Dear Alan 3

​Dear Alan,
 
I recently had a patient who was the living embodiment of two of the seven deadly sins (sloth and gluttony). Things were going well until I tried to raise the chair. The chair failed to budge. The obese patient was left stranded like a beached whale with arms flailing searching for something to grab onto. He could still be there but my assistant managed to push him onto the floor whereby he grabbed hold of the chair and pulled himself up. My question is. Do they make bigger chairs for today’s bigger patients?”
 
Regards,
 
The chair I have can lift 175kgs. There are people who weigh more than this but it is more likely the motor in the chair was failing. Don’t blame some poor victim of the marketing arm of multinational food conglomerates when all he is doing is telling you the motor in your chair is starting to fail.
 
Dear Alan,
 
I have recently moved to Sydney.  How do I decide which orthodontist to refer my patients to?
 
Orthodontists are different. I mean they are all different from each other. I don’t mean they are different from normal people. They differ in personality; the way they run their practices and in their area of interest. To find out you need to start referring to the local orthodontists and looking at their patient management. The other way is to go and visit then in their surgeries. Spend time talking to them and watching them work. 
 
As you have a variety of patients with a variety of needs you should refer to several different orthodontists. There are multiple benefits in doing this. Different patients should be referred to different orthodontists based on the idea that each patient should go to the best orthodontists for that particular patient.
 
The other way to do it is to refer to the guy you went to Uni with. Not as stupid as it sounds. You need someone you can communicate with. It is easier to ring and discuss a patient if you share memories of a noisy, smoky room full of drunken testosterone charged students; late night souvlaki in Carlton and a hatred of certain Cons demonstrators. It is called bonding and has nothing to with phosphoric acid.
 
Dear Alan,
 
I have a cute patient, with a relaxed smile, who always thanks me and brightens the surgery. I’d love to do a few more fissure sealants, but my wife working in reception refuses to make her an appointment saying she takes months to pay her bill. How do I get to see her?
 
Regards Powerless.
 
Answer: Ring her up and tell her you need to meet to discuss her oral hygiene. Suggest somewhere a little less clinical. Maybe a local coffee shop or pub. Sounds like you might have to pay the bill. 
 
Dear Alan,
 
A patient rings up and says, “The filling you have just placed has just fallen out?”
What do I say?
 
Regards,
 
Answer: There are three possibilities.
 
An unrelated filling on the other side of the mouth has fallen out.  Not directly your fault. But it is possible you indirectly precipitated the loss. When you filled the aforementioned tooth you ground the occlusion and put the force elsewhere and bingo.
 
A scrap piece of amalgam or composite has hidden itself and resurfaced later.
 
The tooth is sensitive and will settle down. A reasonable assumption that sensitivity is caused by something falling out.
 
There is the fourth possibility that the filling you just placed has fallen out. I know what you’re thinking. Nup never happens but it is possible and in fact it did happen to me once. I had to fess up and redo the filling. Before redoing the filling stop, think and work out why the filling came out. No point putting back exactly the same filling.