Remote Area Medical (RAM) - Scott County, Tennessee

RAM is a non-profit group who operates solely under donations of time and support to provide medical care to rural areas in the U.S. mainly in Tennessee, and disaster affected areas of the world.

Scott High School, where clinics were held

RAM trucks unloading supplies

I just returned from my first ever RAM trip and it was nothing short of exhausting, inspiring and incredible. I made the 10 or so hour drive down with a few other classmates and we stayed at a church a few miles away from Scott County High School, where the clinic was held.

Friday night was spent settling in but clinic started early Saturday morning at 6:45am. By the time we arrived RAM volunteers had the dental clinics in full swing and patients registered and waiting, while others were already being seen. We were briefed on the way the clinics run, how we review the patient's form, retrieve supplies, complete treatment and complete what was accomplished before handing the patient their form to check out with.

Southern hospitality

Church where we were lodged

I had an amazing assistant Paula, whom stuck it out with me all day Saturday. We started off doing restorative, rebuilding teeth with composites and amalgams. We later switched over to extractions. While the patients were all tremendously grateful and pleasant, the underlying despair was ever present. Patients had waited all night, and toward 5PM, all day to be seen. Many I spoke with talked about their need to care for their families, or had other situations which made dental care close to impossible for them to access. While their situations were desperate, the ability to relieve pain, and restore dentitions that may have soon been lost was incredibly rewarding. One conversation that will stay with me was with one patient we completed a few fillings for who was very phobic and had not been to a dentist in many years. She expressed concern about a small cavity where a previous filling was lost, and said she was scared she would just have to wait to get it pulled. I was taken aback since the cavity was quite small and was easily restored. But the patient explained that sometimes we are so concerned with caring for our loved one that our own bodies are neglected and there may not be resources to care for ourselves. I felt for her and told her it was wonderful meeting her and she expressed her grattitude before heading off with her grandson.

RAM in full swing

The trip really made it clear to me that there's so much to still be done right here in the U.S. to improve oral healthcare. But oral healthcare is so closely related to mental and physical health. I don't doubt the involvement of drugs and mental unrest in many patient's destroyed dentitions.

Sunday Clean-up 

Sinus Elevation Site #3

With this spring extension marking the start of fourth year, I've been in the clinic 5 days a week, and getting some cool exposure to procedures we've learned about. I'll probably be writing more about procedures from this point on as we'll hopefully be doing lots of dentistry from here on out! Since I had some open appointments this week I was able to fit in observing a sinus lift in the implant clinic.

Sinus lifts are necessary in certain cases when a patient wishes to replace a tooth with an implant in the posterior maxilla. The maxillary sinus sometimes extends lower down than we'd like and to avoid placing the apical portion of the implant into the sinus, the sinus lift procedure is necessary prior to implant placement. 

Heres a couple informative graphics I found online which clearly show what's going on. This patient is also missing teeth they wish to replace in the posterior left maxilla. The sinus has undergone pneumatization which leaves the dentist with little bone to work with. Through a sinus lift procedure they were able to place three implants to restore those teeth 

[http://www.capedental.com/2013/sinus-lift-and-implants/]

[http://www.capedental.com/2013/sinus-lift-and-implants/]

The patient today however was a single 10mm x 4.8mm implant placed in site #3. The patient had nonsignificant medical history and the tooth was lost due to caries some time ago. There was 8mm of bone present and therefore needed a lift of 2mm to place the implant. 

Initially the patient was anesthetized with an infraorbital block, posterior superior alveolar injection and a greater palatine injection with 2% lido with 0.034mg epi per carpule. Once anesthetizd, the patient was draped and scrubbed extraorally with an alcohol swab, and intraorally with a chlorhexidine saturated sponge. 

The initial incisions were intrasulcular around teeth #2 and #4. The second was a crestal incision and a full thickness flap was reflected to expose the alveolar bone. The osteotomy was made using the Straumann kit drills to a depth of 7mm, and a width just shy of 4.8mm leaving 1mm of bone between the osteotomy and the Schneiderian membrane of the sinus. The sinus was then lifted using osteotomes and a mallet. Osteotomes were placed in the osteotomy site and lightly tapped to lift the sinus. Progressively larger osteotomes were used to complete the osteotomy. Two pieces of resorbable collagen membrane were placed at the apical extent of the osteotomy before the implant was placed. This membrane will resorb within 6-8 weeks. 

The implant was then placed at a speed of 35RPM into the osteotomy site to a depth of 10mm so the implant was placed at bone level. The final insertion of the implant was completed using hand wrenches rather than the motorized drill. The healing cap was placed and flaps re-adapted to the alveolar bone and three teflon interrupted sutures were placed. 

Cool experience overall. Post op radiograph looked great and hopefully all goes well with the restorative phase!