Today marked my first truly inpsiring moment in school where I know the crap I do had a true impact on somebody's life. I have a patient in dire need of dental work. She essentially is going to have about 12 teeth extracted (due to extensive perio disease) followed up with partial dentures on both arches. She has no insurance, was laid off last spring, and we are trying our best to spread the extractions out enough so she can pay. We probably will only do the upper arch first. Well this patient has a HUGE gap in the front (#9 missing and #10 has shifted distally). While pretty much all her teeth up top will be yanked minus the canines and premolars, a MAJOR concern for this 40something female is getting that space fixed - especially considering that she is looking for employment and can't stand smiling and looking like Mike Tyson.
So while I know the other anteriors will be extracted eventually, I went ahead and made her what is known around here as a flipper - or interim partial. Basically a removable device that replaces a few teeth - usually used for emergency esthetics.
Now were we ever taught how to make a flipper? You can probably guess the answer to that. So here I am, getting tips from classmates and D-4s, and just really going for it. It took me about 3 hours, but I got the damn thing made. I spent this morning adjusting the wires and removing excess with the patient in the chair.
Was it perfect? No. The thing is not as tight as I would want it in terms of stability and her occlusion is already a bit edge to edge so it is difficult to get that perfect angulation. Her speech is slurred a little with 's' sounds but not too bad (after I trimmed the crap out of it). However, the one part that I knocked out of the ballpark was tooth shade and shape. I added a new #9 and #10 to fill the gap and the color was very close to perfect. The acrylic shade clearly wasn't meant to match african americans, but her smile line is low enough to display zero gum.
The part that makes me happy is knowing that she finally got a job interview for this thursday and I managed to fix the esthetic issue (albeit temporarily). She was happy with the appliance and didn't come back that afternoon which means it didn't break!
So was it the greatest flipper ever made? Hell no. Does it get the job done? Hell yes. Now that my first one is out of the way, I already know what I did wrong and what improvements I can do for the next time. When they say you get out of school what you put into it - this type of experience is exactly what they are talking about.
In other news, I am still chugging along this semester. These next two weeks will be rough. Endo exam (despite having no lecture class), public health final (took today), and OS midterm on friday. Ethics take home final (5-10 pages) and Caries patient portfolio both due next week. Not to mention all the extra lab work I have on the horizon. It kinda sucks having essentially removable cases exclusively. But I can make a custom tray in like 5 mintues now.
First DO amalgam on wednesday coming up. Hope I remember how to use all those carvers!
New D-3 experience post probably up by the end of this semester.
I miss summer vacations.