First Patient!

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Just had my first ever patient in dental school! At this point, we can do prophies (aka a cleaning) or a simple restoration (drill and fill). A lot of my classmates had their first patient weeks ago and you can either schedule a patient or you can wait to have one scheduled for you which is what most people did. I kept checking on the provider schedule and last week found out that I had a patient the following Tuesday!! It was a “prophy” aka prophylaxis or cleaning of the teeth which involves removing any calculus build-up, removing plaque, and polishing.

Honestly, the dentistry part of it wasn’t the hard part. I was more anxious about knowing when to get instructor checks and making sure I was fluent enough with the program we used. Although we’ve entered a lot of simulation patients into the program through MiDentTRAIN, we were now having to enter our first, real patient into MiDentLIVE. Fortunately, everything went smoothly and the patient was relaxed and friendly. I was SO lucky to have my friend and housemate, Raechel, assist me during the whole thing! She hasn’t had her first patient yet but I’m pretty sure she knew the order of things better than I did.

Our patient had A LOT of calculus, this hard minerally stuff that accumulates on teeth when the plaque is not removed on a daily basis. As Professor M had said when she looked at the patient, this was much more than we probably have ever seen and it might take a while. She said it was one of those “in-between” cases which probably could have been given to an upperclassmen. She told me to do one quadrant on the mandible and have her check it. I started working with the explorer to detect where the calculus was. I then used the cavitron and eventually moved on to the hand instruments including the sickle scalar and curette. It was very satisfying to feel and hear the calculus popping off the teeth, sometimes leaving the gingiva still slightly displaced. It was difficult to tell whether I was just feeling the CEJ (cementoenamel junction) or if there was actually calculus on the teeth. One thing I noticed is that despite having only done this twice before on classmates with no calculus, using these instruments felt natural and comfortable. I felt that I had the dexterity and hand skills that I had written about in my personal statement to get in here in the first place. When Professor M came back to see how we were doing, she checked with the explorer the quadrant that I had cleaned. She told me I had done a fabulous job and was very impressed. I was so happy to hear this. She said I could go ahead with the rest of the cleaning. We continued on but unfortunately, we didn’t have time to finish the whole mouth by the time the appointment ended at 5PM. So we discussed with the patient and were able to schedule her in for this Thursday.

Being at the school, the appointments can be very long…the morning appointments are from 9AM-noon and the afternoon ones are from 2-5PM. It’s not so much the dentistry that takes a long time, but in the VICs clinics, a lot of the time involves waiting around the faculty to come to your cube to do a check since we are technically working under their license at this point. But of course, as someone brand new to clinic, I’d hope to become faster as I get more used to using these tools and figure out what works best.

Overall my first patient experience went really well. I will never forget this moment and I now know that I am definitely where I’m supposed to be!

A Displaced Wisdom Tooth

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Saw this amazing and somewhat terrifying case today during my external rotation at the oral surgeons office. The wisdom tooth can be seen in the X-ray just floating above all the other teeth. Apparently it was pushed up there by an abscess into the maxillary sinus which is why it didn’t cause any pain but just congestion for this poor man. But this doesn’t happen overnight. This man hadn’t seen the dentist until he was 19 and it was an easy spot for his dentist to overlook…although it should have been caught early on before it got this bad. I think the patient was something in his late 30s. The doctor said that the abscess would have a grape-like feel to it as it pushes into the sinus space with epithelial tissue growing inside it with nowhere else for it to go.

About two years ago (wow I can’t believe it’s been that long!) when I was working in another oral surgery office before dental school we saw a case just like this and the oral surgeon went in, drained the abscess, and removed the tooth. It was kind of a mess with black and brownish colored pus coming out of the abscess. Shadowing today was very eventful and reminded me of the days before dental school when I worked in the office. Plus, I’m starting to get to know specialists in the area to whom I may eventually refer patients out to if I ever join a practice in town.

I also asked the doctor what he would suggest in terms of making it easier for the oral surgeon. He said to be proactive. For example, he said many kids who need their wisdom teeth removed don’t get them removed until they have pain or when the surgery would be more drastic due to more developed roots, etc which can lead to a higher risk of complications. He said it’s much better to tell the patient that the surgery could wait rather than telling the patient that it’s too late.

Procrastination and Temps

I have been procrastinating so terribly for my exam tomorrow. I went through all the lectures yesterday and today, there were only 8 this time (which is probably why I have been taking it way too easy), and it’s in pharmacology, a subject that is interesting and actually applicable. But going over everything and getting things to stick has been a hard thing to try to make myself do when all I want to do is everything except that. In general, I think I need some sort of panic in order to make myself study. I am just not disciplined enough. I wouldn’t say I “thrive” on panic, but it definitely makes me a much more efficient person.

Anyways this morning we worked on making “temps!” A temp is a temporary “tooth” that we make from a plastic stent to place over a crown prep. So for example if you had a bad cavity where we had to remove a lot of the tooth structure including all the cusps, we’d carve the tooth in a way to fit a crown, take impressions and send them to the lab, but since making the crown takes time we have to place something over the prep to protect the sensitive dentin in the meantime aka a temporary. We have a practical coming up Monday that involves both the prep and the crown so we’ve been working on these for the past week.

Honestly, temps have been kind of fun. It’s functional art and we get to use tools to carve the temp to look like a real tooth. Interesting, one classmate told us that his mother, a dentist, had told him not to make the temps “too good” otherwise patients won’t come back for the crown! Interesting advice, but I’ve definitely heard stories of temps lasting a lot longer than they were intended.