
Increasingly, the difficulty swallowing increased, the pain under her tongue and in her jaw became more severe and frequent, and she finally sought help. The ulcerated, bulging lump ventral to her tongue and the nodular involvement appreciable in the submandibular and cervical areas were hardly subtle. Even the greenest dental student would raise an eyebrow with the symptoms and presentation.
While waiting on the oral surgeon, I made small talk with the patient. We both had family in Ohio. Our places of employment are nearby one another. Yep, it sure is windy today.
The oral surgeon confirmed our suspicions without needing biopsy. "T3 or T4," he said, soberly shaking his head out in the hallway. "I'm sending her to Dr. ---- in Boston. She needs a head and neck surgeon - probably radiation, maybe chemo...."
We returned to his exam room to try to gently tell the patient that we would do what we could to facilitate her treatment. "Can I wait 'til my insurance kicks in?" she asked hopefully. "Two months?" my colleague said incredulously. "Ma'am, I don't want you to wait two weeks. We need you down in Boston next week." He wrote out a script for a strong narcotic so she could sleep at night.
Dr. ---- was in surgery, so the oral surgeon dismissed the patient, promising that his office would call her as soon as they reached the Boston doctor. I shook her hand as compassionately as I good, encouraging her to not hesitate if my agency could do anything to facilitate her transportation or other needs. She left smiling unconvincingly, with a hint of tear in her eye.
It's easy to scoff at people for smoking too much or not seeking care. Harder when the person has a face and a family. I wish she'd come in sooner.
Sunday, February 12, 2006
A Million Little Root Canals....
Much furor has been expended over the "embellishments" of James Frey in his "memoir," "A Million Little Pieces."
For those not tuned in to All Things Oprah, a brief synopsis: Mr. Frey wrote a book detailing a horrific and harrowing experience with drug addiction. It was, fiction or not, moving to many people, including Oprah and her Harpo cronies. They selected it for her Book Club, which is pretty much the writers' equivalency to winning American Idol. Possibly better.
I've heard the author even sold the movie rights to Brad Pitt. (Paging Tyler Durden...)
Eventually, a number of discriminating readers started to question the somewhat incredulous claims made in the book. Several pilots, flight attendants and others in the airline industry said, "Hey...you can't put someone on the plane who is unconscious (and bleeding and covered in bodily fluids) without a doctor...you just can't do that! No one does that..."
People started asking questions. Eventually, Frey admitted the book isn't so much about fact as "impression and feeling."
see his statement from the publisher's website
Now I don't mind a little literary license, but Mr. Frey is doing the dental equivalent of shouting "Fire!" in a crowded theater.
Read this account from a Pennsylvania dentist regarding the absurdity of the story!
While I'd been previously just irritated or amused by this whole brouhaha, I am now of the state of mind of those offended by Denmark's cartoon depictions of The Prophet. He has basically tainted the water for thousands of people who are already paranoid about dentists and now have yet another reason to avoid needed treatment. He has in effect, contributed to others' suffering. Why? Because of an impression.
Look, if you want to say, "Wow, that last exam was brutal - Professor Smith totally f---ed me up the a--!" that's fine, but if you do so in such as way as to imply that you were ACTUALLY sexually abused by your teacher, it's irresponsible.
I have treated dozens, possibly even hundreds of addicts, recovering and otherwise. When I worked with Narcotics Anonymous, I found that they were terrific patients. Right around step 7 or 8, whilst making amends, many of them decided to address long-ignored dental concerns. Transitioning back to the job market, they usually had plenty of time for visits (even a long visit with a student dentist!) and appreciated the reduced fees of being at a teaching institution. They never asked for narcotics, and despite how drug-addled some of their brains might have been, I never encountered an addict so foolish as to think that local anesthetic could get them high or cause a relapse.
I've thought about the concept of triggering our natural fears of dentists in the pursuit of art, and decided that I don't really mind that pursuit in a fictional setting. Marathon Man and Brazil are films where people are tortured by dentists for dramatic effect, while Little Shop of Horrors does so for comedic effect. But no one ACTUALLY believes that this is what will happen at the dentist any more than one fears being eaten by carnivorous plants at the flower shop.
If you need me this weekend, I'll be the one out in Market Square, burning a copy of Frey's book.
For those not tuned in to All Things Oprah, a brief synopsis: Mr. Frey wrote a book detailing a horrific and harrowing experience with drug addiction. It was, fiction or not, moving to many people, including Oprah and her Harpo cronies. They selected it for her Book Club, which is pretty much the writers' equivalency to winning American Idol. Possibly better.
I've heard the author even sold the movie rights to Brad Pitt. (Paging Tyler Durden...)
Eventually, a number of discriminating readers started to question the somewhat incredulous claims made in the book. Several pilots, flight attendants and others in the airline industry said, "Hey...you can't put someone on the plane who is unconscious (and bleeding and covered in bodily fluids) without a doctor...you just can't do that! No one does that..."
People started asking questions. Eventually, Frey admitted the book isn't so much about fact as "impression and feeling."
see his statement from the publisher's website
Now I don't mind a little literary license, but Mr. Frey is doing the dental equivalent of shouting "Fire!" in a crowded theater.
Read this account from a Pennsylvania dentist regarding the absurdity of the story!
While I'd been previously just irritated or amused by this whole brouhaha, I am now of the state of mind of those offended by Denmark's cartoon depictions of The Prophet. He has basically tainted the water for thousands of people who are already paranoid about dentists and now have yet another reason to avoid needed treatment. He has in effect, contributed to others' suffering. Why? Because of an impression.
Look, if you want to say, "Wow, that last exam was brutal - Professor Smith totally f---ed me up the a--!" that's fine, but if you do so in such as way as to imply that you were ACTUALLY sexually abused by your teacher, it's irresponsible.
I have treated dozens, possibly even hundreds of addicts, recovering and otherwise. When I worked with Narcotics Anonymous, I found that they were terrific patients. Right around step 7 or 8, whilst making amends, many of them decided to address long-ignored dental concerns. Transitioning back to the job market, they usually had plenty of time for visits (even a long visit with a student dentist!) and appreciated the reduced fees of being at a teaching institution. They never asked for narcotics, and despite how drug-addled some of their brains might have been, I never encountered an addict so foolish as to think that local anesthetic could get them high or cause a relapse.
I've thought about the concept of triggering our natural fears of dentists in the pursuit of art, and decided that I don't really mind that pursuit in a fictional setting. Marathon Man and Brazil are films where people are tortured by dentists for dramatic effect, while Little Shop of Horrors does so for comedic effect. But no one ACTUALLY believes that this is what will happen at the dentist any more than one fears being eaten by carnivorous plants at the flower shop.
If you need me this weekend, I'll be the one out in Market Square, burning a copy of Frey's book.
Friday, February 10, 2006
Telling it on the Mountain
Hello - as promised, I will (briefly?) discuss my last trip to the cinema to view the critically acclaimed Brokeback Mountain. Although overhyped a bit, it's definitely an excellent film - touching without being overly manipulative. By the end, if you didn't feel the longing and frustration and sorrow experienced by several characters, you probably don't have a heart.
One nice aspect of the film was it's sparse style - the dialogue and pacing often resembled the spare but beautiful scenery. A lot was said by what WASN'T said or even there.
My biggest impression is that you could basically write a book based on audience comments whilst exiting the theater.
From some girls about 10 years younger than me, in regards to a "skinny-diving" scene where the guys jump naked off a cliff into a lake: "Um, hello...I would have been ok but what was the deal with all the flapping genitalia? ohmigod!"
It took a great deal of self-restraint to resist saying, oh, i don't know... "Well, ladies, I don't want you to be TOO surprised on your wedding nights, but let me explain a few things..." or even "Hey, let's try a little experiment. Go take a running jump into a lake (topless) and then we'll talk about who's flapping...." la la la....
and then there was the inevitable: "Ya know, I was pretty much ok w/ the love story but...c'mon, it was two GUYS!"
Um. let's see. That earns a big critical blank stare and head shake from this movie goer. I mean...duh. that's like when I saw some young ladies leaving Saving Pvt. Ryan some years back going, "Oh! I just wanted to see Matt Damon...I didn't realize it would be so VIOLENT!"
All ya had to do was read ANY snippet of any article or see any bit o' TV or hear anyone at all talk about it and the words "most gorily realistic cinematic portral of war EVER" would show up.
Anyway, what I found most interesting was how the two leads were both quite functionally bi-sexual. Most gay men I know are, realistically, as repulsed by the notion of sex with a woman as straight guys are by the possibility of a homosexual encounter. Or at least that what people say - obviously Kinsey & co. feel that everyone is on this continuum....
Anyway, I don't have any more pithy thoughts on the subject, but will welcome comments and discussion!
I'll try to get back to more dentistry next post!
One nice aspect of the film was it's sparse style - the dialogue and pacing often resembled the spare but beautiful scenery. A lot was said by what WASN'T said or even there.
My biggest impression is that you could basically write a book based on audience comments whilst exiting the theater.
From some girls about 10 years younger than me, in regards to a "skinny-diving" scene where the guys jump naked off a cliff into a lake: "Um, hello...I would have been ok but what was the deal with all the flapping genitalia? ohmigod!"
It took a great deal of self-restraint to resist saying, oh, i don't know... "Well, ladies, I don't want you to be TOO surprised on your wedding nights, but let me explain a few things..." or even "Hey, let's try a little experiment. Go take a running jump into a lake (topless) and then we'll talk about who's flapping...." la la la....
and then there was the inevitable: "Ya know, I was pretty much ok w/ the love story but...c'mon, it was two GUYS!"
Um. let's see. That earns a big critical blank stare and head shake from this movie goer. I mean...duh. that's like when I saw some young ladies leaving Saving Pvt. Ryan some years back going, "Oh! I just wanted to see Matt Damon...I didn't realize it would be so VIOLENT!"
All ya had to do was read ANY snippet of any article or see any bit o' TV or hear anyone at all talk about it and the words "most gorily realistic cinematic portral of war EVER" would show up.
Anyway, what I found most interesting was how the two leads were both quite functionally bi-sexual. Most gay men I know are, realistically, as repulsed by the notion of sex with a woman as straight guys are by the possibility of a homosexual encounter. Or at least that what people say - obviously Kinsey & co. feel that everyone is on this continuum....
Anyway, I don't have any more pithy thoughts on the subject, but will welcome comments and discussion!
I'll try to get back to more dentistry next post!
Monday, February 06, 2006
A little bit of chatting...
So at six pm a mom comes in w/ 9 yo daughter; she has a cavity, and we're going out of town.... can you fix it? sure; that was an easy fifteen min. procedure, since we didn't have to anesthetize, and the girl was very cooperative.
Mom had a few questions. Actually, she then had an HOUR worth of questions. Since she was the last patient, and I had no where to be, I was happy to answer - why are silver vs. white fillings sometimes better or worse? What about this crown I had done? why do some dentists try to fill everything and others are "wait and see" and now all my kids have cavities??
So I answered her questions for the better part of the hour ans she was ASTOUNDED that I would take the time. Well, if I had someone else waiting for a filling or something, sure, i couldn't do that. But she was SO happy. She's coming back and bringing her husband and other three kids... I figure I could open up a practice two hours away and she'd happily visit twice a week, now that she's sold on the fact that I will always answer her questions when she (gasp) wants to actually TALK to the dentist.
Kinda always ticks me off when people pay 30-70 bucks for an exam and then just get a 50 second "look-see" and no conversation/explanation from the dentist... Yes, sure, it's busy, and you have to whip through folks to make ends meet and pay the staff, but honestly, most folks only need a couple minutes.... so that was gratifying.
In a completely unrelated story, I saw Brokeback Mountain this weekend. Wow; I could just about write a book on the comments heard whilst exitting the theater. wow. more later perhaps....
Mom had a few questions. Actually, she then had an HOUR worth of questions. Since she was the last patient, and I had no where to be, I was happy to answer - why are silver vs. white fillings sometimes better or worse? What about this crown I had done? why do some dentists try to fill everything and others are "wait and see" and now all my kids have cavities??
So I answered her questions for the better part of the hour ans she was ASTOUNDED that I would take the time. Well, if I had someone else waiting for a filling or something, sure, i couldn't do that. But she was SO happy. She's coming back and bringing her husband and other three kids... I figure I could open up a practice two hours away and she'd happily visit twice a week, now that she's sold on the fact that I will always answer her questions when she (gasp) wants to actually TALK to the dentist.
Kinda always ticks me off when people pay 30-70 bucks for an exam and then just get a 50 second "look-see" and no conversation/explanation from the dentist... Yes, sure, it's busy, and you have to whip through folks to make ends meet and pay the staff, but honestly, most folks only need a couple minutes.... so that was gratifying.
In a completely unrelated story, I saw Brokeback Mountain this weekend. Wow; I could just about write a book on the comments heard whilst exitting the theater. wow. more later perhaps....
Sunday, February 05, 2006
Am I back? perhaps...
Due to popular demand (thank you for nagging Sean, Hank, et al.) I have returned to attempt to be a good blogger again. Geez, it's like working out; you really have to be committed!
So, to update, I have 80% sold out; that's right, I'm now working at a private office in Exeter. Everyone says, Oh, NOW you're making the big money! Well, um. no. not yet. Nevertheless, I remain confident that the "big money" will soon come rolling down the pike, yessir.
I'm still one day a week (and more occaisionally) at the non-profit, so I'm keepin' it real for all da homies, yo.
(to wit: "keepin' it real" means "making dentures" and "da homies" equals toothless or mostly toothless folks w/o insurance.
"Yo" is just added for street cred.)
so i'm going to send this off, eat some breakfast and tell y'all i'm back. more to come, perhaps (ooh!) during the Super Bowl.
So, to update, I have 80% sold out; that's right, I'm now working at a private office in Exeter. Everyone says, Oh, NOW you're making the big money! Well, um. no. not yet. Nevertheless, I remain confident that the "big money" will soon come rolling down the pike, yessir.
I'm still one day a week (and more occaisionally) at the non-profit, so I'm keepin' it real for all da homies, yo.
(to wit: "keepin' it real" means "making dentures" and "da homies" equals toothless or mostly toothless folks w/o insurance.
"Yo" is just added for street cred.)
so i'm going to send this off, eat some breakfast and tell y'all i'm back. more to come, perhaps (ooh!) during the Super Bowl.
Friday, September 23, 2005
Nothing is Happening!
Wow; nondescript week! Oddly, none of the following occurred:
- 90 minute extraction due to extreme decay and divergent roots
- patient consuming truly heroic quantities of narcotics and then have the nerve to ask for more
- uncontrollable screaming child ignoring the fact that we haven't hurt them a bit and bursting into tear for shear effect
- mom blames her cavities on the baby "sucking the calcium out of teeth" presumably in utero
I did have a woman lose her denture swimming (presumably in the ocean) and call in desperately wanting a new one. I fear she's going to ask to get it free, since we only put it in less than a year ago. I always appreciate it when you spill your coffee or drop your burger and the person at the counter says, "Aw...hey, here's another on the house." Tragically, I don't have that luxury.... The overhead is a bit higher. So, I'm going in today to see her. I'm off, but she's pretty upset, so hey. Maybe we can put in a flipper by next week....
I did have a young lady come in w/a lot of decay; we fixed most of it two years ago, but daggumit if she isn't STILL drinking 12 cokes a day... I'm sorry...correct myself; I said, "How many cokes do you drink a day?" "Coke? are you kidding? I don't drink that!" "Oh." "PEPSI is the only way to go." Duh. Anyway, I asked her if she ever did any meth. "What? Drugs?!? Heck no; I've got two kids!"
Ohhhhh. Well, speaking as someone who has lost a patient who OD'd on heroin while pregnant, forgive my not assuming the connection between motherhood and sobriety.
Similarly, I saw a teen girl a few months back. "Hey, Melissa; you didn't check this box on the health history. Are you taking any birth control pills?" "Huh? I'm just 14, silly!" Gosh, I wish is was silly. I wanted to pat her on the head, give her a (sugarfree) lollipop and a hug for being innocent and charmingly naive. At least 'til some 17,18-year-old jerk manages to take advantage of that. Seriously tho', the hormones interact w/ antibiotics (actually vice versa) so we need to know. And of course, a number of young women take them strictly for regulating their period.
One more. Me, jokingly, after extracting a retained baby tooth: "Ok, Jimmy - you a smoker?" "No way! I'm just 13!" Again, how many of my 20 year old smokers started at 12? Yeah.
"House" is back on the air. Both my assistant and I watch religiously and then compare notes, fantasizing about being that openly cynical in front of patients. Mmmmm. He and Dr. Cox on "Scrubs" are just the most lovely alter egos... of my id, at least. Or is that an alter id? Does such a thing exist? Paging Dr. Freud....
- 90 minute extraction due to extreme decay and divergent roots
- patient consuming truly heroic quantities of narcotics and then have the nerve to ask for more
- uncontrollable screaming child ignoring the fact that we haven't hurt them a bit and bursting into tear for shear effect
- mom blames her cavities on the baby "sucking the calcium out of teeth" presumably in utero
I did have a woman lose her denture swimming (presumably in the ocean) and call in desperately wanting a new one. I fear she's going to ask to get it free, since we only put it in less than a year ago. I always appreciate it when you spill your coffee or drop your burger and the person at the counter says, "Aw...hey, here's another on the house." Tragically, I don't have that luxury.... The overhead is a bit higher. So, I'm going in today to see her. I'm off, but she's pretty upset, so hey. Maybe we can put in a flipper by next week....
I did have a young lady come in w/a lot of decay; we fixed most of it two years ago, but daggumit if she isn't STILL drinking 12 cokes a day... I'm sorry...correct myself; I said, "How many cokes do you drink a day?" "Coke? are you kidding? I don't drink that!" "Oh." "PEPSI is the only way to go." Duh. Anyway, I asked her if she ever did any meth. "What? Drugs?!? Heck no; I've got two kids!"
Ohhhhh. Well, speaking as someone who has lost a patient who OD'd on heroin while pregnant, forgive my not assuming the connection between motherhood and sobriety.
Similarly, I saw a teen girl a few months back. "Hey, Melissa; you didn't check this box on the health history. Are you taking any birth control pills?" "Huh? I'm just 14, silly!" Gosh, I wish is was silly. I wanted to pat her on the head, give her a (sugarfree) lollipop and a hug for being innocent and charmingly naive. At least 'til some 17,18-year-old jerk manages to take advantage of that. Seriously tho', the hormones interact w/ antibiotics (actually vice versa) so we need to know. And of course, a number of young women take them strictly for regulating their period.
One more. Me, jokingly, after extracting a retained baby tooth: "Ok, Jimmy - you a smoker?" "No way! I'm just 13!" Again, how many of my 20 year old smokers started at 12? Yeah.
"House" is back on the air. Both my assistant and I watch religiously and then compare notes, fantasizing about being that openly cynical in front of patients. Mmmmm. He and Dr. Cox on "Scrubs" are just the most lovely alter egos... of my id, at least. Or is that an alter id? Does such a thing exist? Paging Dr. Freud....
Tuesday, September 13, 2005
The only thing more fun than a dentist....
...is a GROUP of dentists!
What do we call a group of dentists? I mean, you've got a congregation of pigeons, a parliment of rooks, a murder of crows... So...maybe an extraction of dentists? An amalgam of dentists.... I actually like a gaggle of dentists. I mean, some people gag, and so.... hm.
I'll accept nominations!
In the meantime, I'll report on some activities of my local SOCIETY of dentists (Southeast New Hampshire!).
I'm happy to report that everything worked out fine with my event planning... The plate distribution of salmon vs. chicken proceded evenly, with no one sorely disappointed about missing out on their entree preference. Phew!
We also had a nice presentation by a hygienist from Tom's of Maine on their Community Involvement Program.
I'm a big fan, in that they are socially conscious organiation that makes natural-based products that are effective. There's a lot of "all natural" stuff out there that isn't worth the package it comes in. Tom's products, however, routinely earn the ADA's Seal of Approval.
(i just want you all to know I spent 20 min or more trying to import a .gif of the ADA Seal of approval onto this page. but i can't. Go pick up your toothpaste and look at that one. Thbbt.)
Anyway, along with giving hundreds of thousands of dollars back to the community, Tom's sponsors a program where they give dentists coupons to give their patients to buy Tom's products. The customer saves fifty cents and another fifty cents is taken out of the profit and given to various non-profit dental causes, assisting in access for those who can't afford it. Neat-O.
Secondly, we learned of many dentists in the Gulf Coast area who have lost their practices, or at least their patients, who have been dispersed across the region. 400 dental students in the area are going to have to be assimilated into programs elsewhere in the country. This strikes me as being a lot tougher than fitting a couple extra kids into each 4th grade class, since each student needs space to treat patients, etc etc. So, the ADA is contributing $10,000 off the bat, the NHDS is giving $5000, and a few component societies in New Hampshire alone have pledged up to $5000. As the local treasurer, we should be able to kick in a few thousand to the cause.
I can only imagine the total lack of options for people displaced by the storm - They have water but are struggling to just get blood pressure and diabetes meds; good luck if you have a toothache! So hopefully this will help.
In the meantime, I encourage everyone to buy Tom's products. Oh, and in case you care, I DO recommend Trident gum for my patients who chew gum. :)
What do we call a group of dentists? I mean, you've got a congregation of pigeons, a parliment of rooks, a murder of crows... So...maybe an extraction of dentists? An amalgam of dentists.... I actually like a gaggle of dentists. I mean, some people gag, and so.... hm.
I'll accept nominations!
In the meantime, I'll report on some activities of my local SOCIETY of dentists (Southeast New Hampshire!).
I'm happy to report that everything worked out fine with my event planning... The plate distribution of salmon vs. chicken proceded evenly, with no one sorely disappointed about missing out on their entree preference. Phew!
We also had a nice presentation by a hygienist from Tom's of Maine on their Community Involvement Program.
I'm a big fan, in that they are socially conscious organiation that makes natural-based products that are effective. There's a lot of "all natural" stuff out there that isn't worth the package it comes in. Tom's products, however, routinely earn the ADA's Seal of Approval.
(i just want you all to know I spent 20 min or more trying to import a .gif of the ADA Seal of approval onto this page. but i can't. Go pick up your toothpaste and look at that one. Thbbt.)
Anyway, along with giving hundreds of thousands of dollars back to the community, Tom's sponsors a program where they give dentists coupons to give their patients to buy Tom's products. The customer saves fifty cents and another fifty cents is taken out of the profit and given to various non-profit dental causes, assisting in access for those who can't afford it. Neat-O.
Secondly, we learned of many dentists in the Gulf Coast area who have lost their practices, or at least their patients, who have been dispersed across the region. 400 dental students in the area are going to have to be assimilated into programs elsewhere in the country. This strikes me as being a lot tougher than fitting a couple extra kids into each 4th grade class, since each student needs space to treat patients, etc etc. So, the ADA is contributing $10,000 off the bat, the NHDS is giving $5000, and a few component societies in New Hampshire alone have pledged up to $5000. As the local treasurer, we should be able to kick in a few thousand to the cause.
I can only imagine the total lack of options for people displaced by the storm - They have water but are struggling to just get blood pressure and diabetes meds; good luck if you have a toothache! So hopefully this will help.
In the meantime, I encourage everyone to buy Tom's products. Oh, and in case you care, I DO recommend Trident gum for my patients who chew gum. :)
Thursday, September 08, 2005
Kids are...Fun.
So, today I got to yell at a 7 year old. I am a mean, evil dentist. I am like Dr. Mengele, DDS. oh yes.
Nice little girl; we'd done 2 fillings and three crowns on her; just a couple weeks ago, she was reasonably tolerant when we did back-to-back pulpotomy/crowns on teeth A and B. So no worries.
Anyway, we brought her back cuz one of her earlier fillings (mine, I fear) had gone south....it's hard to do a two-surface filling on a first baby molar, cuz the durn thing is like 80% pulp anyway, so good luck not hitting it.... So I did. Shoulda done the pulpotomy on it the first time, but noooo....
So we bring her back, and I'm trying to subtly distract her whilst sneaking up w/ the injection, but she's too smart for that, having been there before. So, she starts whining and crying, "I want my mommy" etc etc ad nauseum. So I use my happy Dr/Mr Rogers voice and explain very very gently how we don't WANT to hurt her, but you see, if we don't get those nasty ol' tooth bugs OUT of the tooth, (which I might add, IS currently sporting a deligtfully pus-filled parulis!) why, you might get sick and have to go to the hospital! Your face would swell up and look REALLY silly and it would really hurt! You don't WANT to go to the hospital, I don't want you to go to the hospital, and you see, that's why Mommy brought you here, cuz SHE doesn't want you to go to the hospital.
"I don't want to be here!!!! waaahh!"
Why? "It's going to hurt!!!"
What's that in your ear, sweetie? "huh?" The hole...in your earlobe. Are your ears pierced? "Uh-huh." Did that hurt? "Just a little..." Well, there you go..... no, just open... "I want my mommy!!!"
At that point she jerks her head dangerously close to appoaching syringe, therein threatening myself, my assistant AND herself w/ acutal serious injury. At that point, you can send her home, or get tough. It's no different that Super Nanny or Dr. Phil. Stop, lower voice, speak a little louder and quite sternly. "Jenny. It is VERY important that you sit still, or someone could get really hurt. Now, I know that you don't act this way at home. I know you are a big girl, but right now, you are acting like a four-year-old. We have four-year-olds that don't even behave like this! This is OUR office and you need to follow our rules."
A much subdued "Jenny" then opens and barely notices the injection. Was that so bad? [sheepishly] "no...." after that, easy procedure. 10 minutes.
So. Nothing new there, I get one or two of those every week. However, THIS time, I'm later pulled aside by a nurse I work with who really felt that I was too loud, too mean, and inconsiderate to the terrified little girl. Why didn't I let Mom back with her? Sometimes that helps them calm down. I should recognize that a lot of people have different anxiety and pain thresholds etc etc. She said that she TELLS her patients when she's injecting so they know what to expect. Also, as a mom, she felt bad for the little girl.
I seriously have the deepest respect for this woman, and I admit that I don't know everything. I further concede that "you're acting like a four year old" may be a little inappropriate. However....
1. Mom is in the waiting room with two other girls, 5 and 2. She can't hold "Jenny's" hand and watch the other girls. Further, I don't want them seeing the sister upset. The odds are, if no one hears horror stories from older siblings, they're just fine no matter what I do.
2. Having Mom in the room, more often than not, induces the child to act out. They "perform," knowing full well if they yell enough, Mom will scoop them up and carry them away. Lovely, but it doesn't help anyone in the long run. Additionally, having a parent there sends the child a message: "I don't trust this doctor, so if they hurt you, I'll take you away." The kid is then more apprehensive. Mom doesnt' stand at the door the whole day at school. Why? Because she trusts Ms. Applebottom, and Jenny can trust her too. She should trust us as well.
3. Nurses have the luxury of being able to inject people and turn them loose. All done! see ya! -I- have to keep them "on my side" for 30 min or more. If it were just about a quick stick, hey, no worries.
4. She didn't hear the entire exchange. Obviously, I didn't start OUT yelling at the little girl! You start out with lovey-dovey, of course....
5. Lastly, I KNOW this patient. This girl LIKES me and had never given us problems. Sometimes you need to step up and be a little intimidating to let them know "Hey, this is my house. You are not going to play that game." Now, if it's a four year old or a brand new patient, sure, you have to play it by ear.
Regardless, I still feel TERRIBLE for raising my voice and scaring a little girl who may just have been having a bad day. And, admittedly, I'm 6'2 and for all I know Jenny doesn't have a father figure, or even she's had one who is nothing but abusive. I don't know. So I feel bad. My assistant said I handled it "perfectly as usual" so that was gratifying..... Can't help feeling bad...Especially because I really like and respect the Nurse.... She knows her stuff, so I'm torn about to what degree I should have used a different approach....
Thoughts?
Nice little girl; we'd done 2 fillings and three crowns on her; just a couple weeks ago, she was reasonably tolerant when we did back-to-back pulpotomy/crowns on teeth A and B. So no worries.
Anyway, we brought her back cuz one of her earlier fillings (mine, I fear) had gone south....it's hard to do a two-surface filling on a first baby molar, cuz the durn thing is like 80% pulp anyway, so good luck not hitting it.... So I did. Shoulda done the pulpotomy on it the first time, but noooo....
So we bring her back, and I'm trying to subtly distract her whilst sneaking up w/ the injection, but she's too smart for that, having been there before. So, she starts whining and crying, "I want my mommy" etc etc ad nauseum. So I use my happy Dr/Mr Rogers voice and explain very very gently how we don't WANT to hurt her, but you see, if we don't get those nasty ol' tooth bugs OUT of the tooth, (which I might add, IS currently sporting a deligtfully pus-filled parulis!) why, you might get sick and have to go to the hospital! Your face would swell up and look REALLY silly and it would really hurt! You don't WANT to go to the hospital, I don't want you to go to the hospital, and you see, that's why Mommy brought you here, cuz SHE doesn't want you to go to the hospital.
"I don't want to be here!!!! waaahh!"
Why? "It's going to hurt!!!"
What's that in your ear, sweetie? "huh?" The hole...in your earlobe. Are your ears pierced? "Uh-huh." Did that hurt? "Just a little..." Well, there you go..... no, just open... "I want my mommy!!!"
At that point she jerks her head dangerously close to appoaching syringe, therein threatening myself, my assistant AND herself w/ acutal serious injury. At that point, you can send her home, or get tough. It's no different that Super Nanny or Dr. Phil. Stop, lower voice, speak a little louder and quite sternly. "Jenny. It is VERY important that you sit still, or someone could get really hurt. Now, I know that you don't act this way at home. I know you are a big girl, but right now, you are acting like a four-year-old. We have four-year-olds that don't even behave like this! This is OUR office and you need to follow our rules."
A much subdued "Jenny" then opens and barely notices the injection. Was that so bad? [sheepishly] "no...." after that, easy procedure. 10 minutes.
So. Nothing new there, I get one or two of those every week. However, THIS time, I'm later pulled aside by a nurse I work with who really felt that I was too loud, too mean, and inconsiderate to the terrified little girl. Why didn't I let Mom back with her? Sometimes that helps them calm down. I should recognize that a lot of people have different anxiety and pain thresholds etc etc. She said that she TELLS her patients when she's injecting so they know what to expect. Also, as a mom, she felt bad for the little girl.
I seriously have the deepest respect for this woman, and I admit that I don't know everything. I further concede that "you're acting like a four year old" may be a little inappropriate. However....
1. Mom is in the waiting room with two other girls, 5 and 2. She can't hold "Jenny's" hand and watch the other girls. Further, I don't want them seeing the sister upset. The odds are, if no one hears horror stories from older siblings, they're just fine no matter what I do.
2. Having Mom in the room, more often than not, induces the child to act out. They "perform," knowing full well if they yell enough, Mom will scoop them up and carry them away. Lovely, but it doesn't help anyone in the long run. Additionally, having a parent there sends the child a message: "I don't trust this doctor, so if they hurt you, I'll take you away." The kid is then more apprehensive. Mom doesnt' stand at the door the whole day at school. Why? Because she trusts Ms. Applebottom, and Jenny can trust her too. She should trust us as well.
3. Nurses have the luxury of being able to inject people and turn them loose. All done! see ya! -I- have to keep them "on my side" for 30 min or more. If it were just about a quick stick, hey, no worries.
4. She didn't hear the entire exchange. Obviously, I didn't start OUT yelling at the little girl! You start out with lovey-dovey, of course....
5. Lastly, I KNOW this patient. This girl LIKES me and had never given us problems. Sometimes you need to step up and be a little intimidating to let them know "Hey, this is my house. You are not going to play that game." Now, if it's a four year old or a brand new patient, sure, you have to play it by ear.
Regardless, I still feel TERRIBLE for raising my voice and scaring a little girl who may just have been having a bad day. And, admittedly, I'm 6'2 and for all I know Jenny doesn't have a father figure, or even she's had one who is nothing but abusive. I don't know. So I feel bad. My assistant said I handled it "perfectly as usual" so that was gratifying..... Can't help feeling bad...Especially because I really like and respect the Nurse.... She knows her stuff, so I'm torn about to what degree I should have used a different approach....
Thoughts?
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.....
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 p....er, 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!
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 p....er, 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.
-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.
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