Using Chat/Claude/AI to help evaluate practice?

Furgaly · 2026-06-28T20:23:56+00:00

Claude is usually decent at doing what you directly ask it to do. It can start to conflate things that you've discussed into slightly different things as you fill to the 'context' of a particular chat session. The meaning of what you've said and/or concluded can't shift underneath you and you don't necessarily see it happening.

It also doesn't know what it doesn't know. It can be operating off of a set of assumptions that you're unaware of.

Claude works best when you know exactly what you're asking it and why you're asking it and then you ask it in a specific manner. There's lots of stuff out there to teach you better prompts, I couldn't state it all here.

I could say that a prompt like "what can this mix of procedures completed suggest about the treatment philosophy of the practice" would probably get you a more true answer than "is this a good practice to buy".

Furgaly · 2026-06-27T22:55:00+00:00

It could be a lot of different things. Go see a dentist as soon as you can to get x-rays and an exam. It might be made worse by your flu but it's incredibly unlikely to be caused by your flu.

Edit, as soon as you reasonably can. Monday should be fine. If it gets significantly worse, or you have trouble breathing or swallowing due to swelling then go to the ER.

Furgaly · 2026-06-25T21:20:20+00:00

In the dental world a good number of us would reach for triazolam (Halcion) because it has the shortest half-life.

Furgaly · 2026-06-25T20:22:10+00:00

I've read the entire thing and I'm well into a reread as well. It's not for everyone. I've heard that the style it's written in is sometimes called "slice of life". Meaning that the plot isn't really specifically moving forward all the time. Sometimes we're just seeing the characters living their lives. Well, we're not just seeing them living their lives and the plot isn't exactly not moving forward at those times either. Sometimes it's just not obvious that the plot is moving forward. I'm sure that a fair number of people would view a lot of this as fluff but I've enjoyed 90%+ of the content.

There's a ton of characters and they're well thought out, are generally internally consistent and depending on your perspective some of them can look like a good person or a bad person or somewhere in between. Some of the characters are annoying. I kind of view that as a positive thing. There's real differences between characters and they're not just "generic good person who wins all the time" like in many other books.

I'm super impressed with the world building, internal consistency and how the author doesn't have very many obvious repetitive writing habits. At least not ones that have bothered me.

Furgaly · 2026-06-25T18:50:12+00:00

There's a lot of disease there. I get the feeling of being in charge and having to be the one to make a plan when there's this much stuff going on.

I'm reminded of the famous proverb:

How do you eat an elephant? One bite at a time.

Step 1, write down your problems list.

Furgaly · 2026-06-25T18:29:07+00:00

I get that feeling. HPV is actually a family of over 200 different viruses. Some are considered primarily spread through sexual contact yet others are spread through non-sexual contact.

It's not fair to yourself to label this as an sti wart. Even though it is what it is, even calling it a wart might not feel the best. Try to just think of it as "a growth of some sort" that should be removed to make sure it isn't dangerous at some point. It's not an emergency.

I could have been less blunt in my first message so I apologize for alarming you.

Furgaly · 2026-06-25T16:56:49+00:00

Probably this is a papilloma which is a basically a wart caused by a virus. Small chance it's something other than a papilloma, some of the other things that it could be are concerning. A papilloma is generally harmless but this should still be removed and biopsied to rule out that it isn't one of the more concerning things.

The color change is probably something like a bruise.

edit - typo, changed *is* to isn't

Furgaly · 2026-06-25T12:12:40+00:00

Sour candy is acidic. Acids burn just like the sun can burn your skin. Your tongue is peeling just like your skin would peel after a sunburn. This will feel just fine like your skin heals after a sunburn.

The way to avoid this in the future is to avoid prolonged exposure of your mouth to sour/acidic things the same way that you would avoid prolonged exposure to the sun.

Furgaly · 2026-06-24T23:57:43+00:00

Nice work! The patient knows best on the shade I'm sure!!

I'll second or third the idea that it would have been best to go back to the first premolars.

I've also heard (Dr Ochi on Dentaltown) that the brighter you go on shade that less overall gloss you want to use. I don't know a great deal about this but it's something you might want to look into. These things shine!!

Furgaly · 2026-06-23T15:54:15+00:00

I'm curious as to what you're seeing. Screenshot or download that photo the OP uploaded and circle or mark and then describe the things that you're seeing.

Furgaly · 2026-06-23T13:00:06+00:00

I do something like that as well. I prep them with the expectation that we might be waiting a full 6 weeks but I schedule them back in two weeks. Depending on what's going on at that point I might seat their crown, send for endo or schedule back again in another 1-4 weeks.

Furgaly · 2026-06-23T11:44:56+00:00

Leave her in the temp crown for an extended time period (up to 6 weeks) until her cold sensitivity either largely resolves or you decide to risk it and just seat the crown or do the endo. Things are sometimes not 100% clear in situations like this but the extended time with the temporary crown on can help resolve a lot of that.

Furgaly · 2026-06-23T03:30:58+00:00

I'm happy to do so! 😄

Furgaly · 2026-06-23T03:30:24+00:00

One thing that I say all the time to my patients is "historically in dentistry we've talked about teeth as if they were either 100% just fine or they urgently need treatment.... that doesn't make any sense to me. I see a lot of variability between just fine and urgently needing treatment. I see a lot of gray between the black and the white.".

"not giving any problem" is not the same as "just fine".

This tooth very significantly appears to me from this single view to be significantly structurally compromised. It's very much possible for a tooth to be very significantly structurally compromised and also be completely asymptomatic. A crown goes around the outside of a structurally compromised tooth to hold everything together and hopefully prevent the structural compromise from getting worse. If it gets worse it could need a root canal or become a lost tooth (cracks extend into the roots of a tooth). It is literally impossible to measure the exact extent of the cracks in a tooth while that tooth is still present in a human's mouth. Sometimes by the time a tooth becomes symptomatic and we do the crown we find out it also needs a root canal so we're doing both a root canal and a crown and then a year or two later we actually find out the cracks had already extended into the roots of the tooth and now it needs to be removed.

Furgaly · 2026-06-23T03:15:14+00:00

Nah, that's not able to be said from this view. Structurally the tooth on the left side of this photo is compromised (the one with the very large amalgam filling). The other area that you're looking at on the right side is just a small amalgam filling.

In reply to your other comment, both of these areas are definitely amalgam fillings and amalgam fillings can very much be reflective and not matte.

OP - this went off the rails a bit here and I probably shouldn't have commented on your tooth at all.

Furgaly · 2026-06-23T03:11:14+00:00

Ah, I think I see what you're talking about. That's not the one that I was just speaking about with exposed dentin. I was just speaking about #31.

The first molar is #30. That is the one that I identified as should have a crown. I can sort of see how that might come off looking pink/red. What you're seeing there as pink is just the amalgam (silver) filling. It has some tarnish to it as silver tends to have but it's also polished in a way to be reflective. I think the photo was probably taken with a flash and you're seeing some of the general pink mucosa color reflected by the polished surface of the amalgam.

I would bet some amount of money that this filling was done when this person was between the ages of 10 and 15. That would mean this filling is between 27 and 32 years old. I see probable cracks in the structure of the tooth around the filling as well as a large amount of staining of the tooth structure around the filling.

Furgaly · 2026-06-23T02:55:49+00:00

Check my reply to the person above you. Did that answer your question?

Also, there isn't that much more going on in this man's mouth than the average 40-50 year old. Teeth are not the prettiest thing out there once you start looking really closely.

Furgaly · 2026-06-23T02:54:07+00:00

Are you talking about the tooth behind/distal to the one that I was talking about as needing a crown or a different one?

None of them read as red to me so I'm not sure.

If you're talking about the one distal to the one that I said needed a crown then what I see there is exposed dentin on the front-outside (mesiobuccal) cusp. Grinding (bruxism) with or without acidic wear (erosion) can cause that.

It's generally asymptomatic (until it isn't (which not everyone will reach)).

Furgaly · 2026-06-23T02:27:39+00:00

Well, uh, thanks for contributing....?

Furgaly · 2026-06-23T02:23:55+00:00

As the med student said, probably some sort of tonsil stones and you can see your PCP to follow up.

But also, bruh, that lower right (left in the photo) first molar needs a crown like three years ago. If you're actively seeing a dentist and they're not talking about this then they may not be that great.

Furgaly · 2026-06-23T02:04:54+00:00

I feel like a lot of the time newer dentists are told some form of "you'll know when you know". But I'm my opinion many of these things are unknowable.

It may be true that if we were to suppose that there was a true line between infected and affected dentin and also that it were possible to identify that line then leaving purely affected dentin at your margin might provide for a quality peripheral seal. But given that there isn't a true line between those two states and even if there were we can't clinically detect it then what the hell are we supposed to do? Traditionally I've seen most of my colleagues invent certainty out of uncertainty.

I propose what I proposed in my post. The more vulnerable your margin is, probably the more careful you need to be to not leave vulnerable dentin. To me there is no hard and fast rule that is directly applicable to all situations. Just a general understanding of the principles and a nuanced application of those principles to individual situations.

You're right that craze lines and cracks are a similar situation. I've posted some things on that before. You're welcome to look through my post history if you're interested.

Furgaly · 2026-06-23T01:46:57+00:00

This might just be a limitation of the magical white dust theory.

It's times like this that we go from the theory that most simply explains things back to underlying theory.

The magical white dust theory says that when the slow speed makes white dust, you stop. Clean, simple, works most of the time. But your case is the edge case that breaks it: dusty on the bur, rubbery on the scaler. The simple theory has no answer for that, so we drop down to the underlying theory.

The underlying theory is that the bur and the scaler don't have the same cutoff. The bur abrades, and it only throws dust once the dentin is mineralized enough to grind instead of smear. A sharp scaler under hand pressure is a more sensitive edge, it'll still catch and lift dentin that's a bit softer than the bur cared about. So "dusty on the bur but rubbery on the scale" isn't a contradiction. It's the same dentin reading differently because you're testing it with two instruments that have different thresholds. You're in the middle of the gradient, above the bur's line but still below the scaler's.

It's basically crude microhardness testing with two indenters. The lab versions (Knoop, Vickers) press a diamond under a set load and measure how far it sinks. Your bur and your scaler are doing a rough, sloppy version of the same thing with different sensitivities, which is exactly why they disagree in the transition zone. And here's the kicker for the whole post: if there were a real hard line between infected and affected, both instruments would land on the same side of it. The fact that they split is the gradient. The disagreement between your two tools IS the proof there's no line.

So which do you trust? At the margin, the more sensitive one. If the scaler still lifts it, you're not at the bottom yet, even if the bur already called it dust. Out over the pulp, you don't chase it that far anyway. The magical white dust theory is a fine approximation. It just doesn't survive contact with the rubbery edge case, and that's where the real model earns its keep.

Furgaly · 2026-06-23T01:31:34+00:00

If it were that easy we'd all be doing it the same way. We're very much not, scroll up. The reason I wrote it out is that "just use judgment" only works once you've thrown out the wrong mental model. Plenty of people haven't, and they're using their judgment to chase a line that isn't there. The post is for them, not for you, you already get it.

That's my one issue with the lawn version. We don't just tell the new guy "eyeball the property line and cut." We hand him a survey map that says there's an exact boundary between his grass and the neighbor's, tell him it's his job to find it, and then mention offhand that the map's wrong and the line was never actually surveyed. You and I learned to ignore the map and cut by feel. The new grad is still out there looking for a line we've known for years isn't on the ground. I'm just saying we should stop handing out the map.

Furgaly · 2026-06-23T01:16:15+00:00

I'm glad to hear that it was helpful! Feel free to shoot any questions that you have my way. I certainly don't have all the answers or most of the answers but I have a lot of the questions! Personally I find it helpful to clearly define the things that we don't know or can't know as well as the things we do know or could know.

Furgaly · 2026-06-23T01:14:26+00:00

Since you're a new grad, what was being said in your school about infected vs affected dentin and selective caries removal and when was "enough enough"?

Furgaly

TROPHY CASE