Very Clinical: Dental Student Questions, Part Deux!

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[00:01:30] Welcome to the Very Clinical Podcast, brought to you by Zerk Dental Products. In about the time it takes to do an MO on three, we will entertain and enlighten you with tips and tricks for regular daily dentistry. Here's Kevin and Zach. What is up, Very Clinical listeners? And welcome back to yet another episode of the Very Clinical Podcast. I am Zach Miners, coming to you from Kansas City, Missouri. With me, as always, my trusty co-host, Dr. Kevin Harefriar. Kevin, what is happening in the great state of Ohio?

[00:02:01] I want to just give some love to Hufflepuff. Hufflepuff? Okay. That's what, that's your sorting? No, I mean, no one would ever say that. No one knows what we're talking about right now. I feel like people are saying that about you. I've always heard Kevin Fryer, comma, Hufflepuff. Is anyone ever a Ravenclaw? One thing I've always known about Kevin Fryer. Ravenclaw! That's not you, Kevin. I'm sorry. I agree with Hufflepuff. All right.

[00:02:28] Rejoining us from last week, as promised, Dr. Alan Mead. If you listen to this podcast feed, you might have heard his voice. Yes. Possibly. You're a wizard, Ari. Oh my God. Hagrid is in the house. That's right. I, and the bit could have been what house we'd be sorted into, but that's. Well, there's four of us here. Maybe that's the bit. There should be a starting hat. Yeah. There, there we go.

[00:02:53] And also returning from last week, our, our good dental student, Moe. What's up? What's up, Dr. Moe? Not a whole lot. Just hanging out with some cool, some cool mentors. Cool old guys. Where's the cool part? We're talking about Harry Potter like it's real. That's exactly. I know. These are the coolest guys I knew. That's right. Yikes. Well, I love Harry Potter, so. There you go. There you go. Have you seen the SNL, um, Harry Potter skit with Lindsay Lohan? Yes.

[00:03:24] Look, look, look that up. It's an all timer. Just look it up. That's going in the show notes, but I don't want to hear about it. Link that up. Link that up. It's, it's, that's an all timer. Just buyer beware on that one. Really good. Moe, you look that up on YouTube when you're all done. That's the funniest thing. Oh my gosh. Enjoy. Yeah. Yeah. Yep. That's pretty funny. Yep. Enjoy. It's a good one. Uh, okay. Um, we'll see Kevin, what is tonight's bit before we get into more Q and a, as continuation of last week's show. The bit is what position would you play on Quidditch?

[00:03:54] Moe, you're up. There's positions? There aren't there positions? There has to be positions. Yeah, exactly. The only one I know is the seeker. The seeker. I definitely wouldn't be that. I'm not nimble enough. Goal keeper. You call me the seeker. Whichever one of these people. All right. Uh, what we really planned was what we, we have asked an older dentist if we were, uh, in most position when we were back in dental school or pre-dental school.

[00:04:20] So, um, I guess I'll go, let me go first. I would just ask, uh, what do you really like about this job? Because what I thought, what I, my perception of what dentistry was, I got my teeth cleaned every six months and kind of thought that's what it was, you know? And then there was a whole vast array of other things that I had no idea about.

[00:04:49] Um, you know, so I guess that's what I would have asked. Well, as someone who had access and I was going to say the same thing to an older dentist all the time, here's what I wish I would have asked a different older dentist because I could ask, cause I asked my dad, whatever I want. I would have, I wish I would have asked, tell me a little bit, just give me a little overview

[00:05:15] on a dental business and when is a dental business associate ready? Because ours was decidedly not. And I think dad was under the delusion that it was. And I didn't know anything better. I didn't seek another opportunity. I didn't listen to the business classes because I just thought, here's where I'm going and everything's going to be great. So it's like you're in my brain, Zach. That's exactly where I was too. It's exactly where I was.

[00:05:45] You and I should record a podcast on how, how those things turned out differently because I always thought that I was just going to buy dad's practice eventually. And I ended up going a different direction, but it's interesting. Yeah. Well, um, if I would, what do you got out? I guess I would ask this whole list of questions that I have. Yeah.

[00:06:05] I got, I got one now, but it's only in retrospect because would you consider a residency? Okay. Okay. Like I got to tell you, it's only since I've been podcasting over these years that I realized there was, there's a lot that I could have done more that might've prepared me a little better for a lot of stuff. Now, does that mean specialization? Maybe.

[00:06:33] But I also like, I mean, I'm hearing people that are doing AGDs and GPRs and stuff that just got a lot more surgery background. I don't know. I feel like 100% done one of those. I agree. I wish I wouldn't have. I wish I would have too, but I also don't know. Here's my thing. I'm not sure many older dentists knew much about residencies, particularly not specialty residencies. Kevin's got it. Kevin has a comment. Kevin. I did. I did the GPR. Did you really? Yeah.

[00:07:00] I did the residency and it was, but it was not what everyone else's experience was. I think I, I don't want to make, it could have been better. Okay. Okay. Well, and I think it allowed me to practice kind of on my own with someone else watching me and all that. And I got exposed to a lot of crazy stuff, but could have been better.

[00:07:28] Well, I mean, like, and the other thing is Zach and I probably can talk about this. I had as much supervision as I wanted at the time because dad was willing to help out with whatever, you know? Yeah. So, I mean, I had, I had mentorship like that, but I also only had, I only had, I could only see the style of practice that he did because that's, that's what I had, you know? And so he was kind of a roller skate guy. He was, he, he ran multiple chairs at once.

[00:07:55] And that was, and I, I did that for a while and I, it wasn't for me as much. Um, so, I mean, like on some level that situation, I, I, I just didn't, I didn't see as many different ways to practice and, but I don't know that I, and I, so I, on some level, I do think in dental school now you actually get exposed to a little bit more of that. At least, at least I know like for instance, okay.

[00:08:23] So my dad's best friend from dental school still teaches, he, he, uh, he helps run a clinic that the university of Michigan sends students up to every, they do a two or three week rotation through there and they're seeing kind of rural dentistry. Like it's, it's up North in Michigan and it's, there's a lot of big fillings, a lot of extractions and a lot of removable, you know? And you're, and you're sort of like, okay, that's kind of cool. That's, you don't necessarily see all that when you're in Ann Arbor and literally Joe has been practicing dentistry since 1968. So I mean like this guy knows he's seen so much stuff. He's a blast.

[00:08:53] He's great. If you guys ever come to the vetter meeting, you'll get to meet Joe. He's awesome. Anyhow. Cool. So, and he actually listens to podcasts sometimes. So if you're listening, Joe, hi. Hi Joe. But, but the, but the reality is just like on some level, I, I seeing as many different ways of practicing, this is absolutely not a great answer to what would you ask an older dentist, but on some level, being able to being exposed to a lot of different ways to practice. So I, I would ask about a residency and I suspect a lot of the older dentists that I knew didn't know much about residency.

[00:09:22] So I would just explore that as a younger dentist. All right, well, let's get to your questions. Perfect. Let's do it. Um, so first one of the day is what is your advice on mastering occlusion, occlusion adjustments for restorative procedure. And I want to, I want to talk about fillings and crowns here. So let's start with, let's start with that one. So if you're, it really depends on if you're, you know, let's be honest.

[00:09:50] I mean, if you're changing a tooth or two, it's a different animal than if you're, you know, if you've got an entire quadrant or entire arch or something like that. But the reality is, is I'm doing, I'm doing fillings and crowns most of the time. And I've learned over the years, there's several tools that help. So, um, and I, I probably talked about this on the show. I like, I like troll foil, uh, articulating paper. It's probably my favorite, but, and I also use shim stock, which is the eight micron film

[00:10:17] is shim stock tells you when you have to adjust and, and bite paper tells you where you have to adjust. Uh, if you're, if you're trying to, you know, if you're doing a restorative procedure and you're trying to get it back to, back to normal, ideally you have marked and checked with shim stock prior to restoring. So you're kind of trying to go back to where you started from this again. This is, if you're not changing someone's occlusion completely, you're just trying to adapt to what they have.

[00:10:43] Um, I'm going to tell you this, like I using a digital workflow in a lot of cases, I don't have much adjustment on the occlusion and the, and the shim stock will tell me that. But when I do, then I go to my troll foil and, and I can, I can figure it out from there. So I, that took me a long time to figure out the, the different ways of using the, those tools. Okay.

[00:11:07] Um, one thing I guess just wanted to follow up on with that is, so when, what do you do if, um, like for a large filling, do you, do you, so like my professors all tell me that the filling should not be in contact, like period. So is that something you subscribe to not a horrible rule, but it depends on what surface you're restoring to. I mean, on some level, if you can, if you can know what was touching before you started,

[00:11:35] sometimes where you're restoring is going to end up being where it touches. So, um, am I, am I right about that fellows or not? Kevin is nodding. Sure. Yeah. I think that first of all, um, getting the occlusion, right. The first time is a big practice builder. I guess I would say the opposite way, not getting the occlusion, right. The first time is not a practice builder.

[00:12:00] So I, I think it's kind of an art, um, that you just kind of know, which is not a great answer. Uh, Alan's technique is great. I do something similar, but sometimes you just gotta maybe be a little bit more aggressive in removing those marks than what you think you are. That's a great point. Because. That's a great point.

[00:12:28] You, you need to be, when you adjust, don't dick around. Yeah. Get after it. Like, cause it'll take all day if you dick around. You're sorry, Kevin, I interrupted. No, that's, that's it. Because, you know, I would much rather as a practice owner, as someone who cares about our reputation in the community, I would much rather quote over reduce something on their

[00:12:53] occlusion and have it, you know, uh, grow into occlusion than have someone call me back five or six times because we didn't get it right. So that's. 100%. That's my take on that. Um, here's, I mean, in addition to all the things you're already going to learn, like which articulating papers to use and stuff like that, a couple like little things that have gotten me out of situations where the, the person just is like, someone's just like a real lock and key bite and is hyper aware of their bite. Sometimes you got to sit them up.

[00:13:24] Yeah. And, and have them, have them, have them bite when they're actually vertically sitting up, not lying back. Um, sometimes lining the, the, uh, articulating people a little vastly can, can, can help, can help your, uh, really good marks out. Sometimes switching from one brand of articulated paper to another, you know, it's like, I've got the troll foil and it's great. It's my number one, but I've also got AccuFilm too. Yeah. And sometimes, um, one picks up something and one picks up something else.

[00:13:53] And so, you know, for sure only in rare cases do, if the person doesn't say that it feels right, do I, do I really like draw a dig in the sand and say, no, I've got it. You're, you know, this, you're, you're, you're feeling something different or you're numb or whatever, you know, but for the most part, you want to make sure the person's, regardless of what the paper says, the person's got to think they're coming down all the way. Also the sound. Yep.

[00:14:22] You're going to get used to that sound of what it just, what teeth on teeth sounds like. That's part of the art. That's part of the art. That's part of the art. Yeah. And they don't teach that in school. The art of it is like, if, if we were a band, we would play together and you would just know that it was right at some point. Yeah. Once you played together for a long period of time, you just know that it's right.

[00:14:52] Or you would know that it's wrong. Hey, Alan, you're off. You need to tune your instrument, whatever it is. So there is some sort of an art to this that you just know, and you just got to screw it up enough times to, to know. I got a caveat for the getting it right the first time. And it's, it is, it's still technically getting it right. But here's the thing. Sometimes, particularly if it's a lower block, if you're, um, and the patient is really numb, you're going to say, I think I got it. I'm pretty sure we got it, but here's the deal.

[00:15:22] Um, if you come out of the numb and it feels different to you, I want to know. Sometimes I'll say, I'll, I'll say, we're going to call you and find out how it feels when you're out of the numb or for sure. Or if they're close, if they don't live far. If it wouldn't be a pain, tell them, I want to get you back when you're not numb in a day or two. And I want to make sure that we got it right because I'm a little concerned about this. And so on any mega case, you know, for sure, six, eight, 10 units, I'm always going to

[00:15:50] have them to check the bite in, in, uh, but if there's anesthesia involved and they're not sure and I'm not sure, sometimes I, it's my insurance policy to, to let them know that sometimes anesthesia makes this hard to get it right exactly the first time, but I'm going to get it right. I want you back when you're not numb. Patients appreciate that. And that is, that is, that's your get out of jail card. Yep. Cause like, like on some level it's, it's still responsible. It's just that they're numb and you can't, you know, I, it doesn't happen very often.

[00:16:19] There's, you're setting them up for the possibility that you might not have got it and giving them like an, an easy, they're not going to have to call back. You're not going to give them a hard time. Exactly. Or you've already got an appointment set up to, to, to, to take care of it, you know? So, but yeah, you want your like callbacks on bite, you know, like Kevin said, you get enough callbacks on bite and you're, you're losing business for sure. And you're wasting your time.

[00:16:48] Hey, it's Kate, the dental assistant, and it's time to get very clinical. And this episode's very clinical corner. Are you ready? Dr. Mead? Let's get to it. Forehanded dentistry, in my opinion, is one of the best advancements that we've had in dentistry. Efficiency alone is a reason to have extra hands. I agree. When you have an extra set of hands to use, it's a good thing, especially if you're short staffed. Yeah. The dental industry is in a really fragile state when it comes to staffing right now,

[00:17:13] with some states actually reporting a two to 100 candidate to open position ratio. How are we supposed to do our jobs without hygienists or assistants? I can work solo, but it takes a lot longer. Yeah. And it decreases your revenue, right? Even as dental assistants and dental hygienists, we can use the extra hands during some procedures to become more efficient. I can list several procedures that I need for hands or more for proficiency. Isolation devices really help replace the lack of hands during procedures, and every provider

[00:17:42] can actually benefit from using them. Even hygiene? Especially hygiene. So how many times has your assistant been stolen by your hygienist to suction during scaling or sealants or something like that? I appreciate that they're helping out, but I'm always stuck waiting for the assistant to return for our procedure. Yeah. And we hate leaving you waiting. Trust me, it never feels good for us. But listeners, if you're looking to up your isolation game and create additional opportunities to provide care, check out the show notes to learn about how our isolation devices can help.

[00:18:12] All right. What do you got next? Next up. Next one is, what do you do to manage patients who have a very strong gag reflex? I refer those to Dr. Ellen Mead. Yeah. I'm a specialist. I'm a specialist. And I use acupuncture. Well, I asked Kevin about his file technique. He's got his file technique. I've got two tricks. Poke them right in the net. Yeah. Let's hear them, Kev. All right.

[00:18:37] You can do the acupuncture trick with an endophile, number 10 endophile in their chin. And that has worked well. I have not pulled that one out in a while. But didn't I send you guys a picture like a couple of years ago? Yeah. Oh, yeah. I've heard a lot of people doing it, too. Yeah. That'll work. Here's another thing that works really well. Getting your patient numb and putting a rubber dam on them.

[00:19:05] Really numb in a rubber dam is a big deal. That's true. They all think that it's a problem with being back there. I'm like, no, it's not. If you're really numb, you're exactly right, Kevin. A rubber dam actually is helpful. You wouldn't think, but it is helpful for a gaggy patient. And then the other trick I'll pull out sometimes in hygiene, if people are gagging on their x-rays, is to get some salt, make a salt water solution and have them gargle with that.

[00:19:34] And it temporarily turns off that reflex. And you can get an x-ray or do whatever you need to do or back in the day, take an impression or whatever it was. So those are three tricks. Here's for the x-rays in particular. There's the other trick where it ends up, they think there's something to it. It's mostly a distraction technique. You have them hold their foot up or have them hold their arm out. And typically, I have multiple people in the room and we're making a big fuss out of, okay, you can do this.

[00:20:03] And it's a big, and there is, sometimes it works. The distraction's enough. And you're going to see gagging a lot of times on x-rays. That's one of the bigger times you're going to see it. So sometimes it doesn't have to be very, you don't have to do it for very long. You don't have to, you know, they're just trying to suffer through it long enough to get the x-ray. So here's my answer since they gave that side of the answers. As many things as you can invest in to minimize gag problems, the better off you're going to be.

[00:20:30] And those things include a scanner so that you don't have to take allergen impressions. When you purchase your cone beam, one of the ones that has the external bite wing feature, those aren't as good as regular bite wings. Yeah, that'd be great. You know, but oftentimes they're going to be better than the person who can barely handle the bite wing in their mouth to begin with. They're going to be as good. You're going to pick up at least the medium-sized. You're not going to need the board lesions, but you're going to get those.

[00:20:56] I've gotten a lot of compliments on our external bite wings on the people that just couldn't handle them. And then third, sometimes your treatment planning decisions are going to get altered by that. The second molar on some of those people, you're not going to get a good crown done. I don't care how good you are, what technique you use. And so maybe you don't save on someone with that kind of a problem.

[00:21:20] So that's my deal is what can I do to not create a situation where they're going to be causing a problem? I think also not playing into it, like being very stoic about it. Like I've had to talk to team members about them even mentioning it. Oh, I remember your gag reflex. Don't, why are you saying that? Don't bring it up. Don't bring it up. You know? I mean, the patients oftentimes will, but don't you bring it up. Yeah. And downplay it as much as you can.

[00:21:50] The other thing that's worth mentioning is sedation. Oral sedation works really well for gagging and stuff like that. So that's an, if it's an option too, that's, that's helpful. Yeah. That's helped me out for sure. Keep going, Mo. Good thoughts there. So next we're going to ask, how do you keep up with the latest trends in dental technology without overspending? Ooh, that's a great question. You don't, Mo. You pay to play. Yeah. There's ask heaven.

[00:22:20] There's no way out. You, there's, it's a, you, you don't get, you don't stop spending. Right? I mean, there's no way out of it. I mean, I look at it. I think if we're going to have a non snarky answer, which my first answer would have been exactly what Zach said. You're not going to get out of it. But the non snarky answer is what, what is your return on investment of this piece of equipment?

[00:22:46] Because if you're reaching out on investment, three X's, four X's, 10 X's, that whatever that cost is, then it's just a payment. So a good example for me is the combi. When we were making payments on it, it was around $2,000 a month. Now, if I got one implant case out of that, which I knew I was going to get in a month, then it's just a payment. It was worth it. Yeah.

[00:23:12] That doesn't already include all the charges out for panorexes that we're going to take. So it's like a no brainer that we're going to make that payment. Where you get in trouble is thinking you need all of the latest and greatest, and you're not getting the return on that. So you really need to think all that through. Especially when you're new, you don't maybe have the patient flow. Or the skill. And you think the technology is going to attract the patients.

[00:23:42] Not necessarily the way it goes. That's true. I mean, technology is attractive. No diss on that. But people aren't knocking down my door because I bought a scanner. No, that's right. It's just improving the patient's. I think a lot of patients, once they're in the door, they're impressed by it. But I probably don't attract a lot of patients. I think it can keep people in the door. The exception might be Sarah because I've seen some people actually market the same day stuff pretty well. But the other thing is that something funny, Zach and I can say this.

[00:24:11] And actually, Kevin can too. There's always new stuff. In other words, as soon as you decide what you're going to buy, as soon as you know what scanner you're going to buy. Literally, Murphy's Law says the next day they release the new one. And the story on that is that Zach and I both have scanners that are several years old. And I've seen a ton of scanners that I know what I would do if I were getting another scanner. But the other thing is, you know what?

[00:24:40] My MetaDye 700 still with the updates, it still works great. It works really good. I have no regrets. Would I like one with a bigger scanning area? Yeah, I would because it'd be faster. But it's definitely making it work. And it's paid for. And so I'm not in a rush to do that. It's like on some level, I know people who are going to the next scanner in a year or whatever. Well, shoot, I've made mine last for some years now. And I feel like that has made sense.

[00:25:09] Technology's always like that. You're always going to, like in two months, go, I can't believe I bought this one. I could have bought this. That's just the way that it goes. So at some point, jump in and just ride it for a while. You don't have to. Like Kevin said, for the most part, a lot of times it's a payment. And on some of those, it's not even as big of a payment as the CBCT. But you're always going to wonder if you pick the right time. And that's just how it goes. So don't feel too bad about that.

[00:25:39] I think Zach and I are both like pretty happy with the scanners. Very happy with my scanner. Yeah. I like, I'm happy with my cone beam. There were better ones when I bought it. There's better ones now. Yep. And I don't care. Yep. So I'm happy with what I have. Yep. So contentment goes a long way. Yep. You know, for sure. Okay. What's next, Mo? That's good. This one, we're talking about how do you diagnose and treat crack tooth syndrome, essentially. Which I actually am excited to hear what you guys have to say.

[00:26:09] Because my very last patient that I saw was a crack tooth case. So we can start with Zach. Okay. So you're talking about the diagnosis of it? Yeah. Like diagnosis and treatment. Well, you're. Yeah. Okay. So. Is the person walking in the door saying it hurts to bite on? Are we starting with that?

[00:26:38] Or are we, where are we? Give me a little more context and I'll, I'll, I'll shoot. Okay. So we'll, we can use my case as an example. So we, we had a patient who broke a filling. We, and we essentially found a crack in the filling and it was painful for them. So, yeah. Okay. Under the. All right. Who's the crack? It was actually like in the filling itself. Oh, wow. Like the filling had broke.

[00:27:08] Were the marginal ridges cracked? Yeah. It was in the marginal. Okay. So I think everyone should have a trans, one of those little trans illuminator devices in every single one of their rooms, especially their hygiene rooms. I think those are one of the most valuable pieces of equipment. That's not a camera that I have for diagnosis. Do you have one of those, Alan? Do you have a little trans illuminator? I don't use a trans illuminator at all. You don't. But I mean, I have a microscope. I have a microscope in every operatory and that does a lot too. Okay. That's fine. That's, that's great.

[00:27:38] The trans illuminator light. Do you have one, Kevin? I don't. Do you want to mess with those? No, I don't. When you use it, what it is, it stops the, an actual crack stops the light. It's pretty, it's a pretty cool trick actually. I like trans illuminator lights and I think everyone should have one in, in every op. I think they're. Because they're not expensive. They're pretty cheap. They're very cheap. They, they, they find cracks very well. They find decay in approximately very nicely. That's one of those indispensable pieces of equipment that I haven't really talked about on the show much, but I really am a big fan of. And they're very inexpensive.

[00:28:08] Those, those are really good for looking at cracks. A tooth sleuth, which I'm sure you've heard of or have. I'm sure they teach that at school. You know, that's, that's valuable to have as well. Um, some of it's going to be, uh, um, a little bit of experience sometimes with the patient. If you look around the rest of the mouth, if you see the general signs of, uh, clenching bruxism, you're going to have a better idea of what you're, what you're dealing with.

[00:28:35] Um, unfortunately it seems like on most of these cases, by the time the pain starts and if the cracks deep enough, it's over. Yeah. You know? And because we all have had probably lists of ones that we've given a shot on. Yep. That just blow up on you, you know? And so I, especially second molars, especially lower second molars, you know, I mean, there's so many of those you see in hygiene, you see the crack, you see a mountain cause you got the microscope. You probably take the photos of them.

[00:29:03] I always tell people, I was like, if you know, this doesn't hurt, I'm going to recommend a crown to you on it because the second it does hurt, you probably already, you probably might be gone. Yeah. It's probably over. One of the diagnosis things I find is repeatability of symptoms. If you can, if you can elicit the symptom with a cotton roll or a tooth tooth or whatever and multiple times and like consistently, then you're honestly, the cotton, the cotton roll is hilarious or cotton swab. It's amazing how, how simple that is.

[00:29:32] A lot of times you're going to find the, the, the serious ones are the ones not when they're biting down, but when they release, if it's biting on release, get a crown on that yesterday. Cause you, yeah. And the other thing is Zach's point is true. Once it's actually hurting. Um, I, I also, I'm quick to do a provisional crown. We know it's going to be a crown or we're going to shuck the tooth, one or the other, but a provisional crown can help a lot with, with, you know, if you can get them in a provisional crown and they're comfortable for a few weeks, that makes me feel a little bit better about not doing that. I know.

[00:30:01] I've done that several times where I prep the tooth, put them in a temporary, um, you know, take the scan, don't send the scan to the lab and just see the symptoms go away. If so, maybe we've got a good chance. If they don't, I probably wasted my time and now we just got to take the tooth out, you know? So, um, but that at least saves you from doing all the rest of the stuff. Kevin, what do you, I think just having a good diagnostic, uh, tools, including everything

[00:30:29] Zach mentioned, but combing, you can sometimes see stuff on a combing, make sure you're, I'm yet to see a crack on a combing. I got, I got a good one. Ooh. Um, I want to see it. I want to see your crack. Big. I did not see that one coming. I'll tell you, you've seen it plenty of times. Kevin, show me your crack. Um, yeah. Uh, but, uh, also make sure you're perio probing, perio probing. Yeah.

[00:30:59] Like that's, that's a classic. That's a, looks good. Looks good. Whoa. That's the, that's the, that sinks. That also is, that, that is probably the kids. I should have mentioned that. That's a, the, and they also talk about endodontic, isn't the J shaped lesion? Yeah. Isn't that the classic fractured root thing? Yeah. That's a root fracture, but still that's a, yeah. Yeah. That's a whole different. Yeah. But I'm going to try to talk to you guys into these transluminal lights, man. They're just, I'll, I'll even, I'll link you to the one that's. I think also. Cheap and works. And they're nice to have.

[00:31:28] Patient communication to, to sum up what Zach and Alan said, we're going to put a temporary crown on this tooth and see what happens. But there is a good chance you're going to lose, or there is a chance you're going to lose this tooth. Yeah. Okay. Yeah. So. And, and on crack teeth, the, would you be mad if. Yeah. Yeah. Is so, is so good on those. It's like, Hey, look, these crack teeth, these are challenging to deal with. You know, there's a little bit of a, there's a little bit of gamble.

[00:31:57] In this, you know, if we try to save this and it doesn't work out, would you be mad? You spent the money or would you be happy if we gave it a chance? The classic tooth. And as soon as they say month after month. Yeah. Yeah. Yeah. As soon as they say they would be mad that they spent the money, get the tooth out, you know, be done with it, you know, make the person happy. You know, don't, don't jack around in the name of trying to save a question. So, so too. When they come back and you're adjusting it and you're, you're goofing around and all that

[00:32:27] stuff, that's a good, that's a good sign that you make the wrong move. That's it. I mean, I got to tell you, I, I, you get, I get one or two of those every year. Or, you know, just jumping straight to the endo. Endo. Yeah. Yeah. Like, I agree. Started doing it. I just jumping straight to all on, all on four. Yeah. That's the best way to go. I go to, I, I, I say pterygoids or get the fuck out. That's what I say. Yeah. That's, that's a good, that's a practice builder there. I'm very popular for that. Really? Yeah. That really works well.

[00:32:57] I came here for sealants, doctor. Yeah. So I do kind of want to walk through the case that I had. So it was shoot the patient. We had a DO filling. Um, and what number it was number 19. And, um, actually it was, it was an MOD filling actually. So the crack was in the distal though.

[00:33:21] Um, and so we were first thing we did was we actually decided to replace the filling because the crack was like, we could see it in the filling. So we replaced the filling. That's what my operative instructor wanted me to do. Um, and then that was operative instructor. Yeah. I think that was a bad decision because when we saw them, when we saw the patient a month later, we can now visually see the crack, like in the action. It was like, we could see it. Like it was so easy to see.

[00:33:51] So we, uh, I prepped it for a crown, um, and put it in a provisional and they stayed in provisional for five months and reported that they no longer had any symptoms, you know, after basically from like the first couple of weeks, they, the symptoms tapered off and then stayed gone for, for four and a half months is what they said. So then we just scanned it for, for final. So.

[00:34:21] And as soon as you put that permanent crown, as soon as you put the permanent crown on and seal everything up really tight, as opposed to there being like temp bond on there. It's gonna be symptom. God, so many, Kevin, so many times. I've, I've, I've dissected a few cracks that I thought were like, you're doing the crown and you're, and you can actually see there's a line on your, on your, you know, mesial or distal margin. You're like, well, I'll just drop that a little bit. It never stops. I'll just drop it a little bit. I'll just drop it. And you're like, whoa. Yeah.

[00:34:49] This is, these are all things that unfortunately you've learned in the hard way in a lot of cases that sort of the crack teeth are funny that way. Wow. There has to be a whole, before you do, before you do a case, I wanted to crack tooth. You've got to have like a little crack tooth talk to someone about like the ranges of those cracks and the, and the outcomes. We may be able to fix this or you may lose this tooth. Right. And when you don't, you're going to get, you're going to get fried on it.

[00:35:19] You're going to lose the person and they're going to want their money back and all this stuff. It's a tale as old as, as time, you know, for sure. Okay. Perfect. Yep. Well, I think we're out of time. I think that, I think that, yeah, I was going to say that wraps it up. Moe, I hope we got, did we get through even half one of your pages? Yeah. Yeah. We need like five more episodes, right? Yeah. We got a, we got through about 40%, I would say. Oh, wow. Okay. So round two. Round two. Yeah.

[00:35:47] No, this is, it's hard to keep it short because these are good questions. Does anyone have any take backs, apologies, anything you want to double down on? Yeah. I really think I should be in Gryffindor. Okay. I'm glad that it was the, that's really the summary of this whole hero's journey kind of thing. Yeah. Yeah. You think I'd like to apologize to Kevin for asking to see his crack. That was inappropriate. You've seen it. But do send me, do send me the picture. Yes. Yeah. Yeah. What's your WhatsApp? What you Moe.

[00:36:17] Yeah. We'll connect after the show. Okay. I'm glad, I'm glad we had to talk about cracked teeth because I felt like it was, this was my favorite question probably in the, in the whole set. So now I'm nervous that it won't last very long. You should be. You should be. Have the talk. Have the talk. Have the talk indeed. All right. Hey, thank you guys for listening and we will see you next Tuesday. See ya.