Don’t you wish that there are more objective reviews and comparisons of dental practice management software on the web? I’ve wished the same thing for years. Choosing a package with which to run your office is a huge commitment in cost and staff education. How that package scales with you, is supported by the manufacturer, and streamlines your office is something that you can really only figure out after you use one for a prolonged period of time. Reviewing and comparing these software packages in that depth is something that just isn’t really practical.

Every producer of these packages has testimonials and positive reviews on their website. They all say they do the really important stuff that we dentists need them to do. So, how can you really choose which one might work best for your office?

The answer is that each and every one of them will work for you. The pluses and minuses that each has washes out in the end if the software is continuously updated by the manufacturer. And most of the popular packages are updated regularly.

In the end, as so many things in life are, word of mouth carries the greatest impact in choosing a package. Packages that people have used or seen in other offices, that staff learned in school, and that people hear others speaking of positively will tend to generate more sales. Social media is a great way, if not the best way, to market your product with that word of mouth thought behind it.

Unfortunately word of mouth advertising can kick you in the ass and if you decide to open up the web as your mouthpiece, expect that you might have some bad stuff indelibly placed on the web for all to see forever…

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I don’t need too many words for this one. Our patient’s dentist had started the root canal work, found 3 canals, got blocked apically, and then referred.

My post-op film:

Too many canals spread wide to get them all in one shot. In the mirror, lingual is to the right, mesial is to the top of the picture:

In the mirror, from top left to bottom right we have MB, M, ML canals:

In the mirror, you can see DB and D canals:

In the mirror there are D and DL canals:

So let’s say that I’m sitting here in front of my computer and contemplating life and death and how well life has treated me over the years. Maybe it was God’s will or maybe it was just having a positive, thankful attitude as I “grew” up. Whatever it was, let’s just say that I’m sitting here feeling that life has given me many lessons over the years but in the end has brought me more happiness than sadness.

And let’s say that as i dwell on these feelings I develop an urge to give something back — something unique, helpful, and selfless.

I’m a dentist.

I was forced through crazy challenges in school to get to where I am. I’ve been through another school — the school of hard knocks — through my career, and I’ve survived. In fact I’ve become an awesome dentist because of Hard Knocks.

I need to give back, but I don’t want to give my hard earned money away anonymously to local charities that I don’t know anything about. I’m pretty content with the couple of bucks I give to my church every week or ten. My skills are too valuable to not utilize as much as I possibly can fixing people’s teeth, so I don’t have time to volunteer at the food bank.

I feel the need to give back though. Where can I apply my unique skills and knowledge to help people? Where can I do this and show them how skillful and knowledgeable I am, where these people would love me and line up to see me, where I would be “The Man” to them. El Hombre….spanish…latin….

Guatamala, Honduras, Mexico. Hmm.

Wow. I see it now! I can collect equipment and supplies from donors from whom I buy lots of stuff at my practice. I might be able to enlist some dental students to come and help out. I don’t care if I have to pay to travel and stay down south because it’s money well spent to help people. The homeless here in my town don’t need my money like these people do.

When I get down there I’ll show them how much better dentistry in Canada is than in their impoverished community. I’ll put in white fillings, save their teeth rather than pull them, use anesthetic, and wear a mask and gloves. I’ll *help* them. The line to see me will be days long. Unfortunately, as much as I’d love to help these people forever, I have to come back home to make some money. Maybe I’ll stay for a week or two.

I do wonder, though, what might happen after I leave. Might these people not want to see their tooth-pulling, painful dentist anymore? Will they wait and wait and wait for my return while losing tooth after tooth unnaturally? Will that be because they’ve lost confidence in the entire medical or dental system in their country? Would I have caused that?

There would be no lines to see their dentist and so no encouragement of the local profession to improve. I would have decreased national morale among both dentists and their patients and I might not be welcomed back again. I might single-handedly cripple an already precariously perched medical/dental system — all because I wanted to feel good about myself.

So…maybe what I’ll do instead of all of that is take my supplies and equipment and dental students and go to the local health department down there. I’ll tell them that we’re only there for a couple of weeks and we want to help. Have no doubt that we will help. We will suction, mix, clean, and offer advice to the local dentists. We will show them how to use the materials we are supplying. We will show them how we do things by allowing them to do the things themselves while we watch. This is positive, this creates growth, this is beyond ego, and is the greatest thing that we as a human can do.

But how many of us who volunteer do this? How many of us would even want to be seen as subservient to the local professional in that small community you want to help? How many of us need to grow up a bit?

There are certain referring dentists with whom I work well and there are others who have tried me out in the past, but for various reasons send elsewhere now. No hard feelings, no worries.

Just as you can’t please every patient, you can’t be everything to every dentist either. The patient comes first, and if they get more streamlined, effective care via a different generalist-specialist combination, I’m fine with that.

You two or three constant readers of my blog know that I have no problem with patients or dentists looking elsewhere for treatment if they don’t want to abide by my office policies. My treatment philosophies and office policies are what they are for very good reasons and were developed through my years of practice from both scientific evidence and experience.

And yet there are still dentists that try to bully me every now and then. I still have a few things to learn about dealing with them. I react impulsively and aggressively.

Thanks to my co-workers I’ve been able to keep myself under control with this latest episode. They really are the best and I am unfathomably lucky to have them watching over me.

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Most times when a rotary file breaks in a canal, the fragment is either irretrievable or the risk to remove it is greater than the benefits. This is purely because they mostly break apically, around curves, and the fragment is often no more than 3-4mm in length.

Using ultrasonics to remove a fragment in a situation like that can very easily lead to excessive damage to the apical aspect of the root. Apical surgery is often a more predictable approach if the fragment must be removed. Many times, however, the prognosis of completion of endodontic therapy with the file fragment still lodged in the root (ie. obturation that incorporates the fragment) can lead to a decent prognosis still. It all depends on the presence or absence of preoperative infection within the tooth and the management of the tooth through the whole process.

I have found that when instruments break in canals like this, it often is more a manufacturer’s defect than poor technique.

Here you’ve got a fairly thick file that broke off leaving a long segment in the canal. The canal is fairly straight and the head of the fragment is visible in the coronal aspect of the canal. I was able to trough around the fragment to about 2mm beyond the head of it. The energy from the ultrasonic tip them unscrewed the fragment and it popped loose. Often applying the ultrasonic directly to a fragment will cause the fragment to further fragment, but this piece was thick enough, not around a sharp curve, and visually accessible enough that I was able to retrieve the file and proceed to complete the endo normally.

On the post-op film you can see how close I was to a perforation of the root even though I had good visibility of the fragment through my microscope. Imagine trying to do all of that troughing in the apical third of the root.

Note that this file has radial lands, a larger tip diameter, and a greater than 0.04 taper. It’s probably a GT file.