Wednesday, May 19, 2004

Case No.14

20 yr old gagger

A lady in her late twenties attended today. She was moderately anxious with a tendancy to gag. UL7 was grossly carious though only slightly sensitive. A PA showed the caries to be very close to the pulp. But the tooth was salveagable.

She was booked today for an exploration and temporary dressing. Proceeding incrementally, good sedation was, unusually, only acheived initially at 30% N2O/O2. LA was acheived using The Wand Plus TM The Nitrous Oxide ratio was reduced to 40%/60% Oxygen.

Without detailing the detailed clinical stages from here, the net result, was a vital pulpal exposure , needing intra-pulpal LA and a vital pulpotomy.

She was delighted with the result and has promised a testimonial. She was clear that she would not have tolerated treatment "that far back" without the assistance of RA. I am sure you all see patients like this on a regular basis.

RA makes life so much easier for everyone and the patient is sure to return and be a source of referrals.



Friday, May 14, 2004

Case No 13.

20 Year-Old Report

Still Worthy of Repeating

This case report is a bit of a cheat. I actually undertook it nearly 20 years ago!!

It is no less valid today. A cheeky 4-5 yr old boy with a mop of red hair had a number of carious teeth to restore. He was full of beans and not overly keen on cooperating. We introduced him to RA using a simple "tell,show,do" approach. First the nasal hood (without being attached to the tubing) to play with and try out.

Then checking it out on his nose " to make sure he could breathe through it" Then attaching the tubing and providing a few minutes trial run, with no treatment- indeed making sure that he DIDN'T open his mouth. This was very effective and well accepted and he returned for 2 or 3 visits to complete the required work.

At the end of the last session and having had his 2+ minutes on 100% O2, he sat up and uttered the priceless words.

" Mum, will you buy me one of these" !

A great success and words I have recalled and re-told regularly since then. If you would enjoy your day's work more with reactions like that, perhaps it is time you considered introducing RA into your repetoire.

Contact me for more information : richard@the-ra-coach.com

Thursday, May 06, 2004

Case No 12. RA can be ideal

for short notice problems

Today we saw a patient who was so anxious that he had failed to attend two previous appointments. He had arrived at the front door and THEN TURNED AWAY thorough fear. Today he booked himself in under a pseudonym because he thought we would refuse to reserve an appointment for him a third time ( he may have been right !).

So what was his dental problem?

1) He is a commercial pilot

2) He was flying tomorrow and would be away for 3 weeks

3) He was worried about a LL7 which had had a composite placed elsewhere about a year ago and hadn't settled. Having had several root fillings before he assumed he would need the same again.

4) Recent treatment had been carried out under IV sedation.

Given that he was booked in as an "emergency" we were not in a position to offer IV sedation at short notice and with no escort. The tooth was vital but not especially hyperaemic, slightly TTP, no buccal tenderness and with a normal perio condition. The composite filling was reasonably satisfactory externally but was an occlusal with a long buccal extension. A P.A. radiograph revealed no pathology and the filling appeared relatively shallow. I provisionally diagnosed post-composite sensitivity , probably as a result of setting contraction. I advised this was unlikely to get worse in the short term but he was keen for me to "do something".

Using RA we needed to go to a 35% Nitous oxide/ 65% oxygen level to achieve sufficient sedation. I also used the "WAND" for an ID block with no reaction from him. Effective LA was swift and removal of the composite revealed a clean, well prepped ,shallow cavity. I placed a glass ionomer and he recovered uneventfully. I expect that this will have settled his problem . He booked a full New Patient consultation and paid for this in advance before he left today. Another happy patient & another source of referrals. I will ask him to write a testimonial at his next visit. We didn't have time to begin to discuss the reason for his dental anxiety, but RA was the right tool for the job for him today.