Tuesday, March 3, 2015

Am I a dentist now?!



I did my first real-live drill and fill procedure today - a composite #20 DO! All those quarters of direct and indirect restoration classes (and here), improving our fine motor skills were exactly for this moment.

Something I didn't realize before dental school is how precise and fine-tuned dentistry truly is. Whenever I would sit in a dentist's chair to get a cavity filled (I have a million cavities and could probably graduate a student, even as a recreational flosser) - I always trusted that they were in complete control and that fillings must be a breeze for them. I thought all cavities were of the same breed - maxillary, mandibular, right, left, anterior, posterior. I was like, they must all be easy by now!! But man, was I wrong. I mean, I'm sure it gets easier with time, but I think we're talking a significant amount of time before these procedures feel like second nature.

As I started my first direct procedure, I also gave my first IAN injection on a patient other than one of  my nervous classmates. I constantly worried about where my needle was - whether or not my anxious patient would fidget or move during the injection.

Then came the hurdle of placing the rubber dam. He had very tight contacts, so that was a battle in itself. When I finally started drilling, my patient would get nervous and start to curl his lips over his teeth and knock into my hand.. all while having a spinning, sharp bur in his mouth!! :O

After I finished my prep and got it checked off by the overseeing instructor, I thought about how in pre-clinical lab, instructors obsess over open margins, overhangs, little fractions of composite sticking around where they shouldn't, etc.. And though that's reasonably frustrating when you're just trying to finish your project and get out of lab, in reality, that obsession is 100% necessary. Having a slight gap in your filling - I'm talking fractions of a millimeter - can cause a patient pain, problems with flossing, and recurrent decay. The work of dentists is amplified by so many magnitudes, where fractions of a millimeter literally translate to the miles of difference between good and bad dentistry. 

On another note, I was lucky because one of my friends was also doing her first filling at the cubicle right across from mine! As newbie 2nd years, our first direct or indirect procedures are done with our 4th year student in our CPC teams, so that the 4th year can assist you (I really don't know how people put rubber dams on patients without help), and bail you out in case something goes wrong.

Here's a couple pics with my classmates who also had their first 2nd year/4th year direct restorations! It was cute that we were all in the same row on the clinic floor. Gotta support that dental school family! :)

So to wrap up, here are some ways that clinic is different than pre-clinical lab..
  1. Positioning the patient is more difficult.. In pre-clinical lab, you can bring them mannequin head low enough so that your arms are perpendicular to the floor, but for a little person like me, the clinic chair actually doesn't go low enough.. So that was a little strange.
  2. Patients can move, so you have to be extra careful with all things pokey.
  3. Patients have gums.. that BLEED! Mannequins don't. Need to take extra care not to cut someone's gums when doing a class II and dropping the box. The dentist I used to shadow told me always to use wedges in the interproximals.
  4. You only have 2 hands.. and as soon as they go in the patient mouth they're "dirty". Maintaining sterile technique is a bit of an internal organizational battle. Taking gloves on and off, rummaging through "clean" drawers, etc.. 
  5. Patients have saliva.. and you don't want to drown your patient.
  6. No one has typodont teeth. 
  7. Patients are real people! Real people with real fears, real pain, and real questions.

Yay dentistry :)