Mrs. Stain

      Last week a older woman presented to clinic for a cleaning with me. When speaking to the woman, she seemed very interested in her dental health. I briefly asked about her home care while updating her medical history. She stated her brushing and flossing was fairly regular. When I assessed her deposits, I noted only localized light biofilm accumulation and minimal calculus. These findings supported her home care routine. I was very surprised however when completing the perio charting and finding significant probing depths with bleeding. The radiographs provided even more evidence of the bone loss, with moderate vertical bone loss. In addition, I found moderate staining, localized to the lower anterior teeth. Mrs. Stain stated that she frequently drinks tea, which would explain the brown stains.
       Planing the patient's treatment plan was tricky, she had COPD which meant absolutely no cavitron. Removing any deposit was not difficult, but removing the stains (especially interproximally) was very hard. I could not finish the AP during the first appointment and had to reschedule the patient for a summer appointment. Once the patient left, I began thinking about what would benefit the patient the most. The periodontal disease was present, but why? There did not seem to be a local irritant (plaque/calculus). Suddenly the information seemed to stream in... the patient was a type II diabetic and had COPD.  Due to the diabetes, she would have delayed healing and an increased risk of periodontal disease. To treat the pockets, I will seek the advice of a perio resident. Local antimicrobial delivery and oral irrigation (with monoject and peridex) are two options I think may help the patient.
        I informed the patient before she left that we would need to assess the sites and home care at the next visit. I'm hoping that OHI will improve her gingival health somewhat. At the next appointment I plan to get a plaque free score, GI, and complete the AP. If the patient accepts, I would like to make her my case doc patient and help her in achieving improved dental health.
      This clinic session taught me to think outside the box of poor oral hygiene. I had to consider other reasons for the periodontal disease. In the future I will always assess the patient as a whole and take the knowledge I have gained from periodontics, theory, and other classes to create the best plan for the patient.

GPG... testing my dental materials knowledge

  As the semester is drawing to a close, I would like to reflect on my days spent in GPG. Wednesday is my last day spent in GPG land and I feel grateful to be finishing the rotations for now. I found the GPG experience to be very dependent on the day, dental student, and treatment. Overall I felt that it was difficult to find an eager dental student to allow me to perform a cleaning or to assist in the beginning of the semester. I have noticed that as the semester has gone by, the dental students seem much more willing to say yes to my assisting offers. My GPG experience changed with each dental student I helped out. Most of the dental students were confident, easy going, and were amazing with their patients.
      However, there were certain students who were nervous, did not seem to know what they should do next, or had horrible patient communication. In one rotation I worked with a D4 who seemed to be more concerned with time than explaining to his patient what needed to be done. The patient actually confided in me several times when the D4 left that she was confused and was not sure what had changed in her treatment plan. Once the D4 returned, I asked that he explain to his patient what he was doing, since she was confused. He merely stated that he was doing the same thing as before and that he was short on time to go in depth about it. I was quite shocked that he couldn't at least explain it to the patient while prepping the site. Hopefully this D4 will pay more attention to his patients once in practice.
       Aside from the dental students personalities, I felt that GPG allowed me time to review dental material properties. I often questioned the placement of certain dental materials and gained further information from the dental students. I was introduced to a few materials not covered directly in dental materials. Ti-Core is an example of such unknown materials. It was interesting to hear why it was placed and how it reacts. There are two separate parts, the white part is the catalyst and the grey is the hybrid composite (with titanium or lathanide). Ti-Core is self-curing when mixed and is chosen because of its strength and longevity. Ti-Core information 
         I hope that Wednesday's GPG will be well spent and educational. The GPG rotations have been helpful and have prepared me for future communication with dental students and dentists.

Ethics in Dentistry

After conducting an interview with a local oral surgeon I have found a new understanding for ethical decisions while in practice. The interview we had consisted of scenarios to which the doctor was to answer, explaining any particular incidents of such cases. It was very interesting to hear that he would keep open communication with referring dentists even if a patient seemed to present with iatrogenic conditions. He stressed the need to eliminate assumptions or blame upon the other dental practitioner. Dr. OW seemed to feel that the other dentist could relate to the case somewhat easier. This is a wonderful way to enhance professionalism and to educate other dental professionals on current principles of care.
   As for the question Dr. OW answered towards the end of the interciew, he was very eager to share his wife's experiences. It seemed that misdiagnoses of periodontal disease as well as referral to other doctors are two other important questions. It is important to include the patient in the conversation of what is actually wrong with the area.

Radiology free time

Since I did not have a patient in clinic this past week, I was pulled into the radiology clinic for some additional practice. In the past I have taken PAs and PANs. So the experience of radiology is there, it just needs some refining. Having the chance to work in the new radiology clinic on the 1st floor was wonderful. I might add that the clinic is beautiful and has really nice equipment. The part of the session that benefited me most was actually taking the FMX and critiquing each image. Timing ourselves to make sure we could complete all films within the time allotted in clinic was a good test for us. Looking at each image and seeing where we had made our mistakes also helped me understand what I needed to pay attention to while taking the images. As we discussed problems and questions with taking x-rays in clinic, we agreed that we wish we had received an orientation of the radiology clinic upon beginning the program. There was confusion about what needs to be brought, what information is needed, and where to even go once in the clinic. Perhaps just a walk through and having students fill out the forms in the first semester would help alleviate some of the uncertainty. All of the questions and discussions were very helpful.  A day that would have been spent standing around the clinic turned into a motivating day learning ways to perfect my radiology skills.

Rally Day

Both the junior and senior classes were able to take part in rally day at the state capitol. This day was a chance for dental hygiene students to meet with representatives in the Richmond region to discuss DH bills and encourage them to support higher education bills as well. The experience was wonderful, meeting the representatives, learning how legislation works in the capitol, and even receiving a tour of the historic building. While I enjoyed the day, I felt that I was unprepared for the events. Some of the juniors as well as myself did not know what the day's events consisted of. I was also somewhat disappointed that there was no time to meet the other DH students who had travelled from Roanoke or NOVA to be there. It would be beneficial if next year they provided a guide to the events occuring during rally day and even discuss in class before that day the bills that are a concern for us. It would be nice to also have a breakfast time prior to the meeting to speak with other DH students. Overall, I felt that rally day was a great learning experience and will enjoy taking part in the event next year.

Bad Breath iphone app.

Maryland Bridge

I found two sites describing Maryland bridges and variations to the metal alloy wings.

Fibers used in bullet proof vests used in dental composites

Variants of MD bridges