Q. I would like to know how to customize a cart for endo -- I see it mentioned in some of your products, but what is it and how do you get one?
A. The cart I use, refer to and seen in some of my DVDs is made by a company in Colorado called ASI Medical. They do a great job of customizing their cart to your exact needs.
ASI Medical (Englewood, CO)
John McPeek, Owner
Phone: (800) 566-9953
Q. One of my biggest frustrations is administering profound mandibular anesthesia. Are there any techniques that you can recommend, or a video, on the subject of administering an effective mandibular block?
A. I receive many emails regarding how to anesthetize the "hot tooth" but I have never been asked how to specifically administer a mandibular block injection. My explanation would be much too long for purposes here and, even if we spoke by phone, it would not be so easy. The following methods are rated best to worst and are utilized in the event the patient is still experiencing pain after attaining profound block anesthesia.
1) Intraosseous injection - xtip at www.x-tip.com
2) Interligamentary injection (ILI)
3) Long buccal and lingual infiltration
4) Interpulpal injection
Back to your original question --- contact Dr. Stanley Malamed at USC School of Dentistry as he is the expert on anesthesia and office medical emergencies. I hope this helps.
Q. Would you discuss the endodontic flare-up and the antibiotics and NSAIDs that may be beneficial?
A. Endodontic flare-ups are situations where patients report pain and/or swelling following the initiation or continuation of root canal treatment. The frequency of exacerbations associated with retreatment are notorious. Regarding endodontic exacerbations, the classic scenario is a patient who presents essentially asymptomatic, has endodontic treatment, is dismissed then later reports significant pain and/or swelling. In many instances, although the patient presented asymptomatic, there was a chronic underlying problem. Oftentimes, the flare-up occurred due to inoculating debris into the attachment apparatus during the removal of the pulp, bacteria, related irritants or endodontic materials during canal preparation or nonsurgical retreatment procedures. As an example, post-operative exacerbation may result following the removal of a silver point, cytotoxic paste, or shaping a previously missed necrotic canal.
Antibiotics such as Penicillin, Amoxicillin or Clindamycin may be judiciously used to manage a flare-up. Empirically, some patients are prophylactically placed on an antibiotic to reduce the potential for a retreatment flare-up. Clinicians must use antibiotics intelligently and appropriately. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Lodine, Orudis or Toradol are very effective for managing pain and inflammation. Clinicians need to carefully review the patient’s medical history and discuss with their patients the risk versus benefits of the medication as NSAIDs can induce G.I. complications or interact with other drugs.
Q. Do you have any good articles you could recommend regarding the storm brewing over silver amalgam fillings, class action suits and the like?
A. No, but this topic has been extensively addressed on multiple occasions in the JADA. If you don't have the past journals to read, contact the ADA office in Chicago for reprints.
Q. I am interested in the new intracoronal bleaching techniques and materials, and would like to know more about the new materials and their cytotoxicity in vitro and in vivo.
A. Although I have bleached many teeth over several decades, I am not the expert. Traditionally, I used sodium perborate powder mixed with 30% Superoxol and placed this paste into the pulp chamber. In the literature there was an occasional resorptive problem cervically associated with this technique. As such, I switched to water as the liquid and this has been recognized as a safer alternative than Superoxol.
Q. Do you know if I can integrate a flash to my microscope, synchronized with the foot switch needed to record those images, and is it needed to get sharper images (i.e. At higher magnification when deep in the canal)?
A. I'm not sure I can be of much help to you in regards to getting better quality images through your video capture system. I am still an avid 35mm proponent and although I use video for teaching, all of my still photos are obtained with a 35mm camera and no flash. I do, however, use a xenon light on my microscope to get the deep shots in conjunction with a wide-open aperture. It's very useful to bracket and practice on extracted teeth. Within the guidelines of micro-photography, there is a great number of variables. I can suggest a few sources for you to research with your question about having flash associated with your video captures:
1) Dr. Eric Herbranson (San Leandro, California): firstname.lastname@example.org
2) Dr. John Khademi (Durango, Colorado): email@example.com
3) Dr. Martin Levin (Chevy Chase, Maryland): firstname.lastname@example.org
These clinicians are extremely knowledgeable regarding all aspects of this technology and give lectures regarding documentation.
Q. What percentage is endodontics growing nationally? Root canals?
A. According to Dental Economics about 15-20% of a general dentist's annual gross income is produced performing endodontic procedures. Additionally, about 80% of all U.S. endodontic procedures are done by general dentists. This still does not answer growth. Currently, in the U.S. alone, the dental profession performs over 40 million root canals per year.