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Dental train wreck


The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Mark Dreyer - www.rxroots.com
From: Mark Dreyer
Sent: Thursday, January 05, 2006 2:17 PM
To: ROOTS
Subject: [roots] George Burns reincarnated

Not only does he look just like him,  he is even funny like Burns was.  
He was in my waiting room, filling out the tablet PC, and says in a 
really loud voice "You know I could die before I finish this!"

Anyhow, he's seriously medically compromised including an aortic 
aneurism as well as a urinary catheter. He is very very frail looking.  
Talk about a referral source dumping someone on your doorstep without a
tx plan.  How would ya'll handle this dental train wreck?  I'm inclined 
to think that for someone like this, one tooth at a time patchwork would 
be the way to go rather than insisting on a comprehensive tx plan.
I'm not sure he could tolerate any massive reconstructive tx plan.  
I want to help, but I sure don't want a medical emergency in my chair 
either -  - Mark



Mark,
     A call to his physician before anything.
     Status of Aortic Aenurism ?
     Is he too unhealthy for them to treat it with a Stent or whatever ?
     Is the pt. responsible for himself or is someone with him that 
	 makes the decisions ?
     Dr. , pt / helper says ok to treat
     Is he hurting ?
     How much treatment does he want ?
     1 tooth at a time would probably be ok.
     If he wanted extensive treatment ?
     I would have his Dr and my anesthesiologist check him
     If they said ok, then according to how long they wanted to IV Sedate 
	 or General Anesthesia,
     How much can he afford?
     All ok above, treat all necessary 1 visit RCís, stop all decay with 
	 composite buildups,
     extractions if necessary in 1 long appt. under Sedation / GA.
     If he survives that, all the Crown and Bridge he wishes probably on 
	 another visit.

We do Cerec 1 visit crowns, so maybe some of that could be done at the 
1 or more visits under Sedation / General Anesthesia.

This would be in an outpatient Surgical Center ready to treat any 
emergency with lots of physicians, nurses,  and equipment prepared 
ahead of time.

Just some quick thoughts. I am sure there is more to consider. 
Really just saying hello. - Danny

I don't see a problem with carrying out your treatment one tooth at a 
time, but I would still feel better with a comprehensive PLAN.  
Obviously, your plan is going to start with what is hurting, broken, 
or decayed. Once you accomplish that, the rest is kind of up to him.

The flip side of patchwork dentistry is that as this guy's health 
continues to fail, he is going to be less and less able to tolerate 
treatment.  Better in my mind to go ahead and work towards getting 
him as healthy as possible.- Catherine Mincy

Thanks, Catherine.  Believe it or not, every single one of those 
teeth with caries responded vital, and he has no hx of symptoms.  
Of course that doesn't mean endo won't be needed.  I plan to consult 
with his MD to verify that he is stable enough to be treated in an 
outpatient facility. -  Mark

Yikes!  I'd say some caries control with g.i. build-ups and monitor, 
as long as things test vital, and health permits, - Kendel

Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves