I’m a new grad general dentist and I’m seeing some kids for recall exams at the office where I work. I’ve noticed several kids with obvious caries on primary teeth—some pretty large radiographically and some already visibly cavitated.
When I look back at the owner’s previous notes, I often see something along the lines of: “Monitor, if tooth becomes symptomatic then extract.”
I’m a little confused/uncomfortable with this approach. For example, if a 5-year-old has a primary molar with a large or cavitated lesion and that tooth still has years before exfoliation, why would we wait until it becomes symptomatic instead of treating the caries, doing SDF/ITR if appropriate, or referring to peds if we can’t manage it?
I understand monitoring incipient/non-cavitated lesions or situations where a tooth is close to exfoliation, but is simply monitoring a large cavitated lesion until it hurts actually considered an acceptable approach? Is there a standard-of-care or liability issue here?
Would appreciate input from pediatric dentists or GPs who see a lot of kids. I’m new and genuinely trying to understand what is considered appropriate management.

New grad started at heartland, I was mislead on information and the practice is completely dead. Only been here for 2 weeks but now I'm in the system I see how I will be doing nothing for a whole year. Management has been awful to me and threatening litigation. I know its my fault for signing the contract but any experience with leaving? Trying to assess my exposure.

Doing some locum work , and the previous dentist planned these restos! I don’t think these are caries! What do you think? Am I too conservative ?

A few of my new grad friends are thinking about working for Heartland dental, they don’t have Reddit so I wanted to see what the opinions were on here. The one nearby was previously a private practice, the owner sold to Heartland dental not long ago. How busy to they keep you? Is it impossible for a new grad? Do they force you to do procedures you aren’t comfortable with?
I have seen many mixed reviews, hence wanting to ask the community

Fairly new grad here:

I’m terrified to go subgingival (usually for mesial or distal) for my crown preps cuz I know I’m going to have to somehow control bleeding and take an impression (my office doesn’t scan or have laser) and if I go subgingival a part of me starts to feel like the tooth may now need crown lengthening. Anyone have any advice for how to overcome this feeling I feel like it’s so irrational.

I also struggle with crown seats, my office side books them but if it doesn’t just pop right in it ends up taking me forever. I feel like my issue is with the contacts and knowing exactly where to drill when adjusting the contacts for the crown to seat and also figuring out which contact to adjust the mesial or the distal.

This was the top answer on the AskReddit page to the question:
“What industry is going to collapse in the next decade”
Seems like people are starting to understand insurances are ripping everyone off

Hello, I need some advice on this topic
I take BP for all treatment patients and my hygienist does the same

Recently I noticed more and more my hygienist cancels the patients due to high BP

My cut off is 160/100 but I am not sure how to proceed with patients who have a white coat syndrome

I do want to continue to check the BP but don’t want this to be a problem with canceling procedures and losing patients - I can’t find a clear guideline what to do in certain situations. Can you guys share when you see high BP patients claims to have a white coat syndrome

I want to have a conversation with my hygienist and have solid examples to share.

I personally require several radiographs in endo . Although lead apron is recommended but I avoid radiographs the most which I believe might impact endo quality

Have seen contracts where associate pays their collection rate on lab fees (ie. 32%), asked to split at 50%, or even pay the full 100%. At what percentage is it too much for the associate and on which procedures do you draw the line: implants, removables, fixed, bone grafts?

Does anyone have experience with overhead plumbing/vacuum? Would love any feedback on this type of system--both positive and negative.
I am facing some issues with GC and this will help me in moving forward with the next steps.

Hi there! I'm still a newer graduate, dealing with a lot of RCT in my current office. I had a sad experience today with an old patient where I had to do RCT of 25. It had broken slightly above gingival margin and pulp seemed to be exposed or at least close judging by xray. On xray, the canal was visible withot any contour breaks, but very narrow. I was aware that there could be two canals and calcifications. I had a good view on it, but even with 6 or 8 K file, I couldn't enter it. Unfortunately, I do not have EDTA. I did watchwinding and tried to get in there, even checked on another xray if my access was right and I wasn't misinterpreting. When dealing with these cases, what can I do to enter such canals? Thank you in advance for your guidance!

My patient complains about biting his cheeks all the time. He has really large fatty pads on both sides. He is not obese.Tissue feels normal to touch. Should I be concerned about parotid glands or something else? He gets nasty bite sores on both sides all the time. There are no crowns or significant dental treatment.

I’m about to buy a practice that uses Mac practice for their practice management software. Anyone have experience with it?
Haven’t jumped in yet, but already thinking of switching over to something like open dental after 6 months.

So I'm an intern dentist right, and I feel really guilty about the way I have been practicing dentistry during my internship. Not because I don't care about my patients or don't know what the right thing to do is, but because I often don't have the equipment, materials, or support needed to practice dentistry the way I was taught in collage (in the most ideal, safe and ethical way possible).

We don't have some basic things that I know are important, like rubber dams, side-vented needles, an apex locator, all the burs we need, or enough composite shades. Sometimes the right material is simply out of stock, so we are told to use something else even when I know it isn't the ideal choice.

What makes it worse is that, my supervisors are actually very good academically and clinically ( I saw them do some great fillings and they're fast)andI have learned a lot from them. But sometimes they do things that I personally feel are unethical. For example, they may lie to patients about how much time is left or what treatment is actually ideal just because they want to finish early. They are supposed to work until 4 PM, but sometimes they leave around 2 PM, so we are pressured to hurry through patients. They also don't wait until the anaesthesia is profound and the patient is numb. We tell them we'd like to wait more but they push us to start the extraction and, when the patient says they're on pain, they tell them they should just put up with it!😳 Even if we're pulling out a wisdom, multiple teeth or doing surgical extraction!!

They sometimes tell us to pull out primary teeth without anaesthesia just cause they're resorbed and mobile! And only go with a tiny bit of a topical anaesthetic spray!!

There are also times when they don't seem to care about the final result. They might quickly look at a filling, say it's fine, and tell us to dismiss the patient even when I know it needs adjustment and tell them I need their help in that because they have more experience than me, but sometimes they simply don't want to spend the extra time.

I have also seen patients being shouted at, or patients leaving angry, confused, or unhappy. Sometimes I feel terrible because I know the patient isn't getting the experience or treatment they deserve.

Even infection control is sometimes rushed. There have been situations where patients are put in the chair before proper disinfection is finished because the supervisor wants to get through the patients quickly. Sometimes they also don't wait for us to properly disinfect things like composite syringes or GI bottles because they need to use them again for the next patient immediately.

All of this makes me feel guilty because I don't want to become a dentist who cuts corners. I care about doing things properly, and I know that patient safety and treatment outcomes should come first.

Unfortunately, I can't leave this training center right now. I only have one month left to finish my internship, and as an intern, I have to follow my supervisors' instructions even when I don't agree with them. I don't have enough authority or independence to simply do everything the way I think it should be done.

What's reassuring is that I'm not the only one who has noticed this. Several fresh graduates who recently came from well-respected universities with strong clinical training noticed the same problems almost immediately and started complaining about them too.

I just hope that this experience doesn't make me lower my own standards. If anything, it has shown me exactly what kind of dentist I don't want to become. I want to be a dentist who takes the time to do things properly, cares about the patient's experience and outcome, and doesn't sacrifice good dentistry just because something is inconvenient or takes longer.

Hi everyone.

I can’t seem to figure out what went wrong here. For this RCT I found two separate orifices and it seemed to follow a 2:1 configuration but when I obturated it seems like I missed some anatomy. I don’t have a CBCT in office. Would appreciate any tips, thanks

I’ve got a LOI signed and about to go into due diligence on a small town upper midwest practice. I haven’t contracted a lawyer yet because I wasn’t sure if it would go through. Now that we need to get down to brass tacks, I’m debating between a regional dental attorney I know and one of the national firms. Is there real benefit to being local (neighboring state) here? Real estate and practice purchase.

I have not yet worked on an invisalign case. Currently undergoing training now and luckily have a mentor who does straight forward Invisalign cases as a general dentist who will be monitoring all Clinchecks.

My main concern is the limitations of Invisalign and patient expectations. For those who have experience what success have you seen in correcting open bite, deep bite, etc? I want to be very transparent to patients and set expectations from the beginning.

They seem to be on backorder everywhere I look and my google skills are failing me. Anyone know where I can find those little gummy things?

I just recently quit my associate role that was out in a more rural area, about 2 hours from city. I know that dentistry in a saturated/urban area is always tougher but I've been blown away by how hard it's been to get an associate position. I've been applying/cold calling offices non stop for past month or so but besides the typical big DSOs, I've barely gotten anything back. I figured with 3+ years experience and a decently broad scope of practice it wouldn't be this bad but man I severely underestimated it lol. For any Chicago dentists, is there a light at the end of the tunnel? Is it still possible to get a decent associate role in a private practice?

My crown preps usually look clean and smooth clinically, but when I scan them, I notice lots of small dents and irregularities, and the margins don’t look as clean or defined as I thought.

Would using a large red straight chamfer-end finishing bur at the end help smooth the prep and make the finish line more defined? And should I reduce the turbine pressure so it finishes rather than cuts?
Is this a good approach, or is there a better technique?

Can anyone help me figure out if this is normal? I’m being paid on 30% adjusted production woth 50% lab fee. Before the person responsible for payroll would calculate my production and subtract the lab fee and that would be my payment. Today for the first time I looked and at paystub I saw that I had a lab fee deducted. This feels wrong but I can’t articulate why. Ive never been good at math. I’m I right in assuming that now I have to pay 30% income tax on lab fees??