Enigmas in Dentistry

Objectives:

1. To understand and refresh the mechanism of anesthetic action and then begin to understand the various reasons for the annoyance of a failed block. Also, to understand what it may mean if the patient has prolonged anesthesia.
2. To understand the phenomenon of joint hypermobility which is very common and the co-morbidities that are so significant to our daily practices, but not covered by most dental schools’ curricula.
3. To understand the recognition and management of persistent post-endo pain, how to manage, and when to stop any further dental procedures on that tooth.
4. To learn the latest in the literature on Sleep-related bruxism in adults and children. Why is it NOT a “habit” and what more ominous things may come with it.
5. Understand the basics of pathophysiology of snoring and apnea and how this could impact your practice.

Course content: (Lecture topics)

1. Failure and perils of local anesthesia: Why do some anesthetic blocks fail? What if the patient reports having prolonged anesthesia every time? Are there anesthetics I should NOT use in a block? We will discuss the anatomic and other reasons for the failure of local blocks. It is frustrating for the clinician when these don’t work out of the blue for no apparent reason. Is there a much higher hidden danger in a patient reporting consistent prolonged anesthesia after LA?
2. Joint hypermobility: Should I be concerned about my hyperflexible patient? What if she is a ballet dancer or cheerleader or gymnast? Is it possible that this is the patient most prone for IATROGENIC injuries?
3. Persistent post root canal pain : “Doc that tooth you did the root canal on: it still hurts”!! Is this that ever-elusive extra canal perpetually hiding from you, or could it be something else?
4. Appliances for “grinding” : do they really treat bruxism? Sleep-related bruxism is not related to dental occlusion?? Which is better an upper guard or lower? Soft or hard? With a ramp, without a ramp? What is the evidence?
5. Pediatric bruxism: I was told bruxism in children (mixed dentition stage) is “normal”. Literature is saying it might not be?
6. Occlusal dysesthesia: That one patient I can never get the “right bite” for! Is there any scientific explanation?
7. The perpetual denture seeker: This patient has had five dentures made; she still complains of pain! What possible pathology here?
8. Non-dental tooth ache: The seemingly normal tooth that hurts. The case of that newly “leaking” amalgam causing pain! Can dental pain jump from tooth to tooth?
9. IV or GA or LA: What are the red flags for my patient scheduled for IV sedation/or GA?
10. My sleep less , snoring patient: Should I be concerned about my snoring patient with hypertension? Is there any concern with local anesthetic?