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04-03-2017, 15:27   #1
Big_G
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Last edited by Black Swan; 05-03-2017 at 06:26. Reason: Contact edited per Zaph
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28-03-2017, 18:41   #2
EoghanIRL
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Re replacing an amalgam mod...
Is it better to drill the restoration into sections and then push it out with a condenser etc..
or to drill it all away like a normal cavity preparation..

I would probably go with the first option , just wanted to see what others would do in this situation?
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28-03-2017, 23:00   #3
digzy
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Quote:
Originally Posted by EoghanIRL View Post
Re replacing an amalgam mod...
Is it better to drill the restoration into sections and then push it out with a condenser etc..
or to drill it all away like a normal cavity preparation..

I would probably go with the first option , just wanted to see what others would do in this situation?
Best advice I could give for this one is to wear your glasses!
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29-03-2017, 13:10   #4
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When removing amalgam, it is best to reduce aerosol by touching the amalgam the minimum amount with the bur.  The shortest cut that will eliminate retention is what should be done.  I'm not aware of any studies that show whether cutting around the circumference of the restoration or sectioning it are the most effective.  I was taught in dental school to go around the outside and then pop the filling out.  This does not always work and sometimes section is required.
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31-03-2017, 22:44   #5
EoghanIRL
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I found that a mixture of sectioning it and drilling along the amalgam tooth structure interface was required to remove it in the end.
Sectioning it by cutting a cross shape in the restoration wasn't enough to pop it out , but popped out almost immediately once cutting around circumference.
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05-04-2017, 09:03   #6
fitzgeme
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Drill around the margins to release the undercuts, usually the box and bulk fly out. Carbides are usually more efficient than diamonds because the dont "clog up". The question is....is there a problem with the aerosol?
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19-04-2017, 21:43   #7
EoghanIRL
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The list of drugs which cause xerostomia is vast to say the least... Obviously some drugs are classically associated with xerostomia but with some drugs it would make you think what the actual incidence of occurrence is..
For instance some diuretics give xerostomia as a side effect but then after getting a lecture from a physician who prescribes diuretics they said they have never come across this side effect...

Do you see drug induced xerostomia often in practice and is it usually confined to a small number of typical drugs?
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25-04-2017, 19:12   #8
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In the US polypharmacy is a much bigger problem than in Ireland. A recent pharmacology lecturer revealed that of the top 200 prescribed drugs in the US, 2/3rds can cause or contribute to xerostomia. I am quite regularly seeing patients with signs and symptoms of dry mouth and often the only possibility is pharmacologically induced xerostomia. Once you know what to look out for, you'll start seeing them more often. Doctors might not see it because they won't be watching for it and it also depends on wheter the pt is subjectively or objectively dry.
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26-04-2017, 22:55   #9
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I see a good bit of dry mouth. Usually poly-pharmacy induced. Often psychiatric meds. Next most common cause is age related. There is also the fact that the quality of the saliva can be effected with an abundance of serious and a lack of mucous saliva. The patients mouth is subjectively not dry but all the good protective stuff is not there....frothy saliva syndrome.
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16-05-2017, 22:28   #10
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If a patient asks you not to include something they told you in their medical history , does this mean that you have to not make note of it even if it was an infectious disease?
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16-05-2017, 22:57   #11
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If a patient asks you not to include something they told you in their medical history , does this mean that you have to not make note of it even if it was an infectious disease?
I've had the same scenario arise & asked my indemnity organisation what their view was. Couldn't get a concrete response.
Theoretically, you're meant to treat *every* patient as though they have an infectious disease, so someone disclosing their diagnosis shouldn't make a difference in terms of cross infection control. However, it can impact on their treatment in other ways (meds, xerostomia, mood/behaviour, attendance, drug interactions, dietary habits, ect).
I would say to respect their wishes& not document it, as requested. But to get consent to reference something very very vague like "discussed with patient& requested no written record" on the chart (this could cover anything from adoption to depression to cancer, so wouldn't be betraying the pts confidence to anyone reading the notes but would still be a reminder to you the practitioner)
Also to reassure the patient that their medical history is completely confidential & won't be disclosed to any 3rd parties.
Tbh, particularly in the case of HIV, I'd be far more worried about the **undiagnosed** patients walking around, clueless as to their condition,& without treatment- highly infectious.
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17-05-2017, 21:47   #12
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Hi dianthus, thanks for replying.

In the dental council code of practice it refers to in extreme circumstances protecting the public interest.

However with standard precautions and needle stick injury protocol it's hard to tell how much of a risk it poses.
Definitely contentious that's for sure!

What if you were working in a practice with multiple dentists across different specialities. Would it be appropriate to warn your colleagues of the infectious status of the patient if they were to treat them.

I think that the infectious status of the patient doesn't meet the criteria for protecting public interest. I feel protecting the public interest refers to something more serious in nature such as a child being kidnapped on your premise or child abuse etc
So I am leaning towards respecting the patients wishes and not breaching confidentiality.

Is this a grey area or is it black and white and I'm not seeing the answer?

Last edited by Fishorsealant; 17-05-2017 at 22:10.
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17-05-2017, 22:26   #13
Dianthus
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Knowing the patients status should not make any difference to the public interest.
We are trained to treat every single patient as though they carry an infectious disease.
Equally, we are not allowed refuse to treat a patient because they have an infectious disease- it's considered discrimination.
Needlestick injuries have a standard set procedure & any reasonable& decent patient would disclose their status if asked after such an incident.
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01-06-2017, 22:10   #14
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Preventive resin restorations or just placing a fissure sealant over a composite after placing, yes or no?

Some supervisors push yes some no...Have heard divided opinions on this

I dont really see the point in placing a fissure sealant over a composite if you have got a good hermetic seal anyway?

Maybe if patient had a filling and a deep fissure as well but I don't really see the point otherwise.
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01-06-2017, 23:39   #15
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Preventive resin restorations or just placing a fissure sealant over a composite after placing, yes or no?

Some supervisors push yes some no...Have heard divided opinions on this

I dont really see the point in placing a fissure sealant over a composite if you have got a good hermetic seal anyway?

Maybe if patient had a filling and a deep fissure as well but I don't really see the point otherwise.
If a supervisor is teaching students to place a fs over a composite they should be students themselves. I'm shocked.
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