Dental Reflections 014

i guess wall-of-text posts can be quite dry. here's something a bit different.

just the other day we had a walk-in. c/o pain q2. there was some pretty extensive FP work in place, with #16-#25 as 2 bridges. #26 was unrestored, and what i tentatively labelled as #27 had the weirdest prosthodontic restoration; it looked for all the world like a pre-fab temp crown and yet had been left as a permanent restoration for 20+ years. it was in fact older than the rest of her FP work, although it was done at the same clinic. as it was tender to percussion and the patient wasn't too keen to dis-ass it and kiv RCT, i took it out there and then. sorry, no clinical pictures. what i have for you is a series based on what i did the next day during lunch time.

*note: the pics i uploaded are too damn big, please click to see until i can fix them*

quite a sight, isnt it? i actually asked the patient which village in china she did it in. apparently its called 'bukit timah'...

here's the buccal view. i support my claim that this was a pre-fab item made in tin or aluminium by the fact that my claw forceps could put that dent into it that you see at the gingival margin.

it even has a seam line!

a root view to let you see once again the magnificent overhangs. and just imagine, they were equigingival clinically... that weird lump of meat near the palatal root is some granulation tissue.



the suspected caries were just away from the forceps, at the distopalatal...

so i proceeded to put a bur to it...



the soft, cheap-ass metal yielded easily enough. the luting agent underneath was impressively thick, and still mostly white.



i continued to hack around the temp crown...



after prying the sucker off with a combination of ultrasonic scalers and violence, here's what it looked like. i was at first thinking that the cement may have been ZOE but it was hard as heck. might have been ZnPO4.



here's another view



i found big-ass root caries, which was probably what led to the endodontic infection



much easier to appreciate when dry.

at this point the smell was really getting to me and i chucked all the stuff. the one thing which i forgot to show about this? there was no evidence of caries or restoration of the coronal structure under all the cement!

so... why the heck did the dentist do what he did and leave it that way? i think the only possible answer is that this was in fact #28, with the #27 extracted and drifted forward. the temp crown may have been placed simply to fill the interdental space. with all that ZnPO4 within the confines of the temp crown and locking into the natural coronal bulbosities, the temp would have stayed in for all those years, while the overhangs made it impossible to do any form of proper hygiene maintenance...

Bob Lennon - Urasawa Naoki

Dental Reflections 013

i guess it's a reflection of the current state of the economy that i should be talking a bit about how the government funds its dental services. from the complaints lodged in the papers, it would seem that the people expect the Ministry to be something like Santa Claus, giving away good, cheap stuff and quickly too. i'd also like to clarify that while i am on a Ministry bond, i consider myself a healthcare practitioner and not a civil servant in the usual sense.

most people know that i despise the assumption that one can get cheap fast and good in one package. this is no different.

the way i understand things work, the government gives the polyclinics a certain allotment of money to fund their activities. whatever fees the polyclinics charge goes into supplementing this yearly budget to fund their operations, manpower and logistics costing.

polyclinic dental services are no different. grant costs must fit with takings to keep the dental service in the green, despite the higher materials cost and slower consult times that dental management requires. manpower and supporting infrastructure is also much less.

where does that leave us? a recent spate of letters to the forum sections has been bemoaning the long queue times that are needed to get a dental appointment. now, here's a thought. why are we so fully booked? i believe a lot of it has to do with our fantastically low prices. where else can you get an enthusiastic idealistic young DO to do a SAP for $25.60 that's worth $70 in the private? and if these people can't wait, why not head out to the private? are the dental polyclinics so saturated?

imagine another scenario. every single one of my appointment slots for 6 months is booked solid with the patients i have seen before, returning for 6/12 hygiene reviews. thats... 2000 patients (a nice round number for illustration). we have 10 chairs in SHP. that means we can theoratically saturate at 20000 patients in the whole of the south to east side of singapore. lets throw NHG into the mix. imagine... they have 20 chairs (illustrative, i havent collected the stats) which means they can see, what, another 40000 patients? this brings us to a total of 60k patients. one can appreciate that this represents less than 2% of our 4mil singapore population. even considering our huge database of defaulters and one-off attendees, we'll never be able to cater to more that 5% of the people of Singapore at once.

so now how, you ask. oh great rich and prosperous Santa Claus Zheng Hu, what will you do for us? to increase our dental staffing means a need for personnel, infrastructure and logistics. this all costs money. dentists dont grow on trees, neither do dental chairs. so... where can we get this cash from? there is only one place where governments primarily fund their activities. this is tax. how much do you want to raise the income tax and the GST to give us this supposed cheap treatment? GST at 15%? sky-high income tax? is this fair to tax the general populace just to pander to the whims of the few? and when the tax rises to an unfair level, wont the rich people and the businesses run off and take their money elsewhere, leaving us poor slobs to die for our selfishness?

what is the other way to make the queues shorter then? if money can't be touched, what can we sacrifice next? quality. its very simple. shorten the appointment times, or double-book the slots. so what if you force the DOs into situations where they have to do incomplete scalings or crap-ass ugly CRs? the patients are being seen! oh joy! never mind if they come back with dropped fillings or periodontitis because we missed the calculus or had no time to give OHI. they wont know the difference.

bollocks.

someone needs to stand tall and decide what they want out of our polyclinic dental services. do you want us to truly care for our patients? then restrict who can see us so that we can truly serve them. do you want to cast your net wide and still have short queues? be prepared for complaints about shoddy quality. you cant have all 3 factors, you cant have your cake and eat it.