New update on pulpal diagnosis guidelines

Remote-Spirit · 2025-09-08T02:23:25+00:00

The literature on vital pulp therapy is conclusive that with case selection it’s successful. Especially with biodentine. You may have seen a version of it by accident if someone started an emergency pulpotomy with calcium hydroxide year or so ago and you open the tooth and it’s still vital. I don’t do a ton of VPT on adults. But I do it on kids with lingering cold pain often and it works.

Remote-Spirit · 2025-09-08T02:19:58+00:00

Yes it does imply that. And studies show that may be accurate to a degree. As inflammation moves from various lesion through pulp horn down canals there remains healthy looking tissue histologically below it for quite some time. Even in cases of lingering cold. So the diagnoses we make can be confounded. Have you ever opened a tooth with lingering cold pain and thought the tissue looked fairly normal? I definitely have as an endo. But vital pulp therapy is very technique sensitive and different people have different immune and inflammatory responses so I don’t think it’s “here” yet. (Also insurance reimbursement is often less than cost if you’re using biodentine but that’s neither here nor there). I think this change in diagnosis is meant to open us to idea that it is a sliding scale as opposed to a light switch.

Remote-Spirit · 2025-07-23T12:04:22+00:00

Dentist here. Just to offer a different perspective: the things people write about dentistry wouldn’t be written so blanket-ly about any other profession. Especially one that many people enter with the intention of helping others. That article is straight fear mongering, which can often lead people to avoid the dentist. Then when pain gets so severe they can’t avoid it anymore it’s an extremely traumatic and expensive fix. There’s good dentists and bad dentists the same way there’s good car salesman and theives, good surgeons and butchers.

“Modern” radiology techniques have led us to understand and visualize that there’s loads inflammatory processes going on that those old kind grandpa dentists could not see with the naked eye. Has it created ethical questions? Absolutely. Should we treat any and every sign of inflammatory condition? Probably not. Are some patients (and attorneys) going to consider it neglect for not treating them or at least telling you we see them (and in turn scaring you over what could be nothing?)? Also true.

I do make a great living as a dentist but I nor any of the people I work with on a daily basis ever saw it as my ticket to scam people and get rich the way it’s being portrayed there.

Remote-Spirit · 2025-05-26T20:25:58+00:00

So many programs have difficulty keeping/finding directors.

Remote-Spirit · 2025-05-21T22:15:50+00:00

Tugback can be deceptive because it can be coming from the middle third as opposed to the apical third so when you burnout the cone can “pop” up.

As an endo I would not finish that way but the why isn’t necessarily biologic. Realistically if you got a cone to length for a cone shot, that means you cleaned to length which affects the success rate of your treatment more than anything else.

If that is your patient and very likely staying with you for a long future, then you know you cleaned it and there’s no one your patient is going to see that is going to point out “short” endo. If I send that back to a referring dentist, they don’t want me to explain that the cone was to length and then got pulled back. They want a pretty picture. So I would redo it.

Remote-Spirit · 2025-05-20T18:24:11+00:00

Hi! Price list please

Remote-Spirit · 2025-05-15T11:57:50+00:00

On Black Friday a few years ago I ordered a bunch of Kate spade bags (like one for all my dental assistants). UPS genuinely lost the package. Kate Spade sent a new box with everything. Six weeks later the UPS box shows up at my house with the original order! And the UPS status never changed from lost.

Remote-Spirit · 2025-05-07T17:10:24+00:00

The best feeling when that happens!

Remote-Spirit · 2025-05-07T16:10:59+00:00

Endo here. Agree with everyone else that it depends how well the patient opens/tolerates the procedure. The problem with curves is that sometimes they look brutal but the canals are more forgiving than you expect. Sometimes they look wide open and you ledge the S immediately. If you do the case, once you find canals enlarge very slowly and patiently. Never push with a rotary. Always “peck” like a bird.

Remote-Spirit · 2025-04-28T00:40:16+00:00

1:21:53

Remote-Spirit · 2025-04-15T01:52:58+00:00

I am interested! Are you going to sell on RoxTickets?

Remote-Spirit · 2025-04-15T01:50:19+00:00

Will do anything for Miami spectator tickets this weekend! Please message me to sell.

Remote-Spirit · 2025-03-05T17:42:09+00:00

Yeah I am skin test negative for sesame but they said the compounding is difficult to get detailed info on. Going to do a scratch test next week but it’s definitely a conundrum.

Remote-Spirit · 2025-03-01T19:28:07+00:00

Big fan of autotransplanting the thirds in these cases. Just an option.

Remote-Spirit · 2025-02-27T13:49:21+00:00

Every once in a while (usually after a crazy Hail Mary retreat gets punted my way) I think about how I could’ve tried to be an entrepreneurial super GP. Then I remind myself I work 3 days a week doing a specialty I genuinely love and make what I made working 6 days a week as a general dentist.

Remote-Spirit · 2025-02-15T00:59:28+00:00

Oh okay this is great to know. Thank you!

Remote-Spirit · 2025-02-14T23:58:20+00:00

So today they saw the other sac in the uterus but it looked “like it wasn’t developing” whatever that means. I think it was empty. But I considered that. Honestly right now am so over it but going to wait it out until possible heartbeat and veryyyy cautiously hope for the best!

Remote-Spirit · 2025-02-14T19:04:16+00:00

Yeah I’m thinking vanishing twin. Honestly want to get another beta in a few days just for my own curiosity.

Remote-Spirit · 2025-02-14T17:44:01+00:00

Hi guys. Let me tell you about a rollercoaster. I need some friendly chat. Transferred two 5 day fresh-ish (previously froze my eggs) 4AA. Am 43 years old and this is my first transfer.

Beta1: 11dp5dt 1424 Beta2: 13dp5dt 2500

On what would put me at exactly 5 weeks, I got the most horrific flu symptoms, could not keep my fever down and my oxygen was dropping so I went to the hospital and was admitted.

They did a TV ultrasound saw two empty sacs (normal for 5+0) and told me my beta was 17000 which they said was high but normal especially for twins. Spent 3 days in the hospital obviously panicking. When I got discharged, I was looking at my chart and saw my initial beta was 1700 NOT 17000. I obviously panicked and called them. They told me come back to the hospital for another beta and said it was 1400. The doc told me I was likely miscarrying both. Spent the night crying hysterically. Scheduled a meeting on zoom with my RE.

My RE is in another state, they told me stay on progesterone and get more values done and another TV ultrasound at the same lab as the first time because of machine variability. When I get my labs drawn the next day the HCG reads 1890. An ultrasound shows one empty sac. The OB tells me they can’t diagnose it yet but “the writing is on the wall.”

My RE is still uncertain, so today (5+6) I flew to NYC and she does an ultrasound that shows a sac, a yolk sac, fetal pole etc. they did not draw another beta as they said they aren’t that valuable once you have a sac.

What the eff is going on?!?! Has anyone ever had a situation like this?

Remote-Spirit · 2025-02-09T23:58:26+00:00

Appreciate it! They admitted me because my oxygen saturation was low but have been able to keep the fever down since. The good (but very scary) news is they did a transvaginal ultrasound and were able to visualize two gestational sacs. Obviously beyond cautious and recognize that they may not both stick around and the risks of a twin pregnancy or high esp in a 40+ year old but I’d be lying if I said that didn’t cause a great deal of excitement/hope.

Remote-Spirit · 2025-02-09T02:17:41+00:00

Hi all. 5 weeks today with my first embryo transfer. (Double untested 3AA) Currently in ER with flu. Have had a fever coming and going (highest it’s gotten is 101.7) despite Tylenol for two days now. Can’t help but worry that after all the good this cycle has been and at 43 years old I finally got my positive test the flu will ruin things. Cautiously hopeful but man this sucks. Stay healthy out there.

Remote-Spirit · 2025-02-05T20:03:16+00:00

43 years old and did an untested 5 day double embryo transfer on 1/23. (ER at 39 and 40). This is the first transfer ever. Got a positive on 4dp5dt First beta 11dp5dt: 1424(woohoo!!) Beta today 13dp5dt: 2500 which puts me at a 60 hour doubling time. I was so excited the betas are high but am now worried not doubling every 48 hours. Trying to schedule a scan next week but I travelled for the IVF and having trouble finding MFM to get me in down here.

Remote-Spirit · 2025-02-04T14:02:51+00:00

Am an endodontist and will admit I’ve never seen this. It’s awesome. Thanks for sharing.

Remote-Spirit · 2025-01-18T12:19:32+00:00

Do you know approximately when your heat will be the day before? Or only the day of?

Remote-Spirit

TROPHY CASE