MOCKBOARD

FAILED...dangit.  It was very good to go through how the board procedures will go.  The paperwork was so confusing at first but is a lot more clear, now.  It was also good to experience what my stress levels would be like.  My professor talked to me after the ordeal to let me know how I did and what I could work on.  He complimented me on my probe and recession measurements, but told me I missed one spot and burnished a few more. :(  We talked a lot about improving my exploring skills.  He said to explore as if you are looking at someone else's patient, because when you think of them as your patient, you rationalize saying "there can't be anything left there, I spent forever in that pocket".  I think it will help me a lot.  I haven't really focused on exploring a lot because it is so time-consuming, but it is definitely worth the time if it is the difference between passing and failing.

You've gotta pay for what you want!

Had another class 3 patient.  He said he didn't have the money so I paid for him.  :(  Lame, but it's my grade so I guess it's worth it.  Quite the experience cleaning a real class 3.  

September 30th

Another day of class 3 patients!  YES!  My first patient has been a class 5 for years but hasn't been in for a while now so there were signs of infection and some calculus deposits.  I didn't feel like she was a well-maintained perio patient so I took a chance and explained her case to my instructor claiming I felt better about classifying her as a three.  Maybe a tiny portion of that was that I need this classification, but I really did feel like she was not a 5!  End of the story...got a class 3 exam done. :)  My afternoon patient was incredible.  He had never had a cleaning before and displayed the worst infection I've seen yet.  He even had occlusal calculus!  And tons of it.  He requested some x-rays so it was a good opportunity to get some periapical x-rays done.  I took a lot of pictures with the intra-oral camera as well because I thought it would be neat to see before and after pictures.  It also helped to use for educational purposes since he didn't speak a word of english.  I put him on a chlorhexadine rinse to reduce the infection and bleeding before I attempted to clean.  I'm looking forward to him coming back. It should be a great experience.

YIKES!

Started the day with a class 3 (so exciting!!!!), but unfortunately I only finished one quad...
WHY?
Well...problem number one..
I BROKE AN INSTRUMENT
Yup, that's right.  I didn't even do anything differently and wasn't putting more force than I usually do...but it was in a very deep and bloody distal pocket of #3.  Luckily on the outside I remained very calm.  I told the patient to bite on a piece of gauze and I would be right back.  In my head all I could think of was "OH CRAP, OH CRAP, OH CRAP!"  I notified the CA (thanks for your help, Kathy!!!!) to find the instruments that we use in this situation, but apparently the VA doesn't keep them on hand.  I asked Professor Bossenberger to come help and luckily after a few minutes of skilled searching she pulled it out.  WHEW!  Later she complimented me on how well I handled the situation, which surprised me because I just felt terror throughout the whole ordeal.  She also told me that it has happened to her many times in her 30 years of practice so maybe I won't make such a big deal about it next time.  It was quite the experience, but I actually think it's a good thing because I figure no matter what happens, I've already had worse (hopefully)!


problem number two....
The dentist took a long time doing the exam...which is ok because the patient needed the attention, but frustrating for me.  On the upside, I ended up only missing 2 spots.  A lot better than I expected.


Afternoon patient was a young and healthy guy...pretty easy class 2.  Gotta remember those distals of the 2nd molars...

A CLASS 4....

My morning patient....Wow...I have my work cut out for me.
I finished my day off easy (as planned!) with an 11-year old.  One 1A down...one to go.  I usually am more enthusiastic and put more effort into being fun with the kids I see, but I think I was still thinking about my morning patient.  I'm not too proud of myself for not putting my energy and attention into making the kid I treated feel comfortable and motivated to improve his oral hygiene.  Sometimes I just don't have the energy...

Another day...

I like doing the hard patients in the morning and ending my day with a nice, easy, and friendly patient.  I know that won't always be the case, but at least for now when I have control over my patients, it's better for my stress levels to schedule my patients that way!!! My morning patient was a class 3 and although I only finished the OD (extensive medical history...) I'm excited to get started on him.  I've only done one class 3 in my life (last year) and I was at a lost at how to effectively treat back then so I know this will be a learning experience for me.  One thing I need to remember is to keep an open mind during OHI and not to judge too quickly.  My patient was really picky about the toothbrush and toothpaste he liked and said he didn't want to brush more because it hurt his gums and they bled.  I tried my best to explain to him (in spanglish) that his gums were sore and bled because of the periodontal disease.  I talked to a classmate later about her chemotherapy and she mentioned the same things...sore gums, couldn't handle really minty toothpaste.  I felt horrible that I didn't understand and be more compassionate with my patient.  I'll talk to him next time he comes in about it.  My afternoon patient was SOOO sweet.  It really helps me relax and do better work when my patient is confident in my abilities and compliments me.  I really enjoyed working with her.  It made me excited for when I can work in an office and hopefully create relationships with my patients as I see them for recall appointments.

Can't think of a title...

I love the VA because I get to meet such amazing heroes of our military. That may sound cheesy, but I just really appreciate what they do for us. I saw a young soldier today who suffered from severe PTSD. I had never seen anything like it before. He was VERY nervous. He would check around his shoulders when I came into the room and couldn't even really handle me working in his mouth. I offered to give him nitrous gas which seemed to help A LOT. He was able to relax a little bit. He also chewed tobacco so I was able to see a "chewing tobacco patch". It looked like a white lesion in the vestibule, where he keeps the tobacco. The doctor and I both urged him to quit and he said he had cut back a lot already. I hope he is able to quit someday soon because not only did he have TERRIBLE breath, but it will really take a toll on his oral and systemic health. I saw another older man who was paraplegic. It was a great learning experience on working with a patient who had a severe physical handicap. He was able to put himself in and out of the dental chair. It was amazing. He also had SEVERE stain. I found out it was from a liquid iron supplement he was taking. (Take note!) It covered his teeth. It was tedious but I got it all off with the ultra-sonic scaler. He went out of there with a brand new smile. Unfortunately he wasn't the type to be too excited so he didn't share in the thrill with me, but I was happy!

And so it begins...

THE HARDER PATIENTS... I knew it couldn't be that easy. I had two class 2's today. Luckily, one of them qualifies to be my mock board patient. YAHOO! The other was a recall patient from last year. I'm not sure how I did so well last year because I missed 14, yup fourteen, spots of calculus on her. Two words--SUBGINGIVAL CALCULUS. Hopefully I learned my lesson.

Here it goes...

What a great way to start clinic. I was able to clean an easy 1B and 5 without many problems. I'm glad I started off with easier patients. It helped ease me into the routine again. By the end of the day I felt like I didn't have a summer off at all! My class 5 patient was an older gentleman who went on and on about how great I was and then I received a few compliments from my professor as well so my confidence is boosted up...all ready for it to be shattered as soon as the problem patients start coming. At least I know that I am at least somewhat competent.

THE VAMC

Wow...the VA has an incredibly huge and nice dental clinic. This morning we had orientation which was helpful, but somehow I still didn't have any idea what I was doing once I got a patient in my chair. I felt very scared and nervous to see a patient here. Not sure if it's just a new environment or what, but I haven't felt that scared since my first patient ever! Luckily it was a relatively easy class 5. He was such a nice man, but unfortunately he had about every medical problem in the book and he was pretty much dying from cancer. He was old and frail, but we made him comfortable and I felt like I was able communicate pretty well with him. Through the health history interview, I found that he had two artificial joints. (Sidenote: one thing that's GREAT about the VA is the fact that most of the people go to the VA for all their medical needs so everything you ever need to know about them medically is at your fingertips.) My patient had had the surgery done at a different facility so there was nothing written in his chart. Luckily I asked and even more luckily, I knew that they had just changed the regulations with artificial joints and he needed to be pre-medicated. I felt so elated knowing that I was able to catch that and prevent any further complications.

Welcome Back!

I reread my last post and realized I must have forgotten my "summer goal" the day school ended. Oops! Hopefully it'll come right back. I'm feeling anxious but excited for this year. MY LAST YEAR OF COLLEGE! Cannot believe it. Today we worked on instrument sharpening and then we paired up to get back into probing and exploring on each other. I found out I've been exploring wrong this whole time. Apparently the curved tip is supposed to curve around the mesial surface... I could definitely tell a difference! I feel much more competent with instrument sharpening, though. It was nice to get one-on-one instruction. Well, wish me luck! I'm off to the resource list...

April 14, 2010

My patient was about 45 minutes late but I was still able to finish her today. An easy 1B was a great way to end my first year of clinic. I feel like I've really improved my scaling techniques and knowledge, I am just worried about retaining what I have learned through the summer so I can continue to improve next year instead of starting all over again. My goals for the summer are to review my instrumentation books and to practice on my typodont at least a couple times a week. Till then...au revior! (sp!)

April 12, 2010

Finished my requirements today. What a sigh of relief. I saw a 9-year old girl, attempted to take a pano (pano machine was broken, also left her goggles on..oops!), did a few sealants (yes!), finished my 1A requirements and then finished my class 3. Lesson for next year: get my requirements done as early as I can. Treat the beginning of the semester like it's the end!

April 7, 2010

My patient today used to be a class 3, but now...yup you got it, another class 5. She was very sweet. She spoke just a little English so I hope I didn't take advantage of that by getting her to do my blood glucose test! I just asked her if she had been tested before and she said she would like to...so I did! I was also able to take 8 PA's on her. (She had never had x-rays, at least in the last few years she had been coming to our clinic.) Something interesting: I had never wondered whether something was a cavity or an amalgam before! It looked so much like an amalgam, but it was a cavity. Oh and on a wisdom tooth. All 4 wisdom teeth=my new worst nightmare. I wasn't able to finish her and I have no more room to fit her in (and neither does anyone else) so I feel awful. I hope she can come in the fall. Oh also, I was so amazed by her homecare! From what I could tell from my evaluation and reading past chart notes, she has been doing so well since she first came in as a class 3. I could even tell that she flosses regularly! I never see that!

April 5, 2010

Had another class 5 today....argh. It went well though. I was able to take BWX and PA's! Finally, I'm in desperate need! I passed off the last of my Class 2/3 PE's. Yes! Those have been haunting me. I barely finished in time. I need to do better at getting faster. I'm at a lost at what to do different though. Call ahead for a health history? Probe faster? When instrumenting, don't come out of the mouth as much!? I have no idea.

March 31, 2010

My patient had braces! And I succeeded! I really do appreciate these learning experiences, even though I don't need the classification and would really feel more comfortable getting in some easy patients for my extra requirements, I am glad I am challenging myself. I really think it's best I have these difficult experiences while I'm in school rather in a professional setting. It actually really wasn't that bad. Yes, probing was impossible and instrumenting was less than smooth and skilled, but I cleaned him! I was also inspired by my patient. He has dental insurance and just wants to stay extra clean during orthodontic treatment so he comes into our clinic in between 6-mo appointments. Needless to say, I didn't have a lot of oral hygiene instruction to give him!

March 29, 2010

I got to see my husband today! It was such a relief after such stressful patients before. He was easily cleaned and even let me do a sealant on him. What a nice husband I have! My goal is to find another patient to do a sealant on! Every patient either has sealants, fillings, caries, or I just don't think to look or ask! So many things to think about and remember!

March 24, 2010

I had a hard time communicating today. My patient was a little defensive during OHI. The weird thing is, I hardly saw any signs of infection yet when I took a look at his x-rays, he had significant bone loss. This is when I went through the whole "perio talk". After struggling through that, I talked with my instructor and figured out that his bone loss was due to malocclusion and past trauma! It all made sense after that. I also had to sheepishly take back my periodontal infection speech.

March 22, 2010

CA in the morning and a class 3 in the afternoon. Whew! Unfortunately I was only able to finish 2 quads on my patient. He and I were both upset, but he was a doosey! The ultrasonic was really bothering him which made it extra hard on me. He has one of the strongest mentalis muscles I've ever seen as well. I was very greatful to my instructer who had a little talk with him and told him how important it was to come back and get finished and not to get frustrated with me because I didn't know how tenacious the condition of his mouth would be (not to mention he hadn't been cleaned in years). I really hope he comes back! I hope he doesn't hate me after not finishing him...I really need the last 2 quads...

March 10, 2010

The worst part of clinic is securing a patient! I'm not even picky enough to demand certain requirements! I just need a body in my chair! I called the Kenyan patient a had and told him I would pay to finish his cleaning. I wasn't just desperate to have a patient, I just felt like I was doing him a service and it felt good! I found out that he had been flossing!!! Everyday!!! His BFI and PFI GREATLY improved. What we do really makes a difference! I just think it's amazing that I was able to help a young, healthy man who had never heard of floss develop habits that increase his overall health.

March 8, 2010

I finished a patient in one appointment today! I love that feeling. I'm feeling more and more like a professional! Of course, his wife and kid were getting cleaned at the same time so I pretty much HAD to finish him. I realized today that OHI isn't always a breeze with some patients.

March 3, 2010

Another hectic day trying to find a patient. In the end, I had my nephew Camden come. I was a little worried because he is 2 1/2 and from what his mom says is scared of the dentist. While working as an assistant, it was always a fun challenge to allow the kids to cooperate and let me do my thing. I took today as a challenge and it went soooo well! I was thrown off a little bit by the fact that in the process of (casually) calling from the resource list to secure a possible 2nd patient of the day after Camden, I had a spanish-speaking patient come in when she misunderstood me and came in without confirmation and about an hour early. AHHH! It was neat to see a child's mouth, though. I was intrigued. He had frenal attachment and pacifier habits that really affected his occlusion. He had a few white spot lesions as well. The greatest thing of the day was seeing him really enjoy the time he spent with me and hearing later that he liked to play dentist! It is such a great feeling to give a good dental experience to such a small child. I think your initial feelings of the dentist will stay with you the rest of your life! My second patient was very sweet, though it was hard to communicate. She is coming back the last day of clinic for me to finish her.

March 1, 2010

My long awaited, non-English speaking, never had his teeth cleaned patient didn't show up. I had my brother call to remind him of his appointment and he said he couldn't come! I spent last night and this morning trying to find someone to come in. I was unsuccessful but was able to schedule 2 future appointments. My mom had to end up coming and finished her cleaning from when she was my first patient. I think I learned something new...if I have had bad patients for a while and then a clean one, I need to be a LOT more gentle. I kept catching myself digging in way to hard into her shallow pockets. Good thing she is my mom and she will forgive me. I also learned about the different effects of the different prescription mouthwashes and the locally applied antibiotics. Cool stuff.

February 24, 2010

A CLASS THREE! Holy smokes, it's like I'd never seen calculus before. Everything I've seen before seemed so minimal to this guy. It was covering the buccal surfaces of his max molars and the lingual surfaces of the mandibular anteriors. I learned that if I'm not able to get accurate probe measurements because there is too much calculus, I have to do a gross scale. So that's all I did today...and take a set of BWX. I'm excited for him to come back in so I can do a proper scale and root planing. I saw calculus for the first time on one of my patient's x-rays. He spoke broken English, so I hope he was able to understand the importance of BRUSHING and FLOSSING and coming in every few months. I really hope he comes back too, first of all because we learned that gross debridement is not effective and also because I get my 4 quads of class 3!

February 22, 2010

Lucky day today. I had a patient from off the resource list and she turned out to be a class 2! I was able to do my exam on her and I finished her in 1 day!!! I loved seeing all her calculus chip off. Such a huge difference when it was all clean. I talked to her about coming in more regularly and she told me to call her when I started next year to schedule her again. Good day.

February 17, 2010

No patients today!!! Wahoo! Such a nice break from the stress. We learned how to do blood glucose testing, the diagnodent, and denture cleanings. I learned that I really need to get in to see a dentist about a cavity. The diagnodent registered a 52! Denture cleaning was a breeze, now I just need to find someone with a denture! Glucose testing was pretty simple and way fun. I got poked twice :S, but found that my blood sugar levels are pretty normal, even a little low. I even got to pass off my instrument sharpening PE. Yay!

February 10, 2010

My patient today was from Kenya! Such a nice guy. Unfortunately, the cultural and language barriers prevented me from letting him understand what I was going to do to him today. Even though I talked to him on the phone and felt like he understood everything, he came thinking he would get his two very broken and decayed teeth fixed. I had to tell him I was just there for prevention and would only be cleaning his teeth. He was very nice to let me clean, but was unprepared for the charges. He didn't want to take x-rays because of the cost, and was very hesitant about the cost for the cleaning, but agreed at least to the cleaning. He told me a little bit about the dental care in Kenya, and then I told him all about American care and how much we value prevention. I loved teaching him about the etiology of gingivitis and caries because it was all so new to him. I felt like I had sufficiently taught him the importance of prevention, but after I only finished 2 quads today he asked me if he REALLY needed to come back to finish. Poor guy, I could tell it was just a financial problem. I told him that it would help to prevent further big problems, but that if he needed to just use his money to get the very visible concerns restored first, then that would probably be best. I told him to call me if he ever wanted to finish the rest of the cleaning. I hope he comes back. I want him to understand a little bit more about prevention and hope to avoid the big restorations that could come.

February 8, 2010

I finished my dad today. Everyday I care more and more about my patient's oral health and I really love teaching about what I've learned in classes about oral problems and how we (the patient and I) can both do our part to improve their oral health. I also love the feeling that comes after finishing a patient! Wow, I just feel at peace and accomplished...unfortunately, it starts all over again in 6 months for that patient and in 2 days for me!

February 3, 2010

My first stranger patient, today! She was very sweet and patient with me. She was a 1B, but with some actual visual calculus! So exciting. I love getting it off! Such a great feeling. Also took another set of BWX. My goal is to get some sealants done. I just found out we have to do 3 by the end of the semester!

February 1, 2010

Got a FMX done! Lucky my dad loves me enough to pay $40 for x-rays. They turned out great, only one retake. I also was able to get the HHX and OD done, but that's it. :( He's coming back next week and I'm setting a goal to finish. Then I'll have my first 4 quads of a class 2. Technically he's a class 5 so I can't use him for my exam. Time to start calling off the recall list and praying for class 2's and 3's!

January 27, 2010

Finished my brother, David, today. It always feels so good to finish a patient. I did my intra-oral camera PE and took some great pictures of some "suspicious areas". Basically some chipping and decay off of a few fillings. I also "prescribed" some Prevident. I need some myself! I should remember to get some for me! Need some class 2 patients now...

January 25, 2010

Finished my friend, Shar, today. She was an excellent patient. Super healthy, awesome teeth, hardly any calculus. I did my 1B exam on her and it was such a great choice! It feels great to finish a whole patient. I also did my air-powder polish PE on her, poor thing. She was very accomodating and I'm done with it for this year, thank goodness.

January 20, 2010

Note to self: always remember to put a duplicate film in when taking conventional panoramic x-rays! Yikes! Luckily a TA was able to help me duplicate it, but the duplicate film is awful. Fortunately my little sister was my patient today so I can evaluate her good copy. She was very patient with me and I was able to finish the entire appointment! :D It feels good. I did forget to see if she wanted a prescription toothpaste, though. I'll have to remember that when she comes back in for her recall appointment. I also used her as my 1A exam and passed off 2 PE's! Hope it keeps going smoothly.

January 13, 2010

My patient today was my good friend, Shar. She was so nice to let me work on her. I feel bad for my patients because I'm still having a hard time not hurting them! I did a lot better focusing on my angulation and activation. That dang adaptation is getting me everytime. I felt like I was more aware of where my tip was, I guess that's a good start. X-rays went awesome. No retakes! She was so easy I used her as an exam patient. Only 2 more quads on Shar. Can't wait to finish her off and be done with my 1st exam!

January 11, 2010

My husband, Josh, was my patient today. And patient he was. X-rays are still causing me some problems but I got them done with a couple retakes. I'm getting faster at probing. Maybe it's because I'm just getting more used to seeing the same numbers over and over again. I remember how hard it used to be to tell what the measurements are, but now it's like there's an automatic response to when I see how far my probe penetrates into the sulcus. I'm excited for Josh to come back. He's an easy patient....only 3 more quads!

January 6, 2010

My brother, David, was my patient today. Things went very smoothly! I wanted to scale his whole mouth because it'll be hard to get him back the rest of the semester, but I was only able to finish 2 quads. He was very patient and told me not to worry about hurting him because he has had his teeth drilled on without anesthesia during his mission in Uruguay. I was pretty clumsy scaling, but got back into it after a little bit. One thing that went really well was the OHI. It just seemed natural, I didn't even realize I was doing OHI! He was very interested and also very excited about trying some things we discussed. I love the education part of my job.

January 4, 2010

First day back! Seems weird to be here. It feels like I just left for the break! We practiced ultra-sonicing and area-specific scaling (with the Gracey's). It felt good to practice on my typodont again. It helps regain my confidence. We'll see how it goes on Wednesday!