My English is quite rusty although I got band 5 for my muet.
Haha. Long gone babe, just history now.
Practical+Theory=Life. Theory says the usual step, usual way
to do things, but practical shapes the life. As today, another experience comes
in. it make me wonder how life flies so fast.
Before, it’s just the word: you are first year, no need to
know detail, just be familiar with the basic.
Now: What happen to you my dear, already final year yet
don’t know to diagnose properly, don’t know to present properly?
How life change. The word may make your pride goes down or
may motivate you to study more, take your pick.
Ok. About today. I got no patient for GDP case, so just wait
for OPD. My ‘rezki’ , I got a patient as early as 223pm.
Topic: Pulpal problem is difficult to localize if compared
with periodontal problem. So, from chief complain I have to look for the exact
cause of toothache. Namely 3 teeth to be investigated which are 25 (food
impaction with caries extend to pulp, cavitation on 27 and secondary caries
under mesial gic of 28. (28 suprarerupt due to removal of impacted 38 3 years
back.
To complicate the situation, on percussion all posterior
teeth are tender, difficult right? Not that difficult actually, just put
dressing on 27&28, 28 is preferably for extraction case (non
functional+deep caries) and pulp extirpation of 25. These considered as
emergency treatment as patient in pain. There, solve the problem. Before, do
investigation like xray-OPG for impacted 8’, PA for deep caries & bitewing
for interproximal caries detection. Simple right? I love to be a dentist..haha
But, 1st of all, give oral hygiene education.
Most important, technique of toothbrushing-if needed advice to use floss &
brushing before sleep. Why it is important to brush just before sleep? Coz
during sleep, quantity of saliva reduced, so the self cleansing effect of
saliva is reduced too. This will favour accumulation of plaque on tooth surface
and lead to demineralization process that with time will contribute to caries
formation.
My experience, I got this kind of toothache. (my mom make
joke about this: dentist also got toothache? Haha) . after all, dentist (I mean
dental student now) too human being. Pain during mastication/eating only
especially meat. Feel like food stuck there. So, check any caries. If not,
check tenderness to lateral & vertical percussion-tender mean perio problem
in origin. Next check for probing depth. Not so deep to consider as perio
problem. But, there is interdental papilla loss. Actually, my case, me I mean
referred to perio specialist.
My treatment, just do root surface debridement there and
advice for using interdental brush. There was granulation tissue found there.
If no improvement, I may need to undergo periodontal surgery just to facilitate
oral hygiene measure there. I hope not. I love to do surgery on others, but not
me, ironic right. This is me being dentist, love to do filling on others, but
afraid to undergo filling on myself.
Please don’t cry, I love u myself. You stay with me in all
happy & sad situation. I’m not gonna leave you alone myself.
TODAY IS ANOTHER BIG DAY FOR ME. I LOVE BEING A DENTIST TO
BE AHAKS
I’m indebted to one of my colleague for one extraction. It’s
payback time. During perio session yesterday, I found one tooth indicated for
extraction due to irreversible pulpitis, so I give her the tooth today to be
extracted. Me? I’m enjoying the session being an assistant for apicoectomy
procedure to remove foreign body namely non setting calcium hydroxide on the
apex of 22.
Last year, I’d experience to observe apicoectomy or so called endodontics surgery
to bevel part of the tooth apex to create apical seal due to periapical lesion
of non vital tooth. We have 2 options either to do orthograde RCT or retrograde
RCT. This time, only TF and retrograde RCT preferred.
Be warn that this is painful procedure that profound
anaesthesia is really necessary.
Infiltration was given on palatal and buccal site. 2 cartridge 2.2ml LA with
adrenaline was expected. One carpule before starting and another reserved in
the middle of procedure. Full mucoperiosteal flap was raised with vertical
releasing incision on 11 and 13. Semilunar flap is only indicated if tooth is
crowned.
I’m the one holding the suction 2 hours. Left hand holding
the suction tip while right hand holding the Howarth periosteal elevator. How
exciting to be able to see all the procedure clearly! After that, using K file
60, clean and shape the canal. Use actual working length measurement to
estimate how far flap should be raised/reflected. Raise a little bit more than
WL.
Then, use round bur to create window on the bone around apex
based on working length. Then, curette the non setting calcium hydroxide use
curettage until no more material. If needed extend the window use larger size
round bur. Don’t forget to irrigate along the way. Then, if satisfied, take
periapical X ray to see no more excess there. This non setting calcium
hydroxide is radiopaque, so it’s easier to differentiate.
Next, dry the canal with paper point and cotton pellet
inside the window. Use larger size gutta perca to obturate until there is
tugback. Before that bevel the apex with fissure bur. Then, obturate with GP.
Cut excess GP on the apex. Last , suture with interrupted suture, maybe 5 up to
6 interrupted suture use 3-0 needle. Give post op instruction &
prescription of antibiotics & analgesic.
Done! Time to clean up instrument.
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