Part 1 and 2 Amalgam restoration

Added: 2026-05-23

[00:00:10]Guys, this case is very important case and again guys Tuesday the good thing about Tuesday classes it's very interactive classes you'll find that you're going to learn lots and lots of good information knowledge about EDC the main the main and the most important thinking there says you learn the critical thinking how ADC exactly exactly wants from you Okay.

[00:01:06]Saying this, saying this guys, this actually means you really need to learn this part.

[00:01:22]given guys please one sign guys if you can see me on the Facebook page sorry if you can see me guys on the Facebook page please guys let me know thank you very much guys. Am I now guys?

[00:02:55]Let me check this on the Facebook.

[00:03:08]Okay guys, this is great then.

[00:03:11]So guys, let's start with the case. In this case, guys, it's an Oscedia.

[00:03:21]And then this guy's a case.

[00:03:27]Who's guys willing to do this case with me today? Please guys pay attention to our our discussion and my questions because every single question I'm going to ask that can be one questions in your in your exam.

[00:03:50]So please guys ensure you actually get pen and paper right now and write down everything we discuss here.

[00:04:03]Okay. Who's guys willing to do this this replay with me?

[00:04:14]Guys raising hand. Please guys raise your hand if you're willing to do this.

[00:04:20]By the way, let's guys take you through some points which is very important point. That's actually what we're going to teach our candidates in part two. And this points as well. It will be very important for part one candidates. Now this part guys is very important how to listen to what the patient experiencing.

[00:04:50]And I always say be giver not a taker means don't ask too many questions.

[00:05:00]You may do some tests explain the test to the patient but no necessity to ask too many questions.

[00:05:13]Can guys, one of you please give me.

[00:05:18]By the way, guys, this is Oskiedia.

[00:05:22]I know maybe the first time ever guys you see this.

[00:05:30]Okay.

[00:05:56]this guy is a B part.

[00:06:09]And then I will not really show you guys what I have in this type of information here cuz this is going to be later on and get discuss it with our candidates.

[00:06:33]But for now we going to discuss this scenario. So now those guys willing to do this scenario with me.

[00:06:42]Let me check this guys before I start. I would love to check on every one of you guys. And by the way, I need the new champions to be brave enough guys. I will be not I will be next to you. I will be supporting you.

[00:06:59]Just please guys start. I would love every one of you guys to start.

[00:07:05]If you take the first step right now toward Oski, you will be the best ever. Just take step. Take the first step. Look at the I remember the first time I started my preparation, I wasn't confident. But time by time I got my confidence.

[00:07:28]Okay.

[00:07:33]I see Dr. Amna raising hand.

[00:07:41]Dr. Sanche raising hand. Dr. Larry raising hand. And Dr. Sama raising hand.

[00:07:48]Okay guys, four of you can talk to me right now one by one.

[00:07:51]>> Hello Dr. >> Hi guys. How you doing?

[00:07:56]>> Hello Dr. Vido. How are you?

[00:07:59]I'm Dr. Sancherry.

[00:08:03]I don't know why I cannot hear you.

[00:08:06]>> Say something.

[00:08:10]>> Hi Dr. Beo, how are you?

[00:08:13]>> Now I can hear something but no it's too far.

[00:08:18]>> Hello Dr. Beo.

[00:08:20]>> Now it's very clear to me.

[00:08:22]I see even Gladiator raise hand.

[00:08:25]Everyone guys raising hand. We actually will take you. Yes.

[00:08:32]Hello Dr. Bido. Can you hear me?

[00:08:34]>> Yes, I can hear you definitely. Yes.

[00:08:37]>> How are you?

[00:08:38]>> I'm Dr. Sancherry.

[00:08:39]>> Thank you, Dr. San. Yes, I know. I can go.

[00:08:43]>> Hi, Dr. Larry. How you going?

[00:08:45]>> I'm good. How are you all going?

[00:08:48]>> Oh, good. Thank you very much, Dr. Larry. So, now we have two big votes here, guys. One is Dr. Larry and Dr. Sanari. Both of them. Also I can see Dr. Sama raising hand, Dr. Gladiata raising hand and Dr. Amna >> and also Hi guys.

[00:09:08]>> Hi guys, how you doing? All good >> good doctor. How are you?

[00:09:14]>> Good, thanks guy. Thank you very much you guys. Everything's perfect guy.

[00:09:18]Thank you very much. Okay, we need one of you to do role play today. Who is this?

[00:09:24]Well, I think you need to be the person that has exams sooner. That's how we always do.

[00:09:31]>> Yes. And also And also um the champion who didn't do the replays recently to with me.

[00:09:39]>> Yeah. Absolutely.

[00:09:40]>> So let's put this two conditions here right now.

[00:09:44]Anyone guys, if you guys >> We're always fair, right?

[00:09:47]>> Huh?

[00:09:48]>> We are always fair.

[00:09:50]>> Always.

[00:09:51]>> Yes. Absolutely.

[00:09:51]>> We try to be always fair. You see? Yes.

[00:09:53]So try to be fair all the time.

[00:09:56]Okay. Uh please guys, you can be on Facebook, you can be in Zoom. If you want to really discuss guys and ask questions, please be on uh Facebook. If you want actually to um uh just to be a listener, be on Zoom.

[00:10:12]Otherwise, you need to be on Facebook if you want to ask questions. Okay. Now, who guys didn't do role play? Who guys did role play in the last two, three weeks with me?

[00:10:23]I don't remember. Uh, did I do it last time? Do you remember, Larry?

[00:10:28]>> Um, no. I don't think you've done it with Dr. Peter recently.

[00:10:34]>> My exam is on 17th of June. Um, >> is what? I still have a month. That's a good time.

[00:10:42]>> Very time.

[00:10:43]>> But I'm happy. I'm happy with Century.

[00:10:45]I'm happy with any one of you guys. I'm happy. Tell me which one and then I will you can discuss and then I'll be happy for this.

[00:10:53]>> Yeah, I'm happy for Dr. >> And who's Dr. Gladiator as well? Dr. Gladiator. Hi, Dr. Gladiator.

[00:11:01]>> Uh, hi Dr. Bidor.

[00:11:04]>> How you going, Dr. Gladiator?

[00:11:05]>> Gladiator. Oh my god, how you doing?

[00:11:09]>> Like that name?

[00:11:11]>> And how is everyone? Uh my name is Gulam Ali Dr. Bidu if you remember and you can call me Ali but here >> uh it is us gladiator.

[00:11:24]>> Thank you very much. No problem at all.

[00:11:26]Thank you very much Ali.

[00:11:28]>> Thank you.

[00:11:29]>> Look you are h you are you have bad luck because actually you are one man between how many women now? One, two, three, four, five, six women. So >> that is too much right? When is your exam Dr. Gliera?

[00:11:44]>> Dr. Vid as as I see the other doctors their exam uh date is so close. So I give them the chance for me. So we just newly passed part one. So >> I think we have many times >> to start too, you know.

[00:12:06]>> That's a good way to start. Yeah, probably can do next time.

[00:12:12]>> Absolutely.

[00:12:13]>> So brave.

[00:12:15]>> I'm very proud of him.

[00:12:19]>> Very good.

[00:12:21]>> I'm very proud of you. That's right.

[00:12:22]That is a good start. That's perfect start.

[00:12:24]>> I think that Dr. Sanar should do it. She got exam very soon.

[00:12:29]>> Anyone uh closer than mine? I'm happy to >> Dr. J. How you going? Dr. Jice, Dr. J here is a Dr. J score as well.

[00:12:40]Hi Dr. Beer. How are you?

[00:12:43]>> Good, thanks Dr. K. How are you going?

[00:12:45]>> I'm good, thank you. So yeah, I just passed my part one. So I want to be a listener at the moment.

[00:12:53]>> That's okay. It's my pleasure.

[00:12:55]>> You should do you should do two cases today, Dr. Peter. One for Okay, we'll try >> and the other one for a new person that just passed part one. I would be amazed.

[00:13:07]>> That's your big red then. Let's do this.

[00:13:09]Let's try to do this. Okay.

[00:13:12]>> Okay guys, thanks very much. Seems like Dr. Amna, Dr. Sama because guys, I don't want to really you need I need to talk as well. Guys, if anyone gets closer than Dr. Sanche, please let me know.

[00:13:23]>> Um, not closer but almost the same.

[00:13:29]>> Almost the same. Okay. Dr. summer.

[00:13:37]>> I try to be fair as much as I can. Yes.

[00:13:41]>> Yes. My exam is next week.

[00:13:45]>> Yeah.

[00:13:47]>> That is a big head on the >> on the head, right?

[00:13:52]>> Yes.

[00:13:55]>> Okay.

[00:13:56]>> Do you want sunshine now? What do you think?

[00:13:58]>> I'm happy. Yeah, absolutely.

[00:14:00]>> I'm I'm fine. I just want to listen if Dr. Sanche want to go. Uh I'm happy with your >> You should definitely practice. Every every role play matters. Go for it.

[00:14:11]>> Oh, thank you.

[00:14:13]>> Anyone else want to do it? I'm happy to to go for them.

[00:14:17]>> You seem to like you now Dr. Sam. I'm very happy for this.

[00:14:21]>> All the best to you then Dr. Sam. Okay.

[00:14:22]Dr. S.

[00:14:23]>> All the best Dr. San will be next time then with Dr. Amna. Okay.

[00:14:27]>> Yes Dr. Thank you so much. Okay guys, now let's learn this. Okay, thank you very much guys. Let's learn this please guys. Now this case here now Dr. San Dr. Sancherry we all by the way guys we all going to be on Facebook and please Dr. Sama Dr. Amna Dr. Larry Dr. Gladietta Dr. Kor and everyone of you guys everyone here the Facebook is there when we ask questions you can answer as well same time I'm asking Dr. Sanctary is that guys clear to everyone of you?

[00:15:01]So you still can participate by commenting as well on Facebook like you can com you can now open the Facebook chat and comment there. If I ask San you just can comment there what is the right answer what's the right management for uh everyone here guys for part one please guys pen and paper because you're going to learn lots and lots of good information and going to help you in part one as well. Okay, let's start. Are you ready? Dr. Sanchari, sorry that Dr. Sama, Dr. Sama, are you ready?

[00:15:35]>> Yes, doctor. I'm ready.

[00:15:37]>> Can you please just cuz you know what? I cannot hear very well. It seems like I have a noise around me. Can you be shout when you speak to me?

[00:15:46]>> Okay, doctor, can you hear me now?

[00:15:49]>> A little bit louder. Louder, please for me if possible.

[00:15:52]Okay.

[00:15:54]>> Can we just get a little bit closer to the mic?

[00:15:58]>> Yes, I'm quite close to the mic. I'm holding mobile in my hand. I don't know what's >> the phone, right?

[00:16:05]>> Yes.

[00:16:06]>> That's okay. Seems like should be fine now. Okay.

[00:16:09]>> Okay.

[00:16:11]>> Yeah. I think Yeah, it's much better now. Thank you very much. Okay. Let's start right now. There's a case here.

[00:16:18]Can you see the case on the screen?

[00:16:20]>> Yes, doctor.

[00:16:23]Okay, can we please read the case guys?

[00:16:27]This is a case you're going to get in exam either part one, part two. You're going to get similar cases like this.

[00:16:32]And then your job is to understand every single word. We kill we say we call them as a keyword. Okay. Now um yes please Dr. Sara can please loudly please tell me like how you can go through this case please.

[00:16:52]So >> read it first.

[00:16:55]>> Okay.

[00:16:58]S Chen, a 30 year 38-year-old accountant attends your practice complaining of ongoing discomfort on 236 which is lower left first mer.

[00:17:14]>> Good. Yes. She had root canal treatment on this tooth 3 days ago at another practice.

[00:17:23]>> Okay.

[00:17:27]>> Yep.

[00:17:29]>> Yep. Uh the original issue was acute pain due to deep TK.

[00:17:36]>> Very good. Keep going.

[00:17:37]>> Hour after the treatment, she continues to experience a dull throbbing pain that worsen when she chews.

[00:17:48]Very good. What else?

[00:17:51]>> She is frustrated because she expected to be painfree by now.

[00:17:57]>> Yeah.

[00:17:57]>> The tooth has been restored with temporary filling. Sara is worried that something has gone wrong and that she might need extraction.

[00:18:09]>> Okay. Very good. Then now the bald part is this. If you look at here right now this is a board part.

[00:18:19]What do you think is this cluster?

[00:18:25]Assess pain. Explain causes discuss next step. Reassure and manage expectation.

[00:18:31]What do you think is this?

[00:18:34]>> It's here by the way.

[00:18:36]>> Diagnosis and management.

[00:18:38]>> Treatment planning and evaluation.

[00:18:40]>> Treatment planning and evaluation. Okay.

[00:18:42]>> Very good.

[00:18:43]Now having this case and again clinically think about it clinically what are the key words in this case.

[00:18:59]>> So >> you know what let's start let's start with the most important single keyword in this case that's if you go and really to cover it and then being successful to discuss this point you'll be able to make the patient happy. What is this exactly?

[00:19:28]>> Um a dull throbbing pain.

[00:19:31]>> Thank you very much. You're very good.

[00:19:34]Dull throbbing pain. Why? Why dull throbbing pain is very important here?

[00:19:43]Um because it's the nature of pain where we decide that because before she had acute pain and we will differentiate it uh >> the type of pain she's having now to identify the cause >> the diagnosis right to get into diagnos cause address the cause and diagnose >> look what I'm teaching right now is why we call it as priority that's the smartest way to analyze any case. So in the as a dentist in the clinic that's what I need to find out. I need to find out what sign of signs symptoms that can help me to get as you said to address the cause and then get the proper diagnosis. Now pain itself is very important. What else? What is the second the most important? Please guys if you can comment on the Facebook as well just to know guys you're understanding that will be great. What else guys apart from this?

[00:20:45]>> I think uh reassurance because patient is worried that she need extraction so we need to reassure.

[00:20:53]I agree in this very much but there is another there is another uh factor because without these two factors you will not be able to reassure because reassurance come from your diagnosis once you diagnose properly you will be able to reassure another factor as well >> I tell you three days Right.

[00:21:23]>> Yes. 3 days.

[00:21:25]>> When it happens after 3 days, it can be normal pain.

[00:21:30]Right.

[00:21:31]>> Yes.

[00:21:31]>> 3 days after RCT can be normal pain.

[00:21:36]What else?

[00:21:39]>> Beno biting again that could be normal as well. So can you please tell me if you put it's a puzzle game right now.

[00:21:48]Put the things together. Put dull pain thropin pain actually keep dal pain alone throwing pain will keep it differently now dull pain have been three days and then pain on showing what do you think you diagnose in this case let's say what do you think is the most likely likely diagnose in this case >> it could be especially If it's pain on biting, it could be a high feeling.

[00:22:25]>> Uh, could be. What else? But I I need the most likely. By the way, I will give you now an X-ray to look at it too. This X-ray.

[00:22:44]>> Okay.

[00:22:46]>> Okay.

[00:22:47]>> Can I see this X-ray right now?

[00:22:50]Yes, doctor.

[00:22:52]>> Very good. Look at the X-ray and tell me what can be done.

[00:22:58]>> So, there is a short filling in one of the canal.

[00:23:04]>> Very good. You see this? There's a short filling, right?

[00:23:07]>> Yes.

[00:23:08]>> And this one is okay. Like when I look at it could be normal somehow. I know this is this is not the root by the way.

[00:23:16]The root is this one.

[00:23:19]Yes, >> that is okay. Somehow this is short.

[00:23:24]So how you call this condition? So what happiness pain 3 days throwing type or dull pain special showing? How you call this? After 3 days only started after 3 days >> is uh >> flare up. Let's say flare up. Yes, flare up.

[00:23:48]>> Yes, thank you very much. So, this case right now, it's a flare up case.

[00:23:53]>> I see the champions. Who says flare up?

[00:23:56]I see guys, some of you said flare up.

[00:23:58]That's amazing. I love this. You're very smart guys.

[00:24:03]Dr. Marlin said flare up. I was very happy to see this. Right. The most look when we think about it, we think about the most common cases in the practice.

[00:24:13]The most common cases. And look at this.

[00:24:16]The root looks okay. Like there is not really that much issues here on the X-ray. Like there is not that much reducency. That's normal with X-ray.

[00:24:25]Could be um just a little bit widening here. But the rest is still okay here as well. It's normal. There is no like see this is normal like this is normal tooth. It's normal to see a little bit of widening on this high magnified X-rays. So now most probably the most common now reason is flare up case, right?

[00:24:44]>> Yes.

[00:24:46]Now why flare up has happened or normally happens?

[00:24:52]>> Ineffective cleaning if uh we cannot properly clean the canals or any miss canals or cannot properly seal the canal.

[00:25:04]>> Okay. What else?

[00:25:08]>> Okay.

[00:25:10]I'm thinking >> that's okay. Take your time. You can think >> if there is a crack or >> no flare up. Let's focus on flare up only.

[00:25:33]>> Okay.

[00:25:33]>> Just focus on because flare up means the bacteria has overgrowing again.

[00:25:42]>> Yes.

[00:25:44]Did you get my point?

[00:25:45]>> Yes. If the coronal >> so what can make the Yes. Sorry.

[00:25:50]>> If coronal seal is broken.

[00:25:54]>> Uh not really in 3 days time.

[00:25:57]>> Yeah.

[00:26:00]Cuz if you go and say the if you go and say flare up has happened because of this that will be uh that will be actually um a completely different diagnosis.

[00:26:16]>> It will take time.

[00:26:18]>> Exactly. Will take time.

[00:26:20]>> Yes.

[00:26:23]>> So what as it could be Dr. Bido? Uh I believe >> flare up it's a >> okay okay flare up it's actually it can be just bacterial resistance regardless of how much clean you're going to do.

[00:26:46]You may do the best clean ever. You may use hydrogen peroxide which is too much.

[00:26:54]We don't like in Australia. We like sodium hypocchloride. But I'm giving you something very potent as well. Right. Um you may use chloroxidine. You may do a proper cheomechanical preparation. At the end of the day, no one can control the flare up.

[00:27:13]So in this case, we'll find the bacteria are more stronger than the body. And this this bacteria it can be somewhere like normal bacteria for some reason can them then you can't find them they overgrow straight away. Do you get my point?

[00:27:28]>> Yes. In that case he will say no matter how much we will we clean >> uh and that some of the bugs still uh stay behind and overgrow and cause infection.

[00:27:41]>> Not infection. One second. Hello. One second. It's just inflammation infection because if you feel infection right now that's got change the scenario be careful wordings okay so guys now guys if I ask a question is a flare up flare up happens between the visits or flare up soon after the treatment do you think guys Dr. Larry. Okay. One second, please. One second. Dr. Larry raising hand.

[00:28:16]Yes. With Dr. Larry.

[00:28:18]>> Oh, I'm sorry. I didn't lower my hand.

[00:28:20]I'm so sorry.

[00:28:22]>> That's okay. That's okay. That's okay.

[00:28:24]Okay. So guys, what I'm saying is >> do you think guys flare up is an infection?

[00:28:32]>> Sorry.

[00:28:32]>> Or inflammation or what sort of it is flare up?

[00:28:41]It's all right.

[00:28:43]>> Yeah.

[00:28:44]>> Yep.

[00:28:50]>> Guys, can you hear me? Can you see me?

[00:28:51]Can you hear me?

[00:28:57]Dr. Sama.

[00:28:58]>> Yes. Yes, doctor. We can hear you.

[00:29:00]>> Yes. So, what do you think it is?

[00:29:03]>> It's inflammation.

[00:29:05]>> Inflammation. Dr. Brag, are you okay?

[00:29:08]Dr. Ali, I don't know why the people raising hand nails. Okay. Inflammation.

[00:29:12]Very good. Why this inflammation has happened? Because resistance bacteria.

[00:29:18]Okay. Easy.

[00:29:20]>> Yes.

[00:29:21]>> Very good. And I'm happy for this right now. Okay.

[00:29:25]What else can be? What else do you think can be the um uh diagnosing this condition?

[00:29:42]H >> um sometime if because it's not in this situation if sometime they put a band around the tooth if it's impinging on the gum we can say that we can check if it's impinging on the gum can cause pain >> um can be if if there is a band around yes if the band around the tooth yes around the crown yes what else but I need the second most important Let's let's have this mentality. We need to think about the second most important. Do you have a short canal or not?

[00:30:20]>> Yes.

[00:30:21]>> The short canal, right? What can happen in the short canal?

[00:30:33]>> So it's it's not properly sealed. So >> yes, totally. You're totally right. Yes.

[00:30:39]What going to happen then?

[00:30:43]So it's again um the bacteria can just again go in and >> infection.

[00:30:50]Very good. So what going to happen then what bacteria does there how we call this one leftover bacteria right that's a word you need to use leftover right >> yes >> it will grow back again leftover true >> yes >> okay can you decide in this leftover bacteria today >> sorry >> can you decide that This X-ray is actually short X-ray as you see it. Can you decide and can you confirm with 100% confidence that the root canal treatment is showed on the distal root canal?

[00:31:44]>> Uh no, it could be the angle of the X-ray.

[00:31:48]>> Yes. Why? because this two dimension X-ray right >> yes >> very good and that's may result in what we call it as epical predonitis has happened there now it's inflammation not infection most probably because I don't see that bone resorption happening anyway anyway that's the second most important can you tell me in real life in real life in this case how to doublech Check if the canal is short or not. As a general dentist first, not as a specialist, a dentist, what you going to do in this case?

[00:32:29]>> Take an X-ray from the different angle.

[00:32:32]>> Thank you very much. Take an X-ray of different angle or otherwise you can get CBCT at the at the last resort. True.

[00:32:42]>> Yes.

[00:32:43]>> Very good. Then now how far ideally should be the oburation ends at the top part of the root which is the apex >> 15 to 1 millm >> 0.5 to 1.5 or 1 mm right?

[00:33:09]>> Yes.

[00:33:11]>> Okay. 0.5 to 1 mm. It could be an ideal.

[00:33:15]But what is what is the acceptable distance from the the table for the end of gatersia to the end of the root?

[00:33:30]>> I'm not very sure Dr. Vido maybe 1.5 to 2 mm.

[00:33:36]>> No to 3 mm.

[00:33:39]And some references some studies made and say they mentioned actually can be even sometimes 4 mm.

[00:33:47]Okay. While you doing this in your practice before you decide is it really 1 mm or 2 mm or 3 mm or even 4 mm is actually is actually the right working length in your practice plus X-ray or actually what could be the most important tool you can use to help you to determine that you are getting the right working length.

[00:34:30]>> Something start with apex.

[00:34:32]>> Apex locator.

[00:34:34]>> Yes.

[00:34:37]>> And does locate something.

[00:34:43]It's apex and does locate something. So what's the name?

[00:34:50]>> It's called Apex Locator. No.

[00:34:52]>> Yes. AEX locator. AEX locator. Right.

[00:34:56]>> Yes.

[00:34:57]>> So AEX locator plus X-ray will be the most sec the most important two tools you need to use to determine your working length. Okay.

[00:35:09]Clear right now?

[00:35:11]>> Yes.

[00:35:12]>> Very good. What else can be raised in this case? So let's say one it could be just a mild if it's just a mild pain it can happen after RCT can be normal.

[00:35:25]>> Yes.

[00:35:26]>> And that's expected to be resolved by time just patient may take painkillers and then after a few days he should be fine.

[00:35:39]The second most important is flare up.

[00:35:45]And the flare up flare up as we mentioned most it will end up with again inflammation which is the periabical inflammation because of resistance bacteria.

[00:36:07]The third the third diagnosis could be insufficient RCT especially for the distal canal which is looks visually by two dimension X-ray short but we can confirm this until we get another X-ray from different direction or otherwise later on if necessary we can do CBCT. Do you agree on this right now?

[00:36:40]>> Yes, sir.

[00:36:46]>> Dr. Sama, do you agree on this stuff?

[00:36:48]>> Yes, doctor.

[00:36:50]>> Good. So, now there are lots of points, important points here we need to understand, we need to know about.

[00:36:56]Okay.

[00:36:58]Not bad.

[00:37:02]No.

[00:37:05]What else can be reason? I think the rest like you going to say for example there is a band around or inflammation the gums or high spot. It can be okay.

[00:37:18]>> Okay.

[00:37:20]>> Okay.

[00:37:23]>> Are you ready right now?

[00:37:27]>> Yes. Dr. ready?

[00:37:32]>> Yes.

[00:37:33]>> By the way, we'll prescribe antibiotics in this case and >> no, >> we won't prescribe because uh we don't have any symptoms of infection like any swelling. Very good.

[00:37:51]>> Very good. I'm happy.

[00:37:53]Do you think that dentist had made something wrong?

[00:38:01]No.

[00:38:03]>> Ah, you cannot be that confident. No one. Yes.

[00:38:09]>> Like it could be or could it could not be.

[00:38:13]>> Yes. In this type of questions, be smart. Don't take only one decision. Yes or no. Cuz it like on X-ray right now what I can see is there is a little bit short canal. But does it mean that it's real? It's really short.

[00:38:28]Okay.

[00:38:29]>> Okay.

[00:38:31]>> Okay.

[00:38:36]>> Do you think this patient has vertical root fraction?

[00:38:44]>> Um vertical root fracture >> or deep or deep crack all the way down to the roots.

[00:38:53]Advanced crack into the root. Uh no because we have X-ray and usually with the virtual root fracture it's a deep pocket on the side of fracture.

[00:39:06]>> Very good. Then why then there is a band around. Why do you think there is a band around the crown? Then >> because there is a temporary filling. So just to protect the tooth from being fractured.

[00:39:22]>> It could be a reason, right?

[00:39:24]Yes.

[00:39:26]>> Okay, that is good then.

[00:39:29]I'm happy with this answers.

[00:39:32]Okay, what else? Let me just give you some good questions.

[00:39:45]What if dentist didn't tell the patients about complications and the dentist and then the patient was was unhappy and upset professionalism cluster. What will be your answer then?

[00:40:05]Um I will say I'm not sure why it is happened because usually uh we uh discuss the comp uh complication before the procedure but uh let's discuss um your concern today and regarding this uh you can have you can discuss with your dentist.

[00:40:28]>> Can you please repeat this answer again?

[00:40:31]Okay.

[00:40:34]I will tell them. I'm not sure why it might be happen. So the best person to discuss this is >> one second. One sec. Look at this. Let's write down this together. Okay.

[00:40:45]>> Okay.

[00:40:46]>> Give me a second please. Let me write down this.

[00:40:53]You saying look at this. I I'm going to break down your language word by word.

[00:40:58]Okay. I may choose red color. I don't know.

[00:41:12]Why?

[00:41:14]So the word I don't know. Do you think the patient will be happy?

[00:41:21]>> If you say I don't.

[00:41:22]>> Do you think the patient will be happy?

[00:41:26]But is it better to say I'm not sure?

[00:41:30]>> Maybe you can say I'm not sure.

[00:41:34]>> Okay. What was the question about first?

[00:41:37]>> Uh the dentist didn't tell about the complications.

[00:41:41]>> Yes.

[00:41:43]So if the patient says this one, you should look at this. Okay. One, you should guys. Please guys learn the skills guys. other part and part two candidates. One, you must understand the patience concerns.

[00:42:04]Two, don't deny, don't agree, be neutral.

[00:42:15]Three, answer the question itself or the nature or cover the nature of the question rather than the question itself.

[00:42:31]How this the patient asks me right now, do you think the other dentist did something wrong? The answer is oh yeah because he didn't tell me about the complication.

[00:42:52]The first things you must tell the patient I hear you or I understand you right. It should be very frustrating if the dentist didn't tell you about the complications.

[00:43:20]Did I say right now the dentist is drunk?

[00:43:26]>> No.

[00:43:28]>> Did I say the dentist not drunk?

[00:43:32]>> No.

[00:43:33]>> That is a smart sway. The smart way is don't as long as there is no clear signs or symptoms or no clear mistake in the X-ray things I cannot rely on it right in this case don't say yes or no directly but you treat the condition itself just talk about the whole things and say as dentists one of our do Beauty of care is to discuss the complications of the treatment.

[00:44:13]>> Did you get my point?

[00:44:15]>> Yes.

[00:44:18]However, the best way is to to talk to your previous dentist or otherwise if you would like me to talk to him, just give me a consent to do this for you. Did you get now how we sort out this problems?

[00:44:38]>> Yes, sir.

[00:44:39]>> Back again. The way you said I don't know. Not good.

[00:44:45]Okay. the way you say for example what did he say as well you said something as well you have said something I cannot remember exactly what I said but you said something else as well here >> I said I'm not sure why it happened >> not sure as well was there was another another point was really important point you mentioned as well I can't remember what was okay >> yes >> easy now do you know how to fix these issues >> yes >> right Yes.

[00:45:17]>> Okay. Very good. Then are you ready right now with the replay?

[00:45:21]>> Uh yes, doctor.

[00:45:23]>> Should I right now set up 10 minutes for you?

[00:45:32]>> Uh yes, doctor.

[00:45:36]>> Okay. Uh sorry. 3 minutes. 3 minutes. So how long you need for um guys by the way guys in part one and part two exam every single word it does make big big difference in exam every single word now record where is the timing gone time time I think should be down there.

[00:46:08]Me just put this one here.

[00:46:14]Record show time. Time app.

[00:46:19]Two minutes. Three minutes reading.

[00:46:20]Which one? Three minutes reading.

[00:46:22]>> Uh yeah, three minutes reading.

[00:46:24]>> All the best you then. I'm starting now.

[00:46:26]Three minutes reading.

[00:46:29]All the best you then.

[00:46:35]Can I see the Can you see now the uh timing?

[00:46:39]>> Uh yes, doctor.

[00:46:42]>> Very good.

[00:46:44]All the best you then.

[00:46:46]>> Thank you, Doc.

[00:47:18]Guys, the questions I'm going to ask here, they are very important questions.

[00:47:22]Please guys, pen and paper and write down everything question and the answers please. Here answers my and also at the end I will be answering this question too.

[00:47:42]Can I see the bold part?

[00:47:44]>> Yep, definitely.

[00:48:47]50 seconds left.

[00:49:50]Yes, please.

[00:49:57]>> Um, let me go a little bit up. I want to see the name.

[00:50:05]>> Yep.

[00:50:11]Can uh >> can you go a little bit up? I want to see the scenario. Doctor, >> that's okay. Dr. >> So, how may I address you?

[00:50:34]>> Chen. My name is Chen.

[00:50:36]>> Okay.

[00:50:39]Okay, Chen, I'm done with the examination. I will make the chair upright so we can discuss. Are you going okay so far?

[00:50:48]>> No, doctor. Um, tooth really hurt me a lot, doctor. Um, really need to do something for me today.

[00:50:56]>> Yes, definitely.

[00:50:58]>> Doctor, um, just a second. I forgot your name, doctor.

[00:51:03]>> Okay, let me introduce myself. I'm Dr. summer and I will be looking after you today. So, uh I can see in my notes as well that you have got root canal treatment done 3 days ago but uh you still have pain after that. Is that the case?

[00:51:23]>> What do you mean that the case? Yeah, you mean like that's what I feel right now. Yes, doctor. That what I feel.

[00:51:29]And I can see that the pain is uh uh happens when you bite and it's a throbbing dull pain, right?

[00:51:40]>> Yes, doctor. You're totally right. Yes.

[00:51:42]>> Okay. So, uh would you like to explain a bit more about the pain?

[00:51:48]>> Just as you mentioned now, doctor, no more than this.

[00:51:51]>> Okay. So, when did exactly it started?

[00:51:57]I think I already give this information to your um assistants in the beginning and also to you in the beginning of um this um visit doctor.

[00:52:09]>> Okay. No worries. I can understand that you are feeling pain uh you are feeling pain at the moment. So let's discuss what could be the reasons that uh that can lead to the pain after root canal treatment. How does that sound?

[00:52:24]>> Okay, Dr. Okay. So, usually uh we can experience uh pain after root canal treatment. It's because we do some in uh use some instruments and some materials that can cause some irritation and pain but it usually go away in in a week time and slowly get better and we usually recommend taking some painkillers. So, are you taking any painkiller or are they not helping?

[00:52:54]Yes doctor I'm taking penadol and um I don't think it help it it helped me a lot it's not >> okay or there could be other reason that might be contributing it sometime while we are cleaning inside the tooth uh there's possibility a part of the tooth might left behind we are we cannot properly clean it sometime there are very tiny canals inside the tooth that are not visible or sometime time despite being we uh clean the tooth very properly some germs left behind then grow that can grow and cause inflammation we call it flare up are you following so far >> okay >> yes so there might be something some left behind the germs that have left behind that causing the inflammation okay >> doctor do you think this has made because of the previous dent Okay.

[00:53:54]>> Okay. So, it could be or it could be not because uh I have taken an X-ray as well. So, uh let's look together at the X-ray, I can see that there are two uh if you look at the two uh lower part on one side, I can see that the filling is right till the tip of the uh tooth. But on the other side, it feels short. Now according to this X-ray >> doctor Okay doctor what do you mean the other side? Do you mean like which side is other side?

[00:54:32]>> So towards the back the dist we call it dist.

[00:54:35]>> You mean this one right? Okay.

[00:54:37]>> Yes.

[00:54:39]So this side you can see that it's it seems a bit shorter. That means this much area is not properly sealed where germs can re-enter and can cause inflammation again.

[00:54:56]Are you following me so far?

[00:54:59]>> Yes, I follow you.

[00:55:00]>> Okay. So based on this, this could be the reason but it could not be because on this X-ray we cannot say 100% that it's short.

[00:55:13]Maybe we take the X-ray from another angle and it's it's fully sealed. So, uh I I would say that it might be a cause or that might be the other things that are contributing to it. Does that make sense?

[00:55:27]>> Okay. What other things doctor?

[00:55:30]>> Okay. So, other things could be when I can see that you have a temporary filling at the moment. So sometime if there it is high at some point it can cause pain especially when when you bite. So it could be a reason.

[00:55:48]>> Okay. How do you know this doctor? How do you know is it high or not?

[00:55:52]>> Okay. So I I will need to check your bite by using a special paper. We call it biting paper. And if if it's if it's high then it's it seems that it might be contributing to the pain.

[00:56:07]Okay, doctor, you mentioned that on the X-ray it looks like it's short. So, how far ideally this rook treatment should be then?

[00:56:19]>> So, it should be ideally just uh 05 to 1.5 mm. That should be the ideal length that it should be.

[00:56:30]>> You mean 1 mm, right? Okay. Okay. Okay.

[00:56:32]That's fine.

[00:56:33]There's a question here right now just came in my mind. Why does it hurt if the nerve was removed?

[00:56:44]So it it hurts as as we discussed earlier if there are still germs inside that are causing inflammation that means the nerve is not properly removed. Maybe a part of the nerve is still there.

[00:57:01]>> Very good. Okay doctor, I got this point right now. Do you think doctor this is an infection? The tooth is infected.

[00:57:09]>> Uh no, I cannot see any signs of infection that usually uh happens. Uh you might have swelling around your gums or the other signs but at the moment it seems like inflammation >> more inflammation. Very good doctor.

[00:57:26]>> Yes.

[00:57:28]>> Okay. Dr. Do I need antibiotics?

[00:57:31]No, you don't need an antibiotic. Now I I believe that uh we can just check and identify the cause and then uh we can just follow up this to see that what exactly is the cause?

[00:57:47]>> Okay. What sort of medication doctor will you uh will you prescribe if there is any you going I'm I need to take today.

[00:57:56]>> Okay. So uh as you said that you were taking uh paranola and it was not helping. I will prescribe you another uh painkiller which is called ibuprofen which is anti-inflammatory as well which means it help with the inflammation as well. It will uh you can take along with penatol every for every 6 to 8 hours for 5 days.

[00:58:21]>> Okay. So Dr. how do you know what is the main condition today? My main issue then.

[00:58:28]>> Okay. So I will uh first I will assess the tooth. I will check the tooth and check its bite and I will check I'll check gums around the tooth and also I will take another X-ray. Uh but it's it's wait and watch thing. I will prescribe you painkillers and uh put uh do a follow-up appointment. So it's to see that if the pain is uh going away or resolving or not. If the pain doesn't resolve with these it might be the insufficient uh root canal or it might be some flare up. So in that case we might need to redo the root canal treatment.

[00:59:11]>> Uh who's going to do who's going to redo the root canal treatment doctor?

[00:59:15]So rroot canal treatment are best done by the uh root canal specialist which is called endodontist.

[00:59:23]>> Do you advise me at any stage that I need to go back again to my dentist, my previous dent or my other dentist?

[00:59:32]>> Yes. Uh I believe so you can go back uh to your dentist.

[00:59:36]>> What's your advice? Should I shouldn't?

[00:59:39]>> Yes, you should. I think you should because you have done root canal treatment done with your dentist and uh he's the uh he's the best person to to assess that uh what's happening because that treatment is done by him or her.

[00:59:57]>> Do you think do you think Dr. this tooth will need do you think this tooth need to go um after sometimes or when exactly will feel better?

[01:00:09]It it should feel bad if if it's if if we are not expecting any flare up or any inflammation caused by insufficient root canal, it should be better in in a week time.

[01:00:24]>> In a week time. Okay, doctor. This is good.

[01:00:27]>> Uh Dr. Why there is a band again around the tooth? It does because it has a big crack on it, do you think?

[01:00:34]So when when we do the root canal treatment and also when the uh tooth has a big filling they are usually very weak and very prone to crack. So we put band uh before putting any cap on the tooth so that it doesn't break just to protect the tooth.

[01:00:56]>> Okay doctor that is good then no problem. Thank you very much. Times up anyway. Thank you very much Dr. Sal.

[01:01:03]>> No worries.

[01:01:04]>> How you feel guys? What do you think guys about? Okay, you Dr. Sal first tell me how you feel first.

[01:01:12]>> Uh I'm not sure that I was good in explaining or I was not sure that the uh the treatment I told was like fine.

[01:01:23]>> Okay. Do you know that what is Okay guys, I always say this. I am a doctor who prescribing a medicine to you only you. If you have flu, I prescribe flu to you. Flu medicine to you. If you have stomach pain, I prescribe stomach pain medicine to you, not to anyone else. And this guys, how is ADC exam for you Dr. Sama? I tell you where exactly I need to prescribe your medicine. Okay.

[01:01:55]>> Okay. The meds I'm describing to you right now is the area that we need to improve in.

[01:02:04]Now I tell you where about your issue now Dr. uh summer the main issue coming from the start you somehow somehow at the beginning you feel I believe anxious stressed and they don't know how to start the case and you take time to start the case and this is actually going to affect to build up prop the patient patient.

[01:02:40]Do you know you have done great job?

[01:02:43]Very good job. Amazing job from the second from the second minute.

[01:02:48]From the second minute, do you know this?

[01:02:53]Yes. Dr. You said each and everything right. I was bit anxious and I didn't know how to to start this case and I was not sure if I need to ask about pain or not. But I started asking Yes. Right. And and if you can manage this part and make it easy to you, you don't need to ask for pain because already we have enough information.

[01:03:20]We have the type of pain. We know when the pain started.

[01:03:25]You don't need after the second minute.

[01:03:29]You did everything perfect. Totally perfect. There was not even one single mistake in anything. Even I tested your um uh I tested even your listening part and your attention. I even pause for sometimes for more than like 20 seconds or 10 seconds. I found you actually you checked on me and it was very good. I was very happy you did this.

[01:03:53]So now the main things to s to you is actually the start when there was no introduction. What if you can say something? For example, look guys, I'm going to teach you all the stuff because I'm changing now the capsule something different. Now, what the capsule had this stuff too, but I think this time will be more clearer as well. Now, what if you can say something like I'm the dentist is looking after you today.

[01:04:25]Good, right? No bad.

[01:04:27]>> Yes.

[01:04:29]>> And then my name is anything. Michael, for example, choose my name. I know like it's a it's a male it's a female name but you see can use a male um a male name like um the surname I don't know whatever okay Mr. something call me with the same name Mr. something now done this one is done then reassure the patient the beginning I will be helping you you will be free of pain right I will I will helping you today if you don't lie you will help him today Right.

[01:05:14]>> We we will assess the pain itself. What is the reason of pain today and then we will manage the pain approp appropriately today.

[01:05:28]That's the one easy patient will be happy. Okay. You know where is the fatal mistake in the first two minutes you make?

[01:05:39]>> Yes. Here >> you missing misinformation. Look at this.

[01:05:47]Missing important information the scenario. How did you miss? You ask me.

[01:05:52]Guys, what do you think guys? Which important information she missed in the scenario? I think Dr. Summer know.

[01:06:06]>> Um >> Amy, what did you miss in the scenario?

[01:06:09]the the things that's made me upset in the beginning as a patient.

[01:06:14]>> Uh the other dentist.

[01:06:16]>> No, >> that >> no the uh pain.

[01:06:20]>> Yes. What was what was the issue with the pain?

[01:06:34]>> What did you miss?

[01:06:39]You have asked me question about information was in the scenario. What information you ask for and the information was a scenario. You missed important information. Look at this in the scenario.

[01:07:00]You said when the pain has started.

[01:07:04]Do you remember this?

[01:07:06]Yes. And it's written 3 days after root canal. Yeah.

[01:07:10]>> And then in the scenario, look at the scenario. Let me just give you the scenario now.

[01:07:21]Look at the scenario.

[01:07:26]Is it mentioned the scenario when the pain started or not?

[01:07:33]Um >> it actually was 3 days, right? The the stuff has done by three days, right?

[01:07:40]>> Yes. It says she continues to have pain.

[01:07:42]Yeah.

[01:07:43]>> Yes.

[01:07:45]Okay.

[01:07:46]>> Okay.

[01:07:47]>> So it can be because of inflammation, over instrumentation, it can be flare up, it can be anything of his stuff, right?

[01:07:55]>> Yes.

[01:07:56]>> Okay. Very good. them. So if information given the scenario you cannot ask questions. Look any information given scenario don't answer the question about it again. Okay.

[01:08:07]>> Okay.

[01:08:08]>> Okay.

[01:08:10]Apart from this you did great job. The only thing you need to do is the first first minute. That's it.

[01:08:19]The first couple of minutes.

[01:08:23]>> Okay.

[01:08:23]>> Okay.

[01:08:24]>> Okay. Now tell me do you have any question regarding this case at all guys anyone of you guys have any question regard this case you stop tell me >> so >> I really was very happy I was really very happy very happy after the second m perfect there's not even one issue >> thank you Dr. I'm happy doing this this case today. Uh I just want to know about the management like is it exactly the same like we will just uh uh see the issue with the teeth clinically and we will prescribe pain and it's just a monitoring we will monitor and if it doesn't resolve >> it will probably we will refer to the endo. We won't be doing anything.

[01:09:10]Um no you don't need to do anything right now unless if it's really severe type of pain like severe severe type of there is infection in this case you may need to refer the to give antibiotics and they refer the patient back to the his original dentist or maybe for a specialist but not at this stage as long as mild pain you don't need really >> okay and regarding sending to um their original dentist should I include like I just said that if it doesn't resolve I will send you to the endodontist. But should I include their own dentist as well?

[01:09:44]>> Very important point. Yes, it's better to let the patient talk to his dentist as well. He should go back to his dentist. Yes.

[01:09:52]>> Okay.

[01:09:54]>> Very important. Yes.

[01:09:59]What else? Please.

[01:10:04]>> No, I don't with this case. Yeah. You explain it very very >> you you even went very very nicely like very simple things was very this simple you didn't really got that much demon unnecessary information um things was very clear to me you didn't use any words which any words which is actually jargon so you didn't right I was very happy for this only the first minute be confident don't worry patient will not bite you then will not bite you right just only be open be open that's okay from the beginning >> okay okay thank you Dr. We do.

[01:10:50]>> Okay. I think we did this case and there I don't think there's any I'm my eyes on the comment there. I see people actually um no one has any question. I can see right now. No one has any question.

[01:11:10]>> Yes, you explain it very well. Even I know um this case now. I hope I do it well but I know it very well now.

[01:11:18]>> You did very well. You did very well. I can tell you did very very well.

[01:11:24]Okay. And no treatment. No no no antibiotics in this case unless we have signs of infection. If no size infection I don't think you need to prescribe antibiotics in this case. We need to be very conservative prescription antibiotics these days.

[01:11:38]>> Okay. All good doctor.

[01:11:40]>> Okay. No problem. Thank you very much you guys. That was great.

[01:11:43]our champions our part one session will be tomorrow which is Wednesday.

[01:11:49]Thank you very much guys and then and uh for our part two candidates our session will be on the Thursday we we start the technical online technical course this Thursday and all the best to Dr. summer then everyone of you guys.

[01:12:06]Thank you very much you guys. Have a great night everyone of you. Thank you very much.

[01:12:14]Thank you guys very much. Thank you.

[01:12:16]Have a great night.