Patients ask me that sometimes as they sit in the chair. Depending on my mood I’ll joke with them and ask them how long they’ve got.

Remember that convict that I saw for consultation a while back? His first of two treatment (retreatment) appointments was today.

Him: So how long am I gonna be here today?

Me chuckling: How much time do you…have?

I realized the context of that statement after I said it. He looked at me sadly.

Him with a shrug: My whole life.

Me: Oh. Well you’ll be done here before that.

The Guards: *chuckle*

I didn’t ask any more silly questions for the rest of the appointment.

Although I’m perfect, not everything that I do is. And if you believe that, well…well you’re welcome as a guest in my house anytime!

Here is a case that is about 12 months old. The right central incisor had a history of trauma and at the consultation appointment there were clinical signs of infection (chronic apical abscess).

By the time I saw the child for treatment, the apical lesion had enlarged. The plan for treatment was endodontic therapy, of course, but I was unsure if apexification would be necessary. I assumed it would be, but decided to play things by eye.

Once I got into the tooth I found pus in the coronal third of the canal but as I worked my way further up the canal, hyperemia developed. The apically vital pulp was likely the reason that I found an apical stop.

The apical vitality and stop allowed me to complete the case, rather than medicate it therapeutically against infection or for apexification purposes. I was a little overzealous with my obturation (warm lateral condensation for this case) and squished out a heavy amount of sealer.

To show you that presence of infection is really the only factor that affects apical healing, I took the third film as a recall this year. The left central incisor has completed apical maturation. The sealer outside the right central is still there but the periapical radiolucent area has practically disappeared. Clinical examination found no signs of infection and our patient reports no issues with the tooth.

This is a healed case.

The goal of my therapy is not to squish sealer out the apex, but to create a favorable environment for osseous healing. I did both of those things here. Extra-radicular material will increase post operative inflammation and will cause a foreign body reaction which can result in a fibrous connective tissue scar. The scar can look like a persistent lesion over time and complicate future diagnosis.

Histology of the periapex (yes, that’s my name) of this tooth would probably show fibrous encapsulation of the sealer, but in this case the capsule is thin enough that it does not show radiographically.

Hey, I’m not perfect and not everything I do works out the way it is supposed to. Fortunately for our patient this case did. Seeing how a substantial Ellis II fracture line is now obvious on the left central, I might see this guy again at some point in the future for work on that tooth.

And lest I forget, one more thing: When you get your cases back from an endodontist and they say that the tooth has been temporized with a cotton pellet and Cavit, please remove the cotton pellet from under the Cavit before you place your permanent filling.

I haven’t been able to do as much blogging as I would have liked these last few weeks because of the Pro Am that we were working towards, The Girl’s job transition, and our on-going landscaping project. Probably more importantly, however, some other internet interests have also captured my time.

Here’s a song that sums things up. I’ve reworked the lyrics to an Olivia Newton John song. The very first CD that I ever owned was one by her. Click the play button to listen to the song as you sing the lyrics below:

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Maybe I hang around here
A little more than I should
The Girl says I’ve got somewhere else to go
But I got something to tell you
That I never thought I would
But I believe you really ought to know

I love you
I honestly love you

You don’t have to Comment
I see it in your Tweets
Maybe it was better left unsaid
This is pure and simple
And you should realize
That it’s coming from my heart and not my Wall

I love you
I need to Twitter you

I’m not trying to make you feel uncomfortable
I’m not trying to Chain Drop at all
But something like Entrecard doesn’t come along everyday
And you shouldn’t blow the chance
When you’ve got the chance to say

I love you
I have to email you

If we both were born
In another place and time
This moment might be ending on a BBS
But there you are with yours
And here I am with mine
So I guess we’ll just be leaving it at this

I love you
I really must blog you
I have to facebook you

I think that anything and everything that we do in life can be seen as a waste of time depending on the perspective. Isn’t art, however, all about perspective? And isn’t life all about the art of living and interacting with others?

Twitter doesn’t have to be about broadcasting your daily activities to the universe pointlessly. It doesn’t have to be about meeting strangers in a corner of the internet for mindless chatter. Instead it can be used for a greater good.

I am actively using Twitter to try to form an online community of people in the dental field who will be able to interact in real-time. Possibilities formed by this sort of interaction are endless, geeky, and a subject of future posts.

Here‘s one Twitter experience that will give you a hint of the usefulness of real-time online social media and the relevance it might have to our daily practise of dentistry. The players are I and some buddies that I made on Twitter. These buddies are dentists and a non-dentist — a patient. The director of the production is Twitter itself. The Washington Post blogged about our shenanigans here.

Microblogging on Twitter will never replace continuing education courses or blogs themselves as a vehicle for detailed dental information. The art of Twitter, though, is perspective.

Twitter will give patients a view into a dentist’s day and it will give dentists a view into one another’s practice. Questions will be asked, opinions will be given, and through all of this new perspectives of dentistry will be developed by patients and people within the dental field together.

Join me on Twitter if you’re interested. Check out my follow list for other dental professionals and add them too. Let’s get talking:

We’re gearing up for the Pro Am competition this weekend and Calculus is retiring from full-time dental hygiene today. There’s been lots of stuff happening and not enough time to do it all within. That will change soon.

Calculus did manage to find some time to drag me out to Menopause Out Loud in Toronto on the weekend. It’s a musical comedy about women and the issues they experience with menopause. It was surprisingly funny and entertaining — even if I was one of maybe 5 men in the entire theatre.

The gender distribution was so skewed that when we approached the ticket-checker at the door, she said, “and how are you ladies doing?”.

I looked at her blankly. She looked back and blinked.

She said, “I mean lady and man.”

I smiled. She continued, “Don’t worry. There are other men in there too.”

As we walked by her I think I heard her chuckle.

Of course, our seats ended up being in the front row.