Oral clinical work is highly technical, and many issues are only understood through experience. Pure theoretical knowledge from textbooks is still somewhat distant from clinical practice! Today, let’s discuss the “top ten” dangerous practices in oral clinical work (excluding surgery)! Although the consequences may not be severe, I hope this helps my fellow dentists who are just starting out.
1. Incomplete Sealing of Rapid Devitalizing Agents
– Especially common in teeth with severe proximal decay, such as the distal-buccal of the upper and lower second molars.
– Consequence: Mild “burning” of the gingiva (interdental papilla), severe cases can lead to bone septum necrosis.
– Prevention: Ensure a well-prepared proximal wall, as tight as possible. Sometimes, just using an air syringe to check for bubbles is not enough. For such cases, I now generally perform pulpectomy under anesthesia, eliminating the need for high-risk agents like arsenic trioxide. These agents are not only dangerous but also time-consuming to prepare. If you are busy with many patients or if anesthesia is not effective, consider using arsenic-free devitalizing agents.
2. Using a Root Canal Paste Syringe Without a Rubber Dam
– To protect the previously sealed root canal’s dry and sterile environment, a cotton ball is placed on the lingual side, especially for lower 6 and 7.
– Consequence: Very likely to cause the root canal paste syringe to entangle and break the cotton ball, wasting a syringe and money.
– Prevention: Do not place cotton balls near the tooth being operated on. Use a mouth mirror to pull back instead, as the operation is not very long.
3. Using Latex Gloves with a Korean Polishing Machine to Carve Temporary Plastic Teeth
– Consequence: Easily causes a latex glove finger to get caught on the polishing head, ruining the glove and potentially injuring the finger. A dentist’s hands are crucial.
– Prevention: Be cautious, the position of the fingers holding the tooth is key! Also, stay focused and avoid chatting with the patient while working.
4. Accidentally Spilling FC Solution
– Sometimes when sealing FC solution, especially if the bottle is full, an inadvertent move by the doctor or a sudden movement by the patient can cause the FC to spill.
– Consequence: FC can splash onto the patient’s skin or clothes. If it’s just on clothes, it’s not a big issue, but if it “splashes” onto the patient’s face, especially sensitive areas like the chest or eyes, the consequences can be severe.
– Prevention: Be careful and avoid distractions. When handling FC liquid, the doctor should turn away and avoid operating within the patient’s danger zone.
5. Using a Band Elevator Incorrectly for Orthodontic Bands
– Poor fulcrum, incorrect technique, lack of experience, or using a band that is too small.
– Consequence: Can lightly scratch the patient’s gums or oral mucosa, or severely create a small hole in the palate. I’ve seen several such cases.
– Prevention: Choose the appropriate band, master the fulcrum, protect with the left hand, ensure correct technique, and use a band pusher if necessary.
6. Improper Connection of Needle to Syringe for Palatal Anesthesia of Maxillary Incisors
– Consequence: Due to the dense tissue of the maxillary incisor palatal mucosa, there is high resistance when pushing the anesthetic. If the needle is not tightly connected to the syringe, it can easily detach under pressure, resulting in the anesthetic spraying into the patient’s mouth and onto the doctor’s face.
– Prevention: Always ensure a tight connection between the needle and syringe before drawing anesthetic.
7. Manual Root Canal Preparation in Maxillary Back Teeth with Limited Mouth Opening
– Incorrect patient positioning, fingers sticky with saliva, or fatigue from prolonged operation.
– Consequence: Root canal files can fall into the patient’s mouth, with severe cases leading to swallowing.
– Prevention: Be meticulous and cautious when manually preparing root canals in maxillary back teeth. Ensure the patient’s head position is not too far back, keep the thumb and index finger dry, and consider threading a safety wire around the root canal file. If the file falls, remain calm, lift the patient’s head forward, and retrieve or have the patient spit out the file.
8. Using Autopolymerizing Plastic Directly in the Patient’s Mouth for Temporary Teeth
– Not paying attention or misjudging time, or being too busy with other patients, causing the plastic to harden directly in the patient’s mouth.
– Consequence: Hardened plastic is difficult to remove, leading to more time and effort, causing frustration for both the dentist and the patient. Direct hardening can also harm the periodontium and pulp, potentially leading to pulpitis in vital teeth.
– Prevention: Avoid multitasking. Stay close to the tooth and remove the plastic several times before it fully hardens, trimming excess with scissors, which actually saves time. Remember, sometimes the saying “the busier you are, the more chaotic it gets” holds true.
9. Using a Hammer to Extract Upper 6 with a Broken Root Instead of the Correct Method with a Dental Drill
– Consequence: Risks knocking the root into the maxillary sinus! Once it’s in, you’ll understand what some call a “nightmare.”
– Prevention: Generally, use a dental drill to cut and separate the roots for extraction. Strongly advise against using a hammer. The era of routinely using a hammer for extraction should be over, as modern dentistry emphasizes minimally invasive and more humane methods. Avoid using a hammer for other teeth as well. If you can’t extract it, either leave it or seek help from a skilled colleague. Don’t wait until the root is in the maxillary sinus to seek help; it’ll be too late.
10. Incorrect Adrenaline and Anesthetic Mixing or Failure to Effectively Withdraw Before Injection During Block Anesthesia
– Improper ratio of adrenaline to anesthetic, not effectively withdrawing before injection, high sensitivity to adrenaline, or underlying cardiovascular diseases in the patient.
– Consequence: Mild cases may result in short-term tachycardia or hypertension, severe cases can lead to irreversible consequences, even sudden death.
– Prevention: Be diligent and cautious, avoid chatting with nurses or assistants while drawing anesthetic, and do not distract them. Pay close attention to the patient’s medical history, especially for high-risk individuals. Operate meticulously and strictly follow standard procedures. Observe the patient’s facial expressions while injecting, not just the syringe. Always remember, even a small mistake can lead to serious consequences.
Comments (1)
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