We got back from the Pacific side of Costa Rica yesterday. Because Signature Vacations bumped us from hotel to hotel a couple of times before we got there, we ended up staying at one (Allegro Papagayo) that wasn’t our first choice, but we didn’t let that stop us from having a good time.

Costa Rica doesn’t have the kind of beaches that you’ll find in places like Punta Cana. People really don’t go there for the beach. The sand tends to be black because of all of the volcanic activity within the country.

We did a couple of day trips to Guachipelin and Arenal that included horseback riding, zip lining, rock climbing, mud baths, and hot springs.

This is why people go to Costa Rica:

Our guide said this was a monkey cum. I looked at the Girl and she looked at me.

“What did he say that was?”
“He said it was monkey cum.”
“Huh.”

Then the woman behind me said to her husband, “What did he say that was?”
“I dunno, I think he said it was monkey cum.”

Silence.

Turns out he was saying monkey comb. It’s a fruit that has this nickname.

The second day into our trip saw the girl already trying to destroy the ecosystem there by stepping on one of these puffer fish. Luckily for the fish, he gave her a good sting so that she didn’t completely flatten him. That’s a picture of one after he’s puffed up and floating on the surface. Once you realize how important ecologic conservation is in this country, you think twice before even swatting a mosquito. Costa Rica’s motto is Pura Vida, or Pure Life.

Here’s an email thread that might interest some of you. I received this:

—– Message from XXX ———
Date: Sun, 17 Dec 2006 19:14:51 -0500
From: XXX
Reply-To: XXX
Subject: MTA
To: XXX

> [Me], it’s [Referring DDS] writing to you. How are you?
> I have a question for you. How effective is MTA? I was thinking of
> getting it for immediate repairs of a perfs or closing open apex.
> Apparently through a collegue of mine who went to a [Big Name Endodontist]
> lecture, it was highly recommended that GPs should have it in their
> endo set up.
> Who do I contact to obtain it? Is there a special instrument or
> carrier to purchase for the delivery of MTA into a canal?
—– End message from XXX —–

Good question. Here’s my reply:

Hi [Referring DDS], I’m doing well thanks. Hope you are as well.

MTA is the most effective material we currently have at sealing root ends and perforations. It works well in wet or bloody conditions. However, it is very difficult to handle because its consistency is that of portland cement.

You can order it and some of the instruments used with it from Tulsa Dental.

MTA will not work miracles on hopeless cases. In general, once a case becomes complicated enough to require the use of something like MTA, a referral to a specialist should be considered. Exceptions to this rule include cases such as direct pulp capping with MTA, or immediate perforation repairs in furcations.

One step apexification with MTA is difficult to achieve well, I don’t recommended it if infection is present in or around the root, and works best with a microscope (as do all of the above procedures).

Unfortunately for many dentists that attend lectures given by specialists, they will come away with lots of ideas that are really not practical for their offices. The goal of many of these lecturers is to have you spend time and money on supplies and equipment, get frustrated with not being able to achieve the results that are shown in the presentation (results which, of course, are the best ones that the presenter achieved), get even more upset that they spent all this money and time trying to learn the stuff…and give up and refer to the specialist anyway. The only difference is that now you think the specialist that gave the lecture is even more awesome because he or she is able to do this stuff that you had difficulty doing. Maybe you’ll send your patients to them instead of your usual specialist.

The difference is that we’ve had years of formal training, and years of practical experience where we’ve learned (through the school of hard knocks) how to deal with those same problems. It’s all that we do as specialists.

Your strength is the diversity of your practice and knowledge. Don’t fall into the trap of over-diversifying. Do what you do best, refer the other stuff.

We attended a benefit for Free the Children last night and got to experience an awesome concert put on by Neeraj Prem.

There’s lots of bullshit in our world. Some of it is dangerous, most of it is ignorant. One of the reasons that I went into dentistry is because it’s a profession that helps people get out of, or prevent, pain. It’s just teeth that we work on–not your heart or your brain. You can try to save them, or decide to lose them. In the end it really doesn’t matter to me. If you decide you want to try to save them, I will do for you what I would do for my mother, my father, my brother, my girl.

Yet we have these people spreading fear and controversy just so they can make a buck. Their dentistry is probably crap, so they have to resort to this: Biological Dentistry, Biologic Root Canal.

I’ve blogged about this before here.

I caved in and bought a cheap remote shutter release from Ebay the other day for the Nikon (the remote is made in China). Using the remote, I can lock exposure settings prior to framing the shot and also minimize camera shake by not having to push the button on the camera itself.

Any shaking of the scope gets magnified a gizillion times. This is my first test shot. It’s an upper 6 showing DB and the two MBs.