Winding Down Summer Clinic

This past week and a half was quite eventful! I delivered and closed out my denture case (whoop!) (and he really likes them - they fit great!) and I waxed, casted, and cemented my first crown yesterday (what a relief and answer to prayer!). I feel like I haven't done half as much as most people have in summer clinic, but the two things I started and finished were actually pretty big deals. The minutia of fillings and pulling teeth will come - my patients need plenty of that. But to actually finish out and send my patients on their way with new prostheses is a really good feeling and I'm glad I got to go through the process from start to finish during these weeks. My denture patient doesn't really need any more treatment unless he needs adjustments, so we had a "good-bye" moment which was strange after working with him since April? May? My crown patient is a really cool guy who recently met the Lord and I'm so excited that he's excited about growing in the Lord (and coming back to get the rest of his teeth fixed!) What great patients! I have 3 ladies waiting in the wings and we will get all of their treatment started when I get back...I really like them all and so far they seem happy with the way things are going. I see my cousin tomorrow to get her started in diagnosis, so now I get the experience of treating friends and family which can be an entirely different experience, although it's one you have to get used to.

So 2 more patients this week and I'm done! I really had to get used to the idea of "real world" dentistry and not the world of perfection they beat into our skulls during 2 years of lab work. Apparently there is something called "good enough" otherwise known as "clinically acceptable" - a line which I never understood because most of us were trying to be really good at what we were doing in lab. You know, to get good grades. So now, even though I think a margin on a gold crown kinda sucks and would never want to turn something like that into Dr. Miller, in the real world, it's clinically acceptable and we're cementing it on! Allrighty then. Of course my skills will improve over the years and I can move beyond clinically acceptable, but for now it kinda freaks me out. And that's a good thing.

I Did It.

I cut on a tooth. The assistant handed me the high speed handpiece with a 169L bur and I cut into a maxillary 2nd molar (#2 to be exact). The total crown prep took around 1.5 hr with packing cord and trying to smooth the insanely deep distal margin that I'm still not sure is good enough. The rest of the 3 hr appt was vitals, injections, making the provisional and 2 impressions, and getting approval and advice from my professor.

Thank God for a great (patient) patient! I'll find out how well it really went Monday when I pull the casts from the 2 impressions we took. And I'm anxious to call my patient on Monday to see if his temporary stayed on over the weekend. I got a "well done" and a "pretty good job" from my prof. Not bad, I guess.

Everything else, I'd done before: injections, impressions, even making temporaries. I didn't think there would be any decay since he'd already had a root canal, post and build up, so it was a bit of a surprise when I broke mesial contact and found some soft, tan, diseased dentin. But I got it all out and got it covered well, so we should be good until I can wax up and cast his gold crown. My patient and I are hoping the next time I see him is to put the crown on, and that I won't have to bring him back to smooth out that margin. But I know I'm learning and certainly can't expect my first live crown prep on an insanely-hard-almost- deemed-non-restorable tooth to be perfect the first time around. I do kinda wish my prof would have "fixed" anything questionable for me so my pt wouldn't have to come back...they do that all the time. Que sera. I've jumped off the cliff and I'm no longer a restoration virgin. Well, at least I'm half way there. Gotta cast a crown.

Summer Clinic - Week 2

Procedures accomplished:

• preliminary denture impressions
• made custom trays for final impressions
• prophy
• impressions for diagnostic casts
• MOD onlay and DO inlay preps for typodont exams

It's nothing glamorous, like the occlusal preps a few people got to do, or even scaling and root planing, but it's progress. Those diagnostic casts mean I'm one step closer to prepping a crown - craziness for a first go round, but that's how it works around here.

Up for next week:

• final denture impressions
• record bases and wax rims for dentures
• custom trays, templates, mounting of diagnostic casts for crown prep consult
• cast MOD only and DO inlays by Thursday

Let's just say I need to get used to short lunches and staying late to do lab work....

Summer Clinic Week 1

All I can say is that so far, this is not at all what I expected.

Monday, we got our ginormous "comp care" binders which have this huge threat? warning? whatever it is, it's telling me that I better figure out what's going on and fast! And then, in true BCD fashion, the page quickly tells me that all of this could change in a second so everything I learned before will then be useless. Classic. The problem was that I didn't get much of a chance to sit down with this book all week. And come Friday, I wished I had. That whole "knowledge of the contents" part, you know.

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So much sitting and listening, just like D1 orientation. But this time, we get the clinic directors rotating in and out telling us how things run in their clinic. Of course, we get information that contradicts what we've been told before, and most of the time, people can't answer our questions. I spent Mon-Thrusday without patients, so I used my time to consult with professors about my denture patient, plan out his care, and study up on the xrays for my patient on Friday. I also had time to clean out my locker and get all my instruments sterilized for the upcoming rush.

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Wednesday, I was in class until 10am and then spent the day at lunch and then shopping with mom. That's my idea of summer school.

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Thursday we placed rubber dam on each other, and all I can say is I hope to never have to enjoy that experience again. It's just that I'm a mouth breather (which is a bad thing) and it kinda made me panic a bit.

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Friday was slow in the morning, but once 1:30 rolled around, I was sprinting until 5pm. My poor patient. He told me he wanted to finish the consults since he lives an hour away, but I don't think he (or I) knew what all that would entail and we were both exhausted when all was said and done. Oral diagnosis was great. It took an hour, and I actually did a pretty good job diagnosing all the cavities and my patient is great.

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Now, up to the 3rd floor for consults. Thank God Stephen was up there and free to help me get set up and on the right track (this would be the point at which knowing that entire binder would have helped).

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Operative consult, check. Preventive consult, check. And then they decided to take intraoral photos which was a bit of a circus, but that's ok. Fixed consult, here we go. This turned into an endo consult and then back to preventive and then we're throwing in nightguards and fluoride scripts and on and on. Once we finally got that all into Axium (grrr...) I had to go back to the operative consult to enter in the treatment because that professor was not helpful enough to guide me through the process (for my first time) and ask to sign off on my treatment plan. So, I finally got it all in the silly computer and got the script signed (to which the professor said, "Your patient is still here?) and we could finally go home (well, I could after I raced downstairs to clean up my chair, then back upstairs to clean up that chair).

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Did I mention that I had a runny/stuffy nose all day? By the time I got to Mom and Dad's to meet up for margarita night, I was officially working on being sick and now I've been on the couch all weekend. Gotta get better to see a patient on Monday!

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Please, Lord, let him come back and get treatment from me! I sure hope I didn't scare him away with our marathon appointment! Lesson learned: 2-3 appointments are the absolute limit with 2 being a much better option!

Going Back Tomorrow

It was a short two weeks. 6 weeks of school and then 4 more weeks off. Let the countdown begin!

First of all, I need to write down a few things I've been pondering so hopefully, I'll keep pondering them enough to maybe actually do something about them.

1) Been thinking about my lack of community. We really just observe at church, observe in our neighborhood and in this town. I go to school in Dallas and Erik works in Duncanville, and we just sleep here in Rockwall and go to a church service on Sunday. Last night, I thought about Zaccheus and how he tried to get away with just observing Jesus and what he was doing. He got called down out that tree super fast. Observing is not acceptable. Then Jesus went to his house with no notice - today. No time to run to the market or cook a lamb or sweep the floor - just straight up said "you don't get to just watch, in fact I'm going to be a part of what your life is really like - you don't get a chance to put on a show." Just some thinking.

2) Been thinking about my selfishness. Seriously, when I was in high school and college, I can't even name all the community service what-not I was involved in. I am so careful with my time now and so jealous of it. My time is so precious to me...but it's not mine and I tend to forget things like that. Guess that goes back to community...I'm not even very quick to give up time just to hang out with people. What is wrong with me and my reclusiveness? So not what Christianity is about.

3) Been thinking about what takes up my time. I had a bit of a FB hiatus that kicked off this thinking. It was great. I've totally revamped how I do FB and I'm still thinking about why I do it and what benefit it is. I've found that there are a good number of things that just kinda popped up in my life that are perfectly harmless, but take up my time and I never really thought through what "good" is in them. You know that passage of "whatever is good, whatever is noble...think about these things"? I found some of these time consumers (esp FB) creating issues in my life that weren't "good" for me. And none of the other things in that passage either. And even if chatting with friends seems harmless, a lot of it is mindless and useless and what place does that have in my life? I wondered, when did I just start doing things because it's something to do? When did I stop thinking about whether or not it was a "good" thing for me to do? It sure is cool though. At least I thought it was. There is so much good in simplicity. In making sure the important things are taken care of before spending 30 minutes on FB. Like studying. Or doing laundry. Or cooking a healthy dinner. Or working out. Or spending time with God. Or time with my husband. Or, heaven forbid, a new friend. 30 min in real life with a real person (possibly with coffee involved!) vs. 30 min on FB with random tidbits and maybe an encouraging word somewhere out there for good measure. Poor FB. It's not just that, there's a list of things I'm thinking about (including quilting...). I'm just glad I started thinking again.

I Can Already Tell This Break is Going to be Too Short

I kicked off my break by going down to Houston Saturday, then to Galveston Sunday to spend a night. This picture makes it look really good, doesn't it? (No, I didn't take it...) But it's all the beach I'll probably get this summer and for a long while, so I'll have to take what I can get. I wish we could have stayed longer and actually enjoy the sun for a while.

Day one of break was a lot of laundry, cleaning, and sewing. I have a lot of quilt deadlines coming up: birth, graduation, birth, wedding, possibly a camp reunion, and two births I'm already behind on!

Day two, so far, much of the same.

I keep checking my email praying for a message about grades being posted for one class in particular, but no news. Don't know if that's good or not.

Even though this break is short, there is the promise of a longer one later this summer, so I must be patient.

Getting Back on Track

From John Piper's Hunger for God:


The greatest enemy of hunger for God is not poison but apple pie.
It is not the banquet of the wicked that dulls our appetite for
heaven, but endless nibbling at the table of the world. It is not
the X-rated video, but the prime-time dribble of triviality we
drink in every night. For all the ill that Satan can do, when God
describes what keeps us from the banquet table of his love, it is
a piece of land, a yoke of oxen, and a wife (Luke 14:18-20). The
greatest adversary of love to God is not his enemies but his gifts.
And the most deadly appetites are not for the poison of evil, but
for the simple pleasures of earth. For when these replace an
appetite for God himself, the idolatry is scarcely recognizable,
and almost incurable.
...

“The pleasures of this life” and “the desires for
other things”—these are not evil in themselves. These are not
vices. These are gifts of God. They are your basic meat and potatoes
and coffee and gardening and reading and decorating and
traveling and investing and TV-watching and Internet-surfing
and shopping and exercising and collecting and talking. And all
of them can become deadly substitutes for God.

***A ton of his books are available for free download on his website: I like free!***

Almost Done, But Not

Three and a half days to go of second year and finals are in full swing. Last week we did full mouth extractions on my removable pt and today I will hopefully remove sutures. Impressions this summer and he should have teeth by the fall. A long time to go without teeth, I know.

This will be my first real break in a long time. Spring break doesn't count and wasn't long enough. I'm really looking forward to this time to do some re-centering. Re-focusing. Re-evaluating. Some real mission-statment making kind of stuff like I used to take my senior Bible study girls through before they went off to college. Every now and then you just have to take stock and it's been a while for me. The way some things have gone lately has made that painfully obvious and it's about time this is done. I mean spiritually, I mean physically, I mean dentally. Especially before I really kick it up a notch and throw a bunch of patients in the mix. It's only gonna get crazier...

Dentures, Anyone?

Technically, I've already had 3 patients. I cleaned Erik's teeth, another gentleman's teeth, and did a full mouth series for a young man. Unlike these patients, the patient I saw on Monday is in it for the long haul. Ok, maybe Erik is, too. But anyway, making dentures (the BCD way) is quite a process. I found a 3rd year gunner to do extractions for me. I'll get to do the local anesthesia, so that will fulfill a requirement for me : ) He'll get 27 extractions. After quite a bit of healing (approx. 4 weeks), I'll do preliminary impressions, final impressions, and get to work on a wax try-in. This will all start this summer. I would love to get him his dentures before the summer is over, but we'll see.

I was assigned to a very nice Dr. in removable. The only problem, is that if you don't ask him questions, he assumes you know what you're doing, unlike most Drs. who assume you know nothing (because we don't) and talk your ear off while you desperately try to remember what they are saying. So, since we rushed through our consult on Monday, I had to go back and pick his brain a little bit today after discussing my case with some 3rd years. He's a really nice guy and really has a lot to teach me, I'm just going to have to be on my toes on this one.

So, tomorrow, I hope to schedule a chair in the Oral Surgery clinic for my patient : )

Busy

We're just doing all kinds of stuff, right now. These pictures are from fixed lab where we took impressions of each other and face-bowed each other...again. Alex (sits to my right) and I are pro-partners, now. We've also done extra-oral and intra-oral exams on each other, cleaned each others' teeth, and spent countless hours helping each other in lab. He's a good friend, and a good lab buddy.

He was kinda shocked when he discovered that we weren't acutally going to be automatic partners for our local anesthesia injections. Sorry, Alex! Didn't mean to throw you for a loop! Jennifer (sits to my left) had coralled me last semester and asked me to pair up with her because she had a horrible experience when she got injections at NYU Dental School. She figured since I had at least done them before in Mexico, surely she had a better chance at getting by without a huge bruise on her face!

No pictures of the injections, but it went very well. Four blocks and a maxillary infiltration. I was crazy numb and sore that night and the next day. After we get one more lower block checked off, we will be authorized to perform injections at BCD. Crazy. A few days earlier we did nitrous (laughing gas) administrations, which was fun. A little like going to the bar with your friends, only you're all laying down in dental chairs with funny masks on your noses.

I got my 1st patient-that-counts' name today. We'll call him Wayne. John Wayne. : ) Extractions and full over full denture. I can't wait to look at his chart and study up for the big day on Monday. But first, yet another test to study for. Blah.

Firsts

Upon returning to school after spring break, I will be encountering a lot of firsts. First denture patient, first nitrous oxide administration, first injections (okay, maybe I did some in Mexico), and first diagnosis appointments. Here we go! Summer clinic will bring even more, but it's time to ramp up, get lots of good advice, and think about how I want this to go (I'm sure I'll look back on this and laugh hysterically).

We had a lunch and learn with the upperclassmen last week to get advice on how to make the experience of entering clinic as smooth as possible. I took good notes (literally typed it up) and I'm planning on running through it and making a sort of action plan. At this point, my general goal is to treat my clinic years as if I'm starting up a practice. I'll bring in lots of call patients (friends, family, friends of friends, friends of family, friends of friends of friends, you get the idea) and count what they throw my way as icing on the cake. I'll micro-manage my appointments, and work to avoid having paperwork and labwork preclude me from chair time. Can it be that different from a cake business? ; )

At this point, I feel like I'm ramping up. I don't want to over do it and make things harder on myself than they have to be, but I want the experience to be better than it has worked out for some 3rd years so far this year.

And spring break? A lot of the moving is done, still bits and pieces to do. LOTS of house finishing before unpacking. And some serious quilting is in my future. And a birthday cake. Maybe two.