"Dentist admits to using paper clips in root canals"

[mike3kgt]

---

Members don't see this ad.

http://www.msnbc.msn.com/id/46114848/#.Tx9Ilfnatjc

So you may have heard about this story... so whatever you believe about it from a dental professional standpoint is fine.

What I find most intriguing about this link is comment #25.2.

Be careful what you post on a public internet forum

 

[Bereno]

Wow. Sadly, this does not surprise me. 👎

I had a laugh at that link BTW. Funny thread haha

 

[lemoncurry]

I'd say it is not uncommon for some dentists to use paper clips as temporary posts. I would certainly autoclave them first.

 

[mike3kgt]

I'd say it is not uncommon for some dentists to use paper clips as temporary posts. I would certainly autoclave them first.

I've seen them used before and actually some dental schools teach this as part of their curriculum for provisional restorations. Obviously this doc made the mistake of #1-making the paperclip "post" permanent and #2- probably billing medicaid for a definitive cast post and core restoration.

Anybody try putting a paperclip into the autoclave? Do they hold up to the heat?

 

[HupHolland]

we were taught to use paper clips as temporary posts in a pinch. I actually used it once in the dental school clinic. no need to autoclave it, in my opinion. assuming it came straight from the paperclip box, I think spraying it down with a bleach solution is good enough - at least that's what I did. most things inserted into the patient's mouth are not sterile, anyways.

on a side note, i still don't understand the rationale behind using sterile gloves when performing extractions.

hup

 

[mike3kgt]

on a side note, i still don't understand the rationale behind using sterile gloves when performing extractions.

hup

I've seen our perio department using sterilized aluminum foil to cover the headlight and using sterile gloves. To do what? A freggin' connective tissue graft.... hahahhaha. It's a slice of meat and they're treating it like a kidney transplant. Then the perio resident grabs an air-water syringe that was sprayed down to clean. Sterility? Gone.

 

[DavesNotHere]

we were taught to use paper clips as temporary posts in a pinch. I actually used it once in the dental school clinic. no need to autoclave it, in my opinion. assuming it came straight from the paperclip box, I think spraying it down with a bleach solution is good enough - at least that's what I did. most things inserted into the patient's mouth are not sterile, anyways.

on a side note, i still don't understand the rationale behind using sterile gloves when performing extractions.

hup

To avoid infection at extraction site

 

[Bereno]

To avoid infection at extraction site

Its an extraction, not an implant. It will be open to all kinds of stuffs regardless of using sterile gloves or not. Regular latex or nitrile is what I have always seen used for an extraction.

 

[Daurang]

A patient called me today cause her pfm #9 fell out (along with the post and core). The previous dentist had used paperclip with amalgam core buildup. I guess it's a common thing.

 

[mike3kgt]

A patient called me today cause her pfm #9 fell out (along with the post and core). The previous dentist had used paperclip with amalgam core buildup. I guess it's a common thing.

It is a common thing but only fits for provisional restorations. While I would argue that there are better options for these situations, I don't think I could state that it would be below the standard of care pending proper sterilization techniques (at least a hypochlorite soak).

Now for definitive treatment, I would certainly state that it is below the acceptable standard in restorative dentistry.

The trouble lies in that sometimes we get so used to doing some things for provisionals, we start believing that it will work for definitive use. Mainly it's motivated by low cost materials... i.e. basically free vs. moderately expensive. And those who use the technique are in a community clinic or a medicaid office. There are, however, many low-cost options available from a dental supplier, why take the risk with using a paperclip? Even the lowest cost clinic can justify a $1.00 post (via henry schein) even if for peace of mind.

 

[Masseter]

As a temporary for post and core treatment using paperclips is fine and in no way is a foul or butchered practice. In fact, you could still use a 170L bur if you want to.

However using a paperclip for final work? How shady is that. Putting a few hundred dollars crown over flimsy work? Well Karma is a bitch! 🙂

Edit : When I read the thing I tough this would be paperclip vs gutta percha. Melting paperclips is quite easy, it provides perfect sealing as long as you watch for bubbles and it kills any bacteria left.

 

[DavesNotHere]

Its an extraction, not an implant. It will be open to all kinds of stuffs regardless of using sterile gloves or not. Regular latex or nitrile is what I have always seen used for an extraction.

Im not saying i would only extract with sterilized gloves....no one does that, i was just giving the rational. And i mean if there's a sinus exposure that's an area that could have been completely protected from outside contamination if it hadnt been for the disease laden non sterilized gloves.

 

[Bereno]

Im not saying i would only extract with sterilized gloves....no one does that, i was just giving the rational. And i mean if there's a sinus exposure that's an area that could have been completely protected from outside contamination if it hadnt been for the disease laden non sterilized gloves.

Ah, good point.

 

[DrJeff]

This story is the CLASSIC case of the media picking up on relatively speaking a minor detail and reporting it to be the major detail.

What REALLY got this guy in trouble was the repeated medicaid fraud (and using a paper clip wasn't the vast majority of the fraud). As has already been stated, the use of a paper clip in a post endo tooth, atleast as a temporary restoration, isn't a big deal (and one could likely make an arguement that under certain situations a paper clip post, even as a definitive restoration, with it being sealed from both from the apical and occlussal sides wouldn't be a big deal), but the media picked up on the omost emotional component of this story and ran with it.

This battle between emotion vs. science is one that you'll have to face over and over in various forms in one's dental career

 

[mike3kgt]

This story is the CLASSIC case of the media picking up on relatively speaking a minor detail and reporting it to be the major detail.

What REALLY got this guy in trouble was the repeated medicaid fraud (and using a paper clip wasn't the vast majority of the fraud). As has already been stated, the use of a paper clip in a post endo tooth, atleast as a temporary restoration, isn't a big deal (and one could likely make an arguement that under certain situations a paper clip post, even as a definitive restoration, with it being sealed from both from the apical and occlussal sides wouldn't be a big deal), but the media picked up on the omost emotional component of this story and ran with it.

This battle between emotion vs. science is one that you'll have to face over and over in various forms in one's dental career

👍 DrJeff, as always, great post.

That same dentist got sentenced to 2 1/2 years in prison but will serve 1 year (due to legal process). Typical media headlines though, nothing about the medicaid fraud in the headline... only paperclips. http://www.msnbc.msn.com/id/46189842/ns/health-health_care/#.TybMIfnatjc

 

[HupHolland]

Im not saying i would only extract with sterilized gloves....no one does that, i was just giving the rational. And i mean if there's a sinus exposure that's an area that could have been completely protected from outside contamination if it hadnt been for the disease laden non sterilized gloves.

I respectfully disagree. The second your sterile gloves enter a patient's mouth they are immediately non-sterile.

And a sinus perforation? For one, many of the bacteria that call the sinus home are also in the oral cavity - hence why you treat a sinus infection with the same spectrum of antibiotics as an odontogenic infection. Also, as soon as a oroantral communication is created it's impossible to keep the oral microflora from entering the sinus.

I'm not preaching sloppy, dirty dentistry. Sterile dentistry does not exist; however, "clean" dentistry does.

Hup