DIY PERIODONTAL - CURETTES -  started 04-24-12 -  DRAFT
"I was against it before I was for it." OR "I was for it before I was against it."

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08-29-13 - SUPERCURETTES - Background is that calculus doesn't have to get peeled off or broken off. It can get split off too. Just like a log gets split by the log splitter.

SUPER-CURETTES - w SLAP-HAMMERS - Universal blades are flat and don't take advantage. Gracy curettes actually angle away and are not very aggressive. What DIYPERIO proposed are much more aggressive curettes. One way to make them more aggressive is slap-hammers. This proposal is fairly benign. Higher instantaneous force at single moment to overpower the tensile and shear resistance of the calculus. Thereby causing it to break off in big chunks.

SUPER-CURETTES - MORE SURGICAL - Basic idea is that if a chunk of calculus can be compromised in some fashion then it will break off. SO... "Want to play ball scarecrow?" - Ideas here include tips that look like snowplows, or that have serrated edges, or possibly just more scoop-like mini-edges. MORE DANGEROUS? "You betcha" - So the logic is how to compromise between more effective and more dangerous. Obviously don't want to stick pure knives in there. So logic is to reduce the actual knife portion of the curette down to a minimum while maximizing its effectiveness.

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FINE CURETTES FIRST - THINKING IN REVERSE - MANAGEMENT BY OBJECTIVE - MBO -  The natural flow of activity starts with a highly gross primary debridement, almost like taking a hatchet or wood splitter to the calculus deposits. You can visualize the initial deposits as almost like continents, complete with mountain ranges. Sort of like Italy or Appalachia. Once the primary debridement is done and you move on to the secondary debridement what is left you can imagine like a series of islands. Sort of like Greece or Japan or the Caribbean or Indonesia. But actually they are more like a Jackson Pollack painting. Or a Van Gogh. With a thin base layer of calculus or cementum or dead periodontal membrane still left behind. With thick smears of hardened calculus sitting on top, full of biofilm, like a small city.

Then... once you get this removed you will typically find the exact same situation just a millimeter or so below. So if you have a pocket that has a base depth of say five millimeters that was accomplished in more or less the same series of debridements. Then you find lower layers of calculus once you get through the upper layers then you might have to go through three or four or more basic gross debridements before you finally reach the bottom. Indeed if the calculus has gone all the way to the apex, or like 12 or so millimeters deep it might seem close to impossible to get to the bottom, even after lengthy series of of even dozens of debridements over many months. Especially since the bottom of the tooth is rounded and you are right next to the tooth nerve.

Likewise the calculus can also be imagined like layers of newspaper glued together. The protein that holds the calculus together is a lot like glue. Which is sort of like a tangle of twisted string. Or cotton candy. Deriving its strength from the twisted convergence of the multitudes of different strands twisted together. So the torsion or torque forces (twisted) and the tension forces (pulling) are largely resisted by other strands that compensate and resist contrary to removal. Likewise can visualize a piece of wood that breaks fairly easily with the grain, but not so well across the grain. And also where a knot had a rounded grain or sometimes even a twisted grain.

BOTTOM LINE - OVERWHELMING FORCE MEETS OPPOSING FORCE AND DESTROYS IT - Just like in warfare the idea is to have overwhelming force attack a small enough counter-force, ie the calculus or whatever, so the calculus breaks away. There are basically two ways to do this. One is to break off small enough pieces that the force of the curette is stronger than the section of calculus you are working on. This is equivalent to an attack force. The second way is to progressively weaken a larger area of calculus so the weakened areas essentially turn into a leveraging tool against the stickiest area. This is equivalent to a seige where you recruit the disaffected to attack the center along with your striking force curette.

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OTHER SUPER-IMPORTANT CONSIDERATION - STOCKHOLM SYNDROME - Not really sure how this works but for some strange reason the gums or gingiva want to attach themselves to the calculus. This makes it very difficult to get the curette to penetrate into the lower layers. But once the calculus is removed and the surface of the tooth is smooth then the curette will penetrate fairly easily and the Stockholm Syndrome won't be so present.

WHY DOES THE STOCKHOLM SYNDROME EXIST? - One explanation is that the calculus is rough. So the curette won't slide so easily. Presumption is this answer is partially true but certainly incomplete. Second explanation is the gums or gingiva naturally like to cling. Plus the inside facing part is apparently quite wavy. So it would tend to permeate itself into the nooks and crannies of the calculus. Likewise perhaps the gingiva in some sort of self-protective mechanism try to prevent the calculus from getting too much access to the outside world. In a sense trying to smother the calculus. But the calculus has energy chains anyway. So the effect is to thwart the debridement process. Once the gums dilate the wavy edge clinging to the calculus releases itself and the curettage becomes much easier. Also later when there is little to no calculus the gums don't cling anymore to the smoother surface.

WHY DO THE GUMS DILATE? - Obviously because they fill up with blood and blood products, presumably to wash out the toxins that are released by the curettage. SO... the introduction of the biofilm-infection toxins is certainly a primary cause of the dilation. In addition the gums tend to dilate in not just the one location but in other nearby locations too. So there is some type of general stimulation. In addition the mechanical disruption of the gums also would seem to stimulate them to "open up" too.

HOW DO YOU GET AROUND THE STOCKHOLM SYNDROME - One method is obviously to use very thin curettes to start. But more practical is just to wait for the gums to dilate or do whatever they do from all the stimulation. This happens in stages starting at around a half hour and becoming quite open after an hour or so at a single location. At which point the gums will de-attach themselves from the calculus and the calculus becomes accessible. At which point you can go to town. Why do the gums dilate? Certainly mechanical stimulation has something to do with it. But additionally it looks like the gums are also reacting to the toxins getting released from the calculus. stimulating the gums to "put out" gingival fluid, which is sort of like plasma, in an attempt to wash out the toxins. So in a sense the gums turn into miniature water balloons. So naturally they will tend to become less wavy, smoother and harder and will separate from the calculus.

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FINE CURETTES FIRST - THINKING IN REVERSE - So now we are thinking that our job is almost done. Just the ongoing tertiary debridement until every last speck of calculus and biofilm can be successfully removed. Which you can imagine as similar to picking out pieces of sand from a towel after a day at the beach. As in GFL. But you set the challenge and want to keep the teeth. So roll up those sleeves and let it roll. NOTE - Also keep in mind the body will help out with the final debridement. Turning those last remnants into bloody debris and detritus that will then wash out. Given the proper mechanical stimulation combined with either natural (bloody) or artificial irrigation. 

FINE CURETTES FIRST - THINKING IN REVERSE -

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NOTE - STERILIZE CURETTES W BLEACH - NO! NO! NO! - Don't even think about it. Bleach will hurt the plastic handles. Likewise bleach can cause the stainless steel to corrode. DON'T DO IT.

NOTE - I could be completely wrong about not using bleach to sterilize instruments. My logic is to use the povidone iodine and that is it. Forget about other alternatives.

NOTE - STERILIZE CURETTES W POVIDONE IODINE - YES - I use a narrow cooking tray just slightly longer than the curettes to minimize the water and maximize the concentration without using up a lot of the povidone.

What I do is first clean the curettes with concentrated dish soap and a little bit of water, rubbing them with my fingers to remove any invisible slime. Which will be sort of like shellac and can even be invisible.

I don't bother to completely rinse off the curettes before adding the povidone. The general idea is to add enough povidone to make the solution light brown, looking like tea. Then to let the instruments soak for several hours. Or even overnight. Then to rinse off and let dry.

HOW MUCH CONCENTRATION? - Apparently povidone-iodine is not so popular in the medical world for sterilizing instruments. But it is popular in the beer world. So may have to look at different guidelines.

FDA GUIDELINES - Apparently the FDA recommendations are a minimum of 13ppm (?)  to sterilize equipment (?) - 10% povidone-iodine yields 1% iodine, which would be 10,000 ppm. So sounds like you could dilute the povidone 1,000 times and it would still work. So how about more concentrated?

DILUTION RATIO - Realistically you could have a pan with say 20 ounces of water to make sure to cover the curettes and put in one teaspoon or 1/6th ounce to deliver at 120-1 dilution. Which would be around 80 ppm of effective iodine. Or a good 5x the FDA minimum. Sounds reasonable, without wasting too much iodine.

NOTE - general review is that a 100-1 dilution of povidone-iodine is generally recommended for sterilizing "equipment." This includes endoscopes and things that go inside the body. Which is not quite as high a standard as might be required for "surgical instruments" but still seems good enough. When in doubt give it another squirt.

Some people would say you need to sterilize the instruments before each use. But if the curettes are for just one person think a general rinse and wash with soap before and after each use is sufficient. Then to sterilize after any major debridement that is also very bloody too. Since the blood is the infection. Or after several uses.

Largely you can figure the infection is not going to stick to stainless steel. And that a soap and water cleaning though not as good as a sterilization is still pretty good.

Also if you know you are going in deep, into sinus or nerve territory then obviously sterilization is much more important than if your curettage is going to be more superficial.

Since... if you think about it... when you go into these territories you are pretty much going inside your body into the innards, aren't you. Yeah, you're right. But the blood is going out isn't it? Good point. But still how about if you sterilize just in case.

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NOTE - Great explorer - Hu-Friedy Immunity EXD11/12AF - Also knows as the Old Dominion University Dental Explorer. Can just imagine some old school old coot coming after you with this thing. It isn't exactly what I would imagine is great. But it has an angled shank and then a little curved thingey at the end. Plus it is really thin and I can use it to get down into the nether regions and check things out. It doesn't really have much scraping power, but if something really wants to come out it will. Likewise it can function as a pilot or scout. First use this explorer and then come back with something with more firepower.

Often I start with this explorer to explore the perimeter and then switch to the Furcator to patrol the edges for anything that wants to come loose.

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WTSHTF - BUG-OUT BOX - Will outline various possibilities. Nonetheless, with a good enough bug-out box you do not need become one of the Toothless Ones that will be roaming the post-apocalypse landscape. "Open wide! Let me see your teeth." Main issues are:

1) everyday tooth cleaning, or prophylaxis.

2) More serious periodontal curettage. To attack infection plus curettage periodontal abscesses.

3) Periodontal abscess resolvement issues - which are more much finely based.

4) Cavities or Caries. Mostly logic here is not to fill in the cavities - too problematic, not worth it - but rather to neutralize the bacterial infection, encourage the tooth to remineralize the border area and to wait for the fibroblasts from the inside of the teeth to create a dentine "wall" that can more or less resolve the problem. Though still left with a hole. Plus no guarantees.

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MINIMAL BUG OUT BOX - note - Extended Access gives access to deep pockets - Mini also gives access plus puts more force into smaller area.

PERIODONTAL - WTSHTF:

1) EXPLORER - Plus TOOTHPICK HOLDER
2) ADAPTABLE UNIVERSAL CURETTE - ANTERIORS & POSTERIORS - Langer 1-2 - Extended Access - Mini
3) OFFSET UNIVERSAL CURETTE - POSTERIORS - Langer 3-4 - Extended Access - Mini
4) STRAIGHT UNIVERSAL CURETTE - LANGER 5-6 + STRAIGHT SICKLE -  (both sides equal - so add sickle) - H5/L6 - PDT MINI-ME SCALER-SICKLE
5) STRAIGHT SICKLE w MINI-SICKLE - Towner-Jacquette, U15-33
6) OFFSET SICKLE - McCall 13-14S (for sharp) is the mainstream standard. Plus several larger and longer others for more deep access or more brutality.
7) ARKANSAS FINE SLIPSTONE - to sharpen curettes. Has teardrop shape.
8) Optional - LR Furcator - if have deep problems - This curette is basically a furcation explorer with a scoop on the end. Good for War of Attrition Type Debridement. It is functionally such a practical instrument that it deserves to go into the bug-out bag. It is the instrument you would otherwise wish into existence.

In addition are various other minor tools and substances:
1) Proxy brushes - get a variety as Walgreens. Can also look into the mini-proxy brushes.
2) Brush Picks - these are CRITICAL - They have a TV antenna on one side and a spear on the other side. They are particular useful for War of Attrition Type Debridement.
3) Povadine Iodine -Should only be used in moderation. Since it is poisonous. Basically kills stuff on contact. BUT periodontal disease is largely a biofilm that resists poison. So povadine iodine is best used in moderation as a finishing tool against biofilm that has already been disrupted. And only on a once a week to three day basis. Not everday in large quantities or you will poison yourself.
4) Hyaluronic Acid and Needles - Our bug-out box is starting to get pretty big isn't it? Needles and irrigation are a separate issue and are largely secondary, not primary, and are largely useful for rehab, once the infection has been largely eliminated, not the initial problems. Where largely they turn out to be make-believe. "Tail of the Dragon nonsense."
5) EDTA - Dental cleaner - again our bug out box is starting to get pretty big. Other options for cleaner include Vitamin C and just plain old dish soap.
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PERIODONTAL - WTSHTF - BUG OUT BOX - add GRACY OPTION:

STRAIGHT CURETTE FOR ANTERIORS - Gracy 1-2 extended access mini
DISTAL CURETTE FOR POSTERIORS - Gracy 13-14 for backs of teeth - note - operates on pulling stroke with is fairly easy. This curette is also highly adaptable.
MESIAL CURETTE FOR POSTERIORS - Gracy 11-12 (or 15-16 okay for more angular) - for fronts of teeth - operates with shoving stroke. This stroke is more difficult but necessary for mesial corners which are close to impossible to work with.

PERIODONTAL - GRACY OPTION - SPECIAL NOTE - Keep in mind that you can get standard Gracy curettes off the web on eBay quite cheaply. So can purchase standard Gracy curettes for only $5-10 per curette and build up a portfolio of curettes quite easily and quite cheaply. When just getting started can use these curettes to debride the bulk of the calculus... THEN... as get deeper... can keep eyes open for Extended Access - After Five - and keep eyes open for Minis. If you are lucky you will be able to buy these curettes quite cheaply too. Since almost nobody does DIY. You will also be able to use them for quite awhile before you have to worry about sharpening.

PERIODONTAL - GRACY OPTION - FOCUS ON WELL ESTABLISHED REPUTABLE NAME BRANDS - Hu-Friedy, American Eagle, PDT are the main well-known US companies. LR from Finland is also good. Famous for their Furcator. Miltex from the UK is also presumed good. Forget about no-name brands. WHY?? CHEAP STEEL WILL NOT STAY SHARP.

PERIODONTAL - GRACY OPTION - SPECIAL NOTE - Suggest to stay away from the cheap curettes on eBay offered in sets. WHY?? CHEAP STEEL.... However... there is a place for the cheap curettes to get adapted into "hatchets" and possibly into "pluggers" which have their purposes in dealing with caries, cavities. But I am weak on ideas here.

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PERIODONTAL - WTSHTF - BUG OUT BOX - add FINE CURETTE OPTION - These curettes or both for rehab and to get to deep areas almost impossible to get to otherwise.

HU FRIEDY MICRO MINIS - 1-2 - 11-12 - 13-14 - Expensive - Over $100 for set. But these are the narrowest deepest penetrating curettes in existence. For actual final resolution of real serious problems these curettes are critical. In particular if you are hoping for 100% hygiene and remodeling.

PDT QUEEN OF HEARTS - This is basically an offset sickle with a blunt tip. Excellent for fine-debridement post abscess curettage. This is a very delicate instrument. Also turns out to be critical. Especially if you are suffering from apical periodontitis. Which is fine deep calculus. This instrument will just slice off that nasty stuff right off and leave a clean surface behind. Can't say enough for it regarding fine-debridement rehab... It's only real weakness is that there is not a straighter deep-access version available. You can imagine the QoH like a corkscrew where it would be nice to have a straighter corkscrew when you want to more directly address the business with more of a straight curette.

PDT O'Herir 1-2 straight extended access - minimal - Basically a probe with a small shovel at the end. This probe will go in deep past obstacles and attack deep periodontal abscesses or reach deep inaccessible calculus. Can be used as a shearing instrument to get very very nasty against disobedient calculus. Otherwise it can be used as a fine-debridement tool. Or it can be used to attack dead periodontal membrane and dead cementum. Which are both obstacles to resolution, healing and regeneration.

PDT O'Herir - 7-8 (perpendicular) & 9-10 (parallel) - These are both extended access. One perpendicular and one parallell. These basically extend the O'Herir concept to a complete set. More or less when you need the O'Herirs they are the best curettes for the job. But otherwise are not critical. Can work around them. But still miss them.

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CARIES - CAVITIES OPTION - SUGARMAN 1-2 - PERIODONTAL FILE (round) - This is the one critical tool you will need to deal with cavities. In addition you can also either purchase "hatchets" or make your own hatchets with old dental tools. Where you snip off the tips, sharpen what is left, and use the resulting blade to shape the inside of the cavity.

Largely the philosophy is to debride the cavities and to forget about filling them. What will happen if you are successful and the tooth is still alive is that the nerve will recruit fibroblasts to go and block off the invasion. Resulting in clean cavity walls that resist further invasion. Plus if you successfully debrided the cavity and cleaned out all the bacteria then where exactly is the disease still left??

DIYPERIO largely believes that the philosophy of filling in cavities is an old-school holdover. It has its place but is not critical. What is critical is that the caries infection does not continue to destroy dentine and burrow deeper into the tooth. But if the hole is debrided and the infection is eliminated and destroyed on an ongoing basis the where is the continued caries activity?? Granted it can still be in there in some nook or cranny. But if you go into the hold with the explorer you should see some debrided material excaping, shouldn't you? If there is a lack of debrided material then doesn't this mean the infection is stopped?

SO WHAT IS THE CRITICAL TOOL HERE?.... The critical tool is... SUGARMAN 1-2 PERIODONTAL FILE ... This tool is round and can be used in short bursts to file off any infected dentine. Possibly it is the same size as the Sugarman 3-4. But was told it is slightly narrower. Narrower is better. Other than that, aside from some BS that one is for buccal-lingual and the other is for mesial-distal, which may in fact be really really important, it is just that I am being arrogantly dismissive. But the pictures look pretty much the same. So I would just buy the 1-2 or if unavailable the 3-4.

Logic is to break into the cavity with the explorer and then with the sickles and debride out what you can. Then file the walls with the Sugarman periodontal file. If it turns out the cavity has invaded the nerve then I just steered you wrong and I am sincerely sorry that you had to get your tooth pulled because you listened to me. NOTE - The dental community "believes" in drilling. Plus "believes" in the possibility that the caries has penetrated to the nerve and to leave a bed of caries behind if it did. The DIYPERIO philosophy does not cove this possibility. So if the caries has penetrated to the nerve you will be screaming soon enough. Hope you have a towel to bite down onto. You will need it.

SPECIAL NOTE - DON'T PANIC - Also keep in mind that if you flip out while using the Sugarman Periodontal File that you will be in critical danger of breaking your tooth, hence destroying it. I got the Sugurman stuck in my tooth several times. But each time I seriously chilled and was able to extract the file without further incident. But had I flipped out I definitely could have easily broken the tooth. Since the inside of a cavity is very very vulnerable to tooth breakage.

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SHARPENING STONE - I have an Arkansas Stone - Fine or Extra Fine - Slip Stone - Don't buy the square stones. Buy the rounded ones. So from the side the stone looks like a teardrop. One side a fairly large 1/2 inch, which I don't use. The other side a fairly sharply rounded 1/8 inch . Which I do use. My opinion is to forget about the oil. Just use water.

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PERMANENT EDGE CURETTES (Gracys) vs SHARPEN-ABLE (Universals) - The permanent edge curettes are more expensive and never need sharpening. They have some type of special alloy or superhard coating. For Gracys would definitely recommend the permanent edge. Since Gracys have an offset edge and are therefore more difficult to sharpen precisely. Plus conversely it is very easy to mess up the angle and screw up the edge. So the curette is no longer sharp.

 I have some Hu-Friedy After-Five Micro-Mini Gracys. Which is a highly specialized instrument for very narrow spaces. Plus some American Eagle Extended Access Mini Gracys, which is more mainstream. And which have held their edges for several years quite nicely.

SHARPEN-ABLE UNIVERSAL CURETTES - Since universal curettes have a 90 degree edge there is not much mystery to getting the angle right. What I do is draw the blade across the stone while forming a perfect T. Then I smooth out the sides for any burrs.

NOTE - Easy sharpen-ability is another argument in favor of universals. Since they can be sharpened so easily. And also a case against Gracys. Since sharpening is more difficult and problematic. Along with their tendency to skip over the calculus. But still... there is a lot of good to be said about Gracy's ease of movement. Where I have gotten totally confused and stymied when I tried to use universals. Where the Gracys just seemed to slip right in to the heart of the problem and were still able to extract tough pieces of calculus.


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NOTE - Gracys are hard to sharpen because you have to figure out the exact correct angle. To match 70%. I drew lines at the correct angle on a box to use as a guide for just the right angle. Universals are fairly easy to sharpen. Since the blades are at exactly 90 degrees. So all I do here is draw the face of the blade across the stone. Then rub the sides of the curette back and forth a few times to remove any burrs and I am good to go. Also I try to avoid saving the day. Rather it is best to just sharpen a little bit every time. Or if you let things go then to recover the edge a little at a time too. That way you only have to concentrate on getting the angle just right for only a minute or so at a time.

PERMANENTLY SHARP BLADES - Hu-Friedy makes these. So does American Eagle. Largely this is a good idea. Since you probably won't do enough curettage to make them ever lose their edge and they will stay close to permanently sharp in the meantime. But they are expensive. Like $35 per curette. So a combination of Gracy 11-12 and 13-14 will cost you $70.


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CONFESSION - I love Graceys. I hate Graceys. This is similar to a woman's lament about men or cars: "If it has wheels or balls it is going to cause you trouble."

ISSUE #1 - Graceys have an offset blade, 70 degrees, instead of 90 degrees like the Universals. So they are easier to move around the dentition. But they skip.

ISSUE #2 - Regular shank length or extended access (after 5)? - ANSWER - Start with the regular length if you can buy the curettes dirt cheap. But if the cost is significant then just buy the extended acess, especially if you thing you will end up deep.

ISSUE #3 - Regular blade length or mini-blade? - ANSWER - Personally I am now a big believer in the mini-blade. In fact the regular blades to me now feel highly cumbersome. Logic is you are not a hygienist. You are not under time pressure. The mini-blade gives you greater force in a small area.

COUNTER-ARGUMENT - The extra length of the regular blades does come in handy. Especially if you are digging in deep or trying to smooth an extended surface. So don't be so dismissive of the regular blades.

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PROBLEM - Seriously, how many curettes do you want to buy? One set for this. One set for that. Adds up after awhile doesn't it? So what is the minimum number of curettes you can buy that will realistically cover most of the different scenarios you will face. Does it really make sense to buy both Gracys and Universals? (YES - Pony up the money)

DIFFERENT SCENARIOS - The first scenario would be you are facing a pile of crud that seems endless. Like you are shoveling out a barn. But also consider that at first you would largely be working with the upper layers. Once these are cleared out then you would have access to the lower and deeper layers. In turn these might also seem like you are shoveling out a barn. Except that now you are in deep, very deep. Plus the surface layers obviously are younger than the underlying layers, which are much harder.

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GRACEYS: Move around easily but skip rather than dig in and grab the calculus firmly.

Gracy 1-2 - Straight blade. Easier to get a sense of feel.

Gracy 11-12 OR 15-16 (more angular shank- recommended) - Blade is facing away from you. This blade is used for Mesials. You can imagine it like pushing a broom away from you. Curette can be imagined as similar to a corkscrew. Clock-wise or counter-clockwise. Where the curve enables the blade to go around corners. Which is needed for working in between the teeth.

Gracy 13-14 (OR 17-18 - more angular shank - NOT recommended) - Blade is facing toward you. This blade is used for Distals. You can imagine it like pulling a broom towards you. Again it is similar to a corkscrew. CW or CCW. Also you can imagine how the 13-14 has a much more powerful stroke and a much more intuitive stroke than the 11-12, which is largely quite awkward for many strokes.

My general thoughts... would be to

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UNIVERSALS: Grab the calculus firmly, but don't move around very easily and can get very confusing, causing you to feel lost and afraid.

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SUMMARY: I flip-flop on this issue all the time. But in some imaginary perfect world you might start off with the regular Graceys.



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PERIODONTAL FILES - 09-13 - My new BFFs - Hirschfield 3-7 periodontal file - (buccal & lingual) - Hirschfield 5-11 periodontal file (distal & buccal) - had previously pondered periodontal files. But they were very expensive. So found some on the cheap. What's the deal?? - Turns out the dead periodontal ligament and dead cementum are close to impossible. Same goes for the more rock-like calculus. All of which I have been attacking with sickles. Foolishly. Spend the money and buy the files!! OK? OK!

What do files do? Basically they are similar to the Track-Two razors. Since they have multiple blades the second and third blade make additional passes at the calculus. So instead of putting all the effort into one pass that then skips off the top can make progressive progress more diligently. To be honest with you haven't really tried much with them. But super confident they will address the most persistent areas. Suspect they will not turn into any magic bullets, but will rather allow consistent progress on highly difficult areas rather than dramatic attacks that seem to get repelled.

What else do files do? Files can also be used for final smoothing of irregular surfaces. Using a light touch to smooth out any roughness. Also keep in mind that files are perfectly capable of filing down dentin too. Leading to the proverbial or perhaps hypothetical or even mythical "hourglass tooth" that naysayers say results from too much curettage. So logic then suggests to try to do everything with a light touch even if it takes longer. And to resist the siren call of using extreme lateral pressure to get what you want to break.

COMPARISON OF PERIODONTAL FILES - The two main choices for slim compact files are the Hirschfields (bought) which have three blades, and the Orbans, which have seven blades. All in all think the Hirschfields are probably the better conservative choice. Since I believe in compactness above all. You can always work longer and harder. But you can't make an instrument smaller.
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BUY ALL TOOLS WITH FAT HANDLES IF AVAILABLE !

one-tool box - Langer 1/2 - Extended Access - (mini if available) - ( or Langer 3/4 AE (mini) to do deep molars except for wisdom teeth)
two-tool box - ADD - Langer 3/4 Extended Access - (mini if available)
three-tool box - ADD - PDT Mini-Me - w deep anterior Langer 5/6 + straight-sickle
four-tool box - ADD - McCall 13/14s (for sharp) - This is an offset sickle w sharp pointy thing on end to break off chunks nicely - OR - PDT Montana Jack - similar to McCall 13/14 but on larger scale (I like it better)

Langer 17/18 Extended Access ?? - (FAIL! TOO MUCH ANGLE - five-tool box - ADD - Specialized wisdom tooth curette -) - NOTE - WISDOM TEETH -2ND MOLAR GAP IS DIFFICULT AND TREACHEROUS!)

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THREE CURETTE MINIMAL KIT - MY OPINION - FOR HIGHLY EXPERIENCED OPERATOR - PLUS EXPLORER - Why minis? You aren't in a hurry are you? Minis concentrate the force on a smaller area

LANGER 1/2 MINI EXTENDED ACCESS - This is a relatively modestly angled universal curette - presumed for mandible molars.  But also adaptable to any modest angle situation. In particular this curette is straight enough that it is reasonably easy to visualize. The more offset the curette the more confusing the visualization... NOTE: This may not be a standard curette and you will have to special order.

LANGER 3/4 MINI EXTENDED ACCESS - This curette has a sharper angle - presumed for maxillary molars. But also handy anytime a sharper angle is handy. BUT this curette falls mightily short in being able to reasonably deal with wisdom teeth.

FAIL - TOO MUCH ANGLE!! - LANGER 17/18 MINI EXTENDED ACCESS - This curette has an even sharper angle - and is specifically designed to work on wisdom teeth. But could also come in handy for first molars and cleaning out furcations. But the angle could also cause you to flip out and break your tooth. STAY AWAY!!

BUT - This kit lacks a proper curette for properly dealing with front teeth (anteriors), though the above curettes provide a lot of adaptation. But there are a lot of options there. All the curette has to be is straight. Then there is something sickle-like, like the McCall 13-14s for sharp tip. Or alternative. With a few other choices for sickles. Which are good finishing tools. But which tend to be too dangerous if there are large chunks to deal with. Since the sickle can more easily slip and cause serious damage.

PDT Mini-Me - has a straight curette on one end for anteriors. Plus has a straight sickle on the other end. For serious seriousness. The straightness of the sickle is good for serious seriousness where brutality is judged as a necessary calculated risk to dislodge the piece of calculus. Where you can safely predict that the only thing that will get sliced up is air and not you.

McCall 13-14s - Classic tool - Modest offset sickle with pointy point.  Even though it is offset it has a fairly deep curve which tends to make it hug the tooth nicely. Which provides reasonably good sensory feedback. So it is not quite as dangerous as its offset sickle character might make one think. In my opinion. Or maybe I just got used to it and liked it. As a modest sickle it could even be considered indispensable. It's pointiness is really important for grazing the edge of the bone too. Or gouging out a tenacious piece of calculus. Which can be a good alternative to trying to break it off.

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VISUALIZATION ISSUES - The teeth only have rudimentary self-visualization abilities. Indeed, without any visual feedback at all it is very easy to become completely confused. Not even knowing which tooth, where on the tooth etc. Or the brain will concoct its own false realities that you may believe to be true. But which are in fact false. SO... the straighter the curette the more true the brain's interpretation of reality. The more offset the curette the more the brain will concoct its own false realities. So logic dictates that the straighter the curette the safer the curette. In particular offset sickles can be particularly dangerous.

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#1 - BACK TEETH - Hu-Friedy Universal Curette - 3/4 Langer - Mini-Five - SL3/4MF - Posterior but also adaptable. After Five means Extended Access. Mini Blad is half as long as a standard blade. Which gives it greater access and also more power at the contact site.

WHY? This is certainly the most capable and adaptable curette for the greatest number of situations as any curette I know about. In particular it is also adaptable to very deep detail work. Especially debriding calculus between very deep root, even impinging on the nerve, and bone which may still be viable. Hence the curette has to go in deep, be able to fit into tight spaces, and be highly functional in tight spaces. This curette does all of that. Though it is primarily for the posterior it can also be adapted for the front teeth, in particular the backs and sides of the upper fronts.

DRAWBACKS - The universal curettes are inherently more dangerous and harder to work with than the Gracey curettes. To break off the calculus more easily universal curettes have a squared off blade, which can catch easily. The blade can also get stuck more easily. Plus it may tend to slip more violently. So especially for inexperienced people it may be hard to move around and the Graceys might be better, since they have a trailing edge which can't get suck so easily.

DRAWBACKS - Also the professional dental world does not seem to appreciate this curette. So it only has the standard handle and is not available in fat handles. Which I prefer.

ALTERNATES - The regular blade Langers also work okay as long as conditions are not too tight. The regular length Langers are probably okay if the periodontal disease and loss of bone is not too great.

NOTE - Technically the 3/4 Langer is for the UPPER POSTERIORS. For the lower posteriors should also get a... 1/2 Langer Mini-Five - SL1/2MF - But certainly the 3/4 is adaptable to the bottoms too. So hard to say whether it is worth it to buy both.

#2 - FRONT TEETH - Anterior Curette - 5/6 Langer - Mini-Five - SL5/6 Mini Five -

Article - Why do I use Langer Curettes - This DDS says he only needs three curettes. The Langer 1/2 for lower posteriors (mandible), the Langer 3/4 for top posteriors (maxillary) and the 5/6 for front teeth (anteriors).
NOTE - He also likes the Minis. List price of all the Hu-Friedy periodontal curettes is around $35. So can get three curettes for a little over $100.

1/2 Langer Mini-Five - SL1/2MF - for lower posteriors (mandible) - Slightly less angle than the 3/4 Langer - OPTIONAL

3/4 Langer Mini-Five - SL3/4MF - for upper posteriors (maxillary) - Slightly more angle than the 1/2 Langer - BUY - ZERO READY KNOWN SUBSTITUTES FOR THIS CURETTE - BUY

5/6 Langer Mini-Five - SL5/6MF - for front teeth (anterior) - blade is fairly straight - In fact both blades angle so little they are identical - BUY OR SUBSTITUTE

ALTERNATES FOR FRONT TEETH -  This is basically a curette that is straight up and down. Without any significant bends in the upper or lower shank, angles or corkscrews. Universal or Gracey or both.

Periodontal curettes can be purchased on Amazon - periodontal curette - and through dental equipment dealers. Manufacturers and many dealers do not sell to the public. Wholesale to DDS only w license number. But curettes are legal to buy and many dealers will sell to the public. Just search for exactly the tools you wish to buy and do not think some other curette will be better. Unless you want a bunch of curettes you won't need. Also can check out cheap curettes on eBay. In particular look for - After-Five - Extended Access - Mini blade - with my best recommendation still on the 3/4-Langer-AfterFive-Mini for the posteriors to start. Then fill in the gaps in the kit with the curettes you want that address the particular issues.

PDT Dental Technologies (Missoula Montana) manufactures some good stuff - catalog
American Eagle ((Missoula Montana) also makes great stuff - catalog

SICKLE-BLADES - WHY? -  IT IS LIKE A SWORD - PLUS GOOD FOR BRUTE STRENGTH - Two issues. One is the end points straight. So there is a long edge for the blade. So you don't really have to do much figuring on where the blade is. It's right there. Second is you can apply brute force and it does not break. With conventional curettes apply enough force and the curette will snap. And likely slice you up at the same time. Same goes for sickle blades. They will slice you up too. But if all they slice up is air then no damage to soft tissue to you.

PDT - MINI-ME - STRAIGHT SICKLE BLADE - is great - it has a sickle on one side and the Langer-5 on the other - So it addresses the Anteriors (front teeth) nicely. Plus this particular sickle is fairly thin.Nice thing about a straight-sickle blade if you can get the angle right is it is reasonably easier to visualize where you are. This makes it helpful to articulate a difficult and treacherous area by feel. Especially if you have any thoughts about applying brute force at a particular time. Which if you get just the right opportunity you just might. And risk getting sliced up to dislodge some monstrous calculus king-pin.

PDT - MONTANA JACK - OFFSET SICKLE BLADE - I LIKE FOR FRONT TEETH - UNCONVENTIONAL APPLICATION - SUPPOSED TO BE FOR POSTERIORS -  So can do sickle work in the posteriors. Here I am neutral. Since it is also awkward around corners. I usually prefer the Langers and don't want to use brute force on curved areas anyway. Second application which I like a lot is detail work on anteriors. Here the sword-like properties of the sick give it good penetration. Plus the point-part is good for dislodging things. Plus the offset angle gives good clearance past the front teeth.


GRACEYs - The basic short set is - 1/2 for anteriors (front teeth) - 11/12 MESIAL -  for front of molars - 13/14 DISTAL - for back of molars - Here both AfterFive & Mini are good. One option is to go more conventional for the bulk of the debridement. Then go for more detailed instruments as the work gets into finer and finer detail. Which can also alleviate sharpening issues. If people don't want to or find it too difficult to sharpen their curettes. Since don't want to lose sharpness right when getting into the most detail. So idea here might be to start off with some quality but cheap curettes on eBay then switch. Could also simply buy two of the 3/4-Langer-Five-Mini and save a second curette for later detail work only.

ADDITIONAL CURETTE - Something pointy, something sharp, something curved and thin and sickle-like with a slight corkscrew twist. Neo-Medieval. No way to make a mistake and think it's a friendly blade. Standard classic example is the McCall 13/14s. With a curved sickle narrowing to the point. With a slight corkscrew to accommodate different angles of attack. That can catch an edge of calculus and flip it away from the perimeter and down the drain. These types of curettes have sharp tips. Which comes in very handy but can also cause damage. In particular the pointy end is good for prying calculus off that is right next to the bone or nerve. Where every move is very delicate and very dangerous

LIST OF UNCONVENTIONAL CURETTES AWAY FROM THE BEATEN PATH OF GRACEYS - TO BE USED MOSTLY FOR DETAIL WORK ONLY AFTER MAIN DEBRIDEMENT HAS BEEN COMPLETED AND HEALED

PDT - MONTANA JACK SICKLE BLADE - is a curved sickle similar to the McCall 13/14s. But w more extended access and a longer blade. It isn't really a substitute for the McCall because its larger size tends to make it more awkward in shallower curved pockets. But it has great penetration and does particular well on deep sweeping curves.

PDT - OHerir 1/2 Extended Access - unconventional curette - for detail work and access down long narrow passages. Possibly for abscess corridor strategy work too. It has a small disc at the end of a long straight shank. So it can mess things up nicely in the bacteria world and shake stuff loose through both light scraping and agitation.

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PREMISE - DIY WORKS - POST SRP - The premise of DIY Perio is that it is possible for people with fairly severe periodontal disease to learn to debride their own teeth under the gumline by themselves. And hence help remove the nasty debris under their gumline that is causing their periodontal disease. But that the original primary task of Scaling & Root Planing (SRP) with periodontal curettes is quite close to impossible. Plus dangerous too. The main reason for this is calculus ledges. Which are thick, hard and deep and close to impossible to remove, ie. debride.

So let the hygienist tackle the calculus ledges. And go looking to remove random pieces of crud instead. Start with the toothpicks and then work your way up as far as you want to go without causing damage. And also keep in mind that not all that appears to be damage is really extreme damage, as long as you don't break something off or really do something bad. And that even if you do cause what appears to be serious harm but really isn't then it will tend to heal itself up in a few days or few weeks anyway. And sometimes damage is simply the price that has to be paid for debridement. Just don't damage any nerves or bone or sinuses or blood vessels. Or get confused and think bone is calculus. Or end up attempting to break off a portion of tooth, thinking it is calculus. Lots of ways to screw up. But most of the time the screw ups will heal eventually and you will learn not to make the same dumb mistake again. Hopefully. Sometimes the risk of the dumb mistakes cannot be avoided. Especially when things get dicey and honestly scary.

Such is the risk and danger of a DIY attempt to stop the periodontal disease and save the tooth or teeth or rack of teeth. Or deal with the much more serious damage of abscesses and holes into the sinus. Where DIY also has applications and where dental professionals might sometimes be short on solutions that are not very expensive and without a lot of cutting and tooth loss.

But... if and only after the periodontal hygienist does a full mouth SRP, typically costing $800-1200, or roughly $300 per quad, with the gums on anesthesia, ie. novacaine. That way the hygienist can go in deep and debride away the calculus ledges. These ledges are mostly ignored during standard cleanings and buildup over the years. Then they finally blow out as periodontal disease. Also, all the talk about how there are no symptoms is false. The symptoms are bleeding gums. Which then get ignored. Until too much damage gets done and the person is in big trouble.

Also, once the disease gets below floss level it is very difficult to stop without removing the calculus ledges. But certainly flossing everyday is good. Plus no sugar. And it does seem possible that good hygiene can help starve out the deep calculus ledges. And help keep them relatively benign. But also remember that the ledges can feed off of blood. So they will continue to infiltrate down the side of the tooth.

To summarize... over a period of time... through various means... starting with brushes, toothpicks and brush-picks. Then possibly leading on to the explorer. Then considering more powerful tools. Such as the debridement needle.  Namely the Gracey and Universal curettes.

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DEBRIDEMENT NEEDLE STRAGEGY - Can also use the debridement needle or toothpick or brush-pick to disrupt the infection in the center. But without quite so much mechanical destruction as with the curettes. THIS CAN ALSO BE CALLED DRAIN THE DOG OR DRAIN THE HOLE. But don't fool yourself into thinking you killed the dragon when all you really got was the tail of the dragon or the TIP OF THE ICEBERG. Be open minded - THINK THERE IS ALWAYS MORE UNTIL THERE ISN'T.

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CORE CURETTES - NUKES OF DIY PERIO - Graceys 11/12 & 13/14 - McCall 13/14S - Langer (Universal) 3/4 - Including Standard & After-5 Mini & Gracey Micro-Mini

OPINION - FORGET ABOUT GRACEYS. DON'T EVEN LISTEN. JUMP FORWARD AND GO FOR THE UNIVERSALS. THAT WAY YOU WILL NEVER EVEN KNOW WHAT YOU ARE MISSING. AND WHICH WASN'T WORTH IT ANYWAY. REALITYLAND - GRACEYS ARE EASIER BUT LESS EFFECTIVE. LAYERS SUCK. UNIVERSALS ARE MORE DIFFICULT. BUT WILL BREAK CALCULUS OFF IN LARGE CHUNKS. CHUNKS ROCK. CASE CLOSED.

UNIVERSALS - Universal curettes are already set at 90 degrees. These curettes will tend to catch onto any imperfection and can be difficult to try to move around. But once they catch hold on a calculus ledge there is a good chance to hang onto the hold and break off the calculus. Or even break off a chunk of jaw bone. Which would obviously be bad. Unless it was doomed anyway. But who is to say. Ask your periodontist.

BUY - LANGER 3/4 MINI-BLADE EXTENDED ACCESS -  AS PRIMARY CURETTE - EVERYTHING ELSE IS OPTIONAL - SINCE THIS CURETTE IS SO ADAPTABLE.

GRACEYS - Gracey curettes have a blade that trails off at an offset angle of 70 degrees. So the blade must be angled in an additional 20 degrees to engage at 90 degrees. In addition the handle is bent to the hygienist can judge her angle by whether the handle is parallel to the tooth.  What this means is the blade is fairly easy to move around. But to get it to engage well with a troublesome piece of calculus is very difficult. And more often than not the blade will slip anyway and you will just end up burnishing and polishing the calculus so it gets even more impossible to remove. I love Graceys but think I am now a bigger fan for Universals. Especially for the After-Five Extended Access Minis. Which focus a lot of power deep and tight.  I am a big fan of both Hu-Friedy and American Eagle Instruments Inc

THIN CURVED SICKLE - w SHARP TIP - UNIVERSAL - Good for POSTERIORS - Prime example is - McCall-13/14-S - for sharp tip. Many folks consider the -  Montana Jack Sickle Scaler - with its greater reach and slightly shallower curve to be superior. The sharp tip is more dangerous but is also able to go in deeper more easily and also debride in close proximity right next to the nerve and bone. But have to be more careful about causing more serious injury or death. OUCH.

THICK STRAIGHT SICKLE - Typically these look like a straight-forward miniature replica of something that must have been carried by some medieval guard. They are good for applying massive force into a small area. Since they will not deflect under stress, and then slide out of a catch, like a typical periodontal curette will do. They can also cause massive damage and injury if they slip.

HOE - These are supposed to be used to destroy gigantic ledges of calculus. They go straight in. And have a short blade at the top angled 90-degrees right at the top. Reasonably they should be good for liberating any areas with massive amounts of calculus. But they are also large and cumbersome. My general opinion is these could be the answer for areas that have massive calculus ledges. Possibly even to dislodge iceberg sized pieces of calculus instead of scraping off the tip of the iceberg so much of the time.

 
TOP-BUY - EXTENDED-ACCESS - AFTER FIVE mm - The shanks leading the blade into the pocket are longer.

GRACY-1/2

PERIODONTAL CURETTES - The two main types of curettes are Gracey. Which has a blade that angles away from the tooth. Which much be angled towards the tooth to engage.

Plus the Universal Curettes. Such as the Langer 3/4. Which have a perpendicular blade. Which can catch on the calculus ledges without slipping as easily as the Gracey. Idea being not to try to fight the ledges too hard. But rather to try to dislodge and break them off in large chunks. Rather than have to try to peel off the calculus layer by layer. Which ends up taking a long time. But the chunks are almost impossible to break off without a big fight. And possibly with the curette slipping and cutting right through the gum. So there is a big dilemma. How to get the calculus to break free. So good idea to study the book a lot before trying anything. Also to practicing with toothpicks and proxy brushes and possibly with the irrigation syringe too. Then if you feel up to it to try out the Gracey and then finally the Universal.

The most important curettes: The Gracey 11/12, for the fronts of molars. Which has a sort of "push stroke." The Gracey 13/14 for the backs of molars. Which has a "pull stroke." Both of these curettes are also highly adaptable to other regions. Coming almost to resemble long reach toothpicks.

The Gracey 1/2 for the front teeth. Plus the angled Gracey 7/8 is reasonable too. The other three Graceys, the 3/4, 5/6 and 9/10 aren't really necessary. Since the four mentioned are so adaptable. Also for the more detailed work it is good to have these curettes in the After-Five (deep pockets) Mini versions. Plus both Hu-Friedy and American Eagle have curettes that don't need sharpening.

- FORGET ABOUT GRACEYS FOR DEEP THICK TENACIOUS CALCULUS
 - GO UNIVERSAL (?)

Also, think I screwed up by mostly using Gracey curettes rather than Universal curettes to remove thick calculus ledges. This caused me to lose a lot of time only being able to peel away the layers of calculus. Universal curettes are somewhat more difficult to work with than Gracey curettes. They tend to catch on every little imperfection of the tooth.  And it can be very difficult to figure out where you are and what you are doing. Plus have to have the confidence and know-how to be able to safely give it a tug without ripping up your gums. But nonetheless, can catch edges of calculus, working in from the edges, and do the so-called "ape hanger" routine.

Meanwhile the Graceys have an edge that trails off at 60 degrees. trailing edge that is easier to work with. The blade is engaged

m is completely wrong. And that only the Universal Curettes will work. Such as the Langer 3/4. Also like the McCall 13/14S. Which has a sharp knifelike tip. Which is good for cutting away calculus along the gumline. Plus also planning to get a periodontal hoe. Which is very narrow. And can be inserted into deep holes. Also looks like the hoe might work for calculus ledges too. Idea being that if the force is concentrated enough it should help to break off the edge. Makes sense. Will find out. Planning to get the ...

Also, for very fine and deep work, especially in periodontal disaster zones, like the Hu-Friedy Micro-Mini After Five Graceys. 1/2, 11/12 & 13/4. But these instruments are too delicate to use for any rough work. So... the sequence is from the rougher instruments, like the normal Graceys, Universals, plus possibly the hoe. To the After-Five Graceys & Universals and then finally to the Micro-Minis. To get into the deepest areas and delicately debride. Then finally include the irrigation syringes. Which can go deeper than any of the other instruments. And avoid damaging things, especially the nerve. And avoid jamming the curettes into the sinuses.  

In a nutshell: All the curettes operate with a pull-stroke. Object is to angle the blade of the curette at approximately a 90 degree angle to the tooth. Which curves. A shallower angle will tend to cause the curette to skip over the top of the calculus. A sharper angle will tend to cause the curette to gouge the tooth.

There are a number of books on the subject. For a general idea google - where there is no dentist - which is available online for free. To get the general idea. Also can go to half.com ir eBay and search for books on dental hygiene. Reasonable quality books that describe all the procedures cost anywhere from $5-$25. But if you are trying it on yourself there is always the risk of slipping. So have to be realistic about what is possible. And what is too ambitious and dangerous.


WHICH ONE TO USE? - So one might ask - Then what good are the Graceys? Think my answer would be ease of operation. Plus getting into nooks and crannies. Plus think the Universal curettes are more potentially dangerous. Since they tend to bite in so hard. But I have tried both and finally years later have decided that I spent too many hours using Graceys and not enough using Universals. Think I could have made things go a lot faster if I had used the Universals as the more primary curette. Specifically the Langer 3/4 After Five Mini.

CORKSCREW CURETTES - It is simple enough to see that the curettes are shaped like corkscrews. Only with fewer bends. The corkscrew shape enables the curettes to fit around the corners of the tooth and still allow the handle to stick out of the person's mouth. Similar it is easy to visualize the difference between a right and left hand corkscrew. or curette. Essentially the working tip starts by coming out of the handle at some angle. From here it can angle off either right or left.. Then repeat in the same direction until reaching the blade. At this point the blade can be either on one side, like the Graceys, or on two sides like the Universals.
angles off.

I pretty much believe in having three sets of curettes for the two main Graceys, the 11/12 & 13/14. Reason is the deeper and thinner instruments are more delicate. So start with the Regular. Then switch to the After Five - Mini. Like the American Eagle XP or Hu-Friedy Eversharp. Then finally as the penultimate, switch to the Hu-Friedy Micro-Mini. Which can ultimately slip their way into the deep nether regions where the kernel of the disease is hiding and bubbling away. Plus the needle. Which can go in even deeper. Then add on at least one Gracey 1/2 --

Could also just start out with the - Gracey 1/2 - Gracey 11/12 (or more angular 15/16) - Gracey 13/14 (or more angular 16/17) - all Extended or After Five - all Mini - also like the fat handles.

COUNTERPOINT -- But isn't this expensive so many curettes? Yes... need to rethink. Plus not as exited about the Graceys as I used to be. Think they might be good for training, almost like a trainer airplane, then switch over to the high-octane model, the Universal Curettes. Topped off by the Sickles, which are like swords and also seeming to be very guillotine-like. Which are both certainly more deadly to be sure, but realistically who wants to spend dozens upon dozens of hours scraping their teeth? Once people know what they are doing perhaps isn't something more deadly in order? As long as it is respected properly. Can't help but agree.

TOP BUY - Explorer. Good for investigations and minor debridement. Generally for any serious pocket whatever the explorer might liberate is typically the tip of the iceberg. BUT... the explorer also offers an avenue to become more nosey about your teeth, snooping around and writing stuff down, and then going back to your hygienist to give the area a good cleaning. Or you can switch to the toothpick. etc.

TOP BUY - The McCall 13/14s,     S is for Sharp Point. With the curved hook and pointed tip is also highly practical for gouging away at thick ledges.

TOP BUY - ALTERNATIVE TO McCALL
***TOP BUY - The Universal Hu-Friedy - Langer 3/4 Mini Five - SL3/4MF -- This particular After-Five Mini is a godsend against tenacious calculus on the molars. And can also be adapted for the front teeth. It is a rare beast and well worth the retail purchase of around $35. Why is it so good? Let me count the ways. First it is universal. So it can go head to head against tenacious calculus and win. Second it is an After-Five. So it can reach the innermost problems. Third it is a Mini, ie half-sized blade. This gives it both the extra reach for tight spots plus the focused energy. Plus the blade should be naturally both thinner and stronger. Only weakness is it is only available in a regular handle and does not seem to be available in the fat handle type curettes. SUMMARY - TOP BUY - Indeed this particular curette is adaptable in various ways for the front teeth too. It won't do everything. But it comes pretty close.


I also kind of like the LM Furcator. Which is a specialized instrument designed to lightly debride furcations. Resembling a furcation probe with a tiny shovel at the end. Though it can't really do much against calculus it can disrupt things and dislodge loose debris. Which is a good start. To get the crud from as many sources as possible.

WHAT ARE MY MAIN STROKES or TUGS?

IDEALIZED STROKE OF THE HYGIENIST - The dental hygiene books describe a finger rest and fulcrum resembling a finger rest in billiards. For hygiene the object is leverage. Presumably this means that the fingers can be used as lifters. But more commonly the strategy is to roll over the objective.

The idealized stroke the hygienists use is to angle the blade properly at one of the sides of the calculus ledge and similtaneously slip the blade under the calculus ledge and twist the blade at the same time. The result is the ledge breaks off in a chunk. Breaking ledges off in layers is to be avoided. Reason is there are so many layers it slows down the job almost to an apparent standstill. Since hygienists do not have the time to spend very many minutes on a single location to clear it out as completely as possible.

But the finger rest is backwards for DIY. My experience has been to work ad hoc. Wishing I had a great idea but otherwise doing the best I can with available resources. Leading back to the premise of the difficulty of breaking off calculus ledges.

Technically I probably could learn to do a finger bridge. Will give it a try. But otherwise do use various parts of my face as a bridge or sometimes just tug in the middle of the air.

IT'S LIKE FLIPPING A HOCKEY PUCK - COMBINATION OF PRECISE & FORCEFUL SHOVE & FLIP - All the dental books say to first find a particular calculus ledge, then to find the edge, then to break off the ledge by using the finger as a fulcrum to pull back on the ledge with great force. Ideally there is also some type of windup, where the energy gets applied in a jerking twisting motion. But it can only go a short distance or there is risk of slipping and possibly causing injury. So in practice this particular move is fairly difficult even for a skilled hygienist.

For a DIYer getting the leverage is significantly more difficult. My experience is that I can't really do this move at all. Reason being that I hold the curette at whatever angle is needed to maintain control over where it is going. But the angle might not be such a great one for gaining leverage. So my experience is that while oftentimes I can get just the right angle to fairly passively dislodge a piece of calculus that the tenacious calculus ledges are very difficult. So what do I do?

 THE PENDULUM - This is one of my main moves. Here I will attempt to engage the blade into a calculus ledge. Which then becomes a pivot for swinging the free end of the curette. Result is that the engagement point gets a tugging from several different directions. Which might be enough to dislodge some serious crud and calculus.

MIN-PENDULUM W TOGGLE - This one is primary too. Idea is to get a secure hold on a calculus ledge and try to dislodge it without using too much force. Different angles and light jerks then give the calculus ledge an opportunity to free itself and evacuate the tooth. Oftentimes resulting in serious mother lodes, ie the combines for the entire empire.

FIST FIST PULL - This is one of my most normal moves when I am either probing or attempting to engage. Here I will use my right hand to hold the curette in a fist. Then I will use my left hand like a bridle to control the right fist. Mostly the curette is manipulated with the fist in free air. Then, when something is discovered the challenge becomes to try to find a hand position that can gain leverage on the calculus. Here the fist can be stabilized by grabbing the face or pushing against it.

FIST SQUEEZE - This is a fairly primary move against calculus ledges. Where the issue is gaining leverage. Here the curette is engaged against the calculus, and is held in the fist which is pushed against the jaw. When the fist is squeezed the force against the calculus increases. Often helping to break off the calculus. But calculus oftentimes responds better to short and quick movements. Which this is not. Rather the approach here is brute force. With possible wiggling. But have to make sure that any slips are most short. Or the damage could be bad.

JAW-PULL - I have started liking this one more and more. But it can be pretty scarey. Especially if you are determined that a particular calculus ledge will break one way or another. For the upper teeth the lower jaw can pull down on the hand and act as an upside down crane. Likewise for the lower teeth pulling the lower jaw down can can the curette to pull up on the calculus. This can lead to the ideal object. Which is to break off the calculus in large chunks or slabs. And not layer by layer. Without a few lucky breaks thee is not much choice but to scrape it off layer by layer. Reason is the calculus becomes "burnished" or polished. So the blade will tend to slide right over the calculus and not properly engage for debridement.

DANCING BACKWARDS - Here I attempt to work the curette into the pocket while pulling the curette just a little back out. Thereby cleaning out a small flat area that can be expanded. Object here is to create a clean field. Almost like a landing strip. That can be used as a base to clean the surrounding areas. Plus it also represents tooth. As opposed to bone. So can avoid ripping out stuff that might be better left alone.

RAW BRUTE FORCE - w BACKSTOP - Have to be careful here. Since a slip could slice right through the gum. So what I will tend to do is to try to create a moment of instanteous pressure that only lasts for a moment.

BREAK THE CALCULUS - WHAT DO HYGIENISTS DO?? - Hygienists basically use their thumb and forefinger to hold the curette, much like a pencil. Then use their other three fingers, plus the momentum of their hand as a kind of springboard. Which then applies the pressure from the blade to the edge of the calculus. Then.... right when the blade is starting to engage they do this funny twisting manouver which catches the edge of the ledge just right to cause the ledge to break suddenly. You can think of this as akin to a professional golfer.

WHY NOT DO THIS ON DIY ?? - But... the DIY person doesn't get the same leverage as the hygienist. Everything is backwards. Plus they can't see what they are doing and have no idea where they are. So any "sudden springboards" and "fancy twists" are not so easy. And can even be dangerous. Since the curette could slip. Also BTW, most hygienists don't do such a great job on this particular move either. Otherwise cleaning teeth and getting out the deep calculus would be a breeze. But rather, just to say, the point is that the ideal stroke is also the most difficult to perform. And typically leads to inadequate results.

WHAT DOES THIS MEAN? It means that the ideal professional stroke to break the calculus is typically more of an ideal than a reality even among professionals. And for a DIY is more of a pipe dream than anything else. Meaning the DIY has to put up with poor and inefficient means to remove the calculus in layers instead of soaring in a dream made reality of braking off the calculus in chunks. Basically breaking calculus off in chunks makes life a lot easier. But the unpleasant real reality is that most of the time just had to take the calculus off in layers. Which is exactly the wrong way to do it. But it was the only means available since the right process - breaking off the calculus in chunks -  was so difficult to impossible to perform.

Also keep in mind that the calculus can provide almost limitless numbers of layers. Just imagine it. Like some geologic world. Where you peel through one layer and then lo and behold there is another layer right below it. And then continue this process indefinitely for an hour or so and you will get an idea about what a total pain it is to not have much luck with breaking the stuff off in chunks, or getting what you can, and then having to get the rest of it out in layers. Not fun. Very time consuming too. Like hours and hours for one area.

SUMMARY OF STROKES - Certainly do the best you can to break off the calculus in chunks. Like said, like The Pendulum for this task. And if you can somehow build up the leverage and deftness to break off the calculus in chunks - likely using the Universal Curettes - then great. But otherwise if you get stuck trying to peel the calculus off in layers because that is all you can figure out to do then that has to be the way it is. Even if it is highly incomplete and leaves a lot of calculus behind. You can get more next time. Even if it takes months and months. And can compare against the question of taking a long view, since the teeth will either stay or get lost for a long time. That's the reckoning to compare the hygiene tasks to. So if it takes hours and hours just to get one area clean and you imagine that it would have gone much faster in chunks than that is just how it works out. And better skill next time.


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DANGER SECTION - WARNINGS - RISK OF DANGER OR DEATH (bacteremia) - DANGER OF INJURY - DANGER OF DAMAGE OR LOSS TO TOOTH & JAW

BIGGEST RISK - ANATOMY OF A MAJOR SCREWUP - LOCATION IS BETWEEN UPPER WISDOM TOOTH AND SECOND MOLAR - IF THE CURETTE SLIPS FROM THE OUTSIDE TO THE INSIDE ALL THE WAY THROUGH AND BECOMES TRAPPED IN BETWEEN THE TEETH - UNABLE TO REMOVE - CHEEK IS PRESSING AGAINST THE CURETTE HOLDING IT AND PUSHING IT AGAINST THE TEETH - PANIC SETS IN - DANGER ARISES - WITH LIKELIHOOD OF PANIC AND DANGER TURNING INTO A FULL FLEDGED PANIC ATTACK - This has happened to me on numerous occasions. Getting a curette stuck in my teeth with no apparent way to remove the curette. With possible danger that the curette will become jammed and become even more difficult to remove than it already is. With the panic and fear rising up and taking over the mind. Leading to possible aggressive action almost autonomously. Thereby causing damage. With the curette still stuck in between the teeth. I get shivers and waves of fear just thinking about it. SO WHAT WILL YOU DO IF YOU GET INTO TROUBLE?? HOW WILL YOU MENTALLY PREPARE YOURSELF FOR WHAT TO DO IF YOU ENCOUNTER ACTUAL DANGER?? Before you even attempt to do anything at all you should have already worked out your plan about what to do if you are both in danger and you panic at the same time.


REMEMBER - Curettes are stronger than teeth. So you risk breaking your tooth if you force the curette.

REMEMBER - IN CASE OF ANY TYPE OF PANIC - LET GO OF CURETTE - OR AT LEAST LOOSEN GRIP - CURETTES CAN ALMOST ALWAYS BE LET GO FAIRLY COMPLETELY.

REMEMBER - PANIC ATTACKS ARE THE MOST DANGEROUS PROBLEM - EVEN ONE MOMENT OF EXTREME PANIC WITH HAND ON CURETTE CAN LEAD TO VERY VERY POOR JUDGEMENT, SPONTANEOUS MOVEMENT OF HAND AND GRIP AND SERIOUS DAMAGE AND INJURY TO TEETH, BONE AND SOFT TISSUE INCLUDING NERVES AND SIGNIFICANT BLOOD VESSELS.

SUMMARY - ANYBODY WHO WANTS TO CLEAN THEIR OWN TEETH HAS TO FIGURE EVERYTHING OUT FOR THEMSELVES. FIRST SUGGESTION IS TO STUDY VIDEOS ON YOUTUBE THAT SHOW HOW DENTAL HYGIENISTS USE THE VARIOUS CURETTES.  CAN ALSO LOOK AT LITERATURE FROM DENTAL SCHOOLS, MANUFACTURERS ETC. THE ACTUAL ACT OF FUNCTION OF USING PERIODONTAL CURETTES TO REMOVE CRUD IS FAIRLY STRAIGHT-FORWARD. AT THE SIMPLEST MOST ELEMENTARY LEVEL. BUT ONCE THINGS GO DEEP IT GETS VERY SCARY AND DANGEROUS. SO IF YOU HAVE ANY DOUBTS THEN DON'T. OR ALTERNATELY YOU CAN START REAL SLOW IN ONLY THE EASIEST AREAS AND IF YOU FIND ANYTHING TOO DEEP AND SCARY THEN LET YOUR DENTIST OR HYGIENIST DO IT. OR OTHERWISE ACCEPT WHAT HAPPENS TO TEETH THAT GO BAD. (What DOES happen to teeth that go bad? Periodontally. Typically they end up getting pulled. If the disease is severe enough classic therapy is pulling the tooth. This halts the disease and allows the bone to regenerate.

NOTE ON DANGER - PANIC ATTACKS CAN BE DANGEROUS - In particular if a curette gets stuck. Especially dangerous is if the curette slips right between the tooth to the other side and can't be easily removed. At this point it is very easy for panic to set in and to try to forcefully remove the curette. Which is obviously dangerous. Hence it is very important to have a mental battle plan about what to do in case of panic attack.

ANSWER TO PANIC ATTACKS & GENERAL STRATEGY TO REMOVE STUCK CURETTE

- ALWAYS HAVE A MIRROR HANDY IN CASE OF EMERGENCY - ALWAYS HAVE SOMEWHERE YOU CAN LIE DOWN IMMEDIATELY - WITH SOMETHING TO SUPPORT YOUR HEAD

 - 1) RELEASE or LOOSEN GRIP ON CURETTE - LET GO OR HOLD IN RELAXED MANNER - OBJECT IS FOR CURETTE TO BECOME COMPLETELY NEUTRAL IN ITS ENVIRONMENT

- 2) RELAX - EITHER STAY IN CHAIR LIE DOWN ON THE FLOOR OR BED - SUPPORT ELBOWS SO HANDS ARE STABILIZED - SUPPORT HEAD AND ELBOWS IN A NEUTRAL CRADLE-LIKE POSITION. CHILL. THEN CHILL SOME MORE. DO NOT DO ANYTHING UNTIL THE WAVES OF PANIC SUBSIDE AND YOU CAN THINK IN A RATIONAL MANNER. REMEMBER TIME IS ON YOUR SIDE. YOU HAVE ALL DAY TO EXTRACT THE CURETTE.

- 3) ORIENT YOUR SELF TO CURETTE - NOTICE HOW OPPOSITE SIDES OF CURETTE ARE MIRROR OPPOSITES - MOVE CURETTE BACKWARDS - OR SLIP OUT

CAN ALSO GENTLY TWIST FROM SIDE TO SIDE - DO ANYTHING - JUST DON'T PANIC - AND BE PATIENT SINCE YOU WILL ULTIMATELY BE SUCCESSFUL IF YOU ARE PATIENT
STUCK CURETTES - GRAVE POTENTIAL DANGER - IF CURETTE GETS STUCK IMMEDIATELY RELAX GRIP COMPLETELY - NEVER TRY TO FORCE A CURETTE - STUCK OR NOT - ALWAYS CONSIDER A STUCK CURETTE AS AN EMERGENCY - THAT CAN QUICKLY LEAD TO A PANIC ATTACK & EXTREME DANGER - REMEMBER THE CURETTE IS STRONGER THAN THE TOOTH - BUT ALSO REMEMBER THAT A CURETTE CAN ALWAYS BE UNSTUCK TOO - IN A GENTLE MANNER - NO MATTER SOMEBODY'S STATE OF FEAR OR PANIC - IF THEY CALM DOWN THEY CAN SUCCESSFULLY AND SAFELY EXTRACT THE CURETTE WITHOUT CAUSING DAMAGE OR DESTRUCTION

PRIMARY DANGER-DANGER - CURRETTE GOES COMPLETELY PAST TOOTH TO OTHER SIDE AND IS NOW STUCK BETWEEN THE TOOTH WITH NO SIMPLE WAY TO REMOVE THE CURETTE AND WITH PANIC SETTING IN.
One especially dangerous situation is when the curette goes between the wisdom tooth and second molar and slips all the way past the tooth to the inside next to the tongue. What is the natural reaction? PANIC ATTACK. Yikes! You mean it will then become highly likely that a person will do something stupid and then possibly injure themselves? YES. ABSOLUTELY. FOR SOME PEOPLE IT MAY BECOME DIFFICULT NOT TO DO SOMETHING STUPID. OUT OF PANIC, ANGER OR FRUSTRATION OR FEAR.

ADDITIONAL DANGER-DANGER - NOT ONLY IS CURETTE STUCK BUT EVERY WAY YOU MOVE IT THREATENS TO LEVERAGE AGAINST THE TOOTH AND BREAK OFF THE TOOTH  - YIKES! - What does this mean?? What it means is that sticking curettes into your teeth is DANGEROUS - AND NEVER FORGET IT

OTHER DANGER - ESPECIALLY FOR WISDOM TEETH AND BETWEEN BACK MOLARS - IS THE LIP GETS IN THE WAY. And pushes against the curette and causes it to jam.  Again, solution is to relax the curette and relax the lip at the same time. SO HAVE TO BE EXTRA CAREFUL WORKING AROUND THE MOLARS FROM THE OUTSIDE NOT TO LET YOUR LIP JAM THE CURETTE IN A DANGEROUS MANNER.

ALWAYS RELAX LIBERATING STUCK CURETTES - So imagine the curette slips right past the tooth to the ligual side. You can't get it to come back. What to do. First, DON'T PANIC. Or if you do panic then make sure to either stay perfectly still or transfer yourself to the floor or bed as quickly as possible. Then calm down and evaluate the situation. What is the problem? FIRST -  is that the curette is pushing back the side of the lip. Causing major annoyance and fear. So CALM DOWN & ACCEPT & POSITION YOUR HANDS IN A COMFORTABLE POSTION IN A LOOSE GRIP & STRETCH TIME.  SECOND - is VISUALIZE - what is the right position for the curette to get it to slip back? Also to realize that this is really the only practical solution. To remain calm, figure out the problem and extract the curette. First get it to slip back past the outside edge of the tooth and back between the two teeth. Then get it to slip out. THIRD - Look at the opposite end of the curette and fully understand the CORK-SCREW EFFECT - Meaning that whatever you do to the opposite end of the curette will also happen to the problem end that is stuck. In a perfectly mirrored way. FOURTH - Try everything in a calm rational manner. Do it over and over again. Very slowly. Don't get frustrated. Eventually what will happen is you will do it the right way and the curette will literally pop out of your mouth. YOU ARE FREE!

ALWAY RELAX REMOVING STUCK CURETTES - LET GO OF CURETTE (!) - Also don't try to remove the curette in an unconventional manner or else you may be doubly-screwed. REMEMBER - Conventionally curettes always point inward towards the bone and away from the crown. If you forget this one then you could possibly get the curette back in between the two teeth but not be able to extract it? Don't know. Maybe it can work, maybe not. But removing the curette in a conventional way, pointing towards the bone, should always work, mostly. Eventually Hopefully. Et Voila! YOU ARE FREE!     OTHERWISE YOU MAY HAVE TO CALL EMERGENCY WORKERS TO FIGURE OUT HOW TO REMOVE THE CURETTE.

DANGER OF STUCK CURETTES - ALWAYS STRETCH TIME - What difference does it make if it takes an ten extra minutes out of your life to extract the curette? Even if it took an hour, would that make a difference? What if you were crying and fearful but you succeeded anyway? - NO - Hence you will be able to eventually extract the curette. Have no doubt about that. KEEP YOUR HOPES UP!  What about the fear? Or what you might interpret as the depth of fear. It is hard to say. BUT it is important to remember. IT DOES NOT MATTER HOW STUCK A CURETTE MAY SEEM. ALL YOU HAVE TO DO IS TO GENTLY GUIDE IT GO BACKWARDS EXACTLY THE SAME WAY IT WENT IN. TRUST IN THAT TRUTH AND YOU WILL BE FREE. And then never forget to always respect a stuck curette but know you can always win and extract it without damage no matter what. This is also what is known as CONFIDENCE and BUOYANCY. In spite of what may seem like negative odds. Or strange instantaneous panic attacks. Since the odds only appear negative. In reality they are in truth favorable.

FEAR IS A MENTOR - It is also important to remember that fear is sending you a message that is always to be respected. In the case of curettes the solution is always to...
 EXIT IMMEDIATE SITUATION - AS SLOWLY AS POSSIBLE - SLOWER IS ALWAYS FASTER FOR SHORT DISTANCES - ESPECIALLY SINCE EXTREME FEAR ITSELF IS SO DANGEROUS.

REAL VERSUS PERCEIVED REALITY - Now afterwards the comparison of the fear and reality might not match so well. In particular somebody might feel they were too fearful. Or how close they could have come to true panic and its possible consequences. Almost like instant ptsd. Over a tooth! Or really over a stuck curette that did not look like it would become unstuck. But finally did. Thank god. Or they were doing something stupid and weren't fearful enough. But nonetheless the general idea is to always respect fear. Anyway, there is something about the self-feedback of fear that functions as a guide. Which also works in opposite. Which is to use absence of fear to become more aggressive. Whatever. Or maybe it is that there is some fine feedback that needs to be nurtured and developed. And fear is as good a starting point as any. With the mantra - How afraid am I? Should I try to tug on this calculus or could it be bone? Hmm. OR It is starting to hurt a lot. Am I too close to the nerve or is the calculus transmitting the pain impulse to the tooth? So maybe I could compromise and break off the calculus a little bit at a time instead of risking an unnecessary chance of  being too close to the nerve? Yes, that is the idea. GO SLOW

GO SLOW - EXPAND TIME - TURN ONE SECOND INTO TWO SECONDS OR EVEN THREE OR MORE SECONDS - Our society has a general bias in favor of doing things as quickly as your skill level is capable. As a result people tend to rush and to things in a hasty way. This can lead to tragic errors, like damaging the tooth nerve, or even a major serious tragic error like damaging the Tri-Geminal Nerve.

REVIEW - TRI-GEMINAL NERVE - SUMMARY

Maxillary Tri-Geminal Nerve - Is located on the floor of the sinus and is really close to the tips of the teeth. Especially if there are any abscesses, burst or still intact, in this upper tooth maxillary area - ALSO KNOWN AS THE TRIANGLE OF DEATH -  Any fussing right around the root tip and nerve of the tooth could cause adverse effects or damage to the Tri-Geminal Nerve... BUT... for most people the Tri-Geminal should be tucked away sufficiently well that you will probably not damage it or even get close to it. BUT IF YOU FEEL SEVERE PAIN OR TINGLING - EITHER GO SLOWER OR STOP.

Mandible Tri-Geminal Nerve - Is also located fairly close to the root tips of the lower teeth. Here the most likely danger is if there is a deep pit or crater between the molars. YOU MAY EVEN GET A SENSE THE PIT GOES ON FOREVER = DANGER.

THE CRATER GOES ON FOREVER - WHAT DO I DO?? In my opinion pits or craters are always to be treated very delicately. ONE NEVER KNOWS DOES ONE? NO ONE DOESN'T KNOW. So what is the answer?

USE BULLS-EYE STRATEGIES TO GO AFTER PITS? Plus possible holes into the sinus. What is this? Idea is to circle around the particular dicey area but don't go right into the middle of it - THIS IS ALSO CALLED THE BIG O - Idea is to clean around the edges, then give the area time to heal and get stronger and capable of surviving more manhandling without serious injury, then to go in some more eventually gathering the courage and favorable probability to be able to go right into the center or real close without injury. Or if there is injury it won't be as bad as it would have been if the entire area was still seriously infected. SUMMARY - GO AFTER THE INFECTION FIRST. LET HEAL FOR AT LEAST TWO WEEKS. THEN GO FOR THE CENTER.

P

NO
www.diyperio.com

tom@diyperio.com

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