Dentaltown July 2021 - 29

I'd start 3, 4, 5. Depending on what they look like with excavation may infl uence how I
proceed. ■
7/3/2018
I'd leave all these alone. Have been for about fi ve years. OHI, diet, 5,000ppm fl uoride
toothpaste, 3/12 23,000ppm topical fl uoride, BWs in 12/12. One or two might advance but even
at 12/12 it will be so slow. Very occasionally get caught out and they come back with a big hole.
But my anecdotal experience is that for every one that gets huge, you have not drilled hundreds.
Of course, it does depend on the individual patient. I ask them if they are going to try to prevent
huge holes. If they say no, fi ll, but they will fail too. ■
7/3/2018
Doctor J
Interesting to see some of the responses.
1. Those X-rays are not very clear. With the sharpen tool on Dexis they can be a lot clearer.
2. Having said that, on some patients these will end up being confi ned to enamel and in some
patients these can be well into dentin; impossible to tell without seeing clinically. No way
anyone here can say they look crystal-clear on those BW.
3. I would bring patient in and prep 4 DO and inspect 3 mesial. You'll have your answer
right there. If there is yucky brown decay or if it's just that white chalky enamel. You
may be surprised. Then you'll know how to proceed. Best case, you can be happy to give
the patient PreviDent and fl oss and give them the speech. Worst case, you need to place
composites everywhere and see them again in 10 years to do it all again.
4. No way would initially plan all those fi llings. Gain their trust. You gotta be confi dent in
your approach to do that. ■
7/3/2018
ricklin
Your BWs will be far more diagnostic if you lower the KV and raise the exposure time.
That's if you can adjust KV. For my Intraskan we can do BWs at 55KV which will deliver more
contrast. Exposure time does increase, as does patient absorbed dose. It's also very helpful to
lower the room lights and allow eyes to adjust, then read images. Make sure your monitor is not
too bright. ■
7/4/2018
Chmrb
So many times the lesions are much larger than they appear in the radiographs. Just this
week I was on the fence about a lesion I saw. Should I treat it? Or not? I decided to drill and
boom, big old cavity. The axial wall had to be extended an extra 2mm more than the " ideal "
prep. And on the radiograph, the black triangle only extended to the DEJ.
Whenever I see a set of BWs like this, I sit down with the patient and fi gure out what the
root cause is. Nine times out of 10 it's sugary beverages. I tell people they can have sweet tea or
they can have teeth, but they can't have both. ■
7/4/2018
Wow! Shocked by the responses so far. The only one I would consider opening would be
4D (would clinically check 3M). Agree with the above posters that rads are not the clearest but
radiographically I don't see the others as being past DEJ.
Agreed this can and may lead to a lot of needed treatment in 6-12 months without serious
change from patient. But who's to say restorations won't fail in a short time if patient doesn't
change his dietary and OH habits either? ■
7/4/2018
quikag1
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Dental Mechanic
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Dentaltown July 2021

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