Design and Class

That's right! I'm talking INSTRUMENTS.

Wednesday, we went over all our instruments and what the difference is between them.

We have 10 different instruments that actually touch a tooth.

There are differences between each one that the untrained eye can't see.

Now that my eye has been trained, I can tell the difference between a Nevi and Nebraska.

and I'm not just talking the color of the handle.

Some differences to look for include, but are not limited to:

1. Is the working end RIGID/ NON-RIGID?

2. Does the instrumentation remove LIGHT/ HEAVY CALCULUS?

3. Is the tool primarily used on ANTERIOR/ POSTERIOR SURFACES?

4. Is the TERMINAL SHANK SHORT/LONG?

5. What is the ORIENTATION of the blade?

A few things stuck out to me during this clinic session.

All the blades are a 90* Angle, excluding the Gracey's (70*)

The explorer is the only subgingival instrument with a pointed tip instead of a toe.

Today Professor Costly got CRAZY with her lesson and had a contest.
Whoever could set up their pod for Pt. Tx. fastest, would get a treat.

Short story long, I WON! 
... because I'm awesome!

overall: pretty chill day. Now to memorize all these instruments. :)

take a look around... go ahead. explore!

I learned how to explore today ... with an explorer, of course.

Danielle was my lucky victim today!

This was soooo much better than probing. Maybe just a little less frustrating.

With an explorer, you have to find the correct end to use. The anterior and posterior teeth have two different ways of finding this end.

Anterior: lay the working end on the facial side of the tooth. make sure the curve of the shank is along the tooth, if it is pointing up, that is not the correct end.

Posterior: use the interproximal space for this one. Watch your wrist as well as the shank of the instrument. The shank will be parallel with the tooth, and your wrist won't be all crazy trying to make it parallel. If you're getting all crazy up in there, switch the end.

After you find the correct end to use, you can start by going subgivivally and using upward stroking motions. Keep the toe (or tip) on the tooth. I think this feels like I am scratching the tooth.
Following the toe will help you not push your instrument into the tissues surrounding the tooth.
This will help you find the calculus on the teeth, both supra and sub gingival.

All around, sounds pretty simple. Putting the words into practice, is a little different.

UDHA Convention

Yesterday and today is the UDHA convention. I was required to go yesterday and today I am going to help out in the SADHA booth for 2 hours. This will fulfill 1/2 activity requirements for the SADHA program.

There are classes to fulfill your CE [[continuing education]] requirements for those who already have a degree. They go over new techniques and products to better help in the clinical setting. A lot of people were there including 6!!! schools. It has made me very worried for the availability of work once I graduate.

They had only 1 class specifically for students at the end of the day. They talked about different ways to use a degree in the USA, including everything from the military to working on pt.'s who are in prison. This is a very well paying job where ever you are, it's just getting the job that is the problem. :)

They had a ton of booths there that we could get fit for loupes or test out some ultrasonic scalers. My very favorite was the massage station. They gave us massages for 3-5 minutes and they felt AMAZING! Everyone gives you free stuff that you get to try out for yourself. Many come to Weber and do a Lunch and Learn for us. They bring us all lunch for free and we get to learn about their product, and give us free product again! In April the man from Sonicare (electronic toothbrushes) told us that he would be visiting and everyone gets a FREE SONICARE BRUSH!!!!! This made me want to bow to him to say the least.

Anyway, here is a picture of all the free stuff I got,

just in case you didn't believe me. :)

This might pinch just a little...

Well... when I am probing, it pinches a lot!

[[ you probably shouldn't be my pt. for a while]]

I had a hard time maneuvering the instrument
...apparently you aren't suppose to probe the lip.

We practiced on marshmallows for how hard to push and candy corn for the correct angel to hold it at.

Poor Misty, probably regretted her decision to let me probe her when I was digging around in her gums trying to find the correct angle.

="ouch" was her favorite word that day=

Reading the probe is really hard, because someone thought it would be a good idea to put a mm length on the probe so no one can read it without focusing really hard.

This is why the professors recommend buying loupes.

Problem with buying loupes: they are lots and lots of money. I have never seen a pair of glasses for $1000!!!
... plus you look like a weirdo when you wear them. :)

Positive about buying them: You can see what you are doing without compromising your body position.

All in all, I think probing will come with time and I am very excited for it to be that time.

OPEN UP!

On monday, we performed intra-oral exams. This is where we just look inside the mouth.

[[We are not yet trusted with sharp objects in there.]]

We go over everything from the vermilion border to the uvula and back to the filiform papillae.

Lots and lots of structures to name, this part worries me a little. I'm getting more used to the medical terms as the semester goes on.

It was really cool to have a pt. in my chair that could open their mouth without a lever. :)

With every clinic session, I get to learn more and more about my career and lots of different things that I will be performing on a daily basis.

Can I feel your face real quick??

No... This isn't weird at all. Well... maybe a little.

This is an extra-oral exam that we do to check for anything that might be wrong, like cancer.

You feel the pt. face and neck down to the collar bones.

[[definitely have to talk to your pt, so they don't think you are going to do anything inappropriate]]

I am pretty familiar with the structures, it is just remembering them all as I'm going.

Another weird part is that if you don't feel anything, that means they are good.

The part I have a hard time with is feeling the sub lingual and sub mandibular nodes. You have to reach under their chin and grab the excess skin, pull it up and around the mandibular bone. Then you let it slip out from your hand and try to feel the node. I can get it after a few tries, so it's just working on getting it on the first try.

Tip: talk to the pt. and joke around a little bit, this will relax everyone. :)

120/80??

I was very surprised to find out we take pt. vitals... AT THE DENTIST! Weird right?

That being said, it is really easy. I personally have taken vitals before in a pediatric hospital when I was interning there. It was a long time ago, so I had to reach into my memory quite a bit. :)

I first struggled with finding the radial pulse, but my pod partner, Danielle, told me to use 3 fingers.

This was Genius!!!!

[[don't know why I didn't think of that before]] 

After that, I was having troubles hearing the thumping sound.

So I had my pt. make a fist, and that seemed to help a lot too.

My husband is now very sorry that I have to do this because he is now my model at home. :)

HHX & HHRX

Starting with the Health History and knowing what to write for everything was very stressful. After you know what you are doing, charting isn't the worst thing in the world. I was very overwhelmed when we started talking about it. After I had done about 2 or 3 I started getting the hang of it.

I am not excited to memorize all the different situations that my pt. has to pre-med for.

This is going to be the roughest part for me.

We are now getting into the things which are specific to what I will be doing in the office setting. 

I am starting to feel like a Dental Hygienist finally. :)

Instrumentation

This has to be the worst PE there ever was for me.

I am one of those people who hold their pencil like a crazy person.

My thumb doesn't even touch the writing utincle.

So you can see how I am having a lot of trouble with instrumentation.

A few points to remember with holding your instruments:

• Thumb and index finger opposite one another (not touching or overlapping) bent in a relaxed grasp, should make a circle, no blanching.
• Middle finger should rest lightly on the shank
• Ring finger and pinky rest on each other forming a stack (pinky is not lifted in the air, we are not drinking tea)
• Ring finger is the fulcrum, or rest finger

Hand is held a little high, but you get the point. :)

I won't lie, I had to take home my typodont and instuments to practice. Another thing that is helping to get the finger hold down is to start holding my pencil and pens this way. My hand gets tired really fast because I am focusing on it so hard. Hopefully it will come with time and I will be able to make the instrumentation natural.

They Leave, You Clean

After the appointment there is a lot of steps to take to keep the operatory clean. I was very overwhelmed with this PE at first. After practicing and reading through it a few times, it has come pretty natural. There is a reason for everything we do, like waxing the metal portions of the operatory. You can tell by the little things we all do before and after every appointment, how well the space has been kept. I am looking forward to when I can clean up after an actual patient. :)

Sit Straight

Wednesday 8/31

I have never thought about having posture while cleaning teeth. After hearing the stories of the instructors, I now know it is a very important part of the job.

There are a few key points to remember:

• Adjust stool so thighs are parallel to the floor
• Position patient chair in supine position
• Adjust patient chair so operator's elbows are at waist level while performing instumentation
• Position bracket tray and unit light within easy reach
• Direct light to illuminate the area of treatment
• Back and shoulders in a relaxed position
• Do not bend over patient or cross your legs
• Keep at least one foot flat on the floor

You are now able to swivle the chair in the correct position to make it easier to remain in the correct posture while performing treatment.

•  Maxillary/ mandibular right facial and maxillary/ mandibular left lingual- 9:00
• Maxillary/ mandibular left facial and maxillary/ mandibular right lingual- 10:00
• Anterior (maxillary/mandibular facial/lingual) all surfaces toward- 8:00
• Anterior (maxillary/mandibular facial/lingual) all surfaces away- 12:00

While working in the mouth, let the patient help you out (turning their head). This will make your job a lot easier while saving your body by being able to stay in the correct posture position.

If you are not use to this position, it might take a while for it to feel normal. It is hard for me, personally, to not bend over the patient to see into the mouth.

I have trained myselp the wrong way and it is a long hard road to retrain my body.

 





 

Set Up and Tear Down

Monday 8/29

Clinic has been really simple until today. Our PE for today was how to set up and tear down your station. I am having a really hard time with remembering what goes where and when.

SET UP: You start by dusting all the equipment in your station withwith a damp paper towel and PPE on. I have never done this before in the office I worked at. We had a lady who cleaned the office weekly and would dust everything. I can say this definitely makes the station look REALLY good and clean. On the patient's side, I like it because I'm not worrying about how the office isn't clean. Next we sterilize anything we might touch, and run the water from the A/W syringe line (2 minutes) to clear out any germs that might be caught.

Barriers= Overdone
Before putting any barriers on make sure to take your gloves off and disinfect your hands. With all the equipment we have and precautions we take, we use more barriers than is needed. We put a cover on anything that we might touch (or even look at: jk). This includes: counter top, operator chair adjustment levers, bracket tray, A/W syringe, evacuator and saliva ejector heads, pt. arm-rest buttons, light switch, mirror, mouse to computer, and much much more. It is nice to know that we are taking every precaution to keep our patients, loved ones, and ourselves as healthy as possible.

The patient then comes into the office and rinses their mouth for 30 seconds with mouthwash. This helps eliminate aerosols. While the patient is doing that, we open the sterile instruments without touching them with our bare hands. (if you open before pt. gets there, cover with bib.) Seat the patient, and provide protective eye wear that has been sterilized. After that put back on your PPE and avoid direct gloved-hand contact with contaminated surfaces (especially mask, eyewear, hair, patient chart). After the appointment, remove gloves, and sanitize hands. Avoid contact with dropped instuments.


TEAR DOWN: Now it's time for the hard part. After the pt. walks out and charts are done, we start our cleanup by putting on our PPE. Run water through the blue boa and detach. Remove and discard A/W syringe and evacuator tips. Next you put all your biohazards in the correct waste container. (fluid soaked in a contaminated disposable supplies in biohazard bag)

Now you want to place the instuments in a cassette and take to the clean-up area on a tray. Run them through the ultrasoniccleaner for 15 minutes. After, wipe down the tray and put take it back to your station. Go back after 15 minutes and take out the cassette without placing hands in the solution. rinse and blot with paper towel. Put the instruments into the correct size bag, write your name and number on it, and place into the sterilization bin so it's standing on edge.

Back at the station, you will reglove and disinfect all surfaces that may have been contaminated by touch or aerosols. discard all disposable items and wax the metal equipment. At the end of the day, run the lines with solution for one minute.

* This PE was very difficult to me. Although I have already worked in an office and have the experience of set up and tear down, it is intimidating to learn it all in a new place and to remember every little step. This one will take a lot of practice in order to pass this one.