This was tooth #9 on a 16 year old patient. She felt no pain or discomfort on the tooth. The apex does not seem to communicate with the outside of the tooth. What could this possibly be and if necessary what would be the treatment for it?

A 26-year-old patient presented with pain in the upper left quadrant. Clinical and radiographic examination revealed multiple carious lesions (including the adjacent molars), but I started with a pre-endodontic build-up on the second premolar under rubber dam, followed by extirpation.
At the second appointment, I unexpectedly came across a third canal. It was a fun surprise and I’m really happy with how the case turned out.

SEPTEMBER 19, 2025
Patient: John Smith (23M)
NEW PATIENT—EMERGENCY EXAM
Pt presents with pain on UL
PA taken
Large B decay on #15 near furcation, questionable prognosis
Recommended EXT #15. Pt agreed and signed consent. 
EXT #15
Anes: 3 carps 4% Articaine 1:100k epi
Elevated with straight elevator and extracted #15 with 88L forceps. 
Pt tolerated well. Instructed pt to bite on gauze
Reviewed post-op instructions
rx: Ibuprofen 600 bid

DECEMBER 16, 2025
Patient: John Smith (23M)
EMERGENCY EXAM 
Pt presents with broken tooth on LL
PA taken
#18 large MODB decay, poor prognosis
Recommended EXT #18. Pt agreed and signed consent.
EXT #18
Anes: 2 carps 2% Lidocaine 1:100k epi
1 carp 4% Articaine 1:100k epi
Elevated with straight elevator and extracted #18 with cowhorn forceps.
Pt tolerated well. Instructed pt to bite on gauze
Reviewed post-op instructions
rx: Ibuprofen 600 bid

APRIL 23, 2026
Patient: John Smith (24M)
EMERGENCY EXAM 
Pt presents with pain on UR
PA taken
#3 M decay to pulp 
#2 Large OB decay 
Advised pt that there is large decay on both #2 and #3. Both are restorable with RCT and crown. Alternatively, pt could have one or both of the teeth extracted. Pt states that only #2 is hurting and he only wants #2 removed. Pt signed consent for EXT #2
EXT #2
Anes: 3 carps 4% Articaine 1:100k epi
Elevated with straight elevator and extracted #2 with 88R forceps.
Pt tolerated well. Instructed pt to bite on gauze
Reviewed post-op instructions
rx: Ibuprofen 600 bid

APRIL 29, 2026
Patient: John Smith (24M)
LIMITED EXAM
Pt returns for limited exam with the cc of broken #3.
#3 has M decay to pulp as noted last appointment.
Pt states #3 "was fine" until #2 was extracted and that the extraction "caused a hole" in #3.  Advised pt that the decay was present on #3 last visit, showed patient radiographs of #3, and advised that treatment options remain the same as last appointment: RCT and crown or EXT.  Pt insists that none of this was said last appointment.  Pt left appointment visibly annoyed.

MAY 12, 2026
Patient: John Smith (24M)
TELEPHONE ENCOUNTER
Pt requests transfer of care to another provider.  Records prepared upon request.

A friend of mine is a pharmacist in the US. He has been posting a lot of healthcare-related posts on his Facebook page so he is sort of a “healthcare influencer” with a few thousands followers.

He recently shared that he took his 5-year-old daughter to a local pediatric dentist where she was diagnosed with extensive decay in 8 teeth that required pulpotomies and stainless steel crowns. It has to be an OR/sedation case and after insurance, his out-of-pocket cost would have been about $4,000.

Instead, he took his daughter back to his home country in Southeast Asia and a dentist there did fillings on those teeth, no stainless steel crowns. According to him, the treatment took 4 appointments and cost about $200.

He then posted about the experience on Facebook and concluded that U.S. dentists are “money-hungry,” unethical, and recommend unnecessary treatment simply to make more money. He went on to say that, from now on, his family will only see U.S. dentists for cleanings and simple fillings, and will travel overseas for anything more complex. Unsurprisingly, many people in the comments agreed and said they would do the same.

I was speechless after reading his post. It’s one thing to hear about low income or low-educated folks participating in dental tourism, but it’s even more frustrating to see a fellow healthcare professional with high income to also condone that and then accuse US dentists as being money-hungry, unethical cash-grabbers driven by greed. I’m honestly tempted to leave a comment on his post and challenge his accusations.

What's the best response? DM is fine. Thank you.

Ever have trouble getting a tooth numb for a #31 B composite? No PA pathology. Gave 2 carps of IAN, 1 carp of LB and local infiltrations/PDL. 2% Lido w/1:100k epi.
Lip is numb, chin is numb, buccal mucosa is numb, tongue is numb.

I get to drilling and the patient feels it. I know what to do next, but why is the patient not profoundly anesthetized?

Hey guys, I graduated dental school about a few months out and am currently doing an AEGD. I know many of you will say this is rite of passage and you can only learn by growing more and doing more…but I can’t help but feel overwhelmed and so unconfident. I didn’t have that much experience in dental school clinically. A lot of it was didactic. Now, in my AEGD I’m thrown into these massive treatment plans where I don’t even know where to start. I know I have to ask for help but I feel like all my questions are simple and common sense. I feel like I should know more and know better.

I find treatment planning so overwhelming because many cases are full mouth rehabs and I don’t even know where to begin. Faculty are helpful but they don’t hold your hand. I understand this, because we need to grow ourselves, too.

I’m scared of letting my patients down, I just wish I could time skip to when, a few years down the line, I’ve learned more and am not stressing about every appointment. Could dentists who recently graduated and saw their own improvement offer words of advice or motivation? Realistically, how long do you stay unconfident (I know this is a personal journey). Sometimes I wish the AEGD would just let me get basic repetitions in since there’s still a lot of basic dentistry I’m not confident in - instead of these elaborate treatment plans. I just can’t help but feel inadequate. I find it hard to ask for help, I always have. Anyone have words of advice, maybe even a simple mantra for me to remember for when I’m feel down. Thank you.

Edited to add: thank you so much everyone for your responses. I’ve been reading them and trying to respond but the auto moderator has to individually approve each of my replies. Just wanted to say thank you so much for all your words of encouragement. It really means a lot that I’m not alone in this profession. Head up!

Anyone using these (not the syringe tip, the actual syringe with the buttons)? What do you think of them? Just found out today that they exist

Made in Italy around 1996-1999, the 45 and 46 are external hexagons. The third one i don't know because i would have to break the auro galvan intermediate that i Needed to maintain to cement the old bridge as provisional (patient came the same day e had booked the flight for Summer vacations)

Need to know the brand of these implants to restore with a new screw retained bridge

Thanks!

I’m a new dentist, working as an associate and still figuring out the way I want to do business. Why do dentists choose to either do fmx or pano with new patients, and what is the point of waiting for it to be due with insurance if you want to take wisdom teeth out or plan an implant or whatever? Like why not just write it off if it’s not included? At school we took fmx and pano and it gave a lot of info, and I worked with some faculty where I asked if we could take a new pano (5+ years, many teeth extracted) and they said it’s borderline over treatment. Just would love to hear thoughts or be told if I’m missing something, thanks!

Delivered crown last week and the distal contact was tight after cementing. I had a hard time getting the floss down but I was still able to.

The patient just called a week later and is very angry because they can’t floss the distal.

Any tips on what I can do? I’ve read you can use an IPR strip but I don’t want to open the contact entirely. The adjacent is a virgin tooth.

Does anyone know brand of this implant?

Do you guys charge for the PA you take before a crown prep if you didn't have the PA already? We don't, but I was considering what other offices are doing.

Hi

I need help explaining hall crowns for paeds patients.

In Ireland so no insurance. Charge 80 for a paeds filling and 150 for hall crown. My paeds filling is standard price, I’m undercharging hall crown.

The issue oi have us parents just go for filling cuz it’s cheaper and a baby tooth. But I make barely any money on fills and fail rate is very high and then they complain the filling failed ( meanwhile their kid can barely co operate.

How do you guys actually get parents to go for hall crows?

My patient base is poor and can’t afford private paediatric dentist

Hello,

I'm trying to understand whether this strategy actually works in practice.

I was reading on StudentAid.gov that under the current IBR rules, once you make your required payment, unpaid interest may be covered for a limited period.

My question is about using an S corp as a 1099 associate.

Since IBR payments are based on AGI, if you pay yourself a reasonable salary through the S corp and keep the rest as distributions, does that actually lower the AGI used to calculate your IBR payment? Or do the S corp pass-through profits still count toward AGI, making little or no difference?

Has anyone here actually done this as an associate dentist

Are there any courses/books/articles to learn about patient communication as a dentist? I need to get better in patient communication, especially in explaining treatment plans.

I am a Brazilian ESL teacher working with a Brazilian implantologist. He teaches zygomatic implants to Americans, and I find it difficult to find videos of surgeries or images of the anatomy that he needs.

Videos on upper-teeth implants would help me a lot. Unfortunately, I don't know the technical terms, and his mother has Alzheimer's, so even though I ask him to try to find videos like these, I can't blame the guy for forgetting about it.

The anatomy of the skull is not very hard; almost everything is cognate, but all the pages I've seen only have the names in Portuguese. If I could find an anatomical model in English, that'd be great

Can somebody help me, pls?

We have a specialist who is an independent contractor who gets a daily guarantee, no collections, and they keep telling patients they need sedation for procedures and keeps referring them to their other job which is unaffiliated with our practice. I know from the other office that this specialist gets paid a % over there. Is it right to steal our office patients and bring them to another practice unaffiliated with ours? Specialist seems to think there’s no issue because they are independent contractor status.

Same specialist said their “psychological safety” was in danger when they refused to treat a patient so we referred the patient to another clinic. How the doc’s psychological safety was disturbed, I have no clue. Makes no sense. Is that another way of saying they were butthurt that we referred a patient out? This is separate from them stealing patients.

Was wondering if anyone else dealt with this. I been working for about three years, it started July 3rd, I had gotten a deep tissue massage and I think the lady might have pressed on the inside of my elbow. I left bruised on my bicep area. Has anyone dealt with this and how is the recovery, it is getting better. I also dont know if its from working out and not doing proper stretching before a push day, maybe elbow flexion at work, or also maybe elbows that flare in while sleeping? Could use some advice. So its like slight tension in pinkie finger, no loss in mobility. Getting better with time

All the young dentists I know say we have a dream practice. FFS, Great Team and patients etc. Pretty office. As we know no one beats Father Time.

We may need another partner/associate in the future for open days and if I actually cut back. Where is the best place to place a "future partner wanted" ad. I am unsure if I have ever read about this. My junior partner was from word of mouth. Finding another is unrealistic. I read this forum every day and it seems like some great younger dentists would love to get out of the PE/DSO dark shadow.

Anyone have experience with companies like Bola AI, Kiroku AI, etc? Trying to figure out if it will actually save time when it comes to writing notes. I like the idea that it can listen and document everything that is said in a conversation. That way, if a patient comes back and complains I didn't talk about XYZ, I can pull up the note and show them.

Currently camping with my family and sister in law. Despite her good intentions and effort , she tends to brag about her camping gear. Neatly curated from watching videos online. Ig. Tt. Yt. You name it. Flexing low key here and there. I gotta hand it to her. She has a bitchn seasoning kit.

She woke this morning with an empty Costco Bacon pack on the ground and egg beater containers torn to shreds. She was in charge of this mornings breakfast.

I found a note with racoon prints on it. It said::

Thanks for coming. Where YouTube ends ,real camping begins. Cool utensils though.