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!