Very Clinical: Getting Ahead of It, part 3: Fixed Prosthodontics

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[00:01:49] [SPEAKER_02] This is a production of the Very Dental Podcast Network. Welcome to the Very Clinical Podcast. In about the time it takes to do an MO on three, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:02:16] [SPEAKER_01] What is up, Very Clinical listeners? Welcome back to another episode of the podcast. This is Zach Miners, coming to you from Kansas City, Missouri. With me, as always, my trusty co-host, Dr. Kevin Hare Fryer. Kevin, how's that hair doing in Cleveland tonight?

[00:02:31] [SPEAKER_03] My hair's great, but I gotta tell you, Zach, you are one lucky boy.

[00:02:36] [SPEAKER_01] Oh?

[00:02:37] [SPEAKER_03] Yes. The Cleveland Indians did you a favor last night and lost, because if they didn't, there would be a Game 7 right now, and I'd have to choose between being with you and watching Game 7 of the Division Series.

[00:02:53] [SPEAKER_01] You'd have to choose Game 7 on that, and I wouldn't have been even remotely mad about that, but sorry you lost.

[00:02:58] [SPEAKER_03] Once again, wait till next year.

[00:03:01] [SPEAKER_01] Yeah. Yep. Wait till next year. We also brought back an esteemed guest. If you've listened to this podcast feed for any amount of time, odds are you've heard one of the shows by Dr. Alan Mead. Alan, what's going on tonight in Michigan?

[00:03:15] [SPEAKER_02] I have no teams that are worth rooting for at all. So that's... The Lions are doing just fine. They're having a nice... They're fine.

[00:03:23] [SPEAKER_01] They're fine.

[00:03:23] [SPEAKER_03] The Browns are in first place.

[00:03:24] [SPEAKER_01] Yeah, that's nuts, by the way. It is nuts. You thought they were going to be 0-17. And they're not good.

[00:03:30] [SPEAKER_03] They're still not good.

[00:03:33] [SPEAKER_02] I haven't been really watching much NFL. I've made a point of not watching the Lions. The superstition was if I don't watch them, they'll do better. So I just look at the score on my phone. That's true fan. Speaking of superstitions. Yeah, it is a superstition. Let's hear it. Let's go.

[00:03:49] [SPEAKER_01] Let's do it. We got a bit tonight. Next week's Halloween. Yeah. It is. Next week. Um, Kevin, what's the Halloween based bit this year? So it's not a bit of honey. It's not a bit of honey like last year.

[00:04:04] [SPEAKER_02] Which will take fillings out. That's not sure.

[00:04:06] [SPEAKER_03] Gross. So gross. So it's called trick or treat, right? It is. It is. Normally there's lots of treats, but there sometimes there's tricks. So I want to know if you guys ever did any tricks on Halloween or were tricked. So Zach, it sounds like you were tricked.

[00:04:26] [SPEAKER_01] I was, I was tricked. Um, I, around the middle school time, somewhere in that seventh or eighth grade, one of my classmates must have really had it out for me because I, I did get the, uh, flaming bag of poop on the door. So my parents were pissed. Yeah. It was like, yeah, and pooped. Uh, so yeah, no, I got that.

[00:04:55] [SPEAKER_01] And, uh, I, of course I had to clean it up even though I had nothing to do with it. Pranksters. That's even worse. You won by the way, if you're listening, you won. You, you aren't. Yeah. Whoever you are. Whoever you are. I never found out who. I never found out who. Uh, but yeah, no, I had the, I had the flaming, the flaming poop bag. Who lit the poop? I don't know if it was human or dog. I, I, I, I'm hoping I didn't, I didn't, uh, didn't really dissect the situation. Yeah.

[00:05:23] [SPEAKER_01] Anyway, that was, I was tricked and I was not the tricker. I was the tricky.

[00:05:26] [SPEAKER_03] So, uh, Alan, have you ever pulled any tricks? Wink, wink.

[00:05:33] [SPEAKER_02] I see where you're going there. I remember vividly coming back from trick or treating probably late in my trick or treating career. So I was probably, you know, 12 or 13 where you're getting on the very high end of when you're really supposed to trick or treat. And my, my parents' house was being toilet papered.

[00:05:53] Hmm.

[00:05:54] [SPEAKER_02] And I like ran up there on him. I ran up there on him and say, Hey, get out of here. This is my house. They did not care at all. They were unimpressed by me. They were unimpressed by my dad. They just kept toilet paper. It was, it was, it was some kids that were tougher than I was. And it ended up being, they just TP'd us. So that's, that's, uh, I feel like I should.

[00:06:12] [SPEAKER_01] Did you have to be the cleaner upper?

[00:06:13] [SPEAKER_02] Like, yeah, yeah. I'll say toilet paper's better than, better than, than the poop bag for sure.

[00:06:19] [SPEAKER_03] They are related.

[00:06:20] [SPEAKER_02] Yeah. They can't be, they often are. Yeah, I agree. Um, the other thing is, is that when I, a little older than that, I, I would hang out outside of, uh, a buddy of mine's house for his parents to do. We were, you know, probably, probably like a year or two later, we're 14, 15 and we would, we would hide and scare people, jump out and scare people and stuff like that. So we did some tricking, but it was not, it was not too bad. Little kids. You don't want to like, you don't want the parents in your neighborhood to hate you because

[00:06:50] [SPEAKER_02] you've traumatized their children. So there's pretty hard. Sure. Stuff.

[00:06:54] [SPEAKER_01] Kevin, you seem like someone who was up to no good. Yeah. I feel like Kevin's got stuff.

[00:06:59] [SPEAKER_03] I've got in the seventies, seventies.

[00:07:01] [SPEAKER_01] Sorry.

[00:07:02] [SPEAKER_03] I've got two of them. One involves a gun that was pulled out. Whoa. So I, I, I might not say that one cause both of them are kind of funny, but let me, so probably around, uh, 12 years old, 11, 12 years old in the summer. Uh, some, I remember this summer hot day. We were, we'd always play, uh, sports and stuff in the street and inevitably a ball would go in the sewer or something like that. Yep.

[00:07:29] [SPEAKER_03] And that was, that was a common, uh, theme of my childhood. And one day we're sitting on the curb and someone had brought up something called sewer gases, which as a 12 year old, we didn't know what that meant. And then someone said like, what do you think would happen if you lit a match and threw it in the sewer? And my brain went to the whole street would blow up. That's what my premise was. The entire street would explode. That would be it.

[00:07:57] [SPEAKER_03] And everyone's like, no, that could never happen. And, um, so I decided on this Halloween that I was going to throw some firecrackers in the sewer and blow up the street. That was it.

[00:08:13] [SPEAKER_01] You were taking out the whole street.

[00:08:15] [SPEAKER_03] That was my intention. Okay. So unfortunately or fortunately or stupidly, naively, I picked the sewer right across the street from my house. So like my parents could see exactly what was happening. And I threw like three firecrackers into the sewer. And they exploded and flames shot out of the sewer. Like really did. Yes.

[00:08:45] [SPEAKER_03] However, there were dry leaves in there from the fall.

[00:08:50] [SPEAKER_02] Okay.

[00:08:51] [SPEAKER_03] So imagine 12 year old Kevin's brain when flames are shooting out of the sewer.

[00:08:58] [SPEAKER_01] You thought this was it, right?

[00:08:59] [SPEAKER_03] I did it. Here it goes. The whole street's going to blow up. Yeah. And then when it died down rather quickly, cause dry leaves, um, uh, guess what? The street did not blow up. So.

[00:09:11] [SPEAKER_02] Oh, it didn't. Okay. No, that's good. I feel like had you had a street blow up in your history, you might not have been a dentist.

[00:09:19] [SPEAKER_03] Yeah.

[00:09:19] [SPEAKER_02] I probably would have been in the, in the, still be in prison at this point. You might've been in the pipeline to the criminal. You might not have made it, man. You might not have made it out alive.

[00:09:27] [SPEAKER_03] I just liked the, uh, preteen logic.

[00:09:30] [SPEAKER_01] Yeah. No, I get it.

[00:09:32] [SPEAKER_03] Yeah.

[00:09:32] [SPEAKER_01] I get it. Uh, Halloween's on a Saturday this year. I feel like that's peak Halloween for kids.

[00:09:37] [SPEAKER_00] It is.

[00:09:38] [SPEAKER_02] It is. I, both of my kids are way too old to trick or treat. And yet I know at least one of them really wants to go out. He's not going to trick or treat, but he wants my, my mother-in-law's neighborhood. They go all out. He's like, I don't really want to see all the decorations I want. So he's not going to trick or treat. He's just going to walk around and look at the.

[00:09:55] [SPEAKER_03] That's cool. I did like that. You said later on in your trick and trick or treat career, it's like you're an athlete, but you're in your final. Yeah. I was drafted.

[00:10:04] [SPEAKER_01] I almost went pro.

[00:10:06] [SPEAKER_03] Yeah.

[00:10:07] [SPEAKER_01] See, I, I have a seventh and a sixth grader and I kind of feel like this Saturday, maybe the next, maybe next year on Sunday, but I feel like we're about ending. I feel like they're about going to get into that. Like, why we just want to go to a friend's house and watch a scary movie or something like that. Yeah.

[00:10:22] [SPEAKER_02] That's coming. The other thing that's crazy is, you know, you can go to the store and buy candy. Who knew? You know?

[00:10:27] What?

[00:10:28] [SPEAKER_01] They sell it? Yeah. It's crazy.

[00:10:30] [SPEAKER_02] If you wait, if you wait, if you wait, if you wait till November 1st, you can buy wheelbarrow for nothing.

[00:10:37] [SPEAKER_01] You're going to tell me next I can, I can buy my own Christmas present on Amazon. You can. That's crazy. You can buy your own trophy. Your own pickleball trophy.

[00:10:45] [SPEAKER_02] All that stuff.

[00:10:46] [SPEAKER_01] All right. Uh, real content now coming, coming your way. We were continuing on with the getting ahead of it. Um, we're getting ahead of it. And that is, we are trying to, well, I don't know. I'm, I apparently I'm not, I'm getting behind it. Anyway, we're trying to talk about the things that we talk about with patients or do for

[00:11:09] [SPEAKER_01] patients so that we don't get the dreaded question callback, you know, concern, all those things you don't want to hear. You don't want your staff to come up and knock on your door and be like, Hey, Susie doesn't understand this. Where do you put this crown margin? She can see it.

[00:11:28] [SPEAKER_02] Anyway, all that kind of stuff. Yeah. So in our, our, our topic for getting ahead of crown and bridge complications, right?

[00:11:34] [SPEAKER_01] Crown and bridge, crown and bridge. And, uh, yeah, we got a little ways to go last week. I think crown and bridge that the term crown and bridge dates us.

[00:11:43] [SPEAKER_02] I really do. It does.

[00:11:44] [SPEAKER_03] I always hated that term.

[00:11:46] [SPEAKER_02] Yeah. Why? It should be crown and partial venture.

[00:11:50] [SPEAKER_03] Why do you hate the term? Oh, just kidding.

[00:11:55] [SPEAKER_02] Nerd alert. Well, I just, I always thought crown and bridge was like, okay. Okay. At the University of Minnesota, the department was fixed prosthodontics. Yes. Thank you very much.

[00:12:04] [SPEAKER_01] Yeah.

[00:12:05] [SPEAKER_02] So, okay.

[00:12:05] [SPEAKER_01] Anyway, so let's change the title of this. We are going to talk about, uh, getting ahead of it in fixed, fixed prosthodontics.

[00:12:12] [SPEAKER_02] Yes. You have to, you have to kind of say it through kind of through your nose a little bit too. Yeah.

[00:12:15] [SPEAKER_03] I don't do bridges. So I I'll, I'll agree with the fixed prosthodontics.

[00:12:20] [SPEAKER_02] All right. Okay.

[00:12:21] [SPEAKER_03] Back ahead of me.

[00:12:24] [SPEAKER_01] Anyway, last week we talked about anesthetic and fillings. If you want to, if you want more on this topic, buddy, we're going to talk about basically your basic crown today here. Alan, why don't you start us off here? What, uh, when you're doing a standard crown prep on a person, what are the, what are some of the things that you talk about, about the procedure, about what they're getting any of the phases of it? What do you, what are some things you talk about?

[00:12:48] [SPEAKER_02] I was trying to think a lot of, a lot of the stuff that I try and get ahead of is, is the stuff that they're going to notice between the, the, you know, after we put a provisional crown, I know Kevin's laughing provisional crowns. Why would you do that sort of thing? But in my office, I'm afraid we do that. And so we'll kind of warn them on stuff for the temporary. And then we'll, so I will tell you that I have found that provisional crowns, I don't know

[00:13:13] [SPEAKER_02] if it's that they're sensitive on biting per se, or they feel different than a regular tooth because they're made of plastic. I think that, have you ever noticed, am I, am I crazy to say that? In other words, if I have someone complaining about something about their provisional, I don't get it a lot, but it probably, probably, probably one out of three, one out of four people say, I really, I couldn't really chew on this. I couldn't really bite on it. And I'd rather tell them that it might feel weird to bite on, or it might be sensitive.

[00:13:41] [SPEAKER_02] But, and typically it's, I, I, I chalk it up to the material. I chalk it up to, it's a different kind of material or whatever, because routinely we can say, and this is my favorite thing. My, my, my office manager who used to be for the longest time, my, my chair side assistant would always say, geez, you know, I, when I've had them, I have a hard time chewing on them too, but it always seems to resolve itself by the time for the final one in. So I plant that seed. I'd rather that they're not, and if they, if they can chew on it just fine, great. I'd rather warn them.

[00:14:09] [SPEAKER_02] I'd rather, I'd rather suggest in, in, I mean, I hate to say it, but all this stuff is kind of like getting their expectations down low. Yeah. Because then if something happens, they're not shocked by it. But if nothing happens, then they just forget that you even mentioned the low, the, the low thing. So I'll tell them they, they might be saying, I rarely are they sensitive to cold and hot unless I'm already worried that this tooth is, is going to need more treatment like end out or something like that. But I think particularly on, you know, individual units, sometimes it feels funny to chew on it.

[00:14:38] [SPEAKER_02] I don't, I won't necessarily say it might hurt to chew on it as it might feel different to chew on it. So I'm going to tell them that right off the bat. And the other thing that's great is if they came in with a busted marginal ridge or an open contact or whatever, I promise them I'm going to fix it in the temporary. And I can promise them that because you almost always can with a visit roll that you can. And I will, I'll make sure that it's a really good contact before they leave, because that's an improvement from what they get like right away. Even if the, even if it feels funny to chew on, I gave them a great contact.

[00:15:08] [SPEAKER_02] So I'm always kind of really aware of that. That's, that's one of the things I'm going to tell them. I got some other things too for finals, but I thought that's a starter. You want, you want me to give more?

[00:15:18] [SPEAKER_01] You want to go to someone else? I'll take, you know, I, I would agree that when it, when it comes to the, the temporaries and I think I, I think I make a pretty, pretty good temporary crown. Uh, but I, I, I, I almost treat the, like a temporary crown, almost like a, uh, almost like a, you talk, when you talk about dentures to people, it's like, you're really talking about how, Hey, this, this has a matte finish rather than like a really polished finish. So you're, if your tongue gravitates towards it, that's not normal, you know, finish instead

[00:15:47] [SPEAKER_02] of rougher than your final. Well, cause I, I mean, honestly, I, I'm going to probably tell them that it's going to be not as smooth as the final. I like that. I like that. A matte finish.

[00:15:57] [SPEAKER_01] Yeah. So, and then, um, you know, uh, you talk about how, especially maybe on some interior work or even something that's anywhere near the front. This is not the color we picked out. I only have a couple of different shades of temporary material and, you know, please don't judge us on the, you know, judge, say, hold your judgment until we get the final, final one in, you know, and that, that, that usually appeases most. And again, most people are pretty complimentary. My temps, I feel like I do a pretty good job, but you know, it's maybe the part of that is

[00:16:26] [SPEAKER_01] because I've gotten ahead of it. Yeah. Um, let's see.

[00:16:31] [SPEAKER_02] Something you said, something you said there just made me think of something. So, uh, there's this guy, forget his name. I'll look, I'll look it up and find him, but he's, he's a Japanese microscope dentist. He's just an insanely good restorative dentist. He just does a lot of bread and butter dentistry really well. He makes, he always makes his temporaries by just putting a wad of, of acrylic on the tooth and then it put, and he'll, he'll carve the anatomy in it. They always look perfect when they're done. But the one thing that he does, he makes them just like be one white, no matter what color.

[00:17:00] [SPEAKER_02] And I think that's an interesting take, like for as amazing as that provisional looks and the contours and the polish and everything, the color is always terrible. And that, that, so he's clearly doing that on purpose to say, you know, is that, you know, to make sure they don't love their temporary too much. I don't know, but that's interesting that you say this might not be the exact right color. That might, that might, I can see that being a feature rather than a bug. And I haven't really thought much about it.

[00:17:24] [SPEAKER_00] Okay.

[00:17:26] [SPEAKER_01] Um, I think you always have to, especially if you're a, if you're a person who packs cord or if you had to do some like gingivectomy work, maybe the tooth, you definitely got to warn them about the gum being sore afterwards. I mean, I standard, you know, recommendation to rinse with some warm salt water. Um, that seems to appease most people when it comes to like the, the, the sore gum side of things. And I, and I know whether I like, did you, did you lightly pack it or did you have to pack

[00:17:54] [SPEAKER_01] the shit out of it to like really get some retraction or do you have to really deep margin or something like that?

[00:17:59] [SPEAKER_02] Or do you have to do a real on gingivectomy? Sure.

[00:18:01] [SPEAKER_01] And so you can kind of give people a range of how, how bad you think that's, that's going to be for them. Um, a lot of times I'll tell them that honestly, your gum is probably going to hurt more than your tooth does. Yes. I say the same. I say the same exact thing.

[00:18:15] [SPEAKER_02] I say the same exact thing. And the beautiful thing about gums hurting is it, is it fixes itself in a couple of days. So that's good. Yes. Go ahead, Kevin.

[00:18:22] [SPEAKER_03] I'm at an like when someone's, uh, gingiva has grown into the broken part of the tooth and you have to trim it away. Um, when I say something like, oh, I had to trim your gums away because it grew into that area that broke. Most people's eyebrows will raise like, oh my God, like that's like, that's super normal thing for us. But for the patient, I think that's surprising to them. So it is. I had to trim that away. So it might be sore, uh, gets ahead of that being a problem. I like that.

[00:18:52] [SPEAKER_01] I agree. And in using those exact, I use that exact word trimming it away. And I think people are always like, well, that sounds, that sounds serious. That sounds wild. That sounds wild. It's exactly right. Uh, and to another, I guess, you know, we're kind of almost going backwards here, but when it comes to packing the cord on, I think you guys are all three cord, you guys use at least one.

[00:19:13] [SPEAKER_03] I'm a cord packer from way back.

[00:19:15] [SPEAKER_01] Way back.

[00:19:44] [SPEAKER_01] Mm-hmm. Don't, then there's nothing to be said about it, you know? Um, so that's, that's, that's one I've used for sure here. Anything in particular you use when you're talking about someone who's never had a crown before their first, their first one, anything that you, you talk about with like the, to almost get them prepped for that. So the, they don't call back with a million questions. Kevin, how about, how about you, you shoot on that one?

[00:20:07] [SPEAKER_03] Um, well, uh, typically it's someone who's had fillings before. So it's, it's usually something like, uh, the filling that you have before in this tooth. Um, we, we can't do another filling because you've reached the limit of what a filling can do. Yep. So we have to do a crown. Uh, and a crown is where I kind of fib a little bit just in my spiel, but I say, we

[00:20:33] [SPEAKER_03] take a millimeter off your tooth, 360 degrees around and your crown will fit on your tooth like a hat.

[00:20:41] [SPEAKER_01] I got hard. Yeah. I use a hard hat as well.

[00:20:43] [SPEAKER_03] That's what we do when a filling won't work anymore.

[00:20:48] Mm hmm.

[00:20:49] [SPEAKER_02] That's that's good. I think, I think the you're, you're, you're avoiding the, it's like you cut my tooth down to a peg. Yeah.

[00:20:58] [SPEAKER_01] Like that, you know, you're sort of getting ahead of that. And that's how about when they say that? Or boy, you sure did a lot of grinding on that, you know, kind of thing. Yeah.

[00:21:06] [SPEAKER_03] I just always poo poo that. Not really. You know, it may seem huge to your tongue. That's what she said, but it's, it's really not.

[00:21:16] [SPEAKER_01] Um, um, Kevin, anything in particular, like with the CEREC process, especially that you're talking about as you're moving along with people so that they're not wondering what's especially maybe if they've had a lab crown in the past and you're doing something different for them, anything you're saying or talking about.

[00:21:37] [SPEAKER_03] We usually give them a preface that, um, you know, cause typically we'll prep the crown and I just hand that off to an assistant and they'll design it and then it goes in the mill. So there's some downtime while we're doing something else somewhere else.

[00:21:52] [SPEAKER_01] Yep.

[00:21:52] [SPEAKER_03] On another patient. But, um, I guess, uh, if we schedule them for an hour and a half or two hours, most people will say, I'm going to be in the chair for two hours. You're going to be working on me for two hours. And then we explain, you know, most of that is waiting for the crown to be done in the oven. So that's a way to get ahead of that. And, um, and I usually will say once it's scanned and we start, um, designing it, well,

[00:22:22] [SPEAKER_03] the hard work's done for you. Yeah. Like I always make the joke for you, the hard work is over, but you know, we still have some. So I think that's a way to get ahead of that. The waiting.

[00:22:36] [SPEAKER_01] Um, going back to temps again, I know that takes Kevin out of the conversation. Alan, when you do like a back to back grounds, do you splint them?

[00:22:45] [SPEAKER_02] I always, I always splint them.

[00:22:47] [SPEAKER_01] You gotta get ahead. Always get ahead of that.

[00:22:50] [SPEAKER_02] Yep. You can't floss between these two, but you'll be able to floss between the, when we put them in.

[00:22:54] [SPEAKER_03] I do have a temporary crown comment. Um, I remember when we had, uh, I think it was Clint Clinton Timmerman on.

[00:23:05] [SPEAKER_02] I've heard of him. Remember that guy? The other Timmerman. Yeah. The other one. Yeah.

[00:23:08] [SPEAKER_03] The lesser Timmerman. Oh my God. Clint, I love you. He's not listening. He, he's the one that put the birth, the dog poop on your stuff. Yeah.

[00:23:17] [SPEAKER_01] That was him. He did it. Okay.

[00:23:20] [SPEAKER_03] Uh, and the shrink wrap, uh, crown prep. Oh yeah. Yeah.

[00:23:25] [SPEAKER_02] Lance, Lance always does the shrink wrap. Yeah.

[00:23:27] [SPEAKER_03] Yeah. So does Kevin. Now I've been doing that for years when we have to make temporaries cause occasionally we do. And I just, uh, shrink wrap those pumpies on there. I don't cement them. I let, let the, um, I let the material stay on there for four minutes.

[00:23:43] [SPEAKER_01] Are you talking for a single poster unit or are you talking on your anterior stuff? Everything. Oh, okay. Right on. Everything.

[00:23:50] [SPEAKER_03] And, uh, are you familiar with this gentleman called Strump?

[00:23:55] [SPEAKER_01] I am. Uh, Strump? Yeah. Strump.

[00:23:59] [SPEAKER_03] Yes. So he touts this, uh, I'm going to blow it. Um, this, uh, chlorhexidine rinse.

[00:24:08] [SPEAKER_02] Four percent. Yes. Four percent. Yeah.

[00:24:10] [SPEAKER_03] Yeah. Yeah.

[00:24:11] [SPEAKER_01] I thought Strump was the holy triad guy. Isn't he the holy?

[00:24:14] [SPEAKER_03] No, that's what you put on the tooth.

[00:24:16] [SPEAKER_01] Yeah. Oh.

[00:24:17] [SPEAKER_02] This is how you treat gum.

[00:24:18] [SPEAKER_03] The anointing afterwards.

[00:24:20] [SPEAKER_01] Yeah.

[00:24:21] [SPEAKER_03] Okay. There's an anointing with the holy triad. Yeah. And there's an anointing of the temporary. Okay. We give people a syringe of that and gosh darn it, uh, that's eliminated a lot of problems in my life.

[00:24:33] [SPEAKER_02] Interesting. So you give them, do you, do you, where do you get the 4%? I thought he was the only guy who, I thought he had like a, a run on the market.

[00:24:40] [SPEAKER_01] Yeah. Yeah. I was going to say he, Kevin goes right out to Florida, picks it up off his, uh, he

[00:24:45] [SPEAKER_02] puts it, he, he jams his trunk full and drives it home. Yeah. Yeah.

[00:24:49] [SPEAKER_01] Let's let's, let's talk about seating crowns. And, and I mean, Kevin's out, I've just got a seated crown too. Um, seating crowns to numb or not to numb. That is the question.

[00:25:01] [SPEAKER_00] Oh, there's a good one.

[00:25:02] [SPEAKER_02] I, I, okay. So I, I routinely let the patient choose. If I had my druthers, I'd probably numb everyone. And then we wouldn't have any surprises, but I'm shocked.

[00:25:12] [SPEAKER_01] Vital. Numb the vital teeth. Yeah.

[00:25:13] [SPEAKER_02] I'm shocked at how many people with vital teeth want to try without. And I'm shocked how many of them do okay with it. Be honest. Which also means they're probably non vital. We just didn't get the right, we didn't get the right. Well, maybe, but age is a big factor there.

[00:25:28] [SPEAKER_01] Yeah. If I'm doing a crown on someone that's under say 35. Yeah. I'm probably gonna, I'm probably gonna numb that too. Yeah.

[00:25:35] [SPEAKER_02] And you know, if they're not going to do well with it, you're going to know because

[00:25:38] [SPEAKER_01] as soon as you put it. Also, if you know your person and you know how they kind of reacted and what their pain tolerance is like, that, that helps you guide it. Yeah. I mean, certainly on someone who's over 65. I mean, it's, I'm not gonna. Worth a try. I was never gonna numb that too. Yeah. I don't know. Kevin, when in the days before you had the CEREC machine? No, I'm still now.

[00:25:59] [SPEAKER_03] If I shrink wrap something, I'm getting that person numb because you gotta cut those things off.

[00:26:03] [SPEAKER_01] Oh, okay. So that's not, that's a non-negotiation.

[00:26:05] [SPEAKER_03] I don't even give them a choice. Like, okay. We're gonna get you numb.

[00:26:08] [SPEAKER_01] Also. What if the tooth's dead?

[00:26:10] [SPEAKER_03] That's a different story.

[00:26:11] [SPEAKER_01] Okay.

[00:26:11] [SPEAKER_03] I won't do that, but.

[00:26:13] [SPEAKER_01] Okay.

[00:26:13] [SPEAKER_03] Um, yeah, that's a vital tooth. They're getting numb and I don't, I would.

[00:26:20] [SPEAKER_01] Okay.

[00:26:20] [SPEAKER_03] Much rather get you numb than have the surprise or hurt you. Like.

[00:26:25] [SPEAKER_01] Right. You don't want it to be a negative experience.

[00:26:27] [SPEAKER_03] Yeah. That was worse than the crone last time. Like. Yep. I don't want to ever hear that again.

[00:26:34] [SPEAKER_02] Kevin don't play. Yep. He's gonna, he's gonna.

[00:26:37] [SPEAKER_03] I've got some magic juice in my office that makes you not feel stuff. So I'm just gonna use it.

[00:26:42] [SPEAKER_02] Yeah.

[00:26:43] [SPEAKER_01] It's amazing. Oh man. Yeah. Kevin's magic juice. That's what.

[00:26:48] [SPEAKER_03] They've all said, honestly.

[00:26:50] [SPEAKER_01] What he, how about, okay. So let's just say you are, you are working on someone who's, who's a vital. Um, I, I feel like you almost have to get ahead of it in terms of like, I, you know what? This might be me and not Alan. Cause Alan, you said your crowns always seem to go in no adjustment. That's not, I don't have that luxury. I feel like I always have to say this might be tight. This might meet a few tweaks on it. Yeah.

[00:27:18] [SPEAKER_01] Sometimes the lab is the, the lab is really good, but they're not perfect. Like we're going to like, you know, we're going to make sure this has a good fit, a good.

[00:27:25] [SPEAKER_02] If I have, I will say if I have to adjust, I have to adjust. I'm so spoiled at this point. If I have to adjust, I get kind of pissed about it. Uh, like, you know, and I will say this, I have taken the Kevin and Zach technique. If, if it's, if you've got a tight, I'll tell the patient, sometimes I need to polish the teeth on either side of this thing. No, yeah. So, and so I'll, even at the seat date, I'm going to, if, unless it's a zirconia crown or something next to it, I know that I'll just take a disc and zip it a couple of times.

[00:27:53] [SPEAKER_02] A lot of times, but if it, my contacts are usually pretty good. And you know, the best thing, the few times I have a contact that's light enough where I'm worried about it, I can take it over to Chad and he can just add to it. Like, well, that's just, Oh God, it's the best thing ever. You're just spoiled. I am. I'm wildly spoiled. I could do an entire episode on how spoiled I am to have a lab next door, but what's the, what's the CEREC seating experience like?

[00:28:18] [SPEAKER_01] So we're doing frequent contact or bite adjustments or no, or what's that like?

[00:28:23] [SPEAKER_03] We're doing Emax only. Right. So we, I always try them in out of the mill in the blue phase or purple because I haven't called mine, whatever you'd like to call it.

[00:28:33] [SPEAKER_02] Yeah.

[00:28:34] [SPEAKER_03] Lavender. Um, and one of the interesting things about my team is they're really good, but try as I might to get them to get the contacts right there, always make the contacts too heavy.

[00:29:15] [SPEAKER_03] Mm hmm. I'll say something like, it's too tight. And ha ha ha. And then the assistant who designed it will fake, Oh, I'm going to lose my job or whatever. Or like, cause.

[00:29:32] [SPEAKER_02] And then the hilarious thing is that you fire her on the spot. Yeah.

[00:29:35] [SPEAKER_03] You're right. Gather your things. You're gone. Gather your things. And then I go away, be gone.

[00:29:41] [SPEAKER_02] Yes.

[00:29:42] [SPEAKER_03] It's usually a couple of zips on the contact and it'll drop in. Yeah. It happened today. You know, I used to, I used to panic. And what really is, is designing the contact below the equator. What like, I like to call it below the equator of where the, the contact is. Yeah. The height of contour, I guess you would call that if you were in a fixed prosthodontic program.

[00:30:09] [SPEAKER_02] In fixed prosthodontics. That's what we call it. Yes.

[00:30:11] [SPEAKER_03] Um, and anyway, so I'll just zip it away there or I, when I do check them, which is also 95% of the time, I'm just pushing that. That's hard to explain. Yeah. I'm pushing it away from the equator and usually they'll sit by. I don't really, it's not, it's very rare that we have a huge problem with that. It happens occasionally.

[00:30:34] [SPEAKER_01] And then what are you guys saying in terms of maybe what the person will experience in terms of, uh, you know, after the numbness wears off after they've got their crown is, is maybe a way to kind of get ahead of a callback.

[00:30:50] [SPEAKER_02] I'm super old school, nine times out of 10, I am, I am cementing with a glass ionomer. Sure. Resin reinforced glass ionomer. I'm not bonding in and I'm typically doing zirconia 95% of the time. Okay. And so I, I tell every patient that's about to leave that you'll, you'll likely be cold sensitive for the first couple of weeks. And, and most of them actually aren't, but again, I'm going to tell them that because the ones that are, uh, Yeah. You won't hear the end of it. Yeah. You won't hear the end of it.

[00:31:18] [SPEAKER_02] I mean, and, and the reality is, is like, that's what I've, I've routinely say they never last for more than a week or so. I'm not exactly sure what the magic is in them. Maybe, maybe the, I, we tell them that it takes a while for the cement to set completely or something like that. But it's, but essentially that I don't really run into a lot of cold sensitive teeth, but I tell them it's going to be like that for a couple of weeks. I mean, we're replacing a body part. So I typically they're, they're relatively reasonable, but I'm going to tell them, I'm going to tell them that all the time.

[00:31:45] [SPEAKER_02] And, and even if only, you know, one on one in four experiences that cold sensitive, they've told them ahead of time for sure. And, and the other thing is if we had to do anesthesia, we talked about this before and I let them know that if, if you, if it feels like it's hitting funny when you come out of the numb, an easy fix when, when you're not numb. So don't be afraid to call us. We're happy to get on it. And that's, I mean, that any, anything you're going to put in their mouth, essentially there, yeah, it's a good rule. What about you, Kevin? Yeah.

[00:32:12] [SPEAKER_03] I usually say the tooth, the tooth we put a crown on is probably going to be sensitive for a couple of days. That's normal. It'll go away. And I look them right in the eyes when I say that that's normal. It'll go away.

[00:32:24] [SPEAKER_02] And if you just slap them, you ever slap that's normal. And just kind of just to drive the point home. I think a kick works better to be honest.

[00:32:31] [SPEAKER_03] I think, you know, a kick to the groin.

[00:32:34] [SPEAKER_01] Yes. Directly to the groin definitely makes a point. A better point for sure.

[00:32:38] [SPEAKER_03] I'll usually say, you know, if your bite doesn't feel right, call right away.

[00:32:43] [SPEAKER_01] Yeah.

[00:32:43] [SPEAKER_03] It's much easier for me to fix it. If you call right away, like, you know, these people, like you put that crown on. And three months ago, and it never felt right. Like, well, you didn't call. Like, I didn't. Sorry, I didn't drive to your house with my mobile dental van and parking your driveway.

[00:32:58] [SPEAKER_01] No, I hate that, too. When they come back on six-month recall and say something like that, it's like, oh, my gosh. Are you serious? You saved this up for today? And now you want me to fix it in the three-minute hygiene exam?

[00:33:08] [SPEAKER_03] Being a non-dentist, like, or whatever, being a dentist, the precision that it would take for us to get that right every single time. Like, it's never going to happen every single time that you get their bite right. And so, you know, I'm resigned to that fact, but I do want to plant the seed. Call me right away.

[00:33:28] [SPEAKER_01] Sure. So, basically, everything that you guys said, I say the same things. I will say this. If I have the luxury of seeing someone that I know has had sensitivity complaints in the past, I'm probably going to put a fluoride varnish around that crown complimentary before they walk out the door, just maybe. And sometimes on a multi-unit thing, I'll give them one of the 5,000 parts per million toothpaste that we have around.

[00:33:58] [SPEAKER_01] Just anything I can do so that they feel like they've got something, if they have the problem, rather than calling me. I don't want to be called for anything. Don't call me! All my patients that are listening to this, don't call. Just don't call ever.

[00:34:13] [SPEAKER_03] Unlisted number.

[00:34:14] [SPEAKER_01] Unless you're making an appointment, you know? Change your number. Or you have a bill to pay. Then call, for sure. Please call with money. That's always appreciated.

[00:34:22] [SPEAKER_02] You know whose crowns hurt?

[00:34:23] [SPEAKER_01] The ones that didn't pay for them yet. That's who's hurt.

[00:34:26] [SPEAKER_03] Oh, yeah. That's classic.

[00:34:27] [SPEAKER_01] Science right there. And taking it one step further. And I said something to this effect last week. If I'm doing, let's call it three plus units, a lot of times I will just schedule the person back for a check. Like if you were replacing an entire quadrant or you're doing one of your, you know, a larger type of case, I just schedule them back. I schedule the complaint back. Um, and frequently I have to do something.

[00:34:57] [SPEAKER_01] It isn't much, but it's frequently some, something.

[00:35:00] [SPEAKER_03] I will say this too. Like on the sedation patients, it's hard to know.

[00:35:05] [SPEAKER_01] Oh, I would imagine you have to have them.

[00:35:07] [SPEAKER_03] I will tell the driver, like, I've started doing what you recommend, Zach, and just scheduling it. Or like today I told the driver, um, you know, what I really said to her was, I really think we nailed the bite on this, but with the, she saw how high he still was. Like you, I can't tell. So if it doesn't feel right, call me right away.

[00:35:29] [SPEAKER_01] Right. Right. Yep. Yep. All good stuff. All right. Well, I think we're up, but up against it. Any, uh, any final thoughts on basic crown and bridge, but I'm sorry, fixed prosthodontics.

[00:35:44] [SPEAKER_02] Fixed prosthodontics.

[00:35:45] [SPEAKER_03] I, um, well, I, I think this is a great topic, Zach, because you could do the best crown in the world and have the most pristine margins and all that bull crap, fixed prosthodontics bull crap. But if you don't have the verbal skills to, um, exit the procedure, you're going to have, you're going to have a unhappy life.

[00:36:08] [SPEAKER_01] I agree. Well, and I think most of us as young dentists who don't have that, cause they don't, they don't cover that.

[00:36:14] [SPEAKER_03] Yeah.

[00:36:15] [SPEAKER_01] That's, that's all the grief comes from that. All, all, all the grief I had doing this initially, some of it came from lack of experience. Most of it came from poor communication.

[00:36:25] [SPEAKER_03] Poor communication and you learn to say the things that you said to avoid the pain of the later on call. Yeah. So I, I support that.

[00:36:35] [SPEAKER_01] Correct. Absolutely. Absolutely. Um, any final thoughts, double downs, apologies, take backs?

[00:36:42] [SPEAKER_02] I think the flaming dog poop is worse than toilet papering.

[00:36:46] [SPEAKER_01] I don't, I see. I don't agree with that. That, that, that did not take a huge amount of time. Getting all that toilet, depending on your trees, that seems horrible. I'm going to say, I'm going to disagree with that.

[00:36:55] [SPEAKER_03] How about blowing up your street?

[00:36:57] [SPEAKER_02] That's pretty bad.

[00:36:58] [SPEAKER_01] Um, that sounds like a crime, Kevin. And I would like to report you. Statue of the limitations is probably clear, but wow.

[00:37:05] [SPEAKER_03] Probably 1975 or six.

[00:37:09] [SPEAKER_01] I think I, I think I saw you on America's most wanted now. I think that was you.

[00:37:13] [SPEAKER_02] I saw a news story about that. The whole neighborhood went up. It was nightmare.

[00:37:17] [SPEAKER_01] Unbelievable. Thank you guys for listening. Uh, happy Halloween in advance. And we will see you next Tuesday.

[00:37:25] [SPEAKER_00] See ya.