Our school works like this:
We have various duty days – days assigned to us where we go and work in certain clinics. We have oral surgery duty, radiology duty, pedodontics, admissions, etc. We see new patients while in admissions. They come into the dental school and this is the initial visit. It is fairly quick. A health form is filled out, bp is taken, pulse rate, extra oral exam, intra oral exam, etc. Everything about their health is reviewed. Meds, surgeries, dental health, etc. And some forms are filled out with a general statement of what the patient would like done, or needs done. Based on this preliminary information they are assigned to a student. As a duty student you do not get the patients form admissions unless you brought the patient in yourself.
After being assigned a patient from admissions the next appointment is treatment planning. A chair is scheduled by the student, which can be done up to two weeks in advance (every day at around 4:30 a day two weeks in the future becomes open to schedule appointments) and the patient comes in. So this is where I started. A random student on admissions duty saw my patient and then the patient was assigned to myself. I made an appointment, scheduled a chair, and at exactly 12:30 PM I walked my first patient from the main lobby, down the hall and to my assigned chair. If you remember your first patient you can remember the anxiety and relate with me. I was absolutely terrified. Mostly because I didn’t know what to do during the appointment. I had assisted a few times in treatment planning and had a general idea, but most of it was going off the seat of my pants.
Here is how it went: I started setting up my chair/work space at 12:15. It was 45 minutes early, but I wanted to be prepared. I got all the cotton rolls and suction tips out and cleaned off the chair and got out a basic kit (perio probe, explorer, mirror, college pliers) and read over the patients chart one more time. You know when you read something about 20 times, but can’t remember a darn thing from it? Same story. I read over our treatment planning manual for the fifth time as well. This manual outlines a treatment planning appointment. At 12:30 I went and got my patient and sat them down in the chair, went over PMH, took bp, made sure they were still healthy since thier last appointment and then presented the case. A case presentation includes things like age, gender, race, chief complaint (why they came to se the dentist) like: “My teeth are brown”, “I hate the way my laterals look”, “I am in pain”, etc. and briefly describe what the patient wants, etc. The faculty may ask some questions and then they will give the OK.
At this point I returned to my patient and began a comprehensive intraoral exam – I took probing depths with a periodontal probe of 3 spots on each tooth buccally and lingually (6 spots total/tooth), indicated missing teeth, decay, current restorations, and anything else I could find in the mouth. My particular patient had several residual root tips and unrestorable caries on teeth 6-11. Their posterior maxillary tooth crowns were missing, which had caused extrusion of the lower molars and loss of posterior support. There was some calculus and chiped enamel on a lower PM. After charting is done an overall look at the mouth is possible and a treatment plan is made. What does the patient need done? What is the proper sequence? What does the patient want vs. what is realistic. Since it was my first tx plan, I really had no idea what we should do. I referred to the instructor for guidance. I obviously knew that the residual roots had to be extracted. I found out that 6-11 would also have to be extracted- due to unrestorable caries. Also because of the extrusion of the mandibular molars they would have to be extracted as well so room could be made for the upper denture.
A treatment plan paper is then filled out. It includes the sequence of treatment – what will you do 1st, then 2nd, 3rd, and so on. Here is the grief tx plan that we came up with for my first patient:
1) Extractions: 3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 31, 32 (they are already missing 1, 2, 4, 5, 19, and 30). Only 17 and 18 have a complete crown, the rest are residual rot tips. This will be the first appointment (or two appointments – thats a lot of teeth for me to pull as a rookie and it is also traumatic to the patient – physically and psychologically)
2) SC/RP
3) OL restoration on a lower PM
4) Maxillary complete denture and mandibular partial denture
After this you get a consent form signed, another form signed for credit, and fill out the progrss notes, get everything signed and then you are done. I have an appointment set up within the next two weeks to start on the extractions. I was mentally drained and thus exhausted after this three hour appointment. As far as working in the mouth, that wasn’t a big deal, it was all the paperwork that drained me. There are various forms that need to be filled out and signed for legal reasons and so you can get credit for the procedure. It was a headache the first time, but overall it went well. Other classmates of mine have had similar experiences of being lost up a creek with no paddle or canoe during thier first appointment. As of right now, I have three more appointments coming up – the extractions, another treatment plan and another in pedodontics. Wish me luck, and as always I will let you know how they go.
You can also discuss this topic or wish me luck at the forum.
!
