Signs of dying tooth redux

Signs of dying tooth redux

About nine months ago I foolishly let a factory-style dentist replace
amalgam fillings with resin in seven of my upper teeth. (I wasn't against
amalgam - he just said the fillings needed to be replaced and used resin as
a matter of course.)

Since then I have had nothing but aches and pains in more and more of my
upper teeth, even teeth that he didn't treat. A couple of them are even
getting slight darkish shadows on the side.

Could something have been done that is slowly killing off my upper teeth?
One of the resin fillings already needs to be replaced because of decay
underneath it. What would you guys suggest my next move be?

Thanks.

Re: Signs of dying tooth redux

On Fri, 2 May 2008 21:07:13 -0400, "Robert"
<guyinct17@NOSPAMyahoo . com > wrote:

>About nine months ago I foolishly let a factory-style dentist replace
>amalgam fillings with resin in seven of my upper teeth. (I wasn't against
>amalgam - he just said the fillings needed to be replaced and used resin as
>a matter of course.)
>
>Since then I have had nothing but aches and pains in more and more of my
>upper teeth, even teeth that he didn't treat. A couple of them are even
>getting slight darkish shadows on the side.
>
>Could something have been done that is slowly killing off my upper teeth?
>One of the resin fillings already needs to be replaced because of decay
>underneath it. What would you guys suggest my next move be?
>
>Thanks.
>
>
>
>
>
Find a new dentist.

And as already suggested, consult with an endodontist.
w w w .aae.org

Re: Signs of dying tooth redux

<Newbie@bix.nex> wrote in message
news:fuen14p17o33k5q2snr758usu7v6d9p1dg@4ax . com ...
> On Fri, 2 May 2008 21:07:13 -0400, "Robert"
>
> Find a new dentist.

Well, finding a new dentist is a given. And I am going to an endo next week.
But have you ever seen this kind of thing before? If so, what does it
likely mean?

Re: Signs of dying tooth redux

On Fri, 2 May 2008 21:33:48 -0400, "Robert"
<guyinct17@NOSPAMyahoo . com > wrote:

><Newbie@bix.nex> wrote in message
>news:fuen14p17o33k5q2snr758usu7v6d9p1dg@4ax . com ...
>> On Fri, 2 May 2008 21:07:13 -0400, "Robert"
>>
>> Find a new dentist.
>
>Well, finding a new dentist is a given. And I am going to an endo next week.
>But have you ever seen this kind of thing before? If so, what does it
>likely mean?
>
>
>
Yes, and afraid so.
Amatus hinted at a case we did together.
Review the other thread.


Dartos would readily tell you that composite
placement is very technic sensitive.
Dartos is *the* old school master and pioneer in
the field of posterior composite placement.

Amatus is also a pioneer and master of placing
machine milled ceramic.

My special interest is in Endodontics.

SB is the kewlest gentleman, and a very knowledgeable
contributor to SMD. Patience of a Saint.

Steven Fawks is also a master dentist of the old guard variety.
Well spoken, and a no BS kinda guy.

Vaughn is a very special, intelligent man.
The SMD regulars highly value his opinions.
When he speaks, we listen.

Feel extremely fortunate to call these men colleagues.
Have learned many finer points of modern dentistry from them.

Hopefully, have shared some nuggets/pearls.

If I left anyone out, or you don't like my description of you...
Well, I am *not* sorry, but feel free to sue if you care to.
<come get some, haha>

We have some other sporadic contributors, perhaps
this missive will drive them out of the woodwork. 8^]]

Re: Signs of dying tooth redux

<Newbie@bix.nex> wrote in message
news:fnin14pp9fhclgi88ob123oon4lns9rj7t@4ax . com ...
> On Fri, 2 May 2008 21:33:48 -0400, "Robert"
> Yes, and afraid so.
> Amatus hinted at a case we did together.
> Review the other thread.

Is that the one where he said "I ended up removing all the resin fillings
and restoring every tooth in his head."? Can you elaborate what that meant?

That doesn't sound like a happy future for me. What do you suspect is
actually going on in there? Why would the dull ache be affecting teeth he
didn't even treat?

How do I find a dentist I can trust to do the right thing? I thought the
factory dentist was doing the right thing.

Re: Signs of dying tooth redux

Unfortunately, many people think that much-less expensive can still lead
towards high quality. This is not a commodity where unsold inventory is
heavily discounted to get it out of a warehouse. This is a service where
you are buying tine, experience and dedication. All dental offices have
about the same overhead costs. To offer cheap fees, something has to be
eliminated. Ask someone in the UK how much time they get for a cleaning
with NHS.

Amatus

I have realy to get ready for my lesson in 90 minutes,,, bye.


"Robert" <guyinct17@NOSPAMyahoo . com > wrote in message
news:481bcf6e$0$11633$607ed4bc@cv . net ...
> <Newbie@bix.nex> wrote in message
> news:fnin14pp9fhclgi88ob123oon4lns9rj7t@4ax . com ...
>> On Fri, 2 May 2008 21:33:48 -0400, "Robert"
>> Yes, and afraid so.
>> Amatus hinted at a case we did together.
>> Review the other thread.
>
> Is that the one where he said "I ended up removing all the resin fillings
> and restoring every tooth in his head."? Can you elaborate what that
> meant?
>
> That doesn't sound like a happy future for me. What do you suspect is
> actually going on in there? Why would the dull ache be affecting teeth he
> didn't even treat?
>
> How do I find a dentist I can trust to do the right thing? I thought the
> factory dentist was doing the right thing.
>
>

Re: Signs of dying tooth redux

"Amatus Cremona" wrote in message
news:FJudnUs22YnQ44HVnZ2dnUVZ_v2pnZ2d@wideopenwest . com ...
> Unfortunately, many people think that much-less expensive can still lead
> towards high quality. This is not a commodity where unsold inventory is
> heavily discounted to get it out of a warehouse. This is a service where
> you are buying tine, experience and dedication. All dental offices have
> about the same overhead costs. To offer cheap fees, something has to be
> eliminated. Ask someone in the UK how much time they get for a cleaning
> with NHS.

Believe me, he was not less expensive. If anything, more expensive. I call
him a "factory" dentist because of the way he advertises and gets a large
flow of business through the office. And you can't leave the place without
them trying to sell you some product or service.

I can't imagine what possessed me to let him do so much work on me in such a
short time. I must have been mad.

Re: Signs of dying tooth redux

Newbie@bix.nex wrote:
>>
> Yes, and afraid so.
> Amatus hinted at a case we did together.
> Review the other thread.
>
>
> Dartos would readily tell you that composite
> placement is very technic sensitive.
> Dartos is *the* old school master and pioneer in
> the field of posterior composite placement.
>
> Amatus is also a pioneer and master of placing
> machine milled ceramic.
>
> My special interest is in Endodontics.
>
> SB is the kewlest gentleman, and a very knowledgeable
> contributor to SMD. Patience of a Saint.
>
> Steven Fawks is also a master dentist of the old guard variety.
> Well spoken, and a no BS kinda guy.
>
> Vaughn is a very special, intelligent man.
> The SMD regulars highly value his opinions.
> When he speaks, we listen.
>
> Feel extremely fortunate to call these men colleagues.
> Have learned many finer points of modern dentistry from them.
>
> Hopefully, have shared some nuggets/pearls.
>
> If I left anyone out, or you don't like my description of you...
> Well, I am *not* sorry, but feel free to sue if you care to.
> <come get some, haha>
>
> We have some other sporadic contributors, perhaps
> this missive will drive them out of the woodwork. 8^]]


You're very kind. And of course I've learned plenty from you, esp.
endo. If I did impactions I would have learned that too.

Best,
Steve

PS--yes I have an intraoral camera, but not interfaced with my computer
system.

Re: Signs of dying tooth redux

>
> PS--yes I have an intraoral camera, but not interfaced with my computer
> system.

What are you waiting for man?? !!!

Need help configuring it?

Re: Signs of dying tooth redux

Amatus Cremona wrote:
>> PS--yes I have an intraoral camera, but not interfaced with my computer
>> system.
>
> What are you waiting for man?? !!!
>
> Need help configuring it?
>
>


Oh, it's much worse than that! (I wouldn't know how to make it
compatible with any computer ports anyhow--it's a Tele-cam--the guys
went belly up about a year after we bought the two cameras. For that
matter, I'm too lazy to change the bulb, which burned out months ago. I
most often use it to blow up my retro--emulsion x-rays from the viewbox
for my patients' delectation.
For that matter, I'm using DOS-based practice mismanagement software.
It's much worse than you know, and you already know I use temporaries.

Steve

--
Mark & Steven Bornfeld DDS
* w w w .dentaltwins . com
Brooklyn, NY
718-258-5001

Re: Signs of dying tooth redux

ARRRRGHHHHH !

[runs off screaming into the distance with his arms waving in the air above
his head]

--
/

Amatus

/
"Mark & Steven Bornfeld" <bornfeldmung@dentaltwins . com > wrote in message
news:3e2Tj.2071$GC1.1016@trndny07...
> Amatus Cremona wrote:
>>> PS--yes I have an intraoral camera, but not interfaced with my computer
>>> system.
>>
>> What are you waiting for man?? !!!
>>
>> Need help configuring it?
>
>
> Oh, it's much worse than that! (I wouldn't know how to make it compatible
> with any computer ports anyhow--it's a Tele-cam--the guys went belly up
> about a year after we bought the two cameras. For that matter, I'm too
> lazy to change the bulb, which burned out months ago. I most often use it
> to blow up my retro--emulsion x-rays from the viewbox for my patients'
> delectation.
> For that matter, I'm using DOS-based practice mismanagement software. It's
> much worse than you know, and you already know I use temporaries.
>
> Steve
>
> --
> Mark & Steven Bornfeld DDS
> * w w w .dentaltwins . com
> Brooklyn, NY
> 718-258-5001

Re: Signs of dying tooth redux

On Fri, 02 May 2008 23:33:07 -0400, Steven Bornfeld
<dentaltwinmung@earthlink . net > wrote:

>
> You're very kind. And of course I've learned plenty from you, esp.
>endo. If I did impactions I would have learned that too.
>
>Best,
>Steve


Thanks.

Have refined my endo technic and should go ahead and share.

Am using # 6, 8, and 10 C+ files for initial negotiation.
Almost every time a #10 will go to length, don't often need
the #8, and even rarer a #6.

Using some ProLube for initial instrumentation, and only at the
beginning, alternate with NaOCl-. You will be surprised how much
detritus floats out.

To flare the orfice, am using the SX rotary file (Dentsply/Tulsa)
The trick to using this file is to use the "side" of the file, not the
tip ! Use a circumfrential sweeping motion. Then switch to The S1
to length. Irrigate often and renegotiate often with the #10 or 15 C+.
Use your #10 C+ file freqently for patency.

Now use the apex locator (am using the Parkell model) to get your
final length. The second YELLOW light next to the red is 1/2 to 1 mm
short of the apex. If you choose to go by the RED light that's fine
but be sure to shorten you length by 1/2 to 1 mm.
dabbing a cotton pellet, plus a blast of air. By now you will likely
need to use a larger file to get an accurate reading. If the
ApxLocator is giving you some funky readouts, go to the next larger
file size until you get a consistent reading.
An apex locator is much more accurate that a length film !!!

Depending on the size of the canal use an 40/06, 30/06, or 20/06
Most times this file will not go to length. If it does, you are
finished, if not switch to the XX/04. Renegotiate and Irrigate
often, and between every file.

Once to length with your final size rotary take a hand file of the
same size and gently instrument the apex by hand.

Did I say to Irrigate and Renegotiate often ?

For the final rinse am using Chlorhexidine (CHX)
use your final size hand file, and use the entire
little ampule. (~3 - 4 rinses) you want this irrigant
to the apex, total time about 1 minute.
Again you will be surprised how much detritus floats out.

Then flush with water and dry with paper points.

You are now ready to obturate.
Try in your master cone, if it goes to length, excellent !
Am doing this dry without any sealer and use the cotton pliers
(get some nice heavy duty ones and only use them for endo,
have been using Meriam pliers for years)
You can mark the GP point with the pliers, check your length.

Re-instrument if necessary or drop down in size.

Lentulo spiral Grossman's sealer and place your master cone.
use a spreader then place one or two fine points.
Use spreader before each new point. Now cut off excess
at the orfice (important !)
Am using a Gutta Cut for this. Cordless, and has four tips. Forget who
I ordered it from, it's not expensive <$300 IIRC, that info is at the
office.

Use the spreader again and place either one more fine (then cut)
or start using mediums. Repeat until you can't find anymore space.
Cut off excess after no more that 2 points.

Once all canals are obturated take a #6 or 8 round surgical lenth
low speed bur and trim the GP at the orfice for a clean, smooth
divot.

Remove excess sealer with Cavilax or CaviDry on a cotton pellet.
Use water to rinse as the excess sealer and solvent floats.
Two to three rinses like this are usually sufficient.
Dry with air.

Am using ClearFillSelfEtch next, RD is still in place BTW.
Cover the orfice(s) and floor with some flowable after curing
the bonding agent. Am using 3M white. 1 - 1 1/2 mm is sufficient.
Now place Fuji 9 or composite of your choice as your build up.

Take two final films, one with RD in place and one after removal.

Check the occlusion and adjust prn.

Have had great sucess with this method and must tell you
that post op pain is almost nil.

Also you can/should give the patient at least one carpule of Marcaine.
Am using Articaine for initial local anesthesia for its quick onset,
and then giving at least one Marcaine carpule after the the onset
of the Articaine.

OK you guys I just saved you big bucks on an CE endo course.
Am willing to send a certificate for 8 hrs. of CE to those who request
one.

Endo Course for the Docs

On Sat, 03 May 2008 16:22:53 GMT, Newbie@bix.nex wrote:

>On Fri, 02 May 2008 23:33:07 -0400, Steven Bornfeld
><dentaltwinmung@earthlink . net > wrote:
>
>>
>> You're very kind. And of course I've learned plenty from you, esp.
>>endo. If I did impactions I would have learned that too.
>>
>>Best,
>>Steve
>
>
>Thanks.
>

This one deserves it's own thread.... so....
##################################

Have refined my endo technic and should go ahead and share.

Am using # 6, 8, and 10 C+ files for initial negotiation.
Almost every time a #10 will go to length, don't often need
the #8, and even rarer a #6.

Using some ProLube for initial instrumentation, and only at the
beginning, alternate with NaOCl-. You will be surprised how much
detritus floats out.

To flare the orfice, am using the SX rotary file (Dentsply/Tulsa)
The trick to using this file is to use the "side" of the file, not the
tip ! Use a circumfrential sweeping motion. Then switch to The S1
to length. Irrigate often and renegotiate often with the #10 or 15 C+.
Use your #10 C+ file freqently for patency.

Now use the apex locator (am using the Parkell model) to get your
final length. The second YELLOW light next to the red is 1/2 to 1 mm
short of the apex. If you choose to go by the RED light that's fine
but be sure to shorten you length by 1/2 to 1 mm.
dabbing a cotton pellet, plus a blast of air. By now you will likely
need to use a larger file to get an accurate reading. If the
ApxLocator is giving you some funky readouts, go to the next larger
file size until you get a consistent reading.
An apex locator is much more accurate that a length film !!!

Depending on the size of the canal use an 40/06, 30/06, or 20/06
Most times this file will not go to length. If it does, you are
finished, if not switch to the XX/04. Renegotiate and Irrigate
often, and between every file.

Once to length with your final size rotary take a hand file of the
same size and gently instrument the apex by hand.

Did I say to Irrigate and Renegotiate often ?

For the final rinse am using Chlorhexidine (CHX)
use your final size hand file, and use the entire
little ampule. (~3 - 4 rinses) you want this irrigant
to the apex, total time about 1 minute.
Again you will be surprised how much detritus floats out.

Then flush with water and dry with paper points.

You are now ready to obturate.
Try in your master cone, if it goes to length, excellent !
Am doing this dry without any sealer and use the cotton pliers
(get some nice heavy duty ones and only use them for endo,
have been using Meriam pliers for years)
You can mark the GP point with the pliers, check your length.

Re-instrument if necessary or drop down in size.

Lentulo spiral Grossman's sealer and place your master cone.
use a spreader then place one or two fine points.
Use spreader before each new point. Now cut off excess
at the orfice (important !)
Am using a Gutta Cut for this. Cordless, and has four tips. Forget who
I ordered it from, it's not expensive <$300 IIRC, that info is at the
office.

Use the spreader again and place either one more fine (then cut)
or start using mediums. Repeat until you can't find anymore space.
Cut off excess after no more that 2 points.

Once all canals are obturated take a #6 or 8 round surgical lenth
low speed bur and trim the GP at the orfice for a clean, smooth
divot.

Remove excess sealer with Cavilax or CaviDry on a cotton pellet.
Use water to rinse as the excess sealer and solvent floats.
Two to three rinses like this are usually sufficient.
Dry with air.

Am using ClearFillSelfEtch next, RD is still in place BTW.
Cover the orfice(s) and floor with some flowable after curing
the bonding agent. Am using 3M white. 1 - 1 1/2 mm is sufficient.
Now place Fuji 9 or composite of your choice as your build up.

Take two final films, one with RD in place and one after removal.

Check the occlusion and adjust prn.

Have had great sucess with this method and must tell you
that post op pain is almost nil.

Also you can/should give the patient at least one carpule of Marcaine.
Am using Articaine for initial local anesthesia for its quick onset,
and then giving at least one Marcaine carpule after the the onset
of the Articaine.

OK you guys I just saved you big bucks on an CE endo course.
Am willing to send a certificate for 8 hrs. of CE to those who request
one.

Re: Signs of dying tooth redux

Newbie@bix.nex wrote:
> On Fri, 02 May 2008 23:33:07 -0400, Steven Bornfeld
> <dentaltwinmung@earthlink . net > wrote:
>
>> You're very kind. And of course I've learned plenty from you, esp.
>> endo. If I did impactions I would have learned that too.
>>
>> Best,
>> Steve
>
>
> Thanks.
>
> Have refined my endo technic and should go ahead and share.
>
> Am using # 6, 8, and 10 C+ files for initial negotiation.
> Almost every time a #10 will go to length, don't often need
> the #8, and even rarer a #6.
>
> Using some ProLube for initial instrumentation, and only at the
> beginning, alternate with NaOCl-. You will be surprised how much
> detritus floats out.
>
> To flare the orfice, am using the SX rotary file (Dentsply/Tulsa)
> The trick to using this file is to use the "side" of the file, not the
> tip ! Use a circumfrential sweeping motion. Then switch to The S1
> to length. Irrigate often and renegotiate often with the #10 or 15 C+.
> Use your #10 C+ file freqently for patency.
>
> Now use the apex locator (am using the Parkell model) to get your
> final length. The second YELLOW light next to the red is 1/2 to 1 mm
> short of the apex. If you choose to go by the RED light that's fine
> but be sure to shorten you length by 1/2 to 1 mm.
> dabbing a cotton pellet, plus a blast of air. By now you will likely
> need to use a larger file to get an accurate reading. If the
> ApxLocator is giving you some funky readouts, go to the next larger
> file size until you get a consistent reading.
> An apex locator is much more accurate that a length film !!!
>
> Depending on the size of the canal use an 40/06, 30/06, or 20/06
> Most times this file will not go to length. If it does, you are
> finished, if not switch to the XX/04. Renegotiate and Irrigate
> often, and between every file.
>
> Once to length with your final size rotary take a hand file of the
> same size and gently instrument the apex by hand.
>
> Did I say to Irrigate and Renegotiate often ?
>
> For the final rinse am using Chlorhexidine (CHX)
> use your final size hand file, and use the entire
> little ampule. (~3 - 4 rinses) you want this irrigant
> to the apex, total time about 1 minute.
> Again you will be surprised how much detritus floats out.
>
> Then flush with water and dry with paper points.
>
> You are now ready to obturate.
> Try in your master cone, if it goes to length, excellent !
> Am doing this dry without any sealer and use the cotton pliers
> (get some nice heavy duty ones and only use them for endo,
> have been using Meriam pliers for years)
> You can mark the GP point with the pliers, check your length.
>
> Re-instrument if necessary or drop down in size.
>
> Lentulo spiral Grossman's sealer and place your master cone.
> use a spreader then place one or two fine points.
> Use spreader before each new point. Now cut off excess
> at the orfice (important !)
> Am using a Gutta Cut for this. Cordless, and has four tips. Forget who
> I ordered it from, it's not expensive <$300 IIRC, that info is at the
> office.
>
> Use the spreader again and place either one more fine (then cut)
> or start using mediums. Repeat until you can't find anymore space.
> Cut off excess after no more that 2 points.
>
> Once all canals are obturated take a #6 or 8 round surgical lenth
> low speed bur and trim the GP at the orfice for a clean, smooth
> divot.
>
> Remove excess sealer with Cavilax or CaviDry on a cotton pellet.
> Use water to rinse as the excess sealer and solvent floats.
> Two to three rinses like this are usually sufficient.
> Dry with air.
>
> Am using ClearFillSelfEtch next, RD is still in place BTW.
> Cover the orfice(s) and floor with some flowable after curing
> the bonding agent. Am using 3M white. 1 - 1 1/2 mm is sufficient.
> Now place Fuji 9 or composite of your choice as your build up.
>
> Take two final films, one with RD in place and one after removal.
>
> Check the occlusion and adjust prn.
>
> Have had great sucess with this method and must tell you
> that post op pain is almost nil.
>
> Also you can/should give the patient at least one carpule of Marcaine.
> Am using Articaine for initial local anesthesia for its quick onset,
> and then giving at least one Marcaine carpule after the the onset
> of the Articaine.
>
> OK you guys I just saved you big bucks on an CE endo course.
> Am willing to send a certificate for 8 hrs. of CE to those who request
> one.
>
>
>
>
\

I think I have some of the SX files, but I don't think I've used them
yet. My motor was set close (but not exact) to the rotary
specifications. The Tulsa guy did come into our office. He didn't say
anything about a circumferential motion.
I've had nothing but trouble with my apex locator (a Bingo, and it
wasn't cheap.
Glad to hear I'm not the only fogie still using cold GP.

Steve

--
Mark & Steven Bornfeld DDS
* w w w .dentaltwins . com
Brooklyn, NY
718-258-5001

Re: Signs of dying tooth redux

On Sat, 03 May 2008 18:45:07 GMT, Mark & Steven Bornfeld
<bornfeldmung@dentaltwins . com > wrote:

>
> I think I have some of the SX files, but I don't think I've used them
>yet. My motor was set close (but not exact) to the rotary
>specifications. The Tulsa guy did come into our office.


>He didn't say
>anything about a circumferential motion.

Of course he didn't, he's a sales rep not a dentist.


> I've had nothing but trouble with my apex locator (a Bingo, and it
>wasn't cheap.

Am using the one made by Parkell, they used to be in Farmingdale.
A little LI town where I spent many summers.
You must have a clean canal for the Apex locators to work correctly.
If there is any pulpal tissue, you get a false reading.
The pulp chamber must also be dry, and it actually helps
if the canal(s) are not soaking wet.

Severely weepy canals should be treated with some CaOH mixed
with a NO VASOCONSTRICTOR local anesthetic.
Coronally seal well with Fuji9 or composite, and be sure to place
cotton or temporary stopping of some sort over the orifices.

Tactile feel, a bit of knowledge of average lengths, combined
with eyeballing the radiograph will get you in the ballpark.

> Glad to hear I'm not the only fogie still using cold GP.

Until my endo mentor changes his technic, am sticking with his current
protocol. Will get you the instrument number of the spreader, I buy 3
or 4 at a time. they are good for about one quarter. So thin that they
get bent and wrecked very easily. Always good to have several on hand.

BTW it's not the temperature of the GP, it's how you place it.
And warmed GP, as is true with most solids, shrinks upon cooling.
Have kept my GP points in the fridge for over two decades now, so
after they are placed they actually expand a little bit. Even at room
temperature they will expand a bit at 98.6
I really do use "cold" GP !

You will be doing 1st molars in about an hour by the end of this year.
Another hour or less and the crown prep, impression, and
temporization is done.

- Or my name may be MUD <hehe>

What's a temporary ?
>
>Steve