Very Clinical: WWVCD?

[00:00:00] Welcome to The Very Clinical Podcast. In about the time it takes to do an M-O on 3, we will

[00:00:22] entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin

[00:00:27] and Zach. What is up, very clinical listeners and welcome back to yet another episode of The Very Clinical Podcast. I am Zach

[00:00:35] Miners coming to you from Kansas City, Missouri with me as always my trusty co-host actor Kevin

[00:00:40] Hare Friar. Kevin what's cracking in Cleveland? We're doing pretty pretty good. Very good. I like that. I like

[00:00:49] that. As a returning guest from last week, Dr. Alan Mead, what's going on man? Well hello, how are you?

[00:00:56] You know. Also, pretty, pretty, pretty good. Okay. Obviously we're using some Larry David lines because

[00:01:08] Curb your enthusiasm just ended. Yes. Are you bummed Kevin? Are you sad? Um. Or was it time?

[00:01:16] I'm not going to say I was bummed. I think I'm glad I got to see him. You know what I mean? It was a great show.

[00:01:31] It meant a lot to me in terms of humor. I suppose it was time. Larry's getting old and all that sort of stuff.

[00:01:42] But I just loved it. It's just a fascinating show to me. What are your thoughts? Give me a review of the

[00:01:51] FNAW. What did you think of the Finalist slash Last Season? I thought the Last Season was great.

[00:01:57] I read a pre-review that said it was mixed, but I thought it was fantastic. I also read somewhere

[00:02:05] and I agree with this that Larry and Leon are one of the greatest comedy duos ever. I love one of the lines in

[00:02:14] the finale where Larry leans over in the airplane and tells Leon, I don't consider you a person.

[00:02:24] It's just so funny to me. I don't know how any of those actors got through any scenes with J.B.

[00:02:30] and he's so funny and so off the wall. His delivery is something else. It's just like one of those

[00:02:43] characters where I just start laughing even, you know, he could literally say the Gettysburg address.

[00:02:49] Oh, wait a minute. Larry did that. And I would laugh. Yeah, it was interesting if you watch an episode

[00:02:58] where before that season of the season of the Blacks coming in, it's a different show. It is.

[00:03:07] And then that really changed things after that. But I thought the finale, I thought they did a great

[00:03:10] job. I love that Jerry Seinfeld was on. They kind of had some re-dos of the

[00:03:19] Seinfeld finale away. It was really cool. It was a good show. I'm glad they went out on a high

[00:03:25] note because it shows end on a man note. So, you know, very good. Good on them. And, you know,

[00:03:33] Richard Lewis passing away and also Funghouser. Yes, super, super Dave. Dave Epstein. Yep.

[00:03:44] Yeah, which was several years ago. But still, you know, just proof everyone's getting older.

[00:03:50] Yeah, it was time. Yeah. It was time. But good show, good finale. If you're a fan of that show and

[00:03:58] you didn't start this season or just do it, it's an enjoyable way to end it up. And now you've

[00:04:05] got nothing because you've never seen an episode. I've literally never seen an episode. Now I'm

[00:04:08] okay. So we went back and watched some season one stuff and it is an entirely different show.

[00:04:14] But like a lot of things, they're just getting their footing and trying to figure it all out.

[00:04:18] That was 20 years ago. Long time ago. Yeah, so 20, 20 years. That's a longstanding.

[00:04:24] It's interesting how HBO allowed him to make the show on his terms rather than

[00:04:29] having to do it in consecutive years and all that. Yeah. Do you have a favorite episode?

[00:04:36] I know we've talked curb on this show before, but like, do you have a favorite episode?

[00:04:40] Well, we're talking off air. I guess it's called the lefty call. It's the one where

[00:04:44] Larry gets in a little conversation in the bathroom and

[00:04:51] kind of backs down from a guy. And then Leon gives him this whole big pep talk about,

[00:04:56] you got to stand up for yourself and get up in that ass. And I can't even think about it

[00:05:03] without laughing. But you send us a list of behind the scenes. You could take any of those.

[00:05:16] Anything from the season with Moca Joe and particularly the finale of the Spite Store,

[00:05:25] how that all ended. The Spite Store. Just hilarious. Good stuff.

[00:05:31] All right, Alan, since that thoroughly bored you for about five minutes there,

[00:05:38] let's go on to part two. You've got the scenarios. Okay. So one of the things that's always worked

[00:05:43] out great for podcasts is that you kind of go to scenarios. What would you do scenarios? We've

[00:05:50] done this multiple times on the Brain Trust and stuff like that. I think we've done it on

[00:05:54] very clinical too. And I had several of them saved up from emails and message boards and

[00:05:59] stuff like that over the last couple months. And so I have some for us to discuss. So

[00:06:06] I'm going to go ahead and I'm going to read them so I get it right. So okay, what is so from a message

[00:06:12] board? A private group actually, what do you want your patients to call you? My team always

[00:06:18] refers to me as Dr. Mead in front of patients. And most patients refer to me as Dr. Mead.

[00:06:24] Occasionally, I will have a patient that refers to me by my first name. Don't call me by my first

[00:06:30] name. You don't know me. I hate patients who use my first name without permission. This was

[00:06:34] from someone else. This is not my story. This was but so in other words, you

[00:06:39] this is comes from someone who it drives them crazy when people call them their first name

[00:06:43] because they haven't been given permission. So I want to throw that to you guys. I

[00:06:48] actually know how Kevin and Zach feel about this. And I kind of feel the same way. But

[00:06:52] Kevin, when you hear that, what do you think? So I introduced myself to all new patients as

[00:06:58] Hi, I'm Kevin and shake their hands. So I don't care. I don't need to be called Dr.

[00:07:09] I don't necessarily want to be called Dr. I had a patient that went to high school with me that

[00:07:18] I was not friends with who was a recent new patient and she just walked in and called me Kevin

[00:07:24] and said, oops. I mean, Dr. Fryer. I'm like, come on. I mean, I've no use since I was 14.

[00:07:32] I just I don't want that to be a barrier. I literally I don't care. Call me Kevin.

[00:07:38] What does your staff call you?

[00:07:42] In front of the patients, they generally call me Dr. Fryer. But behind the scenes,

[00:07:48] I prefer that they call me Kevin, please. Okay. Yeah. Okay.

[00:07:53] Zach, how do you feel about that? I introduced myself as Zach to all the all the patients.

[00:08:00] What they decided to call me from there. I don't care. In my office since my dad was there too,

[00:08:07] we kind of had to have like, sure, Dr. Miners and I'm Dr. I was Dr. Zach. Yeah. So like a lot

[00:08:14] of the staff is a little of that too. Dr. So a lot of us, a lot of the staff ends up calling me Dr. Zach,

[00:08:20] which is that's fine. I don't care. Again, I don't care what they call me either. But like,

[00:08:25] that's what they tend to call me. And then patients kind of I let them take it from there.

[00:08:30] Some of them really feel like they need to add that formality in.

[00:08:35] I and I don't say anything, you know, that's fine too. But if they call me Zach,

[00:08:39] I don't care. Like I said, I don't want that to be a barrier. In fact,

[00:08:43] I think I read one. I read a story one time that said that people are also somewhat less likely to

[00:08:51] complain slash sue you if they're on like a first name basis, this like overlord.

[00:08:57] I don't have a citation on that or anything like that. But I remember it being just,

[00:09:01] you know, I think it also brings you down all the better down to their level. And that's where

[00:09:06] you should be really. That's a Howard for an thing. I remember him saying that I'm like,

[00:09:10] okay, I'll be Kevin. But just to push back, I will say this, I introduced myself as Alan.

[00:09:18] And I would say 85 to 90% of my patients call me Dr. Mead. I think the one thing you can say

[00:09:24] though is you are an authority figure to most of these people one way or the other, whether

[00:09:29] you're intentionally or not because you're you're someone with an advanced degree and they're

[00:09:34] choosing you to care for them. There is sort of the formality does make sense to me for

[00:09:39] a lot of people. I think they feel better knowing that you're doctor or whatever. So that would be my

[00:09:44] pushback that said, I don't like I said, I introduced myself as Alan. I will say this,

[00:09:51] the people that go out of their way to call me by their first name, my first name,

[00:09:55] I do feel like it's a little bit of a flex on their part like in maybe maybe that's maybe

[00:10:01] that's me like I don't feel like I need to be called doctor but I can think of the people

[00:10:06] specifically that call me Alan. In a lot of cases, it feels like it's a bit of a flex.

[00:10:10] It doesn't I don't care, you know, it didn't bother me but it's but it's funny because I guess I'm used

[00:10:14] to them calling me Dr. Mead so the ones that don't, I can kind of remember. So maybe that's

[00:10:19] the I but I don't yeah I would never in it. Can you imagine introducing yourself as Dr. Mead

[00:10:24] or Dr. Mead? Or regular like social setting. I don't I don't want that.

[00:10:32] We all work hard. 100% not in a social setting. We all worked hard for that degree but also,

[00:10:40] you know like the people who really want to be called doctors or PhDs and stuff like that,

[00:10:44] you know what I mean? You ever had one of those? My favorite was the we bought our we bought our

[00:10:50] farm from a chiropractor and of course I'm a dentist and she introduced herself as Dr.

[00:10:57] Don. Dr that was that was like really? Oh really? Nice. I just can't imagine. I just so cringe

[00:11:05] whether it might be the reason I introduced myself as Alan. I just don't care. It was bad.

[00:11:09] Yeah. All right what do you got next Alan? Okay, so that's a pretty good one. I have to say

[00:11:15] for people who are listening to this in agreeing or because there are probably people

[00:11:19] that strongly disagree. I will say this. There were I did have on some of these threads

[00:11:25] women were asking if this is something that that patients do to women more than men

[00:11:30] on some level like saying that. Not if I invite it. Hi, I'm Kevin. And I do think it's a matter of

[00:11:38] permission like like the person said I hate patients use my first name without permission.

[00:11:44] The three of us have just indicated that we give permission from the very first time we meet

[00:11:48] the patient so the reality is it's obviously not a concern but if someone was not comfortable

[00:11:52] that I could see that getting under their skin but I still would say check yourself a little

[00:11:56] bit because it doesn't seem like the kind of thing that should be a deal breaker to me. Right.

[00:12:00] All right so this one is I will say this one is mine. This is this is a I want to hear what you

[00:12:06] guys have to say about this. I don't think I've told you about about this clinical situation.

[00:12:09] This is a good situation that I'm dealing with. Patient presents. Well this was this

[00:12:15] like a month ago. Patient presents with severe pain and an upper left premolars

[00:12:19] swell. Patient's relatively recent kidney transplant recipient with a medication list a mile long

[00:12:26] and they also tell you they're having a pretty invasive eye surgery in a couple of weeks.

[00:12:30] I diagnosed a necrotic number 12 and heroically I was very proud of myself perhaps against my

[00:12:36] better judgment opened the tooth and actually the patient called the next day they were doing

[00:12:40] great. I got some calcium hydroxide in it. She was comfortable and I think we were fighting

[00:12:45] the infection as best we could prior to this surgery. I didn't want to finish it because

[00:12:50] it was really I mean it was it was draining and that sort of thing so she's doing great.

[00:12:54] So I thought she's good. She's good to go for the fast forward a couple weeks. Patient calls

[00:12:59] your front desk says they had the eye surgery everything seemed to have gone fine

[00:13:03] in the eye surgery was like last week now they have a bunch of swelling on their face under

[00:13:09] their eye. You got that? So question number one what goes through your mind what are you thinking

[00:13:16] when and then she sent me a picture she was big swollen on her like like right kind of under

[00:13:23] her eyes she's big and swollen so what will go through your mind? I'm a little I'm a little

[00:13:31] worried about my tooth yeah I mean based on the area that you're you're pointing out exactly

[00:13:36] I'm like oh yeah under your eyes seriously after all this yeah so that was one thing and so what

[00:13:43] questions do you what do you ask the patient what do you what do you what do you want to know?

[00:13:48] Well I mean in this case it's it's likely two things it's either from the eye surgery

[00:13:55] that's a possibility right and it's also likely that it's your tooth yeah and so how

[00:14:01] the suspense is killing you yeah she had the surgery on her right eye and the swelling

[00:14:08] is on the right side so it was not too there was oh okay it was 12 so it was a left side

[00:14:14] so you can imagine my relief yeah okay yeah so okay so notice this is like the scenario

[00:14:21] that tooth you did who's crowned of it that's always the always the first question I lost a

[00:14:27] crown who's crowned was it exactly right now that was my first thing like so I can't tell you how good

[00:14:32] the other thing is I have to say having cleaned I really got this tooth cleaned out really well

[00:14:36] like yeah if I wasn't a two-step guy I could have filled it I also didn't have enough time but

[00:14:41] I could have filled it it was it was really we did really well with that so I was very

[00:14:45] I was really surprised that this was going to blow up but you never know it's endo man

[00:14:48] you never really know so okay so she sent a picture and she did have a big she was

[00:14:54] swollen right up right up under her eye and in having seen a few of these over the years

[00:15:00] my guess was okay if it isn't the eye surgery and she said she talked to the doctor

[00:15:05] and they were convinced it wasn't the eye surgery it's really so now it's a

[00:15:09] just another tooth that is well okay they sent them to me they wanted me to see them because

[00:15:16] they're convinced it was a tooth now I had a full mouth set on her from from two years ago

[00:15:21] in the right side she just has nothing remarkable she had a d.o on four that we did probably two or

[00:15:28] three years ago that was pretty deep but it wasn't wasn't remarkable and she had like an m o amalgam

[00:15:35] from a thousand before I ever knew her on number three she didn't have number two or number one so

[00:15:41] and I'm thinking to myself when I see a swelling like that what I know I don't know much about

[00:15:46] these but I think fascial planes and I think I think you know like I think a canine space swelling

[00:15:52] that's why I was thinking and I'm thinking I looked the full mouth set in the canine not only had never

[00:15:56] had a restoration it had no decay had no restoration nothing and you're like canine doesn't just

[00:16:03] abscess for the sake of abscess so let me tell you what you got involved with it was why I like

[00:16:08] to call it like doctor blaming or like someone trying to get out of something have her how often

[00:16:12] have you seen like a ent guy be like this isn't your sinus anymore this has got to be a you got

[00:16:18] to go back to your dentist and you know and I think we sometimes kick it in the other direction

[00:16:24] sometimes although like our diagnostic abilities are pretty good but I think we kick it in the

[00:16:28] other direction sometimes too but I mean it's a I've seen this game back and forth between like

[00:16:34] well basically no one knows so they're like what's got to be something the other guys

[00:16:38] got a hundred percent hundred percent me all that okay the other thing is she's swollen like crazy

[00:16:41] but also it hurts like hell so she was scheduled to come in to see me today but I told her I said

[00:16:47] you know she called like at like 4 30 last night as we're wrapping up and she said which I do I

[00:16:52] sent her to the ER I see you go to the ER your face is really swollen she's in ton of pain

[00:16:56] so they put her on IV clindamycin and gave her a bunch of dilaudid so she felt better

[00:17:00] but then they sent her home they sent her home with with with an antibiotic

[00:17:05] and in what here's what they didn't do they didn't do any imaging of any kind yeah so like

[00:17:10] imaging I'm sitting here thinking I would like to see a cone beam yes because okay there it could be

[00:17:18] a simple explanation a non-dental explanation there could be going something going on in

[00:17:24] her sinus especially if that area is manipulated I we don't know what the eye surgery was well

[00:17:29] okay so I got more for you she came she did come in to see me today um she could barely walk like

[00:17:35] her mom had to help her walk in she could uh she had gone to the eye surgeon and they said oh yeah

[00:17:40] the eye there's a lot of pressure on the eye they gave her some some eye drops when she was there

[00:17:46] but they said I'm we're certain this is a tooth well so I she came in and you know part of it

[00:17:51] is like when they say that I always feel like they're blaming me like I did something first

[00:17:56] nothing has been done on the right side for you know forever so there was really nothing

[00:18:00] like it yes could a tooth like abscess on its own yeah it really could but it wasn't it didn't

[00:18:06] seem likely to me you know I don't it's when you hear hoof beats are you looking for horses

[00:18:11] are you looking for zebras she just had surgery on her eye and it wasn't like a minor surgery

[00:18:15] and this is just swelling under her eye so so she did come in and she was like literally she had

[00:18:20] she had my trash can in her lap and she had oh this is this morning she woke up and she was very

[00:18:26] light sensitive like she couldn't like the light was causing her horrible head it was almost like

[00:18:30] migraine symptoms and I'm thinking to myself it's not a fucking tooth okay this is not a tooth

[00:18:35] so but she came in and I took four or five PA's I didn't take a pano because I didn't think

[00:18:39] it was gonna be useful but there was not a single parodontal ligament widened on a PA and

[00:18:44] I mean I know that a CT is the right thing I don't have one but the reality is like okay what

[00:18:48] we used to go by is we look for the periodontal ligament to be widened there wasn't a one in her

[00:18:52] head you know and I percussed and guess what everything hurt but it didn't it wasn't the

[00:18:57] I'm peeling her off the ceiling it's that I'm tapping on her head and she has a horse she's

[00:19:01] in horrible pain her head so there was there was not one indication that it was a tooth

[00:19:06] do you know what kind of surgery this was yes it was a vit oh god what was it hang on it's a

[00:19:12] uh it sounds horrible they drained the vitreous humor and and replace it with some other solution

[00:19:19] of vitrectomy is what it's called a vitrectomy is a laser vitrectomy I think Zach's humor has been

[00:19:25] drained a long time ago yeah yeah but I mean like like this isn't I mean I think it's done

[00:19:31] minimally invasively but it's it's not a it's not like a nothing surgery right it's nice so

[00:19:36] so anyhow I sent her back to the ER after I was like I'm sure this isn't another

[00:19:40] tooth but I mean she was dying in my chair she's just like literally I had to give her my trash can

[00:19:44] because she was she was dry heaving in my chair she was hurting so what's the oral surgeon um

[00:19:51] do you have one yeah I do I'm in reality the reality is this someone needs to do a CT

[00:20:00] yeah so there's there's she's swollen and that swollen is gonna that swelling is gonna be connected

[00:20:04] to something I don't have the CT and honestly I the oral surgeon would have had a really hard

[00:20:09] time like he was in I know the guy would send her to was in surgery all day so I sent her to the ER

[00:20:15] and they said that they would have done imaging last night but they were just backed up I'm like is

[00:20:18] that an excuse also do you know when someone's in that kind of situation I the antibiotics

[00:20:22] at someone with no diagnosis I don't I get backed up a lot I'm 60 years old so I know it's

[00:20:28] it happens to the best of us Kevin it really does so anyhow so I still don't really know what's

[00:20:33] come of this I'm 98 percent certain that this is not Odonta not a tooth and I don't think it's a tooth

[00:20:40] I agree and she did just have a surgery on the same side so I'm just you know the eye doctor

[00:20:46] doesn't want to you know think that there's anything they could but but I mean you know

[00:20:49] like to Zach's point though she probably said I just had a root canal done you know exactly

[00:20:55] that's that's what I'm saying yeah you know wrong side yes wrong side I don't she knew she

[00:21:00] knew that we'd done the root canal on the other side she knew that much and they were not there was

[00:21:04] no one was blaming me none like her mom came in with her she's a 30-some-year-old woman she was

[00:21:10] freaking dying no one was mad at me at all she just wanted a solution and the eye doctor wasn't

[00:21:14] giving it to her so she goes to the next person right and she's and the eye doctor went but I

[00:21:17] mean I feel like I said I can't be 100% sure but I am very certain I can rule out a tooth

[00:21:24] on this one and so then I sent them on there and I gotta say I'm hoping to hear from her tomorrow

[00:21:28] see what you know yeah I want to know we all want to know yeah so cliffhanger keep you posted so that

[00:21:34] was that was my scenario and I'm so here's what I'm glad to hear you guys had all the same thoughts

[00:21:39] that I did I'm like I didn't know anything it's just like a yeah and of course was it the tooth

[00:21:44] we worked on and for about 20 minutes yesterday before I got the text back I was thinking oh

[00:21:49] god yeah the tooth that I was certain that you know was gonna was gonna keep her before

[00:21:53] that through the surgery blew up but so but it was not that but so what is it about the dental

[00:21:59] mindset though that anytime someone calls with something you know a crown off or a

[00:22:05] tooth that's hurts we always like god it had to have been something we did and how often at

[00:22:11] least half the time right is it's not a crown we did or it's a different tooth or a different

[00:22:17] area or they're not even the same side that we we did anything I mean but our I think we always

[00:22:24] default to the worst case scenario it seems like yes I know mentally that's where I go all the time

[00:22:29] it's unhealthy and I don't know what the problem is with me but I think it's all of us you're 100%

[00:22:34] right uh we always do that all right what's next what's the next one you have finished a long

[00:22:40] week in the dental office and you head to the movie theater to catch the latest marvel flick

[00:22:45] which I don't even know what the next one I think Kevin's not gonna do that latest art flick art

[00:22:49] latest art flick whatever you fill in the blanks you know okay make make this work

[00:22:53] sit down with a giant bucket of popcorn and a slushy maybe some good and plenty's to enjoy the movie

[00:22:59] on your third wait man what is a good and plenty good but you don't know what that is can you

[00:23:04] know I don't know what that is fruity if you're not a licorice guy oh two Charlie was an engineer

[00:23:10] you don't know that uh commercial yeah we'll get commercial for this you know oh my god yikes

[00:23:16] on your third gigantic handful of popcorn you shoved in your face you hear a loud crack and feel a

[00:23:22] piece of number 19 probably the distal lingual cusp on your tongue what do you do who does your

[00:23:30] dentistry and how quickly do you have something done so this is this is a hippo violation waiting

[00:23:36] to happen because I'm having you admit about your dentistry stuff so Zach who does your who would

[00:23:43] take care of this uh this restoration of 19 I'm not asking what restoration because of course no

[00:23:49] that's okay sure yes gold crown gold no my dad's gonna do it I still my dad's still I didn't think

[00:23:55] about that yeah so yeah I've got mine mine's easy I'll have him do it and it all was good

[00:24:01] let me tell you though that I I recently chipped a very small piece of the distal

[00:24:08] lingual of 30 and decided to smooth it myself with you know with the with the burn a mirror

[00:24:16] and an awkward angle and sure so I did do some self dentistry you know but it was that was just

[00:24:22] a smooth it wasn't like a broken cusp okay but yeah no my dad would do it so my my you guys

[00:24:25] you've got you okay yeah Kevin who's doing your who's who's helping you with number 19

[00:24:33] well in the past uh so my number nine is an implant I had some trauma as a child

[00:24:40] I was locked in the closet and not given any food for a long period of time

[00:24:46] oh it's not funny I'm gonna show I'm having that but anyway I fell off my bike and so

[00:24:51] number nine is an implant uh so I did not place the implant myself obviously my oral surgeon buddy

[00:24:58] placed that but when it came there's a youtube video of like a russian dentist I saw that yeah

[00:25:04] tooth out and puts the implant I gotta find that because that's no I think it's a terrible idea

[00:25:08] on all counts but the video was kind of impressive I have to say that so when I had it restored um

[00:25:15] I guided my EFTA who'd see me do this this was pre digital days

[00:25:21] actual pvs impression I had her do it under my direction I held a mirror and said who she's

[00:25:26] you know she knew what she was doing it just sure you know she she wanted the reassurance or

[00:25:31] whatever and then when it came back from the lab I had her put it in torque it torque it in

[00:25:37] cemented in so that was probably illegal except it was on me so I don't really care

[00:25:45] and um but now I would that crime no victim to that right I would um have my associate do it

[00:25:53] as a oh that's right you know three months ago something like that happened again

[00:25:57] but um in the past uh Sam shout out to Sam she would um do my dentistry for me

[00:26:04] all right so mine mine is is a multi layered uh thing so for one thing my dad did a ton of

[00:26:14] dentistry on me as a kid he did my ortho did the veneers that he did veneers on me when I was a

[00:26:19] sophomore in college I still have him so yeah I mean he's done a ton of dentistry he doesn't

[00:26:24] he doesn't really practice anymore he I it didn't that he couldn't but it's been a while since

[00:26:29] he spun a handpiece he does removable uh now and again but he doesn't so I so he could do it for sure

[00:26:35] I wouldn't worry about it that much but I've had I actually have had my friend Bart in Minnesota

[00:26:40] do some work on me oh because I wanted to see how the Sarac worked so I had I had he and his

[00:26:46] his his partner do some Sarac's on me I have a guy in Saginaw that's done some work on me too

[00:26:52] I to be perfectly honest I probably go to him only because for ease of use proximity and I

[00:26:58] have done and I've done some work on him too um so but honestly like if I had a chance uh

[00:27:08] well I'll probably let's be perfectly honest I uh not proud of this but I drink a lot of soda

[00:27:14] I drink a lot of diet soda I drink a lot of fizzy I drink fizzy water I drink all kinds

[00:27:18] of fizzy stuff I have acid erosion worse than anyone you've ever seen your whole life

[00:27:22] I will likely need some kind of full month rehab at some point like if anything I'm just

[00:27:27] going to need the occlusals of my teeth I don't have a lot of decay I just have a lot of acid erosion

[00:27:32] and you know you know who I probably I think I've said this on the show before

[00:27:36] Bill Strauss probably go to Dennis Dennis Hartle if I could because he's got that that CPR

[00:27:43] yeah yeah yeah he does that he does a mock well it's not a mock-up it's like a full-on composite

[00:27:49] you'll open your bite back up and stuff like that I've talked to him about it before

[00:27:53] I guess I have to wait until I need to end out or something before actually make a move

[00:27:56] but I probably should do that but it is a funny question you like who who does the are you losing

[00:28:02] are you losing vertical dimension you need like you opened up I don't know I don't I don't know

[00:28:07] I mean okay I'm gonna lose you know Dennis is Dennis's rock solid I'd let Dennis you know

[00:28:12] work on I mean yeah Dennis is probably one of the most talented Dennis in the world I

[00:28:16] it's a safe bet that he could be doing it but yeah so it's but I mean it is an interesting question

[00:28:22] who does the dentists dentistry especially if they don't have someone that they work with it's not

[00:28:27] necessarily a it's not a super obvious question sometimes so if my dad hung it up and didn't

[00:28:32] feel comfortable using the handpiece anymore I've got I got some good buddies within you

[00:28:37] know 30 minutes an hour from me that are that I'd yeah I'd go down the streets to my friend

[00:28:44] yeah yeah yeah that's so it's doable it's doable okay I have one more scenario this is this is a

[00:28:50] great scenario this is a scenario that every every every restorative dentist has has an opinion on

[00:28:56] you're placing a crown to do a current decay on the distal margin you choose the crown I don't care

[00:29:01] whatever whatever crown you want let's say it's a posty area though just say okay you need to

[00:29:05] remove the crown and reprep so what burrs and instruments do you use to remove the crown

[00:29:12] for zirconia or lithium decilicate and then separately what do you use for pfm or gold and

[00:29:17] then what are your steps what is reprepping a crown look like to you and how do you evaluate if

[00:29:23] you need what you need to change and how do you change stuff so that's a lot of stuff in there

[00:29:28] but I'm gonna just go ahead and I'm gonna throw it to Zach Zach how do you how do you get crowns

[00:29:32] let's start with the how you get crowns off let's do that okay so if it's if I'm cutting

[00:29:36] officer conia crown um I buy all my birds from a company called dental re re they have a line of

[00:29:46] that like that audio if they want because the re sounds like a handpiece they can have that for free

[00:29:51] if they want it I've mentioned them so many times they owe you like an ad you know what I had this

[00:29:58] thought I don't know why I'm bringing this up now because I meant to bring it up at the beginning

[00:30:02] um all the podcasts I listen to are sponsored by ag1 how come we don't have that

[00:30:09] yes that's true yeah where's our ag1 money you know correct so we need we need a ag1 sponsorship

[00:30:15] I'll start taking it if yeah if they'll throw us a few bones yeah I bought it once for Charlie

[00:30:21] and he hated it but what is ag1 I don't even know that that athletic greens

[00:30:26] I didn't okay got it got it okay we should just make our own ag1 commercial that we insert in the

[00:30:32] middle of the podcast and maybe put dental re in it too just because sure that's all right by the way

[00:30:39] dental re's like come on yeah give us some love I've mentioned you like five times for free okay uh

[00:30:45] they have a zirconium zirconium room I think they call them their cyclone first I don't know

[00:30:49] something like that I would use those for taking off zirconia yeah I'm not gonna say they cut

[00:30:53] them off like butter but they do a pretty good job at a reasonable price and then if it's a pfm

[00:30:58] okay so here's the thing okay let me just ask you though and I don't mean to cut you off but

[00:31:02] no we're using those first off sometimes even with I use the microcopy the z-cutters which are

[00:31:08] is probably good for removing either that or a very fine of some sort like a very fine

[00:31:13] those cut through it better but yeah what I've found that even when you get a good nice

[00:31:19] slice down to tooth structure and of course you want to take it probably listen to me I'm just

[00:31:22] answering my own questionnaire take it down to the gingival take it down to the level where you've

[00:31:27] got a good split I find that those things don't break very nicely like they break off in pieces so

[00:31:33] I'm fine what are you using to cut them off uh or I mean what are you using to pop them off use

[00:31:39] the christian screw yeah I mean it's essentially like a thin screwdriver head yep it is and and I

[00:31:44] mean I know it was designed with porcelain fused a metal and porcelain fused a gold in mine but

[00:31:48] man like occasionally you get a nice clean but even so let's say you get half of it off

[00:31:54] then the other half doesn't want to move a muscle this is where I think to myself why in the world

[00:31:58] are people bonding these things on I can't get them off with I mean unbelievable those things

[00:32:03] so anyhow like what like okay so Zach you do this you get the christian instrument on it

[00:32:09] you take off and maybe the the let's say the mesial half of it comes off then what do you

[00:32:14] do where do you put the next slot what do you do then the occlusal yep just you know right across

[00:32:19] straight to the distal from wherever it broke to the distal uh huh yeah and then you get then you'll

[00:32:23] get like a small piece of the distal lingual that stupid crown sure and then you can usually take

[00:32:28] a hemostat and get the get the rest so that's I find I find myself I find every goddamn piece

[00:32:34] holding on to the last second like that's what I've just drives me crazy I was hoping you guys

[00:32:39] were gonna tell me that you had some kind of magic well maybe Kevin's got a better system

[00:32:43] that's my how do you how do you remove let's do the zirconia lithium basilica all right so I use

[00:32:49] disposable diamonds from park l and uh I might go through two of them but it will cut through

[00:32:58] zirconia and I'll cut through emacs uh I don't use anything special at all it'll cut through make

[00:33:06] a slot on you do the christiansen crown remover or do you use uh I use a special instrument

[00:33:13] known as the cement spatula that I put in my slot and twist it so I'm making a slot from

[00:33:22] the buckle cross the occlusal down the lingual yes right yes correct I take a cement spatula that's

[00:33:28] already in my kit because it's the crown kit stick it in the slot that's what she said

[00:33:33] give it a twist that's also what she said and oftentimes one half will come off and the other

[00:33:39] half will stay on then what I do is I don't know how to say bad words I take a I take the same

[00:33:46] diamond and I make a horizontal slot in on the buckle and lingual of the piece that remains

[00:33:54] oh okay okay so I'm making like a grip yeah and then I have a crown removing instrument

[00:34:00] that I can put into that slot and give that a little twist if it comes off great if not then

[00:34:07] I'm on to sectioning more pieces off like you guys just described I would say that maybe 40% of the

[00:34:14] time 30 or 40% of the time I can get that other piece off by using that little trick it's not

[00:34:20] foolproof two two cuts is going to get that that that first cut and then by the time the second

[00:34:26] cut happens that's that's nine out of ten yeah are gonna be are gonna be done at that

[00:34:33] that's not my experience at all god I if I can get a half of it off I'm always feeling pretty good

[00:34:39] because I know I'm gonna be fighting the rest of it the whole way off I just I don't have good luck

[00:34:42] getting and uh I don't know what the story is on that maybe you need to make a bigger cut

[00:34:48] maybe you need a better better burr I think that's important too you need

[00:34:53] something fatter in there that's why I use the chamfer diamond a bigger slot and

[00:35:00] these cyclone burrs are big I mean they're like they're they're way bigger than any burr I would

[00:35:06] I would prep a prep a regular crown with for sure okay so no Zach bragging

[00:35:13] Magnum

[00:35:15] Magnum burr exactly Magnum that's right all right so when it's a PFM or a gold

[00:35:20] I used to think to myself this is the best part of my day because this is the easiest to take off

[00:35:27] I take a diamond burr and take any porcelain off to get to the mill then I'll get one of those like

[00:35:32] cross cut fissure that's a 557 or something like that or a 1550 set whatever they call them

[00:35:38] and those will usually cut right through whatever metal you're talking about even even a even like a

[00:35:44] what's the what's the non-bass metal you can even cut through base metal of that pretty

[00:35:48] quickly it's base metals a bit hard yeah yeah base metals a bit you know take out you're taking

[00:35:54] off like a bridge so where it's like there's a thick prep oof I have these like that things we

[00:35:59] label as the metal cutting burrs like that piranha style burr if you've ever seen those

[00:36:03] advertisers or something like that or barracuda or I don't know whatever dental reese equivalent of

[00:36:08] a lot of nautical animals used in these burrs and weather phenomena a lot a lot of those things

[00:36:13] yeah piranha and cyclone and stuff a lot of violence really violent

[00:36:20] same old disposable burr for everything special and just yeah run to it it's special because

[00:36:26] you're doing it let's be perfect yeah that's what it is so so here's the thing like and then you

[00:36:32] get the same christiansen thing and usually you could usually these come off much easier because

[00:36:35] much easier yes but here's here's lately I gotta tell you what happens sometimes when

[00:36:41] there's metal and you've broken the porcelain off you ever notice that you get it to pry about

[00:36:45] half off and and then your it doesn't come all the way off and then you've got this freaking

[00:36:50] razor sharp oh yeah and then I'm like please don't get their tongue on that thing exactly okay so

[00:36:56] that has happened to me the last three times in the the like several months ago I know I think

[00:37:01] I told the story on the I had the crown like a half of the crown fly off and slice the

[00:37:08] floor of this guy's mouth oh you told me that story it's a bad beat it was in the other things

[00:37:14] he wasn't numb it was an endo treated to him so he wasn't even numb now mind you it didn't hurt I

[00:37:19] must have cut him really good anyhow he's bleeding like I'd so sharp with it with it yeah so and

[00:37:25] I and I'm thinking myself I'm terrible at suturing and that is a really hard place to suture on

[00:37:30] really fine tissue so I took some gauze and pressed on it like 10 motherfuckers and and

[00:37:36] honestly it it it did okay I didn't throw a suture I didn't even throw any fiscus dead

[00:37:42] and I didn't like that he just tissues tissues great yeah no tissues great and I saw him for the

[00:37:49] temporary and uh and he wasn't he was bare like it was all healed of course that's you know

[00:37:54] mucosal tissue he was like crazy he he teases me about it but it wasn't anything it's what I

[00:37:59] thought I thought he was going to send me the ER for cranial I thought he's gonna bleed out on me

[00:38:04] oh so scary so now I see those I used to think this is the best part of my day now I'm like uh

[00:38:09] and it seems like every time I think about it I get that jaggedy edge I had one of those um

[00:38:14] earlier this week I'm like in and I literally was just holding his lip and cheek out of the way

[00:38:20] because I'm like I gotta get this thing off before I let go of this because one wrong move I'm

[00:38:24] gonna slice my that of course that little paranoid from the hole under the tongue thing

[00:38:28] that was terrible so three words someone someone actually asked me the other day

[00:38:34] that needed some crowns replaced is this gonna be cheaper than doing it for the first time

[00:38:38] and on my head I was like you know what actually I think I would rather much rather prep uh

[00:38:43] prep it to the first time you know so I was like if anything it should be more yeah more expensive

[00:38:48] you what were you gonna say we're gonna see after gate I'm right I interrupted Kevin I'm sorry

[00:38:52] rubber dam rubber yeah but honestly even a rubber dam is a little sometimes it's hard

[00:38:57] sometimes it's hard I get it because only only because sometimes the the crown is holding the

[00:39:02] dam part down so that's the you can do a split dam and still probably be in better shape that way

[00:39:06] but it all depends on your isolate would probably work even an after gate would probably be pretty

[00:39:10] good too I guess what I was using none of those for any of it at that point but yeah back to

[00:39:15] Zach's point I had uh you never know what you're gonna find underneath these and then

[00:39:22] there's some sort of art to in my case if it's a posterior tooth making it look prepping it right

[00:39:30] so that I can use my saric you know like I've got uh there there's an art I can't even describe what

[00:39:37] I'm doing I'm just making it look right but I also had recently uh a veneer case where I was

[00:39:42] replacing veneers I had to cut these veneers off and the first one I cut off I was like oh

[00:39:47] crap because the way they were prepped I like uh I started to sweat a little bit if you know all uh

[00:39:56] I don't know how many teeth we did 10 maybe if all 10 of them are going to be like this

[00:40:01] this is going to be quite the day and it was that I would much rather start from uh

[00:40:10] you know regular tooth prep and cut cut these things off that was difficult

[00:40:16] I had a zirconia crown I cut off today I might have done the original I don't know it had it

[00:40:22] was at a deep distal margin uh cavity I did not know what to expect and it was a short prep

[00:40:30] it was a short prep it was like I like I I couldn't tell and of course nothing better than taking

[00:40:37] off a zirconia crown that's got three and a half millimeters of occlusals I mean as I just

[00:40:42] burr after burr just to get through there and I did get it off got a nice clean and I was able

[00:40:47] to drop the margin enough to grab hold of some tooth structure but I didn't know what I was getting

[00:40:50] into and so that's when I when I say you know what do you do to reprep it's like it really depends

[00:40:55] on what you've got underneath it and you kind of have to just do your best with it that deep

[00:41:00] deep decay under crowns I mean that's when I you know I'm telling my sister so I don't know

[00:41:05] if we're going to need the laser we're going to get every goo and goo tissue stuff you've got

[00:41:10] um like I said those are tough situations and if anything the patient that asked me that I

[00:41:16] I wish I would have just bullied said I think it should be more you know it's it's going to

[00:41:19] be more work for me definitely uh but you know you're asking the follow up on that almost

[00:41:25] the first thing I do after getting that off depending on the decay I mean it's real deep

[00:41:29] that I don't but get some get the cord in yep yeah get the cord in yep um as soon as possible

[00:41:37] so you can visualize things better yeah so that's the next thing I'm going to do and then from there

[00:41:40] it's just you know kind of regular crown stuff dude doesn't need to be built up built up no you

[00:41:46] know what am I going to do to make this look right from there yeah that was that was uh uh

[00:41:51] today's we ended up it was a decent prep it's not one that I probably would have put up in

[00:41:56] style at Aliano because it was so dang short to start with but we made it work and cord was

[00:42:01] a big part of it like I got some cord in there I was able to drop that margin other millimeter

[00:42:06] and a half which all of a sudden made it a tune that I looked at going man am I going to be able

[00:42:09] to restore this to one that's like that's not a bad prep so it was a yep but and I gotta tell you

[00:42:14] I'm gonna uh there is a I've talked about it on the show and I'll put it in the show note only

[00:42:19] because I I've I've had a love hate relationship with cord for a long time and a lot of cord

[00:42:26] packers don't do me justice okay so oh what's his name Ed McLaren designed a cord packer

[00:42:32] and it's from Pascal and I want to say it's called pack it or or I forget the name of it I've talked

[00:42:39] about on the show before god I have the Pascal I have the Pascal uh cord packing instrument it's

[00:42:45] great the serrated guy it's kind of a smooth no this is this is new ish I'm gonna find out

[00:42:49] oh um the one I'm using is not new so but it is a Pascal product it's called get packed

[00:42:56] by Ed McLaren get that's some marketing yeah some marketing right yeah go get packed it's a multi-angle

[00:43:03] cord placement instrument and it really what's really cool about it it's goofy looking and then

[00:43:07] when you better name than Panavia what does that mean what's that about it's got two ends and it's

[00:43:12] got in and what's really funny is you find like listen get it in there it is it's really good

[00:43:17] it's probably the best one I've ever used by far when we retire they need to hire us to name

[00:43:22] these products because we've brought it up twice they're named after um aquatic animals or or weather

[00:43:31] events let's we're mildly insulting statements like get packed yeah yeah we can do better like that

[00:43:38] yeah too better it's in any case or a crocodile file is the dumbest name ever or or like how about

[00:43:45] you know 3m we'll just add more adjectives yeah you know 3m ultra mega supreme supreme

[00:43:54] they got the magnum 3m 3m could use some help with their website too to be perfectly honest I'm sure

[00:44:01] they've got they've I'm sure they spend millions on it and it's a very tough website I've always

[00:44:06] wanted to be the guy that named the paint colors on the paint chips that's a job what'd you do

[00:44:12] today honey well funny you said that I named something honey and right yellow yeah and then I took lunch

[00:44:22] yeah no there you go and then I got packed so to speak yeah anyhow so I think I think

[00:44:30] cord is a big deal well on these particularly on the ones when you're redoing I think

[00:44:33] chords are nice like you said because then you can make sure you can you can drop that margin

[00:44:37] if you have to because I feel like a lot of times if you if you're replacing a crown that's been

[00:44:41] there for 10 years you're going to have a little bit of a session you want to catch up on if you

[00:44:44] want to have a good uh emergency profile and stuff like that so I think I just like to see

[00:44:50] it seems like anytime you're replacing a crown the gums aren't going to be the greatest around

[00:44:54] there too right and if man if you're replacing multiple crowns get the person on some paradex

[00:44:58] before you start make your life easier yes excellent advice if you can think of it so

[00:45:04] anyway we're probably up against it Al these these are long for very clinical episodes

[00:45:10] extra extra content magnum

[00:45:12] magnum episodes thank you for thanks for uh yapping with us this evening Al appreciate it man Kevin

[00:45:17] any uh final thoughts any takebacks apologies double downs um you gotta get up in there Larry

[00:45:24] all right hey thank you guys for listening check out our Facebook group the very clinical

[00:45:29] Facebook group thank you guys for listening and we will see you next Tuesday see you