Last Clinic Day

It was a weird feeling today walking into clinic knowing that this would be my last time ever seeing patients in here. It was also crazy to think that these would be my last patients I see until I am out in clinical practice! My morning patient was not coming until 9:00, so I was able to do my air powder polishing PE on Stefanie (Thanks Stef!) My patient was a recall class V who had not been in for a year. I was anticipating a very easy cleaning but he actually had quite a bit of calculus buildup. Everything went really well with his cleaning and with his x-rays. I am proud of how much better my x-rays have been these last couple of months. I guess it really does just take practice. My afternoon patient no-showed, so I was able to see a walk-in patient. She had a lot of bleeding on her mandibular anteriors. She showed me that even when she pushes on her gums lightly, they bleed. She explained that she sometimes wakes up with blood in her mouth and on her pillow. I removed the calculus from beneath the gums and I explained that she should see improvement as I explained the etiology of gingivitis. I really am feeling more and more like a "real hygienist".

I want to thank all of my professors and instructors from these two years. I have learned so many things from each one of them. I am so glad to be graduating from such an amazing program with amazing staff. I also am lucky that I am part of the class of 2012. I love you girls, I could not have asked for more amazing and supportive friends to go through these two years with. GOOD LUCK EVERYONE!

BAM!

I miss you ultrasonic!

I passed my clinical DH board!!! I am so happy, I found out yesterday! We were not really supposed to find out until finals week, so I was very surprised to get the e-mail, and even more surprised when I saw the result. I guess I need to have a little more faith in myself :). My morning patient today was my board patient, I was able two finish his last two quadrants. I ran into the exact same problem I had with my board exam, his anterior teeth are SO sensitive to the ultrasonic no matter what I do. I did a pretty good job with his cleaning, but his calculus is just so tenacious and it was difficult not being able to use the Cavitron. He was a good learning experience patient for me. In the afternoon, I saw a new patient from the resource list. She had just had her lingual bar removed so there was tons of lingual calculus on her mandibular anteriors. Again, this patient was pretty sensitive to the ultrasonic on her mandibular anteriors. I used the ultrasonic on low for a minute, and then went to hand scaling. Marilyn taught me to always do a horizontal sweep in the distal of the back molars to smooth any roughness and to not miss those line angles. Also, she taught me to not be afraid to get out my little wimpy Nebraska for tight contacts in the mandibular anteriors. Doing that will help me get the little grainy pieces that the larger anterior scalers cannot get. I realized today how much I love the ultrasonic when I wasn't able to use it much at all. One clinic day left!

Kiddos

Today for my morning patient I saw a recall patient with maintained mild and moderate periodontitis. I was able to get 2 quads of a class III and 2 quads of a class V because her upper quads had some slight subgingival calculus and she had quite a bit of BOP in those areas. For my afternoon patients, I had saw two adorable sisters, and Jamie saw the other two sisters. These were probably the best 1A appointments I have ever had, the kids were so good and I could tell that my speed has really improved since the last time I saw two 1A's. I learned a good trick taking x-rays when the child's tongue will not let you slip the film near their teeth. Joy taught me to place the film up near the maxillary molars, and then have the child bite down. It worked well for this little girl who was not wanting to bite down at all. It was a very good day overall. I am happy that I am pretty close to having all of my requirements and PE's finished. We never believe the professors when they promise us that it "will all work out somehow," but it always does! I think we need this promise in huge letters on the clinic wall. I can't not believe how close we are to graduation. When I think about graduating I feel 80% excited and 20% freaked out. Some days I do not feel ready to be out there doing dental hygiene on my own. Other days, I realize how much I really do know and how much I have learned in these two years. I also know that increased confidence will come after time in clinical practice.

A much needed easy day

This morning I saw a recall class V patient. Her tissues have responded really well to periodontal maintenance and she has good home care. Also, her probe depths and bleeding sites have really improved, except there are still two sites where there is a 10mm pocket and 7mm pocket. I placed arrestin in those two areas. Instructor Wold gave me a good tip for placing arrestin. She recommended I use the probe first to visualize the best angle to go into the pocket and then go in with the arrestin syringe the same way I went in with the probe. It was rewarding to see a patient I had seen earlier in the program and to see the improvement at her recall appointment. It proves to me how important patient compliance and home care is in non-surgical periodontal therapy. For my afternoon patient, I saw an older gentleman who had 4 mandibular teeth and had lost the rest of his teeth because of periodontal disease. I think he must have been pretty lonely because he talked the entire appointment. He had not been into the clinic for a cleaning in about 4 years so I discussed with him the importance of a frequent recall for the maintenance of perio and keeping his remaining teeth. I was given one quad of a class V for him. I also was able to get some conventional PA's and my Velscope PE. Overall, it was a good day which was much needed after this very stressful Spring Break. My goal for the rest of the program is to really pick up on my speed and watch the clock so that I am aware of the areas that I can save time.

Found a board patient!

I found a board patient on Thursday! YAY! I can finally breathe for a minute. This morning I saw back my class two patient. He requires anesthesia so I had his treatment plan broken into two appointments. I did miss some spots today. Alexander walked by as I was scaling and reminded me when I was scaling anteriors to really be right over the patients nose and staying up up on my fulcrum. I did some really good OHI for this patient. He has so much gingival inflammation and bleeding from the calculus and biofilm that were in his pockets. This afternoon I saw my board patient to get his x-rays taken and to scale a quad. Alexander classified him as a class III because his bone loss is right between a class II and III, and because he has so much subgingival calculus. I will be cleaning the upper left for the board. I also learned that when I was probing a couple of his teeth, I was tilting the probe a little too much which was giving me a deeper reading. I learned that the probe still needs to be mostly parallel with the long axis of the tooth, but slightly dipped into the col on the interproximal areas. Alexander commented that his calculus was definitely heavy enough and it was a bit tenacious. He also has bulbous crown anatomy which makes the scaling a little more difficult. This worries me, but at this point I just need to be grateful I have a board patient. His anterior teeth were very sensitive to the ultrasonic, so next time I will use more anesthetic on the infiltrations. I really hope everything goes okay for the clinical board. We got all of our instruments ready today after clinic. It is all happening so fast, I can't believe the real boards are here. Wish me luck!

Cancellation

This morning I saw a new patient who ended up being a class II. He has quite a bit of subgingival calculus but not quite enough for boards and has multiple restorations. I was able to get a pano and a film set of bitewings on him. He had lots of plaque and bled a TON! I polished before I scaled to try and save some time and get rid of most of the plaque. The injections went well and I had one calculus error. I learned that I need to really explore those line angles, and use a horizontal stroke to feel them. I also learned that it is best to not use my thumb to retract when giving a left PSA. When I use my other finger to retract, I have more room to get my angle right. Instructor Wold also taught me to feel the vestibule before entering the mouth with the needle, to feel the soft little depression where I want to insert the needle. My afternoon patient was supposed to be seeing my class IV patient back, but he called and left a message during my morning appointment saying that he found a job and he cannot miss work and he needs to reschedule. I am worried that I won't be able to get him back in to finish his cleaning and my Eaglesoft patient assignment. His teeth are very mobile and I worry that if he does not come back to get them cleaned, they will fall out very soon. Hopefully I can get him rescheduled. I really can not complain too much, I have been pretty lucky when it comes to my patients confirming and keeping their scheduled appointment times. The search for a board patient continues! My goal for the upcoming weeks is to be more active in my OHI and try to really get my patients involved in their own treatment.

Final Mockboard!

Yesterday was our final mockboard! I can not believe that was our very last practice run before the real deal. I am glad it was a success. I almost died of shock when Adrienne told me that I had no calculus errors and no probe depth errors. I love seeing improvement, it makes me so happy! I gave my patient a little thank-you note is his toothbrush bag becasue I am so grateful he came in for 2 of my mockboards, and kindly came in for Karen when her mockboard canceled. He was so reliable, and I am so grateful for patients like that! Now on to finding a real board patient, which is my main stressor right now. I really wanted my final mockboard patient and my real board patient to be the same person, but that did not work out. I hope I find one soon so that I can at least clean one quad and see how the calculus is or how the patient's tolerance is before the day of the real board. Monday was my Process of Care Exam, I am not so sure how I feel about it. It was more subjective than I thought it would be. I just have the National board on March 10th, my clinicals the next week, and then I think I can finally breathe easy. It is really sinking in that I am not going to be around all of these girls and instructors in a couple short months and it is making me sad! I love everyone here! My main goal for next week is to find a board patient!

Class IV

This morning I saw my previous mockboard patient to do his OD and scale another quad. I was getting worried because next week is our last mockboard and I still had not found a patient. This patient had one quad left, and I asked him if he would not mind being my mockboard patient one more time. He said that was no problem at all, I was so relieved! My afternoon patient is my class IV. Jamie found him at the last screening and did not need anymore class IV quads, so she did his OD this morning and he stayed all day so I could start his cleaning this afternoon. I have come to the conclusion that I really do not like working on Class IV's. I 'm so glad he got an appointment because he really needs it, but I think mobility is just the saddest thing! All of his teeth are mobile and as I ultrasonic the bars of calculus off of his teeth, they just get looser and looser. I was getting really worried that he would be confused of what is going on becasue he doesn't speak English. I had Mr. Salomon explain to him that his teeth may feel more loose than they did before becasue of the calculus is holding his tooth more snug in the pocket. Once that is removed, the teeth are going to be more mobile than before. This patient is so kind and he brought Jamie and I a little gift when he came for his afternoon appointment. His calculus is some of the most tenacious I have ever seen. I had to go over it several times with the ultrasonic to even make a dent in it. I do not dare scale the teeth too much becasue I am worried that any lateral pressure will pull it right out! I finished one quad today and did not have quite enough time to finish another quad. So Instructor Wold recommended that I do one quad + 3 teeth and call it a day since he had been there all day. I am sure glad he came in. I am worried to start his mandibular anteriors becasue I know they are going to be so mobile when the calculus is removed. But the patient says he understands, so hopefully it will be good in the end and he will be glad he came. He seems so grateful to be here. My goal is to practice the angles for the left PSA. My left PSA today was less than beautiful. Final mockboard next week!!

LA Mockboard...A Success!

This morning we had our local anesthesia mockboard and I passed! My wonderful husband was my patient. I promised him beforehand that the the injections do not hurt, and he agreed... they didn't hurt at all. I am so glad that we do mockboards so that we can learn from our mistakes and know the process of real boards so it is not so terrifying when the real day comes. I did learn that I am being a little too aggressive with my aspirations, and that I just need to pull back a few millimeters when aspirating. My examiners reported that angles on my PSA were correct and that my IA was right on. It was a much needed little confidence booster. Until..my afternoon needed a LEFT PSA...FAIL! I forgot how hard it is to get the correct angle on that left side. Marilyn gave me some really good pointers to pull the cheek out and up, and to feel the site of penetration with my finger before had so I know how far back I need to be. I did have a few scaling errors today. I feel like I could have done so much better if I could have used my ultrasonic on him, but it's a great experience to just scale and know that I can remove all of the calculus just with my hand instruments. Marilyn gave me some good pointers today. She reminded me to always examine my x-rays for little flecks of radiographic calculus so that I know the areas to really explore when I'm done scaling. She also reminded me to get the tip under the deposit after exploring with my scaler, and then pop the calculus off. Don't just blindly scale the missed area again, really feel the deposit, and get directly under it. Overall, it was a pretty good day! My goal is to find a mockboard and hopefully a real board patient at the screening on Friday! Fingers crossed!

Class III's!

I am so happy to finally be getting done with some class III patients. This morning I saw my class III patient who had a cold sore a few weeks ago. She has lots of calculus and could be mockboard material, exceot for she is pregnant so I could not take any radiographs. I was able to finish her last 3 quads with only 3 errors which made me happy. I also passed off my Calculus Removal and Ultrasonic 2 PE's. I feel like my scaling techniques are improving a little bit each week. My lateral pressure especially has improved. I saw my class III/IV back this afternoon. This patient is so nice. He has COPD, so I cannot use the ultrasonic. I forget how much I love my ultrasonic until i can;t use it! But I got 2 quads done with just one missed spot. I was also able to get 4 injections. Prof. Perry have me some super helpful tips for my injections today! For the IA, he said usually if you aim for the natural little tissue fold near the raphe, it's dead on. My PSA was no bueno today. I kept hitting osseous and had to withdraw. He later told me that I was just not quite far enough out in the mucobuccal fold. I had a good day because I had a little moment while I was scaling that made me feel like I was finally getting the hang of this! I love productive days! My goal for next week is to pass my LA mockboard!

Oh baby!

I learned something this week. When a patient walks in for a 3-hour dental appointment with her 3-year old son by her side...this is not the best of scenarios for a student dental hygienist. My morning patient was a very nice class II and her little boy was adorable. How long can a 3-year old sit and wait? About 15 minutes. The paper and pencils I gave him were not quite entertaining enough. After that, he was trying to get into drawers, pulling on the blinds, smearing lotion from his mom's purse all over his hands and face, and finally, emptying mom's wallet and making it rain with quarters and $20 bills. I cruised as fast as I could with the appointment so the poor little guy would not have to wait too long. For a 3 year old, he really was being pretty patient. I missed, probably due to my hurrying, some sheet calculus on the lingual mandibular anteriors. Well, don't I feel stupid! It was a good lesson. I think I sometimes get so focused on scaling interproximally and feeling for calculus, I forget to use my eyes and look for supra calculus. Besides that, I did not have any errors. Dr. Hanson showed me a good tip, to use my scaler and clean the pits in the premolars. My afternoon patient turned out to be a class III/IV which was exciting! I also found a patient who was willing to pay for a FMX, double exciting! Unfortunately, taking a full-mouth series of X-rays seemed to take me longer than it should. I hope it becomes a little quicker with practice. My goal for next week is to always use my air to check for calculus!

Mockboard #2

Tuesday I had my second dental hygiene mockboard. I am pleased to announce that this time went SO much better than lat time! I had 3 calculus errors, but I passed! It was the little confidence boost I needed. Now that I know I can do it, I can focus on just becoming better so I have no calculus errors on my next mockboard. I was also able to get a couple injections on my patient as well. I am so grateful for my patient, he is so reliable and happy to help. Karen's mockboard patient canceled yesterday so my patient said he would come in again today for her. What a guy! I hope my real board patient will be as reliable as he is! Yesterday was a pretty good day at the VA except..HOLY MOLEY my patients were talkers. Both my morning and afternoon patient talked through the entire appointment. Even when I would put my instruments in their mouth, they would keep on talking. I have never had this happen before! But they were so friendly and just happy to be getting their teeth cleaned. Minus the instrument selection, I really do enjoy the VA. It is a great place to meet requirements and learn new things about many different types of patients. It is also giving me some good practice doing exams with the dentist. Well, LA Written exam next week...wish me luck!

Dang cold sore!

My Tuesday morning patient was my class III from last week, but when she came and sat in my chair, I noticed that she had a cold sore. Dang it! I had Mr. Soloman explain the clinic cold sore policy to he and I scheduled her back in a few weeks. I could not get any other patients to come in the morning, so I spent the rest of the AM clinic session trying to find screening patients. My afternoon patient was a recall class V from last semester. His appointment went very smoothly. Overall, not the most productive day in clinic, oh well! On Friday we had our screening and a sealant clinic. Big thanks to Tanya who found me a name to screen, and he ended up being my mockboard patient! I am excited for this mockboard, I am anxious to know that I really can do this! I am grateful we do so many mockboards in the program. It would be so terrifying to go into the real clinical board with no practice runs at all. I have been pretty dang stressed lately, but whenever I start feeling down, I try to remind myself...I wanted this! It took me three years to get in the program and so many others would kill to be in my position right now! I am exactly where I want to be, stress and all! I'm finding out that attitude really is everything. The Friday sealant clinic went great. It feels so good to provide this free service to the kids who really need it and may not be getting this care otherwise. I am really enjoying the children's screenings and sealant clinics this semester. My goal for next week is to do well on my mockboard and to pass off two PE's at the VA. (And hopefully schedule my LA Written Exam!) The semester is already flying!

Welcome Back!

Welcome back! I can not believe this is my last semester of college! I know that this semseter is going to fly by..which makes me excited and freaked out all at the same time! I hope I can gain more confidence this last semester and refine the skills I have learned. I purchased some loupes over Christmas Break and I was excited to try them out in clinic today. I really like them a lot! They are going to take a little getting used to but I can tell I am really going to love them! My morning patient today was a class III. She would be a great mockboard patient except she is pregnant, so I can not take any x-rays on her. Dr. Naylor gave me a good tip, to use my air on the buccal of the maxillary molars to check for any supra calculus. I missed some light flaky caculus on the distobuccal of #2 and #3. She said that this is a spot that the boards examiners always check and it is easy to remove using the SH6-7. That was a good little wake-up call becasue I should not be missing supra calculus at this point in the game! This patient has pretty tender gums and she is pregnant, so we have been trying to scale without any LA, and so far she is doing well without it. My afternoon patient was my sister who is an easy 1B and I did not miss any spots on her. I could have gone a little quicker though. I feel so rusty after not being in clinic for just one month. My goals this semster are to pass of my PE's early on in the semester and to get used to my loupes. My goal for today is to review my operator positioning again. I was kinda rolling all over the place today, which is quite annoying becasue my chair is a squeaky beast!