KJ003ROCK wrote:
之前也是貪圖離家近而...(恕刪)
對阿~
我補的地方也是之前他給我補的地方掉了
他還跟我說:喔~這裡蛀的一個大洞
我說不是
這是之前補的地方掉了
個人積分：7分
文章編號：11732144
個人積分：20分
文章編號：11734544
louisa. wrote:
今天去我家附近補牙齒...(恕刪)
台灣的病醫關係似乎很糟
這個牙醫本身做了一個很不好的示範
手術時候本來就不該講電話, 不論是醫生或是病人
至於你說剛補過的地方有不合, 請問是哪一種情況?
是補牙的地方過高? 還是說補過的地方有縫隙
前者, 一般病人可以很簡單發現
後面的情況, 一般自己看不到, 很難會發現, 有的時候是補完的樹酯沒有打磨, 所以會覺得粗糙, 可能會誤以為是補過的地方有縫隙
koztaiwan wrote:
..沒事還是別看牙醫
這可是大錯特錯
台灣就是因為沒有家庭牙醫的觀念所以蛀牙率, 牙周病率很高
蛀牙跟牙周病在初期的時候症狀是很少的
如果沒有牙醫檢查自己根本就不會發現
等到覺得痛了來看牙醫的時候, 其實多數已經蛀到牙髓了, 這下不是根管治療就是要拔牙
或是牙周病已經嚴重到骨槽萎縮了, 牙齒都搖搖欲墜了才要牙醫想辦法. 這種大概就只能作假牙了
就算都沒有問題, 每半年還是要給牙醫洗牙跟檢查, 就像定期體檢一樣重要
定期的看牙醫跟正確的牙齒保健是不可缺少的
千萬不要說沒事還是別看牙醫
cooltyus wrote:
牙醫是denti...(恕刪)
牙醫如果不是醫生的一種, 請問為甚麼牙醫拿的學歷是 D.D.S. 跟 D.M.D
為甚麼, 我跟其他醫師同僚發醫療諮詢的時候, 他們也是稱我為 Dr. so and so..?
(physician )醫師 跟(dentist) 牙醫都是保健團隊的一員
說牙醫是dentist 跟 doctor 不一樣的人, 只顯示出無知.
更沒有說 dentist 不是 doctor 這種說法
dentist 是 doctor. 我們是 牙齒跟口腔的專科醫生 (doctor of the mouth and teeth)
就像內科, 心臟外科, 小兒科一樣. 我們都是為病人的健康把關. 只是專著的地方不一樣
很多時候, 病人的疾病, 就算跟口腔, 牙齒 無關, 卻會有口腔,或 牙齒 方面的症狀
舉個例子, 有糖尿病的病人, 會比一般人容易得牙周病. 所以病人來治療牙周病, 可是不知道自己有糖尿病, 就有可能是牙醫最先發現跟轉診給內分泌科
也有心臟病患者因為心絞痛誤認為牙痛. 因為心臟的位址接近左下顎, 病人常常會誤認為牙痛而來求診, 血壓一量, 不的了 230/110
才發現是心臟病發作的前兆
cooltyus 的說法太過偏激
牙醫的執業範疇包涵的不只牙齒還有口腔組織病理跟囓顎關節, 以及其他關連性的組織
認為牙醫只是補牙的技工的想法實在不是可取的態度
個人積分：5分
文章編號：11734628
arthurhuang0159 wrote:
後面的情況, 一般自己看不到, 很難會發現, 有的時候是補完的樹酯沒有打磨, 所以會覺得粗糙, 可能會誤以為是補過的地方有縫隙
...(恕刪)
Hi arthurhuang0159,
I read some of your posts on the mobile01, and noticed that you might be a dental student trained in foreign.
I follow almost all of your position, but there might be some differnts in the dental condition in Taiwan. You might hear some of the Taiwan peopl come back TW for the dental treatment because of the health insuance coverage most of the extraction, OD and ENDO treatment excluding the prothesis or implant. Could you conclude that the dentist provide the adequate dental service in Taiwan? I think it must to be a oversimplification. The people here judge the dentists if they provide the cheapest proshesis. You can read millions of thread here that what price of a crown or bridge.
Can you image the choice of impression material for the master cast is the alginate?
Can you image the step of the removal of caries is finished only by one diamond round bur?
Can you image the occlusal adjustment is finished by one white stone without advanced finish or polish bur?
But I always believe that the income would never to be the reason to againt what I learn in the dental school. I strongly encourage you share more articles about what is good prosthesis or what is good restoration then the price would not the only choice for all.
I would like to share some, please tell me directly if anything wrong. Meanwhile, welcome any suggestions and criticism.
本文作者絕對不會透露工作位置，以免廣告之嫌，請勿PM，也讓我能更客觀的分享我學過的知識。
當您不幸需要裝假牙(牙橋或牙冠)填補缺牙的空間或根管治療後的牙齒時，請先確認您支持的牙齒是否健康，也就是牙周和根管狀況良好。
牙周狀況良好的簡單評估方式：牙齒不會動搖，或是牙齦的邊緣，刷牙後不會流血。
根管的狀況良好簡單的評估方式：您可以要求看X光片，根管治療後的牙齒，牙根尖端沒有黑黑的影子或是黑黑的影子相較第一次治療時已經縮小。並且，根館的充填材料(X光片上看到牙根中央新加上白白的)，已經接近根尖或離1~1.5mm。根管治療過程中，醫師有使用rubber dam綠色的橡膠障，保護住您的牙齒，避免口水流入根館中。
假牙，需要修磨才有足夠的金屬或是陶瓷空間。假牙必須密合，才能避免食物堆積，造成二次蛀牙。
裝上假牙前，您可以要求看醫師印製的模型，經過修模後的假牙，應該要僅可能平行(10~15度左右)，也就是閉上眼睛由正上方觀察，幾乎只能看到一直線(如圖一,二)。印模時，排牙龈線可以幫助確認假牙的邊緣。並且若您希望假牙的準確度，則印主模型的材料若是使用水和粉調和的alginate不容易達成。通常silicon類的，也就是使用槍型(兩管混合)或是automixing的
不論您的預算多寡選擇哪一種假牙的材質，密合度都應該是基本的要求。
假牙的密合度，若是以肉眼的基本要求，應該是裝上的假牙使用牙醫的探針由牙根的部位至假牙的部位，都應該平滑的移動，而不會感覺到有縫，也就是如同溜滑冰一樣的經過接合處，不會有停頓的感覺。
不要再相信剛裝上去會有點不習慣，過兩天就好了的說法了。有些人會當然也會習慣，就像買新的鞋子穿兩天就會習慣的傳統迷思???
一般裝上假牙時，若是旁邊的假牙會覺得緊緊的，請告訴您的牙醫師，以便牙醫師使用12um的咬合紙調整與鄰接牙的縫隙。咬合的部分，若是裝上去就覺得剛剛好，不會覺得太高，(請告訴我哪一間技工所的技術如此高超！)因為通常是因為，咬合太低了。請您使用咬合紙，再咬一咬。確認假牙上面有清晰的咬合點，這樣的假牙才有咀嚼的功用。
當然價錢是患者經濟上的考量。請依您的預算選擇您需要的假牙。但不代表貴的就是暴利或是黑心。有些假牙，療程幾次就好，價錢就便宜。但患者裝上去後才發現不是他想要的，尋找別診所的改善。如圖四
有時候是需要費工夫，同一位患者經根管治療後，牙根先美白，接著牙齦修整，選用材質較佳的假牙(此圖並非所謂的全瓷冠)圖五
個人積分：20分
文章編號：11734723
hahah wrote:
Hi arthu...(恕刪)
Hi haha.
You are right. I am currently a D3 student in a US dental school.
I can not conclude any dental work that was performed in Taiwan. Since I am not myself directly working on them.
Some of the responds I provide are guessing at best since I do not see them clinically. Since that is the case, I always suggest whoever posted the question to seek dental help locally.
I can, however conclude from the many unhappy post I seen that the dentist and patient relation is really off in Taiwan.
And this is mostly due, I assume to competition between dentists by reducing cost at the expense of quality.
All of what you told me, using as alginate impression material for the master cast, final removal of caries with only one diamond round bur and occlusal adjustment without polish are in my opinion malpractice. These are things I would never do to my family or friends and certainly not to my patients no matter how desperate I am. Some other things I have notice including no proper isolation during RCT and poor medical history taking.
I agree with you that price should not be the driving force in dentistry. Quality work and care is what I was tough here in the US. Maybe it slow me down a bit when I treat patient, but at least I sleep well at night and I know my patient is receiving, what I can offer them the best at my current skill level. I have no problem answering any questions or concerns people posted here. In fact, I consider this as my way of practicing some interviewing and diagnosis skill, so we all benefit from it.
個人積分：1299分
文章編號：11734749
個人積分：5分
文章編號：11734866
arthurhuang0159 wrote:
All of what you told me, using as alginate impression material for the master cast, final removal of caries with only one diamond round bur and occlusal adjustment without polish are in my opinion malpractice. These are things I would never do to my family or friends and certainly not to my patients no matter how desperate I am. Some other things I have notice including no proper isolation during RCT and poor medical history taking.
...(恕刪)
There are more radiculous things happening. one of my ex-colleague who is the key member of the board of dental quality, servied almost twenty five patients only in eight hours. I think He must be expertise in his technique. Someday, he is off and I notice that he close every embrasure of the proximal resotration. no wonder, he is so fast.
These are the routine works in many dental clinic here. I change many dental clinic and finally found the fit clinic following the standard procedure. I earn less and work for a long time.
Then my wife always ask me why are we so poor ?
I told her that we can sleep well everynight.
個人積分：243分
文章編號：11735187
個人積分：28分
文章編號：11736289
個人積分：0分
文章編號：11736591
個人積分：0分
文章編號：11736620
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