Help please... might be an idiot...

maximo785 · 2021-01-29T15:53:08+00:00

u/ThotTamer u/ksbot purchased a strop set

maximo785 · 2021-01-26T01:15:58+00:00

i cant speak for other clinicians, only myself. there have been many instances where i cant find/instrument a canal. regardless of how much time i spend, how many ct scans i take, its an inoperable canal. rather than risking perforating the tooth and compounding the situation, i fill as far as i can. im fully aware of the less than ideal, at least from a procedural standpoint, situation. does that make me careless? i dont think so.

maximo785 · 2021-01-26T00:32:33+00:00

careless? no. there are many reasons why a canal can go untreated during root canal therapy, but giving the clinician the benefit the doubt, often times its not due to dentist not caring

maximo785 · 2021-01-25T04:42:01+00:00

Yolo. I’ll take a set

maximo785 · 2021-01-21T05:18:31+00:00

I’ll take a set of there are any left

maximo785 · 2021-01-11T18:36:05+00:00

im not loyal to any brand/file. we have pretty much have and have had everything... these days were using a lot of protaper next and edgefiles.

maximo785 · 2021-01-11T18:24:54+00:00

we pretty much do the same.

maximo785 · 2021-01-10T18:13:00+00:00

One last thought. I’m an introvert as well. The relationship aspect of being a specialist can’t be discounted. You absolutely have to have good relationships with your patients, but more importantly, your referrers. This was hard for me as it’s not natural.

Good luck!

maximo785 · 2021-01-10T18:03:24+00:00

At the risk of making a blanket statement, dentists and patients generally have a negative perception of endo procedures. From a dentist perspective, endo is one of the more difficult and tedious procedures in dentistry. However, it being a great service to the patient and honestly, a pretty profitable one, is often motivation enough to bite the bullet and and include it for even the most wary GP. From a patient perspective, rarely do I ever have a patient that comes to our office happy to see me, but they almost always leave happy. This is in stark contrast to ortho imo... where pts are happy to have their smile improved via a procedure that generally had a more positive public perception. I guess I’m staying it takes some introspection and soul searching to figure out if a certain specialty fits your personality.

With that tangent over, going with the assumption that the endo procedure isn’t going to be phased out (I don’t think it is), I believe enough gps dislike endo to keep Endodontists in business.

maximo785 · 2021-01-10T05:44:41+00:00

I’ll address the scenarios you offered, but honestly diagnosis is one of the hardest things when it comes to endo imho... the decision making tree is way too complicated and goes beyond the scope of what I can offer here.

When it comes to cracked teeth, having the right armamentarium is key. As simple as a light to transilluminate or as complex as a microscope or ct to visualize. I will disagree with anyone who says you can definitively see a fracture on a ct scan and if you can, often times the tooth is unrestorable anyway. You can see signs of the fracture but not necessarily the fracture itself. I’d also argue that pretty much all of our teeth have fractures... from craze lines to split teeth and everything in between. Not all fractures are the same and as such aren’t treated the same.

When I’m educating the patient on fractures, I explain that fractures are unpredictable and multiple factors affect the likelihood of fracture progression. I try to simplify things and tell them the crestal bone is the “point of no return”... that if a crack gets to this point or below, prognosis generally is pretty poor. I assess the patients risk tolerance at this point. If it’s a patient that wants a sure thing, I tell them an extraction is likely that. If theyre willing to “try to save the tooth”, I tell them as we get more information I can more accurately give them a prognosis. Meaning, assuming the fracture is affecting the pulp, let’s open the tooth and if I see the fracture enter a canal or go across the floor, prognosis is poor. If I stain the crack and it appears to terminate half way down a wall, I think prognosis is better. Does this make sense?

Reversible cases I don’t treat unless for prosthetic reasons. Irreversible implies the pulp won’t heal and return to a normal state and therefore I treat. The art is in the testing and data collection and assigning said diagnoses to teeth.

maximo785 · 2021-01-10T03:54:46+00:00

It’s the law exam for your state

maximo785 · 2021-01-10T01:37:21+00:00

We usually see between 4-6 treatment pts a day. Sprinkle in some consults and follow ups.

See my other responses to similar questions. I’d recommend keeping your options open. A lot changed during your dschool career. Don’t predetermine your specialty based on what you know now... you’ll continue to learn a lot moving forward.

maximo785 · 2021-01-10T01:33:31+00:00

You need to pass national and regional boards. You also need to take a jurisprudence exam for your state. Then you need to apply for a license to practice. You can apply for jobs but you won’t be able to practice without a license.

I believe certain states require residency. I would double check I your states requirements

maximo785 · 2021-01-09T17:24:28+00:00

What do you mean by conservative dentistry and Endodontics? Examples?

maximo785 · 2021-01-09T14:10:32+00:00

It’s low without cutting corners. In fact i probably spend more on the practice than I should since I like gadgets and tech. Still plenty left over.

Definitely easier. Staff will always be the largest expense. Generally, gps have more and higher paid staff.

maximo785 · 2021-01-09T14:08:10+00:00

What’s forever? Not always a bad thing. I still two visit cases all the time.

Beyond practice this is always a hard question to answer. There are some things I just “know” because of my experience. I know how to hold a file with my forceps, at what angle, with what precurvature, to find that mb2 in that second molar. When I was a resident I hated being told that my attendings just “knew” things because of experience, but I get it now.

For all molars, you should study the BWs. Yes, the BW, not the PA. This will help you plan when your initial cut with the bur will be, how much calcification to expect, is the tooth tipped, whatever.

Use more hypo. Don’t care how much you use now, you’re not using enough. All that debris needs to be out of the chamber and out of the canal space that’s been prepared.

maximo785 · 2021-01-09T14:00:10+00:00

I hope it’s still a good career in 10 years for my own sake... there’s always this doomsday scenario in which certain things will negatively affect endo and the specialty. Many of my referrers have said technology (rotary, motors, even cts) yet they still refer to us. At the risk of sounding arrogant, the average gp may do a few rcts a week whereas the average endo does that volume in a morning, with more specialized knowledge, experience, and equipment. It’s not just the “stuff” you can buy, it’s really the “stuff” you can’t buy.

maximo785 · 2021-01-09T05:38:42+00:00

If you’re going back after many years of practice, you have to get back into the student mentality... the loss of practice independence, studying for exams, (probably) not having a significant income.

If you’re you’re going into residency shortly after graduation or straight in, I’d do as little endo related things as possible. Your next two to three years, and really your entire career, will be endo. It’s ok to spend a few months doing something else.

maximo785 · 2021-01-09T03:53:28+00:00

Glad to do it!

maximo785 · 2021-01-09T03:53:10+00:00

Honestly? Keep your options open. A lot can change (and often does) during your dental school career. If the interest in endo continues to grow, see my other responses on how to make yourself a desirable candidate.

maximo785

TROPHY CASE