Moments of pleasure

Re: Moments of pleasure

Anthony Todd — Fri, 23 Mar 2012 06:44:29 GMT

[quote user="Evelyn Barbour-Hill"]Does anyone have a picture of this instrument? It would be great in the historical section of the journal.[/quote]

Found a picture:

http://www.activator.com/products-page/chiropractic-adjusting-instruments/activator-ii/

The dental version had a Jacobs chuck to hold the elevators or luxators which came in various shapes and sizes.

My chiro says he uses them on babies and children because the "push" can be limited, as I said regarding dental use.

Re: Moments of pleasure

Neil Wheadon — Thu, 22 Mar 2012 23:57:41 GMT

2 year old labrador, presents with smelly breath for 4 months, that's it. Eating, drinking and in good health. Teeth look great from the outside, but she was very very nervous and it took 10 minutes to open the mouth. I've seen sticks across roof of mouth many times, but a clothes peg spring for 4 months!! It took some removing too as had eroded into the hard palate. Apparantly she likes to take the washing off the line.

Re: Moments of pleasure

james herriot lied — Tue, 13 Mar 2012 14:33:50 GMT

[quote user="Bob Russell"]

(she is a very keen gardener and the first person I know that splints daffodils when one of the dogs knock them over!)!!!

[/quote]

Make me the second.

Definitely a whole bunch of moments of pleasure.

Re: Moments of pleasure

Mark Hedberg — Tue, 13 Mar 2012 14:28:00 GMT

[quote user="Bob Russell"]

Moments of pleasure?

Right now! Celebrating with a massive pizza - we have got our passports back after 21 weeks waiting for a visa for wife and daughter - arrived this morning!

Elder son got himself a job!

She who must be obeyed has sent me a text to tell me she has passed her driving theory test after a few tries!

Sod elevators, sod luxators, I will worry about them tomorrow and see about booking a short break in Holland so the other half can see the tulips etc (she is a very keen gardener and the first person I know that splints daffodils when one of the dogs knock them over!)!!!

[/quote]

Congrats on all counts. :)

Re: Moments of pleasure

Bob Russell — Tue, 13 Mar 2012 13:34:05 GMT

Moments of pleasure?

Right now! Celebrating with a massive pizza - we have got our passports back after 21 weeks waiting for a visa for wife and daughter - arrived this morning!

Elder son got himself a job!

She who must be obeyed has sent me a text to tell me she has passed her driving theory test after a few tries!

Re: Moments of pleasure

Rob Davis — Tue, 13 Mar 2012 13:15:53 GMT

[quote user="Evelyn Barbour-Hill"]I should point out that I did not invent the terms "luxation" and "luxator" for the newer technique, and I think they are slightly regrettable[/quote]

I was under the impression that "luxator" is a trade name.

Just to muddy the waters further, I have just ordered a set of "extraktors" designed by Susanne Andersson and Cecilia Gorrel. They are supposed to be a combination of a luxator and and elevator, and I found them useful on the course I recently attended. However as Evelyn said, I think there is no single type of extraction intrument which everyone will get on with (I do like the Wiggs winged elevators!)

Re: Moments of pleasure

Evelyn Barbour-Hill — Mon, 12 Mar 2012 23:47:55 GMT

[quote user="Anthony Todd"]why are elevators now square ended, sort of like a curved spade,[/quote]

I don't know. It's partly, I think, supposedly, to stop the instrument slipping off sideways.There's a lot of shall we say experimental development going on in the veterinary field (not unconnected with ££). Everybody and his mother devises a new pattern, which works really well for him and her, so a manufacturer takes it up and extols it as ideal for everybody. There are many styles of extraction, and it might suit you but not the next chap.

For instance, to name names, I think Wiggs Winged Elevators are useless, but I know another who swears by them.

I'm not interested too much in elevators any more, because I practise luxation - a different style.

[quote user="Anthony Todd"] and luxators pointed .[/quote]

I wouldn't call a luxator pointed, really. The cutting edge should be round. The width of the thing should be proportional to the circumference of the root: about a sixth to a third of it.

The one notable and unconditionally praiseworthy general development has been the trend to chunkier handles and shorter shafts, thus fitting properly in dinky little hands like mine.

[quote user="Anthony Todd"]Of course, taken as a given, that neither are ever used as a lever![/quote]

Indeed. But, actually, you may use either instrument as a lever to this extent: by twisting it a little you have a cam action to force the root sideways a little. Twist and hold (but don't shout), give them fibres time to tear.

[quote user="Anthony Todd"]As an aside, the recent pictures of the Libyan cemetery vandalisation reminded me of some of the cat "dentals" I have seen......[/quote]

Ah, quite so...........

Re: Moments of pleasure

Anthony Todd — Mon, 12 Mar 2012 23:26:53 GMT

[quote user="Evelyn Barbour-Hill"]especially as an elevator, if sharpened, can be used as a luxator[/quote]

Evelyn, purely for my education [although far too late] and not point-scoring or arguing, why are elevators now square ended, sort of like a curved spade, and luxators pointed, [and IMHO therefore capable of serious damage], and thereby only luxating a smaller section of the ligament whereas if they were sharp and thin ie like a very sharp elevator it would do the same job quicker?

Of course, taken as a given, that neither are ever used as a lever!

"elevators" need a name which better defines their function and method of use? "distractor"?? or if sharpened and thinner call 'em all "luxators" and we won't bend 'em all the time!

As an aside, the recent pictures of the Libyan cemetery vandalisation reminded me of some of the cat "dentals" I have seen......

Re: Moments of pleasure

Gillian Mostyn — Mon, 12 Mar 2012 12:39:24 GMT

Brilliant post!

Re: Moments of pleasure

Evelyn Barbour-Hill — Mon, 12 Mar 2012 01:54:12 GMT

[quote user="Michael Woodhouse"]

[quote user="Evelyn Barbour-Hill"]Unmodified human ones, stiil flogged by some dealers and probably still rustily lurking in many a "dental box" along with the mallet, the junior hacksaw and the sharpened screwdriver, are no good.[/quote]

I can still tie some string around the tooth and slam the door? That's still ok, isn't it?

[/quote]

Yes of course. But it must be British Standard string BS34567891234567 and the door must have a 6-part Written Scheme of Examination, together with certified annual service reports and be finished in either magnolia or brilliant white gloss with a reflectivity of not more than 9/10 and not less than 6/10. A RVN may slam the door (providing she has been suitably trained, preferably holding the Cert in door-slamming) and provided the slamming force is between 12 and 18.5 newtons (measured by spring balance or equivalent digital device clearly labelled as BS 3453218963(a)), but you must tie the string, so you will need a certificate in knotting from the Boy Scouts (exceptionally other reputable organisations may be considered). Written consent in triplicate will, it goes without saying, be required from the client.

Otherwise you gonna be OUTA the PSS.

Re: Moments of pleasure

Michael Woodhouse — Mon, 12 Mar 2012 00:21:30 GMT

I can still tie some string around the tooth and slam the door? That's still ok, isn't it?

Re: Moments of pleasure

Anthony Todd — Sun, 11 Mar 2012 22:12:47 GMT

[quote user="Evelyn Barbour-Hill"]Secondly, obviously if any instrument is used incompetently there is potential for disaster. [/quote]

[sigh] Except with the old Union Broach Impact Mallet 'cos the "disaster" can be limited to 1mm or less by simply decreasing the depth of impact, which is where I began......

My only point with the Wikipedia paste was in the first line of the list; luxators are listed under elevators and I can't find a separate entry for "dental luxators", so lots of folk don't think there's a difference, fortunately Wikipedia can be updated easily I understand.

Re: Moments of pleasure

Evelyn Barbour-Hill — Sun, 11 Mar 2012 21:46:49 GMT

[quote user="Anthony Todd"]

This from Wikipedia so it seems that there may be some difficulty with the difference in definition.

Elevators

Narrow and wide, straight and curved luxators
Couplands elevator
Warwick James elevator
Cryer elevator
Periosteal elevator
Root-tip pick elevator
Potts elevator
Cogswell-A elevator

[/quote]

Coupland's elevator: previously known as Coupland's chisel: a very slightly modified bone chisel (or gouge). 40 years ago we used these a) because we knew no better and b) because you couldn't get much else.

Warwick James and Cryer elevators: have little if any use in veterinary practice, even though veterinary companies stil flog them.

Periosteal elevator: is used to elevate the periosteum. As in, for instance, creating a mucoperiosteal flap. Nothing to do with elevating teeth.

Root-tip pick elevator: rarely called such in my experience, better known by its correct name of root-tip pick. It is not an elevator, as one will rapidly find if one attempts to use it as an elevator. It is used for picking a fractured root tip.

Potts and Cogswell-A elevators: I'm not even quite sure what these are! But I am pretty sure they only have use for human teeth.

While we are on this, I should add to my previous comment about forceps. My remarks, it may be necessary to emphasise, apply only if you are using forceps suitable in size and shape for veterinary use. Unmodified human ones, stiil flogged by some dealers and probably still rustily lurking in many a "dental box" along with the mallet, the junior hacksaw and the sharpened screwdriver, are no good.

Re: Moments of pleasure

james herriot lied — Sun, 11 Mar 2012 15:19:24 GMT

[quote user="robloxley"]

Someone needs to get the red star fairy a cup of tea and a nice biscuit methinks

[/quote]

I'm not sure we're allowed to call him a fairy, but as to the culprit, I suspect that you'd find 'Mr Red-star [insert name here]' would have a nice alliterative ring to it.

Re: Moments of pleasure

Evelyn Barbour-Hill — Sun, 11 Mar 2012 14:48:52 GMT

[quote user="Anthony Todd"]

[IMHO] Trouble with the modern ele-luxators is they have a very sharp tip which very very easily goes way beyond the tip of the root and if misdirected, with the often excessive force, way beyond the jawbone!

In fact, looking through a few dental catalogues the only difference I can see is that some elevators are now shorter [less leverage, so better] and the luxators are longer and pointy [so more leverage and a greater chance of delinquent use and subsequent damage].

If you scroll through this catalogue http://www.im3vet.com/ you'll see that they are all stubby and called elevators except, I think for one, but I think most of us use them as luxators, hopefully, anyway. I see the sharp pointed tipped elevators, as they were often known, seem to be missing from the catalogue.....

[/quote]

Which just makes a couple of points. Firstly, the nomenclature is confused (especially as an elevator, if sharpened, can be used as a luxator even though it's really too thick) and you are not helped by dealers who get it wrong.

Secondly, obviously if any instrument is used incompetently there is potential for disaster.

Re: Moments of pleasure

Rob Loxley — Sun, 11 Mar 2012 11:10:03 GMT

[quote user="Lorna McHardy"]

Looking back through the thread, I'm just wondering... Arlo, have you installed an auto-onestar function?

[/quote]

Someone needs to get the red star fairy a cup of tea and a nice biscuit methinks

Re: Moments of pleasure

Rob Loxley — Sun, 11 Mar 2012 11:10:01 GMT

[quote user="Lorna McHardy"]

Looking back through the thread, I'm just wondering... Arlo, have you installed an auto-onestar function?

[/quote]

Someone needs to get the red star fairy a cup of tea and a nice biscuit methinks

Re: Moments of pleasure

Anthony Todd — Sun, 11 Mar 2012 04:45:37 GMT

[quote user="Evelyn Barbour-Hill"]An elevator pushes its way into the periodontal space, cuts the ligament a bit, tears it rather more, levers the tooth a bit, levers the more marginal alveolar bone and distorts the alveolus, fractures the more marginal bone a bit, and finally is used if necessary to lever the tooth out.[/quote]

I think the name gets to the root [sorry] of the discussion. The modern elevator/ luxator is used , incorrectly by many purely as a lever which is expected to "elevate" the tooth out of the alveolus or socket. [often seen bent tips on eleluxators, I'll call them, which would indicate a lot of leverage and not much luxation!!!]

This from Wikipedia so it seems that there may be some difficulty with the difference in definition.

Elevators

Narrow and wide, straight and curved luxators
Couplands elevator
Warwick James elevator
Cryer elevator
Periosteal elevator
Root-tip pick elevator
Potts elevator
Cogswell-A elevator

If the scissor tap-test is negative can you not use the cottonbud ether test on the broken, or indeed any tooth?

Certainly made me aware of a live nerve! And yes, I know a dead nerve doesn't mean no abscess, ever.

Re: Moments of pleasure

Evelyn Barbour-Hill — Sat, 10 Mar 2012 23:16:54 GMT

[quote user="Anthony Todd"]Can someone explain the difference between an elevator [dental!] and a luxator because they look the same to me??[/quote]

I should point out that I did not invent the terms "luxation" and "luxator" for the newer technique, and I think they are slightly regrettable. However, there it is.

In its pure form, in luxation the instrument cuts the periodontal ligament all the way down to the apex, and with repeated insertions the entire ligament is severed so the tooth just pops out as the instrument takes its place in the alveolus.

An elevator pushes its way into the periodontal space, cuts the ligament a bit, tears it rather more, levers the tooth a bit, levers the more marginal alveolar bone and distorts the alveolus, fractures the more marginal bone a bit, and finally is used if necessary to lever the tooth out.

In pictures the two instruments might well look the same, but the essential differences are that the luxator is thinner and sharper.

You are not helped by some instrument dealers not understanding the difference and selling luxators as elevators and vice versa.

[quote user="Anthony Todd"]Oh for sure, and don't you find broken teeth after vets have had a go too, and why?[/quote]

Because they have not acquired the necessary skill. Something for which the veterinary schools are very much to blame. (Of course even the most skilled will occasionally break a difficult tooth, but that's not the point).

I won't add, because it will muddy the waters.......... oh, what the hell, yes I will: although the "forceps extraction" as the human dentist knows it does not apply to dog and cat teeth, the more skilled one becomes the more one can make use of forceps to extract. It requires sensitivity (which can only be learned by practice) and a constant mental picture of the root one is working upon.

Having said all that: I do not believe that a German Shepherd's canine tooth, periodontally healthy, can regularly be extracted by means other than the surgical extraction via a flap, without significant and unnecessary damage to the adjacent soft tissues and bone.

[quote user="Anthony Todd"]And dogs or cats don't? Try the scissor tap!![/quote]

If it's positive, of course it's painful. If it's negative, it does not show that the patient does not have a permanent dull ache. Still less does it demonstrate that the patient will not have an abscess next month.

Re: Moments of pleasure

Anthony Todd — Sat, 10 Mar 2012 23:08:34 GMT

[quote user="Lorna McHardy"]

Looking back through the thread, I'm just wondering... Arlo, have you installed an auto-onestar function?

[/quote]

Suit me; I mainly get red ones anyway!

Re: Moments of pleasure

Lorna McHardy — Sat, 10 Mar 2012 22:38:42 GMT

Looking back through the thread, I'm just wondering... Arlo, have you installed an auto-onestar function?

Re: Moments of pleasure

Anthony Todd — Sat, 10 Mar 2012 20:56:42 GMT

[quote user="Evelyn Barbour-Hill"]Exactly the same principle as an engineer's impact punch.[/quote]

Oh dear, I was trying, obviously unsuccessfully, to explain the principle of a spring being compressed by a larger length, say 10mm thereby storing an amount of energy which is converted into a smaller length when released but, because the same stored energy is released over a much smaller length, say 1mm, but the energy is the same the energy per length is greater.

Sort of like a lever, or come to think of it, to reduce it to dentistry which might make it easier for some to grasp, an elevator where a large low force lateral movement of the handle is converted into a higher force smaller movement of the tip. Newton or Michelangelo Buonarroti probably thought of it first, as some seem to think it is only of historical interest.

Wikipedia describes it well http://en.wikipedia.org/wiki/Punch_down_tool, and appropriately ,'cos if you've ever tried to insert telephone wires into connectors and you slip with a simple push tool it usually goes into the palm of your hand!

With careful direction there is very little lateral force at all; it's all driven parallel to the tooth root ,probably less lateral leverage on the lateral thin bone than with an elevator.

[The dentist that extracted my molar certainly used elevators [or luxators] and I removed a sliver of bone some days later, but that's an anecdote, I admit]

[quote user="Evelyn Barbour-Hill"]They all broke the teeth they were attempting to extract.[/quote]

Oh for sure, and don't you find broken teeth after vets have had a go too, and why? Because they don't dislocate [or luxate?] the tooth from the bone with an elevator or luxator [which seems to be the correct term now] but try to twist and/or pull and /or luxate it out. Inadequate elevation or luxation seems, to me always to be the cause... actually, in effect, using the tooth root as its own luxator........

Wow, this http://www.jsdental.com/images/downloads/luxator_instructions.pdf should be required reading for any vet and, er,they look like what I call elevators to me?? Note the force being directed parallel to the root and the directions in #6

Can someone explain the difference between an elevator [dental!] and a luxator because they look the same to me??

[quote user="Evelyn Barbour-Hill"]But humans can (and generally will) say if they have an ache.[/quote]

And dogs or cats don't? Try the scissor tap!!

[quote user="Evelyn Barbour-Hill"] I wonder if you are confusing it with crowning?[/quote]

Yes, sort of, although some of the exhibitors on that BBC program might get away with explaining the absence of a canine to a judge after a "tragic accident" rather than it being assumed to be a congenital deficiency [not that that matters these days of monorchids etc]

Re: Moments of pleasure

Anthony Todd — Sat, 10 Mar 2012 20:51:54 GMT

Sorry doubled it up and this one wasn't edited.

Re: Moments of pleasure

Evelyn Barbour-Hill — Sat, 10 Mar 2012 18:25:58 GMT

[quote user="Anthony Todd"]

Exactly the same principle as an engineer's impact punch.

[/quote]

We're extracting teeth here.

[quote user="Anthony Todd"]By chance I have a friend, a retired prof. of periodontics at Queensland Uni who practiced in London and his first words, via skype were "they were great, but I didn't do many extractions after London". "You could use them, and pull the tooth out with your fingers, particularly canines with long roots".[/quote]

He was extracting human teeth. They are much easier. And nowadays even human dentists generally use luxators, not elevators or punches.

Little anecdote, of dubious relevance and completely unfair. Quite a while ago, at a BVDA extraction course, pigs' heads were used (couldn't get dogs for that one due to animal rights thugs).Two or three human dentists were on the course (as was quite often the case). They all broke the teeth they were attempting to extract.

[quote user="Anthony Todd"]He did advise root canal treatment for all the reasons already posted but did admit that some didn't seem to cause much trouble, even in humans.[/quote]

But humans can (and generally will) say if they have an ache.

[quote user="Anthony Todd"] no nothing apart from cosmetic [which can be a BIG factor with some owners [show dogs][/quote]

Root canal therapy is not cosmetic. I wonder if you are confusing it with crowning?

Re: Moments of pleasure

Rob Loxley — Sat, 10 Mar 2012 16:42:26 GMT

Is there any evidence that the dog will 'do better' with a root-canalled fractured upper canine than following an extraction? What is the comparative complication rate? My experience is that the cost has always been much higher for referral for RCT than extraction in our practice (and I accept that is for the dental specialist's training, skill, extra materials etc.), and I'd like to feel we charge 'properly'.