Is this real life??

Today I accompanied Ryan to his dental appt.  His hygienist was super nice and answered all sorts of questions for me.  She was a weber graduate.  We started the appt in the familiar way, taking xrays and blood pressure.  What surprised me was how far back Ryans chair was as they took his bitewings.  The occlusal plane of the films were WNL though.  I'm still trying to figure that one out.  No oral cancer screening, no probing, no exploring...really not a whole lot of assessment at all prior to treatment.  I was kinda appalled.  She immediately went in with an ultrasonic, followed by the air powder polisher, flossed and then the dentist came in.  That was it.  She didn't touch her explorer once!  This girl was the sweetest person ever but why would she leave out so many of the essential elements of an exam?  I have to wonder if she just figured I was taking care of those things at the clinic.  She didn't give any OHI...I was in a stupor.  SO MUCH LEFT OUT.  I really don't know what to think.

I did get to witness the excision of Ryan's fibroma, however!  The dentist brought in a Diode laser and lased it from the top-down.  Pretty seamless!  They gave him a mental block and 2 infiltrations coronal to the fibroma, itself.  The diode laser was so much smaller and easier to manage than the CO2 laser.  Both can be used for laser-assisted periodontal therapy and the diode is a lot less expensive, apparently.  Good information.  The dentist did say that he hopes to have a CO2 laser one day, so I assume there are several advantages to the CO2 laser that I should study and understand a little better. 

I was advised to sub at different offices in order to get my name out, and in order to learn which offices would be the best fit for me.  Makes sense.  I told her to keep a look-out for a good board patient for me, and she said she would help get my name out after I graduate.  It is so fun making these connections with people.  I am so excited to get out there and make a difference. 

Wind Blows... :)

Kay, this windstorm was insane! 

I'm surprised I even made it to clinic today!  Things haven't gone exactly to plan.  I had anticipated treating 4 children today.  This would have more than enabled me to meet my semester requirement for 1A patients.  The father who was bringing in the children I was going to see during my morning appt had to park clear down campus because of our closed lot.  I was concerned that his kids would fly away like kites.  There was all sorts of debris flying around so we told him to get his children home safely and that we would reschedule his appt later.  People first.  That left me the rest of the morning to assist other students who had patients show to the clinic.  I was able to be the patient for two different girls as they passed off various PEs.  And we were able to spend some time in front of the window watching all the craziness unfold outside.

They closed off Weber's A6 parking lot after I parked there, so all our cars were essentially used as target practice for sheet metal and giant tar pads all morning. Oh, did I mention the truck shell that got thrown from the big white truck?? I saw term papers (and their owners, literally) flying, and 2 people put into ambulances. 

Be safe out there peoples. Luckily, my car escaped with very little damage. I have a minor fender bender and Ill be cleaning off tar stains for a while!

Lifting Soloman!

In our afternoon lab yesterday, we discussed the proper care of patients who are bound to wheelchairs.  Sometimes it is necessary to treat them from their chair and other times it is possible to transfer them to the operatory chair when using proper technique.  Note** It is always advisable to ask the caregiver to move the patient, if possible, rather than to do it yourself.  I struggled moving Tori to the chair but things went swimmingly with Mr Soloman.  I can't explain that one at all.  Neither could Dr Hanson.  She seemed a little shocked.  But I got 5 grace PAs for the feat!  We also reviewed protocol for emergency situations, MI paste and other medicaments.  It was good to see what these medicaments looked like and we were able to practice inserting them into hotdogs.  Our professors are so fun.  They bring things alive for sure. 

Finally, my husband becomes my patient

Today my husband came in because my morning patients cancelled.  I was going to see two children but that didn't pan out.  This guy hasn't been in for a dental cleaning in 5 years.  I can't even believe that some people live that lifestyle.  I haven't always known I wanted to by a hygienist, but I always valued dental visits and made sure to see the dentist at least two times a year.  My parents were really good about making sure that standard was kept.  For individuals and families without dental insurance, it can seem a considerable burden to make it to the dentist regularly.  It is our responsibility as dental providers that our patients understand the links between oral health and overall wellbeing.  Professor Perry has made the joke a few times that people seem surprised when they learn that they have developed a cavity in 6 months.  They say, "how could I have a cavity.  Everything looked good 6 months ago?!"  He comically replies, "You can practically create a baby in 6 months!  You can definitely develop a cavity."  That really puts things into perspective.  Ryan, my husband, must have pretty great genetics, because his calculus buildup was miniscule after that 5 year period and I know from first hand observation that it feels like pulling teeth getting that boy to floss.  I'm lucky if I can get him to floss once a month.  I told him that his days of no dental visits were over.  You cant marry a hygienist and not expect to see the dentist regularly.  That's like a boarding an airplane and not expecting to fly.  Anyways, I passed all sorts of PE's off on Ryan (3).  We performed a caries risk assessment on the poor guy and it turns out that his saliva does an excellent job of buffering the pH of his oral cavity.  That boy has a lot of good things going for him.  We made him a dental appt and look forward to hearing what his dentist has to say about his perfect smile (thanks to me!, haha).

Robin Returns

My title sounds like a quote from Batman...haha.  Kay, its really not funny.

Ada returned today for the rest of her cleaning.  I was initially nervous that I wouldnt be able to complete three quads of her class III dentition in one appt for a variety of reasons.
1.  Sometimes cleaning one quad of a Class III can take one hour for a very experienced practitioner.
2.  I didn't want to anesthetize bilaterally. 
3.  She needed NO2, and LA, and those take time as well.

I was happy to find that I did have sufficient time and that I was able to clean one quadrant without anesthesia, which was the best scenerio I could have asked for.

I passed off my nitrous PE.  I remembered that oxygens international color is green, even though in my head it should be blue...like the sky.  Oh well.  I accurately titrated the ratio of oxygen to nitrous and remembered to start at 1 lpm of nitrous to 5 lpm of oxygen. 

Ada was wonderful and I look forward to having her back next semester.

Reflections of the past week

Ive been craving the opportunity to blog for some reason!  Its a pity that the craving comes now because I really don't have anything interesting to say!  Haha.  I'll just try to start jabbering, I guess.

Thursday the 27th I had an interesting learning experience in clinic.  I had the opportunity to treat a patient that was severely visually impaired.  The appointment started out fine and xrays went smoothly.  I wasn't expecting any difficulty but as we moved into the cleaning, things got rough.  Matt had a very powerful lower lip and he refused to allow it to relax in order to probe his teeth accurately.  His tongue followed me everywhere and he struggled to keep his mouth open at all.  I had to borrow my peers' biteblocks, but he kept spitting them out on the floor so I had to go and find another students' biteblock so I could see in there!  I definitely earned my lunch that day.  It took a lot of patience and patient management to get through that appointment.

Oraqix and Premolars, not necessarily related

Nov 2nd was VA day.  I was able to pass off my Oraqix PE on Bonnie S in the morning.  I love the idea of Oraqix because it causes less anxiety for the patient than LA...but the more I work with it, the less faith I have in it.  I deposit the periodontal gel below the gingival margin just as I am instructed, but my patients (in most cases) continue to have sensation of the tissues.  I will have to ask pointed questions relating to patient perception of its efficacy at future appointments.  I want to believe in this stuff, but right now I feel like I'm forced to be skeptical.  In other news, I was able to take another pano!  I find it so much easier to meet our requirements this year!  I love it.

Eric was my afternoon patient and most of his teeth were missing.  We proceeded through his cleaning very quickly and it broke my heart to have to let him know that his remaining teeth looked to have a lot of decay.  I cleaned his partial denture and gave him some very detailed OHI.  We provided his oxygen throughout the appointment and that was a new experience for me.  He was a very nice man.  I felt really bad at one point in the appointment because I accidentally pulled out one of his mustache hairs.  It would appear as though that hurts.  ;)

I need to reach the distals of premolars  better...that's always where I'm fouled, particularly from the left quadrants.  Dr Hanson advised that we use a "wrist pop" technique with the nevi on each tooth before asking for a scale check so that we are never left with deposits along the CEJ...and I tried to utilize her counsel but still got banged on my premolars on thursday.  In the words of Phil Dumphy, "Come on Tanya!"  BUT but but...I was able to use my perio files finally!  They are a lot easier to use than I thought!  I really didn't understand them when we first practiced using them on our typodonts but our professors assured us that given the right situation, we would find them really useful on our patients.  I found that to be true on Thursday.  My patient had burnished calculus deep within the pocket of the distal of a first molar (I can't remember what quad I was working on anymore).  We used the file for two seconds and the initially stubborn calculus came off with one quick working stroke of my 13/14.  Cool beans.  It really didnt take much pressure at all with the perio file to reach the desired effect.  I can see how these are useful.

I need to sleep now.  Tanya out. 

LAT, LA, and Smiles All Around!

Alright, I have a lot I could say right now.  Last Thursday was AMAZINGLY productive, I thought.  My Class II patient cancelled at 10:30 the night before, so I waltzed over to my parents house to gather my moms health history.  I've kinda dreaded having to use her as an alternate because I knew her health history was going to be super labor intensive, but I also wanted for her to see me at work!, so I went ahead and scheduled her.  I collected all the information I needed in order to fill out my TX record Wednesday night, but I wasnt able to enter in drug info till the next morning because my DDR was in my cubby.  My mom is easily on 12 different prescriptions for various things.  She went septic in May of 2010 from a bladder infection and her health just hasnt been the same since.  The medications took me quite a while to fill out, but we finally were able to move forward to xrays.  I really have to pat myself on the shoulder.  I was super nervous about taking xrays last year but it is surprising to me how well they have come out this year on my various patients!  It really is encouraging and I'm grateful that I am getting faster at taking them, finally!  We were in and out of the xray room very quickly.  I was able to probe, chart, and clean 2 quads of her Class V dentition before the morning was through.  (With no errors!)  Not too bad!  I was also able to pass off my blood glucose PE on her.  It was pretty straightforward.

Robyn R came in the afternoon.  I had to dismiss him prematurely at his last appointment because he had a cold sore.  After completing his OD I was happy to find out he was considered a Class III!  I NEED those!  Haha.  Robyn has caps on each and every one of his teeth with implants interspersed so I had to keep a keen eye on my xrays throughout the appointment as to avoid using a metal instrument (or the wrong US tip) to clean the implants.  It was a good experience for me, learning to rely on xrays better in appointments.  After a few glances, I was able to find the tooth I was looking for more quickly, something that has been a frustration in the past.  I get so turned around...LR,RL...bah.  He had significant edema and erythema along his gum tissue, and it was diffuse.  These caps had caused a lot of irritation and the margins were not tailored to his anatomy very well.  My heart broke for him.  I was able to administer 4 injections, that went seamlessly I am happy to add.  I was able to pass off my first LA PE on him!  After his cleaning, we were able to use LAT -- Laser Assisted Therapy to seal off the blood vessels and lymphatics within his pockets that contribute to the irritation his gingiva are experiencing.  It was neat being able to use the CO2 laser on a patient, rather than just a chicken breast and tomato.  Im so grateful for the thorough education I recieve as a student at WSU.  We really do have the best program ever.  We completed half of Robyns mouth and are using the other half as a control when he returns next week for a reeval.  I'm excited to see what results we find. 

I Like Ice Cream

First, lets talk about the important stuff.  Like how sweet Professor Alexander is!  Thanks to her, this ^ is how I will remember my first mockboard experience.  Secondly, lets talk about Mockboards for a sec.  A lot can be learned from these experiences and I'm really glad that our professors give us the opportunity to practice before the real day comes along.  We were able to see, firsthand, the process involved in checking in our patients.  Through the experience of being a student examiner, I learned that I need to improve my exploring methods.  According to Inst. Perry, so do all the rest of us!  At least I'm not alone. ;)  He had a really healthy comment/recommendation that I need to remember...that because I am a leftie, the angles by which I feel calculus deposits are different from that of my professors/peers, etc.  It would behoove me, to explore from right as well as the left, so that I can gain the same perspective as my instructors as they perform scale checks on my patients.  This will be particularly useful on the day of boards.  I was grateful for that advice. 

I learned some other things as well. 
1.  Curved u.s. tips are fantastic and I love them! 
2.  I could use a little more one on one in learning how to use my perio files.  They do me no good right now.
3.  Don't create more work for yourself than necessary when submitting which quads you want to clean.  It was completely unnecessary for me to add two additional teeth beyond the quadrant that I specified I would be working on. 
4.  Be aware that board examiners watch the third molars like a hawk and almost look forward to marking you down for reaching those teeth.  If at all possible, I will avoid seeing a patient with third molars on my board examination.
5.  I can pass...and I did.  Thank the royal heavens.
6.  It is easy to capture third molars in supplemental films by adjusting your POD so that it has a steeper horizonal angle. 
7.  Calculus is stubborn and it needs to be taught a lesson.

Pretty Blue Eyes

My VA patient was beautiful.  Especially his Class III dentition ;)  When Prof. Bossenberger told me that two quadrants were Class III and two were Class II I somehow thought I should be able to finish the patient in one day...I dont know why I thought that.  That's ridiculous.  Anyway, I started by cleaning his upper and lower right and decided at that point that I didnt want to continue any farther.  I think I took on more than I should.  Only clean one quad of a Class III at a time.   I knew that, but forgot that.  I missed a lot of the interproximals, and didnt really have time to get help on how to access them better.  Bahhumbug.  Next time I will allow myself more time on a class III.  My afternoon patient cancelled so I ended up having to CA.  Bah.  Today, I saw a patient who, in times past, has been considered a class III and mostly a class IV.  Instructor Perry helped me to see why this patient, in general, would really only be considered a Class II.  I understood his logic and wouldnt have wanted my patient to be charged for anything more than a Class to SRP in real life, but he had some extremely deep pockets along 10,11,and 18 (18 was 11mm!!!) and I definitely think that for my efforts, this patient should be considered AT LEAST a Class III for the effort.  It is going to be rough!  Gosh, I need this week to end.  Ive taken on far more than I can chew and Im exhausted and discouraged. 

Nitrous Rocks!

We performed nitrous oxide delivery on one another today.  Ive only used NO2 in a dental office once, and I lost faith in it when it didnt make any difference to my level of comfort.  It turns out that when you get the appropriate ratio of NO2 to O2 (for me, its 2.5 lpm of NO2 to 5 lpm of oxygen), you most definately feel the difference.  It isnt disputable.  I immediately started laughing and then the more I laughed the more I wanted to.  I thought of the scene in Mary Poppins where everyone is floating in the air and singing "I love to Laugh."  It was a good time.  I now feel more confident that NO2 can take away tensions that may arise for patients when they come in for dental treatment.  Today has been lots of laughs. 

I LOVE being with these girls and our professors.  They are a hoot!

Mockboard pt found!

Yesterday I was finally able to find a mockboard patient, and his xrays make him look like he may be prime for boards.  Because of this, my professor encouraged me to take PAs of half of his mouth so thats how I spent most of his appointment.  I am so relieved to have found a patient!  In the morning I cleaned two quads of a class II.  She was my first experience with mobility.  #2 was moving with the wind after I disrupted the calculus bridge that was holding it to 3.  I had to hold the tooth as I scaled around it.  There was calculus on every surface.  When I brought in Perry for a scale check he said I had missed small spots on the M and D of that tooth, so he encouraged using more lateral pressure.  I realized right then why I hadnt gotten it all...on a mobile tooth I was afraid to use too much pressure.  In the end though, we arent doing our patients any favors by leaving traces of burnished calculus around.  Lesson learned.  ;) 

FOR THE LOVE!!

I want to use a swearword on my blog right now but I'm not that kinda gal so I won't.  I love a thousand different things about my second year but I HATE one thing...getting people who are obviously apathetic to their dental care to KEEP THEIR APPOINTMENTS!!!!!!!!!!!!!!!!!!!!!!!!!!!!  Coming into today I was ALREADY on my THIRD string of patients and then my morning patient cancels.  I don't cry very often but this news pushed me there.  When our grades reflect the agency of others, the stress goes a lot deeper.  I tried and tried to get a classification met that was beyond a 1B or a V.  Three times, I tried.  Now I have to finally relent and treat the only patients that are truly dependable...1B mother-in-laws.  Don't blame me professors!  I can truly say I tried. 

Stab and be Stabbed; there is no question.

Well, there was no avoiding it so I had to put my brave face on.
We delivered anesthesia to one another last Friday in clinic.  My partner was Karlie Weeks.
What a darling girl.  She is so great.  It's impossible to be tense around her. 
And it turns out there was really no reason to be tense anyway.  Things went swimmingly!
(Who came up with that expression anyway? It makes no sense).
I decided that Karlie should give me the 4 injections first...a Posterior Superior Alveolar Nerve Block, a Middle Superior Alveolar Nerve Block, a Greater Palatine Nerve Block, and a Nasopalatine Nerve Block, in that order.
We practiced with long q-tips first to make sure we had our angles correct.  Professor Costley was our advisor for this lab.  I was pretty excited about that.  She is wonderful.
Karlie set the bar high by giving me 4 flawless injections.  Yay Karlie!  When I get injections, I find it comforting to distract myself by humming or pinching my leg.  I chose humming during the palatal injections and I think I made a bit of a fool out of myself.  Oh well...I was less tense because of it.  Palatal shots aren't very fun by nature, but she did a good job.
Next, I was up.  Professor Costley came to watch my angles as I practiced.  She said I was positioning my "needle" perfectly so I told Karlie that it was safe to expect perfection.  ;)   Alas, I let her down just a bit during the deliverance of the MSA.  My site of penetration was a little far mesial and I had to reinsert my needle at the long axis of the 2nd premolar.  She told me she hadnt felt either of the injections that I had delivered up to that point.  Yay!  Like I stated before, palatal injections arent fun by nature, but she was a trooper and handled it better than I probably handled hers.  I felt a little sheepish for not being silent during her experience.  Next time, I will be better.

We got through it though!   We never pinched a vessel and our areas were beginning to feel properly anesthetized.  Yay for us!  It was a good day...I learned alot, built alot of confidence, and I don't expect to feel further anxiety at the prospect of giving maxillary injections.  We'll see how I feel about the IA next week.

New semesters, New Challenges...I'm ready!

First blog of my last fall semester.  I can't believe we have started into our second year.  Going into this year, I anticipated feeling a type of stress that I am happy to say I have yet to feel.  As a senior student, we are expected to work faster with greater precision.  After 4 months of downtime, I questioned whether this new standard was realistic.  It turns out that I underestimated myself.  Disclosure: I do not mean to imply that I think too highly of myself.  I have a lot left to learn (and much that I can improve on); but I am relieved to have made a more seamless transition into the expectations of my senior year than what I had originally expected.  (Random Side Note (RSN): I'm realizing my grammatical skills need some help!).

My first few weeks of clinic have been surprisingly productive.

I am able to complete my 1B's and V's in one day!  I do lose alot of time if I have to take xrays.  Xrays intimidate the shnoz out of me, but of the 3 or more sets of BWX and PAs I've taken this far, I've only had to retake 1 film.  I guess I DID internalize these things from last year, hehe.  I re-realized that I don't have to shift the POD on its axis as much when I transition from a molar shot to a premolar shot.  Anyway, point being -- I need to be more efficient with my time in the x-ray room so that I can treat my patient sooner.  Any advice?

It took a while for terms like 'exostosis' to register in my brain again, but I'm remembering most of them now. 

My Cc going into this year was:  I FEEL SO SLOW.  I've made a goal to discuss this concern with each of my instructors so that they can monitor my time closely and help me along.  I've had to eliminate the tendency I have to recheck areas I have already scaled, explored, and deemed to be clean.  No going back Tanya!  McCall gave me some good advice about speeding up the process of probing while we were on our way back from VA the other day.  I look forward to implementing that.  I'm really grateful that I haven't been dinged on time management yet...well wait, yes I was once, but that was unjust (I thought).  RSN: My patient at the VA realized he had to pick up a friend from the airport after I had completed 1 quad (he was a 1B).  I was not excited.  He came into the VA expecting that one tooth was going to be evaluated for a root canal...not that he was going to get a cleaning.  Upon his realization of this AT THE BEGINNING OF HIS APPT (before I had even picked up an instrument) I asked if he would be able to stay for 2 hours for the cleaning and he said that he would...then he leaves and I get marked down for it.  Whatever.  Discouraging.  I had woken up at 4:15am to experiment with taking Frontrunner and TRAX to the VA (DO NOT DO IT)  so I was tired and now a little grouchy, and still had to take UTA home.  I was in bed for the night 10 minutes after I walked into my door.  Bless Heather's heart for having to look at my pouty face all the way home.

My first clinic day was great fun though!  That's when I learned that I could clean FM in one day.  I was all grins, even though I was still really tired from the day before.  I think I drank a bottle of 5 hr nrg and 1 can of redbull that day.  I caught myself hiding the can of redbull deep in the garbage can because I felt ashamed for having taken it, hahaha.  Oh Tanya.

RSN:  I must preface this story by saying I do sincerely enjoy VA, and I clarify this because I realize that I  haven't posted anything positive about it yet.  The following story isn't positive, but its true and I want to humor myself with it later. I saw a pt who was a nice enough person but his chairside manner was appalling!  I thought back to VA training when we were warned about the behavioral things we would have to brush off of our shoulders every once in a while.  This man kept making comments about my chest and I kept telling him he was being inappropriate!  After explaining that during his intra and extra-oral assessments I would be looking for "lumps, bumps, or anything that seemed irregular" he asked if he would get his turn (as he stared at my chest).  My stomach sank.  Grossly inappropriate.  Toward the close of the appointment he made a comment that was particularly uncomfortable and I told him (nicely) that it was time to stop with the comments and that I was a married woman!  He responded, "Ahhh, does that mean I'm not getting any?" and I said, "It means you're not getting any-where."  I never felt in danger, which is good, but goodness!!!  He could use some manners! 

OK, so enough chit chat.

What I learned from Todays Clinic:
1.  First, that C.W. has the best oral hygiene habits ever!  She had the cleanest mouth I've ever cleaned (except that she had abrasion and recession, which was sad to see).
2.  Your dental professional knows all.  Even if a patient manages to hide his/her marijuana smoking habit from you all throughout his/her cleaning, IT ALL COMES OUT when you polish.  ;)  What's that smell?!  OHI topic -- covered!!!  Thank you rubber cup!
3.  Next, cold sores sucketh.  I'm blessed in that everything panned out and I was able to treat his wife instead but my stress level jumped there for a while; I was the last to turn in my charts; and I learned the hard way that it behooves you to ask the patient if they have a herpatic lesion before your appointment.  One little question saves you time, stress, backup patients, and plastic barriers.
4.  Guilty pleasures abound in dental hygiene school.  You wanna feel bad for people when their oral hygiene habits are atrocious, but you can't help but smile when you learn that they haven't brushed in weeks or that they haven't seen their dentist in years (or ever!! if fortune smiles your way).  I look forward to a time when my patients' good fortune is my good fortune.  ;)  Reality Check: Will that ever be the case?  No, really, I hope so. 
5.  Periodontal files help to create a ridge on burnished calculus so that it is easier to remove.  Thanks Inst. Wold!  You were very helpful today!  I love your advice.
6.  Always lead with the toe of your instrument.  I know I knew that before, but today I needed a reminder while cleaning 23FD and 20ML. 
7.  Try as I might, my 204S just isn't that effective once you get back along the molars.
8.  Clearing off thin sheets of calculus without an ultrasonic takes TIME!  Kay, maybe I knew that before today.

That's enough learning for now.

Tomorrow we are delivering anesthesia to one another for the first time.  No exclamation points here.  Shots are not my best friends.  I feel okay about giving them, but its not going to be fun receiving them.  But I know I'm in good hands. ;)  Do your worst Karlie!  (or not your worst, whatever feels right at the moment)...

Finishing up those Class IIIs

Ill admit, I was nervous for a second that I wouldnt make it to that second and last quad that I needed in order to complete my patient today.  I spent a good portion of the appointment working on my patients UL quad.  Feeling pretty confident that I had removed all his deposits, I asked for Inst. Caldwell to scale check.  She found deposits on every tooth!  I wanted to cry and just about did.  She must have sensed that and told me not to be discouraged and that this would be a good learning experience for me.  She asked Inst. Hafen, a fellow leftie, to assist me in finding and removing said deposits.  Can I just say that Inst Hafen was a heavensend.  She helped me maintain optimum adaptation as I worked around the line angles of his anteriors.  I immediately felt subging deposits.  His teeth were significantly malposed on the lower anteriors.  Because of her advisement I was able to reach subging with my explorer, recognizing the anatomy of the tooth, and pull off deposits with my gracey that I KNOW i wouldnt have found without her advisement earlier.  She helped me utilize my graceys more efficiently.  I was able to feel a lot more comfortable with my scaling when in the twelve oclock and 4 oclock positions.  I used to struggle with getting stuck between the contacts, and she helped me to orient the instrument so that less of the blade reaches underneath the contact.  While I missed many deposits on the UL, I only missed two on the LL.  MARKED IMPROVEMENT.  Not only should we keep Inst. Hafen next year, we should send her a limo each morning.  ;)  I feel so ready for next semester!  Goal:  Dont forget all that Ive learned before starting up again next fall!  I cant believe Im going to be a Senior DH student! 

Finishing my class 1B requirements

Today Tim and Sharlene came in, and I am happy to report that I am getting faster.  I never thought Id see the day where I could finish 4 quads of someone in one day.  But alas, it has come.  I attribute it to better exploring, as I proved by passing off my PE today.  I was also able to pass off my blood glucose PE.  She handled the test SOOOO much better than I did when we practiced.  I admired her for that.  She had eaten recently and her glucose level was still within normal levels, which may indicate that her normal fasting blood glucose level is low.  This theory is consistent with her comments of getting dizzy if she goes too long without food.  I learned that lots of lingual bars are cemented only to the cuspids, rather than my case (where it is bonded to each tooth).  I thought Sharlenes calculus was the cement so I was careful to stay away from it, but it ended up penalizing me in my scale check.  I can now be aware of this.  Goal: try to fit two 1Bs into one appointment for next time, or very soon thereafter.

Impossible Things Happen Every Day

I love when life seems like a Cinderella story.  With faith and hard work, it seems that things just work out.  Today a senior student came into our class and asked if one of us needed a class III patient.  I have intended to bring in Henry for a month or more and he continually cancels on me.  Because I need him so much, I kept trying but something always comes up.  I tried to get patients to come in on our screening day to see if they meet my requirements but they all bailed so I was really stressing about getting two more quads of my class III.  I asked Prof Costley if I could take my clinic day that day and she thought it was a wise idea.  Angel Pichardo was a great patient, and I loved having the opportunity to sit in Senior clinic and associate with Prof Alexander.  It got me really excited for next year.  His tooth anatomy was rough and it made calculus detection difficult, but in the end, I completed two quads and only missed three places!  I was so excited!  It was a great experience, and Im grateful that the opportunity presented itself to me.  But wow, we need to take those scalers deep in to those molar pockets!  That was a learning experience! 

A day Lost

I gave up April 6th clinic day in liu of a pending extra clinic day in the future. 

Blanca, my second Class II

Kelsey needed someone to switch her clinic sessions so I took her morning shift.  Maren needed someone to see a class II patient for her while she treated their relative or something and I needed another class II so that worked perfectly!  Blanca was a great patient.  She didnt speak a lot of english but she got along okay with what I was saying.  My first three quads were nearly seamless...i did a great job.  I think I missed three spots between the three quads.  I regret to say that on the fourth I felt rushed on time and I TANKED.  Two other girls were in my same boat and we became a topic of discussion in podwrap that afternoon.  What we learned:  do not sacrifice completeness of care based on time...do our best work for the patient and take the knock on time utilization, rather than trying to pass off a half-baked job of scaling.  That hurts us more.  I learned my lesson for sure.  All that hard work on the first three quads got flushed down the toilet.  I owe it to myself and to my patients to be better. 

Most efficient day yet

It felt good to know I was proceeding at the pace I was intending to today.  I saw and finishing cleaning 3 Quadrants of Tamis mouth and then I brought in my niece Kenzie.  She is three and I was able to give her a pretty thorough cleaning!  Good girl!  So all in all, I cleaned 7 quads today!!!!!!!!!!!!!!!!!  and I didnt have ANY errors!  I was very happy!  I passed off three PE's as well!  I passed off my intraoral camera PE, my selective polishing PE, and my removable prosthesis PE.  My computer was giving us difficulty so we werent able to save Tamis images.  That was kind of disappointing because I see how taking pictures can be an effective means of educating and motivating our patients to care for their oral health.  I remember how uncomfortable polishing was when I volunteered in dental offices, but I was pleasantly pleased with my level of control as I polished beneath Tamis gingival margins during my PE.  My motions were very thorough and fluid.  That is one evidence of the progress I have made and I consciously realized how far I have come with fulcrums.  I hardly think about them anymore, but place them autonomically.  Its fun to realize how much progress you are making sometimes.  Kenzie was so good about letting me clean her mouth.  I was able to use my explorer and everything!  She is so good tempered!  It was so cute watching her keep her mouth open, even when she didnt need to.  I noticed some white spots and educated Sharlene about fluoride supplements that she could give Kenzie to guard against demineralization.  She knew very little about the advantages of fluoride and I was happy that I was able to make a difference for her. 

Niece and Nephew Goodness

Today I was able to take my panos, do 2 sets of BWX, and I was able to clean Peters mouth.  Professor Demings advised that I should be able to clean a Class 1A in 75 minutes, so I need to decrease my time significantly in that regard.  Goal for next time: Clean a 1As mouth in 75 minutes, like she advises.  I missed anteriors, which surprised me.  I thought those were easier areas, but I need to work on them more apparently.  Ill give them more attention next time.  As for Panos, they werent as hard to take as I was expecting.  Honestly, I was scared I was missing something but it wasnt bad at all.  I almost forgot to ask the patients to keep their tongue at the roof of their mouth but thankfully I remembered just in time.  I know that would have compromised the integrity of the xray. 

Finishing up Maries Cleaning

I had lots of ideas today.  I wanted to clean all four quadrants of maries teeth, which I already proved to myself I am able to accomplish.  I also wanted to pass off my sealant, diagnodent, and explorer PE's.  Reality set in and things turned out a bit differently.  I passed off an entirely different PE than I had intended, and didnt get to the PEs I had expected to pass off.  My Errors were- Supra: 19M,26M,27MD,28D; Sub:14M,15M I obviously need to develop a greater awareness of which instruments will clear calculus deposits more effectively.  I really need help on cleaning canines...their anatomy can make it so difficult to clean them effectively.  Im still not sure about what instrument is best to use there.  I dont like using the nebraska or nevi there.  Goal:  Ask for help finding an instrument or position more conducive to cleaning cuspids and to improve in those areas.  

Tani Continuing Care Appt

Tani ended up having quads of class II and I didnt get through more that her UL quad but it was a good day!  I wasnt able to finish her today as I was hoping.  I learned that coming to the 12 oclock position and using the nevi while cleaning the linguals of the maxillary left quad can be really effective, especially around the premolars.  I felt like that position was a little niche for me...it felt really comfortable.  I did a fairly good job of reaching interprox and was able to pass off my U/S PE.  Goal: trust myself and commit to moving forward without rechecking all areas.

Air Powder Polish PE and my first child

Joyce came in to have her teeth air powder polished and brought her son to have his teeth cleaned.  I made a custom map of campus to let her know where she needed to grab a  parking pass.  Austin was very timid and leary of coming in.  Im used to my courageous niece coming and had to really work to build a relationship of trust with him.  I started by reading him marvin the magnificent molar and showing him the instruments and tools that he saw in the book.  Then I asked if I could count his teeth.  I told him how big and awesome he was.  I made sure not to tell him he was being brave, like it was going to be difficult for him.  Offering him stickers helped.  I brought him a coloring page of someone brushing their teeth.  I need to remember to bring crayons next time.  He had to use my markers.  Instructor Hafen had a great idea.  She took a glove and filled it with water to keep him distracted.  It was of comfort to him and he was more willing to sit in his moms lap while we looked in his mouth.  He was afraid of the mask at first so I let him try one on and he was able to brush his moms teeth while I brushed his.  It was a good experience trying to enhance patient comfort and he was talking openly with me by the end of the appointment.  That felt great!  Goal for next time:  Remember to ask pt if they are interested in a headdress when I am airpowder polishing.  Everything else was great.  Also, leave more time for Peer calculus removal PE.  Im sad I wasnt able to finish that today according to my plan. 

Finally getting some PA's...

Before:  It feels so good getting closer to meeting my xray requirements.  Today I will be taking a full mouth of PA's on Tani, my sisters friend.  She hasnt been to a dentist in years and feels she could use a detailed look at her anatomy. After:  Tani was an amazing patient and she was very patient as I worked around her mouth and took alot of xrays.  They came out awesome and I was surprised at how healthy her teeth were looking considering how long ago her last dental appt was.  I didnt have to retake a single image and my professor said they were beautiful!  That was so empowering!  I wasnt able to fully complete her OD, which I feel I should have been able to accomplish.  Probing still seems daunting...doable, but daunting.  It just takes time, but really not as much time as I tell myself it does.  Goal for next time: don't let myself think that taking xrays means I have to sacrifice progress in the clinic chair...I can do both and get through alot!

Red Lobster later tonight!

Kay, Im gonna try to focus on what I did today in clinic but Ill be honest, crab is about the only thing on my brain right now.  I was surprised to find that she was a harder classification than what we determined in her OD appointment.  This was due to the great amount of calculus she had on her teeth.  Unfortunately, I wasn't able to detect the calculus...well I did, but after trying unsuccessfully to get it off I figured that it was tooth structure.  Professor Hafen came and used an astounding amount of pressure...more than I would have ever felt comfortable activating, and she was able to get off that tenacious calculus.  I hope that next time Ill be wise enough to know when Im feeling calculus and not tooth structure.  I would hate to use that kind of pressure on only tooth structure.  I need to explore deeper into the contacts of the patients teeth...almost through to the anterior surface on the linguals.  Especially on the mesial side.  Most of the surfaces I missed were mesial.  Goal:  fail to miss any mesial surfaces on my next scaling appointment.  I also need to complete more PEs.  Ill make an action plan in my planner for which days and on which patients I will pass off each PE so I can be prepared.  Now, on to that crab!!!

Goal Achieved! AND the most satisfying day yet in clinic!!

After disappointing myself beyond reason last Wednesday, I was determined to finish 4 quads of a 1B in one appointment...and TODAY I DID!  On my Father!  It was exhilarating!  and Im glad I was able to share the memory with my dad.  Everything went smoothly and of the whole mouth, I only missed one surface of supracalc.  Not bad, not bad!  AND, I finished 2 PEs.  Now that I've accomplished this, I will expect no less of myself and I WILL complete 4 Quads on EVERY OTHER 1B patient I see.  Using the scaler to search surfaces of the teeth for deposits really helped to increase my time, as well as being confident in myself.  It helped that my dad has such a large mouth!  Easier access to all the surfaces!  Professor Costley recommended using and H6/7 instrument for anteriors because it is less bendy than a nevi.  I havent tried using one before, so I put it in my cassette for sterilizing, instead of the Indiana, which I rarely use.  Ill test it out. 

I wish I had finished Tami today!

Monday was Presidents Day.  No clinic.  Today I walked into clinic confident I would be able to finish Tami's OD (including probing) and complete all her quads.  After completing only 1 quadrant I have to admit, I feel rather defeated.  The great aspect of the day was that I didnt miss a single surface on her quadrant, and truth be told I was able to finish the second quadrant.  I just had no time to have a professor do a scale check before I had to have her out the door.  I feel really discouraged about the time it takes me to scale.  I need to improve my time drastically, especially since she was only a 1B.  Next time I dont care what it takes, I will finish all 4 quads of a 1B in one appointment.  That is my goal. 

Major freakout.

Heather stabbed me today.  With a blood glucose lancet.  Nothing short of traumatic.  I HATE blood glucose tests.  Stab me anywhere else and Im fine.  I wont even flinch during anesthesia next year, I just hate giving out my finger!  Well suffice it to say I can sympathize with my patients now, if thats what they were going for.  ;)  We also learned how to clean removable prostheses and pretended to know how to use the diagnodent.  We were the test dummies with that training and our machines werent working the way we expected them too.  Hopefully Ill be okay when it comes time to pass off those PEs.  Everything went smoothly except my big freakout in class and I hope Ill be able to pass off those PEs soon.  Goal:  never have a blood glucose test again. 

CA Duty

Happy Valentines Day!  Today I was able to be a CA for the morning clinic.  Im feeling more comfortable with the responsibilities the second time around.   I do pretty well.  The other 1st year came in a little late but I was able to get things going seamlessly!  I hope I feel comfortable with it next year after the long break.  Im glad Im getting these TA duties out of the way early. During clinic I completed Raphael.  I feel bad that it has taken this long to finish him but it felt good to finally tell him he wouldnt have to return for 6 mo.  I received some good feedback from an instructor regarding decreasing my time.  She said to use my scaler to explore rather than switching back and forth between the scaler and explorer.  Then I need to use my explorer to reexamine those areas I used my scaler to explore (once I think Im finished).  Ill try implementing that.  Goal:  decrease my time scaling.  Im so slow!

OD

I feel like all Im doing are ODs!  I feel like a measly assistant!  I guess it will pay off later.  Marie came in today.  I had to have her sleepover so that I knew she would be there.  Things went smoothly.  I was even able to diagnose 2 sealants on her.  Goal for next time she visits: complete my sealant PE.  Today I got some good feedback. Marie is a good friend so she was really open as to things she didnt understand as I spoke with her.  I learned of those things I can explain differently and more clearly.  I appreciated her feedback.  Goal:  be clear when explaining what I am performing on my patients.  I took BWX digitally, and had difficulty reaching that far back.  I should work on that.

Scaling a Quad II

Today I started off taking xrays of Stephanie.  I did a pretty great job and she mentioned that she was a gagger, but after instructing her to breath through her nose and to lick salt she did just fine!  I felt good about helping her!  Then I was able to treat 1 quad of Raphael.  I would have really liked to get through 2 quads but it took a super long time to get Vining to verify my xrays to Steph.  That held me up a good half hour.  Agh!  At our next appt Im going to try super hard to work through Raphael.  I want to be faster!  And goal for next time: Pass off a PE.  I need to get on that, STAT!  Maybe Ill do anterior and pictures next time! 

My Favorite Father!

Marie was supposed to come in today but she slept in so I had to call my dad.  I was anticipating a really difficult day but his calming influence and ability to "open wide!"  made it so easy!  Plus, contrary to my dental hygienists opinion, he is only a Class1B.  I was able to catch all his restorations and even 9/10s of his root canals!  I was so happy!  It has been a great day, and I feel really wonderful.  I did a swell job of probing and evaluating dentition.  Goal for next time: move through probing somewhat faster.  And I accidentally disclosed my pt before my OD.  Instructors need to be able to evaluate tissues so I need to make sure to do it after.  Only problem is I was asked my pts PFI once at the OD and I didnt have it so I got confused as to when it needed to be accomplished.  Everything got taken care of though.

Doing lots of ODs

Today I realized Im spending alot of time on OD's and that I need more scaling appts.  Time for return visits and I need to study ways to be efficient with my time on scaling...utilizing my explorer and keeping instruments sharp.Still, today was a good day except that I slept through my TA duty and failed the PE because of it.  Slime that I am!  I need to watch my calendar better.  I saw Raphael for the first time today.  He is a really nice guy, and he is a Class II patient.  When I realized this my stomach dropped.  Im not sure I am ready to clean a class II already!  Nevertheless, it was nice to know I have found someone who meets that requirement for me.  I hear finding patients can be a chore.  Goal:  Finish at least two of his quads at his next visit.

It was a short day; it was a long day.

Today I had one quadrant left to scale on Rachel.  I figured an hour and a half would give me plenty of time to finish her.  I didnt account for instructors and I felt really bad as she had to wait forever before she could make it to her other appts.  Inst. Demmings said I was missing areas on the anteriors and try as I did, I couldnt find or remove any deposits.  She came back to scale herself, and couldnt get anything off.  She concluded that the pts teeth must just be that way.  So Im confused cause I dont know if I was missing things or if it was the shape of the tooth.   I guess I need to be braver with my curet.  She gets it right down there and Im more timid.  How is it that 1 quad on a 1B can take so long.  Im kinda depressed.  ;)  I was going to have my sister-in-law come in later to get started on her quads but I didnt have time to bring her in.  Goal for next time: reach scalers subgingively more effectively. 

I love Asians!

Today I met Joyce.  She was an orthodontic patient and had a really cute personality.  I saw that she was missing 7 teeth and I immediately got nervous.  How was I going to be able to tell which teeth were missing for sure?  1st premolars or 2nd premolars?  I looked for the diastemas and managed to mark all the right teeth as extracted (except one).  I felt really glad that I was able to swing that!  It seemed to take forever to get through OHI...probing, charting all restorations, caries, tissue characteristics, etc but I managed to catch EVERYTHING except coated tongue.  Its hard to know what qualifies as coated tongue cause Ive marked it before and was told the person hadnt gotten to that point yet.  But seeing her tongue after being told that it was coated tongue gave me a better idea.  After entering this program, I have been super particular about brushing my tongue.  It humors my husband sometimes.  Anyway, I probed accurately, even with braces to navigate around.  That felt good.  At her next appointment Ive been told to use the US on its lowest setting.  Im so excited!  Goal for next time: explore before using a scaler...sometimes I use the scaler with an exploratory stroke, but Im going to be more careful about my scaling. 

No shows = Greater Appreciation for MIL's

I took all measures to ensure that my patient would make it to her appointment today.  I sent her an email with all the information she needed, including information about where to find a parking pass and a campus map.  I called her the day before and she seemed excited to come.  Then she texted me at 7:50 this morning, having had an emergency, and told me she would have to reschedule.  Oh boy.  Already with this stuff?  Haha.  Well I hope everything was okay with her family.  I will call her later today to see that everything is okay and to reschedule her.  I consider myself very blessed to have back-ups.  Today, I called in my mother in law.  I love Tami.  I had woken her up so it took her an hour to get showered and over to the clinic but I appreciated that she was willing to come.  While I waited for her I helped other students with their patients by recording probing depths, etc.  Emily was super cute and offered to record my patients depths when I was able to reach that point, but unfortunately that time never came.  I had to put together an extensive HHx.  I was pleased with my detail.  I was thorough and confident.  I am getting better at finding pulses!  Hooray!  I took her in for BWX.  I was determined not to get myself worked up, so I kept a cool head and decided to take conventional films.  I need them and Id prefer to take them on BWX patients rather than for a full mouth.  Organizing 40 films sounds like an ABSOLUTE NIGHTMARE.  So, guess what.  I must have lost my touch.  I think there were only 2-3 times ALL LAST SEMESTER that I cone cut my x-ray films and I was a natural with BWX.  Today I did a great job at leaving contacts open but I'm tallying up the conecut images this semester.  What happened?!  Both of my molar shots were cone cut...even on the retakes (although not as much).  I need to repent of this.  I am not going to stand for this!  No way, no how.  My film placement was fantastic...I just need to move the PID closer to the front of her mouth.  Noted.  Good thing that the teeth that were essential to capture in the images were clear.  I was able to perform her extraoral exam but I didnt get any farther than that and OHI.  I am getting more comfortable with explaining OHI in words patients understand...and I dont stumble over choosing my words as much as I used to.  Hooray again!

Compliment to Self:  Continue your good work on charting.  I feel I do fairly well at this. 
For Next Time:  CONE CUT AND DIE...in other words, no more of that nonsense. 
Note to Self:  Make MIL cookies. 

Filling the spaces

I walked into today 100% confident I would finish Rachel.  I only had 3 quadrants to clean afterall!  Don't ask me how the day managed to slip away from me, but after taking longer than I expected I would on scaling, and after waiting a lengthy period of time for my instructor, I only made it through 2 quads which means she gets to come back.  Blah.  I feel defeated...haha.  I feel that Instructor Demmings is of the opinion that I should be working faster.  I want to work quickly but I feel its more important that I master my technique (adaptation, angulation, etc) before I focus on speed.  Still, I need to be able to finish 3 quads of a 1B in one appt.  I will never complete all my requirements if I proceed at snail pace.  Next time I scale, my goal is to improve my time by using my explorer more effectively.  I also need to have more controlled working strokes and a firmer fulcrum.  I will also ask for an instructor earlier so that I get them when I need them!  They have so many of us to help. 

Oh and I had a thought.  HOW COOL WOULD IT BE to have a clinic day where our Senior peer pals observe US!  It would be so neat to have one on one time through an entire appt.  We would be able to ask for pointers and they would be able to teach us a lot!  I think I will recommend that to Professor Costley sometime.  It may not happen for us this year but it may be able to help the juniors next year. 

Chatting up the hair stylist

Rachel came in as my first patient for the semester.  Can I just say how much I enjoy this girl?  Not only does she do an exceptional job of cutting and styling my hair, but she makes for one awesome patient!  My goal was to get through the day.  I was a little intimidated by the tasks at hand.  After going through an OD and scaling 1 quad, I had CA Duty.  I expected it to be a long day, and while I admit that I left it fatiqued, it wasnt as draining as I expected.  Rachel was a Class 1B.  I did better with my probing than I did with Sharlene at the end of last semester.  After scaling one quad, Instructor Caldwell couldn't find any missed areas.  That was the best feeling in the world!  I hope to be an efficient scaler.  Im sure everyone does.  I considered it a great compliment that throughout the appointment, Rachel kept falling asleep.  I could tell I had lost her when she'd go to close her mouth on my hand. ;)  I have always considered it a compliment when people fall asleep in my car as I drive.  It seems to indicate that they trust me as a driver and that they are comfortable.  I can't imagine that it is any different as a patient.  If you can fall asleep as Im scaling your teeth, Im obviously not jabbing you!  Hooray!  Shes coming back Monday so that I can finish her up.  As far as CA duty goes, I have to say that I love paperwork.  I always have.  I enjoyed working at WSCU as a teller...logging stuff into computers and helping members with their membership and loan apps.  It was fun to be at a desk again, as weird as that sounds.  I got more familiar with all that is required behind the scenes to make a dental clinic operate.  Supplies run out quickly and Tori and I were spending a good share of our shift restocking and getting supplies for the girls.  I was able to start an autoclave which was good practice for me.  I need more exposure with that, I do admit.  I enjoyed being there to help the girls as they needed.  I found it really rewarding.  I hope I did a satisfactory job!  I tried.  Im glad Tori was there to help, as she has had a lot of experience working at this clinic.  Thanks Tori!

Back to Work!

I was overwhelmed about a week ago, but today I have been remarkably calm about coming back for a new semester!  In clinic, we went over ultrasonics and graceys.  I have to say I'm excited to use ultrasonics, but I LOVE that we are being encouraged to build our muscle memory before we are unleashed with powered instruments.  They are essential to the work of a hygienist, but it is more important that we learn precision and technique with handscalers.  The more we build our muscles and tactile sensitivity, the more quality others will find in our dental work.  I am glad I am attending a University that challenges me and and helps me to become the best hygienist I can become.  I dont want to cut corners.  Im excited for my patient Wednesday!