[nkdds]

 Dear Dr. Dharakh,

I read your post and could not help but to reply. What India is going through is what has happened here in the US many years ago. The Internet has allowd our patients to become more informed about many dental issues, and in most cases are well equiped with their own opinions about treatment you may recommend. This can put any practitioner in a predicament, and in some cases lose acceptance of treatment.  The "dental chain" as they are called have infilrated the US market and are growing at rates somewhere between 20-30% annually. What does this mean?  It simply means that they have more leverage when it comes to negotiating fees with Insurance companies, Dental laboratories, and most of all marketing dollars.  In addition, they are also recruiting young graduates right out of school and offer them a moderate salary with benefits. On the flip side, these yourng graduates are required to produce a lot of dentistry.  This scenario is just beginning in your country, and this will change the dynamics for everyone else. You are a few years away before your experience what is happening here in the US.  

I would like to hear some other comments about this subject from other members and see what you all have to say. I welcome any comments or questions. 

Regards,

        

[nkdds]

 Alok,

Do you have any photos of this case?  Do you think there is an issue or violation with biological width? Where are the margins placed in the preparations?

look forward to your reply.

Regards,

 

        

[nkdds]

Dr. Veerendra is absolutely correct. Your work is reflected through the lab, and if you cannot communicate properly, then your outcomes are not predictable. Establishing a good relationship with your lab is critical and takes efforts on both sides. Once the technician understands your needs, and you are able to give them everything they need, the relationship begins to grow.  I have found that the biggest complaint from lab technicians is poor communication from their doctors.

Thank you.

        

[nkdds]

I strongly advocate CE for auxillary staff.   Auxillary team members who participate in CE will feel more valued, and will tend to work harder for you.  I find that when the DDS only takes CE, they must transfer information to what they have learned to the rest of the team. Sometimes this information is not as affective coming from the DDS, than from a CE program. In addition, it will improve the office moral if CE is taken together. I would suggest anyone who is interested to have a meeting with your team and ask them what they would want to learn.  Make a list, and then pick the topics that can have the most impact on your practice.

I hope this helps.

Good luck.

        

[nkdds]

 Based on the images presented, a full coverage crown would be ideal, either PFM or E Max. What is the patients occlusal scheme?  Since you are restoring the upper opposing molar, you can work out the occlusion easier.  

        

[nkdds]

Patients will or should be seen for routine Hygiene visits at least twice per year. If the patient is scheduled, then in a way you are keeping in touch with your patients. I think if you are suggesting to stay in touch prior to any hygiene visits, in my opinion would be a waste of time.

        

[nkdds]

I agree with your points 100%. With regard to the photos you posted, what did you do for this patient. It appears that you restored the mouth with full coverage crowns. Did you open the vertical, or was there crown lengthening involved? Did you mount the case in Centric Relation? How did the patient react after the restorative was complete? Please let me know.

Regards,

Neeraj Khanna, DDS

        

[nkdds]

I am curious as to what % of the Indian population requests “grills” to be made. Also, who is fabricating these “grills”? There is a ethical dilemma here. We are here to serve our patients dental health concerns, and to promote the highest standard of care to all patients. If anyone has any data on “grills” in India, please post it.

Neeraj Khanna, D.D.S.

        

[nkdds]

What is stated is true. However, I would like to suggest the following when determining how to diagnose TMD problems.
1. A complete examination is required to determine the cause of a patient’s symptoms. Upto 80% of muscle pain is associated with occlusion. If a patients occlusion can be equilibrated, then we will find that muscle pain can be significantly reduced.
2. A thorough history is needed, especially if para-function is involved.
3. Loading the joint using bi-manual manipulation into Centric Relation can determine if you have muscle or internal joint problems.
4. Determining joint sounds related to anatomic problems is critical prior to restorative treatment. If a patient has a medial pole disc problem, caution must be taken, and the joint needs to be addressed first prior to any restorative action.
5. Mounted models in C.R. will provide ideal clues on how to restore patients who are in need of comprehensive treatment.

Using the above guidelines will help to properly diagnose and treat our patients.

        

[Author]

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