Time to return to technical subjects! Been philosophizing a lot.
Pulps of teeth calcify. Meaning the cells in the living tissue inside our teeth lay down more hard tooth structure, and so they get smaller. This happens throughout life as part of the aging process. My dental school X-rays, for example, which I still have in the office somewhere, show larger pulp spaces than my X-rays do now. Simply because I'm older.
And pulps really get smaller when teeth are challenged by decay or fracture.
Still, they calcify from the crown down. Meaning that if we need to perform root canal treatment, finding the tops of the canals may be difficult, but once we find 'em, they're going to get larger the further we go in to clean them of infection.
Here's a view from above (in the Microscope) during root canal treatment:
This is what I call "the smiling monkey" view, with two canals filled and one cleaned but not yet filled. Imagine if these were just tiny, tiny crevices with just a slight darker color to indicate where they are. That's often the challenge we face initially, as we start root canal treatment.
But as I said, if we can find 'em we can clean 'em. Usually. Every once in awhile, we pass into a canal and get blocked part way in. Like this:
The light lines are Resilon, the material that fills and seals the part of the root canal system that I cleaned. You can see that I didn't get to the end of the root. I couldn't. I felt like all my instruments were hitting a solid wall of granite at a certain point in the root canal system. Nothing I did would pass through it. Now... Note the dark halo in the X-ray that surrounds the tip of the root. This indicates less bone density, which indicates where the worst of the infection is.
Not getting to it is a bad thing.
And yet. I've been around the block a few times by now. I know the value of patience.
After a month and a half or so, we brought our patient back for an additional treatment. I've found that if we "go back in" after some time has passed, the blockage is usually astonishingly easy to bypass.
And so it was:
This endodontic treatment ended up being the most predictable and seamless procedure I did that entire week.
Why are these "blocked" root canals easier to treat on a second try? I've never heard a detailed, scientifically sound explanation. Perhaps we dentists have blocked such canals ourselves, with dentin chips that we create in our instrumentation. This is a known issue; instrumentation debris forms a sort of microscopic mud or plaster that can fill a canal and impede our instruments. But in this case, I remember hitting the wall with the very first pass of my tiniest instrument, so I have my doubts about debris being the reason. Still, perhaps it was.
In any case, a second attempt at treatment (at no additional fee, we're still trying to get an acceptable result for our patient!) is almost always successful at getting past blockages in root canals. Never give up endodontic treatment without a good fight!
One LED closer to eliminating fluorescents from our office entirely:
Bright light for a fraction of the power usage of fluorescents and incandescents.
No maintenance for years to come. (Who was it that designed the fluorescent light fixture? Changing a bulb in one is far more difficult than performing endodontics on a calcified five-canal maxillary second molar in a gagging trismatic.)
Some rare earth elements, but no mercury. We threw the amalgam out of the office years ago, now here's one less mercury stream for the landfill.
THIS, dammit, is what it really means to be an American:
Herbert Hoover, May 17, 1946:
"There are Americans who believe it right, and a duty, to feed women and children of even a surrendered enemy. No one is the enemy of children."
"There are others who believe that the only hope of a peaceful world is to save the enemy peoples from starvation and thus start building them into peaceful, cooperative peoples."
"There are others who, remembering the IMMEASURABLE crimes the enemy has committed against all mankind, believe in 'an eye for an eye, a tooth for a tooth.'"
"To these, let me say that to keep five hundred thousand American boys in garrison among starving women and children is unthinkable. It is impossible because, being Americans, they will share their own rations with hungry children."
"It is impossible because hunger brings the total destruction of all morals."
"It is impossible because of the danger to American boys of sweeping infectious diseases, which rise inevitably from famine."
"It is impossible because we do not want our boys machine-gunning famished rioters."
"It is unthinkable because we do not want the American flag flying over nation-wide Buchenwalds."
Add to the literal meaning of "hunger" the metaphorical sense of hunger as a yearning for freedom, and there you have it. A blueprint for going forward in this, the extraordinarily dangerous 21st Century.
Words and phrases dental marketers and consultants use that I cannot stand:
get target capture acquire go after prospects manage profile branded response advertising team of writers remarket
It's all so wrong. The words we use do have profound influence on our thought processes, the conclusions we make and the actions we take. Bad words do influence bad behavior.
Perhaps we should not repeatedly use the word "get" to describe our business growth strategies. It's an inherently selfish word in this context.
Perhaps we should not use hunting terms to describe our goals of meeting new patients and enjoying the privilege of serving them.
And perhaps we should also be brave and write our own content and stand for what we stand for, never giving in to the temptation to allow a team of anonymous corporate writers to speak in public on our behalf.
The first African-American graduate of a university-based dental school in the U.S. was from the very first class of the very first such school--Harvard in 1867.
My own Academy of Stomatology, founded in 1894, voted to allow "people of color" to become members--in the 1920s.
Most photos of dental school classes going back to the beginning show women students. Male and female dentists have no inherent unfair pay differential, since our income derives directly from the treatment we perform.
Christian dentists, Hindu dentists, Jewish dentists, Muslim dentists and dentists of all the other great religions become fast friends in dental school, practice together, refer to each other, research and write papers as colleagues, and interact in a thousand ways with regard only to ability, not to arbitrary ethnic or religious or cultural background.
Most important of all, we dentists treat patients of all backgrounds equally, concerned with the diagnosis and treatment, not with the kind of person who carries it, and generally always have done so, going right back to our origins as an organized profession.
Maybe the broken world we live in should take a few cues in how to behave from its dentists.
Ah, the arrival of a new Vita 3-D Master Shade Guide...
Two of them, actually.
The thing about shade guides is, they do degrade over time. The color references are not quite calibrated precisely after some years of use, and this has a negative effect on our ability to match shades of dental restorations. We'll still use the old ones for general what-shade-are-my-teeth purposes at recall visits, but when matching shades for crowns and other restorations, the new ones are essential to achieving ideal matches.
Oh, and those three very light shades on the left?
Vita had to add them on. Because of the weatherpeople on TV.
You know, weatherpeople. They generally have the whitest veneers of anyone in show business, which is a business laden--overburdened even--with white teeth. I'm not sure quite why, since A-list movie actors and such make much more income, but weatherpeople have generally gone to American Standard Toilet Bowl White as the ombre de choix for their teeth, outshining those A-listers by a wide margin.
Those left three shades are not, by the way, attainable by whitening methods. They are only attainable by dental porcelains, as in veneers and crowns.
Weatherperson American Standard White, that's what I call the lightest one.
“This is my report to the American people upon the world famine situation. Three weeks ago I broadcasted from Cairo our report upon the situation in Europe. Since then we have examined the food problems in Egypt, Iraq, India, Siam, the Philippines, China, Korea and Japan, thus compassing most of Asia.
“I can therefore now consolidate our findings in twenty-five countries which we visited and upon several more which we have received competent information. “At the request of President Truman I have acted as a sort of Food Ambassador to determine needs; to discover possible further sources of supplies; and to coordinate the world's effort to master this danger to the lives of millions. Beyond this, it has been my duty to represent the solicitude of the American people and their desire to aid.
“Along the 35,000 miles we have traveled, I have seen with my own eyes the grimmest spectre of famine in all the history of the world.
“Of the Four Horsemen of the Apocalypse, the one named War has gone -- at least for a while. But Famine, Pestilence and Death are still charging over the earth. And the modern world has added four more to this evil brigade. Their names are Destruction, Drought, Fear and Revolution. This crisis is not alone due to war destruction of agriculture. On the top of that calamity has been piled drought in the Mediterranean, drought in India, drought in China and partial drought in South Africa and Argentine. Never have so many evil Horsemen come all at one time.
“Hunger hangs over the homes of more than 800,000,000 people -- over one-third of the people of the earth. Hunger is a silent visitor who comes like a shadow. He sits beside every anxious mother three times each day. He brings not alone suffering and sorrow, but fear and terror. He carries disorder and the paralysis of government, and even its downfall. He is more destructive than armies, not only in human life but in morals. All of the values of right living melt before his invasions, and every gain of civilization crumbles. But we can save these people from the worst, if we will . . .”
--Former President Herbert Hoover; excerpt from his May 17, 1946 speech reporting the results of his post-war world famine survey, undertaken at the request of President Harry Truman. (Note the bipartisan nature of this arrangement.)
The entire speech (it's long by today's standards, but engaging nonetheless) can be read and viewed here: