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!
Monday, March 17, 2008
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.
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.
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.
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.
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.
Monday, February 18, 2008
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.
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.
Sunday, February 10, 2008
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!
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!
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