getting into newsbreaker territory

[whitertth]

lets all pick a place..preferrably sunny and form a mini meeting and just hang out and learn from each other….what do u think gang?

[2thlaser]

Whitefish in the summer is unbelievable! Great golf, Glacier National Park….just one choice 😉
Mark

[Robert Gregg]

Mark,

Ron said WARM!!!

Just kidding. I know it’s beautiful and warm in the summer “upthere”.

Bob

[Lee Allen]

Regarding the carious pulp exposure, it would seem that we are gambling that the bacteria are not infiltrated into the pulp chamber with caries being so close to the pulp. Radiographs are helpful but in the end without all of the soft decalicified dentine (Canadian spelling Glenn?) being removed we do not know if there has been an exposure of the pulp. My GPS of teeth does not work well enough for me to tell if I am within 2 mm of the pulp. I can guess, but will the laser sterilize the remaining layer of soft dentin well enough to predict that there will be no or little chance of pulpal infection?

Bob replied to the coagulation of an accidental exposure in a previous forum topic, that while it is more predicable with “clean” (my word) exposures, carious exposures present a more likely endo prospect.

“The laser pulp caps that work are those where the exposure is limited in diameter to smaller then the diameter of the fiber-optic you are using, and/or the area of exposure can be isolated from the main trunk of the nerve/pulp (ie a pulp horn or a small axial pin-point exposure)

Carious/bacterial exposure: don’t expect much. Try if you want, but prepare the patient for future endo.”

Hope it is OK to quote you , Bob, but I repect your opinion which seems mixed with a great deal of experience and science.

So, it would seem that a frank carious exposure has little hope of a laser fix, and a near carious exposure will be of some hope but it is a crap shoot. Maybe this is the time to evaluate the patients gambling instincts.

In my humble opinion,

[Patricio]

Lee,

I have made a decision for some based upon knowing their finances or other relevant circumstances to seal up a potential endo tooth as an alternative to extraction.  I have found most patients when consulted about doing endo on a tooth which is not currently painful and which may survive without the need for endo choose to see what happens down the road even when they understand the tooth may bother them later.  I am hopeful the laser will move a few more into the win column as a final treatment for the remaining degraded dentin.  I guess each patient situation is different and we try to treat them one at a time.

Pat

[Lee Allen]

Pat,

Thanks for the reply. Sounds like we practice in the same conservative way, and I think my patients appreciate giving them a chance to avoid some dental procedure. It can be a relationship building experience as well if it does not work as hoped: they are more resigned to the endo and do not wonder if we are inventing things to do but have their best interest at heart.

Lee

[2thlaser]

Boy, I sure like you guys. I hope I am the same. I really have done quite a few of these, and so far so good. I had one today, that without the use of my spoon excavators, and of course, the laser, we probably would have had a carious/mechanical exposure. BUT, we didn’t, and now we hopefully put off another endodontic procedure for this patient. It’s really a win/win when it works isn’t it?
Mark

[Patricio]

Hey Mark,
About them spoons? Where be dey?
PAT

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