This is a procrastination post because I should definitely be studying. But this weekend was great. E and I got to spend a lot of time together despite the fact that he was working this weekend and I was studying endlessly for finals. We even managed to grab lunch with my parents at Zingerman’s on Sunday. With the timing of our schedules and all, that kind of get together is kind of rare! Plus, I somehow convinced him to pose and take these cozy pics with me that actually define our relationship quite well. Behind the scenes, we are super goofy. Like constantly. I love it. And I love him.
Fortunately, our exams are kind of spread out this semester. About two weeks ago we just took the OSCE, a written exam that also had an SPI (Standardized Patient Instructor) portion that determines whether or not you’re ready to go to clinic. Last Friday we had our first final on our dentures course, this week we have 4 finals (2 Thursday, 2 Friday), and this upcoming Monday we have our last 2 finals! Then we’re off on break until the beginning of next year! And I will officially be starting my last semester of my D2 year. Time flies!
The exciting thing about next semester is the fact that we will actually HAVE OUR OWN PATIENTS. I am like wildly excited about this. I get that there will be a learning curve but this is probably going to be the most applicable semester of school in my life so far. What we are going to be doing in clinic soon is going to be very close to what we’ll be doing for the rest of our careers. ❤
So after about two years deliberation I’ve finally decided what I would do with my lower wisdom teeth. The reason it took so long to make a decision was because the roots of my lower wisdom teeth have decided to grow in a way that would wrap themselves and fuse around the nerve as suspected by the x-rays and later confirmed by the 3D CT scans. The worst thing that could happen is permanent paresthesia which would be a very high chance if my wisdom teeth were removed in the traditional way. Some surgeons said I could just leave it while others said to do a coronectomy…making that decision on my own knowing the risks was a hard one to make. Given new circumstances (complications with pocketing) I’ve finally made that decision.
I’ve talked to a number of different surgeons who had different opinions on what I should do. It wasn’t until recently that my wisdom teeth started causing me problems, not necessarily pain but pocketing between my second molar and the wisdom tooth since the wisdom tooth is impacted. The pocket space next to each tooth should usually be between 1-3mm…but because of the wisdom tooth pushing against my second molar, the pocket is 6mm. The problem with this is that it can lead to food impaction, it’s hard to clean, and can lead to cavities in that space in between the wisdom tooth and the second molar that’s right next to it. So if I don’t do something about these wisdom teeth then eventually I may have to extract the second molars.
At this point, with the pocketing and all, most of the surgeons I’ve talked to (shadowed, worked for, and consult at the school) have said they recommend a coronectomy, a removal of just the crown portion of the wisdom tooth to not cause damage to the nerve as removing the whole tooth would cause an extremely high change of disruption to the nerve. Permanent paresthesia is probably one of my worst fears…the feeling of having a fat, tingly, or completely numb lip, the way you feel after an injection, or possible random shooting pains. These are terrifying possibilities. Anyways, with a coronectomy, based on papers and meta-reviews and such, it sounds like this is the way to go.
Here is an image from one of the studies I was reading. In most of the studies, all the participants had roots that were too close to the nerve and after the procedure almost all did NOT have any nerve damage (one did and it was only temporary) and in some occasional incidents, the remaining roots rise up and can be easily removed once they are at a safer distance away from the nerve. Other times the root remain where they are without complication. Because the roots are being left in there is also a much higher change of infection so the surgeon I have scheduled to do the surgery said he would put me on a full course of antibiotics. I’m considering asking him if I should take premed as well, medications before the surgery, as many of the participants in the research studies did this and it is also something we learned about in class for certain patients.
Moral of the story – get your wisdom teeth out when you’re a teenager! And not when you’re 24 after the roots have grown out long and possibly closer to the nerve. As you get older, bone gets denser, and roots get longer leading to a surgery that has a much higher chance for more complications. In my own defense, my stupid dentist when I was a kid had told me that I didn’t “need” to get my wisdom teeth removed (hello? They were impacted and were never going to erupt) and I was content with that…until years down the line I understand why I should have gotten them out earlier.
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!
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.
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.
And they even hang out with me! I have to admit I haven’t had a tight “group” of friends since high school. I’ve had a lot of close friends throughout undergrad but it’s so nice to know that the people you’re closest to are also going through the exact same thing. We get each other. It’s like a struggle you can only understand if you’re in or have been through it. The best part is that we’re getting through it together.
When I started dental school here I thought I would get tired of seeing the same people all the time since we’re in class with each other 8+ hrs a day. Nope. These people have become my family and I definitely couldn’t do this without them.
First time injecting on one of my closest friends in dental school, Glo 😀 So happy that she trusted me enough to let me do this to her. 6 injections to be exact. And in case you were wondering what they were:
- Posterior Superior Alveolar (PSA)
- Middle Superior Alveolar (MSA)
- Anterior Superior Alveolar (ASA)
- Greater Palatine Nerve Block
- Inferior Alveolar Nerve Block (IAN)
- Buccal Nerve Block
This was probably one of my most feared days in dental school since acceptance day. But it wasn’t as bad as I thought. Especially since Glo was an excellent patient. I have no idea how she was so chill throughout the whole thing especially knowing that this was my first time injecting anyone.
Fortunately, we also had a great instructor, Dr. M, who was extremely patient and helpful and who made sure we understood what we were doing rather than a simple point and inject. At the same time we had to get used to hand skills involved with aspirating twice before injecting because an easy way to kill someone would be to accidentally inject into a vein. Which is why aspirating blood into the syringe would make it pretty obvious that you hit a vein and should reposition the needle. And of course, we did use real anesthetic (lidocaine) but in very very small doses so Glo wouldn’t be numb for long but so we could also tell that it got to the right place.
I felt like this was such a big hurdle to finally get over. It’s amazing that now we are technically qualified to start injecting patients in clinic with the D3/D4 providers. One of my goals will definitely be to inject as painlessly as possible. My family dentist does an amazing job at this and I think it’s because she makes sure to take her time while injecting so that the tissue distention doesn’t occur too rapidly which can result in pain.
I think it will be a while before I feel completely comfortable single-handedly injecting patients. So this year I will get as much experience as I can beforehand. That’s the nice thing about D2 year, we’re a bit more hands-on now and assisting in the clinics feels a lot less like shadowing but more like actual assisting.