I wrote this article a couple of months ago after my first experiance in our oral surgery clinic. I am a little burned out on studying for Part I of the National Dental Board Examination (NBDE Part I) so I decided to edit it a little bit, add to it and post it for your entertainment:
Last week I had three straight days of oral surgery duty followed by a day in the elective oral surgery clinic for a patient of mine who had about 16 retained root tips. It really was very educational, exciting, and challenging. Here is how the days went:
Day One:
We met for a short half hour lecture with about six other classmates and went over the basics. We met around a small table and reviewed the various surgical instruments and steps to properly extract a tooth. We have had two oral surgery classes taught thus far and I thought they were taught well, so this review was minor. Various things like how to load a needle and carpule, how to use the periosteal, elevators, and forceps and proper extraction techniques.
After this we paired up with a senior, grabbed a chart and sat our patient. Our duty days at Temple in the OS department covers all the emergency pain of walk in patients. Some of the patients get referred to emergency endodontics and some get their pain treated on the spot by those in the OS duty department – via an extraction. It really is quite stream lined and simple. The patient is seated and the medical history is reviewed. You ask them about their chief complaint (why are you here), and the history of the complaint. Example: The patient comes in because their tooth is hurting. Where does it hurt? Is is in one spot or all over? Can they point to it? What causes the pain? Does it get worse with something (like cold/heat/sweets), or does it get better with something (like cold/heat). How long have they had the pain? Is it continuous or spontaneous? Does the pain keep them up at night? Various other questions can be asked to get a good background.
The medical history is then reviewed. Anything that they have indicated on their medical history form and a history of family health problems, allergies, hospitalizations, medications and anything else that could effect their treatment such as a complication from a previous surgery. At this point we are looking for contraindications or anything that will hinder our procedure. The more prepared you are before the extraction the lower the chances are of a complication arising AND if such a complication were to ocur you will be better able to handle it.
Blood pressure is taken, along with a pulse and then a clinical exam is done. This is where you actually look into the mouth and have a look at what is going on. Most of the time you can see right away which tooth is causing them pain. It is pretty easy when a huge gaping black lesion is staring back at you when you look at the teeth. Sometimes it isn’t as easy. Tapping on teeth, palpating, using endo ice, etc can help you to pinpoint the tooth in trouble. When the culprit has been found then you present various options to the patient depending on what you think can be done for the tooth. If the tooth is absolutely bombed out then an extraction is most likely indicated. Sometimes the tooth is still in good shape and it needs a root canal. If this is the case we refer them to emergency endodontics and seat the next patient.
In my first four days of duty and my elective appointment I was able to extract about 20 teeth. A few anteriors, some premolars and a few molars. Many of those were from the 16 retained root tips from my own patient – which added up to about 6 teeth. Some were difficult and some were easy to extract.
The first tooth was a right canine covered with the thickest canine eminence I have ever seen. It took quite a bit of time to get it just a little loose. Even then the crown broke (not by me, lol) and in the end our instructor had to come over and show us how a real doctor does an extraction.
I think the biggest hurdle to overcome while starting in the clinic is to go quickly and not stop each time the patient whimpers. During my first appointment I was so worried about not hurting the patient that every time he moaned a little bit I would stop and ask him how he was doing. This added to the time it took to do the extraction. I KNEW he was numb – we dumped a whole carpule of articaine right into the pulp chamber – (he is probably still numb), but I was still a little hesitant. The trick is to learn how to be aggressively finesse, if that makes sense. At Temple to get an A during your junior year 75 teeth are to be extracted. As a senior you have to reach 125 teeth. This includes alveoplasties, the removal of tori, and other minor OS procedures.
Seven months into residency and I am still alive, although, with the number of updates that have been permeating through the internet from my end, you would think otherwise. It is business as usual, and business is staying busy. There is always something to do during the day, and usually something to do at night. Here is a recap of the first six months from my experience. I have also included some pictures for your reading pleasure.
