Lawnchair Denstistry - Good Neighbors Clinic Outreach

Today began at 6:50AM with an alarm that might induce a heart-attack in someone not as accustomed to vibrating mechanisms under their pillow. 6:50AM isn't a time most dental students see on Saturdays, but I was lucky enough to be selected to volunteer at my first REAL dental outreach!

On Jefferson Ave in downtown Buffalo, the Good Neighbors Clinic provides free dental, optometric, chiropractic and medical services to the area on designated days. Today was a purely dental day. Along with a handful of local area dentists, twelve dental students and staff of the clinic we provided care to upwards of 30 patients in the span of 8 hours! Of the twelve students, first and second years were assigned to assist third and fourth year students who would perform procedures. Upon arriving there at 8AM was already a line of patients waiting outside in the snow.  Much work had to be done to set up operatories with the necessary instruments, personal protective equipment and more. Rooms designated for surgery were equipped with reclinable lawn chairs, forceps, gauze, elevators, syringes, carpules of anesthetic and dental bibs. Once a triage system and front desk were set up we were on our way.

I was assigned to a third year student, who was overseen by a dentist. The three of us were placed in room designated for extractions, where I assisted in the extraction of some three or 4 molars.  I quickly learned that during outreach events, conditions are far from ideal.  Watching my third year (Susie), who is a few inches taller than me, extract upper and lower molars from incredibly uncomfortable positions was amazing.  Even moreso was the fluidity and confidence of Dr. Hattin, the designated oral surgeon of the crew. Upon being presented a case he deemed "very difficult" to all onlookers, he would proceed to remove bone around the tooth with the surgical drill and in minutes the tooth that we had struggled with for much longer would be out - next patient.

Not everyone had this much luck, as I witnessed others with more difficult patients. It was through their experiences I learned that patients may sometimes require anesthesia prior to having x-rays due to sensitivity or anxiety. Nonetheless, even though some extra time was needed, quality care was achieved.

When I wasn't showing patients to their rooms, bibbing them, dabbing blood from teeth, collecting freshly extracted ones from Susie and Tom, or bringing supplies back and forth from the sterilization/x-ray room, I spent most of my time learning about taking and developing Panorex X-rays. A dental hygenist who basically ran that room was a great help to me with this. Today I took one periapical and 3 Panorex X-rays - solo! The procedure for pans was:

- Prep the X- Ray machine with a small plastic wrapper that goes over where the patients teeth contact the machine
- Retrive patient from waiting room,  walk to the X-ray room.
- Explain to them what the X-ray machine does, since pans are not your average x-ray and the machine can be somewhat intimidating and complex
- Have patient remove all jewelry from their head and mouth, and jackets if they may get in the way
- Place the lead apron on the patient and have them step forward into the machine
- Have the patient bite onto the peg, with their chin comfortably seated and forehead forward against the headplate.
- Ensure proper tooth positioning on the biting peg by having the patient smile slightly and observing the peg reach back about to the canine
- Have the patient place their hands on the handles and ensure the machine will not be obstructed by the patient's shoulders when it moves.
- Once you let the patient know to remain completely still, you're set!

Lucky for me all of my patients were calm, collected and sociable. I loved sharing stories about my own tooth extraction and my first panorex x-ray that I saved in my room for months since it made a nice window decoration. Not sure what they thought of me after that but at least it made them smile.

I also learned to develop films and pans. The pans were a little more involved in that the room needed to be closed, the machine off and lights off. The film is kept in a cartridge which needs to be opened, then the film must be placed in the developer. Chris helped me reload the cartridge and place the unexposed films back in their package before the lights were turned back on.

For a first time assisting and actually serving in a clinic I feel like I learned a ton. The day flew by and before I knew it, it was 3:00PM and we were cleaning up. While technical skills are important and necessary, the most important lessons of the day were those in patient communication, as well as colleague interaction. Providing care is always, always, 100% focused on the patient. In my mind it's a privilege to treat any patient, since they could have gone to anyone else. In this case, these patients needed any care they could get, but I was still gracious to have interacted with them since they could have ended up in other student's operatories. Every effort should be made to create a positive experience for the patient (which reminds me for future outreach events to definitely bring a radio!) Additionally, patients are people and people love to socialize, especially when they're nervous and need to feel more comfortable. I learned more about patient's children in college, struggles with drugs, favorite movies, hometowns and more than about dentistry today and recalling all that would be an accomplishment. The take away is that the patients are what makes it all so rewarding.

One patient's husband who was a minister told me something that stuck with me. When I expressed an interest in his preaching and mentioned the name of the pastor of my church in Binghamton, he recognized the name and shared that he was actually from there. He then told me it sounds like I have a calling on my life and wished me blessings. Despite the conflicts it's caused, I'm happy that faith still brings us closer together.