"Fire spear my arse that's a fcuking black boy"
I overheard this comment when I was at Bunnings. It was directed at the label of a plant. Commonly known as grass tree, the "Fire Spear" is a plant in the genus Xanthorrhoea. It used to be called the Black Boy (see picture below) but the do-gooders in this country have demanded political correctness and try to get rid of anything that they think would offend the minorities. According to a Canadian friend, his town didn't put up a Christmas tree at the city square last year because do-gooders think it would offend the minorities who don't celebrate Christmas. What a bucket full of shit. I don't celebrate Christmas, I'm not a Christian I'm an atheist but I do like the Christmas atmosphere and the Christmas deco. Since when do I need the do-gooders to tell me when I should feel offended. Just because I don't celebrate it doesn't mean other ppl can't. Luckily they haven't ban the Christmas tree here yet. Anyway, guess what, the guy making the comment was an Aboriginal and he sure wasn't happy they ain't calling the Black Boy a Black Boy anymore.
Mrs S came to me with a swelling next to her 15. According to her this swelling comes and goes and had been troubling her for over a year. Now this is one of my favourite thing at work. If you take a probe and poke at the swelling pus would flow out.
I took a PA. 
#&*@(%!!! What a shitty RCT.I dug up her record and checked the previous radiographs. It turned out the RCT was done by this Pommie locum dentist who comes here every April 2 yrs ago. This husband & wife Pommie locum dentists did some of the shadiest dental work I've ever seen. The husband openly proclaimed that he hates dentistry and was only doing it for the money. He has no respect for the patients and always treat them like a pig/cow/chook/whatever waiting to be butchered. I feel sorry for the patients who end up in their chairs. The patients never get what's best for them, only what makes the most money for the dentist.
Let's see how far I can force this file into the tooth. Oooooh it went through the apex. Haha so fun!
I might as well shove the GP through the apex too and see how long it'll take before pt starts getting abscess. Yummy! I like pus!Besides overextending the gutta percha she had also completed the RCT in one appointment. Doesn't she know that completing RCT in an infected tooth in one appointment without application of intracanal medicament would decrease the success rate??? Yes of course she does, but if you can finish it off in an hour you get to pocket $500, but if you split it up into 2 appointments you only get $200+ in 1 hour so to hell with the well being of the patient just gimme the cash!
I don't understand why she doesn't pull the GP out a bit. It's not like she can't see it on the PA it's so bloody obvious and all it takes is 1 second. ONE BLOODY SECOND. I guess she just couldn't be bothered, after all it's not her tooth. Dentists like her should be whipped and condemned to hell.
I don't understand why she doesn't pull the GP out a bit. It's not like she can't see it on the PA it's so bloody obvious and all it takes is 1 second. ONE BLOODY SECOND. I guess she just couldn't be bothered, after all it's not her tooth. Dentists like her should be whipped and condemned to hell.
Poor Mrs S ended up having the tooth pulled. Look at that sickening GP sticking out of the tooth.
posted by Dentist Down Under at 10:18 pm
8 Comments:
oh man, she can be sued for malpractice!!!
k, even if she wants to do it in one appointment, she could at least be bothered to take the working length and measure the GP!!!
poor patient :(
Sabbie!!! :D
It's difficult to sue her coz she was a Pommie (aka Prisoner of Mother England)locum and was only here for 3 months, after that she leaves and go somewhere else to destroy other ppl's teeth. It sucks. Just because she's Pommie our stupid dental council doesn't require her to pass the extremely difficult exam other overseas dentists have to sit for, but even then it's not a good measure of how well the dentist'll treat his/her patients.
ouch, that must have hurt! i see what you're saying in this post and i can certainly see the flaws in this RCT fill, but to play devil's advocate, i've seen WAY shittier RCT fills that hold up forever (god knows why, i sometimes ask myself) and perfect-looking fills that crap out after a few months. who knows, it's such a crapshoot sometimes. i myself have overfilled on several occasions, despite apex locators, working length verification films, and the like. it just happens sometimes. i let the patient know and keep an eye on it. besides, an overfill of 1-2 mm shouldn't be the end of the world, since gutta percha is very biocompatable. but i did see one malpractice case where a fill on a lower 5 actually perforated the mental foramen and caused a neurofibroma. now THAT's malpractice!
as for one visit endos, i do them, even on necrotic teeth. i ALWAYS use RDI (criminal to do 'em without it), NaOCl irrigation, and Rx for clindamycin for ten days to knock out the remaining infection. saves the patients mutltiple visits and ensures that they are compliant (as some people don't want to return for multiple visits once they're out of pain) and despite shitty fills, the one thing that determines prognosis of a root canal is (drum roll pleez) CLEANING AND SHAPING. once you get it all out while maintaining a sterile field, you pretty much rock solid, even if your fill is kinda jacked. perhaps this doc didn't do that, god only knows how people work. but i've had my share of crappy fills and that's why i'm not so quick to critique other doc's endos.
here's a question - why did she have the tooth extracted when a simple apicoectomy would have done the trick?
Hi dr. mommy d.d.s.,
I extracted the tooth. ;p We don't have the luxury of specialist here and none of the dentists in town do apicectomy. Pt would have to drive another 800km down south to see someone who could do it, she was in pain and doesn't want to drive any farther, not to mention she has no more faith in dentist and only wanted the tooth out for good coz she now thinks RCT doesn't work and doesn't want to spend more money.
You have probably noticed the Pommie dentist didn't even use rubber dam, it's a crime not to use rubber dam when doing RCT, how can you maintain a sterile field without a rubber dam?
I guess dentistry is being taught differently in Australia and North America. My endo professor would kick you out of dental school if you do one visit endo in infected tooth (he actually did his endo specialisation in the U.S.), I still remember him saying one visit RCT is only reserved for non-infected tooth (e.g. in trauma cases). To tell you the truth, I'd attempted a one visit RCT once when I first started working. The pt drove almost 1000km to get to town and it was during the wet season. He won't be able to make it back to town once it starts to rain, the flood would have cut them out for months, even food and daily necessities would have to be airdropped. He wouldn't want to lose his tooth either so I'd no choice but did a one visit RCT. When my boss found out he was furious and kicked up a big fuss and called me names, he said the pt'll be back in few months time to demand his money back blah blah and there's no place in dentistry for one visit RCT. I left the practice after a month so I've no idea what happen to the tooth but I've never done a one visit RCT since.
Sometimes it's not the GP that's causing the problem, it's the bacteria that you push thru the apex that's causing the prob. I do agree with you that cleaning and shaping is one of the determinant factors of RCT success and failure. This dentist however only irrigated it with 3ml of NaOCl. We only have EDTA and NaOCl in the practice. What is RDI? I've never heard of it .
Whenever I saw other dentists' patients who came to me complaining abt aching RCT'ed teeth it always turn out to be a crappy RCT that's why it shits me. So far I haven't had any RCT that blows up (*fingers crossed*) but then again I've only been working for 2.5 yrs since I grad, it might take longer for them to fail. ;p
oops, sorry 'bout that. "RDI" is "rubber damn isolation" and that's the chart entry abbreviation!
and one more thing i just wanted to clarify. not every endo can be done in one visit. if you open up a tooth and there's a fountain of pus, of course you won't fill in the same day - CaOH and wait at least a week before finishing! i guess i was just trying to distinguish between a chronic, asymptomatic necrotic tooth and one with an actual acute infection. those should be done in two visits (i do have some scruples, you know!) ;-P
Hi everyone. There are a couple of points that I wanted to make.
1. Strong evidence over the last 3 decades shows an increased prognosis for root canal treatment and retreatment when teeth with apical lesions are internally medicated prior to obturation. This includes teeth that appear to have no pus in their canals upon initial access. And it also includes teeth that are meticulously cleaned and shaped.
Endodontists who tell you otherwise
are trying to justify the way they practise. Single-visit endos on chronically infected (apical lesions) teeth produce more dollars per procedure than multi-visit endos. Fortunately we're slowly starting to see the paradigm shift developing in a lot of these practices. This is good for patients.
2. Extruded gutta percha in itself is not a problem and will not cause infection, but is likely the result of crappy treatment which will have a higher relapse rate than good treatment.
3. Options for this tooth beside extraction would have included retreatment or apical surgery. Retreatment would have a higher success rate than apical surgery whether or not the extruded gutta percha is retrieved (again another paradigm shift for the older endodontists).
I've briefly blogged about this stuff here and here.
You are an awesome dentist.. Cheers!
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