Starting clinic

[ItsGavinC]

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On Monday we leave our didactic/simlab stuff and move over to the clinic (gotta learn Dentrix first!). Does anybody have any advice for the clinical transition, or advice about first patients? Humorous stories are always welcome. 😀

Is it bad if I *still* can't hold sickle scalers properly without some thought? 🙂

 

[DDSSlave]

As much red tape exists in clinic, it's much more enjoyable than preclinic. Just go in there with confidence and you'll be fine. Be sure to overestimate the time required to do a given procedure and underestimate what you may be able to get done in a given appt. The only times I've had problems with pt's is when I underestimated how long it would take to complete a CD over RPD and when I told a pt it would take 2 appt for a crown (prep and seat) and I ended up not getting the impression after the prep and had to bring them back for an extra appt. As luck would have it, this usually happens with your already difficult pts.

I will probably get struck down by the perio gods but IMO there's really not a wrong way to hold a scaler. Honestly, since you can't go subging where most perio pt's calc is, they're not that useful. I only use them for interprox anteriors and removing "calculomas". Otherwise it's the ultrasonic and universal curettes. The most important part of perio is correctly Dx and detecting calc(with a pig-tail) so you know where to scale and when you're done.

 

[drPheta]

Yay for entering clinic. I was assigned my first patient today. Thanks for the advice.

 

[12YearOldKid]

On Monday we leave our didactic/simlab stuff and move over to the clinic (gotta learn Dentrix first!). Does anybody have any advice for the clinical transition, or advice about first patients? Humorous stories are always welcome. 😀

Is it bad if I *still* can't hold sickle scalers properly without some thought? 🙂

I agree. They spend an entire lab session teaching you meticulous technique with the perio instruments - every surface of every tooth has it's own specific instrument. But really you just use whatever reaches the crap you're trying to scrape off. BTW, at our school we have to do a semester of scaling using hand instruments before we are allowed to take the competency and use the ultrasonic. Do you get that same opportunity?

 

[Wah]

two words... Finger rest.

 

[ItsGavinC]

I agree. They spend an entire lab session teaching you meticulous technique with the perio instruments - every surface of every tooth has it's own specific instrument. But really you just use whatever reaches the crap you're trying to scrape off. BTW, at our school we have to do a semester of scaling using hand instruments before we are allowed to take the competency and use the ultrasonic. Do you get that same opportunity?

We DO have a competency coming up with the hygiene hand instruments. The standard line is that "ultrasonic doesn't replace hand instrumentation, it complements it". Tell that to every practice I've ever assisted/shadowed in.

So in the mean time I'd better figure out which blade to use on which surface...

 

[Mayo Ortho]

We DO have a competency coming up with the hygiene hand instruments. The standard line is that "ultrasonic doesn't replace hand instrumentation, it complements it". Tell that to every practice I've ever assisted/shadowed in.

So in the mean time I'd better figure out which blade to use on which surface...

What the instructors don't tell you though is that there are universal instruments that you can use just about anywhere.

 

[ItsGavinC]

What the instructors don't tell you though is that there are universal instruments that you can use just about anywhere.

Right on. Our instructors are hygienists, and they often have a severe complex about us being able to properly use their "godly" instruments.

 

[unlvdmd]

What the instructors don't tell you though is that there are universal instruments that you can use just about anywhere.

share! what do you do? we did our cleaning competency on our classmates and i can use all the help I can get...

 

[HuyetKiem]

What the instructors don't tell you though is that there are universal instruments that you can use just about anywhere.

Barnhart 1/2 🙂

 

[aphistis]

Barnhart 1/2 🙂

Cavitron 👍

 

[Col Sanders]

(gotta learn Dentrix first!).

"luuuckyy" Napoleon Dynamite 2004

We use a piece of crap software program called Salud, or slow-lud at UNLV. Biggest waste of time and money ever! This alone makes me wish I had gone to another school, but in 1 year I wont care anymore.

 

[DrJeff]

Cavitron 👍

or as I like to refer to it, the "drown-a-tron" 😀

I'll be the first person to admit that I HATE perio!! I hated it in the didatic pre-clin parts, the clinic in dental school, my residency, private practice, and even when I had gingival graft transplanting surgery back while I was in college.

It's for this very reason that I can't say enough good things about my hygenists and the periodontists that i refer to, because they do the "scraping of the schmutz" that I hate to do. If it was upto me the only time during the rest of my entire career that I'd even consider using a scaler is to remove excess cement after I cement a crown! I can talk perio with patients till I'm blue in the face, and can handle a scaler, a #15 blade and some sutures if need be quite well, but when it when push comes to shove with some of my non-periodontist needing perio patients, I'll let my partner take care of my patients needs and I'll return the favor to him by taking out just about any tooth that his patient's need extracted for him(He HATES oral surgery)

Now 1st clinic story. Mine was a mid 20's russian immigrant who was handed down to me by an upper classman. The treatment plan wasn't too clear, so I figured I'd be treatment planning and doing a prophy that 1st visit. Instead I go and check in with the preceptor who looks at the chart and tells me that since #20 DO Amalgam is on the treatment plan, that that's what I'm doing that day 😱 Talk about shocked, I'm already nervous enough about my 1st patient, and then I find out that I have to give a mandibular block, isolate from #18 to 25, prep my first "real" tooth and then restore it 😱 Well 3 hours later, 3 attempts at the block, and she walked out of the clinic with a #20 DO IRM 🙁 And I walked out of the clinic with some serious pit stains from all the sweating I was doing 🙄 I still laugh about this everytime I think about it!

 

[ItsGavinC]

Now 1st clinic story. Mine was a mid 20's russian immigrant who was handed down to me by an upper classman. The treatment plan wasn't too clear, so I figured I'd be treatment planning and doing a prophy that 1st visit. Instead I go and check in with the preceptor who looks at the chart and tells me that since #20 DO Amalgam is on the treatment plan, that that's what I'm doing that day 😱 Talk about shocked, I'm already nervous enough about my 1st patient, and then I find out that I have to give a mandibular block, isolate from #18 to 25, prep my first "real" tooth and then restore it 😱 Well 3 hours later, 3 attempts at the block, and she walked out of the clinic with a #20 DO IRM 🙁 And I walked out of the clinic with some serious pit stains from all the sweating I was doing 🙄 I still laugh about this everytime I think about it!

Great story. Keep em coming.

How bout you Mr. Salud user--your first pt.?

 

[DcS]

FYI the reason that ultrasonics complement hand scalers is because they cannot root plane. Of course that is the second part of Scaling/Root Planing txs. Only hand instruments can remove the bacteria filled layer on the tooth and leave it smooth enough to make the bacterial environment less hospitable (at least that's what they told us the point of root planing is....still don't know if I buy it).


My advice to you in clinics and basically to anyone wanting to go to dental school is this: prepare to be humbled. Know you will feel like an idiot on some days. Your tough clinic days will most likely outnumber your great days when you nail that prep/restoration etc at first. As long as you are able to laugh at yourself and not take things way too seriously you'll do great.

As far as a funny clinic story, mine has to do with a professor. So it was one of my 1st patients and it was only a recall appointment. Well a prof comes over to give the DDS exam, and asks me to pass him the air/water. In any case, the little plastic baggy was still over it and some I was fumbling to give it to him and push the tip through the plastic. Well, in my attempts to perforate the plastic I was successful...but I also layed my finger down on the water button and pretty much painted my full name in graffiti on this guys back. To this day I still don't understand how he didn't flinch

 

[ryche22]

Well 3 hours later, 3 attempts at the block, and she walked out of the clinic with a #20 DO IRM

#20 distal occusal IRM...whats an IRM? 😕

 

[dr_benj]

#20 distal occusal IRM...whats an IRM? 😕

Intermediate Restorative Material, its like a temporary filling.

 

[ItsGavinC]

"luuuckyy" Napoleon Dynamite 2004

We use a piece of crap software program called Salud, or slow-lud at UNLV. Biggest waste of time and money ever! This alone makes me wish I had gone to another school, but in 1 year I wont care anymore.

Well, we're training on it right now. From what we've been told, the only other school to use it is Penn (we're actually using their training manual). Looks like good stuff thus far.

 

[anamod]

First patient was a great easy going guy who had recurrent decay under a gold crown (I think buccal #30). The operative instr. says an amalgam patch would work just fine.this was new to me since I was taught in preclin you can never patch a crown margin but what do I know. So anyway I go ahead and prep a small window in the buccal and i'am removing the remainder of the decay with a slow speed and a round bur, after removing some the decay I stop the hand piece look to see what I have done, it looks like there is a little more so I move my hand with the slowspeed in it to finish and my patient screams as I move my hand. While looking at the prep I had rested my hand with the slow right next to his beautiful full mustashe and when I pulled away there were about 5 hairs snagged on the round bur thank god it was not running. He bled a little bit and was very understanding, but boy was I embarassed. The moral of the story is watch where you place your hands while you check your work

 

[Mayo Ortho]

share! what do you do? we did our cleaning competency on our classmates and i can use all the help I can get...

Ok well if my memory serves me correct it was with a columbia 11/12 or 13/14. Not both just one I think it was the 11/12. For anterior your sickle scaler.
Secondly when it gets to your national boards test you need to get a periodontal file. It looks just like a bone file in oral surgery but smaller. Basically it provides a larger surface area then your typical scaler to crush (or burnish if not sharp) any of those smaller pieces of calculus that usually show up as missed surfaces on your exam. Alot of times they won't let you use these on the practicals during school because they want you to get used to using all of the instruments. My theory "THERE IS A REASON GOD MADE PERIODONTAL FILES, SO GENERAL DENTIST'S COULD PASS THE PERIO BOARDS AND NEVER GUM GARDEN AGAIN!"
Also on your board exam there will be a section on tissue damage and hemorage. The best legal way of controllig this is with a mouthrinse. The one that worked the best was Colgate's Peroxyl. It stops the bleeding before your patient is sent back to be evaluated.

I have a whole list of tips on how to do well on the boards.. If you have any questions about it let me know. Glad to help...

 

[DrJeff]

Well, we're training on it right now. From what we've been told, the only other school to use it is Penn (we're actually using their training manual). Looks like good stuff thus far.

Don't stress too much about practice management software systems, they are literally a dime a dozen, and realistically the one that you end up with isn't what YOU thinks is the best/easiest one to use, but the one that your STAFF thinks is the easiet/best to use. Afterall, if you're staff is happy, they're not whining at you! 😀 👍 😉 🙄

 

[ItsGavinC]

Afterall, if you're staff is happy, they're not whining at you! 😀 👍 😉 🙄

Sage advice never to be forgotten! 👍

 

[Rezdawg]

Ive got a long way to go until clinics, but reading some of these posts is making me worried. I have no clue about 99% of the terminology. I may as well be reading Swahili. You guys talk like pros 😀 .

Im screwed if I dont learn this stuff. 😉

 

[DDS2BE]

Ive got a long way to go until clinics, but reading some of these posts is making me worried. I have no clue about 99% of the terminology. I may as well be reading Swahili. You guys talk like pros 😀 .

Im screwed if I dont learn this stuff. 😉

im in the same boat 😳 Sometimes, it feels like these guys r all talking some foreign language which is kind of cool but scary at the same time. 😀

 

[Zurik5]

You'll both be fine. I had no idea what any of "this" was prior to dental school, and i'm doing well now.

 

[lnn2]

...
Also on your board exam there will be a section on tissue damage and hemorage. The best legal way of controllig this is with a mouthrinse. The one that worked the best was Colgate's Peroxyl. It stops the bleeding before your patient is sent back to be evaluated.

I have a whole list of tips on how to do well on the boards.. If you have any questions about it let me know. Glad to help...

Perio guys said use endo ice to stop hemorage. I'll try Peroxyl! 👍 any good tips for WREB?

 

[ItsGavinC]

Well, hopefully I'll have a "first patient" story to post about soon.

Today I received 5 patients, was able to review their records and call and schedule them for appointments.

What I can say is that some of these folks are on 10+ meds (beta-blockers, ACEI, synthetic T4, estrogen RT, SSRI, anti-arrhythmic, diuretic, bronchodialators, etc!). Not too bad for a "first patient"!

Interestingly, I'm not afraid to get to work on my patients, but I do feel as though I know nothing. It's tough to explain.

 

[Rezdawg]

Well, hopefully I'll have a "first patient" story to post about soon.

Today I received 5 patients, was able to review their records and call and schedule them for appointments.

What I can say is that some of these folks are on 10+ meds (beta-blockers, ACEI, synthetic T4, estrogen RT, SSRI, anti-arrhythmic, diuretic, bronchodialators, etc!). Not too bad for a "first patient"!

Interestingly, I'm not afraid to get to work on my patients, but I do feel as though I know nothing. It's tough to explain.

Im looking forward to hearing all about it. Update this thread every chance you get. This crap is cool.

 

[ehop24]

My first conventional restoration was a DO amalgam on a maxillary premolar. 74 year old lady.

The recurrent decay was running deep, and I kept drilling through my wood wedge on the proximal box. My patient had extremely tight contacts, and as it was, her teeth barely moved when wedging. Frustration was setting in for me, and it was time for a fresh wedge. As I was inserting the wedge with my #110's, the wedge broke. I straight up punched this lady in the lip!!! Hard! And she screamed at the top of her lungs. "OOOOOOOOOOOWWWWW, my rip, my rip, OOOOOOOOWWWW, my rip!" (translation: ouch, my lip. she couldnt speak well through the rubber dam).

My first instinct was try and toss the 110's out of the operatory and plead the 5th. But I didnt. I took it like a man and kissed some butt. When I finished and took off the rubber dam, she looked like somebody had beaten the poo out of her. Her lip was not only swollen, but had torn and bled during the punch due to dryness. So i rubbed some vaseline on it and sent her on her way.

When I called the next day to check on her, I asked about the restoration. "Oh, the filling is fine....but my lip! I dont know if you noticed yesterday, but when that wedge broke, you got me good. I knew it was bad because I could taste blood." Like I didnt notice her screaming at the top of her lungs.

NEVER will i forget that.

 

[ItsGavinC]

ehop, sweet story. I LOVE it!!

 

[egpndoc]

ehop, sweet story. I LOVE it!!

Keep us updated as much as possible Gavin, its nice to see how your experiences are going, especially for us that are going to start dental school or clinical work soon, thanks.

 

[C2H5OH]

My first treatment was a DO restoration as well ... anyhow, while preparing the tooth, suddenly I heard a weird noise ... and I freaked out ... but it was just the snoring of the patient who has fallen asleep during the procedure

 

[tx oms]

My first restoration was a complex amalgam, two cusp coverage. I was sweating that out for three hours.

My worst patient experience was inducing irreversible pulpitis on both abutments of my first FPD. Over prepped to the max.

 

[Rezdawg]

Question for all you dentists and/or dental students who are in clinics....

Would your hands shake when you first started out? Im just curious here because the only experience I have had is when I was shadowing. The assistant fainted because the procedure involved more blood than normal (yes, she didnt last much longer as an assistant). Anyways, the dentist needed help with the suction, so she told me to put some gloves on and get my butt over next to her. So, as Im assisting, I notice that my hands were starting to shake a little. I was nervous and couldnt help it.

Anyways, thats my only hands on experience and Im worried about how I can make that stop because I know that when I have my first patient, some major nervousness will be there. Is this something that everyone goes through and it just stops over time or do i suck monkey balls?

 

[egpndoc]

Question for all you dentists and/or dental students who are in clinics....

Would your hands shake when you first started out? Im just curious here because the only experience I have had is when I was shadowing. The assistant fainted because the procedure involved more blood than normal (yes, she didnt last much longer as an assistant). Anyways, the dentist needed help with the suction, so she told me to put some gloves on and get my butt over next to her. So, as Im assisting, I notice that my hands were starting to shake a little. I was nervous and couldnt help it.

Anyways, thats my only hands on experience and Im worried about how I can make that stop because I know that when I have my first patient, some major nervousness will be there. Is this something that everyone goes through and it just stops over time or do i suck monkey balls?

I asked the same question to a lot of dentists and dental students that are in the clinic. Theyve all told me that its all about confidence, which comes from practice. I guess after all that pre clinical stuff, our confidence will be a lot higher than the first time you stuck a salive ejector in a patients mouth. One dentist told me that on his first patient he was sweating bullets on a procedure that took him like 3 hours, but he can do it now in about half an hour. Dont worry about it too much, we will get there some day.

 

[GoGatorsDMD]

These 1st pt posts are pretty entertaining. Just finishing up freshman year next week so I look forward to it in a little more than a year. Sounds like a crap sandwich that everyone has to take a bite of.

 

[ItsGavinC]

These 1st pt posts are pretty entertaining. Just finishing up freshman year next week so I look forward to it in a little more than a year. Sounds like a crap sandwich that everyone has to take a bite of.

You guys finish your school year up in April? Money!

 

[npayne]

You guys finish your school year up in April? Money!

My first pt. in clinic I was suppose to do a mf on #7. Instead I did the mf on #6 which was in the trmt. plan. After I had prepared #6, I realized what I had done and restored it and went on and prepared #7 and did not tell the doc what I had done. No one knew the difference, but I felt terrible about it, but on the other hand my pt. got a free restoration. Ahh the joys of being in clinic.

 

[Dr. Pedo]

Ok well if my memory serves me correct it was with a columbia 11/12 or 13/14. Not both just one I think it was the 11/12. For anterior your sickle scaler.
Secondly when it gets to your national boards test you need to get a periodontal file. It looks just like a bone file in oral surgery but smaller. Basically it provides a larger surface area then your typical scaler to crush (or burnish if not sharp) any of those smaller pieces of calculus that usually show up as missed surfaces on your exam. Alot of times they won't let you use these on the practicals during school because they want you to get used to using all of the instruments. My theory "THERE IS A REASON GOD MADE PERIODONTAL FILES, SO GENERAL DENTIST'S COULD PASS THE PERIO BOARDS AND NEVER GUM GARDEN AGAIN!"
Also on your board exam there will be a section on tissue damage and hemorage. The best legal way of controllig this is with a mouthrinse. The one that worked the best was Colgate's Peroxyl. It stops the bleeding before your patient is sent back to be evaluated.

I have a whole list of tips on how to do well on the boards.. If you have any questions about it let me know. Glad to help...

hey i take boards in a couple weeks. are the files legal? what other advice do you have?

 

[PERFECT3435]

i love this thread. its probably going to be my favorite thread of all if all you clinicians keep your stories coming.

as for me, ok so i am almost done with my 1st year of dental school. at my school, you are required to go and observe in the clinics twice/semester. so, last week i was up at the clinics trying to observe when the upper classman asked me if i wanted to do the MOD prep or restoration on her patient. 😱
my response: how about i just watch you do both?lol

the she asks me if i could do the anesthetic block. are you kidding me?

well, i had no idea but she told me that as long as you know how to do any of the procedures you could pretty much do it even during your 1st year. now, i feel ok doing somple preps/restoration on the dentoform but doing it on a real patient. um, no i am gonna wait at least one more year.lol

so to make her happy, i helped her put the rubber dam on. good lord, i was even nervous doing that. i was soooooo nervous and tense that the floss kept ripping everytime i tried to floss the rubber dam.

 

[lnn2]

so, last week i was up at the clinics trying to observe when the upper classman asked me if i wanted to do the MOD prep or restoration on her patient. 😱

the she asks me if i could do the anesthetic block. are you kidding me?

Was she smoking something prior to seeing her patient? Man, talking about clueless! I'd love to hear what her instructor has to say!

About the rubber dam, a small amount of vaseline around the punched holes will help it slide through the contacts.

 

[PERFECT3435]

no she wasnt on drugs.lol

apparently, thats the deal here at IUSD. if you have done the preps/retorations on dentoforms and you feel comfortable then you can do it on a real patient under the upper classmen's supervision. or at least thats how i understand it.

now when we get to second year, i have heard that they actually make you do a couple of preps on real patients. damn thats only afew months for me. thats scary.

 

[toofache32]

My first patient was an oral surgery patient (prisoner) with all the big 3: HIV, Hep B, and Hep C. He needed a surgical flap for a root tip, so I walked in gowned, gloved, and masked so heavily that I looked like that Michelin man.

I also cut a couple of tongues while doing crown preps, but nothing ever became of them. One probably could have used some stitches but that would have been a paperwork nightmare.

The worst was when I pulled to wrong tooth on this 39yo lady. The emergency dept sent her up with a note saying "extract #14". She had a full arch of teeth (with all 3 molars on her left) so I pulled the molar closest to the front (3rd from the back). This turned out to be a baby tooth (#J) which you couldn't really tell on the crappy panorex. I was supposed to take out the next molar (the one I would have called #15), but the ER was calling it 14 since it was the first permanent molar. That damn baby tooth looked just like a permanent tooth to me.

 

[ItsGavinC]

My first patient was an oral surgery patient (prisoner) with all the big 3: HIV, Hep B, and Hep C. He needed a surgical flap for a root tip, so I walked in gowned, gloved, and masked so heavily that I looked like that Michelin man.

Blatant discrimination on your part. Naive students, hmmph. 🙂

 

[ISU_Steve]

I don't blame Toofache. That's how we handle patients with ANY of the big 3, let alone all of them in the OR, ICU or ER when we do something likely to cause blood exposure. Hell, if wearing the encapsulated Class A HazMat suits (the "Outbreak" suits) was an option for some of our patients we would do it. It's bad when the report involves: "He's got HIV, Hep. B, shingles and his MRSA has VRE."

 

[toofache32]

Blatant discrimination on your part. Naive students, hmmph. 🙂

I knew I would be haunted here by another forum.