Minimally invasive

So today there was a lecture on minimally invasive dentistry.

There is a big push out of the west coast to start implementing something called CAMBRA.  CAMBRA stands for "caries management by risk assessment."  It is an evidence-based approach to something we've known for a while.  Simply put, caries (cavities) activity is a microbiological disease.

My thoughts on the matter are that we are entering a really new and interesting territory on preventative dentistry.  But it won't stick.  The people who really need this type of intervention are the ones who aren't responsible enough to maintain it.  The patients who will really adopt this are the type of patients who barely get any carious lesions at all.

People will always be people.  In spite of how far nutritional research and cardiovascular research has come and how public it has become, obesity levels are still rising.  The problem with the CAMBRA protocol is that the interventions are not easy.  Or rather, not 'slam-dunk' easy.  It involves rinsing with this or that for one week here, the other for another week there, don't take brush for two hours after using this etc.  The interventions work, but they don't work well together and so there has to be some time/space between each application.

Looking at the cases that I've got to work on these days, decay isn't the bulk of my work.  The bulk of my work seems to be dealing with worn down dentitions (grinding, etc), or dealing with old large fillings and undermined tooth structures.  Hopefully the CAMBRA protocol will reduce the latter.  The former is still not fully understood.

I spent some today at the office of one of my mentors.  He's a very successful prosthodontist.  He treats his patients well.  Fairly.  He doesn't do more than he has to.  Something I really admire about him is that he is not afraid to tell the patients what he really feels about their dental situation.  If an ideal treatment is a reconstruction he will not hesitate to tell them.  I hesitate.  I think I do a disservice to my patients by sugar-coating their condition.  I'm worried that they won't 'like me.'  I shouldn't care.  I should be more objective and tell them what they need rather than tell them what they want to hear and know in my heart that the real solution involves much more work than they are prepared to do.

I'm in the lab right now.  I'm going to prepare a couple of master models.  I wanted to order some implant components but I didn't have the opportunity.  Thanksgiving is right around the corner and the gold-room is closed.  So I'm going to have to get the stuff on Monday.

Also - I'd like to finish some provisionals for one of my patients this weekend.  She's got a tricky occlusal situation.  I'm also terrified of treating her.  Not because of the difficulty of her case but because I don't "OWN" the case.  It was transferred to me a while back and the case is in shambles.  It was in shambles when it was transferred and the amount of work I have to get the case back up and running is tremendous.  The first thing I have to do is prepare some temps and make sure I can get the occlusal plane and position right.  CR isn't going to work here because the VDO is collapsed and if I open the bite I lose all of the anterior coupling I have.  Furthermore, she isn't comfortable in such a retruded position.  I'm going to try my provisionals in a more anteriorly repositioned and open mandibular posture.  We'll see how she tolerates it.  If she tolerates it, fantastic.  If not, I'll equilibrate her in a more posterior position.

Funny.  Google's spellcheck thinks "retruded" should be "retarded."  Sometimes I feel the same way.

Alright, off to the bench.

So we start.

Well.  I guess this this is the inaugural post of my blog.


That's a lie.

I started this blog in 2003.  It started floundering in 2004.  Died.  Now I've broken out the jumper cables and am reviving it.

Secretly.

I've decided not to tell anyone I know about it.  Thus, no pressure about what to write or what not to write.

I'm a dentist.  A secret one.

I'm also a prosthodontist.  Actually, I'm a resident in my last year.  Maybe I'll spend some time one day talking about that.

I will try to tell some stories about patients, about myself, and maybe deep deep down there will be some wisdom.


I doubt it though.  In the very least, I'm going to try to spell things correctly.  Regardless, I'm in the lab right now and about to grind some models.  This is about 90% of what I do in the lab.  The other 50% is mounting casts.  And then bitching about the stone I got in my eye.  That would account for 10%.

Ok.  I have to go grind.