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.
= = =
- 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.
= = =
- 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.
= = =
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!
= = =
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.
= = =
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!
= = =
- 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.
= = =
- 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."
= = =
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?
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tom@diyperio.com
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