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3, 4, 5..... maybe 13 can’t tell with how dark your radiographs are.   Something is happening all around, but most of it is tiny- give the kid a chance ...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Not even at gunpoint. :) ...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
If these BWs were your own, would you let someone else restore all of those?  ...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Nareg has it spot on, the paradigm changed about 10 years ago. So glad to see a few other people on the same page.  Always feel out on a limb when I say I wouldn’t fill any, just treat the caus...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Excellent!  We all end up wiser and smarter with you posting! ...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Actually we don;t know the "cavities" are there. All we can deduce from the xrays is that at some point minerals have been lost from the interproximal enamel. I agree with you tho, "watching" is not a...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Treat it as early and as small as is practical.   Waiting for it to get bigger to assuage your own guilt about telling them he has cavities is a losing game for everyone. He's 18 and has 80 years t...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Nareg, our old friend! Good to see you post!  I'm just not sure why so many are so quick to start burring out enamel on so many teeth.   Fillings are NOT curative.  Fillings are man's feeble attemp...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
these days, diagnosing caries involves 2 things: (1) is it active or not and (2) is it cavitated or not. Hard to know how to treat if we don't have the answers to these questions. Assessing activit...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
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Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
You have to lead in that  no one tries to burn holes in their teeth.  You just didn't know that you were doing this so it is not your fault.  We can help you if you help us  figure out what is causing...
Post Date: 07/12/18 Forum: Digital Radiography Views: 6054 Replies: 112
Yes!  Every time, that is the answer! ...
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
I usually approach the other (sugar, acid) source like this:   "Ok, we've got a lot to go over here! So looking at your xrays I see a lot of decay, mostly in-between your teeth. But for someone y...
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
I never just observe.  I treat all lesions, incipient or cavitated and in dentin.    The first thing I would do is address the risk factors.  High risk means more surgical treatment along with medical...
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
I don't consume any sugars.  I only drink water and brush and floss 8 times a day....
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
These are the worst new patient exams.  Someone in their late teens/early 20s.  Never had a cavity.  Now has a whole bunch of interproximal lesions, of varying degrees of depth into dentin.  Lots of t...
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
This. Drilling into these teeth first will give you an idea of how 'cavitated' the other teeth are. And apparently I too severely under-diagnose haha...
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
I'm not going to make a specific call on which teeth to fill or not...but I will say I would not be filling most of these interproximal lesions.  1.) It's a new patient, you need to build rapport. ...
Post Date: 07/11/18 Forum: Digital Radiography Views: 6054 Replies: 112
This depends on what those carious lesions looked like on previous radiographs. Are those new active lesions at the most recent recall visit or are those arrested lesions that you have been observing ...
Post Date: 07/10/18 Forum: Digital Radiography Views: 6054 Replies: 112
i'd do 4 DO/MO, 5 DO and maybe 19 O. I am very conservative but i would have a talk with the patient that if they don't get over there floss adversion we'll hang out more in the future. one of the few...
Post Date: 07/10/18 Forum: Digital Radiography Views: 6054 Replies: 112
Might I suggest you use transillumination. I use a MicroLux transilluminator. If you are using at least 3.5X magnification (my experience), many times-especially on bicuspids-you can see the shadow si...
Post Date: 07/10/18 Forum: Digital Radiography Views: 6054 Replies: 112
Dentistry = the art of covering ones ass...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Not a diagnostician, don't  play on TV. That said the above is what I hear constantly, and see routinely. Any one care to estimate how much more depth vs. what is evident on the image.....my opinion w...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Wow! Shocked by the responses so far. The only one I would consider opening would be 4-D (would clinically check 3-M). Agree with the above posters that rads are not the clearest but radiographically ...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
3,4,5. Maybe 30,31. The rest I would observe ...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
As you can see from the above comments when it come to diagnosing incipient decay on bitwing x-rays,  it becomes a purely subjective excersise. ...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
3,4,5,13 only...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Whoa. I apparently aggressively underdiagnose. ...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Really? You are 100% certain that #29 Distal is into Dentin......
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Every single one of those lesions DLow diagnosed is already in dentin.  Only question is how fast the decay will advance. ...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
So many times the lesions are much larger that 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 o...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Your B/W's will be far more diagnostic if you lower the KV and raise the exp. time. That's if you can adjust KV. For my Intraskan we can do B/W's @ 55 KV which will deliver more contrast. Exposure tim...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
I didn’t think it mattered if it went into dentine, i thought it only gets infected once it’s cavitated. I think even once in outer third of dentine most are still not cavitated. Since you can’t tell...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
Love these threads...  I'd probably start with the occlusal or OB of #18, 19, 30...  If the patient (patient's parents) are good about getting back in 6mo, I would put the patient on 5000ppm TP and ob...
Post Date: 07/04/18 Forum: Digital Radiography Views: 6054 Replies: 112
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 pateints these will end up being conf...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
I’d leave all these alone. Have been for about 5 years. OHI, diet 5000ppm Fluoride toothpaste, 3/12 23000ppm topical fluoride, Bws in 12/12.  1 or 2 might advance but even at 12/12 it will be so slow....
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
I’d start 3, 4, 5. Depending on what they look like with excavation may influence how I proceed...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
In my office I'd likely leave them all for now; however I recognize I'm likely in the minority on that. Clinical appearance, current OH, motivation to change OH, and whether they're about to lose thei...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
I would not drill interproximal on those unless they were cavitated clinically.  Fluoridex  or FL trays, SDF, sugar is bad talk etc,  and check later. Yes, I would worry.  I'm watching a lot like the...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
The kid needs a heart felt education more than the white stuff.  Sugar, acid, hygiene beat down...... from the heart. :) If you fail to educate and the kid fails to implement, these will break ...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
You guys treat incipient lesions that are in enamel? ...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
I ask because I had a college freshman girl in this week with a similar mouth.  Depression, anxiety, dry mouth, poor oral hygiene.  I just hate to do wall-to-wall fillings on her, but I don't know wha...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
Not me.  The kid goes off to college and they all get bigger. ...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
Xrays a little dark, but I probably would only restore at this time - 3-MO, 4-MOD, 5-DO ...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
This is an almost daily dilemma.  Young person with no fillings, with small interprox lesions everywhere.  Does anyone have a protocol to attempt arresting these lesions, that they have had success wi...
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
I agree....
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
Post Date: 07/03/18 Forum: Digital Radiography Views: 6054 Replies: 112
I bought my practice a year ago. Patient I saw soon after the purchase refused X-rays at that time. Made him sign informed refusal then because I was the new dentist and was worried about patients lea...
Post Date: 05/24/18 Forum: Just Plain Bitching and Moaning Views: 1368378 Replies: 39744
THIS THIS THIS! ...
Post Date: 04/17/18 Forum: Practice Management & Administrative Forum Views: 1471 Replies: 36
Even with a free transilluminator or free X-rays... patients just don’t want it. People don’t want change... people want the same even if your best intentions are there. They will think you are tryi...
Post Date: 04/17/18 Forum: Practice Management & Administrative Forum Views: 1471 Replies: 36
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