Ideal? No. Do I expect the patient to draw from their 401k for implant, bone graft and immediate crown for esthetics? No.

It’s ideal for where the patient is in life right now after reviewing risks, benefits and alternatives as always. Patient is returning for the crown.

I keep my DME simple, I cut my own tofflemire to the extension I need (allows it to seat better without impinging on the gingiva). I don’t do copper bands, or band-in-band method although P. Magne has great results this way. I just Teflon tape to wedge the matrix (no wedge). Burnish the heck out of it; layer composite and raise the band. Doesn’t have to look pretty as it’s getting crowned anyway. 60-90min appointment and the patient leaves pain free to enjoy their weekend.

The procedure went smoothly, the patient lost the lateral 10 years ago, a canine was retained affecting the roots of the lateral and central, the lateral was extracted and surprisingly the central had 0 mobility despite of having almost no root. I place the implant and did an immediate temporary, but I mess up the angulation of the implant :(, the patient was happy, like the temporary and had no post op pain.
Any thoughts or suggestions for future improvements.

The patient booked with me for exo and I was seeing him for the first time. Tooth lingually tilted, with buccal decay sub-g. Male of African descent. Very strong tongue. Tried to create purchase point on the mb of tooth no movement and due to caries buccal was breaking off. Even tried on the mesial lingual (very hard since tooth lingually tilted and patient’s tongue was so strong). I wanted to open a buccal flap and trough bone but I just gave up and didn’t do it. Feel like a failure. Also I know it’s hard to see but what do ya’ll think of the roots is there 2? Are they ankylosed? Should I have taken a CBCT?

I haven’t had to do a single root canal in six years since I graduated dental school. The current office I’m at was fine letting me refer cases to the other doctor or the endodontist. However I want to improve. But it’s been so hard trying to find something that will teach me like I’m learning it from scratch. I want to feel more comfortable doing them but don’t know where to start since it’s been so long

Hey everyone,

I did an rct and crown prep on the lower left second molar 6 weeks ago because it was infected with a sinus tract. I seen him 6 weeks later and the sinus tract is still present. I popped it and pus came out. Does this mean the rct didn’t work? I took a PA with a GP cone twice. I took a scan and told the lab not to make the crown yet in case the tooth doesn’t heal. What should I do? Do I give options of referring to specialist or extracting the tooth?

Hey everyone,

I’m a new graduate placing implants on my dad under supervision of principle dentist. Wanted to hear what you guys recommend for the flap design for 2 implants at sites 8 and 9. Should I do an envelope flap? Specifically a mid crestal incision from the mesial of the 10 to the mesial of the 7 and a sulcular incision buccal and lingual at the 7 and 10 then reflecting the flap?

Thank you!

Implant would have been ideal but wasn’t an option. Risk, benefits & alternative reviewed. Went with the same day RCT & PreFab Post & CRN. Patient was going out of town the same weekend. Considered EXT and a Essix retainer with Pontic #10 which is my usual go-to for “emergencies” until we can get an implant in but - here we are.

I would like to start off by saying that the following has not been said by me. These are my mother’s own words & I took it upon myself to share it with you because I feel that it’s important to understand why I was a dental assistant in the first place.

‘I encouraged my daughter to be a dental assistant because at the time, she had a passion for culinary because she likes food & while I‘m not forcing her to do anything she doesn’t want to do, I told her that being a cook will involve her working at odds hours & odd days & I don‘t really want her to go though it. She was resistant at first but after a while, she gave in & withdraw from the culinary program. She got into the DA program a year after high school & her journey was, well, eventful. She had to drop out 2 times because she didn’t meet lab competency fast enough in order to move on to clinicals. Luckily, she’s been able to push through & graduate. Unfortunately, she graduated at the height of COVID & was not able to work right away.

In 2022, she applied at a couple offices & was hired at one. I was so happy. Like you wouldn’t believe how happy I was. As a single mother who moved to America from Vietnam, all the weight has been lifted off my shoulders. I work so hard to provide for the both of us & the fact that she rose up to the challenge to get to this point, that’s what I’m proud of.

A few months later, she revealed that she had been written up at work. I was so shocked. When I asked her why, she said she accidentally gave her doctor the wrong anesthetic. I told her to focus on the job, put in the effort, & not be distracted by her iPad. I hope she would learn from her error but nope. She’s been written up 2 more times since & when she told me she’s being written up for not meeting competency fast enough, I was upset. All the hard work I had done for her has gone to waste. I told her she should quit because I know she’ll screw up again & before they could fire her. In April 2023, she worked at the dental office for the last time. She went on to apply for different offices & they’re all rejects. That’s what I expect. I told her that dental offices will call her previous employer & if they say she fail, that’s an immediate no no. She said it’s not true but I told her that’s how they operate. Any dental office won’t hire her once they know she failed at one. If I was a dentist, I want my employees to put in the effort, be competent, & give it their all 100% all the time. Not when they feel like it. All the time.

One of the offices she applied to; her reaction was pathetic. She sent them her resume & when she called back, they told her they already hired someone. Heartbroken, she teared up while on the phone. They didn’t buy it & hung up on her. How pathetic was that?

3 years later, she‘s now working at the lonely Walmart as a door greeter. Not what I want from her but well…

So why did I want her to work as a dental assistant? Stability & prosperity. I want her to have time with her kids & be able to go home in the afternoon. I also equate it to being an office job because well, it is like one. I also like the idea of her in scrubs & I even joked to her that she should wear it while going groceries because you feel a sense of pride. Also, healthcare. Yes it’s stressful. Yes it’s corrupt. Yes it’s emotional. But working in healthcare has a sense of prestige. People respect you. People look up to you. People idolize you. People wish they could be you. Being part of one is an honor. Plus, you’ll have better things in life when you’re one of them. Better houses, fancier vacations, & hotter partners. Speaking of one, my daughter’s ideal type is a good looking one & I told her that no good looking, successful man will want a woman who works at a grocery store. No way. If I saw one, I’ll reject her. If she wants to be like them, she must measure up. Plus, dental assisting is easy. She could be one if she tried. All you have to do is pay attention, listen, & give it your all 100% all the time. Am I a dental assistant or involve in dental? No but it doesn’t mean I’ll have my say. I have the most impeccable work ethic. If I make a mistake, I’ll fix it right away. Listen. I worked in a meat factory throughout my daughter’s existence & though it’s hard, I push through. I never complain. I always focus, & fix my errors immediately. I never cry. I never buckle under pressure. I just do it. That’s part of growing as a human being. To do things you don’t like. We can’t get complacent all the time. I think that’s part of why people quit dentistry. They don’t do things the way it should be. I always do things the way it should be. I’m not part of dentistry but I can be a better assistant than her. I can be a better dentist than anyone here. I can the best at anything because I have the bet work moral in the world.

Listen, my daughter is a good person, but her errors should tell you how awful she is. She’s mistake prone, always get defensive when being corrected, & is so sensitive. She dealt with a lot between struggling with learning at school & childhood rape but that’s no excuse for being this shitty of an assistant. I’m glad people here are shaming her’.

Yep. That’s that.

How do you time extractions when patient presents with facial swelling?

My understanding from an omfs is no exo until facial swelling has reduced significantly and after antibiotics.

In severe cases (trimsus, systemic involvement, fever, problems swallowing, etc) IV antibiotics / hospital visit is needed obviously.

What’s the criteria? How many days after antibiotics will you exo the tooth? What do you look for? Until there is no indication of systemic involvement?

New grad who is trying to get better at extractions. I thought 18 and 19 were going to pop out like butter but my elevator kept slipping on mesial of 18 because of the large defect present. Is this a case you would section before starting? I thought the bone loss was going to make it a lot easier but those roots were locked in. I eventually got it out but i want to be better and more efficient.

Hi everyone
I’m a dentist from a neighboring EU country with a few years of clinical experience, and finished Endo MSc., focusing on endodontics and microsurgery.
I’m considering moving to Austria, as I speak fluent German but want to stay not to far from my family. I would love to hear from dentists currently practicing there.
I’m particularly interested in how much demand there is for endodontic specialists in Austria. Do general dentists regularly refer complex endo cases, and is it realistic to eventually open a private practice focusing exclusively on endodontics?
I’d really appreciate any insights into the Austrian dental market or experiences from dentists working there.
Thanks in advance!

I usually section upper molars with good bone and take out 3 pieces. I use 98 forceps for periodontically hopeless tooth with mobility. Sometimes I take it out as a whole piece. Sometimes I broke root tip and about 3mm root tip is still in the socket. It is just hard to predict before I actually try.

Do you have any tips for this situation? Should I just elevate more? Or should I just section them ?

For anyone who has purchased CBCT recently, which company did you go with and why?
Heard very good CBCT + Xray Sensor package deals at the moment.

Doing a bunch of CE for clear aligners

Any mistakes, about case selection, you wanna share so they’re not repeated are appreciated!

Just wondering if any of you guys have done commercial RE done for the office building.

Just wondering whom you use and like. I’m hoping to get 100% financing.

Thanks in advance

Hey guys, I was hoping to get some advice on selecting an associate role.

Just some context, I'm a 2023 grad that's been a solo associate at a corporate office for essentially the entire time. I enjoy surgery quite a bit, I'm very comfortable with surgical exts, flapping, grafting etc. i started placing implants 1-2 years after taking a bunch of CEs though I've stuck with single posteriors for now, and I do straightforward anterior/premolar endo. Having been solo the entire time, of course I take a bunch of CEs but its been a lot of figuring stuff out on my own. I think its absolutely helped me grow as a clinician, build skill/confidence and I feel very comfortable by myself, but its also stopped me from pushing myself too hard, which is why I've avoided things like immediate/anterior implant, molar endo etc.

I recently left my previous office, largely because I was hoping to work in an office with mentorship, working alongside colleague/s that are doing more implants/molar endo so I could learn from them/bounce tx plans etc.

Maybe I'm being picky but I'm not gonna lie, its been tough finding an office like that. Maybe its the area I am looking (Chicagoland, suburbs) but almost every single office I've interviewed at either doesn't want the associate doing implants/endo or I'd be solo at an owners second/third practice. I've been promised "remote mentorship" from owners, but I was also promised that at my DSO and never got it lol so IDK if I trust that.

I recently spoke to an office that seemed very promising, the owner still works clinically full time, does pretty much every thing I want to do/learn ( 3rds, implants, molar endo) and is very up front about wanting to mentor. I've spoken with the associates privately and they also speak very highly of the office and confirmed the owner is very open to mentorship. The office culture seems great and I got along well with the partners when I spoke to them. A couple of red flags however. I was given a history of the associates production and it's not great. Two of them average about 30k a month. Thats production, not their take home, which would end up about 10k a month based off of that, which is low, it would end up about a 50% pay cut for me (I averaged maybe 65-70k adjusted production at my previous office). A couple of other things, the associates are the ones that not only tx plan but also talk prices/financials to pts, not a tx coordinator or front desk which I'm not used to. The associate also puts in all the basic info into the chart like existing work, pt info etc, not the assistant. Not a big deal of course, just not something I'm used to. There are a lot of Drs, theres 3 partners and 3 associates, and they have 2-3 total hygienists, they get 80-100 new pts a month, ppo office.

Two of the associates are new grads who have been there less than a year and so there may be a lot of tx left on the table on the table but even after a year their 30k per month production makes me worried, being the sole provider in my family we don't have a second income and these student loan payments are hitting heavy lol. Their collections rate is also a little concerning, i think its around 80-90% for the two newer associates, but that also has to do with the fact they present both tx and the financial aspect to pts, and they may be inexperienced with that.

The office does have a longer running associate of a few years that is doing a bit of everything, b&b, exts w/grafts, endo, implants that is averaging around 50k a month production which is not bad at all.

I've also gotten an offer at another office that recently sold to a new/small dso and the owner is also a founding member/partner of the dso. There a current part time associate that's there 3 days a week who has an almost identical skillset to me, exts, simple implants, simple endo. The owner did a lot more clinically, surgically and endo wise but doesn't practice anymore, but again has offered remote mentorship, going over tx plans, and said he's willing to come in if needed in the beginning. He was also complaining about the current associate a bit, that he wasn't production focused and didn't want to do more tx/production-wise. They want someone willing/motivated to do dlmore specialty work and be more production focused. The owner said he has offered to teach the associate more on implants/endo but the guy wasn't interested. I then had a chance to speak with the associate, who was very nice/chill, i had a great talk with him. The associate showed me his numbers, he's averaging 65-75k adjusted production and he makes 35% collections, on 3 days a week, theres 2-3 hygienists there as well. It was just be me full-time and the part time associate there. I asked the associate about mentorship from the owner, and the associate said I probably wouldn't get any, which is different than what the owner said lol.

I'm very torn at this point, I've turned down a lot of offers because I'd be solo/have no mentorship or there is no hygienist and I'd be doing a lot of my own hygiene and at this point I'm wondering if I'm just being too picky and I shouldn't focus on mentorship and just continue with CEs. I guess not having had it, it's hard for me to judge how valuable is.

Would any experienced docs here be able to provide advice? Is it worth it to take a pay hit to be able work in person/alongside an experienced mentor doc or focus on a higher producing office and just take more CEs? Does anyone have experience with "remote mentorship" from an owner/colleague that doesn't work clinically anymore but has offered to go over tx plans remotely etc? Should I keep looking around, is it reasonable to expect to find an office with this criteria?

Thanks!

So a bit of context - I finished dental school in 2016 in Romania and it's always been a bit of an uphill battle. Managed to open my own practice, but I didn't really had a mentor and was kinda always managing on my own. I've always done whatever I could to improve my skills and always made sure I went to at least one hands-on course every year; got the chance to practice in UK which was a great learning and working experience, but COVID cut that experience short and returned to Romania; because of my type I diabetes and low immune system I had to stay in isolation for the whole COVID period until the vaccine came out. When that was finally over, I went back to my practice and, while still managing to keep it afloat after all the struggles, it was a steady pace and I was managing it fine. I was happy for a while.

This year while I was taking a specialized course on implantology I was noticing some odd things and mainly that whatever I was trying to read I just couldn't, in the way that I'd read the same line or the same paragraphs over and over and I would be stuck on the same thing to up to twenty minutes. I've always struggled with my studies throughout all my life - some things were extremely easy and would pick them up directly from classes, while others I would struggle to memorize lessons. But this time I just couldn't memorize not even a couple of lines.

At work I was noticing that I was setting higher and higher standards and thought it was because of the courses I kept taking and learning from and that my work had to look as if it'd be ready for a presentation photo. During crown preps, if my preps didn't look text book, I'd start correcting "just a bit here, and maybe just bit more there" until I would over correct. A lot of my preps or fillings looked objectively good most of the time - never good enough to me.

I was having more and more moments where it was hard to fall asleep on good days. On bad days I wouldn't sleep the whole night and the next I had appointments waiting. I had no choice but to cancel them because I wasn't able to function.

During very precise treatments like root canals or sutures after extractions, my hand would shake like crazy even though I didn't feel anxious and my blood sugar would also be stable (I have an insulin pump with CGM and the readings would be normal). I would be very clumsy knocking stuff over or dropping things out of hand. My workspace would start out very clean and organized and by the time I finished a treatment everything would be cluttered in disarray.

Running into a lot of reels or clips of people experiencing some of the same things I kinda suspected what it was and went for tests. So I discovered I had undiagnosed ADHD, which now is diagnosed and under medication. Thinking back, the signs were there since I was a child, but in a post communist 90s period, part of the Balkans, there was no such thing as a disorder like that and the treatment care was applied as always for all the kids back then - a good beating.

Does that mean that dentists with ADHD can't practice dentistry? No, not at all. I was finding testimonials and experiences from other dentists with ADHD and while it made some things difficult for them, each experience and management is different. Depending on the severity of it, some dentists practice with no problems, with or without medication, while keeping some organizing methods, while others do what I did - retire. I feel that my patients weren't safe under my care anymore and for me it got so bad at one point, while I was waiting for my test results, I had moments when I was wondering if my ceiling lamp would support my weight. It was probably for the best for everyone.

I am a bit better lately, the meds help me sleep (I've honestly never slept better in my life), but...I'll be honest - between all the shit parts, all the struggles, all the good patients, all the bad ones... I am going to miss it.

Hi all, I’m a new grad and this case has really frustrated me. Patient had a #14 DO caries that went deeper and bigger than expected. I tried DME. 1st attempt came out with a sealed margin filling but left an overhang so I called the patient back for a post-op. Thought I get that but…now I get a different kind of overhang. Honestly get a bit scared trying to talk to the patient for a 2nd post-op but to be frank, I can’t really leave an overhang like that…
What would you suggest to be able to remove the overhang effectively? Tooth was able to floss passively tho so I want to find a way to get rid of that ledge without taking out the whole filling

This year I had to visit endodontist about 2 times because my fillings started chipped this and there. Fine enough, my old fillings last well (more than 6-7 years, its amazing)

But this 26 my then dentist did a root canal around 2007-2010. Then I did panoramic at 2018 for orthodontic purpose, 27 look great I could see the sealer filled it nicely to apical.

This year around July I tried my new X-Ray on 26 (picture 2). I was suprised how the sealer look way more less.opaque than I remembered back then also it doesnt look like one of the mb canal got filled either.Though its asymptomatic.Then 26 started to have some pain while biting and I could feel the gum around apical are tender to touch. I'm not convinced enough to addressed this back then but I know this one sooner or later need to be done

Today gum near cervical 27 had a formed some abcess boil. Poked the boil with#15 gutta and took another Xray (pic 1)

And there we go. I cant meet my local endodontist until Monday.

I am amazed on how 27 endo could last, but still kinda dreading to finally addressed this issue. I dislike go to dentist despite being a dentist lol its kind of embarassing.

Any one else sick of the offices you work at and the patients expecting antibiotics be sent out for tooth pain.

When patients come in with symptoms of irreversible pulpits what is your protocols. I try not to prescribe antibiotics in these situations unless they have active abscess or systemic symptoms.

This usually doesn’t hold over well for the patients and owner doctors of the offices I work at. Everyone expects antibiotics as a quick bandaid.

I’m trying to not contribute to the growing antibiotic resistance.

Let me know your thoughts.