She is complaining about me and my staff =) 作者: NewLynnHse 时间: 2016-7-4 21:47:24
jackylam 发表于 2016-7-4 20:45
She is complaining about me and my staff =)
why oh why, why are people always complaining about you and your staff? you better do something about it.作者: jackylam 时间: 2016-7-4 21:47:52
NewLynnHse 发表于 2016-6-30 18:26
PM什么,听说他也是兰桂坊的老板
I was...... the building owner sold the building to a developer and will build an apartment now.... so LKF has closed ...... and we are moving out soon as they are pulling the building down =)作者: jackylam 时间: 2016-7-4 21:56:20
I think for any doctor, experiences and also keeping to up to date technological changes are as important.
If a bad chef cook for 10 years, doesn't mean he will become a good chef...... unless he spend time to improve his cooking, reading books, doing courses...... =)作者: jackylam 时间: 2016-7-4 22:03:30
I have checked LZ tooth, she is not tender to percussion, not sensitive to hot and cold, only have pain during biting...but pain goes away after releasing. There are certain possibility, and i have explained every single one to her.......... all i can do is to assess it as according to what we have learnt and tell her the truth and offered her treatment etc...... I am very surprise she said I have an attitude...... 1. I didn't do the filling myself, I and quite independent on this issue even Joe is my staff. 2. She has a filling, ( but not 1/4 as what she has claimed, its a normal size DO composite filling, It does happen every now and then, as each patient, each tooth can react different to patient...... Its a long post.... i will reply in summary what's the causes, and what's the theory behind each of them, and what can be done for each options later.... it will be a long night for me to reply all post....作者: jackylam 时间: 2016-7-4 22:08:06
I wasn't the one who did it.... so i can't tell...... but according to the clinical note, it doesn't required a CaOH2 lining and the reason is because its not deep. I have explained to her step by step what could be the cause of the problem.... and if problem persist, I will redo the filling for my staff for her again for free..... I don't believe she need a root canal at this stage as i have explained before..... Not sore to tapping, no temp sensitivity, just sore to bite on... could be 1. stress on the cusps due to bonding, 2, Not favourable Occlusal loading, 3, cracked cusps symdromes, 4, leaking of the bonding, 5. reversible pulpits. 作者: jackylam 时间: 2016-7-4 22:10:33
I am Jacky and i don't use 小号 to reply....... only people use 小号 will think others use 小号...... you have misunderstood others la...... I don't know who is 天生天羊......
I will reply you at the end once i have read all the messages and reply to all of them =)作者: jackylam 时间: 2016-7-4 22:11:12
開诊所沒有年薪百万的。。。。。。。。。。。 新西蘭牙醫年薪大約 $130K 到 200K。 Specialist will earn around 160K to 250K max.. except Orthodontist and Oral Surgeon, they can earn up to 300 - 500K. This is according to our annual survey by NZ dental association....作者: 马柚子 时间: 2016-7-4 22:33:24
1. I have corrected her..... dentist doesn't earn that much.....
2. Everyone has a bucket list..... Please respect everyone's dream......
3. I only have one account....
4. NZ dentist are required to attend minimum 80 hours of continous education each cycle in order to have our Annual practising certificate......
5 看你脸就跟奸商一样 恶心 ...... 請respect 自己的語行。。。。。 我的脸是爸爸媽媽給我的,你可以不喜歡我的同事,我們公司,我已經offer,如果adjust之後,還是不舒服,我自己免費為你重補。。。。。我同事的問題,我和公司已經幫你安排一步一步的解決方案,你不想來,你不信任,我可以接受。。。 但有必要人身攻擊投訴我的脸嗎? 作者: jackylam 时间: 2016-7-4 23:28:29
护髓 - has a lot of definition and methods. LZ is complaining we didn't use Calcium Hydroxide lining.... I have explained to her in my surgery for like 10 to 15 mins and try to make her understand....this is a lining material if your nerve has been exposed...... In Her case, she has not nerve exposure, its not common to use this lining material in this case..... the disadvantage of Caoh lining in non-exposed situation is : 1. caoh2 doesn't form a bonding to the dentin, and therefore will have micro gaps in between. 2, it doesn't close the dentine tubules and therefore could case sensitivity, The commonest problem of post operative sensitivity is due to leakage..... and therefore in a situation which the hole is not deep, dentine bonding adhesive is the best way to deal with it..... We do use CaOh2 in other patient when its deep and nerve has exposed... but not at LZ case.... I have attached some other methods which has been published and currently using by different dentists around the world....
Gordon J. Christensen, DDS, MSD, PhD
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question to Dr. Christensen, please send an email to info@pccdental.com.
Resin-Modified Glass Ionomer vs. Flowable as a Liner or Base
Q I’m perplexed by the changing use of liners and bases under restorations, both direct and indirect. Some speakers and authors are promoting use of flowable resin-based composites as liners under composites. However, some advocate resin-modified glass ionomer (RMGI), some are using calcium hydroxide, and others are using some new regenerative materials. What is currently the best material to use when bases or liners are necessary?
A There are many choices for bases and liners, and it is interesting that most of them work well if placed correctly. However, dentists tell me that patients complain about postoperative tooth sensitivity related to placement of both direct and indirect resin and ceramic, as well as with amalgam.
There are various reasons for use of a base or liner for direct and indirect restorations. Among them are:
Prevention of postoperative tooth sensitivity
Capping a slight pulp exposure
Stimulation of new dentin formation under the restoration (indirect pulp capping)
Assisting putty viscosity, fully filled resin-based composite to go into undercuts and marginal areas when placing composite resin directly, especially in Class II box forms
As with any clinical procedure, many techniques will work. If you’re satisfied with the clinical results you’re experiencing with the base and liner techniques you’re using, I suggest not changing. On the other hand, if you’re experiencing challenges and failures with your current technique, I have some suggestions.
The most popular materials currently used for liners and bases are:
Resin-modified glass ionomer (examples are 3M ESPE Vitrebond Plus, GC Fuji Lining Cement LC, and Southern Dental Industries Riva).
Flowable resin-based composite (examples are available from every restorative resin company, and some well-proven and highly filled ones are GC America G-aenial and Shofu Beautifil Flow Plus).
Calcium hydroxide (examples are Dentsply Caulk Dycal and Kerr Life).
Bonding agents (examples are available from every restorative resin company, and popular brands include Kuraray Clearfil SE Protect Bond, 3M ESPE Scotchbond Universal, and Kerr OptiBond XTR).
Inorganic chemicals (examples are Dentsply Caulk MTA paste and Bisco TheraCal).
Each of these types of liners or bases has its group of advocates, and all have reported success.作者: 天生天羊 时间: 2016-7-4 23:57:07
jackylam 发表于 2016-7-4 22:41
护髓 - has a lot of definition and methods. LZ is complaining we didn't use Calcium Hydroxide ...
护髓 - normally is done when your nerve is exposed. i.e. direct pulp capping..... we only do that when we can see a nerve expose, i.e. see a pin point bleeding of your pulp after cleansing your cavity........ I didn't do ur filling myself, but from the clinical notes, the clinical symptoms, its very unlikely your nerve is exposed n need caoh2 lining.......
Price varies depends on locations, set up, running cost etc.... it has nothing to do with a clinical decision.... My only point is we will not use CaOH2 lining unless there is a nerve exposure. We use other way to seal the cavity such as GIC lining, Dentine bonding adhesive etc. I don't know why you will get the impression we don't use lining....... what i meant to you is you do not need Calcium Hydroxide Lining....
唉。。。。 我和你聊的時候,你說你因為他叫你等一下,你還是疼,你覺得他騙你,你還把他拉黑 。。。。。我笑著和你說。。。。你拉黑他好像有點不必要吧。。。。。 洞沒有很深, Tapping 又不痛 (排除了Abscess), Hot and Cold is not sensitiive (排除了 bonding failure), only feel pressure during biting, but when not biting hard you don't feel pain, it COULD Be, 我說可能是 cracked cusp syndrome (https://en.wikipedia.org/wiki/Cracked_tooth_syndrome)可能要 牙冠 crown (你說的科普 做牙套只能是牙神经坏死 才能做牙套, 是不正確的,很多情形需要牙冠 i.e. Cracked_tooth_syndrome pls refer to wiki or google.....)。。。。 我把所有的可能也有告訴你,這是我們的 Informed consent......... 你的咬合可能導致你的敏感。。。。 `Occlusal problems are very common, particularly after recent restorative procedures (crowns and fillings), and most often present as sensitive to cold, air, and biting down. Occlusal adjustment will frequently reverse this type of inflammation. you can read the full article at - http://www.dentaleconomics.com/a ... ontic-disaster.html`
已经跟我长篇大论过了 - 我只是希望把我們讀了五年的書,用15分鐘去讓你明白這課題。。。。。
并且一再强调奥塔哥的学术权威 还有他不做护髓 我也没有必要做 -。。。。。。我强调的是,現在我同事用的是3M UniversalBonding system, 是在不深的situation下的做法,我看不到沒有理由要用 CaOH2 lining...... 我也把它的利害告訴你了。。。。 我們护髓當然做, 只是你的情形我同事按你的情形沒有做,我也真心覺得不需要。。。。因為你的symptom與這個無關。。。。。 你沒有 Hot and Cold sensitvity, means, no bonding or leaking problem of the filling..... sensitive to pressure is more due to occlusion problem... just telling you the truth only......... To redo the filling is to eliminate your fear, and we try to reseal the tooth again as you wish..... if you want to put a certain lining....we can do it.....doesn't cost us anything..... i can put it in if you want to... especially if you will feel happier......... but you didn't discuss your concern and start blaming my staff and myself........ and make it one way traffic....... its quite unfair...... Every case every patient, every tooth and every circumstances are different.... how can we come to sky kiwi and explain every clinical steps and decisions for every patient...... I don't mind explain... as i have already explained to you once.... i don't mind give a public educational lectures on a certain topic as well..... but we are trying to help.... since day one and last consultation, I am trying to let you know that's the normal standard operation for a filling of your size and if it hasn't got nerve exposure, we don't need to use CaOH2 Lining material........ and i told you all the possibility, all the options and all possible outcome..... As a dentist, as a boss, as a company director..... I have offered to help for free to try to keep my clients happy.... I have asked to if after a week or two if still not right.... I will followed up myself, so i can see how i can make your tooth feel better..... That's the long conversation about...
Enamel thickness varies between 1.5 to 2.5 mm, and dentine varies from 3mm to 10 mm...... total thickness varies between 4.5 to 12.5 mm the bigger the tooth, n closer to the occlusal surface, normally its a thicker as well..... LZ 's tooth is a Molar, therefore you will be closer to the 9-10 mm depth... instead of the 5mm you have quoted.....
為什麼牙醫那麼難,那麼貴, 因為我們只有 數毫米去 工作。。。 我們 everytime has to be very focus to work on a tooth....to try to save extra half a mm of tooth for our patient...... 唉。。。。。
If you have to keep on thinking he drill to your nerve.... i am speechless.... all i can say is.... if you really have a toothache.... u know what's a nerve pain is all about....... your current situation is due to biting..... only trigger by a stimulus which is pressure..... its still very early stage and we can step by step to sort out your problem.... but i don't know why you react in such manner and keep imagining we are trying to make you suffer......
Once again, i believe every university graduate need to have somewhere to start... its social and corporate responsibility..... All i can see is new graduate use their heart to treat every patient, they have the latest knowledge and skills and technics. They want to learn and they don't want to make mistakes, so they will take extra care to our patient...... They don't push to their limits, they treasure their chance to work in private, so they do their best every single mins in order to keep their job and also keep building their experiences. I believe the best dentists in the whole universe.... he or she, also start with a job and work as a new graduate and gradually learn from seniors and as they work they become a better person and better dentist..... Its same as pilot, same as doctor, same as police same as chef, same as a mum, same as any occupation in the world.... we all got to start somewhere..... And Smile Dental is willing to help the young one and mentor them and make them a better person better dentist..... It has nothing to do with our management..... We have many senior dentist..... and therefore we are more than capable to mentor the juniors and help them to start their career after university..... I hope all readers understand.... we want to help more people, not only patients, but also my fellow Otago Uni graduates as well......作者: jackylam 时间: 2016-7-5 01:18:54
We didn't do that!!!!!!! We discussed cost before we started.... and we only charge her 35 for the x ray..... i checked and double checked.... but LZ keep saying we charge her 40......... due to medical legal reason, i can't post her details n invoice.... but LZ we can print you the full invoice again, so u can check and don't blame us overcharge you 5 dollars............. we didn't do that.......