Very Clinical: Getting Ahead of It, part 4: Endodontics

[00:00:01] 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 3, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:00:28] What is up, Very Clinical listeners? Welcome back to yet another episode of the podcast. I am Zach Miners coming to you from Kansas City, Missouri. With me as always, my trusty co-host, Dr. Kevin Hair Fryer. Kevin, how's your hair doing in Cleveland tonight? Well, judging from the video here, I need a haircut bad and I'm kind of stressing because I don't think I can go for it. I have a couple other appointments, so I don't know what I'm going to do, man.

[00:00:54] It does look too, it looks a little too long. Yeah, I agree with you. You better get that appointment set up. I gotta figure something out. You gotta get ahead of it. I see what you did there. Love that. With us throughout this series, Dr. Alan Mead, welcome back to the podcast. Thank you for being on your own podcast feed. We really appreciate that. Yes, way to go. You're welcome for being on my own podcast.

[00:01:22] You know, of the three of us, I am definitely the thinnest in the hair department, big time. I got the shiny spot here. You guys are kind of making me feel a little inadequate. There may come a time where I just go straight for the shaved head because I just can't really pull off. The lights make it look, it's not quite as bad in real life, but I'm telling you, that is pretty shiny. Can you get a gold hoop earring also? Yeah, there you go. And a bandana. There you go. Ooh, that'd be a good look for you. That'd be a good look.

[00:01:50] Maybe a nose piercing and the ear piercing and have a chain between the two of them. Yeah, that sounds dangerous. It does. It does. I feel like, I feel like I get hooked that on a lot of things similar to when, remember when the headlights used to be a fiber optic box and you'd forget to unplug them? I don't know if you guys remember. I got my, my light cord got hooked on a handpiece today and that was not fun. I didn't enjoy that. I still have a cord hooked to a battery that's in my pocket and I've gotten it caught on a number of things. I got it caught on someone's oxygen tank.

[00:02:21] Oh, that was fun. Yeah, that was cool. Yep. Way to go. Um, Kevin, you have a, uh, movie documentary recommendation for us before we move on to the clinical topic of the day. It's a recommendation without spoilers by Kevin. So that's the challenge. Yeah. So by the time this comes out, the, you can see everything documentary by Nathan Fielder will have been old news, but let me tell you, I saw it on the week it came out opening week, whatever.

[00:02:51] Um, and as you know, uh, we are big fans of Nathan Fielder on this podcast, at least Zach and I, and Nathan is a friend of the show. He is a friend of the show. Yeah. Huge listener. I know that he was listening. He would enjoy the show for sure. Absolutely. Uh, if you don't know who that is, by the way, if you've ever seen the show, there's a comedy central show called Nathan for You, which was, which was popular for a while.

[00:03:19] It was almost like a, Oh, like Sasha Baron Cohen show meets business. And then, uh, and then he's had a show called the rehearsal, which took that to like another level. I don't even know how to describe that show other than it's cool and very interesting. Um, there's, there's more I'm missing. I'm missing some more, uh, a couple more, but, uh, those are the main ones. It's a rehearsals on HBO comedy centrals, Nathan for You. And now he's released a documentary with a 24.

[00:03:47] So Kevin, give us the spoiler free synopsis. So the documentary is, um, involving Elizabeth Holmes of the Theranos, um, scandal. We don't know who that is. She's the lady that promised you could diagnose everything on someone with a drop of your blood. And she scammed a bunch of investors and got in trouble.

[00:04:10] And, um, the documentary takes place approximately 30 days before she's set to go to jail. And she's in jail currently. Correct. She's in jail currently for 11 years. Uh, just so they understand, this is not fiction. This is nonfiction. This is like, I mean, it's, or, or is it, but the reality is it is actually her. It's not an, it's, she is in the movie. Let's say that she is in the movie. He has interaction with her.

[00:04:40] I know that, I know that it's not as simple as that, but yes, he's living in her house with her husband. That's interaction. And I, without any spoilers, I'm not. Uh, so there's a couple of things that I'd like to say. First of all, Alan said something that, that is that really her and all that sort of stuff. And my one way to sum up Nathan Fielder is that we've talked about this before, before in our chat, nothing is real. Right.

[00:05:07] So, uh, this holds true for this documentary. Nothing is real. Also, I will submit without the making any spoilers that Elizabeth Holmes is not the villain of the this movie. She's not a hero, but she's not the villain. There is someone else. Kevin, what is, what would you describe as the tone of this? Would you say humorous? Would you say, would you say like dramatic? Well, what's the tone?

[00:05:36] There were several laugh out loud, uh, moments. Okay. And all also moments of complete shock and wonder of what am I seeing? Why would someone say that on camera? What is going on in this person's head that makes them think they can say that with a straight

[00:05:58] face and, uh, to a certain degree, I believe that, uh, Nathan may have met his match in terms of someone being not completely real. Okay. That's the best way I can say that. Interesting. Also, I'd like to say, so a good mark of a movie is something that you're thinking about later on. So I, I watched it last Saturday. This is Tuesday. I'm still thinking about it.

[00:06:27] And one of the things I thought about is that there is Nathan Fielder, the human being and Nathan Fielder, the character. The character. Would you agree with that? Zach? Oh yes. Yes. That, that holds through with the other shows I've watched. So very rarely does Nathan Fielder, the human, like very rarely does he break character. It happens a couple, once or twice in Nathan for you.

[00:06:53] Um, there is a couple, there's at least two moments in the documentary where the Nathan facade breaks down because what he's witnessing is so weird and off that the audience can't believe like he's acting like the audience. Yeah. And I found that fascinating that he could, with all the crazy stuff he's done and all

[00:07:18] the sort of fantasy worlds he's created that in the middle of his own documentary, the facade drops because he's like, what the heck is going on here? So, um, let me ask you this question. You can say that makes me want to watch the movie that much more, honestly. Yeah. Yeah. Kevin, as does someone going into this, do they need to have watched the, um, Amanda Seyfried,

[00:07:44] uh, uh, um, you don't need to watch the show or do you just need to know the, like, you just need to like read the Wikipedia entry on Theranos to like kind of go in with something. I don't, I don't think you need to watch it. I think, I think, uh, I think there's a lot of people that probably don't know who Nathan is or haven't watched Nathan for you. Uh, that would be good to, to watch and maybe the, the last, um, episode of Nathan

[00:08:12] for you finding Francis, which is kind of a documentary. That's an hour and a half long. That's really wacky. That would be a good place to start. Cause that's really funny and also poignant and weird. Um, so would you say this would be without any watching, having watched any of these shows, would you have gotten the same? No. Well, I still would have laughed. I don't know. Knowing Nathan as well as I know him or know him like from TV from watching him.

[00:08:42] Right. Knowing his content. Yeah. Uh, it certainly helped. And, uh, I, I like to see the, the through line of Nathan, um, sort of looking for love and also shows up in this one too. Interesting. Sort of. That's all I can say about that. Alan, you got any, any movie show or anything you're looking forward to or anything you've

[00:09:12] already you've watched recently that you're, that you dig anything? Any, uh, I have to tell you that, that I, I said this on the, the podcast I released yesterday. I, okay. So I have a, I, I had a, I had to rest last weekend a lot. I had my foot kind of had a blow up on my foot and I was told to be off of it. So I, and I'm not off of, I'm not, I don't do that. We feed horses around here all the time and I kind of, I kind of like doing that. So I, so I actually had to like consciously stay off my foot.

[00:09:39] So I was, I watched, uh, the first three seasons of, of, uh, the legend of Vox Machina, which is the, it's the animated D and D thing. I've watched it before, but I said, okay, I'm really gonna, so I watched him again and that thing really holds up. I really like it. I'm the, interestingly, I'm, I started the first. Is that on Prime? Is that on Prime? It's on Prime and it's, um, and it's, it's a D and D it's, you know, it's Dungeons and Dragons kind of stuff.

[00:10:06] It's based on a YouTube series of people actually playing, uh, Dungeons and Dragons. It's, it's very well done. It's, it's adult. It's not. Legend of Vox Machina. Yeah. It's, it's terrific. It's very funny. I really am rooting for the characters. And, and honestly, I started the fourth season and I'm, I'm having a hard time getting into the fourth season, but I also know that I was able to kind of stay with it because I wasn't going anywhere. I was, I was literally, you know, the, the idea was I wanted to stay sitting down and not doing anything. And this was a good way to do it.

[00:10:36] I don't, I don't have the attention span for TV shows. I really don't. That's one of the reasons that I haven't really ever gotten into the Nathan for you or anything. Cause I just, I, I, I don't do well watching serial TV cause I, I, you know, if I can get up and walk around and do something else, I probably will. I can, I can watch a movie though. I can go to the theater and watch a movie without any trouble, but I have a hard time with, but I did this weekend. That was great. So I, I, again, I, I think I recommended that in the last episode of the Almeida experience. I really, that's a good show. And they're, they are doing a fifth season. They're going to wrap it up. They're doing a fifth.

[00:11:05] Nice. That's cool. Yeah. I'll tell you this, this will be out by the time this, this podcast comes out, but the day of recording it, it's not. But, um, on the October 23rd, um, Sasha Baron Cohen is releasing the, another Ali G movie called Who Is I? And I adored that character from the early O's and the HBO show. Yeah.

[00:11:32] And the fact that he's let like, you know, over 20 years go by and now he's bringing him back. Um, I am sure it's not going to be what I want it to be, but I'm just, I'm excited to see if it's, if we can even capture half the magic, I'm going to be giggling and I'm going to be just thrilled about it. So another Ali G movie, if you like, uh, super uncomfortable, Sasha Baron Cohen stuff. That's what the, that's the, the through line between Nathan and Sasha. Yeah, for sure.

[00:12:00] I mean like the, the, the cringe stuff I'm, I'm, I'm made very uncomfortable, comfortable by those things. I have a hard time doing that. So like, I kind of, I have to look away a little bit. I love it. Yep. Yep. I know, I know Alan, I'm sorry. I know Kevin will watch Ali G. I'm almost sure of it. I'm you'll check that one out probably. For sure. Okay. Um, we are sticking with the getting ahead of it, uh, topic. Kind of like, uh, you know, Alan, Alan's hair and Kevin's haircut that he needs. So, uh, we're talking endo this week.

[00:12:30] Uh, endodontics. Getting ahead of endodontics. Endodontic. Yep. Now, Kevin, I feel like you're particularly qualified because you're given, you're given some semi-regular courses on, on endo. Is there anything? I am. On the getting ahead of it, patient management side of root canals that you are talking about in your course? Are you mostly talking about nuts and bolts? I'm mostly talking about nuts and bolts, to be honest.

[00:12:59] That's fair. But I'm trying to think of like, I think that, uh, getting ahead of it for endo patients in general is 100% tied to the level of pain they're experiencing before you start everything. Yes. Yep. And so, you know. Let's unpack that. Keep going. The classic hot tooth. Mm-hmm.

[00:13:21] Um, so I will say that in general, using the good old septic cane, I don't have that problem as much anymore. It still happens. And so what I'm getting at is like, as you enter into the pulp chamber, they're feeling it and no matter what you do at that point, you've just got to keep going. And in my opinion, so I think getting ahead of it saying, Hey, you know, like I'll say

[00:13:49] something like, this is the worst part of my job. Cause I know I'm hurting you. Something like that. That's actually really good. I like that. Um, so because you know, there's a public perception that the dentist is a sadist and I'm, I'm certainly not. I don't enjoy giving other people pain, but I do want to help people. I don't enjoy giving other people out in that situation. So I guess it, you know, to technically speaking, opening up the pulp chamber enough so I can

[00:14:15] give an interpulpal injection and then everything hopefully will go away or at least getting a single file in there and extirpating the pulp. I don't know the last time. Good word. Like it. Yeah. Um, I mean, even, even getting ahead of getting ahead of it there. Yeah. I talk a lot about before I start about how difficult aggravated and or infected teeth are to numb. Yes. And I'm gonna say, look, it's gonna, it's gonna take more anesthetic than you're used to for me to numb this tooth.

[00:14:44] I'm gonna have to probably, you know, anesthetize it from a couple of different angles to get this, to get this right. And, and we're, we're gonna have to work through it together. So, you know, you really got to set, set the table on that for sure. If you don't set the table on that. And I have to tell you recently, I've run into this. Uh, you got to do it way before you're, you're, you're jumping into that. They, so you have to do it when, when their rational brain is still working. Yeah. So let's, let's take a step back.

[00:15:15] You come in and you're in a tremendous amount of pain. If I start talking to you about that and you're in a lot of pain, I'm not sure you're going to hear me. It's not so good. If I get you numb. If you get them a little numb. Um, take it, take, dial the pain down. Then we have this conversation. Yes. Yeah. I agree. It can, it can be, it can be after like what I would call round one of anesthetic. I, yes. Good way. And before you start, you know, cause on those kinds of teeth, I'm almost always going

[00:15:43] to PDL those teeth. Sure. Yep. Because I know that the block or the infiltration or whatever it is you you're doing probably isn't going to be enough for that. Yep. Um, odds are. So I agree. I agree that though, that you're right. If they're, if they're apps, if they're like one of those people that's coming in and they're holding their jaw, that they're not going to hear you. Yeah. They're not going to hear it. That applies to the extraction. Yeah. When we get to that one, it looks the same thing is going to apply to that too.

[00:16:11] You can give them some of that information after some initial, that's odd. I haven't thought of it that way. I really liked that actually. Let's, I mean, I think I might do that, but I never thought of it as like getting, getting them into that. I don't know. I get, that's a good point. I will say this. This is a, this is a little, I am to a point now, unless there's a contraindication like diabetes, I, I have people on a, on a, on a steroid a lot of times before doing any endo if I can, if I can do that. A steroid? You're putting them on a prednisone? Yeah.

[00:16:40] Medrol dose. Okay. I'd like to see them on it for a couple of days beforehand. Oh, interesting. If I can. Now that's if they're, if they're symptomatic. I mean, like if it's a dead tooth, it's not symptomatic. I'm going to probably do that. But for a hot tooth, man, if I can get them, if I can get them on that for a couple of days, my, my anesthesia becomes less of an issue. It seems like. That's a, that's a good approach. If I've never tried that. This could be completely anecdotal. I could be completely wrong about that, but it sure seems to help. I think.

[00:17:07] And it, and honestly, it's well, it's in people, you know, it's well tolerated. It's not a huge deal and, and make our, make it a little smoother. Uh, that's, I'm going to try and do that. Let me, let me use Kevin's line and tell you how I use it in a different way. You know, Kevin's getting ahead of it, talking about this is the worst part of my job. And with, with the, the tooth that he knows might be uncomfortable to work on. The other part of it is the tooth that you're getting ready to do a root canine because of an abscess or whatever. It doesn't hurt at all.

[00:17:35] And I always, I will use that line, man, this is one of the worst parts of my job because you don't, you're not, you're not coming in with a problem and, but you're going to, you're going to leave feeling worse than you did. That's excellent. When we, when you walked in the door, I mean, not always, but I mean, you know, odds are it's not going to, you know, when they come in with a no pain situation, odds are it's going to be worse than when they walk out the door. And I always say, man, I, I hate, I hate that.

[00:18:00] I I'd rather be solving pain and causing it, but here we are, you know, you know, so I've used that a version of that line for that exact scenario. Another way to get ahead of it in that situation is I will, at the end of the procedure, I'll sit them up and look them in the eye and say, your tooth is going to be sore for a couple days. That's normal. Yes. That's, that's normal is a very good thing to say.

[00:18:25] And sometimes people will say, well, why does my tooth hurt if the nerve is gone? Yes. That would say it's the bone surrounding the tooth that is giving you pain because I've been working in that area. I, that's not really how I say it, but that's what I mean. And, uh, so it's going to take a little bit for that to heal and all of that's normal. Yes.

[00:18:50] But if you don't say, if you don't, in my experience, if you don't say, pick people ask, why does my tooth hurt if the nerve's not there? Mm hmm. Um, because I don't want the phone call of he didn't take all the nerves out or whatever. Oh my God. Better than that. He did the wrong tooth. My tooth still hurts. I thought the root canal was going to solve, you know, whatever.

[00:19:15] So like, and you know, like biomechanically, if you're taking some files past the apex and banging into their PDL and it's already infected or, or inflamed. Hotter than I expected. This conversation got banging, banging into the PDL. That's right. Endo is just full of innuendo. It is. When you're, you're putting sealer. Yeah. You can almost describe it as like, especially on the tooth that doesn't hurt in advance.

[00:19:44] It's like, this is like a surgery where you got to heal from it afterwards. Yeah. And the one, and especially one of the last things that's going to get better is your ability to put pressure on it. Mm hmm. Because that's, that's the, that's the, that's the truth of it. You know, the last thing that's going to get better. Mm hmm. Is your ability to put pressure on it. And, and of course they want to know what, why that is. And then that's when you get into the whole banging into the PDL or whatever you want to call it, you know? So those are, those are good stuff. That's good stuff.

[00:20:13] Um, what else, Kevin, what's, what's another thing you, you talk to people, uh, maybe to prep them for the procedure. They've never, if it's their first one, you know, what are we, what are we talking about? Well, uh, like rolling it way back, you know, I'm a big rubber dam user. Um, but certainly we're going to use a rubber dam for a root canal. So sure. Uh, you know, I'll preface that with, um, we're going to put on the rubber screen to keep your tongue and cheek out of the way.

[00:20:41] Uh, and also so that we don't get any saliva in your tooth because that will cause a different infection. I don't know where that came from in my verbiage. I just say it, uh, it's probably not factually true. No, I say, I say we're disinfecting your tooth and we do, and, and the saliva is full of bacteria. Yeah. That's, that's about it. Yeah. That's, that's all. Do you ever, do you ever say we're also, we also, some of the stuff we need to do to this tooth uses some pretty, pretty strong. I try not to say that.

[00:21:11] No, I leave that out. I leave that out. I don't want to, I leave that out. And, uh, sometimes people will say that smelled like bleach and I'll be like, yeah, it did. It did. Didn't it? Sorry. I farted. It has a lot of the same ingredients, you know, it has a lot of the same ingredients. I don't know what you're putting in there, but it smelled like bleach. Yeah. You'd be surprised. Yeah. You'd be surprised. You'd be surprised how many ingredients it has in common with bleach, you know?

[00:21:38] Um, uh, let's see what else I, I, a lot of times. Why does my shirt have a spot on it? Oh yeah. I'm not a molar. I always, I also tell people this is probably going to take longer than you think it ought to take, you know, because I don't know how, I don't know if it's going to be, if I'm gonna find the canals immediately and we're going to cruise or whether it's going to take me a while. I don't know. I just say that. I've always, every time, Hey, this is, this is a little more time consuming than you think it's going to, it should be, especially if we're talking about more, I'm trying to find

[00:22:08] three needles in a haystack and then cleaning them out. So, um, sometimes I'll say like, sometimes this will happen. Like you'll do the, if it's a lower molar, you'll fly through the distal canal. That's all easy. And then the mesial buckle is fine. And then you get to the mesial lingual and for whatever reason, like God hates you for that fight, you know, and I'll usually blame the patient. Like, Hey, there's always one. Thanks a lot for making my job harder this morning. Huh? I just blame it on them. Right.

[00:22:36] Weird, weird anatomy, which may or may not be true. Um, but that seems to happen to me. Not a lot. Uh, it happens often where two or three of them, you just fly through in the last one. You're like, what the heck's going on here? Absolutely. Absolutely. I also try to get another getting ahead of it thing is talking about how, you know, we would love to finish this today. Yeah.

[00:23:04] But, but I can't guarantee that. And, and, and here's, and here's the why's if this too, especially if I know if it's an infected tooth, I was like, you know, sometimes if it's still draining, you, you can't paint a wet wall or, or, or, or, you know, uh, stain a wet deck. And so if this too sweat, we can't seal it off. Um, and or if it's, go ahead. I'll usually say something like my intention is to finish this today, but your tooth will tell me.

[00:23:35] Like that's a good line. I like that. Yeah. That's basically what I'm saying in more, I use more words. So your, your lines better. Um, that's, that's like that. And we'll, we'll know in a few minutes. Sure. Sure. And if the tooth, one of those hot teeth, like you're talking about, not going to finish that in one day, I've had bad experiences. If it's necrotic, if it's necrotic, I rarely get, I, I, I, that is an indication not to. Yeah. Yeah, for sure. For sure.

[00:24:04] Um, let's see, what are some other things that are worth getting, getting ahead of it and endo? Alan, what do you got? I didn't let you talk at all, actually. So you, you know, all these, all the, all the stuff you're talking about, I, I, I feel the same way. I think I don't have as much verbiage. The other thing is, is that, um, try not to say anything about, I don't, I don't want to over talk about the, the difficulties, the finding the canals and stuff like that, because sometimes. No, I don't over talk about, I guess.

[00:24:33] I, I, I might have. I might have. I just say it's time consuming. I say it's, I say it's time consuming. It's a hard job. And I guess that you're right. I sometimes I do talk about the canals, but like for me, the procedure, just the pleasantness of doing the procedure, I, I know if it's going to be, if it's going to suck or if it's gonna be great in like the first 10 minutes of. Yeah, that's true. And that's, that's a funny thing. Like I, my day is good or bad based on how, how ridiculous finding the canals are going to be there, which is not nothing. Everyone knows that, but it is.

[00:25:02] Well, and this is where Kevin and I have the benefit of the GPS with the cone beam. Yeah. Yeah. And, and so a lot of times we probably know in advance if a canal looks really tiny on the cone beam or if you can't even see it. Well, that's actually, that's, that's my, actually my favorite part of the cone beam is knowing which ones to just not even start. Yeah. Really. Whereas you don't, you don't get those. Um, but it also does give me very much of where to go.

[00:25:30] And when I didn't have that, there were certain, a lot of those where I was like, oh man, where is this stupid? I mean, that, that is one third of the course that I give is just using this thing as a GPS and like it, I don't know. I, I've, I will say that I've got a microscope. I'm 95% using the microscope. It is, but I don't think, I don't think it's the same kind of microscope. Like, you know what I realized? I think the CT is, I think even, even ended on us to tell you the CT is probably more important at this point.

[00:25:57] Although I, they're all using scopes too, but, um, the combos pretty is, is why they can It makes a lot of sense. It's what's really funny about it is once you found in, in kind of navigated the canals, you could, you can practically do with your eyes closed, like on some level once, you know, but that is my point. This last class, I gave the, um, wonderful. So these guys, these gals were great.

[00:26:24] Um, but they kept saying, I can't see the canals or whatever. And I realized that I'm doing a lot of this by feel. Yeah. Like I, I don't necessarily need to see it if I can feel it. So man, that takes so many reps though. Kevin does. I get there. That's what I'm, that's what I'm getting at. That's the problem. My brain had to process that. Like, I'm not really seeing a lot of this.

[00:26:50] I just know where they are because I know from the Comey and I've done this 5 billion times. Yeah. 100%. I get it. And that's, that's what I think makes teaching endo, um, to the inexperienced person. That's gotta be hard when someone is like, I don't know. I just kinda do it. Yep. That's, that doesn't, that didn't work. That didn't teach well. I had to not, that's what I was thinking. Yeah. But I had to not, had to. Yeah. Not say that.

[00:27:20] Right. 100%. Correct. I agree with you. Correct. What other things do we get, do we get ahead of it in endo? I mean, obviously we're probably, you're probably talking about maybe what's gonna happen to the tooth afterwards. Is this tooth and a crown? When does it need a crown? You know, when, um. That's a conversation to have before you've ever started the root cancer. Sure. For sure. Um, a lot of times, especially if I'm not going to do the crown same day and I know that, um, I talk about how I'm gonna, I'm gonna shorten this tooth so it doesn't touch. It'll heal better if it doesn't touch. Yep. Yep.

[00:27:50] So, and I, I talk about that. Hey, we'll restore it to bite at the crown time. Yep. I say something like, it might feel weird to your tongue back there, but I promise you when we put the final crown on there, it's gonna feel like a normal tooth again. It's a good line. I dig that line. Yep. Uh, because I don't want that call back. Hey, what? My tooth is short. Yeah. I, I explained why. Actually, that's a really good one. It's a really good one. Yeah. Yep. So something that we take for granted that we do, we're gonna reduce the occlusion

[00:28:20] because that's what everyone says to do. That's the right thing to do. Yeah. But if the person's like, man, you, my tooth's destroyed now. Yeah. That's, that's, that's, that's not the call you want. And that's the wrong time to explain it too. Yeah. Yeah. That's the whole point of this whole series is that anything that's explained in advance is a, a valid explanation. An explanation. It's not an excuse. It's not an excuse. It's not an excuse. How do you guys, um, uh, sear off your gutta percha?

[00:28:51] I have a heated, not the same thing you have, Kevin, because we've talked about it before. Yeah. Okay. Now I do mention there might be some steam that comes up. Smoke. So they don't, cause I've been asked before, is my tooth on fire? Not on fire yet. Oh my God. Yeah. That's my, that was my plan. That was my, you figured me out. Well, you can set the street on fire. Um, the getting ahead of it for that is, um, making sure your assistant has a suction on nearby while you're doing that.

[00:29:20] Yeah. That helps too. Yeah. So the times when that hasn't happened for whatever reason, uh, it's right, you know, I'll, I'll get that question. Are you burning my tooth or whatever? I'm like, no, no, no, no, no. I make up some, some excuse. So that's a good get ahead of it. I say the same thing if when you're doing, if well, maybe I know you don't electrosurge anymore, but when you did, if you didn't have the suction up near that, it's like, man, is my, are my, my gums getting fried? For sure. Yep. That's not a good smell. So for sure.

[00:29:52] Did I miss anything? I'm trying to think because. Final thoughts? Double downs. Endo as a patient, I will say this, this is, sounds a little silly, but endo as a patient in a lot of cases, once you've, once you've kind of opened the tooth up is maybe a little bit more pleasant. Cause it's not as noisy. Like all the instruments are quite a bit quieter. And that's fair. And there's not the bunch of water cause they're in there. Yeah, yeah, exactly. There's in, in some ways I feel like there's a lot more space to fill with because they can't say anything or do anything. Cause they're in a rubber dam.

[00:30:22] If you don't, if they're not, you know, we have TVs lately. It's been a lot of, a lot of, I love Lucy and, and love boat and stuff like that, which is great and a fantastic distraction. So then I don't have to, but, but if they're not really engaged in something, man, I do feel like the, is the quietest, it's so quiet. Once you get going, it's really quiet and it's, it's got so much passing back and forth and so many different instruments and stuff. So you kind of, it's, I don't know that you warn them that it's a, a quiet, but I say, ah, this is when you lucked out. This one's a little quieter than most of this stuff or whatever.

[00:30:52] So it's, it's an interesting take. I got two quick, I got two quick ones. One, when you're bringing back for someone for root canal, root canals have a crap load of stuff to get out. And I've had people like almost comment when they walk in the room, like what the hell is this? Or they look at it afterwards, like what in the world happened? I almost got to set them up for like, this, this procedure has a lot of parts and pieces to it.

[00:31:14] There's a slide in my lecture of the world's worst, uh, dirtiest crap all over the place operatory. Um, because of that. Yeah. Like, like the solution is to, you know, that's, that was one of the selling points of the endo pilot was, Hey, you didn't have everything. Clean your system for sure. Uh, here's another one.

[00:31:38] If you don't get like the tightest seal in your rubber dam, get a little product called liquid dam. Yeah. Yeah. Squirt it all around your, like, you know, some of the like, um, in our proximal areas, if you're, if you're doing, if you have a quadrant sealed off or even just around the clamp, if you're doing a single tooth seal, because that will make it so they don't get any of the stuff that smells and tastes like bleach in their mouth.

[00:32:03] Because man, if they get that on their tongue, it's, it's an, it's an instant bitch and an instant, like, you know, cause for concern for them. But if you shoot a little liquid dam around the tooth, around a clamp, I mean, if you've got an impeccable seal good on you, you probably don't need it. But there's plenty of times where you don't have like that a hundred percent seal and that stuff solves the problem. And then no matter how reckless I am with this stuff. Is this light cured? Yeah. Okay. I, but it lights cured. The stuff sets up.

[00:32:33] It doesn't sound like composite. It sets up kind of pliable. Um, okay. Okay. Have you ever used liquid dam, Kevin? You know what I'm talking about or no? Uh, I've not used it. Well, I use the, I use the putty from ultra dent, which is, or the caulk from ultra dent, ultra dent. Oh, so you use the most expensive possible version of, uh, I'm talking probably the liquid dam you can get from net 32 for a few bucks. I know, I know, but I found the light cured stuff doesn't seal as well as I want it to. Okay. That's kind of why I like that.

[00:33:01] I actually should just go to the hardware store and get a huge thing of actual caulk. I feel like that would be the move. That's a great idea. Yeah. Huh? Use flowable composite. You can, but I also think flowable can leak pretty good too. I have a, I have a pet peeve. Liquid dam is better because it's almost like, like pliable. So it like kind of seals just a little better than just straight resin, but that's okay. Go ahead, Kevin.

[00:33:25] My pet peeve is the patient that says, uh, the roots are gone on that tooth. Yeah. Like after the root came out. Yeah. Like that, that's, you took the roots out. Yeah. You took the roots out or I thought that tooth didn't have any roots. Yeah. That's, that's similar to, I have TMJ, which just goes in my head. Like, but see, I show, I show it. I show a final PA. Yeah. Okay. Every single time. Yeah.

[00:33:53] Except for if I'm, you know, didn't go my way. I'm talking about like a couple. Yeah. Unless it's horrible. Unless it's horrible. Unless it's one of those that's going to be used. If I wouldn't show it to you guys what not to do. Right. Years from now when that tooth fails, cause it will, and you're going to extraction graph to put an implant in there, they will say, I thought that, I thought the roots were gone. Yeah. And then I just think in my head, like your tooth has just been floating around in your mouth magically somehow for five years. Actually, I get what they're saying.

[00:34:23] It's just, it's just. I make a point of berating the patient to their face. Yeah. No, you idiot. I didn't take a fruit out. You moron. Yeah. The more derogatory terms, the better. You gotta really. I feel like that really, I feel like that really helps. And the patient appreciates my, my camera. Yeah. Yep. But make sure you throw something on the ground whenever you see like, Oh my God. Yeah. You gotta look frustrated. I like to throw my gloves on the ground. Snap them. You gotta do the snap and toss. That's the way to, yeah. Yeah. I agree.

[00:34:51] That's a good, that's always a good technique. Idiots. All right. Well, I think we've covered it. Endo, we've got you. Yep. We got you. We got you, baby. Final thoughts. Try that med drawl. Try that med drawl. Do more. Wait a minute. Tell me what you do. What's, what's the script? What do I write? Med drawl dose pack. Med drawl dose pack. Do you do this, Kevin? Is this what you do also? I do it post up. Like most of my. Like when? When do you do this?

[00:35:20] Um, post up would mean when they're done. No, no, no, no. I mean like every time. That's after the procedure. Like you don't know. Every root canal? No, not every root canal. The ones that are in hot teeth that are in extreme pain, uh, super like infected tooth where there's a bunch of pus coming out. Like. More so than antibiotic or you do both? Both. Both. Double down. Yeah. Okay. Why not both? Yeah. But wait, I, I, there's more. I feel like the med drawl prior to particularly on a hot tooth.

[00:35:50] Now if, if they come in that day and you're going to do it that day, obviously. But if you've got, if you've got a little time, I'm gonna throw that at them. Most of mine are. Do you put them on an antibiotic also? Are you, are you doubling down? Are you writing two scripts? Medrol and amoxicillin? If it's infected, yeah, for sure. If they have signs of the infection where I think it'd make a difference. I mean, I mean, if they have a draining fistula, I mean, a lot of them expect an antibiotic because I think dentistry, we've not been the best stewards of the medication. I, if they've got, if they've got actual swelling and pain, yeah.

[00:36:20] Like I'm, I'm probably not going to do it for without that. I want to see some, I want to see some of that. I just feel like I got, I got one more thing. Speaking of, okay, let's say they have one of those like external swellings. How often are you guys like popping and draining that at the same time you're doing this? Is it fluctuate? Will it drain? Because a lot of times it's the cellulitis and it's not going anywhere. No. Like you can, you know, it's, you know, it's getting ready to. Kevin, do you do that? I mean, I'll do that all the time with extraction.

[00:36:49] Well, no, I'm not talking about extraction. I'm talking about endo. Yeah, I'll do it. For sure. Yeah, I do too. Yeah, I do too. Is there any better, is there any better thing though, that getting pus out of the tooth once you've opened it up? That's like, oh, that's that. That's well, yes, there is. When you go into a vital tooth and you pull out the entire nerve in one, like fell swoop, which just happened. It happened to me the first time in a while. I was like, wow, the other day I got the whole thing in one fell swoop and man, that's satisfying. There are two prizes in the endo world. The full pulp extirpation.

[00:37:20] Yep. And then I proudly lay that on the patient's napkin, look at my assistant and say, guess what's for lunch? It's a month. Yeah. And then the other one is the access to the chamber and pus and blood just starts flowing out like Peter Brady's lava volcano. Is there even better when you actually push on the vestibule and it comes out faster? Yes. No, no, no. That's really great.

[00:37:47] We bring everyone in the office into the operatory to watch this display of this flowing volcano. A lot of times if I'm in the scope, I've got it on a monitor. It's just glorious. Well, you're right. It's actually glorious. But the funny thing is, is like that full pulp extirpation is kind of like the, is like the, is like the no wipe. It's the one in a million. Yeah, it is. It's no, I can, I can count the number of times on, on even with all the ones I've done, I can count maybe on one hand, the number of times that that's happened to me.

[00:38:16] And one of them was just within the last like, you know, three to four weeks. Is this on a file or is it a bar brooch? Well, see, that's the other part. I don't think I have any bar brooches now, but that was always, the conceit was if you used one of those, you were more likely to get it. Yeah. So that's the other thing is that it has, I think part of the reason it hasn't happened to me very much is cause I'm now I'm going in with these rotary files, you know, all the most immediately and you're never going to, those just obliterate the thing rather than, you know, get the, get the pole.

[00:38:43] So I think if your last name is brooch, you should name your kid Barb and male, female, send them to endo school. Yeah. I agree. I think that's mandatory. They were, they were, they were born that way for sure. All right. Hey, thank you guys for listening. Um, we will continue this series with my extractions and implants and, oh, we got, we got a few more rounds. Yeah. We got, we got more in the, this has got legs. Yeah, it does. Yeah. It's got legs.

[00:39:11] Thank you for listening and we will see you next Tuesday. See ya.