Oral Health Management (Clinical Dentistry)
Prevention is the treatment
Most clinical dentistry is disease management, not just restoration. Caries management by risk assessment drives the plan: high-risk patients get fluoride varnish, sealants on at-risk pits and fissures, silver diamine fluoride for arresting cavitated lesions (noting black staining and avoiding use near pulpal exposure), xylitol, diet counseling, and short recall intervals. Restoring a lesion without reducing risk predicts recurrence.
Periodontal care
Scaling and root planing is followed by re-evaluation at roughly 4 to 6 weeks, not 2 weeks, because tissue response takes time. Persistent pockets of 5 mm or more with bleeding after therapy signal a need for further therapy, not simply a longer recall. High-risk patients go on 3-month maintenance.
Restorative and surgical principles
Margins must be cleanable, isolation must be adequate for adhesive materials, and remaining tooth structure (ferrule) determines restorability. Antibiotics are not indicated for irreversible pulpitis or localized abscess without systemic involvement; drainage is the treatment. Know maximum local anesthetic doses.
Acute care
The two highest-yield emergencies are trauma and medical crises. For an avulsed permanent tooth, handle it by the crown, rinse briefly, replant immediately or store in milk or saline, splint flexibly about 2 weeks, give antibiotic and tetanus coverage, and arrange endodontics within days for a mature apex. Never replant a primary tooth. Syncope is managed with supine positioning and airway support; anaphylaxis needs epinephrine.
Traps
Choosing a restoration instead of risk reduction. Re-evaluating too early. Prescribing antibiotics instead of drainage. Exceeding vasoconstrictor limits in cardiac patients.
Rule of thumb: for 2% lidocaine with 1:100,000 epinephrine, each 1.8-mL cartridge holds 36 mg of drug; the healthy adult ceiling is about 7 mg/kg (maximum roughly 500 mg), and medically compromised patients are limited by epinephrine dose rather than lidocaine.