AuthorTopic: Collapse Dentistry  (Read 1004 times)

Online Eddie

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Collapse Dentistry
« on: April 24, 2018, 05:40:55 PM »
On instruments...quality varies. You can get some good sets of instruments on eBay, in that they are a complete set, but the quality is probably like if you bought what looked like a great skinning knife from Pakistan. They look right but they aren't the greatest. Still, they work, just not as good as name brand stuff.

I buy all my surgical instruments from Karl Schumacher. They are without a doubt the best. They look like traditional instruments, but they have been improved by good engineers working with real surgeons. It does make a difference.

The difficulty of removing teeth varies so much, I just can't emphasize that enough. Some people have bone like forged steel and teeth with 25mm roots. There are people I still dread to treat, especially when I do have to take out maybe 20 teeth or more to deliver a denture. And I've taken out thousands of teeth, including every type of difficult impaction...anything you'd ever, ever see (and things I never wanted to see, like large pieces of bone that came out with teeth...not a good thing, usually.)

All front teeth and bicuspids are removed with an anterior forcep. Upper anterior forceps are fairly straight. Lower ones have beaks curved at about 60 degrees or so.



Upper forcep on left. Lower forcep on right.

It hurts a lot to extract teeth. Most people can't tolerate the pain unless they have some kind of anesthetic, or lacking that, some kind of badass painkiller (think fentanyl).

Loose, periodontally involved teeth (not much bone around the tooth) can be quickly snatched out before the patient has time to react, but it still hurts like hell. Teeth that aren't loose have to be worked loose. First you can use a blade or any sharp object (we use what's called a periosteal elevator) to make the gum tissue turn loose of the tooth. Not always completely necessary, but makes it less traumatic to the soft tissue afterward.


Periosteal elevator.

I try hard not to hurt people, but it isn't always easy not to (even with all my drugs and gear), so I will tell you that I have taken out some teeth with patients in serious pain. They can handle it if you go slow and work them up to it. Better to go very slow if you don't have pain control and anesthesia. If you don't you can put someone in shock and they could die from something triggered by sky high blood pressure or tachycardia. Remember that if you get the tooth out but the patient dies, that is considered bad form.

Taking out teeth hurts so much we give patients local anesthetic even when if they are already under general anesthesia. Not many other kinds of surgeons ever have to do that.

The basic move to take out any anterior tooth is to grasp the tooth firmly, pushing into the gum tissue hard (not pulling at all) and twisting to rotate the tooth around its long axis. As it starts to loosen you can rock the tooth back and forth while still pushing in trying to grasp the root below the gum line, to get as close to the center of the tooth as you can. If you just grab the crown and yank, you'll snap the tooth off at the gum line. Slow, controlled movements, twisting, and rocking back and forth. Perseverance furthers.

Broken teeth have to be removed with some kind of elevator, usually. An elevator looks a lot like a sharpened screw driver.



Elevator


Basically you have to jam the tip of the elevator between the root and the surrounding bone and create space. Takes time and work. Easier to do with the forceps, unless the tooth is chronically infected and loose already.

Chronic infections are usually not a big deal. Tooth gone, patient heals.



Acute infections are the big problem. Facial swelling equals cellulitis. This will not always go away when the tooth is gone. Chronically infected teeth sometimes turn into acutely infected teeth overnight, and you need to get antibiotics to get the swelling down. No antibiotics, maybe you can punch a hole into the gums and get some drainage, and use oral rinses, whatever you have, salt, peroxide, even warm water, preferably clean.

In BAU the worst case is some guy who has had 6 rounds of penicillin over the last year, never got real treatment  and has now managed to cultivate some anerobe. You give the patient penicillin and just watch the swelling get worse and worse. I give flagyl for those. It's my penicillin back-up. If you call me Friday afternoon after five and tell me your face is swelling (and especially if it isn't the first time) I give both penicillin and flagyl. I don't like patients having to go to the emergency room.

The real killer with infected teeth is when you get bilateral neck swelling and lose the airway. Rare but it happens. Antibiotics are magic. If they work.

So that's your primer on anterior teeth and bicuspids and general drug regimen for bad toothaches. I'll add a post on molars later. For molars, you need molar forceps and/or elevators. There are four different basic molar forceps.




« Last Edit: April 24, 2018, 05:44:31 PM by Eddie »
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Offline Surly1

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Re: Collapse Dentistry
« Reply #1 on: April 25, 2018, 02:19:29 AM »
Quote from: Eddie
Remember that if you get the tooth out but the patient dies, that is considered bad form.

Now THAT's funny AF. Unless it's one's own tooth. :icon_mrgreen:
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Offline cernunnos5

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Re: Collapse Dentistry
« Reply #2 on: April 25, 2018, 06:11:56 AM »
On instruments...quality varies. You can get some good sets of instruments on eBay, in that they are a complete set, but the quality is probably like if you bought what looked like a great skinning knife from Pakistan. They look right but they aren't the greatest. Still, they work, just not as good as name brand stuff.

I buy all my surgical instruments from Karl Schumacher. They are without a doubt the best. They look like traditional instruments, but they have been improved by good engineers working with real surgeons. It does make a difference.

The difficulty of removing teeth varies so much, I just can't emphasize that enough. Some people have bone like forged steel and teeth with 25mm roots. There are people I still dread to treat, especially when I do have to take out maybe 20 teeth or more to deliver a denture. And I've taken out thousands of teeth, including every type of difficult impaction...anything you'd ever, ever see (and things I never wanted to see, like large pieces of bone that came out with teeth...not a good thing, usually.)

All front teeth and bicuspids are removed with an anterior forcep. Upper anterior forceps are fairly straight. Lower ones have beaks curved at about 60 degrees or so.



Upper forcep on left. Lower forcep on right.

It hurts a lot to extract teeth. Most people can't tolerate the pain unless they have some kind of anesthetic, or lacking that, some kind of badass painkiller (think fentanyl).

Loose, periodontally involved teeth (not much bone around the tooth) can be quickly snatched out before the patient has time to react, but it still hurts like hell. Teeth that aren't loose have to be worked loose. First you can use a blade or any sharp object (we use what's called a periosteal elevator) to make the gum tissue turn loose of the tooth. Not always completely necessary, but makes it less traumatic to the soft tissue afterward.


Periosteal elevator.

I try hard not to hurt people, but it isn't always easy not to (even with all my drugs and gear), so I will tell you that I have taken out some teeth with patients in serious pain. They can handle it if you go slow and work them up to it. Better to go very slow if you don't have pain control and anesthesia. If you don't you can put someone in shock and they could die from something triggered by sky high blood pressure or tachycardia. Remember that if you get the tooth out but the patient dies, that is considered bad form.

Taking out teeth hurts so much we give patients local anesthetic even when if they are already under general anesthesia. Not many other kinds of surgeons ever have to do that.

The basic move to take out any anterior tooth is to grasp the tooth firmly, pushing into the gum tissue hard (not pulling at all) and twisting to rotate the tooth around its long axis. As it starts to loosen you can rock the tooth back and forth while still pushing in trying to grasp the root below the gum line, to get as close to the center of the tooth as you can. If you just grab the crown and yank, you'll snap the tooth off at the gum line. Slow, controlled movements, twisting, and rocking back and forth. Perseverance furthers.

Broken teeth have to be removed with some kind of elevator, usually. An elevator looks a lot like a sharpened screw driver.



Elevator


Basically you have to jam the tip of the elevator between the root and the surrounding bone and create space. Takes time and work. Easier to do with the forceps, unless the tooth is chronically infected and loose already.

Chronic infections are usually not a big deal. Tooth gone, patient heals.



Acute infections are the big problem. Facial swelling equals cellulitis. This will not always go away when the tooth is gone. Chronically infected teeth sometimes turn into acutely infected teeth overnight, and you need to get antibiotics to get the swelling down. No antibiotics, maybe you can punch a hole into the gums and get some drainage, and use oral rinses, whatever you have, salt, peroxide, even warm water, preferably clean.

In BAU the worst case is some guy who has had 6 rounds of penicillin over the last year, never got real treatment  and has now managed to cultivate some anerobe. You give the patient penicillin and just watch the swelling get worse and worse. I give flagyl for those. It's my penicillin back-up. If you call me Friday afternoon after five and tell me your face is swelling (and especially if it isn't the first time) I give both penicillin and flagyl. I don't like patients having to go to the emergency room.

The real killer with infected teeth is when you get bilateral neck swelling and lose the airway. Rare but it happens. Antibiotics are magic. If they work.

So that's your primer on anterior teeth and bicuspids and general drug regimen for bad toothaches. I'll add a post on molars later. For molars, you need molar forceps and/or elevators. There are four different basic molar forceps.

Now, that right there is the beginning of an awesome article. A very needed article. Might I suggest that you take a month to chew it over in your head before writing, Specifically, what would you tell, say, a plumber facing having to pull out the tooth of his wife so she doesn't die, snowed in over a winter with no help coming. Or, even worse, the economy has collapsed to extent where a parent is having to make the decision whether to feed the children that month or get that molar pulled

No pressure.  ;)

Offline RE

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Re: Collapse Dentistry
« Reply #3 on: April 25, 2018, 06:55:31 AM »
Now, that right there is the beginning of an awesome article. A very needed article. Might I suggest that you take a month to chew it over in your head before writing, Specifically, what would you tell, say, a plumber facing having to pull out the tooth of his wife so she doesn't die, snowed in over a winter with no help coming. Or, even worse, the economy has collapsed to extent where a parent is having to make the decision whether to feed the children that month or get that molar pulled

No pressure.  ;)

It definitely is an article, or series of articles in the making.  This one is already long enough for a Part 1.

The biggest problem here I think as Eddie mentioned is the anaesthetic problem.  You definitely need to stock up on the lidocaine and syringes/needles.

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Re: Collapse Dentistry
« Reply #4 on: April 25, 2018, 07:00:13 AM »
I'm going to split this off to it's own thread, "Collapse Dentistry".

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Online Eddie

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Re: Collapse Dentistry
« Reply #5 on: April 25, 2018, 07:12:06 AM »
I have to be careful about what I say and how I say it. While I am happy to impart information about how extractions are done, and how such a thing might be handled in a situation where normal services were/are not available, I can't ethically support folks taking each others bad teeth out to save money when dentists are widely available.

An extraction isn't heart surgery, and the worst case financially is usually a couple of hundred bucks. When people claim to have paid more, the fees usually involve costs of IV sedation or general anesthesia and services performed by an oral surgeon (they do charge more than GP's in most locales.) I'm not an advocate of DIY dentistry.

And...I don't care to become an online source of dental info, generally speaking. I'm a good clinician who makes a living treating patients, and that's where my expertise lies (and where I wan to keep it). I've always been happy to answer Diner questions about what's going on with their own personal teeth via PM. My private advice is private.

For general info, I recommend Murray Dickson's book:

https://www.amazon.com/Where-There-Dentist-Murray-Dickson/dp/0942364058

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Re: Collapse Dentistry
« Reply #6 on: April 25, 2018, 07:16:42 AM »

And...I don't care to become an online source of dental info, generally speaking.

You could make a lot more $MONEY🤑 as the Dr. Phil of Dentistry.  ;D

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Online Eddie

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Re: Collapse Dentistry
« Reply #7 on: April 25, 2018, 07:20:57 AM »
I seriously doubt it. LOL.
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Offline RE

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Re: Collapse Dentistry
« Reply #8 on: April 25, 2018, 07:24:34 AM »
I seriously doubt it. LOL.

No employees, no overhead, NBC Today show pays you $1M/year.

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Online Eddie

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Re: Collapse Dentistry
« Reply #9 on: April 25, 2018, 07:42:10 AM »
Sign my ass up. LOL.
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Offline RE

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Re: Collapse Dentistry
« Reply #10 on: April 25, 2018, 07:58:18 AM »
Sign my ass up. LOL.

I am working on the Pitch to the Today Show producers now.  As your Agent, I get 10%.

You also have no Medicare/Insurance billing to do!  :icon_sunny:

You will also get fully paid first class Global travel as you visit Dentists all over the world to video their dental practices.

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Online Eddie

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Re: Collapse Dentistry
« Reply #11 on: April 25, 2018, 08:04:19 AM »
Show me the money.
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Offline RE

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Re: Collapse Dentistry
« Reply #12 on: April 25, 2018, 08:09:38 AM »
Show me the money.

We need to make a demo tape first.  Gotta get you on camera to reveal your dynamic camera presence as a "Franchise Quarterback Dentist".  I suggest we do the demo tape down in Los Algodones.  We can tour all the dental offices in town.

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Offline jdwheeler42

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Re: Collapse Dentistry
« Reply #13 on: April 26, 2018, 08:49:54 AM »
It definitely is an article, or series of articles in the making.  This one is already long enough for a Part 1.

The biggest problem here I think as Eddie mentioned is the anaesthetic problem.  You definitely need to stock up on the lidocaine and syringes/needles.
If it truly is a life or death situation, there are herbs that will help.  The issue being, that pesky problem-solved-but-patient-dead thing.... if an herb is powerful enough to block pain signals from tooth extraction, it is potential powerful enough to block nerve signals to keep the heart beating.

With that caveat, Spilanthes is known as "the toothache plant", and Death Camas can cause numbness on contact.
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Offline RE

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Re: Collapse Dentistry
« Reply #14 on: April 26, 2018, 09:38:41 AM »
It definitely is an article, or series of articles in the making.  This one is already long enough for a Part 1.

The biggest problem here I think as Eddie mentioned is the anaesthetic problem.  You definitely need to stock up on the lidocaine and syringes/needles.
If it truly is a life or death situation, there are herbs that will help.  The issue being, that pesky problem-solved-but-patient-dead thing.... if an herb is powerful enough to block pain signals from tooth extraction, it is potential powerful enough to block nerve signals to keep the heart beating.

With that caveat, Spilanthes is known as "the toothache plant", and Death Camas can cause numbness on contact.

Where do you find those plants and/or can you grow them in your garden?

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