Last clinic session

This morning I had my daughter come in for my last 1A patient. I did the caries risk assessment on her just to satisfy my curiosity about her susceptibility to caries. I was suprised that she was in the low category which I was greatful for. I also did a pano on her to see where she was as far as being ready to think about braces. The pano turned out really well and she has some time yet before braces in that the canines are still high in the bone.

This afternoon my last quad of a class III, and my last one for an exam cancelled on my before clinic started. I did have another patient scheduled already for the second half of clinic. I reviewed her chart and she does happen to have one quad that has already been charted as a class III. I may still get my requirement done after all. stay tuned!

My second patient ended up having 2 quads of class 2 and 2 quads of a class 3! I finished one quad of a class 3 and placed 2 arestin medicaments! I made it!!!!!!!!

Class 3

My class 3 was tough in that getting used to cleaning deeper pockets and watching the instruments work deeper in the pocket is a different sensation. It is like flying on instruments only. I loved the challenge and the opportunity to use the files. I found that the visual of how the roots on the tooth are formed helped in instrumenting the file. I almost want more experiences while the desire to continue to learn is there.

3 patients

Today I managed to see 3 patients. I saw a 1B, finished her, a1A, 2 year old, and a third for x-rays only. I even was able to get all my charts in before pod rap. After this mornings clinic I took some extra time to walk through everything that I would need from instruments to paperwork and had them all laid out in stages, either on the counter or in the drawers ready to pull out and assemble as soon as I had the chair reset up. I found it quite exciting to undertake the challenge today. It was great!

first day of seeing 2 patients

Today I proved to myself that I can see 2 patients in one clinic session. I had a pt that needed to be seen and was very adament about it. Both patients needed probing. Luckily neither of them needed x-rays so that helped out on productive time. I would not pause to write down probes depths until the probe numbers broke the running pattern. I was greatful for the use of my loops to see things clearly. I felt that I was a wreck when clinic was over but excited that I had pushed my self to get a class 5 and a class 2 completed starting from square one.

Class 5

Today I saw my first class 5 in clinic. I have had several at the VA. I lucked out in that this was a new patient as well. This patient had spent the last 2 years in Africa. She had made mention that she still had her teeth cleaned every 6 months, but that it is not as thorough as an American cleaning. She was maintaining her pocket depths nicely. She had very little build up at all. She was planning to go back to Africa in Dec. 2008. This time she does not have a return flight scheduled. She is trying to get all her dental work up to date before she goes back to Africa. She graduated here at WSU in 2000 in nursing and wanted to not be stuck doing the ordinary. She mentioned that in one area that she has been working in that there has been a lot of military invasions and a lot of villages burned and inhabitants displaced. She has sold her car and her home to fund her trips. Quite an interesting patient!

VA Experiences

Having the opportunity to work on patients at the VA has been very beneficial to me. I find that the environment is what I envision the real world to be like, in a way. The staff to work with is incredible and our instructor is as fair as the day is long! I find that learning under Professor Hanson has been an incredible experience that has proven to be extremely helpful in learning instrument techniques and professional patient interaction. She has been an immense boost in self-confidence for me. Though she will push for an increase in speed and efficiency, she still leaves you with a feeling that she is approachable and a student advocate! I have had patients that have left me discouraged at my lack of knowledge of how to get the cement off their teeth and watch her come up and with the flick of her wrist, show me how to pop it off, leaving me with clinician envy.
So far, the patients that I have worked on have been a delight, pulled at my heartstrings, or have been extremely patient with me as I have struggled to improve my techniques. I have enjoyed working with each one. I have left the VA each time exhausted, but satisfied that I did a little better that day than I did the time before.

Mock board experience

I was very aprehensive about today. I was glad it was a patient that i had seen before so I was familiar with how to attack his dentition. I used my orange ultrasonic for the first time and was pleased at its power to blast that tenasious calculus off. We had to wipe his mouth out a couple of times to remove the large chunks. I felt confident in my submission when I was through and was pleased with the lack of findings of the examiner! I am very glad for the experience without a lot of weight on it.

Mentally and Physically handicapped class III

I tried last night to think of what my patient might need since she has the functioning capacity of a 4-year-old. I didn't know what to think but decided that it would be fine to talk to her like she was my 4-year-old. She was very cooperative. I was able to test her blood sugars to pass off a PE. When I did start to scale her she had a wall of calculus just subgingivally so I am sure that my probe depths are inacurate. She is very hard to clean due to the tenasious calculus. I got to use my orange ultrasonic for the first time.

Exhausted!

Today I had a class IV patient. She was a diabetic and had quite a bit of perio. She also had a lot of malocclusion so it made taking a FMX challenging. I was able to make it through the OD. This afternoon I had a class II, which shouldn't be that difficult. He was a diabetic as well but stated that he was a type 1 diabetic, but was not on insulin. I had to do a physician's consult. It was then learned that he was a type 2 diabetic. We took his blood sugar in that he said that he had not tested his sugar since yesterday as he had run out of supplies to prick his finger. I was only able to get 2 quads done. The calculus was like cement on the UR molars. I had not seen 2 molars cemented together like the mandibular anteriors. Interesting experience.

CA 10-07-08

Today I was the CA. I was left to myself as Mr Solomon had meetings for most of the day. Needless to say I was a bit nervous to run the whole show. The morning went fine. In the afternoon we had a bunch of walk ins that I was able to find hygenists that needed patients for appointments. There was a mother who brought in an extra son to see if he could be seen as well. I consulted with the scheduled hygienist of the scheduled son, she was not able to see a second child as this would be a 3rd patient for her. I was on my way to let the mother know this would not work out today when I noticed another hygienist was finished and just doing paperwork. I asked her if she would be interested in a second patient. I told her I would help with tear down and set up of her unit to help make it possible. She agreed and I informed the mother it would be a few minutes then we would be able to see the second son. We were fast she seated the patient while a prepared the x-ray room for digital x-rays so she could move through her appointment quickly as it was close to time at the end of the afternoon clinic session. Our team work paid off and she completed the appointment in pleanty of time!! It was quite a busy session in helping several hygienist tear down and set up for second patients.. It was great!!

Maloclussion

Today was quite interesting for me. My first patient was my kidney failure patient. I was able to finish him up and use him as an exam as well. My second patient was a 1B, but he had quite a bit of maloclussion, an over-bite of 100%, and an over-jet of 10 mm. His mandibular anteriors were bent lingually. When I first looked at his mouth I paniced! I am greatful for the ultrasonic for those really hard to reach places. It worked like a charm! When all was done I only had one mistake! The patient was quite a pleasant fellow to work with, which helped make the experience easier to manage.

hard clinic

Today I did find my mock board patient which was the high light and his x-rays have already been taken! This was the hardest experience I have ever had. I found out the difference in the use of the different ultra sonic tips. This patient is a 2/3 class and the calculus on his teeth is like granite. I was near tears trying to get it off. My instructor was the one that pointed out that the stronger ultrasonic tip would be the best bet for him. She stated that it will make the world of difference in the calculus removal.

My second patient had tenacious calculus on the mandibular anteriors so I used what I learned this morning on her with the ultrasonics. Things went much better but I am interested to use the orange ultrasonic before mock boards to try to get a feel for its us! I hate it when learning comes with such an emotional scale.

Sealants and kidney failure

Today I had my daughter in and was able to get x-rays and 2 sealants . I passed off 2 PEs as well so that goal was met well. My second patient had kidney failure, diabetes and he was on the list to have his kidneys and pancreas replaced. I had a physician consult to do and it took a while to get a reply. The gentleman had let his diabetes go uncontrolled for years and know would like to get his kidneys replaced but needs to have all his dental work and a clean mouth before any consideration can be had for transplants. It turned out to be an interesting afternoon.

2nd clinic

Today I saw my husband and with all his sensitivities and his connective tissue condition I was a bit concerned that I would not meet his needs in being gentle enough that he would not feel everything that I needed to do. Today he ended up with it being an extra sensitive day as far as discomfort is concerned. He felt every probe stroke. The ultrasonic was too intense for him; and scaling was just about more than he could handle. I was greatful that he had an improvement in his oral tissues from last time so there was not a lot of work that needed to be done on him. I am greatful to the instructors that will take the time to help me with my instrumentation angles. I am finding that it is a little easier to work on the patient with the additional information. Thanks. I was glad that my afternoon patient who I finished up with 2 quads of a 2 and 1 quad of a 3, went really well. I was able to finish him all today, furcations and all, and even a little ahead of schedual. What a change from last semester where I was practically the one to lock the doors up at night when I left clinic.

first clinic day - full day

My patient for the morning couldn't start her car so I was with out a patient. I was able to get someone to come at the last minute. The high light of the day is that both of my patients were eligible for FMXs. I was really tickled that I could get so many of my PAs done the first day! I did a lot better on my time management which pleased me. I hope that things continue to go so well for a great semester! Good day!

First Clinic of Second Year

Today was very informative, either that or I wasn't as overwhelmed so the information stuck. I was taught some cassette set ups that made sense and was able to set up a couple of sets of each so that I would be prepared for a full day of clinic work. Sharpening instruments made a lot more sense this time around and found that it did not take that long to sharpen my instruments and felt ready to start next week. I am excited about the instructors in clinic and look forward to working with them. This year is starting out much more refreshing and less stressful than last year. I feel ready to learn and am feeling more confident in myself and ablilities and am axious to progress.

Last clinic!!!!!!!!!!!!!

Today I was more concerned at passing off my last PE than I was cleaning this patient. I was able to do x-rays and cleaning, sharing with a pod partner to finish a PE as well and almost had him out at the appropriate time. I am always nervous until I have all the paperwork done and completed before the pressure is off. I'm glad for the upcoming break though!

Last Exam and last 1B

Today went great! I did x-rays and and the whole 9 yards. This patient is particular at having things in her mouth so she was suctioning every few seconds while I was scaling. She also refused ultrasonics so it was all hand scaling. For the first time on a scale check I did not have one area missed!!!!!! That was really exciting. I should finish up my sealant that I was lacking this afternoon then I only have 1 PE left and I have completed all my requirements.!!!!!

Hard day!

Today I had a class II. I haven't had a problem with the other class IIs, but today for some reason it was more difficult. He had a great deal of bleeding. I guess that through me off in that I was afraid that I was digging up his tissues. I wasn't so I guess for some people bleeding goes with the territory. I wanted to finish and do 2 PE's but that didn't happen with the PEs, but I was able to finish the quads that I needed. That just puts a push on getting the last PEs done next week.

Hypercalcification

This patient is a class II, III. This man has hypercalcification on the mand. ant. Even though I saw this patient 6 weeks ago he had quite a bit of build up back on the mand. ant. I had to reultra sonic his mand. ant. before completing the maxillary dentition. I had my first experience in feeling what a class II furcation was like. It was very unnerving to sink the scaler down that far into the gumline to feel for calculus. I had a goal to have him complete so that I could have the requirements for my Class III complete today. I MADE IT!!!! I think I might just make it with all my requirements.

class III

Before I came to clinic today I spent some time looking over instrumentation. I had a goal to get at least 3 quads done on this patient. I felt prepared when I came to clinic. I finished the quad I started Monday and was able to accomplish my goal of having 3 quads of a class III completed!!!!!! I was very greatful that Prof. Costley worked with my showing angles for fulcruming and letting my watch her give LA. She walked my through what to watch for in the shringe preparation and the visual areas to look for when administering LA. I felt much more confident in my abilities after a successful day.

2 Patients

I had a concellation again, so I tried to fill the time with 2 patients. I had my son come back in for a tissue check and then I started my class III patient. I was able to get a sealant done on my son plus a PE on the sealant so I was pleased with that. My class III patient had to be numbed up to start work. I was able to start the ultrasonics on her as was amazed at the calculus coming off. I loved to see the tobacco stains erase off of her teeth. She had several teeth that has rotted off at the gum line so I was scared as to how to go about those teeth. I had to keep telling myself that she was numb and can't feel it. I didn't quite get her 1 quad done so I will tackle her on Wednesday. I am confused about charting and the procedures of doing a patient that has to come back for work.

Class III

I started on my class III patient today. My regularly scheduled class II cancelled last night. I am concerned that I do not have time to reshedule him back. I do not think I am going to meet my requirements and am quite distressed and stressed. I did learn what calculus feels like subgingivally when it is a brick wall, and understand that I need to gently move my probe around the calculus to get an accurate probe reading. I'm glad my instructor is willing to work with me, though I do feel at times that I am overlooked at times due to my positioning in the pods. The odd man out.

Class I suprise !

Today I thought I had a Class 1B, in that the child was only 13. The patient turned out to be a class II on the mandibular arch. I used my loops today for the first time and was amazed at the ability to see such a large structure. It looked like the calculus was just waiting to be seen. I was pushing my time to try to get this patient completed in one visit. As I was scaling the lower arch I was amazed at the amount of stuff I was pulling off. I think the loops will help my a lot as soon as I am more confident in the use of them and relearning to use my instruments. I was able to complete the appointment today so I did feel a success!!!

Jinxed BP three times

Today I dismissed my third patient with high blood pressure. I think I should get a new cuff. Though this patient had a reading of 182/94. I am getting good on the paperwork for a dismissed patient and in calling physicians for consults. I did purchase a small clock so that I could keep track of my time better. I am looking forward to actually using it. We will have to see what next week brings.

Braces

I did not find braces to be as scary as I thought they would be. I think that it was a good experience. The thing that I think that I would do differently next time would be to use my explorer to get off as much creamy calculus as possible before using the ultra sonics to avoid disturbing any decalcified areas. This patient had a lot of areas that were decalcified once they were uncovered and I was afraid of disturbing them. This patient has mental and physical delays and lacks good coordination. It was a very interesting and valuable experience in being more aware of what to look for and cautions to watch for.

Endentulous

Today I saw my first endentulous patient. She was so patient and helpful to me. I felt like I was having a day like I was just starting clinic for the first time. I really am lost without teeth in the mouth. I was able to get a pano on her with the help of a staff member. There is a special chin rest to use to try to position the head properly to make up for the loss of dentition space. It is quite different to hold teeth in your hand to scale them, although you get plenty of light to see what you are doing. I was able to get her all done and was excited to see first hand irritation that does appear on the gums when the dentures are worn without letting the tissues rest. I did have the clinic schedule laminated so that I can put it with my charting materials to help me with my time.

Class III

I was a bit nervous for this patient as he had some really deep pockets of 7mm. It really took me by suprise to have the probe sink down so far! First for everything. I had the hardest time trying to clean his lingual anteriors in that this 76 year old gentlemen kept taking a nap. I am glad for the challenge though. I still have a hard time with watching my time as I get so focused on getting the job done. I really am going go hang the clinic times up or something of the sort so that I can refer to it to try to stay on time.

Class II

Today I saw a patient that was an easy class II. She did not want x-rays so my goal that day was see if I could get her as near complete as possible. She did have some calculus build up on the lower anteriors but that was the most that would need to be really focused on. She had a fair amount of recession due to aggressive brushing. That part made me nervous knowing that it could be really sensitive. I was able to get two quads completed which I was excited about.

Dr. Consult

Today I saw a patient that had really high blood pressure. I did my first phone consult to her doctor. When the doctor returned my call he advised that the patient not be seen untill her blood pressure lowered and to reschedule her after she was seen by her doctor for the cyatic nerve in her back. The patient was in a lot of pain and that may be reflected in the high blood pressure. I certainly am getting a lot of experience with patients with elevated blood pressures. Every patient for the last month has had something to do with elevated levels.

Lab discussions

Today was really helpful in questions that I had for ultrasonic scaling. Scaling around crowns at the base is acceptable and going down into the pockets I have been a bit timid but after today there is more of a better feel for what I am feeling with the subgingival calculus and the ultra sonic scaler. I am anxious to us it on a patient to become more familiar with the feel.

My son big "E"

I learned a few more things about my son today and his oral hygiene. Since moving out his oral care has not been on the fore front of his mind. The path that he is on he will have to have his tissues excised to get them to heal. Maybe this experience will help him to be more consciencious about taking care of himself. He is sensitive to pain in his mouth anyway so our discussion in class about not being over bearing but getting your point across I had the opportunity to put into practice. Being sensitive to the patient's feelings but getting instructions across is an delicate approach. I would like to focus on being more direct in my instruction but then again supportive with my willingness to be of assistance.

Class 2

Today went pretty well. I messed up on a few things, but I can garentee that I will be watching out for those things next time. I was glad that I was able to keep to the proper time commitments and that I am feeling better to admit my mistakes and know that I am not going to be looked down upon. I think that looking ahead of time and being a little more mentally prepared is helping me to work through the appointment schedule in my mind. More confident today!

better

I brought my daughter in this morning as my patient cancelled and I found out that out of the 4 girls, 3 have hypertension. I wonder if it is a genetic thing. I will have to do some sluthing and probably a doctors visit to establish some baselines. I tried to focus on my time for first scale check and was only 15 min off after having delays with trying to get readings with her blood pressue. I feel that I am doing better time wise and a little more confident in my abilities.

first 1B patient completed in one visit

My daughter was visiting this week on her way to New York. She is being transferred with the army. I had a goal to have her completed in one visit, and that was with 4BWX as well. I knew that she was a 1B, and that she did not have any restorations so I figured that she would not have a lot of build-up. I was rushing, but trying to be thorough. I had it in my mind that she needed to be walked out by 3:30 pm so I totally forgot to make a mental note in my mind that she needed to be ready for a scale check by 2:45. I was so focused on getting her done. I was able to get her all finished, though the time element was at least a half hour past acceptable time. I am proud of myself that I got her done without frustrating myself over being behind and instead focused on the end result. My daughter was a great encouragement to me along the way. We sure had fun!

1st CA

The duties of being a CA were extremely interesting and I found quite fun! It is interesting to learn what goes on behind the scenes of the office. I look forward to my next tern to be a CA.

2nd pedo patient

Today went great! I had my helps out and again familiarized myself with working with a 1A patient before clinic so that it would be fresh in my mind. I tried to be more consciencious with my time to have the patient out as close to 3:30 as possible. I still need to work on my time. I did have the patient done and ready to walk out by 3:40, so I was pleased about that. I am planning to make a card with the times that I need to be working on what so I can be more awarse of my time.

Peds patient

Today went pretty good. I reviewed over the clinic manual before class to have the proceedures and charting fresh in my mind before my patient today. I found that this helped me along with my case study notes from last semester. I found that things went a lot smoother and I was able to converse with my patient with out feeling frustrated and stressed. This previewing may help me become more comfortable working my clinic times.

Jan 14

Today was a disaster! I could not get any one to check off my x-rays and waited what seemed like an eternity. This set my behind quite a bit. I became flustered and went blank in the brain. I am learning that in order for me to get my own routine of things done I am going to have to get here a lot earlier so that I can be confident in what I am doing. I am going to have to review my clinic manual more often unitil the pattern of what comes next will be more realistic in my mind. I still think that I need to have my mock pt chart out to be my helpful reminder. I hope Wed. goes better!!!!!!!

Patient day

I found that today was really stressful in that I could not remember what I needed to do next. I know what to do at each step, I just struggled with what to do next. I think that if I had a mock chart in my clean area to look at like my case study from last semester that I wouldn't feel so stressed at doing everything right. Today I did learn that just because you can hear the sound of the instruments on the teeth like you are scaling calculus that it isn't necessarily there. I am trying to learn what if feels like to detect calculus.

first day back

I was nervous at starting back up, a little shaky and fumbling around with the instruments. I think we need the first week to get back in the swing of things before seeing patients already. We pacticed with the ultra sonics today, it was exciting to see a piece of calculus come out of an embrasure so it works!!! I was glad we did practice on each other, that gave me a cleaning after the holidays.