Clinicians looking to improve their endodontic treatment results are faced with some tough decisions regarding costs. Hi tech advances such as Ni-Ti rotary files, MTA, Digital Radiography and Microscopes can all contribute to spiraling overhead costs. This month's EndoFiles Fax will deal with the OTHER end of the spectrum…cheap tools and devices that can help make your endodontic diagnosis and treatment more accurate and cost effective.
1. Heating Irrigation solutions - Salton Coffee Mug Heater - Price ~ $10 CDN
The literature has shown that the activity of irrigating solutions is increased when they are heated. There are dedicated devices that combine such heaters with a multi-button syringe dispenser system. You can find a device such as the Endo Irrigator II at http://www.vista-dental.com/page29.html However, most general dentists do not wish to spend the $2000 CDN or so that is required to install this device. An alternative can be purchased at any Office Supply store for about $10. It is the Standard Coffee mug heater made by Salton. (See my web site for a picture and details.) You simply fill a sterile container with the solution of your choice, place it on the heater element for the duration of the procedure and it stays warm. Fill your irrigation syringes from this reservoir Inexpensive yet effective.
2. Tooth Slooth
Patients seem to be having greater numbers of fractured cusps and cracked tooth syndrome in recent years. The days of the Orangewood Stick are over. The Tooth Slooth should be part of every dentist's diagnostic armamentarium. If you don't have one, you are compromising your ability to recognize specific fractured cusps and are risking unnecessary referral to the Endodontist. It may not be necessary to reduce the entire tooth for a crown if only one of the cusps is weak. In many cases, the patient's complaint can be isolated to a single weak cusp that can easily be identified, removed and restored. Before considering endodontic treatment or crown preparation, use the Slooth. Price: $26 CDN for a pack of 4.
3. Dedicated Transillumination
Another important tool used to examine teeth for possible fractures is the Transilluminator. Transillumination is useful in detecting breaks in the continuity of enamel and dentin that may indicate weak cusps or Cracked Tooth. Many of "cheat" by attempting to use the Fibreoptic portion of our high-speed handpiece. This is a severe compromise over a dedicated unit, for two reasons: (1) We all know that Fibreoptic bundles degenerate with time and sterilization (2) The fibreoptics in a handpiece were never meant for this purpose. The shape of the handpiece does not allow for proper placement against the surface of the tooth. The results in less than optimal light transfer. The preferred method is to have a good, strong light source that is dedicated to the purpose. Several inexpensive battery powered models are available. Unlike fixed or AC powered units, these can be moved from operatory to operatory, so you may only need one per office. Check http://www.kineticinc.com/TransCure-CTS.htm for an example made by Kinetic Instruments that is rechargeable. It also can be fitted with an interchangeable light cure tip to add an inexpensive extra light cure unit to your office. Several other types are available and range from $75- $250 US.
4. Replacing Cotton Pellets with Miniature Sponges
For as long as we have been performing endodontic treatment, cotton pellets have been used to help prevent temporary fillings from falling into the access or to prevent this material from being inadvertently pushed down a canal between appointments. There are several problems that occur with use of cotton pellets. Firstly, microscopic examination of temporary "Cavit -Type" access closures has shown that it is not uncommon for strands of cotton to be caught by the Cavit or IRM seal, leading to microleakage. Secondly, the thickness and lack of compressibility of the cotton can result in an inadequate thickness of Cavit over the access. (Remember, for adequate seal we need at LEAST 4 mm thick layer of Cavit for leak proof seal.) Two types of sponges are available in "pre-made" form and that are the right size. 3M™ ESPE™ Disposable Mini-Sponge Applicators (200 per box) and Roeko (Square versions). Either is acceptable. These sponges compress when temps are placed on them and they have many other uses such as for etching teeth, applying materials topically, etc. Price: $32 CDN for a box of 200.
5. Unidose Methylene Blue Stain
Sometimes Transillumination is not enough to visualize fractures. Vertical root fractures are best seen with a combination of high power magnification and stain. Instead of buying a bottle of Methylene Blue (and risking a big spill that will be impossible to clean up!) an easier way is to buy unidose versions that incorporate a brush. These foil packed single use versions are easy to use, relieve asepsis concerns and are inexpensive. Apply the stain to the area, wash with water and examine closely under high power magnification. Cusp fractures, Marginal ridge fractures and vertical root fractures are easy to diagnose with this tool. You can buy it in packs of 30 from your local dental supply house or at: http://www.vista-dental.com/page16.html. The price works out to about $1.35 per use.
6. Alcohol and Microsuction to Dry Canals
One of the biggest unseen problems in endodontics is moisture in canals prior to filling. Clinicians that use microscopes can see how wet these canals are, even after attempts to dry them with paper points. The best way to dry canals is to do a final rinse with 95% ethanol, followed by high volume microsuction using a small purple "Capillary Tips" (Wright Dental #1341 - $1 CDN each). They are very small (.014") flexible polypropylene tips that have a Luer lock end. These can go very far down into the tooth, almost to the apex in most prepared canals. Once the canals are dry, you can confirm your working length by using paper points - checking for wetness at the end of the point as it exits the foramen. This method (combined with an Electronic Apex locator) gives the most accurate working lengths. (Thanks to www.rxROOTS.com and Dr. Dave Rosenberg for the tip.)
7. ePocrates Rx for your Palm PDA
For those of us with a Palm PDA, this program is a must. EPocrates is a Peer-reviewed drug information program including off-label indications and formularies in an easy to use format. PDA software compatible with Palm OS and Windows platforms only. It is constantly updated every time that you HostSync, meaning that you can receive updates on a daily basis. Best of all ePocrates RX, is easy to download and it is FREE. When you consider the cost of an annual edition of the Physician's Desk Reference in book form, you'll realize what a good deal this is. The ePocrates RX program is also available in a "PRO" version that costs about $55/yr. For the Free version see http://epocrates.com for further details
8. Dirt Cheap Digital X rays
Many of my referrals don't wish to spend the money for Digital Radiography. Some don't even have a digital camera that is capable of talking a picture of an X ray off of a viewbox. The absolute cheapest way of creating a "Digital X-ray" copy is to generate a .jpeg with a web cam. The Logitech Quick Cam Express can be had for as little as $50 or $60 CDN. All you need to do is to: 1.) Plug the camera into any USB port of any computer (I suggest the one at the front desk) 2.) Install the image capture program that comes with the camera 3.) Place films on a viewbox 4.) Fix the focus ring and push the button on the top of the camera to snap the picture. You can take a dozen individual pictures in about 20 sec. Give each image a filename (eg. / patient1, patient2 etc.) They are automatically date stamped. Instant digitized image WITHOUT a scanner! The images are gray scale so they don't have to contain a lot of digital info at 240 x 430 resolution. The file sizes are small. If you need to, you can always tweak the brightness and contrast settings for best results. Email to insurance companies, specialists etc or just print and file them in the patient's chart after printing them up. There is no easier or faster way of duplicating an x ray film.
9. Dovgan Pluggers
Why pay $100 + for a set of Buchanan Ni-Ti pluggers? One of the best alternatives is a set of the double-ended Dovgan Endodontic Ni-Ti Pluggers. There are 2 sizes available: the #35-45 (TFD3545N) and the #60-80 (TFD6080N). At $ 21.95 US each (Endoco.com) you'll never find a better deal on a Ni-Ti Endo plugger.
10. Stropko Ni-Ti Flex-Tip Irrigation tips
Who says you can't irrigate to within a few mms of the apex? You can. But in order to do this you have to have 3 things: (1) A tip with a small enough diameter (2) A tip that is flexible enough and (3) a "safe ended" tip that prevents injection into the periapex. The Stropko Ni-Ti Irrigation tip is a 30 gauge, flexible Ni-Ti irrigating tip that is slotted and side vented for safe irrigation. A special coating prevents clogging from NaOCl and it has a Luer lock attachment that fits most standard irrigating syringes. It comes in two sizes: 17 and 25 mm and is autoclavable. They are about $10 each CDN, come in packs of 6 and are available from Vista Dental in the US (www.vista-dental.com)