Agent Orange

Today was an eventful day.  We had horrible wind driving down to the VA today.  There were 4 semis that were tipped on their sides on the side of the freeway on our way down.  It was rather terrifying.  I won't lie: I really wish we didn't have to go to the VA on a day like today.  I received many code purple messages saying to stay indoors on campus and eventually Weber State was closed.  I wish that would could have gone home as well, but 3 patients showed up in the afternoon.  Everything did end up working out.  I just wish that I could have helped my husband with family issues going on back home.  Anyway, on to my day.

My first patient cancelled and I wasn't all that heartbroken about it.  There was another patient scheduled at 9:30, so I was able to see him.  He was very kind.  While taking x-rays, Prof. M reminded me that his occlusal plane needs to be parallel to the floor.  I was having him tip his chin down instead of up.  I kept getting more root structure of the maxillary teeth than equal of both arches.  I did get to use nitrous on him, which wasn't as terrible as I expected.  He wouldn't even let me in his mouth without the nitrous on him.  When I had completed his cleaning, I needed to let him have 5 minutes of pure oxygen before letting him out of the chair, but he needed to use the restroom, so I had to let him go after only a couple of minutes of O2.  Prof. M said that next time I should put on the oxygen while I polish and floss.  My patient has PTSD, so I didn't want to have him freak out on me by taking off the nitrous too early.  He hadn't been on a very high percentage of nitrous, so I don't think he was getting very much. 

My second patient was just a tissue check and polish.  When I got inside his mouth, I noticed an area that looked like it had food impacted in it.  I removed what was there with my explorer and noticed that there appeared to be bone exposed through his tissues.  This really concerned me.  We have been talking about bisphosphonate use in Prof. Alexander's class and osteonecrosis of the jaw.  It didn't look bad.  The tissue in the area looked healthy and it didn't hurt my patient.  We brought over a doctor to take a look at it.  Then another doctor came over.  My patient had had bisphosphonate treatments 3 years prior.  He had also had extractions done about 3 months before.  This was a site that had not healed yet.  Between the two doctors they decided that the area looked ok and that they are going to watch it.  I gave him a ligajet to take home and wash out the area with salt water in hopes that it will eventually heal.  My poor patient was been suffering from cancer for 10 years.  He has had 3 of his left ribs, part of 1 lung, and part of his stomach removed.  The cancer, caused by Agent Orange, continues to metastesize to different areas.  His original prognosis was that he would live 3 years.  He is still alive and it has been 10 years.  I hope that my patient can continue to beat the odds and be around for his wife, children, and grandchildren for many years to come.

Oh the difference a sharp instrument makes

I had two very distinct experiences today.  My first patient was scheduled for 8:30 am, so I had a little time to prepare for the day.  I figured I had better take the time to sharpen my instruments for that morning.  Like a good little hygienist, I did just that.  I got all of my instruments nice and sharp, prepared for calculus removal.  Patient arrives: I do my usual: extra/intra oral exams, x-rays, probe, and scale.  I had the privilege of giving 5 injections (was once again reminded that I need to go slower). (On a side note, I kept poking my glove during the injections!  I have never felt like the small gloves are too big for me, but apparently they are while I am giving injections.  I must remember to wear extra smalls.)  Prof. Alexander comes over at about 10:45 asking if I am ready for my scale check since it is almost walk out time.  She checks my patient and perfect!  No missed areas!  Wahoo, I cried!

My original PM patient, which was supposed to be a 12 year old girl, canceled the day before.  I called a couple of people later yesterday and a wife was going to make her husband come in for a cleaning.  Well, she calls me at about 8 am and leaves a message canceling her husband's appointment.  I wasn't heart broken by this news.  But later in the morning Prof. Alexander came around asking if anyone is in need of a patient for the afternoon.  I reluctantly raise my hand.  Prof. Bossenberger has a patient for me.  Yeah!  (Sarcasm intended.)  My patient comes in on short notice.  He is a class 3!  Perfect.  I go from seeing most likely a class 1A to a class 3 for my last patient of the semester.  It is good though.  I will need class 3s for next semester.  So, I start cleaning his teeth.  I only get the right side done and run out of time.  While scaling, I didn't completely feel like my instruments were locking into the calculus.  I knew it was there, but knew that I was missing deposits.  Prof. Alexander comes over once again and says it is time to have my scale check.  I haven't had a chance to check with my explorer to see if I missed anything.  She sits down and checks the upper right quadrant.  Three missed areas right off!  She takes an instrument and tries removing some calculus.  She looks at me and says, " I think the problem is a dull instrument."  Lesson learned!

Moral of the story:
AM patient- no misses, freshly sharpened instruments.  PM patient- lots of misses, very dull instruments.  I will never make that mistake again!  I will be bringing my instruments home over the Christmas break to sharpen, then sharpen again.  I know a sharp instrument is critical to what I am doing, but this affirmed that I have got to make sure the instruments are sharp before I go intraoral with them.  Otherwise, what I am doing is pointless and will just have to redo what I had tried to do in the first place.  Bring on Spring Semester!  Goal: always have sharp instruments and have very few missed areas.

You mean that wasn't an infiltration?

Ok, so I learned something very important right off the bat today.  I was lucky enough to do some injections on my patient in the morning.  I knew that I would be doing a PSA and an MSA, but hadn't expected to do an ASA.  Well, Prof. Alexander informed me otherwise.  So, here I go.  My angle was a little off on the PSA, but I got in there and did it.  Next, MSA was just fine.  Well, I get to doing the ASA right above tooth #8.  I inserted the needle half way and proceeded to deposit the anesthetic.  My patient really starts to make some noise and Prof. Alexander tells me to withdraw.  I sat my patient up to let the anesthetic start working.  I went to talk to Prof. A and she tells me, "Two things: first of all- you inserted the needle a too far on the ASA.  You were doing more of an infraorbital instead of an infiltration.  You may want to watch your patient's eye because it may start to droop.  Next, your rate of deposition was a little fast.  That may have been the reason your patient was feeling it so much.  You were putting too much anesthetic too fast into the area."  Oops!  Well, I learned my lesson on that one!  I finished scaling the UR quadrant and proceeded to anesthetize the LR quadrant.  I tried inserting the long needle into the IA about 5 times and still made osseous contact!  I repositioned my needle and still hit.  Finally, Prof. A told me to get the anesthetic in there.  My patient didn't get numb all the way to the midline, so I was lucky enough to do the mental injection also.  So, for my first time injecting on a real patient, I got to do 6 injections.  I loved it though!  I didn't feel nervous or anything.  I got the full experience too.  I asperated.  I contaminated my needle.  I made osseous contact.  I did an infraorbital rather than in infiltration.  Man, what a good learning experience.  I just hope the next time I do injections they go a little smoother.  Hopefully I am past the learning curve.

It was rather comical that both of my patients fell asleep in the chair with me working on their mouths.  We're talking full-blown mouth breathing, borderline snoring.  But at least their mouths remained open so I could continue working.  When they would wake up, I would assure them that they were fine.  It was very reassuring to me that they were comfortable enough to fall asleep.  It was a good productive day with many learning experiences.

Kind of a crumby day

Kayla was a super big sweetheart and traded VA days with me.  I needed last Thursday to stay home with Zach, so I went today.  My first patient of the day was a very typical older gentleman.  Very nice and pleasant to work on.  He was a class II, which I have a ton of quads of.  I had him completed by 10:30 at the latest.  So, I hang out until lunch time which is from 12:30-1:30.  At this point I have been sitting around for 2 hours.  I have tried to be productive by helping the other girls clean their rooms and studying for a boards.  After lunch, my patient no-shows.  He had just scheduled his appointment the day before or today and he no-shows.  It is so frustrating when this happens.  One of the dentist's was seeing a patient for a cleaning, but needed to do some temporary crowns first.  I was going to see this patient, but the Dr. didn't finish with him until 3:20.  I found out that we are supposed to be done with patients by 3:30.  As you can see, this only gives me 10 minutes to complete anything.  What I bum deal!  I have got to realize that anything can happen at the VA.  We are at the mercy of the patients.  There are just times when it doesn't work out for us students.  I also realized that we as friends and fellow students need to be aware of who has seen more patients at the VA.  If someone has a cancellation in the morning, it wouldn't be right for that person to not have a patient in the afternoon.  Or if someone gets two patients in the morning and another person's no-shows for the afternoon, they should be given the first person's afternoon patient.  We have got to take care of each other and make sure that patient opportunities are fairly equal while we are there.

Abfractions?

Today I had a patient that looked like she had abfractions yet didn't present with attrition.  After speaking with Karlie Weeks, I realized I should have done a little more digging into why she may have had these abfractions on so many of her teeth.  I should have asked if she grinds or clenches her teeth.  Next time I see her I will have to do that.

I really had a good day today. I am up to 44 quads of a class II/V and 11 sets of BWX.  I am really happy about that.  In our pod wrap today our instructors asked who is in need of class III.  I really feel like I am in need of class IIIs.  I have been so stressed that I am not getting more and have no idea where I am going to find more.  Come to find out, in pod wrap today, I am actually sitting just fine with my class IIIs.  I have 10 quads and 3 more are scheduled for next Tuesday.  When the instructors ask who is in need of class IIIs, they mean students who have fewer than 5 quads of a class III.  So, all in all I am doing well.  I am looking forward to getting those last 3 quads done on my patient.  I also have two VA clinic days coming up that hopefully will help with class IIIs and anesthesia.  I haven't given any injections yet.  I am really worried that the farther away I get from the last time I gave injections, I will be really rusty.  I will really have to read up on injection sites before I do give them.

Today I didn't really feel like I was on my game with calculus removal.  I didn't have any missed areas, but I just didn't feel super confident in my stroke.  In pod wrap, we also talked about "to the tooth, to the toe, and twist."  I just didn't feel like I was doing that very effectively.  I also felt like I was having some trouble accessing some areas.  I really need to work on that.  I just need to ask an instructor to come over and watch me.  Hopefully in the process I can pass off some PEs and get me closer to graduation.

Ok!  I just ready a blog post from last fall about how much I enjoyed using my Blu-Boa.  Boy, has my opinion changed!  I can't stand the Blu-Boa.  I am so frustrated that we were required to buy 3 when I can't stand the first one I got.  I just don't feel like it is very effective and my patients don't usually enjoy it very much either.  It can't suction up large pieces of calculus or suction very quickly.  What a waste of my precious loan funds.

FYI: We are under the 6 month mark to graduation!  WOO-HOO!

I love seeing family!

My son was a real trooper this morning.  I brought him in bright and early with me to clean his teeth.  I had to reschedule my original patient due to an infection.  It is so nice seeing family because you can pass off PEs that you wouldn't want to inflict on regular patients!  Poor Hayden!  First of all, he needed to have a sealant redone.  I don't mind paying the $6 when it helps me with something for school.  I was also able to use the diagnodent to check his tooth for any cavities.  Diagnodent & Sealant PEs: check & check.  I knew that I had plenty of time with him, so I decided to do the Saliva pH test with him.  Prof. Wold told me she hasn't really seen this done on a child before, but I was bound and determined to do it on him.  He really was a good kid.  He did what I asked of him.  I don't think he spit as much saliva out as he was supposed to, but he did ok.  Caries Risk Assessment PE: check.  What a productive morning!  Another 4 quads of a 1A and 3 PEs passed off.

I love when patients are so flexible.  My called my afternoon patient and informed him that I could see him earlier than 1:45 pm.  He very willingly came in at 12:30 and was even early.  I only had 2 quads to finish on him.  This patient for some reason keeps forgetting to eat before coming in to see me.  He is diabetic and often times needs me to provide him with something to eat before releasing him from the clinic.  Both times I have seen him, I have had to check his blood sugar at the end of the appointment.  He has been low both times.  Thank heavens for Mrs. Neeley's candy dish that has provided him with enough sugar to get him home.

Mock Board

What an experience!  I didn't "pass" the mock board, but it was great to see how the boards will actually go.  It was really stressful.  I was so glad that I got mine over with in the morning.  It gave me the afternoon to think through how it went and realized that it was a good experience.  I also choose a harder classification of patient for this exam.  So, over all I felt that I didn't do too bad.  I ended up missing 4 areas, my x-rays weren't sufficient because my patient is pregnant, and I missed one probe spot.  I felt pretty confident about my probe readings, but I will need to be more careful next time.  We will have 2 more mock board experiences in the spring.  I hope that they go better.

Now I need to talk about the blu boa.  I still haven't decided if I like it very much.  Each patient that I have used it on, it hasn't been efficient at removing the water from their mouth.  My mock board patient was choking on the water because it wasn't removing all of it.  It has been more efficient for me to have my patient hold the saliva ejector and have me pause periodically to have them suction.

Crazy X-ray

I had kind of an interesting day today.  My morning patient was late getting there, but once he and his parents arrived, I got 2 sets of bitewing x-rays and cleaned a 1B.  I was disappointed in myself though.  I missed several areas on the lingual surface of this patient.  He was pretty jumpy and had really bad gingivitis due to having braces.  I just feel so ineffective as a clinician when I can't remove all of the calculus from a simple 1B patient.

Anyway, on to my crazy x-ray story.  I had failed to look up my afternoon patient's phone number before leaving on Monday, thus I didn't confirm her.  Right before lunch, I thought I better call.  She answered the phone and said she was glad that I had called.  She said that afternoon wasn't going to work out after all.  I tell her that is fine and get her rescheduled for November.  I go to lunch thinking, "Oh great!  Now what am I going to do?"  I tell my friends and Heather says she has two patients coming in for the afternoon and that I am welcome to have one of them.  Great!  Well, the one girl shows up, but her sister didn't come.  Back to square one!  I go to the front desk and start looking up names from the resource list.  I call a few people.  No answer.  I then come across a name that says they can come in on short notice.  Perfect!  I call him, he can come in.  I wait about 45 minutes and he arrives.  Go through the health history.  While talking he says to be careful with his upper left lateral incisor.  He explains that he had been hit in the mouth while playing rugby and that the tooth is loose.  I tell him it would be a good idea to take an x-ray of the tooth to make sure everything is ok with it.  We take the x-ray and there is a perfect root fracture staring me in the face!  It even looked like the canine may have been fractured as well.  I show it to my instructor and she tells me that I can't do anything else on him.  I need to refer him to a dentist and tell him to get there asap.  I felt really bad, because he asked me what they might have to do.  I told him that for a fracture like that they may need to extract the tooth and put in an implant and crown.  He didn't seem pleased to hear that news.  But when you play a contact sport like rugby, that is a chance you take when you step onto the field.  I will follow up with him this week to make sure he is getting in.

Requirements...

Are coming easier than I expected.  I am so grateful for this fact.  I thought that getting all of my requirements was going to be an absolute pain in the you know what!  So far I have been really lucky.  Despite having patients cancel the night before and one not show up, I have had a patient in my chair every morning and afternoon for the first 6 weeks.  I am up to 4 quadrants of a 1A, 6 of a 1B, 26- class II, 11 class III/IV, 6 sets of bitewing x-rays, 33 PAs, and 9 root debridements.  Most of my fellow students have met the 1B requirements, but I am not worried about getting 6 more quads during the last 9 weeks of the semester.  My 7 year old still needs to make it in for a cleaning. He will count as 4 quads of a 1A.  The VA has been a great place to get requirements as well.  Dr. Hanson has been great about helping me pass of PEs.  She is usually the one to suggest ones that I can pass off because she was watched me complete them through out the appointments.  She is also so complimentary on my skills.  She makes me feel so competent and like I actually know what I am doing.  Thanks Dr. Hanson!  You ROCK!

Some Good Experience

Last week I made a valiant attempt at seeing two patients in the morning.  One was my wonderful husband who needed a cleaning desperately and the other was my patient needing to get an a transplant list.  I got Trevor in and out of there within an hour and 20 minutes.  Feeling good!  My next patient shows up and still all is going well.  By 10:30 I was getting close to being done with him.  I called him a class III because of everything going on in his mouth.  Had my scale check.  All was well.  Polished, flossed, and added fluoride.  He was on his way to getting on the transplant list.  One unfortunate thing did happen during the appointment.  The amazing thing is that this very thing happened with a patient in the spring.  A composite filling came out of an anterior tooth!!!  I couldn't believe that this very thing would happen twice to me.

My afternoon patient was supposed to be a young woman.  When I called to confirm the appointment the night before, she told me she was expecting Medicaid to pay for this visit.  I had to inform her that we do not take medicaid and that she would be responsible for the visit.  She made it sound very bleak that she wouldn't be able to come up with the money.  I called my dad in a panic and informed him of the situation.  It is a little hard for him to take off on such short notice, but he was able to make it work for me.  I was able to get his cleaning down relatively quickly and then we did some laser therapy on one area.  I hope that it helps to rehabilitate his tissues and close up a pocket.  We will see him back in 2 weeks for a tissue evaluation and to laser the area again.

A Good VA Experience

I have to say that today went very well.  I saw a class V patient in the morning.  I took and pano and 4 bitewings on him as well.  He does an amazing job at keeping his teeth clean, so it really was very easy.

My patient in the afternoon was a little trickier.  First of all, he was hard of hearing.  I felt like I was shouting at him every time I said something.  Next, he couldn't be laid back very far.  I had to do a lot of the scaling standing up.  My back was already hurting me from the moment I woke up, so scaling unsupported was a little hard on me.  But I made it through.  His lower anterior teeth were horribly malpositioned and I didn't feel like I could adapt my instruments very well.  Next, I didn't probe because it had been done 2 months previously.  But there was one pocket that was a lot deeper than the person had recorded.  Unfortunately, I should have caught that by virtue of scaling down into the pocket.  Prof. M was really nice about helping me get to these areas.  We were able to clean off the stain for coffee.  This gentleman even said that it is enough to make him want to quit drinking it.  We'll see!

Staying on the Positive Side

I had a really strange feeling on Friday night after speaking with my afternoon patient.  I just had this little thought in the back of my mind that she was going to no show.  Well, sure enough, she no showed.  But let me start at the beginning of the day.

MeChel was so sweet and let me have her second patient for the a.m.  My patient had cancelled the week before and MeChel knew of my predicament.  Thank heavens for helping friends who are willing to share.  So, I saw the most wonderful, accommodating patient.  I took bitewings and 4 PAs!  She was a class V, but had furcations as well.  I got her completely done and out the door by around 10:40.  I was feeling pretty good about myself.  I didn't even miss any spots!  Woo Hoo!

I had promised my 4 year old that I would clean his teeth that morning and then we would have lunch together.  Well, I was short on time, so I wasn't able to squeeze that in.  I called preschool to make sure that he wasn't sad since I had told him that was what I was going to do.  They said he was doing fine.  Lunch comes and goes.  I let some friends have the things I had brought for my son.  Right before patients are supposed to be there for the afternoon, I get a phone call from preschool saying that Zach is feeling bad because I was supposed to pick him up.  Broke my heart!!!  I talked to him to see if that would help him feel better.  Well, next thing I know, my patient no shows.  Emergency back up?  You guessed it!  Zach Morris.  No, not the guy from Saved By The Bell.  My son.  

When I picked up Zach and as we were heading into my building, he remembered that I had brought him chips to go with this lunch.  When I told him that gave the chips away, he started to whimper.  Mr. Soloman was right there to pick up the pieces.  He promised Zach that "if he would let his mom clean his teeth that he would buy him some chips."  Thanks Mr. Soloman!  That was so awesome of you to do for him.  So, we went back to my unit and cleaned his teeth.  He lost two teeth over the summer, so I took an occlusal film to check where those permanent teeth are.  They're there.  After all of that, he got his Doritos.  I called my sweet hubby to see if he could come in for some x-rays as well.  The stud came up and let me take 18 x-rays.  What a trooper!  

Overall, it was a productive day.  I took 2 sets of bitewings and 19 PAs.  I can't complain about that.  Let's hope for no more no shows.  It sucks!

Not a Very Good Day

I have to admit that today was a little rough.  First of all, my AM patient was pretty foul and kept telling dirty jokes and swearing a lot.  Honestly, the guy wouldn't shut up!  I kept thinking to myself, "just be patient with him."  But deep inside I wanted to tell him to SHUT UP!  I felt like things went ok on him.  I probably could have utilized my time a little better on him (I would have finished more if he hadn't been talking so much).  I only finished two quads of a class 2.  He did have some areas that were tenacious, so they were hard to remove.  I got all but one spot, so I was pleased.

Next, my PM patient was a nightmare.  The poor guy is needing a cleaning to get on the liver transplant list.  Because of his liver failure, I needed to get a Physician's Consult to find out about premedication.  Well, I got a hold of his dr.'s office and they gave me the fax number.  I told them the patient was in my chair, waiting for treatment.  I thought that would have sped things up, but oh no!  They were taking their sweet time.  As a matter of fact, they never got it faxed back to me.  While we waited, I charted existing dental problems in his mouth, but I couldn't do anything subgingivally.  I did get a Scan-X pano taken on him though.  So, 1 pano down and 5 to go.  I had to reschedule this patient for next week, so that we can hopefully complete the cleaning so that when he meets with his doctor next Friday, he can be put on the transplant list.  The whites of his eyes were completely yellow and so was the gingiva of his mouth.  I had no idea that liver failure could cause yellow gingiva.  Now I know.  Here's hoping to a better week next week.

First VA Experience

I had my first experience at the VA all day today.  I didn't sleep well last night.  I think I got a total of 3 hours of sleep.  So, on top of having a boring morning, I as exhausted and ready to go to sleep any minute.  Each of us five students got our patient names.  I was assigned a woman.  What made me nervous was that there was no answer on this woman's phone the day before to confirm the appointment.  I was hoping she would show up.  I was going to be able to take a pano and 4 BWX, do full perio & dental charting.  But I wasn't going to be that lucky.  I was fortunate though, because 30 minutes after my first patient no showed, a very nice gentleman came in for a cleaning.  I was able to take 4 BWX on him and for not having taken x-rays all summer long they looked pretty darn good.  We also have to take them with Schick.  One set of bitewings down and 19 to go.  I completed his perio and dental charting and cleaned one quadrant as well.  I was very pleased because he is a class III.  I did pretty well.  I missed one spot, which was very obvious.  For some reason the area looked like an amalgam filling to me.  I was really mad at myself for missing it, but overall I was very pleased that I was able to complete as much on this patient as I did.  Overall I felt that it was a very good day.  Oh, one thing I will never forget...I forgot to fill my ultrasonic attachment with water before I put the insert in.  I bled it for one minute, but forgot to fill it before putting in the insert and the instrument got really hot because the water wasn't in there.  I didn't realize this was the problem until Prof. McCaunaghy asked if I had done that.  Oops!

It was a decent week

This was a pretty decent week.  I was able to pass off my Removable Appliance PE and scaled four quads of a class II and two quads of a class 1B.  I did struggle with one area on a patient though.  I just wasn't feeling very comfortable with my fulcrum on the upper left side of my patient's mouth.  I was scaling the lingual surfaces of the posterior teeth, but my fulcrum was just off.  No matter what I did, it just didn't feel comfortable to me.  I never had an opportunity to ask my instructor for help in this area.  I am going to make sure this next week that I will ask for direction.  I need to get better at my positioning and where my fingers should go.  I also got my loups several weeks ago and have been using them every time I am in clinic.  I just don't love them yet.  I feel like they help me see better definitely, but I get the worst headaches from them.  I just can't wait to take them off.  On Wednesday the right side was really starting to pinch right behind my ear.  It was so bad I couldn't wait to take them off.  I think I just need to take them to an eye doctor and have them adjusted so they don't pinch.  The odd thing is that they are so loose on my head that unless I have the string cinched nice and tight, they slide down my nose.

I have only 2 weeks of clinic left.  That is only 4 clinic session available to pass things off and complete requirements.  As long as I can complete my class III patient in one more appointment, 3 more quads, then I will be sitting pretty.  I feel like I will be able to get everything I need done.  I have already completed: class 1A, class II, BWX, PAs, panos, and my Removable PE.  I just need to complete sealants on two more people which will happen on Monday, finish scaling my class III patient, and if I get him done then I will see one more class 1B patient on the last day of clinic to have everything done.  I will be passing off three PEs on Monday as well.  I think that Monday is going to be a nice break to scaling teeth.  I am doing 3 sealants on my niece, passing off two unpleasant PEs on my husband along with four sealants, and then passing off one more PE after my patients have left.  I am really looking forward to Monday being very productive.  I can't wait to be done with my first year.  Summer is going to be such a nice break to stress.  I am really going to enjoy spending time with my kids and cleaning my house on a weekly basis!

My first class III

Wow!  I had no idea how hard a class III was going to be.  I convinced my patient to have x-rays taken today since it had been a year.  He seemed reluctant at first, but I turned on the persuasion and he consented.  I am up to 9 sets of bitewing x-rays!  My patient had quite a bit of calculus that I was having a hard time maneuvering around while I was probing.  Most of my measurements were accurate, but there were some that were way off.  I just need to have an instructor show me how to get around it to get accurate readings.  Then I started with his cleaning.  I only did one quadrant of his mouth and he was even missing two molars in that area.  I couldn't believe how hard the calculus was to get off.  When I had my scale check, I had missed 5 areas!  I had started with my ultrasonic, which did a great job of getting stuff from inside the pocket.  My instructor advised me for next time to use the left/right ultrasonic tips.  She said those will help me a ton with his tenacious calculus.  I sure hope so, because that stuff was hard to get off!!!  My patient isn't coming in until my second to last clinic day.  I sure hope that I can get everything done in that amount of time.  Fortunately that is my longer day so I have more time to complete things.  I am looking forward to trying out the other ultrasonic tips.  I hope that that helps my instrumentation.  I really need to use more of a horizontal stroke while working on tenacious calculus.  I will get better, I know I will.  It is just a matter of time.

Trying to do too much

I tried to do too much yesterday.  I saw my son for a cleaning and then had two other boys come in for panoramic x-rays.  I felt so scatter-brained.  Don't get me wrong.  I had a fabulously productive day, but I just felt like I had no control.  We are supposed to finish filling out one chart before even bringing the next patient back, but that just wasn't going to happen.  The two boys were there and ready to go and my room wasn't even clean yet.  Fortunately I got my son completed, Diagnodent and Sealant PEs passed off, two bitewing x-rays taken, and the two panos taken.  I realize that I have got to be better at prioritizing my time.  I felt like I was being efficient by having my x-ray room set up before seating my patient, having all of the sealant material ready to go, but things still just didn't flow as well as I would have hoped.  I did mess up on one of the panoramic films too.  Darn it!  Instead of placing the drum on L1 I placed it on L2.  I won't be making that mistake again.

I am hopefully seeing a class III patient tomorrow.  I will be taking x-rays on him as well, most likely vertical bitewings.  Fortunately I have my peer pals records from his previous appointments to refer to.  I hope that my OD goes well so that I can at least scale one quadrant.  I will really have to be on my A-game to get that much done.  Cross your fingers for me that all goes well.  I am nervous about probing such deep pockets, but it will be a great learning experience.  Bring on the class III!!!

BRACES!

My patient today had braces.  That is difficult to work around.  She was even sweet enough to take out her wires for me.  I was able to take Schick x-rays on her as well.  They turned out fantastic, if I say so myself.  I was really proud of myself for how awesome this pictures were.  I can finally say though that I have taken some digital x-rays.  WaHoo!  I think I could have done a better job of managing my time.  If I had made sure that I had everything set up (my x-ray room and OH aids) then things might have gone smoother.  I was the first person signed up in x-ray room 1.  I could have had that set up before I brought her back.  That would have made things go faster.  Because of this little things that I didn't make sure of I now have to have her come back to finish her last two quads.  I did get her right side cleaned.  It was hard with the brackets though.  Especially probing.  It was really difficult to maneuver the probe around the bracket on the facial.  I now know what to expect when I have her come back.  She does a really great job of cleaning her teeth with brackets on.  She also  has her interview for the program this coming Monday.  I really hope that she gets in so that I can be her peer pal.  I plan on being the best peer pal there is.  I think it is important for a peer pal to advise the first year student coming in.  I could have used a little more advise and help, but I didn't ask for it and my peer pal didn't offer it.  I'm not going to sugar coat things either.  This is a hard program.  Not impossible, but hard.  Especially with a family.  I am looking forward to graduating!  That will be a great day.

I am going to finish up my sister on Monday.  I am hoping that she can bring in her daughter for me to do a couple sealants.  I can pass off a PE and help my niece protect her teeth.  I have two quads to finish on my sister, polish, floss, and use that fabulous fluoride.  Fluoride is fantastic and can do some much for teeth, but I wish they could make it taste better.  If they are going to create something that has to stay on the teeth from 4+ hours, it should taste decent to have it there!  There you go fluoride companies.  That is your challenge for the year.  Make something that tastes better!  Not the melon flavored crap that I have on my teeth right now!

Almost Didn't Finish

I was so close to not finishing my patient from today.  I think we did a little too much talking.  I have got to learn that I need to concentrate on what I am doing inside the mouth.  If the patient is talking that keeps me from working.  Between the two of us, we just did way too much of that.  As we neared the end of the appointment, I pulled out my ultrasonic (which was found) and used that to finish up.  He had several areas that seemed like very tenacious calculus.  I felt like I was hand scaling on some areas for minutes on end and it just still felt rough. I finally got him finished up though.  I was pretty sure I was going to have some areas that I had missed, but miraculously there weren't.  I polished him up, applied the fluoride varnish and got him out of there.  I was so glad that I got him done and didn't have to ask him to come back for yet another appointment.

I am looking forward to Wednesday.  It is a lab day and we don't have patients.  It will be a nice break!

Finishing up a Class V

I completed my class V today, which counts towards my class II requirements.  I now have 8 quads of a class II, only 4 more to go.  My patient from today is even coming back in on my very last clinic day, so that will at least give me my requirements.  I was a little freaked out before my patient got there.  I couldn't find my ultrasonic scaler and he prefers to have that used.  I ended up trying out my other ultrasonic scaler by Hu-Freidy.  I HATED it!  The water wasn't flowing out of it the way it should have been.  At one point I realized that there wasn't any water coming out and I pulled the scaler out from under my patients gingiva.  When I pulled it out I saw a red hole in the gingiva from where I removed the scaler.  I asked him if that had hurt, and he said it did.  I felt TERRIBLE.  The stupid thing should be working properly.  I had made sure that the water was flowing from it and there were just times that it would stop coming out.  I had never used it before.  What a pain!  I sure hope that I can find my slim line scaler.

I was happy to complete my patient from today.  He had a presentation for some teachers today, so I didn't want to use fluoride varnish and have him look like he had cottage cheese on his teeth.  So I had the fun experience of using a tray and fluoride gel on him.  Poor guy!  The stuff tasted terrible!  I hope that he got rid of the taste quickly.

My next patient is one that I am completing from the beginning of the semester.  My good friend.  He is such a nice guy.  I am really hoping to finish all four quads in this one appointment.  He is a 1B, so I don't think it will be a problem.

Thanks Sis!

My sister Jen came in.  She fortunately needed x-rays.  Yeah!  Four more conventional films.  I was able to complete two quads on her as well.  She wanted to try the ultrasonic scaler as per my mom's suggestion.  She enjoyed it.  Now I need to pass off two PEs on her.  Ultrasonic and universal scaler.  I should be able to do both of those.  I haven't felt like I am getting very proficient at my hand scaling though, because most of my patients want to or need the ultrasonic used on them.  I really need to start practicing my hand scaling skills.

My patient from last Wednesday is coming back in this Wednesday for me to finish up his cleaning.  I will just be finishing up his last three quadrants, polishing, flossing, and administering fluoride.  It should be pretty smooth and easy.  I have already done the preliminary work.

One quad of scaling

I am very glad that I had a healthy patient come in today.  He is a moderate maintained perio patient, but I was able to get one quadrant of scaling completed.  I think he was a little disappointed that I didn't get everything done today.  But I should be able to finish him up next time.  He preferred to have the ultrasonic used on him, so scaling when very quick.  I didn't need to take x-rays, but I am getting worried about getting enough x-rays taken.  I should be ok.  I just need to start justifying the need for x-rays. 

My sister is coming in next Monday.  I am planning to chart all of her existing fillings prior to her coming in.  That should speed things up and help me finish her faster.  I hope that I am able to get her done in one appointment as well!!!

My Mother

My mom came in today.  I felt like it went really well.  I had tried to have the green chart and all of her meds looked up before she came in.  That was really helpful.  I was able to get her done in one shot.  I used my ultrasonic on her.  I know that she is grateful that she doesn't have to come back in.  I'm so grateful that she was willing to come in and see me.  I talked to her later and she told me that I did a great job and that she was really proud of me.  She told me dad that she was there for a really long time, but she would have been here longer if I hadn't been able to finish everything. 

For my patient on Wednesday, I have never met him, but I hope that I am able to at least get to scaling.  He is a student up here as well, and needs to leave early.  I hope I have a great day.

What a great day!

I had my fabulous patient come back into to finish her up today.  I used my ultrasonic scaler to doing the scaling today and loved it!!!  I will continue to use that on patients because of how quickly it took care of any calculus.  I only missed one spot, which I felt was great & I passed off two PEs.  Today was a really good day.  I actually got her done within a quick amount of time.  She was out of here by 9:20.  I was very pleased with that.  I have my mom coming in on Monday and am very excited to have her come.  My goal for Monday is to be able to get her scaling at least started.  I don't have to take x-rays, so I will hopefully be able to get lots done.  I know that she would appreciate it if I got her done in one appointment.  My goal is to do freaking awesome!!!  (and not forget some things, like I have done on every other patient I have seen.)

My Little Man

I had the privilege of working my sweet little boy today.  I have to say that he did better than I expected for being 3 and a 1/2 years old and he had to be there for over 3 hours.  That is a long time for little guys.  Heck!  It's a long time for me.  So, I was supposed to have another patient, but she told me the morning of that she was going to be late and that she needed to leave an hour and 40 minutes early.  So, I told her I needed a patient that could be there the whole time and cancelled the appointment.  My little guy was willing to take her place.  I was able to take x-rays, scale, toothbrush polish, floss, and apply fluoride.  It was a great experience having a young child come in.  He did keep asking when we could go home, but that was to be expected.  I feel that this helped me better understand about scheduling children into my schedule.  I will make sure that I have children come in on my short day until I am faster at cleanings and I will schedule more than one child her clinic day.  Prof. Costley said we should be able to get two children done in one clinic day by the middle of February.  I can't wait to do that.  I can't wait to start getting better at this and feeling more confident with my skills.  Goal: don't knock off any more composite fillings from my wonderful patient who is coming back in to see me tomorrow.  Thank heaven she seems to have forgiven me.

Only Mishap

I am really hoping that last Wednesday was my only mishap that I will have on a patient.  At least to that extent.  I had my pt come back to start scaling her teeth last week.  I was doing pretty well and had completed one quadrant.  I had gone back over some teeth to make sure that I hadn't missed any calculus.  I didn't feel like I was applying very much lateral pressure, more of an exploratory stroke, yet as I moved toward the incisal edge from the gingival margin, a chunk of composite filling came off!!!  I audibly gasped and terrified began trying to find where it went in my pt's mouth.  I couldn't believe it!  My instructor was right there with me and got into my pt's mouth and felt the area.  The reason it came off so easily is do to some decay.  So, really it could have happened to anyone!  But it happened to me.  I feel so bad.  My goal for next time is to not make fillings come out of my patients teeth!  I think that is a pretty good goal.

First Full Mouth

A full mouth set of x-rays takes forever to take.  I realized how important it is to look at the bite tabs for placing the tube of the x-ray machine.  It is also important to talk to your instructor and clarify which x-rays need to be retaken.  I thought I needed to retake 5 and did just that, but my instructor only wanted me to retake 3.  Oops!  I will clarify that one next time.  That would have saved me some time.  Also, if I had been looking at the bite tabs I would have noticed that I was going to cone cut the x-rays.  I am so grateful for patient patients that are willing to sit in an x-ray room for about 45 minutes while I get things ready, take the x-rays, have them checked by an instructor, and then retake them.  My wonderful friend Rock helped me out on Wednesday.  He was once in this position and understands what students go through while learning.  Thank heavens for people like him.  I can't wait to get him finished up next month.  I am going to work on being more efficient for me next patient.  I am going to be very specific about how I set things up before my patient gets there and try to stick to my schedule.  I know that I am going to have some learning to do since my patient on Wednesday is a Class II.  I will have to learn how to use my Gracey's and scale subgingivally without seeing what I am doing.  I will be going strictly off of feel.  Wish me luck!

Thanks Darling!

My dear, sweet hubby came in today for me to finish scaling and polishing his teeth.  He was wonderful and patient with me.  I know that his jaw was getting sore and that he was just plain bored, but he stuck with me and let me complete his scaling.  I am just so glad that I was able to get everything finished and that I didn't have to reschedule him for yet ANOTHER day.  I think he was glad too.

He came in and I greeted him with a smile and a hug.  I started with HHx- no changes since____.  HHxRx- no alterations to Tx.  Sign and get instructor signature.  Check- everything going well.  OD- lesion still present, refer to DDS.  OHI- PFI: 75%, big improvement over the last visit.  Way to go, babe!  Next came scaling.  I completed one quadrant and had it checked by my instructor.  I missed a couple of areas.  Rescale and have it checked again.  Fine, so move on to the rest of the mouth.  I was really amazed at how hard it is to get calculus off of teeth.  I felt like I was scraping and scraping and scraping on just one surface to get it off and it still felt rough.  I just need to apply more lateral pressure and use the right instrument.  After scaling for an hour and a half, I was finished and ready for a scale check.  Trev was pretty tired of my hands in his mouth at this point.  He really needed to get back to work as well.  Once again, I missed a few teeth.  I was able to get the calculus off of one area really well, without any help.  The other two spots I needed some extra advice on how to get it.  I realize that I need to utilize my air/water syringe to dry the teeth to check for calculus.  That was really helpful.  I toothbrush polished my hubby, applied varnish and got him the heck out of there.  I did forget to write "complete" on the patient walk-out form.  I can fix that one quickly.  Trev is such a wonderful man!  Only a man truly in love would let his wife stick her hands in his mouth for 2 and a 1/2 hours poking his gums.

My goals for my next patient are to continue to solidify certain concepts in my head.  I need to make sure that I truly get the order of how I chart things.  What order to perform certain tasks, making sure to get the correct signatures.  My goal is it get at least OHI and one quadrant done of scaling.  I am setting my sight high on my short day, but I hope that I can do it.  I may not be able to if I take a full mouth set of x-rays.  I will see if I can talk Rock into it!

Patient Numero Uno

It is a new semester, and I feel totally unprepared.  I feel like having the last month off has turned my brain to mush!!!  I can't believe how many things I forgot over the break.  I hope that I get back into the swing of things quickly, or I will be SUNK!

I had my first patient experience last Wednesday.  I hadn't met her until that day.  It was a little rough.  I thought I was being super efficient by get the name and mg of all of her prescriptions the night before.  I looked them all up and had it typed out, line by line, of how it should look in the chart.  I get the chart to my instructor and I had forgotten to write down where I got the information from.  First thing forgotten.  Next, I took a couple of x-rays.  I love our new system for keeping track of things.  We don't have to fill out a paper any more to get our x-rays taken.  The front desk people just take our word for it.  I got her x-rays taken and all is well.  I moved on to probing and recording all of the work she had previously had done.  My instructor comes over to do the OD (oral diagnosis) check, and I had measured many 4-5 mm pockets and she was getting a lot of 6 mm pocket depths.  (Must work on getting accurate probe readings!)  We don't have much time for scaling at this point, so I  start on oral hygiene instruction with my patient.  I dye her mouth and record her PFI and BFI scores.  But guess what?  I forgot to record them on the green and blue sheets.  I only wrote it in the chart.  After I excuse my patient and start to fill out the chart, I realize that I forgot to get a signature from my instructor that the x-rays were ok to release to my patient and have my patient sign saying that I gave her the x-rays.  What a day of forgetting!

I learned a lot from that day.  I came home a made a list of all of the things that were very easy for me to forget.  I need to type it up and laminate it so that I can prevent these mistakes in the future.

My goal for my next patient is to simply try not to forget anything.  I will write about that next.