Monday, February 22, 2010

The D-3 Experience IV

As I edge closer and closer to completing my third year of dental school, I find myself sad to see it end. Yea, I want to graduate and actually have an income, but once you hit your stride in the clinics, it becomes pretty damn fun. The fourth year will be wrought with the stresses of licensure and I don’t intend to be in such a ‘stride’ ever again during school.

The summer semester you are a bit squeamish, scared if you will, because there is pretty much a ‘first time’ happening every day. The fall semester is a lot better because you are starting to do things you have already done. The spring semester is when it all comes together and you literally feel like a badass. This is because the instructors know who you are now and you are simply comfortable. It also helps to see the psychotic D-2s running around freaked out about doing a prophy or printing out a treatment plan. We’ve all been there.

You eventually get used to the ebb and flow of the controlled chaos that is any dental school clinic.

Today we had a lecture during lunch about the two licensure exams our school is considering for the class of 2011. The current class is taking the NERB, but most classes prior have taken the CRDTS. Believe me, I will be posting plenty on this stuff in the future, but for now I will leave it at that.

In the morning I took a class II amalgam performance exam. I swear dentin never looks the same when I get down into it – especially if there was caries. I’ve determined that the only REAL way to tell if the tooth still has caries is by feel – not sight. Pretty much anything not healthy and yellow looks like caries, and believe you me – I can see why so many people pulp out all the time. If you try to remove anything that isn’t ‘normal’ you may as well just remove the entire tooth. Case in point: my patient this morning had a radiographically simple class II; replacing a composite with a small bit of recurrent decay. Before I knew it, I was damn close to the pulp with a huge brownish-red circle still hovering around the axio-gingival line angle. Now when you are taking an exam, this becomes stressful because if you leave any caries in the prep – you fail. Well, I really poked around with my explorer and the spot felt firm. So I just held my breath, asked if I could place a liner, and had them grade the prep. Whew – no caries.

I find amalgam fairly easy to work with – aside from carving sweet anatomy. But as a clinical instructor I know is fond of saying: “Anatomy? You know what I say about anatomy? Anatomy (pause for effect) is over-rated.” Pure gold.

Finishing a performance exam is like finding relief after a bad burrito – it’s a battle going in, but the feeling of ‘passing’ is unequaled. Good wordplay yea?

So things are going well overall. Aside from the ‘RPD from hell,’ I feel as though I am getting a good deal accomplished overall. What is the RPD from hell you ask? Well, I plan on devoting an entire post to this beast at some point. Here’s a sneak peak. I took the final impression for the framework last July, and we still aren’t done. Yea, it’s that bad.

Aside from a crown performance exam, a couple of presentations, papers/ reports, and finals, I am about ready to mosey on into the D-4 year.

On the horizon decisions:
D-4 Rotations
GPR applications
Pre-order GOW 3 or not

Actually that last one isn’t really a decision, I already pre-ordered.


Saturday, February 20, 2010

Syncope - Finally

As morbid and terrible at it sounds, I have secretly been hoping to see a patient go into syncope for the last few months. I realize the best chance of this would be in my OS rotation which finally wrapped up yesterday. I am glad to finally have more time in my normal clinic for my own patients but dissapointed at the same time because OS is fun.

So what is syncope? Simply put, it means to faint. Of all the 'emergent' situations in dentistry, syncope is by far and away the most common. It is also the easiest to treat if you follow a few easy steps.

Why does it happen? Most commonly, blood is not getting up to the brain which causes hypoxia (no oxygen) up there eventually leading to loss of consciousness. A great example is a young male patient who is super anxious about needles. He knows it is coming, so his body naturally goes into 'fight or flight' mode. This means the blood vessels dialate to get the blood pumping and moving (especially into the leg muscles). Most dental patients are in a sitting position which means that gravity is also kicking in so all that blood is just pooling up down in their feet.

So they pass out. And it finally happened to a patient I was working on. A classmate and myself were tag teaming this guy on an alveoloplasty and the attending surgeon was going over a few pointers just after I opened the flap . Suddenly, the patient's eyes just rolled into the top of his head and he sagged off to the right. The instructor had us grab the O2 tank while he brought the patient into a supine (or laid down flat) position. He technically brought him all the way into trendelenburg (head lower than feet) but either way, that is the first step. We hooked him up to the oxygen and the guy came back really quickly. His BP had dropped a bit, but it wasn't dangerously low (which ruled out cardiac issues). So we finished up and sent him on his way.

There really isn't much else to say. It was crazy to finally see it happen, and equally amazing at how simple it was to manage. Laying him back got the blood going towards his head and the oxygen just sealed the deal.

Obviously many things can cause someone to pass out, and many of them much worse. The surgeon recommended that we have an emergency protocol/practice day in our private practices once every six months to keep everyone up to date. I completely agree.


Wednesday, February 10, 2010

He's A Bleeder

Well since I'm not really doing much dentisty this week I have time to reflect on a pretty cool OS experience. Why am I not doing dentistry? It is mock boards this week. That means I am forced to assist the D-4 students taking the mock boards. This entails assisting from 8am until 5pm with no lunch break for three days. Now luckily I was an examiner assistant one day so that at least allowed me to walk around and wrap about 50 chairs.

What have I learned? Assisting is HARD. It kills the back, you are getting ordered around constantly, and worst of all - it is the most boring job I have ever performed. Maybe it's because we are assisting students. Maybe it's because our chair set-up is NOT condusive to having an assistant.. maybe I just am bored of not seeing what I am suctioning, or maybe even more appalled that I would even care to see what I am suctioning because I don't enjoy suctioning in the first place. At least it served as a chilling foreshadow of things to look forward to next year.

But back to the topic at hand. I got a new patient early this semester with about 14 remaining teeth floating in the most gross batch of perio disease I have ever seen. Basically an immediate denture will not be possible so we are doing full mouth extraction, possible gingivectomy, followed by F/F. This guy is a doo-wop singer so he clearly needs teeth for all that smiling. Unfortunately this process is likely to take some time. I have finished a few arches of dentures (although not for awhile), but the main issue I am foreseeing is whether or not his soft tissue will heal up well enough after the extractions.

That will be a future though. So at this point, I am capable of doing most any extraction outside of impacted thirds. This is a huge perk here at UIC. You do a TON of OS. We get 8 weeks of rotation througout the third year and the faculty here let you do a LOT. As in, surgical extractions/biopsies/tori removal. Laying flaps and suturing is actually pretty damn easy if you have instructors that will let you do it enough to get proficient.

Now this gentleman has 14 teeth I need to get out. I have three left after three appointments. Two were horribly ankylosed which really took up a lot of time, but the other major issue I've had is blood. The most blood I have ever seen. I took three teeth out in about 3 minutes that were not really in bone anymore, but the gingiva was so diseased and inflammed that he literally started dumping blood out by the buckets. I was packing surgicel/gel foam, jamming gauze in, suctioning..and thinking I was going to kill someone the entire time.

The first time this happened I got an instructor to help me out. He showed me a few tips to really packing the gauze as well as getting those first few sutures in during the worst of the bleeding. Last time I did it all solo without any complications.

This was just an awesome experience overall. It helped me learn to manage a somewhat abnormal scenario. It also is pretty satisfying doing these extractions myself and not having to refer him to the 3 month waiting list in PG OS.

He comes in tomorrow to finish the last three, then I will wait about 2 weeks to assess the healing..and maybe take initial impressions for dentures.

ooo boy.

And yes, I remember I was supposed to keep a really accurate log of my first F/F last summer...but I mean, are you really surprised. You can file that in my 'failed mini-series category' along with the vocabulary building and teaching my cat how to use the toilet and anything else I may have forogotten about that is now buried in the 100 some posts I have amassed over the years.

Tomorrow I might actually get to start my second RCT....keeping my fingers crossed on that one!