Tuesday, November 20, 2007
Unusual situation at work
So today I had a very interesting patient and I definitely have not seen a patient like this in a while. He was a new patient, young, Japanese male that had very healthy looking gums. They were soft pink, firm and tight to the teeth. So I got started probing and thought everything looked normal. I then checked the xrays for decay but totally ignored the bone level because everything I'd examined so far was normal. Then I proceeded with the cleaning but quickly began to feel overwhelmed by the tenacity of the calculus on the lower anteriors. I then noticed a large black spot of calculus under the gums on #4. As I took it out, I thought, "that has to be deeper than 3 mm now that its clean." But I was so stressed because I was already behind schedule that I just carried on. Finally, Dr. Smith came in and said, "So, what do you think, 4 quads of scaling and root planing?" I saw the bone level on the xrays and my face probably went red. I was so embarrased that I had totally missed that. He did have gen slight perio with loc mod bone loss in his molars. There was also radiographic calculus on his root surfaces... which explains why I thought he had 3 mm pockets... I was just hitting the calculus as I probed. Then as I cleaned, I didn't get down far enough because I thought the pockets were only 2-3 mm. The odd thing was, there were no spurs under the contact like you usually see and other than the lower anteriors, he had no other clinically-evident calculus. Clinically, he really did look healthy. It really was a very unusual patient! I have learned from this two things that I need to improve on: 1) When I get busy, don't allow myself to stress out and rush. Try to treat that patient as if they are the only patient for the day. 2) ALWAYS LOOK AT THE RADIOGRAPHS!!
Labels:
Hygiene
Subscribe to:
Post Comments (Atom)
8 comments:
Jen,
I love this post and I am going to recommend that others read it. I have had the exact experience you did. Patients of oriental descent, African-American and Arabic generally appear healthy like that and then can have tenacious subgingival calculus. Those types of patients can be tricky. I am sure that this has changed your practice of dental hygiene forever.
Cute picture of you and your husband. It is good to see that you are still blogging. I will visit again. I thought of you and Jalene yesterday because I just bought Adobe Creative Suite 3! Fun!
Jen, you're my hero! Keep up the good work. I make an ass of myself at work all the time. I think we learn from these situations. Well I hope we do! I hope you have a happy thanksgiving lovie! Miss ya!
Jen,
I totally know what you're talking about. Those guys are tricky and I've been fortunate enough to have my dds teach me to look at the x-rays. Sometimes I when I'm doing recall I just jump right in assuming that they were probed last time, but when I get in there my probe drops down and that's when I pick up my probe and spot check. The hygienist before me was a little leanient (hope that's spelled right) and she would let patients slide, but I've just made up my mind to stop that trend right now, if I let them slide, then it will be harder to get them to have sc/rp later. If I don't feel like their build up is enough, I at least talk about perio and say "we're going to monitor these pockets, and if they don't improve then we're going to have to do a deep cleaning to ensure we are getting everything out." So I guess we'll see what happens when they come back in 6 months. Good luck!
-Tatiana
This blog makes me confused. Nonetheless, it has inspired me to be better at... life?
I am not up to date on my dental jargon, so I guess I should study and come read this again!
Wow...that was way too technical, but I got your message in the end. Good point!
Babe,
I am sorry for not listening closer when you said this to me that day. And look I am just getting around to reading it today. I am so stupid. I love you and I will try to listen better.
Love,
Your Main Squeeze
Don't worry, I'm sure he was totally understanding! I haven't been on here forever! Looks like you've been having lots of fun! Cute dogs! :)
Post a Comment