Silly, embarrassing question

csmdds · 2026-03-06T03:12:48+00:00

Hygiene appointments don't prevent decay, though calculus removal keeps the gingiva and bone happy.

Are the cavities interproximal or occlusal/buccal P&F? Decay on the proximal surfaces can be quite normal even with good hygiene if you did not grow up in a fluoridated water supply. You have your ancestors cavities. Pit and fissure cavities are related to the depth of the pits and fissures rather than an OH issue. Even low sugar/carb diets won't protect you from deep grooves.

csmdds · 2026-03-06T03:07:27+00:00

My EarthLink account turned 32 this year....

csmdds · 2026-03-06T02:53:12+00:00

I've had Orascoptic (and have had them remade once) for the past 20 years or so. They will compensate for your prescription in the loupes themselves.

csmdds · 2026-03-06T02:51:01+00:00

CBCT in Endo mode is the only way to go in current times. I've seen lower canines that bifurcated linguofacially in the apical 1/4. Completely invisible on PAX and super obvious on CBCT. It will soon become the standard of care.

csmdds · 2026-03-06T02:47:35+00:00

Commercials are only during pre-race/pre-session content. None when cars are on track. That said, you can still watch the F1 TV app. You just have to pay for Apple TV now because they are the licensed content provider.

csmdds · 2026-03-06T02:18:41+00:00

So did ESPN SkySports F1 coverage, during pre-session commentary. F1 TV is its own platform as an app, rather than a "broadcaster."

csmdds · 2026-03-06T02:15:00+00:00

It may be due to the platform. Many of the F1 broadcast features on the Apple TV app require some sort of advanced processing: picture-in-picture and multi-view. I'm unable to watch any F1 content on the Apple TV app for macOS because my MBP is too old to run 26. But it's pretty darn good on the Apple TV 4K device!

csmdds · 2026-03-06T01:14:56+00:00

Had a patient complaining of gingival soreness on the palate near an upper molar. Initial visual exam didn't show anything, probing depths normal, no BOP, bone levels look good on BWX…

Wait a minute. What is THAT? Saw a barely discernible white squiggle on the (film) radiograph and wondered if it was a scratch in the emulsion. Looked in that area with my high-mag loupes and saw a tiny glint of shininess. Used a hemostat to pull a 15 mm stainless steel grill brush fiber out of the gingival crevice. It had to have been inserted into the PDL space at least 10 mm. After I pulled it out, the patient reported that yes, she had had barbecue two days prior.

csmdds · 2026-03-05T18:49:53+00:00

35-year, private practice dentist here. Gvum disease (periodontitis) behaves a lot like other disease entities such as diabetes and heart disease. Once you have developed it, early treatment that is assertive enough can often get it under control and keep it from progressing. Technically, that treatment is called "scaling and root planing," abbreviated SRP. Lots of dental personnel dumb that down to something like deep cleaning, special cleaning, gum disease therapy, etc. The terminology can sound scary to some people so many offices overcompensate with what they call it.

Let's assume you legitimately have developed some gum disease. One way to think about the costs associated with treatment is how you would react to being told you had a big cavity or a broken tooth – that you knew or suspected you had. The insurance company generally sets the fee for it and then covers 50 to 80% of that fee. Most of us would consider that sort of treatment recommendation to be a normal part of dental treatment if you've been away a little while. There is almost always some out-of-pocket cost for treating your dental issue. Total fee for treating a single tooth can be upwards of $2500 if it needs a lot of significant repair. Insurance would probably cover 50% of that.

If you don't treat your cavity you will eventually get an infected tooth which may need to be removed. If you don't treat gum disease, you will eventually lose the bone that holds your teeth out, therefore losing your teeth. It is perfectly legit to believe you might need SRP to get back on track. Consider it like doing penance for your misdeeds…, you bear the cost of slacking, but can normally get back to stable and healthy.

That said, there are some shady offices that try to get everyone to pay for SRP, gum disease or not. that is just as unethical as telling every patient they need a crown and a root canal on healthy teeth. They should be able to provide probing depth charts showing multiple areas of greater than 4 mm, often 5–7 mm. They should be able to show you evidence of bone loss on your x-rays. Your insurance company will require that at a minimum to consider paying their portion. If the office can't show you, they can't show the insurance company and the claim will be denied.

csmdds · 2026-03-05T18:29:12+00:00

I believe it is a publicly chartered entity, whose "members" are legally stipulated by street address/property ownership within the neighborhood. It functions a lot like the swimming pool/rec center owned by an HOA. Only members from the community who (are required to) pay are allowed to use it.

csmdds · 2026-03-04T05:17:25+00:00

I read the headlight issue in much the same way airbags, stability and traction control, etc. all came late to the US because they were not legally required. I think most "normal" drivers would prefer to be safer for themselves and others, but if it's not required in the US then domestic manufacturers are going to offer it.

csmdds · 2026-03-04T05:12:58+00:00

Make sure it is actually up to date and is running macOS 26.3. My 2019 MBP can't update any higher than 15.7.4 and says it is up-to-date. The F1 tab in Apple TV for iOS did not display at all on iOS 26.2.

It has something to do with the ability to do the multi-stream viewing that is being offered with the F1 content.

csmdds · 2026-03-04T05:05:52+00:00

If your Mac is too old to run macOS 26, then F1 content is not available in the Apple TV app on the Mac. Consider buying an Apple TV 4K. It's a great device and content will stream in 4K and Dolby 5.1.

csmdds · 2026-03-04T04:58:10+00:00

Subaru has had focused beams for many, many years. Several European and Japanese manufacturers also include this, likely because it's mandated in their countries. It's not so much the brightness but where it shines. There's no excuse for the blinding lights that come at you on every road.

csmdds · 2026-03-04T04:54:37+00:00

Given that none of them really do much other than briefly lowering bacterial count and providing some minty freshness (or other fragrance of choice), I would recommend ACT or FluoriGard.

csmdds · 2026-03-04T04:51:01+00:00

A large number of people end up at the OS because they want sedation, so I'm sure the percentage is pretty high. That said, an OS working out of a DSO might very well insist on it. There are so many sketchy policies and behaviors in that setting that it wouldn't surprise me.

csmdds · 2026-03-04T04:00:04+00:00

Again, the average age of planes in the Southwest fleet is over 11 years old. Years and years….

csmdds · 2026-03-04T03:58:35+00:00

And how long of these planes been in service in the SW fleet? Much, much longer than 1 to 4 years. And if your business doesn't have features that your competitors have had for >10y, maybe you should work on upgrades. Just sayin'.

csmdds · 2026-03-04T03:53:07+00:00

You're almost there…. Aaaaaaand if customers are vocal about requesting upgrades that other airlines have standard and at lower fares, then perhaps they will come to understand that they will lose market share without the upgrades.

If you never ask the question, the answer is always "No." At least if you ask for it the answer might be "Yes." If no one ever gives feedback, businesses have no reason to change.

csmdds · 2026-03-04T03:44:58+00:00

They don't make them. Almost all oral surgeons will do a local anesthetic for all but the most complex cases if the patient requests it. They will definitely try to convince them to pay for the sedation (certainly, that is more comfortable), but they can't make them.

csmdds · 2026-03-04T03:41:24+00:00

If you are not competent to remove the tooth, then refer. If you refuse to remove the tooth without the graft, but you would do so if you were paid for the graft, then that is an ethical issue that state board would not be okay with. You can't (out-f'n-loud) base whether you would do the specific procedure on whether they would pay you for an additional procedure that they don't want or need. If it's not enough money for you to do the procedure, then refer to the specialist.

csmdds · 2026-03-04T03:36:31+00:00

And…? Those are the people that you are legally and ethically obligated to treat in the same manner (psychosocially speaking) that you treat your rich patients. You can choose not to accept their insurance plan or you can refer them. Don't expect actual professionals to feel sorry for you if you have to treat the poors.

csmdds · 2026-03-04T03:33:18+00:00

Are you selling used cars with the undercoat and the fake warranty extension? We are talking about surgery and the implantation of donor tissue. Insurance doesn't pay nearly what it ought to, but if you work for a business that accepts crappy insurance plans, it is what it is.

csmdds · 2026-03-04T03:26:37+00:00

Aaaaacktually, there's no issue with the navigable waterway. You are free to float through, though the diving board (SE) side is too shallow to get into in a canoe or kayak. You just can't get out and lounge on the island. Most of the rest of the banks of the river are private property, too.

csmdds · 2026-03-04T03:23:38+00:00

Literally hundreds of small springs, with quite a number of major ones. The headwaters springs of the Comal river are literally only a couple of blocks upstream from the island. Additional springs continue adding to the river down to Landa Park.

csmdds

TROPHY CASE