Category Archives: Junior Year

Immediate Maxillary Denture [Pictures]

Yesterday I delivered my first set of dentures.  I delivered a lower partial denture and an immediate complete upper denture.  The final result turned out very well for my first set of dentures.  Getting to the final result took a lot of extra hours outside of clinic time and classes.  I will quickly review the steps we took to get to the final result:

  1. Extracted multiple retained roots.
  2. Prophy, cleaning, fluoride
  3. OL composite restoration (very small) to fix small chipped enamel on LL PM.
  4. Preliminary impressions
  5. Lower partial denture designed and rest seats prepped into mouth – new impression made, poured up in  pink stone and submitted for framework fabrication.
  6. Framework returned and tried in – perfect fit (PHEW!)
  7. New impression taken of maxillary arch and bite registration taken with framework in lower arch.
  8. Facebow and bite registration used to mount the stone models.
  9. Teeth #6, 7, 8, 9, 10, 11 were removed from maxillary arch and wax rims made to replicate excursive movements and protrusive movements set into the articulator prior to tooth removal.
  10. Teeth set into lower partial framework (Replacing #30, 31)
  11. Teeth set into upper denture. ***Note how I write this down so nonchalant!  In fact this was the most time consuming process – setting teeth, making the wax look good and festooning.
  12. Submitted both upper and lower to lab to get processed at the same time.  Because this is an immediate upper denture we could not do a wax try-in.
  13. Received the processed dentures.  Removed residual resin, polished the denture and removed a few undercuts.
  14. All in the same day: Extracted #6, 7, 8, 9, 10, and 11 and tried in denture.  Fit was good, so we headed over to the removable clinic.  PIP paste was used to check for excess spots and the denture was adjusted in a few areas.
  15. 24hr f/u resulted in some soreness in the maxillary labial vestibule.  The denture was adjusted and lowered in these areas.  The lower partial denture did not need a single adjustment.

Overall the whole process took about 20 appointments!  We still have a few more follow up appointments and some relines to do for the maxillary denture.  The immediate dentures never fit quite as well because of the guesswork being put into the process (teeth are still present in the mouth when you are making the denture).  My biggest tip would be to self regulate your work and be as anal retentive as possible while doing an immediate denture.  The smallest mistake can easily be compounded into a large mistake by the time all the steps are done.  I wish I had taken some before shots, but here is the final product:
complete maxillary upper denture

complete maxillary upper denture

complete maxillary upper denture

The astute observer may notice a few things:

  • The upper teeth do not match the shade of the lower teeth: This is due to patient preference.
  • There is a space between the upper and lower anterior teeth: I wish I had a pre-operative photo!  The patient had a much larger open bite and this is the best we could do clinically to close the gap.
  • Do you see anything else?

Please share your comments!

Junior Year Dental Outreach

A Juniors one of our requirements is to do outreach.  The school has plenty of outreach days available and they include anything from helping with the Special Olympics to doing screenings on children at various clinics in the greater Philadelphia area.  Two outreach credits are needed and the outreach is done in any two days during the year.  The first outreach I did was a table clinic at some Junior College where we talked to students at a graduate job fair and gave them information about dental school and the scholarships available to them if they graduated from said college.  No one wanted to go to dental school which I thought was insane since the scholarship was for a FULL RIDE. Anyway…

For my second day of outreach I visited my son’s elementary school and talked to a his class about brushing their teeth and how fun visiting the dentist can be.  I had one of my friends help me out.  Here is his picture:
Dental Donkey

I spoke to the kids about the typical things.  The average visit at the dental office, Mr. Tickle (low speed with prophy cup), sleepy juice, how to brush, and my donkey friend helped me the whole time.  I used my son to help all the kids count all the teeth found in a 5 year old.  Here are some pictures, enjoy!

outreach speaking to kids about the dentist

loupes on, donkey sedated

showing the kids the instruments

each one gets a turn brushing. watch out donkeys can bite!

counting how many teeth kids have (my son)

Happy New Year! Half Way Through the Junior Year of Dental School

A new semester starts in a couple of days and after almost three weeks of doing nothing but sitting around, eating, watching movies, playing halo 3 and rock band I do not want to go back.  Return I must however, because I have crowns to do and teeth to restore if I want to graduate on time.  This semester will still be hectic and busy despite the class load dropping slightly.  We still have class every day for one hour from 12:30 to 1:30pm.  Every Tuesday morning we have class as well from 8:30am to 11:30.  Seven classes in all which seems easy enough and the material is starting to slightly repeat itself (especially after what seems like 20 perio classes). The classes are:

Restorative Dentistry VI
Pediatric Dentistry II
Oral Surgery III
Orthodontics III
Periodontology (again)
Physical Diagnosis
Practice Management

However, with all of our requirements and mandatory lab work (we do pretty much everything except process dentures and the porcelain part of PFM’s) the schedule is still time consuming.  The book work is a lot less time consuming but is made up for by all the lab work.  I still have more free time on the weekends and weeknights than the first two years.  I have a feeling that this will change over the next few months as the Junior year winds down and I am scrambling for points in the clinic.  Writing about all these classes and requirements has gotten me a little depressed and since I still have a few more days of vacation I think I am going to go back to Halo 3 online and make myself feel better.  Happy New Year and let’s toast to a few more ‘Running Riots’ before the work week starts again.

Finished Midterms and Getting Busier

Our last midterm just ended last week.  Oral Pathology II ended with a bang.  Our test consisted of developmental cysts, bone pathology, odontogenic cysts, and intraoral presentation of systemic diseases.  It was a long list of diseases with some differential diagnosis and specific details about the pathology.  I think most of my classmates started studying a couple of days before the test.  There was quite a bit of information so I would suggest starting quite a bit sooner than this.

Now that midterms are over and finals don’t start for about a month I have been able to schedule my whole week out.  It also helps that some of my patients are out of perio.  I have a gold bridge that I am waxing up this week and hopefully delivering this friday.  I am trying in a partial denture framework, doing a pulpotomy and SSC on my pedo patient, checking a patient out of perio, checking another patient out of perio, extracting #3 from another patient, and doing operative work.  We still have class every day for an hour and every tue and thur morning.

Just a quick update.  I am in the process of seeing if I am allowed to post clinical photographs on my website from the dental school.  Stay tuned.

Taking a Proper Medical History for Dentistry

Over the past few months my classmates and I have been slowly honing our skills at admitting patients into the dental school and treating emergency patients.  This requires a medical and dental history to be filled out and then reviewed by us to help us know what the patient wants, needs and what thier limitations are.  There are not many medical issues that prevent us from providing dental treatment, but there are many conditions that require medications to control so that proper treatment can be performed.  Note that what we are taught in dental school is always different than what you do in private practice, so if there are any dentists who would like to chime in about the ‘real world’ here, make a comment below.  An example is in our emergency clinic.  Some patients present with a severe toothache but their blood pressure is so high (highest I have seen was a classmate of mine with a patient who had a BP of 210/120!)  Patients like this are referred either to the ER immediately or to their physician so it can be evaluated and treated properly with the correct medication.  Why?  High blood pressure can lead to complications during dental surgery.  To name the extreme issues, we are concerned most about a stroke or a heart attack.  No one wants a stroke while getting a tooth extracted.  Here is an interaction I had recently with an emergency patient:

ME: “So have you ever been hospitalized?”

Patient: “No, never.” (At this point some people move to the next question)

It is important to prod and pry a little. ME: “Do you have any kids?”

Patient: “Yes…”

ME: “Were you in the hospital for that?”

Patient: “[LOL] Yeah, I guess I was.”

ME: “Okay, have you ever been hospitalized for anything else?”

Patient: “Haha, yeah, I had breast reduction surgery.”

ME: “Hmmm, okay, were there any complications”

Patient: “No.”

What dentists typically look for are certain conditions like excessive bleeding or other conditions that would warrant a prophylactic antibiotic before any dental treatment is performed, such as a recent myocardial infarction, etc.  AHA guidelines for dental treatment.

I have searched for some other references on the web about proper medical health history taking and it’s importance:

I really couldn’t find much more. Which probably proves that it is more of an art form learned along the way rather than something you learn from the internet – like dentistry! Remember that taking a good medical history can catch many diseases and conditions that could halp the patients lifestyle and even save thier life.  The dental school sends many patients to see thier physician for something they didn’t know they had so it can be evaluated and treated.