…If this was my excitement for the day of work that I put in:

It’s an upper second premolar (an uncommon morphologic phenomenon) with 3 canals that I retreated the root canal work on. The first 2 pictures are the before ones, the second 2 are the afters.

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 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:

If some of you are gum addicts and primarily chew sugar-free gum, or if some of you eat a lot of diabetic (artificially sweetened) products, you might have noticed that you get the runs shortly afterwards.

Here’s some evidence¹ that you’re not imagining what has been the cause of the problem. It’s only a couple of case reports, so that’s marginally better than anecdotal evidence, but still:
Read the rest of this entry »

1. Bauditz J, Norman K, Biering H, Lochs H, Pirlich M., Severe Weight Loss Caused by Chewng Gum, BMJ. 2008 Jan 12;336(7635):96-7. [↩]