Friday, May 6, 2011


Hey, hey, hey! I have two words for you: Fri and day.

I saw this bumper sticker on the way to work this morning and it made me laugh. (double click on it)

Did you ever wonder how Google gets the street view pictures? I finally saw the Google Street view car. (I tried to get a side shot of the car, but the little pip squeak was driving about 80 in a 50.) And the AGD does not condone taking photos in a car while driving.

Anyway, you must be aware of the fact that I haven't given you a book review in a long time. Well, that is because I have been reading the same book for about 3 weeks. It is good book, but every time I sit down to read I get about 3 pages read (two of them are ones that I have read before to try to remember where I am at) and then fall fast asleep.

I read before I go to bed. Gone.
On a Sunday afternoon in the porch while the kids a swimming. Gone.
In the passenger seat while my wife is driving. Gone.
I will try to finish it this weekend. Gone.

I mean, my life is so crazy lately. Three times this week it has been after 7:30pm before I take my work clothes off. That means I go home, beep in the driveway and someone gets in the car for me to take them somewhere. It's either swimming, a baseball game, Bible study, baseball practice... It's getting crazy.

Anyway, that is not why I brought you here today. Because it is Friday, I will make this super light. The other day, I had a 15-B on the schedule. Usually tough, but not something that gets my blood pressure going.

I numbed up this person and went to look for this lesion. OH MY GOSH. I put my mirror back there and asked him to close a little to get more cheek. I just was able to see it with my mirror. This was not a buccal - it was a distal buccal. For you non-dental people, this is the back end of the cheek side of the tooth. I could barely see it, but I could definitely feel it.

This is probably one of those cavities that form after the oral surgeon chips off a piece of tooth trying to get the wisdom tooth out. Regardless how it happened, it was there. I put my handpiece in there and looked again. I didn't start the handpiece because I just couldn't get to this spot. Now, I'll have you know that I have never not done a filling because I couldn't get to it. I am not saying they were all beautiful, but I certainly try to make them beautiful.

This one was different. I looked, I tried, I looked, I tried. I had him move his lower jaw over to the left to try to create more room. I just couldn't do it. I took a break and then came back, but still I couldn't do it.

I tried everything and finally told this guy, "Look, I can't get to it." He knew that I was struggling just to see it (it could have been the cussing I was doing under my breath), so when I said that to him it was probably a relief. I told him I couldn't get to it and that we would watch it. I told him that if it does increase in size that we would have to take another approach; I told him that I would have to go from the top of the tooth and then take that to the area. I explained that it was tough area that sometimes doing a filling there and getting good isolation can be a problem, so it might have to be an inlay/onlay type of thing.

He was nodding his head saying, "Whatever. As long as I can leave now, I don't care what you are saying," with his eyes. He left and I was kind of glad it happened. Glad I finally got my first one of those out of the way. But today, a couple of days later, I don't know how I feel.

I am saying to myself, "It happens to everyone," or "No one could have done that," or "You would have done more harm than good," but I don't know if I believe what I am saying. I have gotten into some very hairy situations where I told the patient, "I finished this, but it is not very good, so we will look at it again when you come back." But you know what? At least I tried. But this one? Didn't even try it.

Am I making something out of nothing? I have done that before. Has it happened to you? What do you do about it?

Have a great weekend.


Jess said...

In that kind of a situation, and I've been there before, I'd spoon excavate as much out of there as I could by hand, make sure I have clear margins, and GIC it. As long as there are clear margins and a good GIC seal (plus Fuji coat or vaseline or whatever your material of choice is) I'm happy that that's a job well done. Edwina Kidd has a ton of research on restoring with clear margins, leaving caries behind, as long as the tooth is asymptomatic, which certainly convinced me.

Have you tried using the paeds handpieces as well? The little bella torques, they work really well in this scenario.

As an aside, and carrying on from a previous post of yours, did you charge the guy for this?

Robert Michael said...

Doc, This post made my day. I am a huge fan of humorous bumper stickers and I now know how Google maps gets the street view. Thanks for the info! Very entertaining post! Thanks!

Frisco family dentist

gatordmd said...

Thanks for the comment.

No I didn't charge him.
I didn't do anything, so I have a hard time justifying a charge.


Anonymous said...

I believe we have all been through situations like this. Just few days ago i was supposed to do a distobuccal of maxillary second molar that i had missed diagnosing at first because of obscure positioning of the lesion and when during hygiene i discovered it, we scheduled an appointment to fix it. Did i ever struggle to get to it... i tried my best restoring it but it would have been better just to watch it. I concluded it is either better to do an occlusal approach or just wait and watch with good oral hygiene instructions. That small lesion made me sweat way more than any surgical extraction.


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