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.
