Mandibular Foramen Puns

Hi! I wanted to come to some of you hygiene experts for help because I’m a dental student who recently started clinic and had trouble cleaning somebody’s teeth for the first time. My attending general docs are unfortunately pretty hands off w/ prophy help and the perio docs are only in the clinic for consults twice a week.

My patient came from a pretty tough social background and as a result, hasn’t been to the dentist in a few years and has a good amount of buccal and facial calc. Normal probing depths besides some deep areas interproximally (some 4’s and 5’s). I treatment planned them for 7 fillings, mostly interproximal, and potentially one endo (depending on endo consult next week).

The patient said that their teeth are generally pretty sensitive every time that they brush or drink water. Knowing this, I tried to first handscale to see if I could get any deposit off without using our cavitrons because the water in our chairs is pretty cold. The patient couldn’t tolerate handscaling and asked me to stop after half a quadrant on the facial side only. Then I tried procuring warmer water for the chair so I could use the cavitron— immediate pain, and the patient couldn’t do it. My doc then told me to anesthetize them with 2 carpules of lido in the greater palatine foramen and bilateral ASA injections so I could at least clean their maxillary arch. Everything was fine until I started using a prophy cup to polish the arch. After one tooth, they said they couldn’t take the vibrations and would have to come back to finish the rest. They didn’t even let me rinse them out or offer them a manual hand brush.

I’m a little stumped on how I should treat this patient when they comes back for the rest of their cleaning. I feel bad that they were in so much pain and wonder if there is anything else I can do to make their mandibular cleaning less painful. I told them to take some Tylenol before the next visit but I think If they’re not being able to tolerate handscaling, warm water cavi, polishing, and even being reluctant to get anesthetized (although I understand that GP is a painful injection) I’m left wondering if this is more of an issue with my technique or if this is more of a behavioral management/anxiety thing.

Do you all have any special techniques for people who cannot or will not tolerate prophys? I was only able to do probing depths, treatment planning, and half a prophy in 3 hours due to having to start and stop so much. I know there’s no way me or m

12/21/21

Hematologic disorder VS Rheumatological disease VS Neurological problem????

Patient: 68y/o Caucasian American heterosexul male in monogamous relationship for 45+ years. NKA. No diabetes.

Current medications: Allopurinol 300mg, Amlodipine 10mg, Atenolol 100mg, Atorvastatin 20mg, Cholecalciferol 125mcg, Clopidogrel 75mg, Prednisone 7.5, Tamulosin 0.4, Trazodone 50mg PRN

PMH: Hypertension, Hyperlipidemia, Gout, Neuropathy, CVA with no residual deficits (2012).

Slight Thrombocytopenia since Nov 2020 (plt count ranges btn 120-130) Smoked 40 pack years, quit 20 years ago. Two glasses of red wine nightly, occasional recreational marijuana, no illicit drug use. Worked manual labor many years, then worked as a project manager

Family hx: Mother and father both deceased (both close to the age of 90 at time of death), cause of death Altzheimers disease and Dementia respectively, sister had breast Ca

COVID STATUS: Has not tested positive for COVID, though very ill Feb 2020. Received first 2 doses of vaccine in March and April, (Pfizer), instructed to wait on booster by rheumatologist.

Timeline of significant events and pertinent lab values:

October 2018: Pt. believed that he was having a stroke as "chin went numb". No other sx at that time, a few days later exhibited significant pain at that site. Physicians seen at that time included PCP, dentist, oral maxillofacial surgeon, and hematologist, ENT, neurologist. Extensive workup inconclusive. Tests performed at that time included:Brain MRI, facial CT, CXR, CT abdomen/pelvis, mammogram, breast US, bone scan, PET scan, all appropriate labs ordered, never had BmBx as hematologist was convinced (based on labs, imaging, and sx) that pt. did not have hematologic disorder. Orbit MRI showed "non expansible marrow abnormality in posterior body and angle of R side of mandible. Abnormal enhancement of R inferior alveolar nerve as it extends in the mandibular canal through this region and in the R mental nerve as it emerges from mental foramen" "Findings could represent marrow inflammation from nonvisualized dental dx with associated neuritis. Alternatively, they could represent an infiltrative neoplastic lesion such as lymphoma or myeloma w/ associated infiltration along the nerve".  To this day chin is still numb.

Lab values at that time: Kappa/Lambda ratio 1.57, Protein electrophoresis (IMM)= No M spike, however hypoalbuminemia present. Beta 2 microglobulin=2.87

Edit: final total for yesterday was 339.

TL;DR: 241 nerve attacks today and counting. Have done all the treatment steps including MVD last year and it's gotten this bad again. FML.

I've never actually counted them before. I usually try to distract myself and not pay attention to the extent that that's possible. Today I have been wholly present to the pain, and I'm a mess.

This is way more attacks than I ever estimated. I've previously guessed I'd have maybe 50 attacks on a bad day. To be fair, I'm both sleep-deprived and have PMS at the moment; both are big TN triggers for me. So it's been an unusually bad day. But still... 241! And the day isn't done yet. Also, while it's up there, this isn't the worst day I've ever had.

Each time I get a series of zaps in the same place, I count it. Could be one shock, could be 20 - that's one "attack". If I have zaps going simultaneously in totally different spots, such as ear and upper lip, with no pain traveling between them (the way it sort of runs through the nerves like lightning, hard to describe), I count that as two attacks.

The attacks have ranged in intensity from 2 to 9 (on the 1-10 pain scale). Most are 4-6.

I had MVD surgery last November. That reduced the attacks in my face area maybe 50%, but in the last month it's getting worse again. More recently I've had two nerve blocks of the mandibular branch of the trigeminal nerve where it exits the foramen ovale. The first, a diagnostic block and purposeless short-acting, helped a ton (zero pain for ten whole hours!). The second one last week helped much less even though it was the same med in the same spot. It was supposed to help more and for longer because the steroid injected with the numbing medicine should reduce chronic inflammation.

I have several benign nerve sheath tumors in and around my left ear, the same side as my TN, so it's impossible to know which attacks are because of TN and which ones are from the neurofibromas. They feel exactly the same. It really complicates things. The tumors I initially had removed for biopsy grew back. These kinds of tumors often do, and combined with the tricky location, it means removing the tumors isn't likely to be a helpful option.

I'm on as much Tegretol and Gabapentin as I can tolerate before the side effects get intolerable. (Fairly low doses - 1200 mg Gabapentin and 100 mg Tegretol.) I'm on a bunch of other meds for unrelated stuff and they all interact making med management a challenge. We've tried ot

I don't want to step on anybody's toes here, but the amount of non-dad jokes here in this subreddit really annoys me. First of all, dad jokes CAN be NSFW, it clearly says so in the sub rules. Secondly, it doesn't automatically make it a dad joke if it's from a conversation between you and your child. Most importantly, the jokes that your CHILDREN tell YOU are not dad jokes. The point of a dad joke is that it's so cheesy only a dad who's trying to be funny would make such a joke. That's it. They are stupid plays on words, lame puns and so on. There has to be a clever pun or wordplay for it to be considered a dad joke.

Again, to all the fellow dads, I apologise if I'm sounding too harsh. But I just needed to get it off my chest.

Do your worst!

I'm surprised it hasn't decade.

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies 😂

It really does, I swear!

Buenosdillas

They’re on standbi

Pilot on me!!

Dad jokes are supposed to be jokes you can tell a kid and they will understand it and find it funny.

This sub is mostly just NSFW puns now.

If it needs a NSFW tag it's not a dad joke. There should just be a NSFW puns subreddit for that.

Edit* I'm not replying any longer and turning off notifications but to all those that say "no one cares", there sure are a lot of you arguing about it. Maybe I'm wrong but you people don't need to be rude about it. If you really don't care, don't comment.

When I got home, they were still there.

What did 0 say to 8 ?

" Nice Belt "

So What did 3 say to 8 ?

" Hey, you two stop making out "

I won't be doing that today!

[Removed]

You take away their little brooms

This morning, my 4 year old daughter.

Daughter: I'm hungry

Me: nerves building, smile widening

Me: Hi hungry, I'm dad.

She had no idea what was going on but I finally did it.

Thank you all for listening.

There hasn't been a post all year!

Nothing, he was gladiator.

Why

It’s pronounced “Noel.”

After all his first name is No-vac

What, then, is Chinese rap?

Edit:

Notable mentions from the comments:

• Spanish/Swedish/Swiss/Serbian hits

• French/Finnish art

• Country/Canadian rap

• Chinese/Country/Canadian rock

• Turkish/Tunisian/Taiwanese rap

There hasn't been a single post this year!

(Happy 2022 from New Zealand)

Nothing, it just waved

Him: I can explain everything!

(It's his best joke yet I think)

Bob

Just to clarify, 12345678

So that I could frequently say, "I am going to walk 5 miles now."

Edit: My most popular post on Reddit! 😀 Thank you for the awards.

Me grabbing a soda from my (what I thought was) half full 12pk...

Notices there's only 2;

Me: "Awe man... This is a damn bird box!" Her: "What the hell does that mean?!" Me: (Pulls both cans out & shows them to her) "It's only got Toucans."

I'm not ashamed to admit the look on her face was glorious.

I was just sitting there doing nothing.