[The Caries Debate] To Drill or Not to Drill with Dr Louis McKenzie

Many Dentists still believe that caries in to dentine on a radiograph automatically means they need to start drilling - why might they be wrong?
Remember that case I posted on my FB and IG page some months ago? It had SPLIT our profession down the middle as to whether you should drill those carious lesions or not.
Well, I asked Louis McKenzie about this case, as well as about caries detections systems and WHEN we should be picking up the drill?
0:00 Introduction
9:27 Why should use a caries detection system?
12:34 Which is the best system?
25:27 THAT one case that split the opinions of THOUSANDS of Dentists
29:57 What would Louis do?
31:21 Find out what I DID end up doing!
32:06 What about cracks? Does that count as a 'cavitation' and therefore warrant restoration?
42:11 Classification to describe radiographic caries.
52:25 Tunnel Prep
Pearl: when you place immediate resin bonded bridges, consider a split pontic technique!
www.rbbmasterclass.com
--------------------------------------
Apply for FREE access to the Nicest and Geekiest Dental Community in the World 🌍
protrusive.app - it’s absolutely Free
We also have paid plans so you can Claim Verifiable CPD/CE + EXCLUSIVE content:
protrusive.app
🔊 Subscribe on Apple: protrusive.co.uk/apple
🔊 Subscribe on Spotify: protrusive.co.uk/spotify
📷 Instagram: / protrusivedental
Online Courses:
😬 Learn Occlusion Online: occlusion.online/
📚 Learn TMD and Occlusal Appliances: www.splintcourse.com
🦷 Gain Confidence with Resin Bonded Bridges: rbbmasterclass.com
🎒 Learn Vertipreps, Rubber Dam and More: protrusive.co.uk/ultimate

[@hamzaahmed5694]

Helps a great deal! Appreciate it a lot 🙏🏾

[@aamin6933]

Keep up the good work

[@mjwallyabc123]

I agree with the info...I think the reason us dentists in the US are seen by the rest of the world as over-treating is in part because a patient with good oral hygiene, diet, and hygiene appointment attendance is very rare. It's pretty rare that I see a completely arrested lesion...a patient in the US who has susceptibility to caries, even on a better than average diet usually has much more sugar in their diet than ideal from the perspective of the ability to propagate a cavity.

[@protrusive]

appreciate your comment and I want to take this opportunity to apologise to my US colleagues for the generalisation!

[@Olaimad]

Thank you so much for this channel

[@protrusive]

Thank you Dr Ola!

[@davidcarroll6110]

Great program!

[@protrusive]

thank you again :) What was your stance on this debate?

[@hamzaahmed5694]

Could you do something related to tips/demonstrations for class II restorations (if not done already)? Thankyou again

[@JamesFokinther]

Id have been picking up the high speed every time for these cases. Great lecture... in the right patient watch them and "get the balloons out" :)

[@protrusive]

Thanks James!!

[@JamesFokinther]

Jaz Gulati loving the podcasts mate. Some really great people you’ve had on.

[@user-pp3qc4xx7c]

Very helpful! Would be interesting to know how that case has turned up since then, did you end up restoring it?

[@protrusive]

I moved practice after COVID to be closer to family. I will ask the new Dentist there whom I have a good relationship with! I now work in a practice where my (now retired) predecessor was watching such lesions for up 30 years and I am proudly managing such lesions preventatively

[@user-pp3qc4xx7c]

I understand, many thanks for the answer! I am also curious about your opinion, would you consider applying silver diamine fluoride on such a lesion to raise the chances of arresting the progression? (if the black staining was not bothering the patient). @@protrusive

[@protrusive]

@@user-pp3qc4xx7c so my wife wrote an essay as part of her MSc about this - Fluoride has LONG TERM data and does not cause the staining. SDF is brilliant and the data thus far suggests a very strong ability to arrest (perhaps moreso than F-) but the black stains are the biggest downfall

[@kiyarashahadi4950]

Please do not try any of these tips and tricks if you work in a busy NHS practice and you don’t know your pts and your pts don’t follow diet and oral hygiene advice and routines . If however your pts are regular and they follow your advice then a lot of what has been said is applicable . Bearing in mind that dentists are often swayed by the type of renumeration they get . If the dentists are remunerated by a strong hygiene department ie income from hygienists working and they get on capitation ; fixed income per head - it is less likely that you will want to fill early lesions .

[@protrusive]

I agree - poor oh and diet is not suitable for this management (but it begs the question: should we even be restoring?) - also agree how remuneration will affect management plans. This is true in any field of work and in all walks of life - thanks for your valuable comments

[@thewirah1]

As a patient, I would rather have my dentist leave it up to me. If I come back every 4 months for a cleaning anyway, I don't see any harm in waiting. It's always suspicious when someone goes to a dentist for the first time, and the guy immediately finds a cavity.

[@melissagonzales7668]

Would it help to use a Caries detection dye before drilling?

[@protrusive]

from my understanding (and how I have used it) is that CDD is applied to an open cavity - I'm not sure if it would penetrate as suggested? I'm open to input from the community!

[@Coco-572]

Pascal Venuti believes the detection dyes don’t signify anything . I’m not sure what his actual wording was when he said this in a presentation.

[@pegsmith5644]

Wow. Interesting to hear another point of view. I’ve been practicing 45 years and use a microscope for diagnosis and treatment. Gotta say I totally disagree with you and your approach.