Dentaltown April 2018 - 40

message board
Chief Teef
Member Since: 04/18/14
Post: 47 of 102

I wouldn't watch these. SDF and Rx of PreviDent is conservative treatment. I would present
a plan with the SDF as well as a plan for the fillings. I would recommend the conservative plan
but let the patient decide. Doing nothing and watching these will result in larger caries. ■
11/23/2017

RichardEhrlich
Member Since: 01/21/16
Post: 48 of 102

A motivated patient can arrest decay even once it breaks the DEJ. I have lots of sequential X-rays
of lesions like this that are static or even reversing. Even on the most motivated patient these would
need fixing. If your patient is going to sit on the couch and drink Red Bull all day, forget it. ■
11/23/2017

drurban
Member Since: 10/19/01
Post: 52 and 57 of 102

I have filled a lot of teeth. Many of them looked like these. I think that #30 could have a pulpal exposure. To quote Gordon Christensen, digital radiographs understate the depth of decay.
Fill these teeth. Fill all teeth where there is penetration of more 50 percent of enamel. Start
doing this now and you will be shocked by how much decay you will see.
Tell the patient they need two fillings and rec tx soon. If they don't want tx that's fine, they'll
enjoy the endo that will come along sooner or later. ■
12/1/2017

Lady Elaine
Member Since: 08/16/03
Post: 62 of 102

For sure fill #30, if you are still on the fence about #31, prep #30 first and directly inspect
#31 at that time. Tell the patient she has one for sure cavity and one really borderline cavity that
you will look closer at when you fi x the for sure one. And then tell her she has two more maybe
cavities on top that for now, you aren't going to do anything with. But, if the bottom ones turn
out to be way bigger than the X-ray shows, you will have to come back and do those too. Tell her
you are giving her a "worst case scenario" plan and treatment-plan all four. Let her know you'd
rather take things off the bill if things go better than you think they will, than add things to the
bill because you found surprises. ■

12/2/2017

Kenphelps
Member Since: 09/27/03
Post: 70 of 102

One of the most important questions I had on my dental history form was a "rate your
mouth on a scale of 1 to 10" graphic. If the patient circled a high number, I knew I had to tread
carefully when presenting any serious treatment, since I was going to transgress their self-image.
If they chose a low number, I knew I could be more matter-of-fact and start off on a "Well, you
were certainly correct..." tack. ■
12/2/2017

sjbnh
Member Since: 03/10/07
Post: 73 of 102

On a patient that I didn't feel had trust in me yet, I have definitely done the partial prep
then intraoral photo on #30. This tooth will definitely show caries in the dentin. People usually
believe what they can see. I will give the whole, let's be conservative and open up the most
obvious one and see what we find speech. I would look at mesial of #31 with #30 prepped. Looks
to me like you will find dentinal caries on #31 as well. ■
12/2/2017

Doctor J
Member Since: 03/08/10
Post: 82 of 102

40

I show all my patients their X-rays on the computer monitor. Whether they have cavities or
not. I show them what healthy enamel looks like and what a sealed amalgam/composite looks
like compared to a leaking one. To me, scheduling the pt for 30/31 is a no-brainer. You prep 30
and inspect 31. On the off chance 31 is fine you're the hero and they get away with one filling
and a warning to floss floss floss.
At some point you have to learn how to educate patients and not be afraid to tell them when
they have cavities.
Our Dexis software has a contrast/invert setting that helps show patients. For what it's

APRIL 2018 // dentaltown.com


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Table of Contents for the Digital Edition of Dentaltown April 2018

Dentaltown April 2018 - Intro
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