Today was my first day in the Midwestern dental clinic. I had no idea what to expect because I am one of the few first year students to do their clinical rotation this year. A few classmates told me that they were able to assist on their rotations. But it sounds like most of my classmates spent their time observing cases.
I was lucky today that one of the third year students needed an assistant. His fourth year partner was placing six or seven crowns on the same patient downstairs. As a point of reference, the average number of crowns placed by dental students around the nation is six for all four years. This student was placing that many in a single afternoon!
My first patient, sort of
So my third year partner, whom I will call James, went out with me to the waiting area to greet our patient. She was a very kind middle-aged female whose chief complaint was pain on one of her maxillary molars. This was her second visit. On her first visit, my partner took a panoramic X-Ray and saw recurrent caries around a large amalgam filling.
James was a very enthusiastic and bubbly kind of guy. He charmed our patient into baking him cookies the next time she came in. I don’t know much about dentistry yet, but I know enough about people to know that he will be a successful dentist with his personality.
First things first
So, James and I started the anesthetic. Well, he did all the work as I observed. But he taught me about what he was doing and why. He showed me some tricks he learned from some outside courses and the clinical professors. He was eager to impart his wisdom to me and I appreciate it!
After the patient was numb we removed the old amalgam filling in her molar. James said that this is the biggest amalgam he has ever seen! This was no exaggeration. The natural tooth was reduced to just a few slivers of enamel on the distal crown and buccal surface with only part of a cusp still intact.
“They probably should have crowned this tooth,” James said. “I’m amazed that the last dentist kept even this little bit!”
The patient explained that she didn’t have much money at the time and the dentist had done the best he could to preserve her tooth.
“Well he did an incredible job!” James replied.
That’s one big amalgam filling!
We placed a dental dam and then set about removing the filling with a handpiece. James did his best to preserve the few fragments of remaining tooth that the previous dentist had preserved. I think this was more a challenge for his hand skills than something he deemed necessary because the plan was to crown the tooth anyway.
James did a great job of removing only the amalgam, right up until he got to the portion of the tooth that had been tunneled through. The tunnel was at a difficult angle, and that part of the mouth with indirect vision is already more challenging. Many dentists hate working on tooth #2 because it is so difficult to access. James seemed to be enjoying the challenge of preserving as much tooth as possible in a difficult place.
Sadly, James efforts were in vain as the tiny enamel bridge above the enamel he was removing collapsed.
“Oh well,” he said. “We were going to crown the tooth anyway!”
After what seemed like forever, he finally finished removing the last bits of amalgam. I had mostly just assisted with suction and keeping the area free of amalgam so he could work.
Next we would have to build up the tooth so that we could later prep it for a crown placement. There just wasn’t enough natural tooth structure left for us to work with.
My chance to shine!
This is where my role became much more important, because I needed to hand James the appropriate resins and bonds as he needed them and in the correct order. I was a bit nervous because it is easy to confuse the myriad bottles and applicators that were lying on the tray.
I managed though, and we ended up with a great result. Next we scheduled the patient to come back in for a crown prep and placement. Our school uses E4D machines so that we can create same day crowns for patients. I hear that the software can be difficult to use, but I didn’t get to see it today.
Always check your work
After our first patient left we had a followup appointment for some previous crown placements. Sometimes a bit of excess cement squeezes out between the crown and the tooth. The cement can be hard to spot and may be right beneath the gum. It is important to remove the excess flash though because it is a prime breeding ground for bacteria.
The patient had one spot that needed a bit of scaling and James spent about fifteen minutes removing it and checking the rest of the crowns. After that I had to take off for a student government meeting.
I was happy to get the opportunity to assist in the clinic today. Observing is great, but you feel less like you are in the way when you are assisting with the procedure. I hope that I can continue to assist on future rotations as well!