4 things I learnt last week

1) Always warn the patient about possible RCT when doing a crown prep, especially when there's gingival recession. If it doesn't happen, good. If it does, patient thinks you're so good you can tell what would happen even before you start.
Mrs P came in 2 weeks ago and told me she wants "tooth coloured crowns" for 2 of her teeth with fractured amalgam. I started preparing her 37 last week. When I was happily grinding her tooth away a pink spot suddenly appeared near her root and it hit me that the slightly exposed root will not have enough thickness for a porcelain crown. Damn it I could have thought about that earlier. I quickly stopped and explained to her that her tooth doesn't have enough thickness for a crown and the trauma from crown prep would probably cause irreversible pulpitis and she might start experiencing pain. I made her a temporary crown and sent her home and told her she can decide whether to have RCT or have the tooth taken out. She came back and said:"You're right the tooth started feeling a bit sore I think I need root canal." I'm just glad she didn't think I was the one who killed her tooth.

2) If the tooth has gingival recession, do not do a porcelain or porcelain fused to metal crown. If the patient refused gold or zirconia crown, refer to someone else.
I don't want to be a hero, I just want to sleep at night.

3) Never assume an Anglo-Saxon Aussie has better command of English than you - a bloody Asian immigrant whose English is a second language.
M came in with several lingual caries on his lower molars. I dunno what shit he's been eating but it doesn't look good, most of the caries are subgingival. It's impossible to maintain a dry field and I don't have amalgam in the practice so I filled them up with Fuji IX. I thought I did a pretty good job considering his bloody tongue wouldn't leave my bur alone but he kept complaining about "sharp edges". I couldn't see any but tried to smooth it out and yet he wouldn't stop complaining. There won't be any filling left if I continue to smooth out the "sharp edges" so I asked him to show me where they are. He just said I'm numb I can't feel anything but they're sharp. What the hell.

I was getting very frustrated trying to find where the sharp edges are. In the end he said he couldn't feel the sharpness anymore but went on to bitch about me to the receptionist behind my back. He told her: " I've had fillings before but they were never this rough". What a dumb arse. Doesn't he know "sharp" and "rough" have totally different meanings??? According to my Oxford dictionary, sharp means having a fine edge or point; not blunt; capable of cutting or piercing. Whereas rough means having an uneven or irregular surface; not level or smooth.

The filling was rough because this stupid idiot waited too long to come to the dentist and the decay had extended below the gum line. I had no choice but to use Fuji IX, which can't be polished into a smooth surface. If he had use the correct vocabulary I wouldn't have wasted 30 mins trying to smooth out the invisible sharp edges. He must have a skull filled with shit.

4) When patient complains about pain but you can't find anything wrong (even after taking a BW and PA), do not dismiss him/her as a loony, take more radiographs!
S drove 4 hours from out west to get here. She had been experiencing severe dull throbbing ache in Q4 for the last 2 weeks. She'll be driving 10 hours down to Brisbane the next morning and wanted something done about the toothache. She has very good OH and only had 1 filling done more than 10 years ago when she was a kid by the school dentist. I looked at her almost perfect teeth and couldn't see any caries. I tapped on the teeth, they were slightly tender to percussion. Cold test was positive so I took a BW.

Deep restoration but seems ok

Don't see any prob on the PA either

Pt is a regular flosser so I thought she might have traumatised her gingival tissue by flossing too hard, which can manisfest as toothache (from personal experience). I was just going to tell her to go home when I thought I better have a look at her gum but it wasn't tender when palpated.

What the heck I'll take another PA.

The previous dentist had drilled into her tooth but decided to keep it a little secret and covered up with composite. It took more than 10 years to finally cause some drama. Fortunately I was able to scare her into getting RCT instead of exo. She is only 19, too young to lose a molar which most ppl don't give a shit because "it's a back tooth and you can't see it".