Dentaltown July 2021 - 30

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Watcher
Member Since: 02/18/04
Post: 27 of 95
Might I suggest you use transillumination? I use a MicroLux transilluminator. If you are
using at least 3.5x magnifi cation (my experience), many times-especially on bicuspids-you
can see the shadow since these are usually just below the contact. Use multiple angles with the
light, even directing the light at the most gingival part of the embrasure. You may be surprised at
what you see/don't see. It's great on anteriors when the X-ray is not distinct. I make a round with
the TI as a part of every exam. I have found a lot of interproximal early caries that did not show
on X-rays and ruled out many as well-at least to the point of being comfortable monitoring. I
hope this helps. ■
7/10/2018
palmers31
Member Since: 07/30/08
Post: 30 of 95
I'm not going to make a specifi c call on which teeth to fi ll or not, but I will say I would not
be fi lling most of these interproximal lesions.
1. It's a new patient; you need to build rapport. Do everything you can to show the parents
and the patient that you care and that you are conservative. I always tell parents, " We can
always do fi llings, but we can never undo fi llings. I consider a fi lling to be a last resort.
If we can stop the decay without doing fi llings, that's always preferable. " When you tell
parents that, they're now on your side. They trust that you're not out to take their money.
You also shift the accountability to them and their kid.
2. I'd put this patient on an aggressive remineralization protocol. Mine is:
* CariFree treatment rinse (the yucky bleach stuff) for two to three months.
* CariFree nightly fl uoride rinse.
* Flossing daily with DentoTape.
* CariFree toothpaste.
* Diet recommendations (minimize acidic foods/beverages).
* Electric toothbrush (Sonicare).
I've had great success with this protocol, but at subsequent hygiene visits there's almost
always a percentage that progress. You can also put a positive spin on it when that happens.
I say something like: " So, in 18 out of the 20 teeth we've been monitoring, the decay has not
progressed. That's a huge win! That means only two teeth will need fi llings. " ■
7/11/2018
Craighdds
Member Since: 07/24/05
Post: 95 of 95
Don't forget to emphasize grazing. I am seeing a lot more of this due to people being bored
during pandemic. Kids who are virtual learning have access to food and beverages all day long
at home where they wouldn't have if in school. People stuck at home more on weekends and not
going anywhere. Masks are drying everyone's mouth out, and it is inconvenient to be sipping
on their water bottle to stay hydrated if masked indoors. My rule of thumb is that if the lesion
is smaller than my 330 bur, I will counsel on eating habits, get them on Prevident 5000 booster
and take new radiographs at next checkup. I will only treat the lesions that have grown. Many
times they will stay the same size, so I can continue to monitor. ■
5/20/2021
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Dentaltown July 2021

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