People are so used to being treated as interchangeable, disposable cogs by big business that the simple act of slowing things down, focusing and listening to what they have to say has become a powerful form of magic.
Self-Etch Primers provide excellent adhesion to dentin as well as enamel. They outperform Total Etch bonding agents on dentin for numerous reasons. These include increased technique sensitivity with Total Etch bonding agents, collapse of the demineralized collagen of the dentin and increased transudation. (Some Self Etch Primers, notably Danville's Prelude SE, do not show any transudation at all.)
Self Etch Primers employ weak acids to demineralize the smear layer and approximately 10 microns of dentin. Several things can interfere with proper etching by these weak acids. Handpiece oil, chlorhexidine (don't scrub with it!) and blood will interfere with the self-etching process.
Interestingly, strong acids, like the 37% phosphoric etchants we use for Total Etch, also interfere with the action of weaker acids of Self Etch Primers on dentin. And don't try to etch "only the enamel:" as you rinse it away, you're etching the dentin with strong acids.
Acidic anticoagulants also interfere with Self Etch Primers. Hemodent and other dental anticoagulants, placed on gingival retraction cord, can totally ruin your bond. Their pH is, like 37% phosphoric acid, around 1.0. In other words, you might as well be etching your tooth when you use Hemodent or similar products.
What to do about this when gingival retraction is desired around, say, a Class V lesion or during a crown buildup? How can we stop bleeding but also not ruin our Self Etch bond with strong acids?
One answer is: use Visine.
Dr. Ray Bertollotti clued me in to this years ago. Let's look at the stats on two commonly used hemostatic agents and Visine.
For reference, the pH of 37% Phosphoric Acid is 1.0. This, then, is our yardstick for what constitutes a "strong" etching acid. Prelude SE, the finest Self Etch Primer today, has a pH of 1.7. (Remember that pH is not a linear scale!)
Hemoban Active Ingredients: Aluminum Chloride pH: 1.6 Cost: 1.0 oz = $43.99
Visine Active Ingredients: Potassium Chloride, Tetrahydrozoline Hydrochloride pH: 7.4. (Neutral/mildly basic.) Cost: 1.0 oz = $5.99
I have not considered hemostatic agents based on ferrous sulfate, as that substance directly interferes with dental adhesion.
What we find with our little analysis is that the commercially available dental hemostatic agents have an unacceptably low pH and interfere with dentin bonding, and also cost ten times as much as Visine. Further, in my experience, Visine actually works better to stop bleeding.
When creating dental adhesion with Self Etch Primers, avoid strong acids, handpiece oil (run them with water before bringing to your patient), chlorhexidine and of course blood. And when gingival bleeding is a complication, consider using Visine as your hemostatic agent, as it will not damage the dentin bond you are trying to create, and it costs 1/10 of what dental propietary hemostatic agents cost.
For April 1st, rather than the usual satire-posing-as-reality I felt like some straight-up poking fun, in this case at The Bottled Water Crowd. Oh, bottled water has its place I suppose. Mostly when thirst strikes in a theme park, or when one is out and about and wishes to avoid the empty calories of sugar-laden sodas. But I still routinely see people buying cases of the stuff at the supermarket, and I always wonder two things:
-Do they realize how much this costs? and,
-How do they really know what taps the bottled water came from, and how do they know those taps are better, somehow, than their own?
Join me then as we examine what the industrialist is thinking when it comes to bottled water. The industrialist who has duped all these millions of people.
This is an excerpt from The Virtue Polarization, a short story I'm writing. It's set in the fictional universe of The Man Who Wore Mismatched Socks, my novel which will shortly be on Amazon in both print and eBook formats.
He was already considering the notion of expanding into non-alcoholic beverages such as soda water. Perhaps, in the fullness of time, the public could even be coerced into buying water itself, in little disposable bottles, rather than drinking it out of their tap. Hudeler had always been maddened by the notion that water, one of the most basic necessities of life, was almost free to the average man. Yes, of course it was plentiful, but it was also extraordinarily valuable. Just ask the fellow dying of thirst in the Sahara. Or those crews of becalmed ships during the age of sail—water rations running out, throats in unspeakable pain, yet surrounded by more water than the human mind could ever comprehend—all of it salt and undrinkable. And water had, further, to be clean! The chap suffering from cholera or dysentery was the very one to ask about the value of water’s cleanliness.
Giving thoughtful consideration to the total absence of a thing was, in Hudeler’s view, the best way to learn its true worth.
Yes, all one needed was just the right set of marketing messages, delivered over long periods of time and with savage consistency, and, so Hudeler was convinced, one could induce the rabble to fear the very taps in their own homes, and to buy an endless stream of bottles and cans of expensive water instead. It was his secret and grandest dream, as the volume of such water sales would make Slore’s output of beer seem as a mere eyedropper in comparison.