 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Dentistry / April 2005Disappearing Nesbitt Bridge [longish tale]
My wife has had a Nesbitt bridge for 20 years. Never lost or broken. I liked the simple technology so much I had one made recently to replace a lost tooth. Like a young kid, I was careless. While eating some dried mango [I'm in Hawaii], I suddenly noticed that the bridge was gone. In the past, I had dislodged the bridge a few times but always felt it move and simply put it back. This time it was gone. I assumed I swallowed it [although I felt nothing]. I called my HMO and they said it would pass in a few days. Advised against ipecac. 4 days later and no sign of it. [Take my word for this: I've checked carefully.] Is it likely that the bridge resin + metal dissolved [partially or completely] in stomach acid? I'd like your comments before I fret over having an xray to see if it's become lodged somewhere in the intestine. Thank you.  SignatureRemove -NOSPAM- to contact me. Go get an x-ray image made today. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > My wife has had a Nesbitt bridge for 20 years. Never lost or broken. I > liked the simple technology so much I had one made recently to replace a [quoted text clipped - 23 lines] > > Thank you. >Go get an x-ray image made today. I'd wait. It still may pass or has already passed without notice. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > My wife has had a Nesbitt bridge for 20 years. Never lost or broken. I > liked the simple technology so much I had one made recently to replace a [quoted text clipped - 18 lines] > Is it likely that the bridge resin + metal dissolved [partially or > completely] in stomach acid? No, it won't dissolve. Get an x-ray before that thing perforates your small intestines. >My wife has had a Nesbitt bridge for 20 years. Never lost or broken. I >liked the simple technology so much I had one made recently to replace a [quoted text clipped - 18 lines] >Is it likely that the bridge resin + metal dissolved [partially or >completely] in stomach acid? Doubtful >I'd like your comments before I fret over having an xray to see if it's >become lodged somewhere in the intestine. I'd wait a bit longer. >Thank you. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > My wife has had a Nesbitt bridge for 20 years. Never lost or broken. I > liked the simple technology so much I had one made recently to replace a [quoted text clipped - 23 lines] > > Thank you. Get an x-ray promptly. If it is still in your gut, you will probably want repeat x-rays until it passes. No one is talking about surgery at this point, but you want to know where that thing is. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Based on your comments, I had my HMO do an xray this morning. Sure enough, the bridge is now at the start of the lower intestine. My doctor was not concerned and thought it would surely pass in another day or two. So I'll keep checking with some peace of mind. Thanks for excellent assistance. SignatureRemove -NOSPAM- to contact me. It might need adjustment after such a journey. ;-) Fawks (Good luck the rest of the way) > Based on your comments, I had my HMO do an xray this morning. Sure enough, > the bridge is now at the start of the lower intestine. My doctor was not > concerned and thought it would surely pass in another day or two. > So I'll keep checking with some peace of mind. > Thanks for excellent assistance. > It might need adjustment after such a journey. ...as well as a bit of soap and water. Vaughn The metal will probably survive intact. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> It might need adjustment after such a journey. > > ...as well as a bit of soap and water. > > Vaughn > Based on your comments, I had my HMO do an xray this morning. Sure enough, > the bridge is now at the start of the lower intestine. You should now understand why a prudent and thinking dentist would never construct on of those things. In the prosthodontic world, Nesbits (Class VI) RPDs are a big no no. Dr. G. > My doctor was not > concerned and thought it would surely pass in another day or two. > So I'll keep checking with some peace of mind. > Thanks for excellent assistance. SignaturePlease reply via newsgroup. >>Based on your comments, I had my HMO do an xray this morning. Sure enough, >>the bridge is now at the start of the lower intestine. [quoted text clipped - 4 lines] > > Dr. G. Come on--no one condemns them because they can be swallowed. No one condemns single crowns nor three-unit bridges for this reason. I had a patient swallow one of my three unit bridges in the past year. I posted here how I offered to replace it if she didn't want to go fishin'. A couple of weeks later, I recemented the retrieved bridge. Steve >>My doctor was not >>concerned and thought it would surely pass in another day or two. >>So I'll keep checking with some peace of mind. >>Thanks for excellent assistance. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 A Nesbit is more likely to "pop" off during chewing than the fixed C&B is >>>Based on your comments, I had my HMO do an xray this morning. Sure >>>enough, the bridge is now at the start of the lower intestine. [quoted text clipped - 17 lines] >>>So I'll keep checking with some peace of mind. >>>Thanks for excellent assistance. >A Nesbit is more likely to "pop" off during chewing than the fixed C&B is It also has sharp little hooks to pierce the sides of the intestinal tract. | >>Based on your comments, I had my HMO do an xray this morning. Sure enough, | >>the bridge is now at the start of the lower intestine. [quoted text clipped - 13 lines] | | Steve I don't know about that Steve. I won't make one because of the risks involved. I don't even think this has anything to do with Dr. G's location (California) where the lawyers apparently affect all aspects of life. Even up here north of the 49th parallel where one is far less likely to get sued for looking at someone the wrong way. Not so recent technology has provided much safer alternatives. There is the Maryland bridge, the Monodont and all the variations of those. Ingestion is one thing, aspiration is even scarier. SignatureRoy rem NADA to reply > | >>Based on your comments, I had my HMO do an xray this morning. Sure enough, > | >>the bridge is now at the start of the lower intestine. [quoted text clipped - 23 lines] > > Ingestion is one thing, aspiration is even scarier. Sure. But anything used in the mouth can be swallowed. Perhaps you're concerned about the clasp arms, but have you ever, ever hears of a GI perforation due to a Nesbit? Yeah, anything's possible. But it's considered bad dentistry because there's no cross-arch stabilization. If we were that scared of patients swallowing restorative work, we'd never put anything into someone's mouth. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> | >>Based on your comments, I had my HMO do an xray this morning. Sure >> enough, [quoted text clipped - 29 lines] > concerned about the clasp arms, but have you ever, ever hears of a GI > perforation due to a Nesbit N J Med. 1995 Jul;92(7):452-3. Perforation of the sigmoid colon following ingestion of a dental plate. Peison B, Benisch B, Lim E. Rahway Hospital, NJ 07065, USA. The authors report on the perforation of the sigmoid colon in a 48-year-old male following the accidental ingestion of a partial dental plate. Sharp, pointed objects may perforate the bowel and surgery should be considered. A review of the literature revealed no previously reported cases. ------------------------------------------------------------------------------------------------------ Diseases of the Esophagus Volume 15 Issue 4 Page 340 - December 2002 doi:10.1046/j.1442-2050.2002.00290.x Case reportCervical esophageal perforation with severe mediastinitis due to an impacted dental prosthesisB. H. A. von Rahden, M. Feith, H.-J. Dittler, H. J. Stein SUMMARY. We herein report about a case of perforation of the cervical esophagus by an artificial denture, which had been swallowed by the patient after a horse-related-injury. Impactation of the foreign body at the level of the upper esophageal sphincter was followed by its penetration through the esophageal wall, causing severe infection of the cervical soft tissue, mediastinitis and sepsis. We discuss the well-known phenomena of prosthesis ingestion and frequently delayed diagnosis, as well as our treatment strategy of cervical esophageal perforation with placement of a T-tube into the cervical esophagus and mediastinal drainage. --------------------------------------------------------------------------------------------------------- I sit corrected. I kinda hope it was a Nesbit, though it doesn't say. Steve >>>| >>Based on your comments, I had my HMO do an xray this morning. Sure >>>enough, [quoted text clipped - 60 lines] > > --------------------------------------------------------------------------------------------------------- SignatureCut the nonsense to reply > Sure. But anything used in the mouth can be swallowed. But..., if you had a choice between a crown, a fixed partial denture or a Nesbit which would you pick? >Perhaps you're concerned about the clasp arms, but have you ever, > ever hears of a GI perforation due to a Nesbit? I'll pass on being in the Guinness book! Don't think I want to be the first guy defending my reason for placing one when, as has been pointed out here, there are ways to treat these situations which carry less potential for patient harm and the threat of litigation. > Yeah, anything's possible. Yup! > But it's considered bad dentistry because there's no cross-arch stabilization. Some consider this a significant drawback to the class VI partial denture. However, it's an argument that is not well thought out. We place fixed partial dentures all the time which have no cross-arch stabilization. Mostly, they work!! > If we were that scared of patients swallowing restorative work, > we'd never put anything into someone's mouth. Except! Most restorative dentists strive to place restorations which are not likely to easily become a part of a food bolus. My restorations (removable complete and partial dentures) are large enough to discourage ingestion or aspiration. I think the idea behind risk management is to do that which lessens risk (for us and our patients) as much as possible. Dr. G. prosthodontist > Steve >>>Based on your comments, I had my HMO do an xray this morning. Sure enough, >>>the bridge is now at the start of the lower intestine. [quoted text clipped - 13 lines] > >Steve Have seen many Nebitts in long term service. I have never made one. Hope you autoclaved that bridge. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Hope you autoclaved that bridge. > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Yeah, I did. I was a little concerned that the steam would crack the porcelain, but it was fine. The patient did the unpleasant part. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > Hope you autoclaved that bridge. Or at least washed it off. > > -- > > [quoted text clipped - 13 lines] > Brooklyn, NY > 718-258-5001 >> Based on your comments, I had my HMO do an xray this morning. Sure >> enough, [quoted text clipped - 3 lines] > construct on of those things. > In the prosthodontic world, Nesbits (Class VI) RPDs are a big no no. I always thought that we couldn't make them anymore? Below the standard of care... While I do not recommend the devices, 'never say never' comes to mind. I recently had an 82 yr.-old lady with a Nesbit replacing her lower right first molar. She'd had it for 25+ years and it was flat worn out. I made a new one (after a brief discussion of the options) that clicks in quite well. I have also made a couple out of Valplast (which should greatly reduce the chance of bowel perforation by clasps). JME, Fawks >>You should now understand why a prudent and thinking dentist would never >>construct on of those things. >>In the prosthodontic world, Nesbits (Class VI) RPDs are a big no no. > > I always thought that we couldn't make them anymore? Below the standard of > care... > While I do not recommend the devices, 'never say never' comes to mind. > [quoted text clipped - 7 lines] > I have also made a couple out of Valplast (which should greatly reduce > the chance of bowel perforation by clasps). That's an interesting case. There are *many* times when I look at an edentulous space, and think "a Nesbit would work perfectly here". But then the unpleasant thoughts of trips to the ER and lawsuits rear their ugly head. > > While I do not recommend the devices, 'never say never' comes to mind. > > [quoted text clipped - 12 lines] > the unpleasant thoughts of trips to the ER and lawsuits rear their ugly > head. You could combine the Nesbitt with that oh so attractive trend of tongue piercing and place a leash around the partial anchored to a tongue stud. Practical and fashionable...what more could you want?? T > You could combine the Nesbitt with that oh so attractive trend of tongue > piercing and place a leash around the partial anchored to a tongue stud. > Practical and fashionable...what more could you want?? > > T How would you eat spaghetti? Joel >> > While I do not recommend the devices, 'never say never' comes to mind. >> > [quoted text clipped - 18 lines] > piercing and place a leash around the partial anchored to a tongue stud. > Practical and fashionable...what more could you want?? Like a wallet with a chain! Great idea! I do a monodont for the same price as the Nesbit and it is not removable. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> While I do not recommend the devices, 'never say never' comes to mind. [quoted text clipped - 13 lines] > then the unpleasant thoughts of trips to the ER and lawsuits rear their > ugly head. I've done a couple Monodonts, but in both cases I tried to squeeze a tooth into a space in the lower anterior where there wasn't enough room for a full size incisor. The cases came out OK (no dark space when the patient smiles), but on close inspection the esthetics left a lot to be desired. It was poor case selection on my part...but I knew that going in...as did the patients. They were happy with the results, so I guess you'd call it a success. >I do a monodont for the same price as the Nesbit and it is not removable. > [quoted text clipped - 14 lines] >> then the unpleasant thoughts of trips to the ER and lawsuits rear their >> ugly head. I haven't used the pre-fab monodonts, but I have done quite a few bonded bridges with Elman bars and Zeza bars. I fit the bar to the preps, bond it in, and make my pontic directly in the mouth. Several are over 10 years old. I haven't tried it for a molar. If a patient got 20+ years out of a Nesbit, I don't think they would be very happy with a bridge fracture in less than 2 years. Fawks > I've done a couple Monodonts, but in both cases I tried to squeeze a tooth > into a space in the lower anterior where there wasn't enough room for a full [quoted text clipped - 22 lines] >>>then the unpleasant thoughts of trips to the ER and lawsuits rear their >>>ugly head. I find the esthetics are as good as you can get with a flipper. Sometimes, the esthetics are better than glazed porcelain, but that is simply due to some teeth matching Bioblend better than Vita. I have done some incisors that look as good as any lab fired FPD I have seen. Premolars are tough to get the same esthetics as you have to get the metal in a position which does not "bleed" through the enamel, and leave room for denture tooth bulk. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > I've done a couple Monodonts, but in both cases I tried to squeeze a tooth > into a space in the lower anterior where there wasn't enough room for a [quoted text clipped - 22 lines] >>> then the unpleasant thoughts of trips to the ER and lawsuits rear their >>> ugly head. You're using a lab, correct? Or do you do them in-office? >I find the esthetics are as good as you can get with a flipper. Sometimes, >the esthetics are better than glazed porcelain, but that is simply due to [quoted text clipped - 29 lines] >>>> then the unpleasant thoughts of trips to the ER and lawsuits rear their >>>> ugly head. I make them all myself. It only take about 30 minutes of lab time to make one (after the model sets up). Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > You're using a lab, correct? Or do you do them in-office? > [quoted text clipped - 36 lines] >>>>> then the unpleasant thoughts of trips to the ER and lawsuits rear >>>>> their ugly head. >I make them all myself. It only take about 30 minutes of lab time to make >one (after the model sets up) The lab fee is about $100 for a Monodont...complete with a stent to show you where to prep the teeth. Since your time is worth more than $200/hr, why do you choose to make them yourself? >>I make them all myself. It only take about 30 minutes of lab time to make >>one (after the model sets up) > >The lab fee is about $100 for a Monodont...complete with a stent to show you >where to prep the teeth. Since your time is worth more than $200/hr, why do >you choose to make them yourself? OCD Plus I will often make the model in the morning, create the Monodont during lunch, extract the painful tooth and bond in the Monodont is the afternoon. No Lob will got it to me in 2-3 hours. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>>I make them all myself. It only take about 30 minutes of lab time to >>>make [quoted text clipped - 7 lines] > > OCD :-) Thanks for all the interesting comments. For me, the x-ray made a startling picture. The x-ray tech, nurses and doctor had seen this before and were not alarmed at all. Apart from reminding me to come back if I had any pain or bleeding, I was told it would simply pass. I infer that perforation is a rare complication. The bridge passed after 9 [nine ! ] days. I am a [California and Hawaii] lawyer. I would never sue a dentist who (1) gave me a product I specifically requested (2) provided warnings and (3) told me not to eat with the bridge. Shame on those who would pursue such a case. From a consumer's view point, I wanted a Nesbit because (1) similar device provided 20 years of good service to my wife (2) I resent the effort to steer me to an implant at 3X the cost (3) I didn't want to sacrifice a good tooth and a good crown for a permanent bridge at 3X the cost and (4) the Nesbit seemed a minimally invasive procedure which I could always improve upon later. Didn't know about monodonts. You ma be right that there are better procedures but I this one "clicks" in nicely and seems to do the job. I'm not convinced that the older methods are passe but I'll be more careful in the future. SignatureRemove -NOSPAM- to contact me. > Thanks for all the interesting comments. > [quoted text clipped - 9 lines] > told me not to eat with the bridge. Shame on those who would pursue such a > case. R E P L Y So you are trying to give sharks a good name? I mean ... well you know ..... Joel > From a consumer's view point, I wanted a Nesbit because (1) similar device > provided 20 years of good service to my wife (2) I resent the effort to [quoted text clipped - 9 lines] > -- > Remove -NOSPAM- to contact me. > Thanks for all the interesting comments. > [quoted text clipped - 20 lines] > in nicely and seems to do the job. I'm not convinced that the older > methods are passe but I'll be more careful in the future. After what happened, you're still going to wear a Nesbit? You state that a bridge or implant costs 3X more. But are you factoring in the Nesbit's additional cost of going to the ER and getting an x-ray? I'd bet that when all is said and done, it's a wash. And with the implant, you wouldn't have had all of the worry that went along with the question of whether the clasps were going to perforate your colon. X-ray cost $34. No other charge. The experience was interesting so I don't consider that a cost but an opportunity. So yes, I still say the implant is 3X more expensive. :) SignatureRemove -NOSPAM- to contact me. It does not usually happen, but if it had,,,,,,,,,,,,,,,,, would having a bowel perforation change your mind? Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > X-ray cost $34. No other charge. > The experience was interesting so I don't consider that a cost but an > opportunity. > So yes, I still say the implant is 3X more expensive. :) Not when you factor in the bone loss 20 years down the road. Economically it is fairly safe to say that a single tooth implant is your lowest cost dental appliance in the long run. SignatureRoy rem NADA to reply | X-ray cost $34. No other charge. | The experience was interesting so I don't consider that a cost but an | opportunity. | So yes, I still say the implant is 3X more expensive. :) Good point, I was not thinking about how an implant would prevent loss of the alveolar bone over time. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Not when you factor in the bone loss 20 years down the road. Economically > it is [quoted text clipped - 5 lines] > | opportunity. > | So yes, I still say the implant is 3X more expensive. :) > Not when you factor in the bone loss 20 years down the road. Economically > it is fairly safe to say that a single tooth implant is your lowest cost > dental appliance in the long run. In fact that reminds me: who amoung us has not noticed that ofttimes the gums around a well-placed implant are healthier than that around the adjacent natural teeth?. It is usually a win win situation. Any dentist can do the prosthodontic work. You need a real Pro to do the surgical aspect. Once done, you keep the bone and therefore the adjacent teeth in better health. The Nesbitt won't do that; neither will a 3 unit bridge. SP SP SignatureFinally: take out the TRASHH > X-ray cost $34. No other charge. > The experience was interesting so I don't consider that a cost but an > opportunity. > So yes, I still say the implant is 3X more expensive. :) You are still taking a risk: forgetting to remove the bridge b/4 eating, falling asleep with it in and swallowing it, having it knocked down your throat (or worse) in a car accident or a slip on the ice on a skiing holiday, waterskiing... And if it _does_ find its way into your innards again, it _may_ just perforate your colon... There's no way to be sure that "This Nesbitt, to, shall pass", so to speak. You mentioned MonoDonts: you cannot wear a MonoDont as you already have a crown on one of the abuttment teeth. If that crown is OK, I wouldn't touch it either. If you divide the price of an Implant over the rest of your life (it is 'likely' to last that long) you may find that it is quite cost effective, without being a worry every time you want to eat. Just my chicken scratchin's SP SignatureFinally: take out the TRASHH > X-ray cost $34. No other charge. Why no other charge? Kaiser HMO... very nice people to deal with in Hawaii. Called @ 10:00, had the x-ray and spoke with a doctor before noon. Had not considered the bone loss angle. BTY: what do you folks generally charge for an implant [tooth number 20]? SignatureRemove -NOSPAM- to contact me. Average fee is $2K to $3K depending on the condition of the recipient site. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Kaiser HMO... very nice people to deal with in Hawaii. Called @ 10:00, > had the x-ray and spoke with a doctor before noon. > > Had not considered the bone loss angle. > > BTY: what do you folks generally charge for an implant [tooth number 20]? Is that the "whole deal" or just the implant? Vaughn (back from Denver) > Average fee is $2K to $3K depending on the condition of the recipient site. > [quoted text clipped - 4 lines] >> >> BTY: what do you folks generally charge for an implant [tooth number 20]? Whole deal. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Is that the "whole deal" or just the implant? > [quoted text clipped - 10 lines] >>> BTY: what do you folks generally charge for an implant [tooth number >>> 20]? > Whole deal. Even in Denver, I think... ;-) I wonder what the costs would be if having an implant placed while flying OVER Denver en route to Florida... ? SP SignatureFinally: take out the TRASHH >> Whole deal. > > Even in Denver, I think... ;-) > > I wonder what the costs would be if having an implant placed while > flying OVER Denver en route to Florida... ? I am sure that they would be truly impressive. Seriously, implants are losing their "premium" status. One wonders when they will replace Endo & crown as the treatment of choice. Vaughn PS: I missed buying a snow shovel at Home Depot this time. They advertised snow in Denver, but we didn't actually see any (except on the distant mountains). "Vaughn" <vaughnsimonHATESSPAM@att.fake.net> wrote in message > I am sure that they would be truly impressive. > [quoted text clipped - 6 lines] > advertised snow in Denver, but we didn't actually see any (except on the > distant mountains). How unfortunate that you missed out on shoveling solidified water. I would lend you a shovel. We have a few. Hope the family was FANTASTIC in Denver. > "Vaughn" <vaughnsimonHATESSPAM@att.fake.net> wrote in message > > I am sure that they would be truly impressive. [quoted text clipped - 3 lines] > > > > Vaughn R E P L Y Lots can go wrong with implants (as lots can go wrong with bridgework!). Joel > > PS: I missed buying a snow shovel at Home Depot this time. They > > advertised snow in Denver, but we didn't actually see any (except on the [quoted text clipped - 5 lines] > > Hope the family was FANTASTIC in Denver. >> PS: I missed buying a snow shovel at Home Depot this time. They >> advertised snow in Denver, but we didn't actually see any (except on the >> distant mountains). > > How unfortunate that you missed out on shoveling solidified water. I will somehow manage to live with the disapointment > I would lend you a shovel. We have a few. We have had to deal with snow on our last two trips, one of which was the great blizzard of '03 where I did indeed buy a snow shovel at Home Depot. > Hope the family was FANTASTIC in Denver. Unfortunately, they live in California; where our little grandson was watching the silly adults celebrate his first birthday last weekend, whilst trying to figure out was was going on. Vaughn I thought they were in Denver. My mistake. First birthday party. Fun! For Salvatore's first birthday party, we rented a tent and had it catered. My neighbor wanted to know what we were going to do when the kid graduated from High School. ;-) My attitude is that the first birthday party is for the adults to celebrate that the kid is there. The rest of the birthday parties are for the kid. So, the past 8 birthday parties have been with his buddies having great fun--no adults invited. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>> PS: I missed buying a snow shovel at Home Depot this time. They [quoted text clipped - 18 lines] > > Vaughn If you are really feeling snow sick, I'll hunt around for one of those collapsible ones you can keep in your trunk. As for me, I'm not putting mine away yet. The grass is just starting to turn green, but we usually get one more blessing of winter before April 30. It has happened locally for the last 32 years that I've been mentally tracking it. SignatureRoy rem NADA to reply | >> PS: I missed buying a snow shovel at Home Depot this time. They | >> advertised snow in Denver, but we didn't actually see any (except on the [quoted text clipped - 16 lines] | | Vaughn > If you are really feeling snow sick, I'll hunt around for one of those > collapsible ones you can keep in your trunk. As for me, I'm not putting mine > away yet. The grass is just starting to turn green, but we usually get one > more > blessing of winter before April 30. It has happened locally for the last 32 > years that I've been mentally tracking it. Last Sunday, we spent a couple of hours in Confluence Park in the middle of Denver. It is an absolutely gorgeous park, and on this day the local citizenry was out in force. We had bicyclists, sunbathers, hikers, families, future families (lovers), dogs wading in the water and emerging often to shake themselves near some unlucky human, ducks, fish, all enjoying the great surroundings and the prime weather. Then I started to notice something strange about the people, they were ghostly white, not a tan to be seen. It must have been one of the first nice weekends of the year. Two days later, we had snow warnings. Vaughn > | >> PS: I missed buying a snow shovel at Home Depot this time. They > | >> advertised snow in Denver, but we didn't actually see any (except on the [quoted text clipped - 17 lines] > | > | Vaughn I heard the snow finally did arrive in Denver. Ouch! Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> If you are really feeling snow sick, I'll hunt around for one of those [quoted text clipped - 45 lines] >> | >> | Vaughn >I heard the snow finally did arrive in Denver. > > Ouch! Yes! It is hard for this Florida guy to imagine that green grassy park that was dotted with picnic blankets just 7 days ago suddenly covered with 2 feet of snow. We were offered two different weeks for our business there, we accidentally made the right choice. Vaughn You must have a good palm-reader. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>I heard the snow finally did arrive in Denver. [quoted text clipped - 9 lines] > > Vaughn > You must have a good palm-reader. Ha! You kiddin' ??? 'Dis guy Vaughn is part o' da Flo-rda Municipal Mafia.... Dose guyse done bought de weadder fo' dat week... an' dey used yo' money t' do it... <the Pipe goes incognito for awhile....> SP SignatureFinally: take out the TRASHH >> You must have a good palm-reader. > > Ha! You kiddin' ??? 'Dis guy Vaughn is part o' da Flo-rda Municipal > Mafia.... Dose guyse done bought de weadder fo' dat week... an' dey used > yo' money t' do it... Hey Tube, Perhaps we shouldn't be making Mafia jokes while Steve is around. Do you like having two working knees? Vaughn > > Ha! You kiddin' ??? 'Dis guy Vaughn is part o' da Flo-rda Municipal > > Mafia.... Dose guyse done bought de weadder fo' dat week... an' dey used [quoted text clipped - 4 lines] > > Vaughn Da Mancuso dude don' bodder me.... I gots a DiagnoDent laser... 'sides: He's goin' ta see da boyse in Chicago.... Say hello to Al's grandkids, 'dere, Don Mancuso SP SP SignatureFinally: take out the TRASHH >> > Ha! You kiddin' ??? 'Dis guy Vaughn is part o' da Flo-rda Municipal >> > Mafia.... Dose guyse done bought de weadder fo' dat week... an' dey [quoted text clipped - 9 lines] > He's goin' ta see da boyse in Chicago.... Say hello to Al's grandkids, > 'dere, Don Mancuso You got it. >"Vaughn" <vaughnsimonHATESSPAM@att.fake.net> wrote in message >> I am sure that they would be truly impressive. [quoted text clipped - 13 lines] > >Hope the family was FANTASTIC in Denver. Snow shovel, what's that ? (What's a temporary ?) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Some day it will snow in DC and you will find out. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>"Vaughn" <vaughnsimonHATESSPAM@att.fake.net> wrote in message [quoted text clipped - 23 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >Some day it will snow in DC and you will find out. Oh, it snows here, but... snow blower. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Some day it will snow in DC and you will find out. You don't shovel temporaries in Troy???? SP SignatureFinally: take out the TRASHH > PS: I missed buying a snow shovel at Home Depot this time. They > advertised snow in Denver, but we didn't actually see any (except on the > distant mountains). It is because most USAian snow is imported from Kaannnaada.... I guess the duties were not paid this year.... ;-) SP SignatureFinally: take out the TRASHH Don't know about that. Most of my snow comes up from the south, through Buffalo. SignatureRoy rem NADA to reply | > PS: I missed buying a snow shovel at Home Depot this time. They | > advertised snow in Denver, but we didn't actually see any (except on the [quoted text clipped - 4 lines] | | SP > Don't know about that. Most of my snow comes up from the south, through >Buffalo. They are re-selling you your own snow.... Go beat the Temporaries outta 'em... SP SignatureFinally: take out the TRASHH >> PS: I missed buying a snow shovel at Home Depot this time. They >> advertised snow in Denver, but we didn't actually see any (except on the [quoted text clipped - 4 lines] > >SP Thought the duties were paid so that you wouldn't send it. Know that SM got more than the fair share this year. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>> PS: I missed buying a snow shovel at Home Depot this time. They >>> advertised snow in Denver, but we didn't actually see any (except on the [quoted text clipped - 8 lines] > >Know that SM got more than the fair share this year. Yes, we had plenty this year, Things are just begriming to turn green now. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > >Thought the duties were paid so that you wouldn't send it. > > > >Know that SM got more than the fair share this year. > > Yes, we had plenty this year, Things are just begriming to turn green > now. Things are not very close to begriming to turn green here yet... SP SignatureFinally: take out the TRASHH >> >Thought the duties were paid so that you wouldn't send it. >> > [quoted text clipped - 5 lines] >Things are not very close to begriming to turn green here yet... >SP I am begriming to think that was funny! .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Mowed the yard yesterday. The Magnolia is blooming like mad, the apple and cherry trees are starting to bloom, redbuds, dogwoods, flowering crabapples, and in another week I'll start hunting mushrooms. I also worked in the garden yesterday and planted sweet corn, green beans, tomatoes, brussel sprouts, and broccoli. Spring is here in Missouri. Fawks >>>Thought the duties were paid so that you wouldn't send it. >>> [quoted text clipped - 5 lines] > Things are not very close to begriming to turn green here yet... > SP >Mowed the yard yesterday. The Magnolia is blooming like mad, the >apple and cherry trees are starting to bloom, redbuds, dogwoods, [quoted text clipped - 16 lines] >> Things are not very close to begriming to turn green here yet... >> SP We just had our first few days of warm weather. 70 degrees 3 days in a row. Cut & aerated the lawn today. Silly in the Sun reading SMD now. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. | >Mowed the yard yesterday. The Magnolia is blooming like mad, the | >apple and cherry trees are starting to bloom, redbuds, dogwoods, [quoted text clipped - 24 lines] | | I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. I'd suggest cutting back on the additives to the coffee if you are being silly in the sun. We had chives out of the garden in our breakfast this AM. 5-6 weeks to go before risking tomatoes in the garden. SignatureRoy rem NADA to reply >| We just had our first few days of warm weather. 70 degrees 3 days in a >| row. Cut & aerated the lawn today. Silly in the Sun reading SMD now. [quoted text clipped - 6 lines] >I'd suggest cutting back on the additives to the coffee if you are being silly >in the sun. You have to love what a PC can do with your handwriting .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Normally I don't plant tomatoes here until the first week of May, but a guy who grows tons of tomatoes told me of a little trick to get them out early. He uses the small 'three-tier' cages and covers the cage and new plant with a dry cleaning bag. You now have a miniature green house for each tomato plant. He leaves the bags on until the weather hits 80-85ยบ. I'm giving that a try this year. Steve > I'd suggest cutting back on the additives to the coffee if you are being silly > in the sun. > > We had chives out of the garden in our breakfast this AM. 5-6 weeks to go before > risking tomatoes in the garden. When my Mom was alive,,,,,, she would start her tomato plants late in winter in egg shells. She would save egg shells and egg cartons and fill the shells with planting soil, add a seed or two, fill the egg carton with these, and cover all the window sills with them. Come spring, she would have 50-100 strong plants started ready to transfer to the garden. The egg shell would decompose in the ground so all she had to do was lay it in the soil and pack some dirt around it. I miss the home canned tomato sauce. :-( She would grow enough tomato plants for fresh salads and occasional cooking use, but we would make a trip to a farm every fall and bring home about 3-4 bushels of tomatoes for canning. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > Normally I don't plant tomatoes here until the first week of May, but [quoted text clipped - 13 lines] >> We had chives out of the garden in our breakfast this AM. 5-6 weeks to go >> before risking tomatoes in the garden. Great story ...... it brings up some memories of my own. My folks canned peaches, tomatoes, loads of fruits, raspberries, strawberries (as jams), grown at our place, pickles, bread-and-butter and dill, stuff like that. A different time, a different place ..... Joel > When my Mom was alive,,,,,, she would start her tomato plants late in winter > in egg shells. She would save egg shells and egg cartons and fill the [quoted text clipped - 38 lines] > >> We had chives out of the garden in our breakfast this AM. 5-6 weeks to go > >> before risking tomatoes in the garden. > When my Mom was alive,,,,,, she would start her tomato plants late in winter > in egg shells. About what month would we be talking here to start 'em up? And when would she have moved them outdoors? How big would they have been, passin' all their time in eggshells; or were there pots with dirt in 'em under the shells? About what temperature would it have been when they went outside? What KIND of tomatoes would these have been (I think there is upwards of 200 different kinds of tomatoes)? ...And what about Naomi? Here we don't use egg shells or any other do-dads. We buy 'em from the nursery. They have to be really big and tough to survive here (bugs, cold nights, the occasional squirrel or whatever herbivore it is what eats 'em, beer bein' spilled on 'em as I cook chicken...etc...). The main thing is that up in these parts, the nursery is a must, if you want a harvest before the frosts of Sept and Oct. I bet the plants in the Nursery are big enough to devour a whole water buffalo by now... One last thing: I heard on the Cee Bee Cee Ray-Dee-O that one must rotate one's tomatoe patch every year: different part of the garden. Tomatoes deplete the soil somthin' awful, and the best way to restore it is to let last year's patch lie fallow (grow nothin' on it). Either that, or pour Am on it... Thanks SP SignatureFinally: take out the TRASHH >> When my Mom was alive,,,,,, she would start her tomato plants late in >> winter >> in egg shells. > > About what month would we be talking here to start 'em up? She died back in 1989, but I think she would start in February > And when would she have moved them outdoors? Once the weather would stay above freezing. >How big would they have been, passin' all their time in eggshells; or were >there >pots with dirt in 'em under the shells? Egg shells in egg cartons. The egg carton fits perfectly on the average window sill. they were about 15-20 cm tall when they went outside. >About what temperature would it have been when they went outside? Around here, once the night-time temperatures stay above 40 degrees farenheit, they went outside. >What KIND of tomatoes would these have been (I think there > is upwards of 200 different kinds of tomatoes)? At one time, it was always the big "beaf'steak" type tomatoes. Then, later on, she mixed it up with different brands so as to get a variety at harvest. > ...And what about Naomi? ??? > Here we don't use egg shells or any other do-dads. We buy 'em from the > nursery. They have to be really big and tough to survive here (bugs, [quoted text clipped - 8 lines] > Tomatoes deplete the soil somthin' awful, and the best way to restore it > is to let last year's patch lie fallow (grow nothin' on it). > >What KIND of tomatoes would these have been (I think there > > is upwards of 200 different kinds of tomatoes)? > > At one time, it was always the big "beaf'steak" type tomatoes. Then, later > on, she mixed it up with different brands so as to get a variety at harvest. We are more limited. They have to be robust and resistant to cold nights. We get those sometimes even in mid-late August. We also get them when every body is _sure_ the cold weather is over... always one or two nights that would wipe out the weak or cold sensitive tomatoes. I think we even have about one month less growing time than Montreal does. Amazing what a difference 300 km can make. Don't know what they use in the nursery, but they do well except against certain bugs. I also planted a bit of ciboulette (chives, I think: like tall onion-flavored grass) a few years ago and it comes right back every summer. Good to keep the bugs out. > > ...And what about Naomi? > > ??? From Sesame Street.... while growin' up, when someone peppered another with questions like I did re: tomatoes, we'd always finish with that Sesame Street line. If your still pushing tomatoes, remember to rotate to another plot of garden each year. Thanks SP SignatureFinally: take out the TRASHH > > >What KIND of tomatoes would these have been (I think there > > > is upwards of 200 different kinds of tomatoes)? REPLY The red ones I believe ...... Joel There are also green. > > At one time, it was always the big "beaf'steak" type tomatoes. Then, later > > on, she mixed it up with different brands so as to get a variety at harvest. > Thought the duties were paid so that you wouldn't send it. > > Know that SM got more than the fair share this year. Y'all can thank GWB for payin' the duties... SP SignatureFinally: take out the TRASHH >> Whole deal. > [quoted text clipped - 3 lines] >flying OVER Denver en route to Florida... ? >SP Depends on the flight dental surgeon. Lotta *overhead* there. <hehe> -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Kaiser HMO... very nice people to deal with in Hawaii. Called @ 10:00, > had the x-ray and spoke with a doctor before noon. The x-ray cost you $45 and you weren't billed by a physician or radiologist for their services? Yes. $34 was the total cost. I think since I reported without an appointment, the services were treated a "emergency" and no charge. Normal charge for a doctor's visit is $15. Apparently waived. That's Kaiser Hawaii. SignatureRemove -NOSPAM- to contact me. > Yes. $34 was the total cost. I think since I reported without an > appointment, the services were treated a "emergency" and no charge. > Normal charge for a doctor's visit is $15. No...the normal "co-pay" is $15. The doctor and radiologist got paid a lot more than $34, or $15, or whatever...but they just happened to get it from the insurance company instead of you. The bottom line is the total money spent on dental and medical care (your money and the insurance company's money) for your Nesbit will end up being about the same in the long run as that implant you rejected. I am a [California and Hawaii] lawyer. I would never sue a dentist who (1) gave me a product I specifically requested (2) provided warnings and (3) told me not to eat with the bridge. Shame on those who would pursue such a case. Thanks for your sentiments. As a California dentist, I am well aware that many of the difficulties in dental practice stem from the actions of California lawyers. I applaud your position that you would shame those who would pursue such a case -- but so far, shame does NOT seem to deter the endless supply of California plaintiff trial lawyers. As you are probably well aware, California law does not allow a dentist to "provide a product" to a patient simply because he requests it. First, it is firmly established in case law that a dentist does not "provide a product." Dentists provide a service. Any "products" provided are simply part of providing a service. Secondly -- and more importantly -- any service rendered by a dentist MUST (according to the lawyers) meet the "standard of care," which is a legal concept, not a dental concept. If a plaintiff's lawyer can establish in court (and they're very good at it) that any certain treatment did not meet the "standard of care," then the dentist is in jeopardy even if the patient requested that exact treatment. The law (again, made by, and interpreted by, California lawyers) holds that no patient can consent to any treatment that does not meet the standard of care. Thus if the patient seems to consent to such treatment, or requests the treatment on his own, or even if he signs a stack of consent forms, the doctor is still required to render ONLY treatment that meets the "standard of care." This means, obviously, that even if the patient wants a Nesbit, the doctor is still legally liable if the plaintiff's lawyer can show in court that a Nesbit does not meet the current standard of care for a missing single tooth. It should not be very difficult for a smart California lawyer to establish that in court. So a California dentist, in my opinion, is asking for trouble, and is being downright shortsighted and foolish if he agrees to make a Nesbit for a patient who wants one. >From a consumer's view point, I wanted a Nesbit because (1) similar device provided 20 years of good service to my wife (2) I resent the effort to steer me to an implant at 3X the cost (3) I didn't want to sacrifice a good tooth and a good crown for a permanent bridge at 3X the cost and (4) the Nesbit seemed a minimally invasive procedure which I could always improve upon later. All those seem like reasonable positions to take. But for the reasons I outlined above, no reasonable or knowledgeable California dentist should make one. Perhaps a dentist in Hawaii could be persuaded to undertake the task, if the laws are different there. Best regards, - dentaldoc > I am a [California and Hawaii] lawyer. I would never sue a dentist > who (1) [quoted text clipped - 19 lines] > MUST (according to the lawyers) meet the "standard of care," which is a > legal concept, not a dental concept. It is a dental concept. And an insurance concept. It's not fair to accuse the legal profession of establishing a standard of care. You may fairly accuse them of utilizing the standard in law suits. The legal profession didn't tell the insurance industry that unilateral bridges aren't the standard of care, but you well know how this intersects with the alternate benefits provision. If a plaintiff's lawyer can > establish in court (and they're very good at it) that any certain > treatment did not meet the "standard of care," then the dentist is in [quoted text clipped - 6 lines] > stack of consent forms, the doctor is still required to render ONLY > treatment that meets the "standard of care." You do agree that patients cannot consent to substandard care? Steve > This means, obviously, that even if the patient wants a Nesbit, the > doctor is still legally liable if the plaintiff's lawyer can show in [quoted text clipped - 25 lines] > Best regards, > - dentaldoc SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 |
Enable EMail Alerts
Start New Thread
Reply to this Message