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:
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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. [↩]

I usually retreat cases like this (access the crown, remove the post, redo the root canal work), but the patient was sure the crown would come off without the post in the tooth, so fine, we decided to do the surgery instead. For those who understand what I’m talking about so far, if the crown is at risk of falling off without the post (during the temporization period), the crown is likely not fitting the tooth as well as it should and is probably leaking. Surgery in situations like that ends up being a short-term solution.

The surgery went fairly smoothly, and I got a decent shot of the root end after I’d resected and filled it. The largest amount of granulation tissue was on the buccal root surface near the apical/middle third junction. The culprit turned out to be a lateral canal. I filled the lateral canal and two main canals with white MTA. The apical bevel looks much sharper in the photo than it really is.

All the bright red is blood-covered jawbone. Here’s the key to the numbers in the picture:

1. Crown of tooth
2. Lateral canal
3. Buccal canal
4. Isthmus between canals
5. Palatal canal

There is also a sinus perforation that doesn’t show well on the clinical photo.

I saw an 11 year old boy yesterday for a root canal.

This was his second appointment with me, but the first appointment for treatment. When I had previously seen him for consultation, I met his dad. His Dad, a really nice guy who wants to do what’s right for his 4 children, told me how he recently found a job after not having a stable one for a couple of years. He’s finally got some money to take his family to the dentist but one daughter needs 3 root canals and this son needs one. The daughter is older and the root canal work is fairly straight forward, so their family dentist will do the work. The root canal for the son is more complicated. All of this work, however, is costing quite a bit and you could see how the prospect of having to pay for it really worried Dad.

Although the root canal was needed on a 6-year molar and the boy is 11, the distal canal was still quite wide, and the pulp chamber huge. At the consultation I wasn’t able to obtain any reliable vitality readings from this tooth or the adjacent ones. The root canal was needed because of approximation of caries to the pulp.

I informed Dad that endodontic therapy was necessary, but I’d assess the pulp once I got into the tooth and decide at that time if definitive treatment would be done or if I’d do a direct pulp cap.

Today after I got into the pulp chamber, I found a vital, uninfected pulp that was not hyperemic. I decided to do a modifed Cvek pulpotomy. I unroofed the chamber, folded some pulp back onto itself and then capped it with white Mineral Trioxide Aggregate (MTA). I’m hoping that this will allow for continued dentinal thickening of root and pulp chamber. Full root canal work might be necessary in the future, but we’ll assess this as necessary.

Dad was very happy that things went so well. After I debriefed him in the reception room, I noticed him pulling out a wad of 20′s to pay for treatment. I made my retreat back to my private office to write my treatment notes (and finish dropping my daily entrecards).

AssistantGirl came in with the post-op xray shortly after and proceeded to ask me about Cvek Pulpotomies. As we were talking, OfficeMom and ReceptionChick both walked into my office together.

“Close your eyes,” OfficeMom said to me.

“Huh? Why?” I said.

“Just do it,” she said.

So I closed my eyes and soon felt her putting something near my nose.

“Smell this. What do you smell?” she said.

So I did. It smelled like pot (how I know this is irrelevant to this post).

“It smells like weed,” I said.

“Open your eyes,” she said.

So I did and it was the wad of 20′s that our Dad had paid with.

I took a deeper sniff and their was no questioning the aroma of marijuana. In fact, it was so strong that if we had rolled just the bills themselves and lit them up, we would probably have gotten stoned.

So this is how I accepted drug money as payment for work done. I feel like a greasy mob criminal attorney now. But at least the Cvek pulpotomy is much less expensive than a full root canal…I wonder what the bank is going to think when we make our deposit.

I saw the prisoner today for his consultation. He and his 2 guards were 35 minutes late for their appointment. He had his leg irons and handcuffs on but he was dressed in regular clothes, including his rasta hat. Both guards accompanied him into the room while I did the exam and went over the details of a retreatment and potential future apicoectomy.

Before I could give anything to the patient (like the AAE brochure on retreatments), I had to pass it by the guards. I guess they don’t know for sure that I’m not in cahoots with the guy.

Overall this was nothing like Oz. The prisoner was a nice guy, and so were the guards — although I don’t know what our next patient thought as he watched them leave our office together.