Autopilot is an amazing thing - on aeroplanes.
My friend flies Boeing 777's from Miami to Gatwick and has the ability to left click the mouse at the jetway in Miami and not touch the aeroplane again physically until it is at the jetway in Gatwick. This is very clever indeed and takes an enormous amount of technology and money to set up but the plane will still land on the runway at Gatwick even if it is on fire or has another plane sitting on it. For that reason, the human element still needs to be in control so autopilot isn't everything and they make the pilots fly the plane entirely every third time to make sure they can.
We recently welcomed Graham Parker from Sirona to the practice to do some high level teaching to myself and Marta on the new XG 3D machine but it was more than a training session.We set the machine up to take OPGs of our patients and thought we were being clever by selecting the P2 mode which removed the condyles from the OPG therefore reducing the dose slightly. When Graham arrived to do the training for us, he informed us that Sirona had set up a 'quick mode' for panoramic's which considerably reduced the patients dose while only reducing the diagnostic yield by a very small amount. We entered into a discussion about this and realised that the default setting on the machine should be the 'quick mode' only stepping up to a higher dose when the increased diagnostic yield was absolutely necessary. This was a lightbulb moment. I appreciate that we should set patients up for radiographic examination considering the lowest possible dose but it is only since the Michael Bornstein lectures and the meeting with Graham from Sirona that this has really sunk deep into my subconscious and should actually be the way we approach healthcare entirely.
What is the minimum amount of damage for the maximum amount of gain that we can produce either for a radiographic examination or surgery.
Following on from this, I then did a hands on oral surgery teaching session on pigs heads at Kings Mill where we started to discuss the possibility of using Articaine for buccal infiltrations instead of inferior dental blocks. Recent literature has been produced to show that it is predictably possible to use an Articaine block on a LR6 to provide root canal therapy painlessly for patients. If this is indeed true, it should be possible to provide a buccal infiltration and a lingual infiltration of Articaine to extract a LR6 or place an implant. Why would we do this?
We would do this to reduce the, small but not insignificant, chance of a permanent anaesthesia from an IDB. We would do this to reduce the damage that is caused to the tissues in an IDB causing post-operative pain and to reduce the opportunity for placing adrenaline containing local anaesthetics into the systemic system.
A small thing but an improvement in marginal gains.
Imagine you looked at your practice entirely like this. It would take you the rest of your career to switch off the autopilot but I think it would probably be fascinating and it has been a real watershed for me.
We will start with the OPG and CBCT machine and already, on re-investigation, we have reduced the OPG exposure time from 14.2 seconds to 4 seconds in some cases with no reduction in quality.
Something to think about.
Leave a comment