General
1. What is a material, instrument or technique that makes practicing dentistry easier for you?
2. Is there any information or adverse effects with the use of ultrasonic scalers/hand pieces with persons whom have had a Sacral nerve stimulator implanted?
3. I wanted some feedback on the guidelines for blood pressure monitoring in the dental office. The hygienists decline tx for any patients in their chair with patients with a history of blood pressure whether on medication or diet and exercise monitored if it is in the 140/95 range. This is an appointment for perio maintenance without local anaesthetic. We want to do the very best for our patients, however this is upsetting a lot of patients. They feel we are wasting their time as they are already under the care of a physician and the M.D has not expressed any concerns about their B.P being regularly at a slightly elevated number. I would appreciate your guidance in this matter.
4. Can an ameloblastom transform into a ameloblastic carcinoma within 3 months. We made a biopsy, the result was a ameloblastoma and after complete removal the hisopathologist said it was an ameloblastic carcinoma.
Periodontics
1. What clinical evidence is available for the efficacy of deep periodontal pocket disinfection with a soft tissue diode laser? What protocols are proven and recommended in terms of frequency of treatment?
2. Educate the general dentist and hygienist to recognize early signs of periodontal disease.
3. Train dentist and hygienist to present this information to patients in a kind, caring non-threatening but motivating way.
4. Have a section, in a concise manner, to evaluate new products. Do this in concise, readable articles, and not the lengthy, with lots of graphs and tables that are meant for researchers and academics.
5. How can we treat halitosis?
6. There are PRP (Platelet Rich Plasma), PRF (Platelet Rich Fibrin, and PRGF (Platelets Rich in Growth Factors??) autogenous growth factors for enhancing bone and gum graft healing. Are they basically all the same thing, but Dr’s change the name so they can call their protocol their product? At one lecture it was mentioned you don’t get as much swelling afterwards with the PRGF product. What are the pro’s and con’s of each of these autogenous growth factors? Which is the easiest and least costly to make from the patient’s blood? Does one stand out as the best? I know a lot of Oral Surgeons like PRP using Harvest Technologies Method ($10,000). As a GP doing implants & grafting for 13 years I want a protocol & product that is simple, inexpensive and works! Thank you.
7. What is the best antibiotic to prescribe for irreversible pulpits?
8. Periodontal dressing: I have not used a periodontal dressing for the purpose of protecting a surgical site in over 20 years. For many of the surgical procedures such as regenerative procedures and soft tissue grafting (especially connective tissue grafts|) the tissues will pass through a phase of inflammation where they become enlarged, a dressing on the site in my experience increases post-op discomfort and soft tissue necrosis. I would suggest that clinicians try this approach and determine which works best for them. As the site is unprotected while healing, prescribe chlorhexidine rinse and educate the patient on avoiding the site.
Prevention
1. Is there any evidence of benefit for the routine use of an antibacterial mouth rinse( ie. chlorhexidine gluconate .12 %) prior to dental appointments. Would there be any contra-indications to this practise?
2. Is there a difference between the dental erosive capability of body temperature orange juice and similar temperature cola drinks? Why?
Oral Surgery
1. I am interested in latest treatments, modalities and rationale for parasthesia arising from IAN slight damage.
2. The long half life of bisphosphonate drug retention makes taking the patient off the drug prior to dental extractions/surgery ineffective at reducing the negative effects of the drug on alveolar bone regeneration.
Some newer, daily- dose oral bisphosphonates seem to have half life retention of under 24 hrs, which would suggest that a “drug holiday” of eliminating the drug for weeks or months could allow for some reactivation of the bone metabolism allowing more normal recovery from surgical intervention.
Are these drugs only used for osteoporosis or are they used for cancer patients that have had radiation and chemotherapy? Why would a physician use the more long-term drugs over ones with the shorter half life?
As part of the discussion please review the debate over why these drugs are used and the evidence that supports their use to reduce fractures of long bones, spine, flat bones such as pevis, skull, and alveolus. A list of the commonly used drugs, their half life, and their preferred target use profile would be helpful.
With patients on long term bisphosphonates, discuss treatment options prior to the introduction of these drugs with ongoing strategies for maintaining them.
3. I am interested in the indications for socket grafting to preserve the alveolus for dental implants. Can we justify the fee structure for this?
4. In the case where there is an oro-antral commmuication. What is the solution?
I would like to ask you about the best flap in case of potential to oro-antral -communication in the upper teeth.
5. Based on scientific evidence, what is the best method of post-operative pain management following surgical extractions?
6. Could you address the ethical dilemma of a patient on warfarin either themselves or by their doctor (not familiar with the current science and practice) stopping coumadin several days before a surgical procedure. The patient is in the chair and the INR is let’s say 0.9. Do you abort the procedure and send the patient home to take their medication or do you proceed now that the wrong decision has been made? Obviously we would instruct the patient/doctor to follow the guidelines you covered next time.
7. If the medical practitioner advises that the patient should not go off his warfarin,pradax, plavix etc.what INR level is safe to proceed in the case of warfarin, and how can we proceed in the case of the others?
8. how what are the differential diagnosis for swelling over the maxilla and intra orally swelling over the left maxillary alveolar ridge without displacement of mobility of teeth
9. My question is do patients with dental implants need prophylactic antibiotics as is being recommended for patients who have undergone knee or hip replacements with titanium implants before dental hygiene.
10. How do I manage paresthesia caused by needle injury, patient felt electric shock on his tongue while I was inserting the needle for a Block. I had not injected anything yet. Is there a different way to manage the paresthesia if you know it is from trauma or from anesthetic toxicity?
11. A 54 Y/O/F patient receives BOTOX Facial Dose/Therapy on a Thursday “in order to decrease jaw pain” expected from a single tooth extraction of a advance decayed mandibular molar the next day. Is there any reasonable documented rationale behind giving a Botox facial injection to decrease post op dental extraction pain? Is there a direct or indirect relationship to the development of a mandibular Ludwig’s Angina (requiring hospitalization eight days later) given that the tooth was extracted atraumatically, without complications on the Friday?
12. What is the general consensus/guidelines regarding oral surgery and patients medicated with biphosphonates? Could you elaborate in general for patients taking it IV and Oral, then specifically for oral biphosphonates and concomitant use with prednisone?
13. Which handpieces are appropriate for use in bone removal and for tooth sectioning during exodontia to minimize the risk of air embolism?
Restorative
1. Between Gluma, duraflor and other 1.1%fluoride toothpastes. What works best for dentin hypersensitivity?
2. How do you manage a terminally ill patient who has a painful broken lower molar? The patient cannot go to a nearby dental office and need pain control at home. In normal situation this tooth needs root canal treatment.
3. Restorative emergency – portion of all porcelain crown breaks off in esthetic zone. Do you etch porcelain first with hydrofluoric acid and then enamel/dentin with phosphoric acid, then silane primer on porcelain, then bond on tooth, then restorative material? Is it a big concern if a little of the hydrofluoric acid gets on tooth structure – could happen easily, especially with a smaller tooth like a lower incisor.
4. Replacing a failing amalgam with composite. The existing amalgam restoration has a deep IRM base and is asymptomatic. Once the amalgam is removed and there is healthy tooth structure surrounding the IRM, I fear taking out the entire IRM when it is close to the pulp in case I introduce a pulpal problem that was not there previously.
As we know, IRM and composite are not compatible materials. Is there a liner or base material that is compatible with both IRM and composite that can be used in a sort of “sandwich technique” to put an interface between the two incompatible materials, and hence allow the clinician to leave a small portion of IRM in the tooth?
5. I was taught in dental school that we could successfully treat deep molar grooves with fissure sealants, and even early decay could be treated with “clean and seal” restorations. I guess my “burning question” is this: does anyone else share my opinion that first and second molars with deep grooves are not indicated for sealants or “clean and seal” restorations, and instead should be treated aggressively using proper anaesthesia and full composite (or amalgam!) restorations? With digital imaging, we are picking up a lot of caries under sealants or small resin restorations on these teeth. Secondary question…is caries detection dye accurate?
6. What is the consensus on indirect pulp capping? Just today I did partial excavation of decay on a first molar with symptoms of reversible pulpitis, left some semi hard decay and did a temporary restoration with IRM. I will go back in 6-7 months and try for a final composite filling and hope to avoid pulp exposure and RCT by doing so. I have done this several times over the years with mixed results, any pointers for case selection or materials?
7. What is the best material to do a direct pulp cap? Is it still Dycal but I heard Durelon. I am not able to do a MOD with the Triodent matrix system (that I love), the two rings don’t fit at the same time. Any inputs? The rep tells me I can.
8. My burning question- who should do the post-endodontic restoration, endodontist or restorative dentist?
9. I think, with all due respect to Black’s Principles, that the preparation can be whatever the decay dictates. It’s the matrixing and contact that are the challenge for most dentists. Also, the finishing & polishing can be a chore, if you don’t have the right tools. I would really appreciate an update on “2012″ matrix types, and also the top tested finishing burs and polishers. Most of us tend to depend on the sales reps (not always reliable)
10. Any detrimental effects of tooth whitening agents on enamel? Some have shown increased microfracture in the enamel seen only under SEM however is it clinically relevant?
11. What are evidence based guidelines in decision making when treatment planning prosthetic restoration of molars as far as the choice between resin bonded onlay restorations (ceramic or ceramic reinforced resins) vs full coverage ceramics, and the different luting agents or cements.
12. Is there any solid evidence that the coating recommended for Resin Based Glass Ionomer Restorations impedes the release or uptake of Fluoride?
13. Is the disinfection of cavity preparations taught in dental schools? I am referring to a CRA, Clinicians report that showed viable gram positive and negative organisms in 100% of all prepared teeth. See CRA Nov. 2009, Vol. 2, Issue 11. “Disinfection of Tooth Preparations-Why and How?” It’s easy. My peers won’t disagree. Their objection is the 2 minutes it would take. If it isn’t taught it’s not likely that many will follow this practice. We waste a lot of time in our work anyway. If bugs are the enemy then this becomes significant especially under sealants. Similarly, is the use of caries detect taught or is the objection the same? It’s one more step. “It would slow me down.”
14. I am presently doing my own research into effective hemostatic agents. Presently many of the bonding and impression techniques we use are highly sensitive to moisture (crevicular fluid), saliva, blood etc. As we do more and more cosmetic dentistry new problems arise with bonding techniques and long term aesthetics in the esthetic zone. By far the best drying, hemostatic agents I have found to date, ferric sulfate and superoxyl have inherent problems with long term black line staining or greying under the restoration or in the case of superoxyl, weakening bond strengths leading to future marginal discolouration. All other products and techniques I have tried to date are less than adequate, aluminum chloride (viscostat,detail, expasyl paste), epinephrine, laser curettage. Any suggestions on techniques or other products? The best of these would be expasyl paste, but clean up is not the best and I am not sure if residual amounts may affect our bonding techniques?
15. I was wondering what the pros and cons of self adhesive resin cements (ie: RelyX, Unicem 2) and resin modified glass ionomers (ie: FujiCEM 2) in regards to crown and bridge cementation. Are they essentially equally reliable?
16. What is the “Ideal Treatment of Choice” for the following clinical situation: A patient presents with a Max. central incisor broken off to the gingival crest. Let’s assume the tooth already has an adequate endo, and has sufficient clinical crown (suprabony, ie. no need for perio surg. / crown lengthening) What is the best way to restore this tooth , way back when I was in dental school we were taught to place a cast post and core, and then restore with a full coverage crown. Is this still the best solution… or is it more recommended to place a “resin fibre post with a resin core build up” ??? Then follow up with full crown coverage. Is there any evidence out there which supports either decision?
17. Regarding direct composite restorations: Is it time to retire GV Black preparations and incremental filling and start utilizing the likes of David Clark (saucer shaped preps/ injection mould filling with through and through curing)?
18. Consider the clinical situation of a successfully endodontically treated tooth which suffers trauma or restoration failure such that the coronal structure is highly debilitated. For simplicity, assume that the periodontal condition is WNL and the adjacent teeth are healthy with no restorative history. What clinical condition must exist such that restoration with a post/core/crown still has a better prognosis than removal and replacement with an implant supported crown?
19. I always worry that the cavosurface margins of class II preps are not fully filled when using composite resin. Is there a difference in the long term margin integrity using the following 3 methods? 1) pack composite resin into the proximal box using an amalgam condenser 2) place flowable resin along all cavosurface margins of the proximal box and cure it prior to packing composite. 3) place flowable resin on the cavosurface margins and then insert composite on top of the uncured flowable.
20. Does warming composite prior to placing in preparation result in better depth of curing?
21. Are there updated criteria to use when deciding if a crack/craze line on an a symptomatic tooth should be attempted to be removed, either with restoration or crown?
22. Best pulp therapy treatment options for deep decay extending into the pulp of 1st molars of a young patient? With and without closed apices?
23. What are the main differences between “posterior composites” and universal composites?
24. What kind of a restoration is best recomended for root caries, especially where isolation is a problem? Sandwich technique with GI? Is a full GI cement resto recomended over amalgam in non esthetic areas? Which is the recomended GI cement for such a resto?
25. Since composite fillings eventually leak…..and many times by the time the patient comes to us the secondary caries has spread a lot under the restoration to cause an even bigger filling(if not RC), what is the best solution to prevent this from happening? Would putting a liner with fluoride release like GI, GI Compomers (ionosit, vitreobond) etc recomended? Do they help in some way prevent or reduce the spread of sec decay?
26. As a practising dentist I am often asked whether it is recommended to change old amalgam fillings to the latest white composites. I often reply with information such as Amalgam fillings are unbonded but the gap fills with corrosion products and seal better as they age(is this true for the newer non-corrosion alloys?). Composite fillings look better but need more maintainence..they last about 5 years(?) They are not recommended in patients with poor oral hygeine, dry mouth etc as plaque and acids acting on them tend to break the bonds down sooner. Please correct me(if I a wrong) and add to my information. What else should I be informing patientsd in order for them to make a well informed decision?
27. Bonding systems and techniques: So many options available and so many different clinical situations, that this question is daily: Examples: One step etch/prime systems – When and where. Enamel or no/minimal enamel.
Veneers bonding – which step, when, what goes on the veneer and what goes on the tooth? When is the adhesive cured, when is it not? Can i mix bonding systems?
28. Cement – Which system to bond and/or cement is best in different situations –Maryland bridge cementing or recementing all porcelain crowns – pressable or not.
29. Temporization – What is the best material for veneer temps? Techniques?
30. Post-op sensitivity after Cl. II composite restoration: I have found that a few of my patients sometimes have post-op sensitivity after a C. II restoration that occurs only when flossing and more specifically when flossing through the contact (at the point of resistance). I have attributed this to “too strong” of a contact or a slight overhang of the restoration, and corrected most cases by easing the contact or overhang with a finishing strip, but it has not worked in all cases. Is there any other method to avoid this type of post-op sensitivity or to correct it once the restoration is in place?
31. Has anyone seen ‘preeruption caries’? I have several cases where there appeared radiographically to be caries on the occlusal surfaces of unerupted teeth. On eruption, I observed them for a while. After the first one increased in size over time, i went in and restored all of them. All seemed to be carious.
32. Some clinicians advocate bulk fill for composite placement, using either flowable (alone or covered with one layer of solid composite- as a second light increment) or solid composite resin alone in one increment.
Given known limitations of bulk fill such as shrinkage and limited curing at certain depths of the restoration, what advantages are there for this technique other than reduced operation time?
The question refers to using this technique for large one-surface restorations (> 2×2 mm) or restorations involving 2 or more surfaces of the tooth. Are there materials that are preferred over others with this technique? Is there peer-reviewed research supporting this technique?
33. My patient came in the clinic with a crown of tooth 24 in her hand complaining about having this crown fallen off for the 4th time ( the crown was made by another dentist). Then,about 10 months ago,I made a new PFM crown on this tooth. Now, the patient came back with grade 2 mobility on this tooth and a very deep pocket on lingual side. In x-ray examination, bone level in mesial and distal is normal. Surprisingly, there are loose contact on mesial and distal although I am sure that in time of insertion the crown had good proximal contacts. I checked occlusion and actually took it out of occlusion. I, also, deep cleaned lingual side. The patient is a very heavy grinder and after all this happened, she accepted to have night guard. None of these treatment helped to reduce mobility. I don’t know what happened to this tooth and what will be the next step. I would appreciate if you could kindly help me with this situation. (I can’t imagine that we can provide advice for this sort of problem – probable response – refer to a periodontist?)
34. What are the advantages and disadvantages of full-contour zirconia vs. cast gold for a full crown on a second molar?
35. I would like to know how your readers would restore a case of severe bulimia. I would send a picture if possible.
37. Portion of all porcelain crown breaks off in esthetic zone. Do you etch porcelain first with hydrofluoric acid and then enamel/dentin with phosphoric acid, then silane primer on porcelain, then bond on tooth, then restorative material? Is it a big concern if a little of the hydrofluoric acid gets on tooth structure – could happen easily, especially with a smaller tooth like a lower incisor.
38. What is the recommended protocol for remineralizing incipient cervical carious lesions using Recaldent (MI paste)?
39. I have been cementing pfm crowns on implants with a temporary cement in case a screw adjustment becomes necessary in the future. What should I cement an all porcelain crown with?
40. If expressed through the apical foramen during RCT, how often and over what time period will any excess root canal cement/sealer dissolve?
41. What is the proper protocol for bonding a composite to an existing composite resin? Does the new restoration have the same bond strength and longevity as the original?
42. Can you bond to RMGI such as Fuji IX and Chemfil Rock? If so what is the protocol?
43. In clinical practice I seem to be seeing more evidence of acid reflux as a major contributor to decay. Is there any method available to measure oral ph over a 24 hour period?
44. How do you prepare primary molars for stainless steel crowns and how do you crimp and cement these crowns?
45. I would like to know what is the current thoughts on bottle feeding and caries on primary teeth. Also, some internet website seem to make an assiociation with labial frenum and caries on primary teeth. As an orthodontist, I have never heard that labial frenum could be related to dental caries and I doubt it could be related. If you can asnwer in french and english, it will be appreciated.
46. Sometimes incisors are surprisingly mobile despite having what appears to be solid periodontal support. Other than full occlusal rehabilitation, are there simple methods to treat mobility of teeth (usually incisors) when occlusion is suspected as the cause?
47. What is the safest adhesive that could be used if needed?
48. Since octenidine hydrochloride (OCT) seems better than CHX, it is available and/or recommended as an oral rinse agent? …and under what name can it be purchased?
49. Do patients with PICC lines, Hickman lines and portacaths require antibiotic prophylaxis prior to dental procedures that could produce a bacteremia?
50. For primary or permanent teeth, does the manufacturers’ recommended tooth conditioner increase the strength of the bond between the prepared tooth and glass ionomer restorative material compared to acid etching or no etching?
51. How does one prevent further wear and treat small cupped pit lesions in areas of occlusion contact
52. Does anyone have information on Cannabis use/abuse and local anesthesia ? Cho et al, (Australian Dental Journal 2005;50:(2):70-74) reported parasympathetic effects of the drug, possibly leading to syncopal episodes. Horowitz et al (1978) reviewed the pharmacology and identified a sympathomimetic response, warning clinicians of the potential danger of epinephrine use in the “high” patient. My understanding however was that local anaesthetic is less effective in the cannabis user .. and I have been unsuccessful in my search. Any information would be appreciated.
53. My question is how can I restore a tooth that is clasped by or has a rest for a partial denture. A usual restorative scenario would be the patient has a cavity or has broken a tooth that the partial denture rests or clasps on. The fit of the denture is still very good and we don’t want or need to change the denture.
54. How do I manage patients who cannot lie down in the dental chair and must have all of their work done sitting up. This is extremely challenging when there are maxillary posterior restorations to do.
55. would the application of 2% fl in trays 3times per week for 2mins sessions before going to bed be of help? Also what is the best material to use for root caries? Thanks
56. On Fridy after extraction of 17 I saw in the socket that there was a oro-antral communication about 3mm in diameter. I placed three sutures over the socket keeping a large blood clot in the sinus, I was not confident in cutting in palatal gingivae to create a flap to cover the socket. I also prescribed amoxicillin 500 mg for 5 days and will be seeing the patient again in a week. How long does it take communication to close over and what is the next best course of action.
57. A book has been written titled “Cure Tooth Decay: remineralize and repair your teeth naturally with good food” by Ramiel Nagel. We have received questions from patients about this, has our organization looked into this?
58. We have recently been asked about “snap on smiles” we have looked it up online and they seem to be all the rage in the states. But what are the pro’s and con’s about them? Are they a stable treatment?
59. When should I take a patient’s blood pressure and what are the guidelines for dental treatment?
60. I have searched the literature to no avail. Gutta percha was developed as an insulator for under sea telephone cables. How did it come to be used in teeth when it has no therapeutic value whatsoever and no adhesive or sealing properties? The only positive thing to be said about it in dentistry is that it is a radiopaque material.
61. I have a healthy 30 yr old female who wants to do porcelain veneers for 11 and 21. What are the main criteria required to determine if I should cut the incisal edge off or not? Is making provisional veneers optional, or mandatory or depends on the case? Answer my questions would be very much appreciated.
62. If a patient has had a reaction to a Emla, a topical anesthetic continuing lidocaine and prilocaine, is there any contraindications to using lidocaine or prilocaine as a local anesthetic in dental treatment? If yes, can a different local anesthetic such as prilocaine or articaine be used or does the patient have to undergo allergy testing first? I have read that there is a high incidence of reactions to Emla, so I assume that the use of lidocaine and prilocaine in dentistry is still safe for the patient or that a different amide type of LA can be used as there is supposedly no cross sensitivity with amide type Local anesthetics but I want to be sure of the situation before I either choose a LA or send the patient off for allergy testing.
63. Do you have any suggestions for managing Parkinsons in a clinical setting to enable a safe hygiene and restorative outcome. I have a patient with advancing motor and swallowing/breathing difficulties that is not manageable for the hygienist presently. Restorative procedures would be equally impossible.
64. In the past month, I have had several patients ask about harvesting stem cells from their wisdom teeth. What do I advise these patients?
65. bonjour;je voudrais poser une question à propos de lutilsation de l’hydroxyde de calcium avant le composite est c’est oblgatoire pour son utilisation selon le degrés de la carie et merci
66. What is the best way to treat a vertical coronal crack on an upper molar that has pain on biting and respond normal to pulp testing and no evidence of radiographic changes?
67. I recently received a question from a patient of mine who is a nurse by profession. She posed the following question to me…
“I’ve noticed some discolouration on my front two teeth. I noticed it a few days ago and then my husband pointed it out today 🙁 My dental routine hasn’t changed but I was recently diagnosed with abnormally low estrogen….could it be related?”
I haven’t found anything in my research. I have however come across a post regarding BPA restorative material and it’s estrogen-mimicking effects. This unfortunately does not answer my patient’s question however.
I would appreciate your insight into any relationships between tooth discolouration and low estrogen.
Oral Medicine
1. What are the causes of burning tongue?
2. In the last month i have 3 patients complain of a salty taste in their mouth what is the cause?
3. My question is do patients with dental implants need prophylactic antibiotics as is being recommended for patients who have undergone knee or hip replacements with titanium implants before dental hygiene.
4. When I have discussed sun damage to lips, a couple of patients have told me that they have been prescribed efudex by their physician. There is apparently no follow-up by the physician and no indication to the patients as to what the desired outcome of said treatment should be. Should dentists be prescribing this and what would the appropriate follow-up and regimen be with this chemotherapeutic agent?
5. A patient presents with an oral infection for which I would like to consider antibiotics as part of overall care. However, she has a history of C.Difficile infection and there is concern that the antibiotic chosen might reactivate the residual C.Difficile in her gut. What is the best course of action in treating the oral infection
Prosthodontics
1. Maybe the experts could discuss crown to root ratio in regards to implants and the latest research. Does C/R matter or not with an integrated implant and then more importantly- what do you do in your practice?
2. What does the literature say about crown- root ratio for implants with regard to short implants and crowns that are long or longer than the 50/50 guide for natural teeth?
3. I have always been intrigued by the use of implants and natural teeth as part of a fixed retained prosthesis. The conventional thinking has been that you will get intrusion of the natural abutment when you use a combined case involving mixing the two. I suspect that there are many other factors that would alter this outcome and that avoiding this combination should not be a hard and fast rule. There is little in the literature that would be an “evidence based” study that has outlined guidelines for this combination.
Discuss scenarios whereby you might consider ….or completely avoid this combination
4. I have a patient with missing upper canine. She previously had implant surgery but it failed, has deep bite, short clinical crown in the upper first premolar and small upper lateral which has elevated risk of pulp exposure if i try to make full ceramic preparation. I thought I could make full coverage on the premolar and class III preparation on the lateral but i am afraid about the impact of heavy occlusal forces. What can I do?
5. What’s the current consensus on the best cement for Implant crowns?
6. When is it appropriate to link prosthesis to both implants and natural teeth? (repeat?)
7. Has anyone had any experience with allergic reactions to casted frameworks for implant supported bridges containing alladium (75%), silver, indium, gallium and gold?
8. Is there any study relating to problem with space opening between a crown on the most distal tooth and the rest of dentition (distalization of crowned 7 for example after crown insert) cause, treatment and prevention.
9. How do I remove a bridge without damage to it or the teeth, where the anterior abutment has loosened and the posterior abutment is on solid?
10. This is a problem i have encountered many times. A space opening up between the 1st and 2nd molars when a restoration or a crown was done. Contact is good when resto or crown is done and then a space is noted months later. even replacing the resto with amalgum and it opens up again. this is very frustrating when a crown is done. in these situations there is no wisdom tooth. I would appreciate your input in why this happens so it can be prevented if possible and treatment. i am afraid that replacing the crown it will happen again as it did when resto was replaced.
11. What options do we have in treating Papillary Hyperplasia in chronic denture wearers, and how successful is treatment with medication (ie. Nystatin ointment, etc.) alone?
12. Hi I never heard about Dahl appliance before and I am really fascinated by what it can do. I would like more clinical pictures and more case reports about using it. Also how exactly to design it and how to make a decision on which teeth exactly to include.
Medicine & Pharmacology
1. I have a patient on long-term prednisone (20-30 mg), type 1 diabetes, myasthenia gravis, who has seizures, who needs a few routine restorative procedures done as well as a cleaning. Last time he had local he said he had a seizure on the way home. I spoke to his family dr about doubling his prednisone dose the morning before his appt to prevent an adrenal crisis. His MD said he is not familiar with doing that, but he doesn’t see a problem with it. His dr also recommended antibiotics prophylaxis. When I spoke to my patient he said he would rather not take extra prednisone as it makes him feel unwell.
How would you handle this situation?
Is it still common practice to double the prednisone dose if they are on it long-term?
2. Is it safe to use vasoconstrictors in patients with sickle-cell disease? Which one is the best choice? Could I perform a painless dental extraction without vasoconstrictors in these cases?
3. Is it safe to use single tooth anaesthesia for primary teeth without causing any harm to the developing permanent teeth? Is it safe also to use 2% lidocaine with 1:80,000 epinephrine for single tooth anaesthesia delivery system? Why is there increase in heart rate following single tooth anaesthesia delivery system?
4. I am searching for advice and recommendations on minimizing narcotic prescriptions and advice on prescribing analgesics for irreversible pulpitis and for wisdom tooth surgery.
5. The current CDA position on antibiotic prophylaxis regarding joint replacement calls for antibiotics for 2 years post insertion of the total joint prothesis.
The American Academy of Orthopaedic Surgeons now advocate antibiotic coverage for the lifetime of the total joint prothesis.
Can you please clarify this apparent conflict? (Euan has provided an answer and copied me)
6. I have a patient who had recently been diagnosed with Lyme disease. The specialist has highly recommended to the patient to have all of the endodontically treated teeth extracted because they are contributing to the sequalae and persistence of the spirochetes and/or toxins. I had the patient get a letter from the specialist detailing the reason for extracting these teeth and the evidence for doing so. In the meantime, I have searched medline, asked several oral surgeons and an endodontist regarding this matter and there seems to no information to support or refute the claim made by the Lyme disease expert. I am waiting to hear back from Lyme disease specialist. How should this case be handled and is there a specialist in medicine or dentistry that the patient should consult with?
Need to find someone who has experience treating periodontal issues with scleroderma. A patient has the typical limited opening due to tightening of the lips. It seems the vestibule is tight as well. It is as if the entire vestibular tissue is one big frenum pull, resulting in advanced recession and stripping of attached gingiva from the roots. My question is, will grafting or vestibular deepening help? More immediately, will a surgical approach prove successful? Will surgical trauma cause more scarring and tightening of tissue, make the problem worse?
Surprising, few of my colleagues have experience with this. I am trying to find info to help guide treatment planning. I can send photos and radiographs. Feel free to contact me directly by email, drpbelzycki@rogers.com or by phone 416-995-0875. I hate typing, love talking. I am 59 and a first time blogger.
7. Are there recommended guidelines for reducing the incidence of shingles in a patient that has a history of developing shingles after dental care?
8. I would value your opinion regarding a patient scenario, where by the patients medical practitioner has requested extraction of the patient’s teeth, some are healthy and some are not, prior to Knee surgery.
I have requested this in writing from the medical practitioner and i feel ideally it should ideally be from the orthopaedic surgeon.
I have yet to carry out an assessment of the patient’s dental needs and my initial thoughts are, to save the healthy teeth i.e. those which can be restore without any apical pathology and those which do not require endodontic treatment. those not grossly periodontally involved.
Are there any guidelines that have been issued, i would appreciate any further advice.
9. While I was away for vacation, one of my patients came to the clinic and complaint of a strong table salt taste in his mouth. It last for several days causing a major discomfort. I saw him today, and although the taste seems to be dying down, he claims it is still present. The oral exam didn’t show anything on the tissue or else. Would you know about any systemic disease that could cause this situation?
10. Do I need to go for prophylactic antibiotic coverage before performing oral prophylaxis in patient who has undergone bypass surgery 1 year ago.
11. I have a wheelchair patient with multiple medical conditions, many meds. has reacted to many. Has extremely dry mouth, cannot change meds, has had 6 month bout of post-47 exo bisphosphonate osteonecrosis etc. Previously had severe lung bleed from warfarin, mow on b.i.d. IM thinner. Has developed an aspergillosis cave sac in left lung, waiting till stronger for surgery. PROBLEM: although Mayo Clinic Internet says not communicable to healthy humans, WHAT about dentist / hygienist doing treatment, airotor, scaling, air-water syringe, cavitron, etc in close proximity for some time to wide open mouth? IS a normal mask sufficient? N95? What is the risk to the dental operator or assistant? What are prudent self-care precautions?
12. How does a patient’s use or abuse of recreational drugs impact the effectiveness of local anaesthesia? (Mark Donaldson?)
13. What is the protocol for 6 week pregnant lady allergic to pencillin with severe dental pain due to grossly decayed molars that need extractions? I had such a patient in my practice,i did not take radiographs but put her on clindamycin300PO 12hrly and chlorhexidine mouthwash.
Radiology
1. I have seem an exponential growth in CBCT at the marketing level (shouldn’t we ALL have one?), and have seen an emerging trend in dentists using them to reverse engineer pans etc. Most recently, an advert came across my desk where bitewings engineered from a pan are the answer. What is the impact of emerging radiographic technologies on cumulative patient ionizing radiation exposure?
2. We are always told than any x-ray on a pregnant woman exposes the fetus to significant risk. Is this really true with lead aprons and digital exposures? Is there not more risk to the patient and fetus by postponing endo till after the birth or not taking x-rays that are critically important in diagnosing serious problems?
3. How much reduction in radiation exposure for my patients can I expect when switching from F Speed film to a digital sensor or PSP system? I am looking at changing from film to digital radiography. One of the important advantages claimed for digital radiography is a significant reduction in radiation to patients. When looking at different systems I am finding it impossible to find what the “actual” clinical reduction in exposure will be. The instruction manual for my Gendex 756 DC intra-oral x-ray units suggests that a switch from F Speed film to PSP ie Digora will need a longer exposure time.
4. What is a good quality scanner to scan conventional dental radiographs and printouts of digital radiographs?
Endodontics
1. What are the pros and cones of using the twisted file system for RCT?
2. Regarding the size and shape of root canals…..the trend seems to be shifting from large tapers(0.8.0.6) occlusally, plus large size files(30, 35) in order to facilicate access of irrigants and flushing into the depths back to keeping the canals narrow in order to preserve tooth structure and prevent fractures etc. Do please advise.
3. Which rotary endodontic and obturation system is the best?
4. This is a 43 yr old male who was hit on his front teeth when he was 12y.o. Complains of discoloured front tooth. Clinical presentation is discoloured 11 which is assymotomatic, radiographically shows external root resorption and periapical radiolucenecy in radicular bone. Tooth is sound periodontally and pt has good oral hygiene with moderate crowding. What would be the recommended treatment for the tooth and radiolucency? (Mary Dab or Aldo Mazer)
Pediatrics
1. What are the current standards for treatment of permanent teeth who have had trauma and require apexification?
2. My daughters play soccer and basketball and no other kids on the field or court wear mouthguards. I am waiting for an avulsed tooth some Saturday afternoon. They have Hanks Balanced Solution in their bags for such an emergency at the game. If the avulsed (permanent) tooth is cleaned in the Hanks solution, should an attempt be made to re-implant it on site or go to a dental office where local anaesthesia and a curette can be used first? Then re-implant, ligate and plan for endodontic treatment within 1 week? And are most dentists available to their patients for such an emergency at any time?
3. Is there a treatment option for bruxism in children (primary and mixed dentition)? I realize that any fabricated appliance may have issues with both long term stability (mouth is changing rapidly) as well as compliance.
4. A parent with a child comes to me because the child’s pediatric dentist is away. I refer the child to a radiology facility for further radiological assessment. The returned report from radiology indicates a suspicious area. I tell the parent that there is a suspicious area that needs follow up. Because the paediatric dentist is now back I tell the parent that I will send the radiographs and report to their pediatric dentist and that they should book an appointment with him for further treatment. The report and x-rays are sent to the pediatric dentist. The parent does not book the appointment. Five years later the child needs major surgery to remove the tumour and loses part of their mandible. This is a quandary many dentists find themselves in when seeing a colleagues patient. Does the responsibility for further treatment end with sending the patient back to the dentist of record?
5. In implementing 1 year old dental visits, I’m encountering many toddlers who have milk allergies or lactose intolerance. What effect will dairy avoidance have on the mineral available for tooth development? Is there an appropriate calcium supplement to be recommended to these children? Is soy infant formula equivalent to cow’s milk formula in calcium absorption?
6. I see a lot of first permenant first molars erupting with significant mottling. How widespread is this? I’ve found that some can be associated with coeliac disease.What are other causes? I usually place an SSC but in cases where it is unrestoreable,what is the optimum timeing to its’ extraction to allow the second molar to take its’ place?
Sleep Apnea
1. Do oral appliances work in treating snoring and/or sleep apnea? Also, what are the risks and side effects of long term use, especially on the TMJ?
2. Are there good imaging studies of upper airway obstruction in these Sleep apnea patients? I see patients with Cpap machines and sleep studies; but there does not seem to be any airway imaging to assess the ability of these patients to breathe normally. Can surgical intervention in the upper airway provide a significant improvement? I have seen amazing results with patients having a bimaxillary advancement.
Princess Margaret Hospital
1. Can an ameloblastom transform into a ameloblastic carcinoma within 3 months. We made a biopsy, the result was a ameloblastoma and after complete removal the hisopathologist said it was an ameloblastic carcinoma.
Anesthesia
1. My question is about “buffering” dental anesthetic solutions with sodium bicarbonate or the products sold by onpharma (tradmark) This is supposed to help achieve a less painful, quicker acting shot. How does this affect the duration of the freezing, and if this is a good thing why isn’t done right in the original carpule Thanks
Dental Hygiene
1. My question is do patients with dental implants need prophylactic antibiotics as is being recommended for patients who have undergone knee or hip replacements with titanium implants before dental hygiene.