REGULAR DENTAL GLOSSARY - diyperio

TOOTH ORDER - 1-32 - Start at upper right wisdom tooth. From your own perspective go counter-clockwise. Think in terms of Quads.
Upper-Right Quad - 1-8 - Molars 1-2-3 - Bicuspids 4-5 - Eye Tooth 6 - Incisors 7-8
Upper-Left Quad - 9-16 - Incisors 9-10 - Eye Tooth 11 - Bicuspids 12-13 - Molars 14-15-16
Lower-Left Quad - 17-24 - Molars 17-18-19 - Bicuspids 20-21 - Canine 22 - Incisors 23-24
Lower-Right-Quad - 25-32 - Incisors 25-26 - Canine 27 - Bicuspids 28-29 - Molars 30-31-32

MESIAL - Toward the center line of the face.
DISTAL - Away from the center line of the face.
LINGUAL - Towards the tongue.
BUCCAL - Towards the outside.

DIY PERIO GLOSSARY - much of this is make-believe terminology that I used to describe the various phenomena. In some cases they have real-life equivilents. But in other cases not or the professional way of speaking about them does not provide me with the explanatory visual description I prefer.

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- STOCKHOLM SYNDROME - OPEN UP THOSE GUMS, WON'T YOU? - ROAD TO BAGDAD/MOSCOW/BERLIN - IMAGINARY BONE - This phenomena is truly the entire key to both severe periodontal disease and to the deep debridement that can reduce the infection. What basically happens is that when you are just getting started with the curettes the gums literally latch themselves onto the calculus. It is virtually impossible to even get the curette to pass by. Plus it hurts, a lot. But after awhile, like half an hour or even an hour the gums start to open up and you can pass the currette through the area more easily. Eventually the area will become completely open, so open it can even become dangerous, with nerves, blood vessels, sinuses, various ducts and what-not and all. WHY IS THIS? One possible explanation is the general stimulation. But I think the true answer is the toxins cause the area to become engorged with blood.

SPECIAL NOTE - This phenomona of things opening up is similar to what somebody might experience trying to remove a deep splinter or cleaning out a boil or regular abscess where everything is very tight and almost impossible to work with. Then like magic everything opens up and it is time to go to town - Like Right Now!! - and then after you finish everything closes back up again real tight. It is also the Road to deep debridement without actual surgery from the periodontist - Save the $$ - Save the Teeth - Save the Whales.

- DILATION - GUMS OPENING UP - This is the technical medical term for the phenomona of the scraping, plus the blood releasing, resulting in the gums opening up so the teeth can be curettaged at a deeper level and also for a general separation between the teeth and the overlying gums. Without this dilation the calculus and gums tighten up together. With the dilation you can go to town.

SPECIAL NOTE - DILATION - IS IT THE BLOOD OR THE SCRAPING? - Pretty sure it is the infected blood and general release of blood that prompts the gums to open up, rather than the scraping. But it could be a combination of both factors. WHY DO I BELIEVE THIS? Because if I scrape long enough areas open up that are separated from the area I am scraping. COULD THIS BE A GENERAL DILATION? Yes Yes! It is obviously a general dilation and not specific to a particular area. And Yes Yes! The area of the actual dilation gets bigger and bigger as curettage is continued. Leading to the strategy of GOING TO TOWN.

GO TO TOWN - This refers to the gums opening up revealing everything. Leading to long curettage sessions that take advantage of the dilation. Since once the gums open up then calculus that was previously unaccessible becomes accessible. Additionally deep granulation tissue oftentimes seems to float right up to the gumline where it can be liberated. HOWEVER... these curettage sessions may last for 8-10-12 hours and even longer. But be certain of one thing... IF you have the stamina to continue to go to town you will get more debridement accomplished and get better results. THIS INCLUDES ABSCESS DRAINAGE.

BUT WHAT IF I CAN'T GO TO TOWN? I'm too tired! I ran out of time! - Don't consider the situation lost if you get tired and stop. Just remember that you only got the job half-way done or maybe even less, even after 8 or more hours. Keep in mind that it may take 40 hours or more to debride a hopeless tooth to the point where it can survive. So are you going to debride for 40 hours straight? Like some Dance Marathon from the 1930s? Of course not! SO WHAT IS THE ANSWER? - The answer is to get yourself more and more hyped and gradually lose the willies over what you have to do. SHOULD I FIGHT THE WILLIES? Not necessarily, unless they last too long. Usually the hyping can overcome the power of the willies and when you are ready to go to town you will. Just be mentally prepared and have the time to debride for at least 5 hours and maybe even up to 10 or more hours. THEN... once you have debrided again for 1-3 hours the gums will open up again and you can go to town.

PANDORA'S BOX - BRAVE NEW WORLDS - NEW MESSES - TOO MUCH TOO MUCH - BRIDGE TOO FAR - This refers to the idea or concept of infected areas, ie large calculus structures, being similar to real life structures, which they are. But once you knock one building down, tiring yourself out in the process, plus traumatizing everything to boot are you going to open up new worlds? Likewise you can compare this to any job you are working on. Where you may find it good to finish the job you started before starting a new job. What is best to do? That depends on circumstances. If you have all day and a lot of energy go ahead and open up that brave new world. But keep in mind that you should ideally be able to carry it to a point of cleanliness that it has a chance to resolve. And not just whack the hornets nest and then leave.

HEART OF DARKNESS - 1 - Largely this refers to a deep area that also appears to be infected that opens up into another deep area that you also figure is infected. A good example here would be an oral-antral communication, which is a hole into the sinus. Which creates a dilemma. It has to be cleaned or it won't heal. But how do you clean it? The answer here usually is "bulls-eye theory" which says to clean the outside perimeter, then maybe take a chance and stick in the curette, but avoid getting brutal. Or alternately to "walk the dog" where you leak off the infection but don't attempt much in the way of mechanical disruption. My general emotional reaction when I find one of these areas is deep primal fear. Which seems appropriate. Then to do whatever business that needs doing. But with great trepidation.

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- VISUAL APPEARANCE OF STUFF THAT GETS DEBRIDED:

- DETRITUS - CALCULUS - TARTAR - Is the hard stuff, like calculus. It is also a very archeological word. Like the Seven Cities of Troy.

- EXUDATE - BIOFILM - BLOODY STUFF - Is usually not strictly blood. But rather blood products or whatever. Is the softer more liquid stuff. It is also the offspring of chronic wounds. Where the body liquifies or self-digests organic material into exudate. Through a process called Autolysis

- NICE PIECE - Is mostly calculus and not much detritus.

- GOOD SIZED CHUNK - Is mostly calculus, but is typically surrounded by a large amount of biofilm.

- GIANT BLOB - Is a piece of nastiness that has more exudate (biofilm) than detritus (calculus). But typically has a large core of calculus. Plus is typically stringy. And may contain multiple cores.

- LARGE & SMALL FLECKS - DOZENS & DOZENS - Smaller pieces of calculus, often in the dozens, that only add up to large amounts because there are so many of them.

- MONSTROSITY - GRANULAR TISSUE - CREATURES -  If the blob is huge and when rinsed off looks like a headless fish, then it is likely granular tissue. This is wannabe regeneration tissue. But it cannot fulfill it's destiny because it is infected. Or because it has no biologically compatable location to transform itself into successful biological tissue. Some granulation tissue may have a blood supply. Not sure about the rest. Largely it has to be debrided out because it has no future. Some day somebody may figure out how to turn it into something useful, like a stem cell or something equivilent.

- FACEHUGGER -  This is a combination of dead cementum and dead periodontal membrane that has gotten turned into a leathery thing that clings to the tooth and is very difficult to remove. You can imagine it like a thick leathery label. It resists shearing. I resists peeling. Plus it hurts a lot to peel it off because the cementum is in contact with the tooth tubules. The trick is to peel back its edges then get one of the surfaces to rise up. So you can work leverage against it like a bulldozer.

- NECROTIC PERIODONTAL LIGAMENT - DEAD PERIODONTAL MEMBRANE - LIGAMENT - Originally cementum forms on teeth and encourages the periodontal ligament to jam it with little hairs attaching two together. But then the bacterial toxins, auto-immune response, resorption and replacement of bone and healthy tissue with dead-end kid granular tissue kills it. Which causes it to turn into this flexible leathery stuff that is close to impossible to remove, that resembles a thick sticky label on a container. Which also prevents any regeneration from happening. Dead periodontal membrane tends to disintegrate when it can be curettaged. Rendering it close to chunk-less. So it's removal is then judged by the resulting smoothness, or obvious transformation of the tooth surface from a leathery skin-like feel into more of a rocky rough feel of cementum or a more glassy feel of clean dentin.

- DEAD CEMENTUM - Like the name implies, cementum is like a thin layer of cement or plaster on the tooth, that gets stuck with hairs from the periodontal ligament. Once the hairs die new hairs cannot grow into the cementum. The only successful regeneration strategy is new cementum forming from a clean edge of "living cementum" and healthy periodontal membrane. This phenomena is well accepted as a theoretical ideal that is difficult to impossible to achieve in practice. DIYPERIO describes this possible reality as more practical following "de-trenching the bone" activities carried out to their final logical sweat-equity conclusion over many many hours, months and even years of rehab efforts. ALSO... dead cementum tends to disintegrate or debride in small flecks rather than in any actual large pieces.

- TAIL OF THE DRAGON - This refers to what may initially appear to be a significant amount of released crud. But is it really significant? Experience shows that relatively small amounts of crud that seem significant may be followed by large releases that dwarf the original release. To the point where the original release was close to nothing relative to the larger amount. General point is not to think that any significant improvement has been made by any particular small release of crud. Though certainly the small releases pave the way for the large releases.

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NOTE ON TERM "SMELL" - Technically smell usually refers to taste. But I prefer to call it "smell" since it is a complex phenomona.

- SHAGGY DOG SMELL - WET SWEATER SMELL - SICKLY SWEET SMELL - This appears to be an indicator of active bone infection. General strategy is not to scrape bone too aggressively but rather to just brush it fairly lightly until it gives up its active infection.

- DEAD SMELL -(BAD NEWS) - Smells just like a dead mouse in the mouth. What is the source? Dead bone? Dead periodontal membrane? A piece of food? Hard to say... My opinion here, based on examples, observations and guesses, would tend to be that the source is a deep deep abscess that is also very old. Containing something dead as it's "dark star." Likewise the smell is obviously scary. So it is important to persist to ultimately find it's source and progressively debride it until it is way way past just gone. Since even the smallest speck can cause it to rise again. And since it is so deep and so old and hard to find the "next time" even if years later is bound to be even worse than "this time."

- STALKY BONE - Broken down bone often seems to have a splintery feeling to it. Which obviously harbors infection. So again the idea is for the bone to give up its infection without getting too aggressive.

- BONE vs CALCULUS DILEMMA - Is it calculus? Or is it bone? You wouldn't want to be aggressively be trying to pull out a piece of bone, would you? Obviously not. So everything that gets debrided has to go through some type of checklist to determine what it is. Calculus or bone? Is it stuck to the teeth? Then it is probably calculus. Does blood and chunks start coming out when I lightly scrape at it? Sounds like calculus. Does it make me want to scream when I tug at it? Then maybe it is bone!

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NOTES ON GRANULATION TISSUE:

- NASTY INFECTED GRANULATION TISSUE - Is what the body replaces destroyed bone with. Technically it has the power to turn back into viable body tissue. However in realityland it's infected!! And it is also a harbor for infection too!! So as a practical matter it is generally recognized that nasty infected granulation tissue should be debrided out gone.

- REGENERATIVE GRANULATION TISSUE - (MAKE BELIEVE OR TRUE? LARGELY MAKE BELIEVE) - Once the infection has been completely eliminated new granulation tissue forms. If somehow this new granulation tissue can be protected from becoming infected too, which is highly spurious and doubtful, then the new granulation tissue can regenerate good tissue - PRACTICAL COMPROMISE - Is to treat the pre-existing infected granulation tissue as infection and debride. Then as long as the area is actively infected to treat new granulation tissue as infection and debride. But not to get too zealous! - COULD IT REALLY BE HEALING TISSUE? - DOES IT BLEED PROFUSELY AND LOOK NASTY WITH LOTS OF BLOODY CHUNKS? If it only bleeds a little bit and it hurts it might be okay so just leave it. If it bleeds a lot then it is most likely infected and has to go.

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GENERAL STRATEGY DESCRIPTIONS:

- FOLLOW THE BLOOD - This basically means that when the area starts to spontaneously bleed that you have an area of infection and can basically stop whatever else you may have been thinking of doing and just follow the blood until it stops bleeding.

- STICK WITH THE TEETH - This is a basic philosophy that helps to avoid doing anything stupid. Idea is to always work from tooth to whatever is stuck on tooth. Bone is not stuck directly on teeth. Bone is separated from teeth by a membrane.

- BONE DOES NOT FLOAT IN THE MIDDLE OF THE AIR - This is a philosophy and strategy for differentiating calculus from the possibility of it being bone. What it means is that anything sticking to the side of the tooth that is above an area that is determined to be tooth has to be calculus. "It has to be calculus. It can't possibly be bone."

- JUMPING OFF SPOT - LANDING STRIP -  - This is a strategy of dealing with large constructions of calculus where you want to make sure they aren't bone. Plus where they just don't want to give up and are almost impossible to debride. Strategy is to find a portion of tooth that you are sure is tooth and not bone. Possibly by following the curette down the side of the tooth to the "jumping off spot." From here you expand your perimeter to create a "landing strip." Then you get your landing strip cleaner and cleaner, smoother and smoother (but don't overdo it!) until you come up against a "glacial wall." Which you then work and work until it breaks loose.

- GLACIAL WALL - This is just a large piece of calculus where the surrounding area has been smoothed into a "landing strip" which has proven portions of tooth apically to the piece of calculus. Idea is then to tug on the calculus in various ways until it gives itself up.

- DEAD CEMENTUM DILEMMA - This is the original interface between the teeth and the periodontal membrane, which then covers the bone. Originally it had little fibers sticking out of it into the membrane. But this original physiology is now destroyed. Additionally the cementum cannot regrow fibers. But what to do with it? And how can you tell what it is and be sure you are not actually on bone? That is a mystery and a dillemma
 
- RESORBED TOOTH DILEMMA - The calculus puts pressure on the teeth and actually imbeds itself into the tooth. This imbedded area isn't really viable tooth anymore and one way or another needs to get removed or the resorbed tooth material will continue to eat into the tooth and ultimately destroy it. So what to do? Ultimately the resorbed tooth material has to get debrided too. Peeled off the tooth. It feels like pulling hot tarpaper off a hot tin roof.

- THINGS ARE OPENING UP - DILATION (technical word - medical) This refers to a general process that is not very well understood. What generally happens is that when you first start debriding the tissue will be very tight. It will be difficult to move the curette around. Then the longer you engage in the process the tissue will tend to open up and make it easier to engage the curette. In addition, at first it will seem that there is a surrounding area that is very vulnerable to injury. But once things open up it starts to seem like you can attack anythng successfully. That literally the entire area is bad nasty stuff that deserves to be debrided out. Is this true? Largely yes. When things are tight it is difficult to differentiate calculus from bone. Then when things loosen up it turns out that what you thought might be bone is in fact calculus. But can you jump the gun and decide what you fear might be bone is obviously calculus? Presumably you could do that, but you might do something dumb.

- CONSERVATIVE STRATEGY - Refers to trying to be close to 100% sure ahead of time that what you think should go should in fact go. But but... what can go wrong? Hard to say here, But largely for myself I have decided that I would rather spend extra time than risk unnecessary destruction. And reasonably there is stuff that is somewhere between life and death and if you leave it behind that some of it will end up recovering. Don't know the answer here. So who knows, it could be possible to rip out a piece of bone that was just a little bit weak but had a chance to recover. Again who knows.

- AGGRESSIVE STRATEGY - Refers to not trying to be so certain ahead of time that something is in fact bad. To trust to experience that almost anything that can come loose is bad. Also to realize that after the fact that what a clean tooth looks like is a clean tooth surrounded by bone that is largely at the same level. Here you can almost imagine the tooth like a bottle stuck into a small inflatable swimming pool. Or some other appropriate analogy. POST FACTO - EVERYTHING WILL BE OBVIOUS  - BUT AHEAD OF TIME IT WAS ALL VERY UNCLEAR - SO WHY NOT GO RIGHT TO THE VISUALIZATION OF THE POST FACTO? GOOD QUESTION!! WHY NOT? - Hard to say what the correct answer is here. But largely you can look at it as opportunism. And not wanting to do anything stupid. So you can reasonably say that you couldn't get that aggressive even if you wanted to. So no point to rush. Just let it play itself out one piece of calculus at a time.

- CONSERVATIVE vs AGGRESSIVE - Usually it is a mix. My general strategy is to try to be conservative at first. But then when I get more information about a particular area based on sensory feedback to get more aggressive. But also keep in mind that I am very slow. And take hours and hours to cover a particular spot. So a more aggressive strategy may speed things up and not necessarily be so dangerous. But then it could be more dangerous, who knows.

- ROCKPILE - Refers to a general sense of the calculus surrounding the tooth as seeming to be very much like a rockpile. How do you dismantle a rockpile? Are there any special tools that will remove lots and rocks at once? Well.. maybe there are... but unless you have some bright ideas then you may just have to remove the rocks one at a time.

- BRIGHT IDEAS - AD HOC - OPPORTUNISTIC - Refers to the activity of simply engaging in a relationship with the curette with the target calculus and perhaps having a general idea about what you want to accomplish. But not necessarily having any great ideas about how you can accomplish it.

- GO FOR THE BLOOD - FOLLOW THE BLOOD - Where there's smoke there's fire - This concept is basic. Blood is where the calculus and periodontal infection is located. Attack the blood until there is no more blood. Finish what you started.

- GET FRIENDLY - INGRATIATE YOURSELF - Means to try to get in close with periodontal calculus and debris without causing much of a fuss or trauma or damage to the area. Then can explore in greater detail and hopefully get something to give itself up.

- GET AGGRESSIVE - MELLOW OUT - Refers to alternating sets of strategies for dislodging calculus. Typically will start off mellow to isolate a promising chunk of calculus. Then get progressively more aggressive until piece releases.

- GET IT TO GIVE ITSELF UP - Largely the difficult pieces of calculus are too difficult to get them to give themselves up directly. But if you hang out with them long enough and get progressively more aggressive as acceptably warranted by the situation then what is likely to happen eventually is the pieces will give themselves up - BUT - This expectation is not necessarily true. Only opportunistically. Alternately what will happen is the large pieces won't give themselves up at all and will be close to impossible to remove. In which case you need a better strategy. Or need to work around the edges and gradually diminish the piece. OR can loosen up the piece around the edges and undermine its support and just trust it will eventually give itself up.

- WALK THE DOG - ELEPHANT WALK - STILT WALKING - Going around the edge of a pocket with the curette when the pocket is already fairly clean. Object is to rustle loose any loose pieces of calculus. Can also swing the opposite end of the curette fairly dramatic distances while twisting it one way then the other so curette will travel short distance along the pocket without actually having to physically move it against the resistance of the pocket - ANYWAY -- You are probably already familiar with the elephant walk. In the case of the curette you can use large gross movements of the shank side of the curette to cause slight movements at the blade end. Then you can twist the blade and Voila! The curette shifts position without having to force it against unaccommodating gum tissue. So this manouver can be used in unfriendly territory where there is a lot of stuff blocking the movement of the curette.

- DRAIN THE DOG - OUTSIDE AGITATOR - COMMUNITY ORGANIZER - STIR THINGS UP - When blood is found can just hold the curette in place to allow any infection to drain out. Along with some light curettage. Idea here is to be able to have an effect on an area that otherwise may be too deep or too sensitive to be more aggressive. By jostling things up the infection gets a chance to escape without anything very traumatic getting done to the area.

- JAMMED IN CALCULUS - DETRENCH THE BONE - Refers to calculus that is jammed into the space between the tooth and the bone. This is the active agent of ongoing periodontal destruction. Detrenching the Bone refers to the process of plucking or scraping out the calculus that is actually below the bone level. It is a very delicate process and can really one be done with a clean field above. BUT it can lead to the halting of the infection-disease and can even lead to regeneration fantasy world belief systems.

- THE MATRIX - This refers to unblocking periodontal abscesses. The analogy is Keanu and Morpheus in their little but real world under the boneline. Where the Empire or whatever opens up a hole into their little world with their specialized machines and drains them right out. Where they know the Matrix is coming after them but there is nothing they can do to stop it. Because the Matrix is very persistent. And wants them out. To go live in the sewers. Somewhere else. But just not here.

- BARBARIANS - BARBARIC BRUTALITY - This refers to highly aggressive tactics to remove tenacious calculus. Including a willingness to let the curette slip and slice up anything in its path. Which will hopefully be just air and not you. In any case, the logic is to visualize a path or the curette to slip in that is virtually guaranteed not to cut anything. But obviously this strategy can only be employed in limited ways or you can and will cut yourself. Including delicate things too, like nerves and blood vessels. So it can be a very dangerous strategy too.

- BARBARIANS AT THE GATES - Refers to the final process of opening up an abscess to it can bleed itself out. Destroying their high-level civilization. Destroying their infrastructure. Subjecting the abscess to barbarian rule until it collapses and turns into a remnant of its former glory.

- SWIMMING WITH THE SHARKS - NERVES IN THE CRUD - DEEP DOO-DOO - etc - Refers to the difficult circumstances of when the infection has invaded either the passageway of the tooth nerves or even the facial nerves, alveolar, buccal and infraorbital. This is highly scary stuff, but cannot be completely avoided. Since if you don't damage the nerve then the infection certainly will. General strategy is to avoid any sharp instrumentation - (NO SICKLES!! NO KNIVES!!) - Graceys prefered over universals. Also to study your Gray's Anatomy!! So you know where the nerves are. Also to stick with the teeth! Don't go wandering off the path. Also never move with any force in the direction of the nerve. Always move away from the nerve. Also always apply any force so any slippage will move away from the nerve. Also to concentrate your best efforts on irrigation. As example honey can float off debris around the nerve. Liquification will then create more debris. Which can then be floated off. As part of a long term process that will eventually get the area around the nerve fairly clean. Also irrigation needles will tend to go around the nerves. Etc. Just accept the situation as very very dicey and dangerous and treacherous. But turns out nerves are not complete shrinking violets. And if you jostle the nerve you will know it right quick. But the nerve will usually recover if you didn't do anything severe... ALSO... keep any chemicals away from the nerve!! Bad bad news! But honey should be okay. Hyaluronic acid should be okay too. But no iodine! No Chlorox! No Peroxide! No liquid calcium! Even that hexachlorophine. Remember any chemicals will quickly turn into permanent nerve damage. So just don't do it!


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- GUANTANAMO BAY - UPSIDE DOWN IRRIGATION - Refers to irrigating the pockets in the maxillary upper molars by lying down and tipping the head upside down. Can also refer to classic irrigation with a water pick by leading over and spraying upside down. Or to conventional mouthwash, peroxide or urea-papain debridement solution etc. Idea is that right side up will cause the fluid to drain right out. But upside down enables the fluid to either get longer contact time or even to penetrate into deeper layers. As example honey can be used with a 23 guage endodontic or irrigating needle to reach quite deep and function as drilling mud to do quite effective debridement under the right circumstances. Likewise it can flow to otherwise unreachable or expanded areas to drive out the infection... But watch out for those sinuses! Don't want to blow the infection right into the sinuses do you? Then have to be careful re any Guantanamo Bay.

- GUANTANAMO BAY - UPSIDE DOWN DRAINAGE OF MANDIBLES - Specifically if there is a break-out abscess on the mandibles... such as in the transits into the sub-mandible zone... then presumably Guantanamo Bay strategies can facilitate drainage. FYI these particular types of abscesses can be very treacherous. Presumably one or more transits into the sub-mandible salivary glandular zone might typically be located around the first bicuspid and the canine. Since that is where the saliva opening is located. Likewise the transit zone into the sub-mandible lymph channels is located between the wisdom tooth and the second molar.

- SPECIAL NOTE - 10-01-13 - I have this problem of sub-mandible abscesses. So I am attempting to progressively drain the lymph channels around the wisdom tooth. Since otherwise the two remaining lower molars are certain goners. Per video on - TOOTHPICK BLOBBAGE. Other abscess in salivary gland has been addressed. But presumably is still there in latent form. So need to go back at some point reasonably soon.

- THAR SHE BLOWS! - HOLE INTO SINUS - ORAL ANTRAL COMMUNICATION - Refers to a hole from the maxillary molars into the maxillary sinus. Problem is the roots of the teeth go right into the sinus. The bone is normally thin anyway and makes a "wave" to accomodate the confined space. Then the periodontal disease destroys the bone and voila! there is a hole into the sinus. Blowing air and blowing fluids between the nose and mouth. Sounds bad doesn't it? Yes it is bad. But if the area can be successfully cleaned and kept hygienic then some special membrane (forgot the name) will grow to separate the two spaces from each other and even return the area to some type of specious health.

NOTE - Watch out for those oral surgeons though (!) and don't be so quick to accept that all is lost and hopeless unless you get the teeth pulled. But yes, you are in some deep doo-doo that is correct. But it is possibly possible to recover without absolutely necessarily giving up the teeth or having the surgeon cut everything up bad. Don't panic!! Personally I have had five oran-antral communications, including two that blew air, plus a complex where I had to tip my head to prevent water from leaking into my nose. Plus another open hole right into the sinus. All of them healed eventually through very careful and delicate applications of hygiene over months and months. But are presumably still there in latent form.

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- REVERSE BAGDAD STRATEGY - Curettage technique to go deep into a pocket and make the assumption that everything that is away from the root is fair game for curettage. Similar to an army clearing a road to a city by approaching the city and then clearing it from the inside out rather than from the outside in.
 
- COWBOYS & INDIANS - ATTACK THE WAGON TRAIN - FORTRESS THEORY - BULLS-EYE THEORY - This refers to a general practice of avoiding the actual object of pursuit. But rather to approach it from the periphery. Then eliminate the periphery. So only the object itself is left. Then it becomes easy-pickings. Also refers to a general practice to approach from the outside towards the center, eliminate the outside then  attack the center. Or stop and allow to rest and heal and then go-back... later.

- BULLS-EYE THEORY - DANGER DANGER - Refers to a center that is very very scary. For the upper molars maybe you could punch a hole right into the sinus. (This is the most common circumstance) Or there is just some void that could be a tooth nerve or a jawbone nerve or maybe even a major blood vessel. OR maybe there is a gigantic piece of calculus and you think if you pull it off you might just rip off a giant chunk of bone or something vital along with it... SO.... If the danger seems to great figure it this way. IF you work the outside of the bullseye, then let it heal for a few weeks, then go back and the danger is truly there then you will end up ripping open a much smaller hole!! So instead of punching a giant hole into your sinus you will only end up punching a smaller hole, not so disasterous.

- SKI-JUMP FACTOR - Describes the phenomena of calculus merging with bone, making it very difficult to differentiate between the two. Typically what will happen is you will be tugging on the calculus with the curette and will end up tugging on bone instead! Which is obviously bad. Alternately you may be trying to determine in some sort of definitive way if something is definitely calculus and not bone and will note get an answer that is clear enough to go ahead without fearing you are ripping out bone. Which again is not good... ALSO... What will happen is you may be traveling down the side of the teeth and next thing you know you will be on bone instead of teeth. YIKES... ALSO... If a tooth is covered in a thick layer of calculus it may be very difficult to figure out whether the thing that is covering the tooth is the surrounding bone OR whether it is really calculus. In real life it will usually turn out it is calculus and is almost impossible to remove anyway. So just have to play it out and dismantle it a little bit at a time from the edges of the tooth. Then hours upon hours later it will typically be revealed that it was calculus the whole time.

- SCIMITAR - (make-believe word) - PDT QUEEN OF HEARTS - Describes an imaginary sickle with a slight bend to the blade resembling a small section of a corkscrew. So you can imagine the curette like a sword with that shape. Why is this shape important? The reason is that the blade gets around curves and you can center it on a high point that is most likely calculus. Then use the point to attack edges between tooth and bone. Which are difficult to reach into. BUT in my opinion this curette works best as a finishing curette and not as a primary curette. Though I suspect I will be proven exactly wrong. But in any case this curette can cause a lot of damage if it slips. Plus it is awkward if there is a lot of calculus. But when things are down and dirty nothing is better. When things are layed open. So if you know exactly what you are doing with an open ledge this works out fine. Plus the McCall-13-14s doesn't scare me much. If anything I wish I could get more aggressive. But some of the longer ones do. With blades that just won't quit and that look like they could tear into healthy flesh fairly easily. -- BLAH BLAH BLAH - Turns out the PDT Queen of Hearts meets most of the qualifications I have been looking for in my imaginary scimitar type curette.

SLIDE DOWN THE DINOSAUR - This refers to attacking an area of calculus and then next thing you know you just dug a giant bottomless pit. Did you just dig out all your bone? Or was it calculus and had to go? Check out your x-rays. It will look like there was bone before... and you just dug it all out, like some idiot. Feel good now? You just slid down the dinosaur! And gouged out your bone. IS THIS ACCUSATION REAL OR FALSE? DIYPERIO believes this accusation is false. In real life DIYPERIO believes that what happened was that the infestation of calculus added some opaqueness to the x-ray to make it appear like there was bone. But it was really calculus. IS THIS A FAR-FETCHED APOLOGIST OPINION? Certainly it is apologist, because it condones the digging and gives a plausible explanation for the "missing bone." BUT THAT IS THE ANSWER YOU WANT! NOT WHAT IS REAL! Again, DIYPERIO says "Prove me wrong!" - "Prove to me that was really bone that just got dug out and not just a bunch of calculus and junk." - "Prove to me that you can have calculus infiltrating down the gap between two teeth and in between the two walls of calculus is viable bone. Prove it."

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DARK STAR - Is when there is apparent evidence of some deep piece, construction or colonies of calculus and biofilm that are causing problems. Assumption always is that irritation is caused by infection, somewhere. So to alleviate the irritation the infection has to be located and debrided.

FALSE FLAG - Is largely a response to pain. What kind of pain is it? Is it from the tooth nerve?


www.diyperio.com

tom@diyperio.com

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