Thursday, April 30, 2009

12am And All’s Not Well

I am so screwed for my pharm final tomorrow. I have never felt this unprepared for an exam in my life. Even coffee and staying up won’t help at this point so I am about to throw in the towel and get some sleep.

There is a list of about 200 drugs that we are responsible for on this exam. Note that this is not a cumulative exam either, we have had these drugs crammed down our throats in the last three weeks. I don’t see how it is possible to maintain all your other responsibilities to school and simple life-maintaining processes like eating and crapping while learning all this. It isn’t like I have been procrastinating either. Yea, I am un-motivated as hell, but I still have logged a TON of time on this shit. The end of the D-2 year is much like the grand finale at a 4th of July show….except you are strapped to one of the final fireworks.

I will proceed to forget everything I have crammed for within 24 hours. Times like these really make me despise school with a genuine passion.

After this test, I get to start studying for Implants, Tx planning, Endo, Fixed, and Ortho.

..god dammit

Tuesday, April 28, 2009

First F/F Case – 1

While I have completed a few preliminary appointments and recalls with other patients, I finally seem to have roped in a committed and punctual patient that I will be treating from start to finish. It also happens to be a complete dentures case (full over full (F/F)). While I really didn’t enjoy the dentures course, I must have learned more than I thought, because reviewing the material didn’t seem so bad.

Obviously as I get into the more technical components, things might get interesting. The thing is, I am extremely motivated to make these things look awesome (much more motivated than I was for the fake patient in the pre-clinic course). I plan on getting a camera soon so that I can possibly upload photos of this entire process because those of you in school learning about dentures for the first time probably know how confusing things can seem.

So today was the first appointment I have had with Mrs. E. (HIPPA!!) The appointment was scheduled for 2 pm and she showed up at noon. She knew the appointment was at 2 also, she just didn’t want to be late…holy crap – talk about someone who actually wants treatment (unlike ½ my patients). I suppose if I had no teeth, I would be anxious to get that solved as well.

I set up my operatory, check out an exam kit from sterilization, grab my mixing bowl/spatula and BP cuff/stethoscope..time to go. I introduce myself to the patient and bring her back. She is EXTREMELY easy-going and well-mannered. Our initial conversation lasted about ten minutes. She told me how in January she had her remaining teeth extracted and palatal torus removed (all in preparation for the dentures). Many dentures patients already have a pair that simply are broken down or not working out. However, this patient has never experienced dentures before. So I try my best to make sure her expectations don’t get INSANELY high. Dentures will never be as good as real teeth, period. I also mentioned the option of converting the mandibular denture into an overdenture (implant-supported denture) once we finished the two arches. This is actually a GREAT deal at the school. An overdenture is created by placing two implants in the anterior region of the mandible and placing attachments on the parts that poke out of the gums which fit directly into the denture – greatly improving retention/stability. This will run you about 4k outside of the school. However, if you get them done at UIC, it will cost you 300 dollars – INSANE bargain. Mrs. E. is on a bit of a financial strain however, and she can only pay so much at a time. So in a rare way, the slow process of treatment at a dental school will actually work in her favor, she will be able to pay most of it off before I even finish.

OK, so I take her BP. I get a fairly high reading using the steth and cuff. However, I am still inexperienced and the clinic is loud so I take it again. Still around 160/90. She told me her BP is usually ‘good.’ I switch to the wrist BP cuff which reads 170/105. Pretty damn high. However, I really question the validity of those wrist readers as they are often all over the place. So I proceed with the med history/dental history/risk factor analysis. She has arthritis and takes a few meds for the pain, nothing else jumped out. It was nice that she was edentulous because I could skip the long process of odontogram charting and focus more on the clinical stuff. I took her BP again after all this talking (15 minutes or so) and it was 149/78 which is much better. However, if I continue to get high readings, I will probably get her a med consult.

So I proceed to the extra-oral and intra-oral exams. She has AWESOME ridges. As in huge, broad, tall, awesome - I really couldn’t have asked for a better patient in terms of success potential – not to mention we are required to do one overdenture case to graduate so it is a win-win (assuming she goes with the implants down the road).

I grab my instructor, he agrees that Mrs. E. has some amazing ridges and checks me off to take the initial impressions.

I was too slow on the first impression. I haven’t used the fast-set alginate enough yet so my speed needs a little work. The material was a little too hard so I didn’t get the tray seated deep enough. My second attempt is MUCH better and will work for custom-tray fabrication. I proceed to the mandible. The first impression was crap; I forgot to pull the lip out first and seated the thing too anteriorly. My second attempt was acceptable. Given the fact that I haven’t taken impressions forever, I was happy to get both arches done in four tries. Obviously won’t want to be doing that in a year, but I’ll take it for now.

I next slapped together a quick treatment plan for the dentures and had the patient sign off. I wrote up my note and escorted the patient out. The dentures will cost about 1000 total, the initial exam was 36, and the overdentures will be 300. Not a bad deal at all. She put down 336 and was on her way. I will be seeing her next at the end of May.

I cleaned up my unit and took the impressions upstairs to pour up. All the damn D-1’s were in the wet lab working on occlusion wax-ups..gross. I went back downstairs to the support lab by our clinic and poured the impressions up in microstone. Seeing as I have a lot of shit to study for, I didn’t do the second pour. I popped out initial models and they looked fine, so I will second pour and create the custom trays before her next appointment. And yes, I know I need to get more efficient doing lab work.

Whew, those initial appointments are exhausting.

I also plan on keeping a running total to see how horribly slow I am.

# of Appointments: 1
-COE, Initial Impressions (1)

Outside of class lab time: 45mins (1st pour, initial impressions upper/lower) - mostly just sitting around waiting for things to set.

Friday, April 24, 2009

100th Post

Wow. I noticed during my last update that I had slapped 99 posts up. That seems like a TON. Granted, I have had this blog going for over two years now, but I still can’t believe I have stuck with it. I know I have been updating less and less over the last year, but given my schedule – I am impressed that I didn’t disappear for months all together if not permanently.

My intentions haven’t changed – I hope to provide blissful procrastination to anyone bored enough to read a dental blog while keeping my fingers crossed that I actually help a few pre-dents and dental students along the way. I know I am terrible about getting back to emails, but I eventually do answer them all.

So I guess this post is just a selfish pat on the back.

Today was 83 degrees and sunny. Soon I will be a D-3, full time in the clinics. Even more importantly, I will be 50% done with dental school.

Now I have to study for the massive load of finals I have in the next two weeks.

Stay tuned:

D-2 experience finale mid May
New blog series on my first F/F denture case
D-3 experience post early June.

Take care all!

Monday, April 13, 2009

Here's To You, Homeless Man

Here I am walking back home around 3:30pm after finishing another dull double-dip of urgent care duties last Friday. I look across the street and notice two things. Firstly, I see a hummer parked outside of the Seven-Eleven. Next, I see a huge homeless dude with a giant beard standing (literally blocking) the entrance to the store. I’m thinking to myself, that can’t be good for business.

So a guy comes out of the seven-eleven and gets into the hummer. As the tank begins to move out of the parking lot, the homeless man suddenly springs to life and just sort of half-ass kicks the rear bumper, while yelling a lot. Now at this point, I sort of stop. Fortunately I am across the street and can safely observe. The guy in the Hummer get’s out of his car and does the ‘tough-guy’ act.

TG: “Did you just kick this truck?”
HM: YES, YES I DID YOU OL’ MOFOING HIGH YERGESLFLKJ HONK STOP (as close a translation as I could make out)

TG: Don’t fucking touch my car again


At this point the guy realized that this homeless man was totally correct, shut his mouth, got in his tank and left.

I LOVED this exchange. The homeless man pretty much summed up how I feel about Hummers. And he had the balls to not back down from his crazy antics.

I have almost been killed by Hummers on so many occasions now that it was nice to see someone that agrees with me. I can’t turn left when there is a hummer turning left on the opposite side. Why? Because I CAN’T SEE AROUND IT. I could go on, but there is no topping the eloquence of the homeless man. He made my weekend.

So here’s to you homeless man. You may need shower and a shave, but you make more sense the 90% of the people on this planet.