You Win Some... You Lose Some!

Today I was at the WSU clinic and, let's just say I haven't had the best of luck there so far! 8 o'clock came and went and my patient did not show. I tried calling her multiple times and could not get a hold of her so I went straight to the resource list. I found someone to come in at 9:30 and, just as I had them confirmed, my patient called and said she was lost on campus trying to find the clinic. So, I ended up doing a screening on my original patient and an OD on the patient I found of the resource list. At first, I was a little flustered. But, I was determined not to let this get the best of me. I just had to tell myself that I was doing the best I could do and the rest was out of my control! I was hoping that my first patient would qualify for mock boards, but she did not have adequate calculus. I was feeling discouraged that I would not find a mock board patient, but my second patient (off the resource list) qualified - this made my hectic morning totally worth it! This was the first day of second year clinic that I did not clean any quads and it was somewhat weird to be in clinic all morning and not clean any teeth! However, I was able to get two sets of BWX and 2 PAX. So, some progress was made. I have really tried to focus on keeping my emotions in check this year and "controlling the controllable" and letting the rest be. Through focusing on this, I have found myself learning and enjoying clinic a lot more because I allowing myself to be comfortable within this setting. Can't wait to get some teeth clean Thursday at the VA! :)

There is ALWAYS something you can do... You can ALWAYS make a difference!

Last Thursday at the VA I saw a severely disabled patient who had several health complications. He only had two fingers on his left hand. He discussed the extreme difficulty he had with brushing his teeth due to this disability. Due to his numerous meds, he had severe xerostomia. Along with his xerostomia, he had a geographic tongue. The combination of these two conditions made it impossible for this patient to use toothpaste as it burned his mouth and tongue. After hearing all of the complications my patient was fighting, I was determined to do what I could to help! As he opened his mouth, I discovered severe plaque accumulation and bright red, raw tissues. To make a long story short, I decided to use a toothbrush and the rc polish with water to debride the teeth. After, I then hand scaled. Upon reflecting on the experience, I was grateful for the challenge to think "outside the box". I think it is very easy to get into 'routine' and forget to PERSONALIZE pt. treatment - today, however, I was forced to do so. It really opened my eyes and made me more aware of the need to find ways to personalize each patients treatment - not just severe cases. Everyone needs something a little different to be successful! All in all, lesson learned - there is ALWAYS something you can do to improve a patient's health. Some patient's baby steps are just as important as major goals of others.

CALCULUS B.R.I.D.G.E...!

This afternoon I saw a CL III pt. with a calculus bridge on her mand. ant. linguals. I decided to tackle it with my triple bend ultrasonic tip first. I was having a little bit of trouble making progress at initially. I felt like I was going to be scaling JUST the lower linguals for the whole appointment at the rate the calculus was coming off! BUT, then I learned a GREAT trick. Well, maybe it's not a trick, maybe it's common sense - but today is the day I learned this wonderful lesson. I learned to use LATERAL PRESSURE when instrumenting with my ultrasonic. I know this may sound like a basic concept, but when I have used my ultrasonic in the past, I haven't had to use much lateral pressure to get the calculus off. However, with the amount/tenacity of the calculus I was dealing with today, it was basically IMPOSSIBLE to remove without using lateral pressure. As soon as I used some lateral pressure, the calculus starting breaking right off... coolest. thing. ever. Today I also focused on using more of an exploratory stroke with my ultrasonic to feel the calculus before activating it. This was very beneficial in helping me both detect/remove calculus effectively instead of just "going through the motions." I also noticed I was able to use my time more effectively by using an exploratory stroke before engaging my ultrasonic/hand instrument. I think sometimes I forget to actually detect the calculus BEFORE I use a working stroke - I'm just so excited to scale! :) However, as I have tried to focus more on this important aspect of instrumentation, I feel like my time management as well as my calculus detection/removal skills improved.

Sept. 13, 2012 Tight tissues...sometimes a BIG problem

Today I was at the VA and I was fortunate enough to see a CL III and gain some more experience with this specific patient treatment. As I started patient treatment, I discovered that my patient has VERY tight tissues. When radiographic calculus is present, this can be quite the dilemma. I would use my explorer to detect (deep) subgingival calculus and then pick of my Gracey's to instrument and I couldn't even instrument HALF as far down the pocket as I could with my explorer - the thickness of the Gracey's were too large to insert subgingivally. I have never wished for inflamed, bloody, loose tissues so bad in MY LIFE! ;) Luckily, Prof M was able to show me a few tricks to help me remove these deep areas of subgingival calculus efficiently. One trick was through the use of perio files, and after seeing the significant effect they made, I can't wait to learn how to properly use them so I can implement them into my instrumentation. Also, I learned that it is OK to be a bit more aggressive with these harder classifications - as being more aggressive with patient treatment is different them being too rough/harmful to the patient. I am excited for all the opportunities I have to grow as a clinician and professional this year - BRING IT ON! :)

Sept. 11, 2012 Mock Board Patient? Maybe?

This afternoon I had an interesting experience with my patient. I saw another Spanish-speaking patient, and that language-barrier was definitely evident. My patient was a new patient at WSU who had never been to the dentist before. I took 4 BWX and a pano and scaled 1 quad. When my patient went to check-out, I discovered she had only brought $20 dollars for her $41 dollar treatment...somewhat of a problem. I had to pay for the remaining balance of my patients treatment which was not the funnest thing in the world. No, it didn't break my bank - but, any financial surprises for a college student are always somewhat of a heartbreak! I had mixed feelings about paying for my patient today. Part of me felt good for this good deed I had done as it was evident she did not have the means for much of the services she needed. However, Mr. Salomon made a very substantial point as he saw me dealing with this dilemma. He said, "your patient's treatment cannot be more important to you than it is to them". This comment put things into a better perspective for me. Not only was this good advice in this context, but it can be applied to all situations when dealing with patients and the services/education provided to them. Aside from the "incidence", the appointment went very smooth. My patient might possibly qualify as my Mock Board patient and will be returning next Tues. afternoon to determine her qualification status. So, cross your fingers! Also, my patient had the coolest (for lack of a better term) calculus bridge on her mand. ant. linguals that I have ever seen clinically. I am excited to use the intra-oral camera at her next appointment for a REAL pt. education experience. I think, because of that language-barrier, the intra-oral camera will be a great resource to utilize.

Sept. 6, 2012 ... Why I Do This...

Today I had one of THE MOST satisfying/memorable experiences I have had in the program thus far. I was at the VA today and had an elderly gentlemen scheduled as my afternoon appointment. As I walked up to the waiting room to bring my patient back, I was a little intimated at first as he presented in a wheelchair. He seemed very fragile and his darling wife informed me that he had been ill and was not looking forward to this appointment. As soon as I heard this, I was bound and determined to make his experience a positive one. Because of his health, he had to sit almost straight up in the chair, but I tried to make his cleaning as comfortable as possible. The majority of the appointment was devoted to OHI, as I demonstrated the use of certain aids to help both him and his wife clean his teeth and mouth effectively. I was also able to give him a few samples of Biotene for his severely dry mouth - the look on his face after I sprayed a few drops in his mouth was priceless...I could have been mistaken for a magician for all he knew. To make a long story short, by the time I finished the appointment, he couldn't stop telling me how this was the BEST cleaning he had ever received in his life - "and I've had a few cleanings in my life time". As I handed him a mirror to view the finished product, his face instantly lit up... he literally couldn't stop smiling as he said, "look how good my teeth look, I look so good". That moment for me was priceless, I gained so much satisfaction from that single moment. As I walked him and his wife to the front, this wonderful gentlemen nudged his wife and said "ask her". She asked for my information and wondered if it would be OK if she gave me a call as soon as I graduated so that they could come visit me in private practice. My heart melted. It is so easy to get caught up in completing requirements, missing spots, etc. that I think I tend forget the "bigger picture". Today I was reminded of the true reason why I chose to make this my profession - to make some small difference in the health/wellness of each of my patients, each and every day. I will never forget this memory. What a fulfilling day! :)

Sept. 4, 2012 - First Day at WSU... First No Show :/

Well, you have to have your first "no-show" sometime right? Why not your first day of clinic? ;) I am convinced I jinxed myself this morning. In my pod, me and the other girls were talking about not looking forward to dealing with "no-shows", and I HAD to make the comment that I had NEVER had a "no-show" thus far. Well, joke was on me! 8:00, 8:10, 8:15 rolled by and my patient still hadn't showed up so I called my Mom and, being the AWESOME lady that she is, she came in so I'd have a patient. I was proud of myself for not panicking and keeping my emotions in check. Because I was able to keep a level head, I successfully completed 4 PAs and all 4 quads. I tried to take my own advice and focus on the positives today and it seemed to help. I know I still have a long way to go, but at least I am taking steps in the right direction! My afternoon pt. showed up (yay) and I was able to classify her as a CL II. A lot of my patients this year are Spanish-speaking, including my afternoon patient today. Having this language barrier and realizing the issues it presented, I became very motivated to learn at least some Spanish to be able to communicate with all of my patients effectively. One of my top priorities in clinic has been to make sure all of my patients have a positive experience at their appointment. I think this speaks volumes as it pertains to their future OH behavior and likelihood to continue care. Through my afternoon appointment, I learned the necessity of effective communication. So, looks like "Learn Spanish ASAP" just got added to the "To Do" list. :)

August 30, 2012 - First VA Day!

For some reason, my blog would not let me sign in - every time I tried it would kick me out. So, I am going to have A LOT of posts on Sep. 15th (today), but keep in mind they are all from previous days/experiences - hence the date in the title! ;) Today was my first day at the VA and I sure had my fair share of emotions! We had orientation in the morning and then saw our first patient this afternoon. I guess there is no easy way to "ease" back into clinic...but I was quite flustered to say the least. I saw a CL V patient who needed 4 BWX, pano, perio charting, an exam, and a cleaning. As unprepared as I felt and as flustered as I was after finishing the appointment, I was proud of myself for completely finishing my patient and properly addressing all of her needs. I was a little nervous to start clinic as a senior because I didn't where my skill level would be at, but after today I feel more confident. I think the biggest thing I need to work on is focusing on the positives. It is easy to get discouraged, but I know that if I continually focus on the positives I will be more confident in my abilities and ultimately succeed in clinic. I CAN DO THIS! :)

OHI and Disclosing...Yikes! ;)

Today in clinic we played with disclosing agents. It was fun but also scary- and very shocking/enlightening to see where I 'really' brush. Through use of the disclosing agents, we learned the Plaque Free Index (PFI) as well as OHI. Through practicing both of these tasks today, I truly learned the importance of patient education. It is one of the MOST significant keys to our success as hygienists. If we cannot properly educate our patients, we are doing them a great disservice.

Marie was my partner today. It was great to be able to work with someone in a different pod and get some different views/ideas/critiques. She was great and helped me pass off my anterior instrumentation PE as well and my adaptation, angulation, activation PE. I am feeling more and more comfortable/confident with instrumentation everyday. It's been SO much fun. Thanks Marie! :)