I can't believe it's the Last Clinic Day!

Thurs., April 24

My board pt came in at 8 so I could do film BWs to match his film fullmouth series. I ended up doing 2 more PAs per an instructor's recommedation, and they were an improvement.
My next pt was a "regular" perio maint. man who wanted to have one more cleaning before the summer months. He did have about 3 pockets of 6-8mm, so we checked those. There was some improvement in pocket reduction from the previously-administered Arestin and lots of tissue improvement due to his home care. During tx we used nitrous and air powder polish, and then I placed Arestin in the 3 deepest pockets. It was a very good experience.
My PM pt had cancelled earlier in the day, so I decided to go on down to the Women's Health Day at the Adams Midtown in the afternoon. It was super busy, and we saw everything from healthy with no problems to severe gingivitis with life-long calculus. Most of the pts spoke little or no English, so we had a crew of interpreters on hand. I think we came up with a number of potential back-up board pts., so we will know more during Tue. PM screening.
Then, I bounced back to clinic for the final Pod Wrap, and ended the day by preparing a Board Cassette. Hone, hone, hone. . . .

Wed., April 16 and Thurs., April 17

Wow! It's the last VA Day! Hey hey hey! Had a very interesting pt all day. There was a cancellation in the PM, so as I hadn't finished him in the AM, he came in the PM also. He went about in a wheelchair due to leg problems, and he preferred to travel backwards. He hadn't eaten or taken his diabetes med. that day, and he said he hadn't slept in about 4 days due to his meds and sleep problems. Brother! He'd driven in from Logan, so before he left Diane and I made sure he had some food and drink. He said his doc is trying to get his diabetes under control, but his blood sugar often is very high. He also had a dx for major depression, so according to him "depression has taken over my life."
By the PM, he was talking with enthusiasm about his great love, scuba diving. He required LA AM and PM, and had 2 quads of a II and 2 of a III. He seemed receptive to OHI, and I hope he follows through.
My WSU AM pt was my "perio project" pt. I'd last seen her in Nov. Ah, what a difference for me (and hopefully for her!). She is a class III, 82 years young, and always looks elegant when she comes in. Her pockets showed no worsening though there were more suspicious areas and despite her report of TBing and flossing there was more plaque than I'd like to see. So, gave her some OHI customized for her situation, and I hope it helps. It's tough to get old.
My PM pt was a class V and had had a cleaning at her DDS in Dec. That, added to her home care, obviously had made a big difference, showing in reduction of pocket depths and almost no bleeding. Due to her medical issues, she is trying to stay on a regimen of cleanings every 3 months. She really likes WSU clinic, not only because of the price but because of the professionalism of the students.

Wed., April 9, and Thurs., April 10

AM at the VA! And Spring is in the air! My AM pt was a very interesting character as well as a class III who needed LA. He also had two areas in his mouth he needed PAs on, and as I needed 2 more PAs, I said thank you to the Powers that Be. It turned out that one of the areas (#13) was sensitive due to root exposure and the other area (#30)was OK, according to the DDS who did the exam. My PM pt was a class V, a very nice, gentlemanly man.

Back at WSU, it was the dreaded last Mockboard!
My great pt was early, as usual, and I went in the AM, which was the first time this semester. I cleaned his LL quad using ultrasonic and hand instruments. I missed 3 little areas, but passed with an 82. WHEW! And now, I know I must get into those ant. interproximal areas with more authority than previously. My pt didn't need LA, and I know I am concerned about tissue trauma. But,I also know that it's most important to remove those deposits! And, when in doubt about recession, if you can't decide between a 0 and a 1, put a 0!
In the PM I got to watch everyone else sweat, all while helping out, of course.

Wed., April 2, and Thurs., April 3

The VA has been such an excellent experience! The range of pts is broad in their needs, medications, and personalities, which affords great opportunities (and sometimes challenges!) to expand DH skills. Today was a day of IVs and more LA injections. The IA injection used to cause me to pause, b/c I lacked confidence in finding the proper landmarks, but this is no longer the case.
My WSU AM pt turned out to be a IB instead of a II or a V, as I'd hoped. It is good to see the way so many recall pts progress after their initial cleaning at WSU. Many become impoved classifications, and though this may make finding certain pts more difficult, it's still good to see.
In the PM I was able to trade pts with Shandee and get some quads of a II and a III, which she didn't need. Again, I was impressed with the teamwork of my classmates. And, she expressed thanks for the IB, because she had not had one in a while. The program works!

Wed., March 26, and Thurs., March 27

My AM VA pt needed a pano as well as local anesthesia as he was a class IV. I notice a distinct improvement in administering LA as I gain experience, which is a wonderful thing. Applying knowledge of root morphology is so important when working on these pt types!

OK, today was my Clinic Simulation Day! I began by completing a IB by 10AM and then seeing a pt for subgingival irrigation and caries risk assessment. I wonder how many DDSs actually use this system. I did see a Diagnodent in one of the offices during my mentor experience, but my mentor said they don't often use it.
In the PM, I saw a delightful IA for BWs and a prophy, and next kept busy with placing sealants on another IA.
It was a good experience, and the time scoots when I'm so busy. Ah. Shades of real life?

Wed., March 19 and Thurs., March 20

OK, back to the VA. AM pt was a class V, and I was able to place arestin. Prof. Alexander says she sees it actually used about 50-60% of the time. My mentors use it 20-30% of the time. Of course, this will vary a lot from practice to practice.
My PM pt was 2 Qds of a III and 2 Qds of a IV. Much more challenging with the deeper pockets! Thank heaven for ultrasonic instrumentation!

Back at WSU, my AM pt was my Board pt, so I did his OD and took 14 PAs of the film variety. So far he's been great to work with, very punctual and easy to communicate with.
My PM pt surprised me by being a IB, but it's all good experience for me. He was a new pt and spoke little English, though he understood a bit, so between that and my bit 'o Spanish and Nicholas' help, we did fine.

SPRING BREAK WEEK!

I don't know why this blog is not getting saved so I can edit it and then post it, but it's giving me problems, and quite frankly I don't have any more time to expend on this, so i will try for the 3rd time and click on the Post button. Hopefully it will work.
Spring break was great even though we all felt the specter of the LA and BIG BOARDS hanging over us. I'm so relieved to say I passed my written and clinical LA exams. Russ was my pt., and I was his the next day. This worked well for both of us, and he did a good job and passed his tests also.
Now, it's into the final stretch for the BIG BOARDS on March 25!

Thurs., March 6

What an interesting day! I had it all figured out. My AM pt. would be a II, and my PM pt. would be a IB.
Well, it wasn't long before it became evident that my AM pt. was not a Class II but a IB! She came late and had to leave early, so I did 4 BWs and an OD. She was scheduled to return March 27.
As I looked in my PM pt's mouth (the 16 yo male) I was shocked. I had never seen tissue so inflammed, red, and bulbous, except in some of my books! It amazed me that he reported no pain or sensitivity. He also had enough bone loss and calculus to be a Class II. This was very sad to see in one so young. Needless to say, we spent a lot of time on OHI, and I tried to educate him about perio dz and how it relates to tooth loss. I stressed his need to take better care of his teeth NOW, or be at risk for losing his teeth in the future. He seemed receptive, and I can only hope he'll comply. I did let his mom know that he needs to brush 2x/day and floss 1x/day, even though I know that at his age her influence may count for less. I also recommended Listerine, and he seemed to think that was good.
So, there you go. You never know exactly what you have until you look in the mouth, and not all teens are IBs!

Tue., March 4 at VA

This week I was at the VA on Tue. instead of Wed., because I traded with another student so she could be with her daughter for something.
My AM pt. was a Class II. I did 4 Qds. with 4 exams.
Later, I placed a periochip in a pt. with a deep pocket on his facial lateral incisor.
My PM pt. was a Class V, and I did 4 Qds with 4 exams, 1 pano, 4 BWs, and 1 PA on a max tooth that had a fistula. The DDS examined pt. and X-rays and determined the tooth would need a root canal. This is the second fisutula I've seen now. They are relatively painless/asymptomatic (except for some bleeding or suppuration) since the infection isn't trapped inside.

Thurs. Feb.28

Oh boy, it's mockboard time for local anesthesia!
I'd thought ahead on this one, and my pt. was a fellow student, Russ. It was great not having to worry about someone not showing up.
Everything was going well until I said "I'm at penetration site" and I heard "Stop and hold."
I'd been so intent on putting the needle into the correct area that my wrist rotated leaving the BIG WINDOW down. Poo!
Well, it was an excellent experience because I was able to practice and complete both injections as well as have a real sense of all the factors involved and my need to concentrate on each one.
My PM pt. no-showed, which was the first time that had happened all year. Fortunately, a pt. was available in the waiting area, so I took the 16 y.o. male thinking he would be another IB. Since I took him in later and he had never had any X-rays in his life, his mom OK'd a full mouth series. There was visible calculus on the radiographs. Something I will be sure to do in the future is look inside pt's mouth before doing X-rays. This pt. had no problem other than a minor gag reflex, but he could have had tori or something else. For some reason I'd gotten out of the habit of doing an intraoral before X-rays, but on reflecting I think in the future I'll make sure I look in the mouth before taking radiographs. I rescheduled him for cleaning the next week.

Wed., Feb. 27, 1st VA Day

OK, let's check out another font.
So, back at the VA, and my first pt. was a nice older man. I did 2 Qds. of a III with 2 exams. Kami was the instructor, and I very much enjoyed and appreciated her input and support.
Something very exciting was that I was able to have 3 local anesthesia experiences, all in one day, whereas last semester I had only 3 the entire semester. With LA exams coming up, that was great!
My PM pt. was a IB, nice young man. Was able to do a Desensitization PE, a pano, and 4 BWs. Being at the VA is a definite plus to the program; it's an excellent experience.

Thurs., Feb. 21

My first pt. in AM was a Class III; she also was my mockboard pt. I did 3 PEs: Perio File, Root Debridement, and Desensitization. She was completed at this appt.; she'd been a nurse for >30 yrs., was an ideal pt. and a great lady.

I had hopes for a Class II in the PM, but my pt. turned out to be a IB. Oh well. It was a very good experience, and I am getting faster. Plus, this pt. was very interesting because she had what looked like (since we can't dx) benign migratory glossitis, and she also had what looked like retro- cuspid papillae on her mandible, neither of which I had actually seen previously.

UDA, Feb. 14 & 15

No clinic this week since we all went to the UDA convention in Salt Lake. I decided to go early on Thurs. and take in a class in the morning. When I arrived I saw Kimber, so the two of us looked over the list of offerings and decided to attend Dr. Glick's presentation: Medically Complex Dental Patients; Identification, Assessment and Treatment Protocols. This turned out to be a very good lecture, and I was glad we didn't attend Anne Guignon's "presentation," especially after talking to some of my classmates about her talk. I had attended one of her classes last year in El Paso, and instead of ergonomics she spent most of the time selling loupes for the company she reps for, Orascoptic. Apparently she did a similar thing here. I think I should contact someone and let them know about her modus operandi.

Of course, I checked out the vendors and picked up pt. info, fluoride varnish, and loupe material, among other things.

On Fri., Brittney and I did our Table Clinic on the Cariogenicity of Foods (particularly snack-type foods). We smiled and talked to students, hygienists, dentists, and instructors
from 11AM to 2PM. It was a good experience; I only wish I'd had time to take in some of the other table clinics. The winning table clinic was entitled "Caries - it's Your Choice."
Sounded similar to ours!

I'll look forward to wearing the hygienist tag at the next UDA and taking in more CE classes.

The Dreaded 2nd Mockboard!

The stress was thick in the air this day as people were awaiting their trial by mockboard. I was scheduled for the PM, so I could be a bit more detached in the AM. At least 2 pts. didn't show, so we had lots of help, but I felt badly for those whose pts. didn't come. I tried to encourage where I could, reminding them that only 10 points were at stake, and more experiences were to come.

My pt showed up on time (as usual). As I began the cleaning I felt a little nervous, which is unusual for me. I began with the ultrasonic, which I'd planned, but as I worked I began to stress over whether I'd be able to get that interproximal calculus. Last semester I'd missed a slew of these areas, and with an older pt. (like this lady) it could be more difficult feeling for calc. because of the surface irregularities, restorations, etc. Anyway, I went over the whole UR quad. with my ultrasonic, hand instruments, and ultrasonic again. Interestingly, during the second ultrasonic pass I spent more time interproximally, using different patterns, and was surprised but pleased to see a few large pieces of calc. come floating out. Then, I used my explorer and checked and rechecked. My pt bled a lot, so after using floss I put cold 2 x 2s on her tissue. Next time I may have some saline solution on hand.
Then I did her extra-, intraoral exam, probing, and paperwork, took her to the front and did that waiting thing. I felt hopeful about passing when I was told I'd missed only one spot: M/L #4. So, I went to work, got it, and did some OHI with my pt. before she left. Later, I was thrilled to find I'd passed with an 85! Yeeeeeeeeeeeeeeeeeeeha!

It's great to know I'm improving! Yes!

Thurs., Jan. 31 Clinic

My AM pt was my only potential mockboard person. I took BWs and 7 PAs of her max. dentition, and lo and behold, calculus was visible on the X-rays! She was classified as a III, and so I asked if she'd be willing to be my mockboard pt, and she was! Whew! Lots of folks were having a heck of a time finding someone.

Interestingly, her son was my PM pt, and he turned out to be a IB with a fair amount of supra calculus in his lingual anteriors. He is a former smoker, and his teeth appeared to have a generalized extinsic stain, so I was thinking it might be an idea to have him come in during my multi-pt clinic project for air powder polishing. He seemed to be up for the idea. We'll see.

Thurs., Jan. 24 Clinic

My AM pt. was a IB and needed a sealant. So, this was the perfect opportunity to do 2 PEs: Diagnodent and Sealant! I was very thankful for this, because I wasn't successful doing these PEs on my first pt. of this semester. So much of what is done clinically improves just by doing it. Later, I asked Dr. Anderton some questions I had about diagnodent and sealants. He told me that he didn't get too excited about higher numbers on the diagnodent unless they were over 50, which was interesting to hear since this contradicts what the instruction sheet said. Then, I asked about whether caries is entombed by a sealant, and he said that if the caries is only in the enamel, a sealant will prevent it from spreading. However, he said that if the decay is in the dentin, it will not. I think the DDSs are an excellent resource to expand on our knowledge.

My PM pt. had cancelled the night before, and I had exhausted all my "patient possibilities," so I wasn't sure what would happen, but as they often do, a patient appeared. I had a IA and was able to add to my sealant experience once again. Yes!

Thurs., Jan. 17

Clinic #2 already?
AM patient was new; hard to determine her class since she didn't have X-rays (they were done 2 weeks ago by her DDS). She said she would bring them in next appt. My instructor thinks she's a II at least due to calculus and pockets, though after seeing X-rays we can look at her bone loss. Her buccal mand. ants. had some deep pockets on the straight facial with Class I mobility and angry red tissue. I think it could be beneficial to try some Atridox in this area or some subgingival irriga. with chlorhexadine.
PM patient was from Fall, had to do 3 quads to complete her. She is a class II, had lots of fun calculus, so I was able to do my second PE on ultrasonic. Fun? Yes, when it succumbs within about 5 seconds to the ultrasonic and pops out, it's fun.
Hum, need to find my mockboard pt. . .

Jan. 10 Clinic, WSU

Hey, it was the first clinic day of Spring '08!
I started with two 1As; the first was a 7 yo in for 4 sealants. I had cleaned her last Nov. I was a bit slow in the beginning, but Jeannie gave me some much-needed assistance and the process became more fluent. I definitely need to review Diagnodent, and I know the next sealant occasion will go more smoothly. However, I did successfully place 4 sealants on the pt's first molars.
The second pt was a 12 yo in for cleaning. Went well except I was rushed and missed some supra calc on ling. ants.
My PM pt. was in to finish her cleaning. We did 1 Qd. of a II. I had an exam and passed the first time, which was gratifying.
Onward and upward!