Fat-free endodontics

Feb. 1, 2002

by Dennis Brave, DDS and Kenneth Koch, DDS

Holiday weight gain is an annual event, just like the Super Bowl. People often resort to exercise and diet to shed this excess baggage. Many diets are totally fat-free and produce lean, efficient results. Endodontics is no different! Reduce the fat and excess baggage through knowledge! These Real World Endo tips are fat- free ways to establish endodontics as a profit center in your practice.

Good anesthesia. Without good anesthesia, you cannot handle emergencies effectively. It is essential to know multiple block techniques and other supplemental methods of anesthesia. These issues have all been addressed in our previous articles, but two tips are worth repeating.

The first is how to obtain profound, long-acting blocks. Try this method: First, administer a carpule of 3 percent Mepivacaine, without vasoconstrictor. Follow with a carpule of regular 1/100,000 epi lidocaine, for a deeper, more profound block. This method is scientifically based and works because of the change in pKa values. You give the Mepivacaine first because it is more comfortable to the patient.

The second tip also involves the anesthetic solution. Articaine has been very popular in other countries and is now available in the United States. Articaine is proving particularly useful because of its ability to sufficiently anesthetize those patients who historically were hard to numb. This is something you can add to your bag of anesthesia tricks. Not hurting patients (especially during a root canal) is a great practice builder.

Emergency treatment. If you have proper anesthesia, you can handle emergencies. Seeing emergency patients and treating them properly can be a huge help in establishing your practice. The key is the appropriate treatment for vital and nonvital teeth.

First, a few definitions:
Pulpotomy — removal of all the coronal pulp tissue from the chamber of the tooth.

Pulpectomy — total removal of pulp tissue and debris in the root canal system.

As a general rule, vital teeth can be handled with a pulpotomy, while nonvital teeth require a pulpectomy. Let's take a closer look.

Vital teeth: A pulpotomy will work. With molars, we also recommend removing the inflamed tissue from the largest canal. Do not put files down in each of the canals, as this creates the need for a pulpectomy. Following the pulpotomy, place a medicated cotton pellet or a plain cotton pellet and temporary dressing.

Nonvital teeth: If the tooth is necrotic, a pulpectomy is best. Rotary instrumentation allows dentists to perform a pulpectomy quickly and efficiently. Remove as much of the necrotic debris as possible at the initial visit. Sometimes, even a partial pulpectomy accomplished with one or two rotary instruments will suffice. Following the pulpectomy, fill the canal with calcium hydroxide, a cotton pellet, and an appropriate temporary dressing.

Also, do not forget to adjust the tooth. The majority of endodontists reduce the occlusion following emergency treatment, which is key in preventing post-op sensitivity.

Single-visit endo. New technologies have made single-visit treament easier to accomplish than ever before.

Time is valuable to all patients, and the ability to complete root canal therapy in one visit is a real practice builder. You do not have to perform a root canal in two visits to justify the fee. To paraphrase Dr. Pat Wahl, people will pay more for "express delivery." Make it an essential part of your practice. We believe it is better — and more profitable — treatment.

These tips will help make your endodontic practice fat-free and profitable. Next month, we will discuss rotary instrumentation and case selection. As always, Real World Endo will continue to give you, as our motto states, "Just the Facts — Nothing but the Facts."

Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years. Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at RealWorldEndo.com.

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