Monday, November 23, 2009
The obvious aside, what about lab work? Most general dentists aren't mounting every case on the articulator or waxing up crowns. I don't know many that even set the denture teeth either - yet we do it as students. I'm glad we do, because you need to know what good is.
Now the point I'm getting at is that it becomes quite easy to get lazy and complacent. Simply assume the lab can do everything. This is ok sometimes, but every now and again we get a situation that requires some improvisation.
So here is my case. I get a patient on public aid that simply can't afford the partial she desperately needs (missing 7-10). She eventually plans on getting the partial but needs more time to save up.
Clearly that is a space that most people would like to have filled up ASAP. So at the college, we require that the patient's balance be UNDER 100$ before we send anything out to the lab. As soon as I prep rest seats, the partial will be charged (and it costs 600$). She needs other work as well that is not covered so we are looking at a couple months before I even start the partial.
So our options:
1) Do nothing, let this lady walk around like this trying to get a job
2) Send to the lab for an interim partial
3) Make the temp myself (flipper)
I had attempted to make a flipper last summer and while I thought it went pretty terribly, the patient never came back (which is actually a complement in this case).
So the flipper is generally made to replace ONE, count em' ONE tooth. If I send to the lab, it will cost her about 300. If I make it, it costs 160. Given financial limitations and my desire to learn - I decided to get a little crazy and attempt to replace the 4 most esthetically important teeth in the entire mouth.
Here it is after about an hour of work and one helluva a time getting it off the cast. She has all of her posterior teeth, so I decided to go without wires.
Now I will be the first to admit that the gingival shade sucks. In my defense, that is really the only color we have to work with in the lab. This is also supposed to be TEMPORARY. I needed to bring the acrylic buccally for a little extra retention. I would not have been comfortable attempting to have those teeth blend into the natural gum line. Again though, considering I couldn't even fix a toilet prior to dental school, I was pretty damn happy with this result. It looks even better far away.
Her voice didn't change at all after a few adjustments but she does use just a touch of denture adhesive. I probably could have used some wires but I used them last time and wanted to try one without.
This post is not to toot my own horn but rather to emphasize how much you can change someone's life by taking the route less traveled. I will never become a prosthodontist, but I would like to think I can help when the easy lab option is not possible. I delivered this thing in september and it is still holding out great. She is interviewing for jobs now and we will hopefully get her partial going early next semester.
With all that said, making your own temps is pretty time consuming. We were never taught this in the pre-clinic so you end up with a little trial and error. With that said, this result completely trumps my first attempt (which I wish I had pictures of) and was quite honestly, a far more difficult case.
Will I be making my own interim partials all the time? Of course not, but it feels good to know I can should the need the arise.
Happy thanksgiving all!
Thursday, November 5, 2009
I obviously can’t really compare UIC versus other dental schools because I can only go to one. I have received numerous questions from randoms and friends/family about how much experience I am getting in the clinics.
So I decided - what the hell, why not just run a production report and find out. I could care less about HOW much production I have made in dollar values but I do care about WHAT I have done or how many procedures.
So I am fairly deep into my time as a D-3, why not see just how much experience I have gotten thus far. I will probably do a follow-up towards the end.
Quick note: I am not including EVERYTHING – pretty much just procedural dentistry. I am also leaving out radiographs because I don’t get credit for the ones I do on rotation and I get credit for simply ordering them but not actually doing it. Needless to say, I feel fine with radiographs for the most part.
I am also including things I haven’t finished or will be (hopefully) starting shortly.
7 – Periodic Oral Evaluation (6 month exam)
34 – Urgent Cares (about to become 35 this afternoon)
12 – Comprehensive Oral Evaluations (new patient work-up)
9 – prophylaxis (mostly on kids)
5 – fluoride application (all kiddos)
5 – class II amalgams
1 – MOD amalgam
15 – class V composites
1 – class III composite
2 – three-surface posterior composites
1 – PFM crown (still in process, 4 more in the near future)
1 – FGC (planned, starting sometime next month)
1 – SS crown
1 – 3-unit FPD PFM (not guaranteed yet..but keeping fingers crossed it doesn’t fall through)
1 – Direct pulp-cap
4 – core build-ups
1 – cast-post/core (still need to cement it)
1 – pulpotomy on a screaming child
1 – RCT pre-molar
8 – Quads of SRP
3 – Arches of Full Dentures
1 – RPD (currently at framework try-in phase)
22 – Extractions
1 – Surgical Extraction (which was awesome)
2 – occlusal guard (one done, one planned)
1 – unilateral space maintainer (planned and on the horizon)
So there you have it. This is what I have accomplished so far. While the list isn’t that massive, I am feeling quite content with my current level of experience. While I am definly lacking in Endo and Fixed, I have done a ton of directs and feel pretty good about them. I also have plenty of fixed on the horizon. The only trouble-area is endo. Hopefully I can pick up another one sometime soon.
My experience obviously is going to be quite different from anyone else in my class. I know someone that has done a ridiculous number of endos already and someone else that has been really dealing out the crowns. However, I also know people that haven’t done an amalgam yet, or a denture. It is completely unique and based almost entirely on your patient pool.
Being a D-3 can be frustrating at times. You go through good streaks and bad, but all in all – especially once you start to feel at home in the clinic, it just kicks ass. I see all those silly D-1s running around to with their bone boxes or skulls and just shudder. Thank god I am done with that. 19 months and I’ll be graduating.