First Patient!

Friday was big. Not really procedure wise, but career wise, I actually treated my first patient! :). The patients presented for a periodontal recall appointment. They got the whole deal - complete with vitals, extra and intraoral exams, cranial nerve exam, periodontal charting, including pocket depths, mobility, plaque indices, oral health instructions, and a thorough examination of the gingiva levels, and junctional levels. After all that, we were onto scaling, root planing and polishing. Being the awesome novice dental student I am, the appointment took a little less than the entire 3 hours we were given (SKILLS...but not really). I'm sure in practice taking that long would be a quick way to go under fast, but for now, it's great. I'm really happy I got to do this so early on, cause it's like an extra boost of motivation as to why we're learning everything we are, and puts everything in perspective.

The major take-away I got was that being knowledgeable and competent are vital, but equally important is a sincere interest in people and communication. I honestly feel like I could have simply just talked to my patient for so much longer, but I was definitely concerned with completing all the tasks.  I need to ensure that explaining procedures before doing them becomes routine. It felt very natural anyway, since dentistry really is a personal encounter. The setting of the dental office does imply some consent and openness to work in someone's oral cavity, but I think people appreciate the added consideration of letting them know what you'll be doing, before touching areas of their head and neck. Probing really isn't my favorite, but after doing it so many times it's becoming pretty routine. I was particularly happy my patient thought I was the gentlest he's had (:D!!). I remember the one thing in the back of my head was something my friend's grandfather told me when I told him I was going to dental school - "You better have golden hands". Thus far I'm probably a bronze, but practice will most definitely make perfect!

Aside from awesome clinical experiences with real people, the semester's moving along nicely with a whole ton of lab work. For removable, we've placed wax rims on the record bases we did to approximate the position of the teeth we'll be mounting next week.  We then took a bite record of the wax rims in occlusion to aid with mounting. Placing the rim wasn't bad, but I'm ever grateful for the help of classmates in using the facebow to mount the record bases on our articulators. To do that we had to fix them to the manikins, secure the relationship of the maxillary, then transfer it to the articulator, then mount the maxillary, then the mandibular using the bite record.  Its crazy how long a way we've come with the facebows and articulators. From struggling through using it last semester on each other, to now. I really can't wait to actually use them for a real patient.

For indirect we had a great exercise in the second floor simulation clinic where we had to prep #30 for a crown using water, then take an impression. Drilling and not having the tooth turn black and brown was awesome, but the water really does make things tricky visually. Mirrors are flooded, and when you think you're cutting a beautiful chamfer margin, you realize it's actually just water being splashed away by the bur. All in all, really fun working in an operatory setting. Hopefully this becomes a more frequent occasion.

After a nice three day weekend we're diving back in tomorrow starting with amalgams in direct. Pathology Exam 1 on Friday, Oral Sciences Exam Monday. If anyone's ever bored with Pathology, or any studying in general I'd reccommend creating an account on DrBicuspid. They've got great news and case studies that are really interesting. Being bored after hours of Path just now, I came across one that was completely applicable to the neoplasm chapter we had in Path. Being able to actually evaluate histological sections and answer questions makes me feel like an almost doctor :).

And, back to the books!
Cheers.

B28: A Second Home

So to all the first years out there feeling like they're basically medical students, except for a class in dental anatomy, set your gaze upon second year, where you'll truly feel like a dental student. A couple weeks in, I definitely love it. We've been busy going through the motions of making dentures in removable prosthodontics, doing more difficult restorations in direct, and taking a step-by-step approach to making a crown for #30. Really need to get back into the lab and practice that crown prep again cause I get the feeling those are going to be really important later on. After watching Dr. Levy do a ton I'd be ashamed of myself if I wasn't preparing proper crown preps.

I heard before that removable would be the killer class and I guess there's some truth to it, but if you really love what you do, it's a great time. The hardest part I'd say was getting the feel for the materials since you work with so many different ones, with different handling characteristics, and there's a bit of a learning curve to everything. Ivolen is definitely my LEAST favorite thing ever. It's a putty like substance we work under a hood with to fabricate a custom tray. The working time is fairly limited, so you need to be quick with the mixing of the powder and liquid, and precise with the trimming so it fits the patient (or cast in our case) properly. Thankfully I got those signed off, so now it's onto the impression, then beading and boxing before pouring up the cast :). 

This week we've got a ton of things due, and a practical exam - preparation/restoration of #12, #5 DO. Originally an MOD but switched to DO because Sabatini fully understands our pain. The month off from working with handpieces really took a toll but after a weekend in the lab it shouldn't be so bad tomorrow. Record bases for our dentures are due and Triad custom trays with wax rims both being submitted for grades. Wax rims...not fun until maybe the 5th one you make, when you become one with the wax. I'm sure the faculty's intentions are good in assigning us exact measurements for every dimension of these wax rims, but they have been quite troublesome. I had a little better luck with the record bases after going through many packs of pink Triad material, and shellac (gutta percha). Triad I really didn't mind, but shellac definitely took some time. At this point I can say I almost enjoy working with the shellac because once you get a sense of how much heat the material can take before burning, it's really adaptable and somewhat fun (unless you get burned...which is kind of inevitable in the early stages). 

For our crown preps we took an impression and poured up some jade stone casts which are totally cool.    The impression looked deceptively simple, but took me 4 hours to get it right. However, I wouldn't trade the fulfillment of finally getting it right for anything else. To take the impression your assistant fills the custom tray with purple heavy body impression material while you carefully cover the prep, adjacent teeth and occlusal surfaces of the arch with blue light body to capture the detail. Then, the custom tray needs to be carefully placed on the arch, pushed down to capture the vestibule, but in a way that you don't get bubbles. Far, far easier said than done. 

So dental school really feels like dental school now and it's fantastic. I'm going to try to get some pictures up here cause I'm really loving the way some of my trays came out! Quiz and a practical tomorrow so its about time for some sleep! 

In a little over 12 hours dental school will be in full swing, complete with a packed schedule, lab work, clinical rotations and of course, exams. After thoroughly feeding off the 1st years energy and orientation, it's about time to get back to reality. I've gotten a little back into things with a few preparations and restorations the past couple of days, but today I just took for myself.

Checked out the progress on our new capoeira space on Utica, Solrise Farm and Cultural Arts Center. The place is nothing less than incredible and I'm really excited to see us grow. They've got a ton of tomatoes, corn, plants that looked like mini squash, and a ton of other things. There's a flower we ate that I forget the name but I really need to find out what it was. Bright orange, and had a spicy kick. I'm beyond jealous of Emily and Corazel who live on the upper floor and maintain everything.  The studio floors were just being coated with polyurethane so we had practice at LaSalle Park on the west side overlooking Lake Erie. Had a roda for the entire time and it was great seeing everyone again and catching up.

After some grocery shopping, and general hanging out all day, I decided to treat myself to a "last supper" of sorts - Lobster stuffed salmon (courtesy Wegmans), over a spring greens salad with avocado and tomatoes.

Looking forward I think this year's going to be a little different than last. I've discovered my interests, in and outside of school and where I really want to place my efforts. Coming in first year, I think it was natural to be riding the hype of dental school, and see yourself giving your life to it. Dr. Comfort, the speaker at the white coat ceremony said it best in that dental school isn't who you are, it's just something we do. As dental students we have the opportunities to reach so many people, and really make an impact. At the same time, as dental students in Buffalo, we have limitless opportunities to grow as individuals.

And so it goes.

Back for More- D2

Been back in Buffalo since the 3rd, but tomorrow the pace will definitely start to pick up. Jam packed day of Picasso training, supply distribution, computer updates and more. Looking forward to the Big/Little lunch though, after meeting a good amount of the first years I'm again amazed at the admission committee's ability to select students. While 2015 has it's own dynamic personality and atmosphere to it,  2016 definitely has some interesting flavor. Its awesome feeding off of their excitement also, because this time last year I was ecstatic. This year I'm just looking forward to getting back into the swing. Maybe it's the olympics inspiring me, but I think this year has limitless potential and I want to realize as much of it as possible.

Had a little bit of an organizationfest today. Upcoming events include:

1. Meeting with James Harris Friday 8/10 to discuss moving the Burmese outreach project forward. After getting involved with For Hope International this summer my heart for dental missions and serving the underserved expanded. Before now I never gave much thought to dental careers with non-profits, but so far it seems like an exciting path. I really want to see this happen.

2. Direct Quiz next tuesday 8/14. Haven't opened VitalSource in quite some time...

3. Perio Practical Practice 8/17

4. Toronto Tough Mudder 8/19. THIS IS GOING TO BE EPIC :D

5. Direct Midterm 8/21. Word from the grapevine is that it's going to be tricky. There are a lot of details from the readings and going through everything again is going to take some time. Should be all right in the end.

6. Perio Practical Exam 8/24

I think that's everything, for August at least. Schedule this semester's pretty intense but I really want to keep up with the Capoeira group downtown, especially since we've got our own studio now. Also, started a pretty interesting book - Everything is Marketing: The Ultimate Dental Practice Growth Strategy by Fred Joyal. I was a little reluctant to buy it since it seemed to be just another lame dental business book, but he's got some clinical tidbits here and there that I'd like to integrate into practice.More on that in the future.

Summer2012

Spring Extension (Early Fall) came and went in an instant, but I'd be kidding myself to say this is the first free moment I've had. Reflecting back now it's easy to see how most people say that will be the best time of dental school, but I prefer the optimistic approach thinking the best is yet to come.

Direct Restorations and Perio are continuing into the Fall and I'm pretty pumped to get back into it. I brought home some waxing supplies for the summer, but have yet to do much with them. I figure I at least want to try out another #8 and a molar. It's strange to think this is supposed to be out "last" summer, since boards are next summer, and summer of third year I'd hope to go on a mission trip of some sort. Speaking of which, being home and catching up with friends and family has brought up some awesome opportunities, one of which I've been saving for this summer. A family friend mentioned a group she's part of who goes to Haiti around the December holidays, and I'm REALLY hoping I get to go.

In other news, summer 2012 is frickin' fantastic. This marks my 8th summer of lifeguarding at the Valley Stream Pool, and may very well be the last, since next summer I'll be searching for something more dental related to do. Aside from arranging some shadowing and such, this may as well be just another summer of undergrad. Getting a head start on the Perio exam coming up would be wise though, since summer really is an incredible about of free time that we won't see again for a while.

I was just thinking the other day how late August is taking on a new meaning as a time of always doing something pretty crazy. Around that time last year I had the DAT, and this year I've just registered for the Toronto Tough Mudder with some med friends. Along with classes, helping out with orientation and that race, Fall is really going to require hitting the group running. Until then :)

D2 Begins

Today was the official start of second year and it's got a good feel to it so far. D1 ended with a bang all around I think, since for the most part our averages were really high throughout. Definitely a needed "break" after the shock treatment of first semester.

Here's a snapshot of the ever changing spring extension schedule courtesy Tricia Hackett-Swanson from class. Physical Assessment is about 2 weeks so that'll be out soon. The class was divided into 4 groups, so that we have our final examinations at different times. I totally lucked out making into the group getting tested last.

I spent most of today practicing putting a rubber dam on my typodont. Since we'll have to use one for every operative procedure in class, and in the clinic I figured this is something I should be pretty efficient with. Those things are much trickier than they appear, and from spending some time in the clinic with upperclassmen, I already knew they were tricky. Although Dr. Sabatini taught us to place the ring around the tooth first, then place the rubbed dam over the ring and tooth, I found it much easier to place the ring through the dam before placing the ring in the patient's mouth. I shadowed an endodontist who I remember placed rubber dams with ease this way. Still need to work on not tearing the dam while placing it through contact areas. A friend suggested using a piece of a spare dam to push the dam through the contact area, which I'll need to try. Floss can also be used but it might cut the rubber. As with many things in dentistry - "whatever works best for you".

All we've got is Nutrition tomorrow, but given the 14 chapters we have to read for Physical Assessment, that time is anything but free. All in all I can see myself spending hours on end in B28 since I'm really loving this stuff so far. Placing and removing a dam for 4 hours was actually pretty fun and I'm sure most everyone's going to love when we start restorations. Here's to second year!

Friday Afternoon Endo

When I see the "C" for Clincal Rotation on our Integrated Dental Practice schedule I'm never sure how to feel. The last clinical rotation I had was spent talking to a fourth year friend for a few hours about impressions, casts, dentures, patients and dental school in general. All very, very useful stuff, but while in clinic it'd be great to do something clinical which is exactly what I got this time around

I had the privilege of working with an awesome third year, named Joy whose name perfectly fits her personality. Our patient was an elderly woman in need of RCT on tooth #11. She had many other dental problems, however the canal in this tooth had been previously treated and needed to be completed. Joy began with a few anesthetic injections before removing the IRM (temporary filling -Immediate Restorative Material), while I manned the suction. Once cleared she then cleaned the canal with the slow-speed and filed and shaped it with different files. Despite some trouble we ran into with excess saliva, and placing the rubber dam, the patient was amazingly patient and understanding. Looking back, I think that situation was exactly what Dr. Goldberg in Orofacial Neurobiology was talking about. Our patients will react to our demeanor and attitude. While competence is vital, compassion and empathy for our patients is also critical.

Once we had a clear canal, the next step involved cleaning the canal with a bleach solution, measuring the correct gutta percha length and filling. While the bleach rinse was fairly painless, measuring the correct length of gutta percha can be tedious. Once measured the apex could then be filled and checked via radiograph to ensure that the apex really was filled. I familiarized myself with the digital radiography program and developer the clinic uses and some protocols for the x-ray room which was nice. Once the apex was filled we could then fill the remainder of the canal then finish it off with more IRM since this patient would need another appointment to crown off the  tooth since so much of it was lost to decay. 

This was the first appointment I got to assist in entirety at UB's clinic and I can say I completely understand  how 3 hour appointments can fly by, how amazingly helpful the professors and assistants are and how great our patients can be. Next week we've got an Orofacial Neurobiology Midterm on Tuesday and Microbiology on Thursday. Group presentations for Community Dentistry are also coming up fast. On a more fun note, I've been keeping up with the weekly Capoeria classes and it feels like I'm getting the hang of it. There's also a couple of bike rides for Diabetes and Cancer that I'm  getting excited for. Never a dull moment!