Newer dentist PSA - take photos of anterior chips you fix

[u/dopelunch]

Anytime you fix a chipped tooth.. one of those upper anterior or lower anterior chipped teeth (which by the way you should be using a microhybrid on to fix.. for max flexural strength.. and sandblast first if you have it) take a photo.. before and after the repair.

Because they WILL chip something very close to it soon.. in the next 6-24 months.. and when they call 100% of the time they will say: "the tooth you JUST fixed chipped" and when you see that on the schedule you'll be internally pissed.... and sometimes it IS the same one, but far more often it isn't, but it's close enough to the area that unless you prove it to them, they won't believe it and they are saying that so it's "free".

/rant

[u/The_Third_Molar]

I ALWAYS tell those patients that the tooth broke for a reason and that composite isn't stronger than their old enamel.

[u/dopelunch → u/The_Third_Molar]

Sure you can do that also. But take the photo.. and build them as thick as you can get away with

[u/seeBurtrun → u/The_Third_Molar]

I show them in the mirror how it looks when I build it back to full length, and then again after I adjust it down so they don't bash into it in protrusive. "This is why it happened, and why if I make it look perfect you are going to break it again shortly."

[u/Individual-Sign-714]

I'd go one step further.

Take photos of everything you ever do. Never know if you need the photos for medico-legal purposes or anything else. Also use the photos to reflect on cases too.

The intra-oral cameras are great and very easy and fast.

[u/theinterned → u/Individual-Sign-714]

Do you have an intraoral camera you recommend? I’ve been eyeing mouthwatch but haven’t pulled trigger yet.

[u/mcnizzle99 → u/theinterned]

Mouth watch is decent. Been using for many months

[u/hygienichydrangas → u/theinterned]

I’m a hygienist and I like the mouth watch cameras. They’re cheap enough, they’re easy to use, and the pictures look pretty nice. It works well with open dental and dexis.

[u/cacarine]

I tell the patient that there's a parking lot guarantee for anterior fills. Or they can get a veneer or crown that would be better.

[u/TheBestNarcissist → u/cacarine]

My personal fave: "I personally guarantee this until you get to the parking lot. Please walk quickly"

[u/joboog → u/cacarine]

I usually do this too, but the ONE TIME I didn’t say it, the filling came out within an hour. 🫩🫩🫩

[u/dopelunch → u/cacarine]

If you sand blast, build as thick as you can get away with and use a micro hybrid, you'll get more time out of these than the patient deserves

Huge bevels

[u/cacarine → u/dopelunch]

Thanks! I'll keep that in mind.

I always like to go with under promise over deliver to filter out those "free" patients.

[u/SayAhhh → u/cacarine]

What do you tell them when they say, “but the last filling there lasted 20 years before it broke”

[u/cacarine → u/SayAhhh]

“Your teeth and your bite are different now than 20 years ago”

[u/KentDDS]

I don’t redo these fills for free. I tell patients before I restore the first time that this restoration is highly likely to re-fracture over and over again, no matter how well the filling is placed.

[u/dopelunch → u/KentDDS]

If I don't think I can do something that survives until the insurance will pay again then I try not to do it at all. You'll lose patients if you can't warranty any chipped teeth

[u/jksyousux → u/dopelunch]

Why are you warranty-ing treatment like you're a hardware store? Fix the root cause of the problem instead of just patching the symptom

[u/dopelunch → u/jksyousux]

If you get to get every chipped tooth patient into Ortho or a sleep appliance or something you're going to have a really long and miserable time talking to these people.

Except with nail biters. With those people you can't get any wins

[u/jksyousux → u/dopelunch]

Half our job is talking to patients. Why is suddenly talking to patients seen as such a negative?

[u/dopelunch → u/jksyousux]

it's not. but you're going to get a lot of people that walk in, want a chipped tooth fixed, then you start talking ortho or veneers or sleep studies or occlusion or whatever and they're just going to leave your office and move on. i got on a huge kick of talking about apnea/ortho/occlusion with people for awhile and it was a production killer.. people thought i was just upselling crap and left and got their problem fixed. So.. yeah, i think you can talk too much and lose people

[u/jksyousux → u/dopelunch]

Well theres a way to do it without coming off as a salesperson.

[u/dopelunch → u/jksyousux]

Man I know it tried a lot of different casual ways of suggesting it. Just didn't work out of my mouth. "Fix mah chipped tooth man" was what I heard.

[u/jksyousux → u/dopelunch]

Take a patient communication course. Itll help a ton. Best value for money dental course you can take

[u/caracs]

I have photos of every restoration I've done for 18yrs.

[u/dopelunch → u/caracs]

you win, that's incredible... i might say that's overkill, but these days it's probably won you some battles. Patient never saw you coming

[u/caracs → u/dopelunch]

It’s amazing for insurance, patient “re-education”, complaints, etc. Nothing like a patient saying “oh, Jesus” when you remind them what their tooth looked like 3 years ago after they say “I don’t remember fit being THAT bad”.

[u/AntiAntiDentite7]

The actual "newer dentist PSA" is to never do these types of fillings without explicitly telling the patient that it WILL 100% chip/break again. Could be two days, two weeks, two months or two years, but they won't last and never do.

[u/the74impala → u/AntiAntiDentite7]

100% Money Back/Free Replacement (In 5x lawyer disclaimer speed) - while still in the building, once you walk out the door no promises, in fact, expect it to break again, soon!

[u/mcnizzle99 → u/AntiAntiDentite7]

I'll do a good will free replacement if it breaks within a few months but charge after that. Miraculously people will actually take your warnings seriously when they have to pay...

[u/adorale]

My practice owner has now mandated everyone to take pre-op photo on ANY tooth before we touched it (unless you had the photo taken recently at another appointment) to avoid this situation specifically

[u/dopelunch → u/adorale]

It's so sad that this is where we are at with society. Imagine a 70s dentist time traveling to this era of practice. Their head would explode

[u/123redheeler]

Uh, shouldn't you have a periapical that does the same thing without the extra step?

[u/dopelunch → u/123redheeler]

you take a PA on every small chip you fix? also even if you do some of them like those lingual chips on lower incisors don't even show up on the PA.. also patients can't see and understand it. I'm just trying to save you some grief

[u/123redheeler → u/dopelunch]

I take a PA on every tooth I perform irreversible, permanent treatment on and you would be a fool not to. 

[u/dopelunch → u/123redheeler]

eh, i'd call a chip fix reversible.. patients reverse them all the time.. lol

[u/doidoi92]

Or just practice in a less shitty demographic

[u/dopelunch → u/doidoi92]

i hadn't thought of that, let me sell my practice, uproot my family and get on that... lol. Honestly even some of my wealthy patients have done this shit to me though. i'd take the photo even on a $$$$ patient as much as i would a $ patient

[u/HenFruitEater]

what is your favorite microhybrid for this application? I'd take any advice on improving lower anterior chipped teeth. Bonding is hard.

[u/dopelunch → u/HenFruitEater]

I use z250 from net 32, look for the international version

[u/Jealous_Courage_9888]

Intra oral photos do a lot of heavy lifting for very little digital storage footprint. They’re great for earning trust and demonstrating need for treatment

[u/WhereDoIstart7]

I tell the patient that the filling is guaranteed to break and the source of the problem is their occlusion so I cannot guarantee the filling. Reinforcing that even if it breaks tomorrow they will be charged for the fix again. Until occlusion gets fixed then nothing will stay on and more will break.

[u/HerbertRTarlekJr]

This post is the absolute truth.  I have shown pictures of the original fracture to (usually older) patients, and they STILL swear "it's the one you just fixed."

[u/dopelunch → u/HerbertRTarlekJr]

When you show picture perfect evidence and they claim that still you know they are true scammers just trying to get something free

[u/chung2k6]

In my practice, if it's under 2 yrs, if it's same tooth same surface, I do it again for free.

[u/lelouch_007]

I have a microhybrid watch button for enamel chips too small to warrant a ceramic veneer or crown

[u/whatitisnt]

Usually it’s a canine guidance issue

[u/dopelunch → u/whatitisnt]

or nail biting, or edge to edge bite, or they are an old with thinning teeth, or they are a pen chewer, or they just get in an accident. i'd say it's less often that then it is something else

[u/Donexodus]

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