Wednesday, February 20, 2013

A Short Story (With Pictures!)

About two months into my current job and things are going swimmingly.  I’m still not busy enough, but slowly but surely, I’m building a patient base.  Luckily the practice is large, so I get all the emergencies to fill in the gaps.  Most emergencies are not particularly interesting, but I’ve been on a bit of a streak as of late.

So here is my story.  A certain Friday afternoon arrives with a middle-aged guy coming in at 2:00 for emergency tooth pain.  We close at 3:00 on Fridays and pretty much every specialist we refer to closes early on Fridays as well.

He is around 45 years old and is complaining of pain in #3.  Persistent for the last 3 days and really hurts when he eats. 

Hard to appreciate the divergent roots in this picture, but you can definitely see the fracture line going straight down the center of the crown.  He’s in a lot of pain and I have two options.
1 – refer to OS and give him pain killers to survive the weekend
2 – Extract the tooth myself
If you had talked to me right out of dental school, no way in hell I try to get that tooth out.  But here is why the GPR positively influenced me.  I decide to go for it.
For some reason, I thought I could get this tooth out in one piece (ohh silly delusional self).  So naturally, the tooth breaks down below the crest.  Fuck.  Now I’m flapping and removing bone with a handpiece and surgical bur.  Long story short, took me an hour to get it out and the sinus membrane was exposed at the base of EVERY root tip.  Fortunately, the membrane was intact and no communication was present into the sinus proper.
The GPR gave me the confidence to attempt this extraction, but more importantly, it gave me the skillset to get out of trouble and analyze the procedure more critically than I would have straight out of school.
What went well:
-Entire tooth removed, all tips accounted for
-no sinus exposure (close though!)
-pain management during procedure and post-op was excellent
What could have gone better:
-Should have flapped/sectioned immediately, controlled tooth breakage is far superior to forceps-induced.  This in turn, would have allowed me to spare more of the alveolar bone as well.
This was my first “oh crap” moment in private practice.  When the crown snapped off, I realized I was in a hole and it was going to require some patience and persistence to climb out.  Great thing is I didn’t panic, everything worked out OK, and the site is healing up as expected at this point.
So that brings me to the very next patient I saw the following Monday.  Emergency comes in complaining of tooth pain.  Young African American male with no medical complications.
Both #1 and #2 need to go.  I felt like this was my chance for immediate redemption.  This time, I adapted from my previous experience and made the correct choice.  I immediately flapped, troughed, and sectioned #2.  #1 was a standard forceps extraction.  Including anesthesia and suturing, I was done in 20 minutes, a marked improvement over Friday afternoon.  No post-op issues, area healing well at follow-up.
This isn’t a ‘brag’ post or anything.  Plenty of general dentists could get these teeth out as well, but I was just really pleased with the immediate turnaround.  I mean, that sort of thing is so rare, to get a chance to do a nearly identical procedure the very next patient and see such improvement in management just made me smile. 
So I’m the extraction guy in our office and I’m ok with that.  I am still waiting to really get rolling with some more prosthetic cases, but the bread and butter stuff is working out fine.  Being out of the game for a few months really didn’t diminish my skillset at all, I feel confident and comfortable with the basics.  Do I still get frustrated?  Yes.  Do I still need time to think and dissect a larger restorative case?  YES!  Am I still learning and getting better every day?  Hell yes!
The only real complaint I can come up with at this point is a lack of consistency on when I get paid.  Supposed to be the 1st and 15th of every month…but is currently the 20th of February, and I still haven’t seen that 15th paycheck.   Not the end of the world, but definitely annoying and making paying back loans and keeping my credit card balance at zero far more difficult to keep up with.  We are getting by and I only expect things to improve after I really establish myself at this office…but it is still rough going financially.  Go figure right?  A husband/wife dentist combo is living paycheck to paycheck.  Can’t wait for that phase of our lives to end, hope it’s sooner rather than later.
Three days a week of work is still not enough, but it seems like the potential to grow is good and I will ultimately get more time in this practice. The question becomes should I find another job for the interim.  The plus side to that would be increased income and exposure to a different work environment.  The con would be difficulty in changing days/hours as my workload at the primary office increases.  We shall see how things develop.
And I’m spent.  Going for a ton of CE at the midwinter meeting…hopefully I learn.