Dental Reflections 005

amongst my experiences in NDC i can now add the WWF Pulpect. i have performed WWF SAP before, whereby when i really need to get a patient cleaned up in a hurry (think pack-a-day smoker, never been cleaned in his life and radiotherapy looming in a month) i will head-lock the patient in the crook of my left arm and get the job done. not my favourite maneuvre, but i do seem to be using it a lot more than i would like to have to. but today, i had to use the same headlock to do a pulpectomy...

pt was scheduled for CAP #47(d).

hx of an impacted #48, causing the caries for which i was scheduled to spend a leisurely hour digging out. NRMH, NKDA

and so there i was, with the patient in the chair. EPT -ve but cold ++ve, non-lingering. this was probably a sign of trouble to come, but as i was checking the tooth over it didn't seem terribly out of the ordinary. 2 carts into the IDN and some initial caries free later, i was greeted by the sight of a mass of hyperplastic, hyperaemic strawberry-red tissue bursting out of the distal cavity. and IDN be buggered, it was sensitive to manipulation.

one quick scream to Dr Lui and some prodding later, and it seemed that my only option would be for the patient to grin and bear it while de-roofing the pulp chamber to allow for a good intrapulpal. the sheer irony of of hyperplastic pulp is that the tissue that you want desperately to anaesthetise is blocking the line of sight for you to get your needle into position to do the intrapulpal. damn. and so i had to headlock the patient and rip a diamond bur across the occlusal, and then stuff in a big-head round bur to slash out the pulp from the chamber, all the while apologising profusely and sweating in the deficient air-conditioning. to compound matters, when i sent the patient in for a PA to make sure i was digging in the right direction, and not to china, the radio auntie didn't have the faintest idea how to handle a PA for a patient with dam on! gwaaaaaaaaargh... ended up grabbing an EndoRay from Dr Kuah and aiming it meself.

upon returning from the PA queue, the pulp stumps were still gushing fantastic amounts of blood (hyperaemia ftl) and so another shoutout to Dr Lui later i was witnessing my first live demo in the use of Ledermix. Dr Lui qualified that Ledermix is not a good thing to use in infected cases in general, but due to the sheer amount of inflammation in this case, closing up after splorking Ledermix onto the pulp stumps would prove helpful and allow me to finish up the case in 1-2 weeks with much less bleeding.

hope it all works out...

Dental Reflections 004 and some spleen

so there i was, with an upset patient in my chair...

pt c/o swelling R face for 7/7:
on 290408 i did a PSA block for cons purposes. after that the patient noted swelling and ecchymosis.

o/e: R lower cheek area presented with ecchymosis, tender on palpation of the bruised region. posterior to the ecchymosis was a region of inflamed skin. pt reported using a muscle ointment on the bruise to cope with the pain. no abnormalities intraorally; buccal sulcus normal. adjacent teeth nttp/pp and vital except for the one with the prior RCT. stetson's duct was patent, with clear fluid expressed.

everything basically pointed towards me having nicked a vessel or something. blood then tracked down the fascia and pooled in the lower end of the buccal space. so what's to be done? AB cover and review, plus some Piriton for the skin irritation that seemed to be connected to usage of an oil of wintergreen-containing ointment. pretty standard stuff, management is basically to make sure that the dead space is taken care of using antibiotics to minimise risk of ending up with a cellulitis.

now at this point the blog will leave didactics and move into full-blown rant mode...

for this patient there is also an incidental finding of acute malignant shit-for-brains. the patient was remarkably ungracious about the whole incident. yes, youre upset because you have a big-ass bruise on your face. yes, you acknowledge it's your bloody fault that when i bent over backwards to give you a fast review you didnt show up because you thought it was getting better, and couldnt be arsed to come down and grace my chair with your presence. but for goodness sake, checking you up one more time costs money too! x-rays don't come free! and medications certainly don't come free either. if you don't want to eat medications and still want to be seen, what do you want me to do? we already bent over backwards to waive all the clinical stuff and x-ray fees, now be a good hippopotamus and eat your medication! no point coming up with stupid excuses about 'i fear medications' (this doesn't translate well from the mandarin) or 'antihistamines make me sleepy'. how do you expect things to happen if you don't eat medications? and when you casually mention the fact that a dentist in your church told you it was just a nicked vessel and not to worry, it identifies you as a person of the book and destroys testimony, not to mention the snide remarks about God blessing you with a haematoma. shit for brains! truly shit for brains...

and i have to review her again on thursday. i am so looking forward to this...

Dental Reflections 003 + some other stuff

when a patient has hope, he always does better than the patient who doesnt have hope. the patient who believes what you say and acts on it will also perform better in the long run.

so what do you do with the patient who
1) has a Hx of NPC with all the problems of
1a) xerostomia
1b) a 1 3/4 finger opening of DOOOOOOM!
2) doesnt use his F- gel
3) is still ACTIVELY SMOKING ~20/day?

doing his CAPs felt like an exercise in self-punishment. there was smoker's breath, exposed dentine blackened, not by foodstuff and caries, but by the assortment of noxious chemicals from the ciggies, bad-ass caries (ever seen distal upper 7 look as if a rat has chewed it?). amazing. hope my little preventive talk got into his thick head...

Kenneth managed to get me hooked on another anime series. Macross Frontier tells the story of a colony fleet, its inhabitants, a group of civilian military contractors who defend said fleet and in particular one particular, well, for want of a better description, reluctant bishonen. i think my general tastes in anime tend towards exploding things and series which have fun and don't take themselves too seriously, notable exceptions being Monster and Gunslinger Girl. this series kinda fits the mould, and they know that they have rabid fanboys amongst the viewers! expect frog abuse, micronisation errors and the ever-loved Macross Missile Massacre(tm) a-plenty!

My Boyfriend's A Pilot - Ling Minmei