Third Floor Emergency

Coming back to Buffalo a couple weeks before school starting was one of the best chance decisions I've made. The school emailed 3rd and 4th year students early on about the opportunity to work in the Urgent Care Clinic in two week increments. Today marked the final day of emergency and I just wanted to reflect back on the experience.

Rotations are generally a hit or miss ordeal. Some days, chairs are booked and we're busier than we can handle, and others we're lucky to see a couple come on. People have lives outside dentistry and it's clear dentistry isn't always a person's number one priority. In emergency situations however, people tend to show up. I didn't really have expectations for this summer rotation, but am extremely pleased to say my chair was full about 95% of the time. After spending some time shadowing earlier in the summer, I had a better feel for the pace of practice and brought that to the clinic. Patients would present, the five of us were assigned a patient, and off we went. Initial assessment always involves a review of medical information, any allergies, heart conditions, joint replacements, adverse reactions to anesthesia, etc. And quickly onto the chief complaint. I've come to appreciate the "problem based exam" as an integral part of treatment. While patients will present for recall appoinmtments and be subject to comprehensive examinations; the limited exam gives us as students the chance to practice our diagnostics, and treatment planning simultaneously. It also forces one to think creatively, on your feet, which will be required constantly in practice. Just to recap a few things learned in the past 10 days:

1. Check Occlusion Manically: I had a couple of appointments where something being left slightly high in occlusion either caused a temporary bridge to fall out, or massive amounts of pain for a tooth that recently underwent a pulpectomy. According to one faculty,  a tooth with an acute apical abscess may hyperocclude after treatment, and it is integral for the tooth to be in light, or sometimes completely out of occlusion. Further, in terms of checking occlusion, one doctor had advised that we check occlusion in the prone and upright position since the differing direction of gravity on the jaw could alter occlusion.

2. Denture Adjustments: Dentures are an experience for patients. For patients that I saw requiring sore spot adjustments, this was not their first. PIP is a great tool for assessing gross sore spots, but a bit of indelible marker can also be helpful if the sore spot is localized.

3. Protective Restorations:  This seemed to be a "treatment of choice" the past couple weeks. These patients often require a crown, and possibly a core, but in the emergency setting we do not begin that kind of comprehensive treatment. Instead, if the fracture has not extended into the pulp, we pulp test the tooth to ensure it is vital. Often teeth that undergo trauma, can lose vitality. Faculty more often than not, advised I use Fuji IX as a temporary fix until the patient was assigned for comprehensive treatment by a student. Fuji IX is a true GI in that it is fluoride releasing, has a coefficient of thermal expansion similar to natural teeth and is wear resistant. I also have a few patients of my own currently in GI protective restorations so I'm looking forward to seeing how well it held up.

Besides the little clinical tidbits, just working in the school, getting to know the assistants, and the protocols for lab work, radiology, and the way things work was great. I'd have to say this rotation is one of the little things that makes a big difference in becoming comfortable clinically. Looking forward to getting back into the swing in the next couple of weeks.

Cheers.