11/6/12

I have come to find out that if a pt will not answer their phone when you call to remind them of their appointment, and won't call you back it means that they are going to be a no-show. Plan on it. Instead I found a diff pt last minute to finish with. I also had a new pt that ended up being a class IV.  YEH! I was needed one of those. It was a good experience also because he had a really high bp reading, so we carefully monitored that throughout the appointment. He was surprised to find out that it was so high since he had not had it read in a  long time. He promised to go get it checked with a doctor so he could take something to control it. When he opened his mouth he a ton of sloughing. I asked him what tp he used, and he said it was crest pro-health. We talked about changing brands.  He was happy to learn that.  I get the sloughing too and it is annoying. He said he was just trying to get the best newest kind that would do the most good. Sorry crest, but I recommended Colgate total. What I enjoyed today working with my pt is having enough knowledge about products and home care that I could use that to help someone else. He was a good pt because he wanted to learn. My goal over Dec. break is to make up small hand outs for home care items and information that is useful to a pt. for example diabetes/perio, chx rinse, tb/flossing skills, prevident, and oral cancer self checks. It would be nice to send it home in writing because it is hard for the pt to remember once they are home everything that you said.

10/30/12

I didn't get a chance to blog for these weeks so I am back tracking a bit. I had 1A pt's today. The one was old enough to do just fine, but the other was nervous, and anxious most of the time. It was the first time she had xrays so it took some effort to get her to cooperate. I am finding there is some skill to entertain children, and what ever it is you do, do it fast, because if they are willing to cooperate it doesn't last long. It turned out good in the end.

10/23/12

Today I had my first clas IV pt. He had 9-10 mm pocketing. The first quad was the lr, which I felt I had an easier time at then on the ur. Access and using indirect vision made it harder to scale. I used my ultrasonic a lot, along with files. This was a good experience. Completely different when they have such deep and easy access pockets compared with a class II. His next visit I plan to place arestin to help with healing in these pockets. Instrumentation is difficult when it is that deep, due to lack of vision, and crown/root access. The crowns feel like they are in the way to place the instrument sometimes. Good experience, as now I see the difference, and severity of this classification.

10/16/12

Today is Mockboard. I was  a student examiner first, which was very helpful for me to observe the procedures and practice exploring for calculus. In the afternoon I was able to give an IA to my pt. My first experience with a real situation. It went well, but I was shacking when injecting....it seemed a very long slow process. But it did get him very numb. I missed three areas of calculus and 2 recession numbers. I realy felt this experience was helpful, as I now know what to expect, to put a 0 instead of 1 on recession, and to make sure all apex's are in the xray.

10/9/12

Still working on my calculus and explorer technique. My first pt was a class V, I missed a few areas, but learned that when the tissues are tight that the slimline ultra sonic is very helpful in getting under the tissue to clean off the calculus. On my second pt today I used it when I was going back over and saw that I had missed a spot on the anterior linguals, and maxillary anteriors, the ultrasonic helped to remove it quickly. I finished both pt's early today and kept within my time goal. I was also able to complete several pe's including a sealant. Yahy!

10/2/12

These next couple of weeks I am focusing on using my explorer better to locate calculus, and then instrument properly to remove it. This will help me to not miss areas. Our instructor this week, Lis is really good at this. She stands there and monitors everything that I am doing. This helps me to learn how it is suppose to be done properly. It has helped me feel more confident in this area.  THanks! to our instructors who care that we learn. I finished a class III, and a V today.

9/25/12

I have been working on getting better open contacts on my premolars during x-rays. Today my pt's mouth was crowded but they turned out pretty good. I like the scan-x, and enjoy being able use the same method each time so that I feel that I am able to master it, instead of jumping from conventional or schick just to meet requirements even when it wasn't the best option for my pt. It is much better this year the way it is set up. I had a class II pt today, but was disappointed he wasn't quite mock board quality.  Sierra and I are coming in on Thursday to screen pt's. I closed my eyes and pulled out three names, hoping that at least one will qualify. Maybe between the two of us we can at least find one pt to share..... I was disappointed today to miss so many areas of calculus. I felt that way because I thought I had been very thorough..ugh. I hate that! Mental note I made, especially after the lab today. Pull out the files.

9/18/12

Today was a good learning day. My first pt had a cold sore, she had to leave early. My afternoon pt signed her HHX, said there was no changes, and then mentioned right before I began that she had knee replacement 9mths ago. She had forgot to mention that. It was a good lesson about pt behavior. It is easy for them to be non-shulant (sp) about their HHX. I realized that I need to keep that in mind when questioning their health conditions, and to be very thorough. We ended up getting her pre-med and did scale one quad. I liked getting the experience with the physicians consult, and it is not so scary now. I really value the variety of experiences we get in clinic. I have learned lots from a textbook, but I learn even more hands on.

9/11/12

The patient today had a lot of recession with root exposure in the anteriors. I scaled for awhile, though I was doing good until Prof. Alexander said to get out my mini Graceys. They started pulling up calculus that I didn't even know was there. They are my new fav. especially in the anteriors where you have to adapt so much, which was even more extreme around the root line angles.

9/4/12

This was our first day back in clinic. I had two pt's, both of whom I predicted were 1B's .  I planned it this way to re-establishment patient care flow, and confidence in instrumentation and x-rays. I finished both pt.'s and it went well. I do have areas that need improvement. The first is not missing calculus on the posterior molars. It is difficult to reach these areas and I plan to use my Montana Jack next time to see if that will help. I took care to practice instrument adaptation, particularly to not miss calculus and for pt comfort. I did miss two spots, which bothers me because they were easier pt's. My plan is to establish a pattern or instrumentation so that it is efficient, but also thorough.

4/2/12

Today I did my denture pe and thought it would be a lot harder. I seem to do that. It wasn't that big of a deal, but now I know what to expect. I removed a ton of calculus. The pt was numbed and I had to chisel it off it was so thick. Great experience. I am learning to be more careful. When I scale check I need to be more careful that when I find calculus I need to scale that area instead of completing checking the other teeth. That way I am less likely to miss an area. This made it so I finished my class III requirement!!! YEHY! I just have four pe's and three children to see and I am done!  

3/28/12

My first class III.  I have always been intimidated thinking I wouldn't know where to start with this. I did ok. and learned some things. I like the graceys, learned to go more subgingival and when removing the calculus apply a little twist to the end of the instrument and it worked much better popping it off. It is more diffucult not to see it and sometimes I felt like I didn't get low enough. I finished 3 quads and she was an excellent pt. I am finding that it is easy to become emotionally attached to the pt. I had a good day, and feel like I am learning lots.

03/21/2012

Goal: my first class 2, my goal is to use my graceys, triple bend and pass off to pe's
I got a lot done today. I loved the graceys on the posterior and wish I had used them before now. I also passed off the 2 pe's I needed and used the triple bend. The pt was very sensitive so I aslo switched to the slim line. The only thing I feel bad was I was rushed to finish the quad and feel that I missed too many areas. I look forward to next clinic day to finish working on her without all the other paper work and xrays to take up my time. She seemed happy and commented her mouth felt better on that side. It was a good clinic day.

03/19/2012

Goal: Complete a full mouth, using good horizontal angulation on bicuspids
I had to us schick to complete my requirements it didn't go so well because his mouth was small and I just couldn't get the size 2 to work out. We tryed every way we could but it didn't work out. I am not pleased at all with them. What I learned was to use scan-x

02/27/12

Goal: Finish pt and place a sealant. Work on better OHI instruction
Accomplished: Finished pt and placed a sealant. I disclosed pt again and her PFI% was the same as last visit. She is young and maybe is not taking instruction to heart, so I went over it again with her especially in areas that were missed. I am self evaluating my instructions the next while to see where I can improve to get better results. One idea is to have them look in the mirror, point out specific purple (disclosed areas) that they missed. Have them practice brushing in those areas infront of the mirror.

2/22/12

Goal: Finish pt and pass of intra oral camera pe.  Still working on posterior teeth feeling comfortable with barnhart.
Accomplished:  Finished PE, and pt's quads today.  I was more efficient in post teeth especially distal of 2, 16, 31, 18.
Her calculus was difficult to remove around lingual bar. That was good practice and I used the ultra sonic to help in that area.

2/13/12

Goal: Is to finish 3 quads and pass of a sealant pe. I am also working on my instrumentation for all distals of 2, 15, 17, 31.
Reality: I finished scaling all three quads today and did my pe. I missed a couple of spots with stain.  They were hard to see with the mirror. It is good practice to help train my eye to see even small less noticeable areas. I am starting to feel more comfortable with the barnhart on distal services. He didn't have a lot of calculus so it is hard to judge. I do feel better with fulcruming closer so that I have more strength in those areas. I also placed a sealant today. I was more nervous than I thought. Can I say that I dislike the HV suction a lot! I made the mistake of having him close on it. Not good.  Won't forget that lesson.
I am happy to have finished another pt and did a sealant too. Things are improving, and I feel more confident. 

2/8/12

Goal: Use ultra sonic and pass off pe, and sharpening pe
Reality:
I did like the ultra sonic more then I thought I would. It went well, other than the pt feels like they are drowning, I learned to pause everyother tooth to let them close and spit out extra water. I got as far as finishing 2 quads!! yah.  It was a good day and I finished both pe's. I want to continue working on scaling post. that is where I need the most practice.

2/6/12

Goal: To improve instrumenting on the posterior teeth
Reality: I had a new pt today with realy healthy teeth.  I spent more time instrumenting on post teeth. I tryed the seating position the instru Wold showed me and that worked much better. I feel like that I am getting better. I did miss a spot distal of 2, he had a lot of groves and ridges there, so note to self...be more careful around those areas.
Today was good. I felt less nervous, and more confident. I did have 2 retakes on xrays, it is more difficult with verticle bwx to get all the anatomy.  practice, practice, practice.

2/1/12

Goal: To scale as many quads as possible. 
Reality:  I did get one quad done. I monitored my use of time and am trying to find areas to improve without rushing too much.  I also found that I need to do a better job with ginival observations, and charting that before the od check. I missed some marginal gingivitis.

1/30/2012

Goal: Work on using univeral instruments post. teeth. Specifically the most distal surfaces of 2, 15, 18, 31
My pt today I scaled three quads. I also spent extra time on above areas practicin chair position, mirror use to see and retract cheek, and instrumenting around that most posterior surface. Instr. Wold helped with ideas, and I am feeling better and better about my ability to remove calculus so far back.  I specifically feel like I have little control or strength in my working stroke when I am reaching so far back. It is getting better. I scaled 3 quads and had no errors !!!

1/25/2012

Goal: To take off calculus!
I have a returning pt who has some lingual aterior calculus build up and I was able to have a chance to scale and see how it removes. It was good experience.  I missed a few spots, but Instr. Hafen is so gd at giving instructions and help. I feel very confidient on my anteriors now and am getting better with post teeth.
I know what my next goal is.

1/23/2012

I had a new pt today. My goal was to be prepard mentally and not become intimidated by all the requirements.
I did well. I finished a fmx xrays, and they went well.  She has a lot of work that needs done and I am excited to have her come back to scale and help her out.
My charting is getting easier for me even though she had a lot of charting to do.

1/18/12

Goal: Finish 4 quads and complete my pt treatment.

Reality: My pt was a no show. I was worried about that because their phones were turned off and so I called a back up person, and their daughter got sick and threw up in the car on the way so she didn't come either.

New Goal: To not get discouraged.

Reality: That is difficult. I am trying  not to be discouraged. It certainly sucks (exscuse the adjective) when you know your pt didn't come back because they hated their last appointment.  However by the time we go through such a lengthy process before we can even scale, we have driven our pt away. At this point if they are not your relative or devoted friend there is very FEW people who want to spend 6 hours in a chair with their mouth open. It is too bad there is no credit for  areas other than scaling or xrays. Just a thought.
Bright side, I know I am better then when I started.  I'll just keep going forward from there, that is all I can do.

1/11/12

Wednesday:
Goal: Behave confidently and professionally (control my nerves) around a pt that I don't know.

This was my first "real pt" today. He came in telling me he has never gone to a dentist before. Once we got started it went well. I actually did well probing, extra, intra oral exam. I found some suspicious lesions, and a deep painful pocket around an possible cavity. We recommended a full mouth x ray. He had a small palate, and a bad gag reflex. So after several attempts, I ended up compromising with two size 2 bwx and two size 1. Amazingly I captured all the anatomy on the size 1 film. I also took a pano to check for an abscess on the bad tooth. It was clear. Now I have a new goal, not take so long.   I felt bad that I wasn't able to get to his cleaning which was why he came. I hope that he is patient enough to keep his next appointment so I can finish cleaning his teeth.  I felt like I spent so much time, and never got to anything that was actually meaningful to him.  At this point in the semester I don't know how to speed the process any more. I am also aware that I have to meet requirements and have so many quads scaled.  This means that I will have to scale at least 3 quads each day left of clinic to meet the requirements. That is not happening.
I did achieve my control my nerves goal. I felt less anxiety today and enjoyed myself.  I only became anxious and rushed when there was so many difficulties taking xrays, which took too long. Live an learn....great help today from instructors.  They were very positive and encouraging.

1/9/11

Monday:
Goal: Get comfortable with Eaglesoft.  Scale two quads.

My daughter cam in today, I tryed to go as quickly and efficiently as possible so that I would be able to finish scaleing two quads. Every thing went well, except I am so unconfident with eagle soft, and Talval. I had to ask how to do everything too much. (which I don't like) So my goal is to become proficient using the programs. I was also able to scale one quad today (wanted 2 so I got closer) I had no mistakes at scale check.