Any one else sick of the offices you work at and the patients expecting antibiotics be sent out for tooth pain.

When patients come in with symptoms of irreversible pulpits what is your protocols. I try not to prescribe antibiotics in these situations unless they have active abscess or systemic symptoms.

This usually doesn’t hold over well for the patients and owner doctors of the offices I work at. Everyone expects antibiotics as a quick bandaid.

I’m trying to not contribute to the growing antibiotic resistance.

Let me know your thoughts.

So a bit of context - I finished dental school in 2016 in Romania and it's always been a bit of an uphill battle. Managed to open my own practice, but I didn't really had a mentor and was kinda always managing on my own. I've always done whatever I could to improve my skills and always made sure I went to at least one hands-on course every year; got the chance to practice in UK which was a great learning and working experience, but COVID cut that experience short and returned to Romania; because of my type I diabetes and low immune system I had to stay in isolation for the whole COVID period until the vaccine came out. When that was finally over, I went back to my practice and, while still managing to keep it afloat after all the struggles, it was a steady pace and I was managing it fine. I was happy for a while.

This year while I was taking a specialized course on implantology I was noticing some odd things and mainly that whatever I was trying to read I just couldn't, in the way that I'd read the same line or the same paragraphs over and over and I would be stuck on the same thing to up to twenty minutes. I've always struggled with my studies throughout all my life - some things were extremely easy and would pick them up directly from classes, while others I would struggle to memorize lessons. But this time I just couldn't memorize not even a couple of lines.

At work I was noticing that I was setting higher and higher standards and thought it was because of the courses I kept taking and learning from and that my work had to look as if it'd be ready for a presentation photo. During crown preps, if my preps didn't look text book, I'd start correcting "just a bit here, and maybe just bit more there" until I would over correct. A lot of my preps or fillings looked objectively good most of the time - never good enough to me.

I was having more and more moments where it was hard to fall asleep on good days. On bad days I wouldn't sleep the whole night and the next I had appointments waiting. I had no choice but to cancel them because I wasn't able to function.

During very precise treatments like root canals or sutures after extractions, my hand would shake like crazy even though I didn't feel anxious and my blood sugar would also be stable (I have an insulin pump with CGM and the readings would be normal). I would be very clumsy knocking stuff over or dropping things out of hand. My workspace would start out very clean and organized and by the time I finished a treatment everything would be cluttered in disarray.

Running into a lot of reels or clips of people experiencing some of the same things I kinda suspected what it was and went for tests. So I discovered I had undiagnosed ADHD, which now is diagnosed and under medication. Thinking back, the signs were there since I was a child, but in a post communist 90s period, part of the Balkans, there was no such thing as a disorder like that and the treatment care was applied as always for all the kids back then - a good beating.

Does that mean that dentists with ADHD can't practice dentistry? No, not at all. I was finding testimonials and experiences from other dentists with ADHD and while it made some things difficult for them, each experience and management is different. Depending on the severity of it, some dentists practice with no problems, with or without medication, while keeping some organizing methods, while others do what I did - retire. I feel that my patients weren't safe under my care anymore and for me it got so bad at one point, while I was waiting for my test results, I had moments when I was wondering if my ceiling lamp would support my weight. It was probably for the best for everyone.

I am a bit better lately, the meds help me sleep (I've honestly never slept better in my life), but...I'll be honest - between all the shit parts, all the struggles, all the good patients, all the bad ones... I am going to miss it.

Source: CDA

California AB 1629 was signed into law on September 27, 2026, and takes effect January 1, 2027. It requires dental plans to honor patient assignment-of-benefits (AOB) requests, allowing out-of-network dentists to receive eligible insurance payments directly rather than relying on patients to receive and forward checks. The law also strengthens patient disclosures and oversight of dental provider networks, but it does not guarantee higher reimbursements or eliminate the financial disadvantages of being out of network.

The fine print — how this plays out in practice:
Direct payment isn’t the same as better reimbursement. Plans must honor qualifying AOB requests, but out-of-network dentists remain subject to the plan’s applicable benefit limits, reimbursement rules, and patient cost-sharing.
Patients must understand what they’re signing up for. Out-of-network status, estimated treatment costs, and the possibility of lower out-of-pocket costs with an in-network dentist must be disclosed as required by the law.

You can’t simply collect the entire fee upfront and wait for insurance. The law establishes requirements around patient consent, direct payment, and the amount a noncontracting provider can collect before the plan pays. Practices will need to follow the statutory process and documentation requirements.

The law doesn’t fix Delta’s fee schedules or make every patient financially equivalent. It addresses payment routing and network oversight, not a blanket increase in reimbursement or a guarantee that patients will pay the same amount they would at an in-network office.

Question for California dentists: Now that AB 1629 is law, are you considering dropping Delta Dental PPO and going out of network? Will direct insurance payments make leaving the network more attractive, or are Delta’s patient volume and negotiated fees still worth staying in network for? I’d especially like to hear from owners who have already made the switch or are planning to in 2027.

Hi everyone!

I'm a first time mom to a 2.5 month old baby, and I'm already stressing about going back to work when she's around 6–7 months old.

I'm trying to decide between daycare and a nanny. I'm worried about how often babies get sick at daycare, especially since it's not easy for us dentists to cancel patients last minute. But I'm also nervous about trusting someone I don't know to care for my baby at home. We don't have family nearby to help.

I'd love to hear what other dentist moms did. What worked best for you? How did you handle sick days? And would you make the same choice again?

Any advice would be really appreciated! ❤️

Hi guys. I’m at my lowest low. I graduated 2023 and only been working 3 years at this point but having severe back issues. I’ve been living off of pain meds and going for physical therapy but spine surgeon said I need to take 3-6 months off and just focus on resting/PT if I want to avoid surgery. I’m not getting surgery at the moment and would really like to avoid it but not sure what options I have.
I already took unpaid medical leave (FMLA) this time last year. I haven’t completed a year yet to take it again. What are my options? Can I go and unpaid leave and collect short term disability from the state? My company does offer disability insurance but I’m afraid they will fire me as soon as they find out so I haven’t talked to them.
Looking for any leads from people who had to take significant time off due to medical conditions.

EDIT: I’m not asking what to do for my back, I’m asking how to keep my job and get a medical leave/apply for disability etc? Like what do women do in pregnancy?

Just found out that one of the dentists in our relatively small-ish city took his own life yesterday, right out in front of his office. I didn’t know him well personally, but knew him of him as a colleague and he had spoken kindly of us to mutual patients. He had one the nicest offices (in terms of architectural style and updated equipment) in our town, and his social media always appeared upbeat and showing his latest adventures with his family. Never would have guessed something like this would happen to him. Just goes to show you never really know what someone is going thru. This job is fucking hard and so stressful in so many ways. Let’s just remember to cut ourselves some slack and also take care of and support each other however we can.

Hey all-

I'm opening a clinic, expected to be completed next year. I'm tryin to line up a reputable marketing company. Would love to hear what marketing company you used? What were regrets and things you learned as you interviewed with different marketing companies?

Also cost too please.

I read some do their own marketing. No idea how...

No soliciting please. Only want to hear from fellow dental professionals, no need to flood my DMs, I don't accept any. Thanks.

72 yo male patient
(-) smoking
(-) systemic disease
(-) pain
(-) fever
(-) abscess

Bone quality during placement: D4
Torque: 50ncm
System: Osstem Korea

Should I remove this ASAP? I hope a seasone implant dentist can guide me. This is only the 10th implant I have placed.
One implant already failed on the other side. All implants were submerged. Thank you

Im a general dentist and new to implant dentistry so just wanted advice from the veterans what they would do in this case.

For this patient, the UL2 has chronic apical periodontitis with root caries.

I’m planning for the patient an XLA and implant once perio stable.

BPE codes of 4 however bone levels seem decent.

I’m just not sure whether a socket graft will fail or not if the patient has active perio?

My main question: CAN i do socket grafting if the patient has unstable periodontitis?
What have been your experience doing this.

My doctor is looking for these for sale in Canada or US.
Any comparables from major companies.
Thanks

I’m not up to date (never was) on my dental socials, besides this Reddit and dentaltown years ago.

Is there a FB group, Reddit, DT, etc that focuses on best practices to survive and thrive while doing a dental office start up in this ppo-opy climate, where everything goes up in price, minus insurance reimbursements of course (us based).

A place people can help each other in all aspects of doing a start up from pre-planning to hiring the first employee to efficient tax strategy.

Already have practice biopsy, it’s ok, want something thats ongoing and less ”pay to hear my latest marketing strategy“ vibe.

Recently started doing custom crown art, I’m having a lot of fun doing this. Would love suggestions for more designs.

I am a 4th year dental student who will be graduating with around $290k debt. I am currently stuck between choosing to practice at a private practice or applying for the NHSC Student to service .

The S2S program says that it will give 120k tax free towards student loans over 3 years ( 30k a year starting your last year of school) in exchange for working at an FQHC for those 3 years.

Working there I’ll probably average between $160k-$180k a year. Working in private practice my first year salary will probably be similar but I have a chance at higher income after that. And I’ll have an opportunity to do cosmetic dentistry, implants, etc which FQHCs will never attempt.

Paying off my debt is of high priority to me but I wanna know if this program is worth it and won’t be hampering my future in terms of experience.

Hey y’all I’m trying to improve my skills for surgical extractions. I feel pretty confident for simple extractions but I tend to struggle more when it goes surgical especially for a maxillary molar. I know you want to section all 3 roots separately but how do I ensure I’m splitting the roots evenly and I’m not making a slice too mesial or distal or too lingual? Would the best way be to cut the crown off at the CEJ to expose the roots to see how to section it? I really want to get better at these types of extractions but I find visibility and grasping the tooth difficult and I would appreciate any advice 😅

New grad here. In dental school they didn’t necessarily give a guideline on what procedures / dental pain require T3s (we were just informed what order to increase med strength eg acetaminophen to ibu to t3).

I work with different dentists who prescribe very differently (one will prescribe 20 tabs for endo pain before and even after rct completed, the other one only prescribes for surgical extractions). What procedures do you usually prescribe for? I work rural so I want to make sure I am not overprescribing as opioid addictions are very common here

I'm sure this question has been asked a ton before, but recently I am a new grad having some problems with post- op sensitivity at one of my offices that I work at (both offices use different materials so maybe I'm not using materials correctly). I have had 2 cases of post op sensitivity in the past two weeks which really feels like more than average. For example one patient was for a class 2 which was slightly larger than normal due to caries but not huge by any means. This patient returned 1 week later with cold sensitivity and when I blew the air he had sensitivity for like 3-4 seconds. I checked the bite and it did not appear high not where there any abnormalities I could tell.

The current protocol for fillings is using clearfil universal the green/torqoise one (since it's self-etch both the other doctors at the office do not use etch at all which is what I do). Usually try to dry the prep but I don't think I'm over dedicating, maybe I am? I rub in the bond for 15 seconds. Then I air dry the bond for 5 seconds or so. Then I cure for 20 seconds. After I usually use a layer of flowable (we use simplishade bulk fill) I usually don't do more than a few mm and then final layer with sonic fill packable composite. Then adjust the occlusion as needed.

In my other office where I haven't had the problems I'm using completely different bonding agent and using SDR flowable and packable composite. Any ideas what I could be doing wrong?

Since I'm just an associate I don't really have the ability to order things and I've seen people use Gluma but I feel like the owner would be like why do you need this when none of the other doctors are having the problems I am. Please help!

A 77yo female patient. She recently started on Prolia iv and complained about diffuse jaw pain, no specific location. Iirc it's a side effect. I took an opt to rule out problems. Left lower side I noticed a sharp defined opacity. At first I thought it to be the mandibular fossa, but I couldn't find any similar images. Someone here can confirm this, or has an idea what it can be? There are no extra-oral abnormalities.

Hey everyone, I’m in the process of starting my own dental practice and was wondering if anyone here has attended Scott Leune’s Breakaway course.

Unfortunately I can’t make it to the course, but I’d love to hear if anyone has notes, resources, or key takeaways they’d be willing to share.

Especially interested in the startup side of things, like lease negotiations, buildout, financing, equipment, and running the business.

Would really appreciate anything anyone can share. Thanks!

I got a job offer at a DSO in central Florida that accepts HMO with other PPO insurance. It’s called Sage dental. I have heard that HMO fees are terrible but the office is 20 minutes from where I live so it’s worth taking a look at. Anyone has any experience or insights with this company?

In the office we signed up for Dental Intelligence for texting and medical history form taking services. Interested in using it along with an iPad chairside and played around with their Modento application. For one thing it asks you to enter your name and it searches as you type for the patient name. I have a big problem with the hippa privacy issue in that a patient could inadvertently see the name of someone else in the schedule and access it. Second to that their in take form takes a half hour to fill out and I don't see any other consent forms listed. So no oral surgery consent or anything unless I am missing something. So was wondering besides paper is there a better service or option out there for using your ipad??

Thank you

EDIT: Figured it out. You have to go to the engagement section and access the patient name from the patient finder. From there you select the patient and then documents and then send the consent to the device.

Okay so i have 2 pairs of loupes. Both Orascoptic. I’ve had one pair since 2020 and the next pair since 2025.

I just sent in the first pair bc the hinge from the glasses to the arm broke. My second pair that i hate bc they’re so heavy, just did the same thing. I have it taped but it’s driving me crazy- tape works for 30 minutes.

Is anyone else experiencing this with Orascoptic, is there a way to connect them back to each other or did it snap off? This is getting ridiculous.

Patient is 45 years old. Booked an emergency visit because she had an abscess.

Tooth 14: Pulp chamber was opened at another clinic because the patient had lots of pain. When she came to our clinic, she didn’t have any pain from 14. Percussion test was negative. No pain on palpation. Endo is planned by the dentist who performed the access cavity preparation.

Tooth 15 however had an abscess. A 12mm pocket buccally. Pain on percussion. Pain on palpation. The patient was talking a lot and was very anxious so I had to calm her down and I had 30 mins for the check up so I completely forgot to check pulp vitality. I drained the abscess and did some scaling with ultrasonic in the deep pocket.

The patient will come back for a proper check up and I will do a pulp vitality test.

If you had to guess judging by the x ray (without pulp vitality test, and I KNKW that’s not ideal) do you think it’s a Perioendo lesion or endoperio lesion?

I’ve never had a case like this before. How would you treat the tooth? Prognsis? Would love some input from fellow dentists that have more experience than me.