Ok everyone, I gotta nerds out for a minute. So this patient came in to have a regular perio maintenance appointment. He has been seen in the office since 1980 (before my dr bought the practice) He has been coming every 3 months to have his teeth cleaned. He has had diabetes for about 2 years--well diagnosed. He has good homecare. in 2007 he had his maxillary teeth pulled and a denture made. So he has been battling perio disease for a long time. He should be pretty aware of his perio health by now. Well 6 months ago he saw the regular RDH that was in the office (whose job I replaced) then 3 months ago he saw a temp. The reg RDH said all was looking good and that he was fine. The temp changed it all. She found general 4-7 mm pocketing, heavy subgingival calc etc. and recommended that he have SRP done. So my dr does the SRP. Then takes an xray after and there is still sub calc on the lower anterior teeth. He dismisses the patient and then proceeds to tell me that there is calc still on the lower teeth from last time and that he had worked for 35 minutes and it was still there. I was frustrated. I HATE dentists cleaning teeth. They are just not thorough enough for me. So I prepared myself to clean his lower teeth. It took me the whole hour to clean those 14 teeth! This mans lip was strong! I kept telling him to relax etc. I did not take an xray after but wanted to; the patient refused. I feel I got it all off. I saw boulders come out with the ultra sonic and the teeth felt smooth. So I feel I did a good job.
The patient however was very frustrated. He was confused as to why his teeth were so dirty after 3 months. What was I suposed to say...the last rdh missed this calc for years and the dds did too? Except the dds did not miss it he just did not remove it. I tried to play the diabetes card and explain the link between perio and blood sugars. But you know what supra was perfect. His tissues looked good. I can really see how that other rdh missed it. It was very deceptive. Well the appointment ended well and the patient was ok with the work I did and was resolved to clean better and floss more and brush after eating each meal etc. I am sure in 3 months when I see him again it will be a lot better. Well the probe depths might not, but the amount of calc will be....I hope. Thanks for letting me get that off my chest and nerdingout for a minute.
6 comments:
Frustrating! I still am not confident in my cleaning skills. I think I'm probably the RDH that leaves stuff sub gingival! How frustrating for your patient too!
I'm so glad you're back in the teeth world, you do so good at it! And also I just wanted to thank you for feeding us dinner last night...lasagna you had left in the freezer :)
The trials and travails of dental hygiene...I have had this happen to me and it is the worst. Which is why I no longer want to practice hygiene. I can't stand the inconsistencies when you're working with other hygienists who didn't go to Weber!
I've seen some major flub-ups and diagnosis on some patients that make me want to scream! Because I'm the one who has to go back and re-explain why the other hygienist was stupid and wrong, which makes me look stupid and wrong.
For example: A patient came in and saw a different hygienist. She diagnosed perio, 4 quads SRP and explained the whole perio bit. She then did and Adult prophy on him and scheduled him for his SRP. With me. WTF?! The patient's pocketing began to resolve and his pockets were all 4's by the time I got to him. Everything supra was looking much better and the patient had started brushing better. How do I explain that the previous hygienist was an idiot and that his perio was getting better and that SRP was no longer indicated? (His worst pockets were about three 6's. The rest were 5's and 4's.) She basically did a FMD and called it a prophy and he repsonded appropriately.
I never do FMD unless it's a 'difficult prophy' because this is exactly what happens. Prof Gall told us this and it's one of the few things I remember from lecture.
Whew! Sorry about the rant; I went mega-nerdy on you.
OH...it's hard to start in a new office! I saw a lot of pts for the first time when i moved here that i wondered if they really could build up that much between recalls....was it the water here or what?! The first 6 mos were rough then after that it was so nice to see my own pts that i had cleaned last time...not to be cocky!! Some do build up a lot, but at least i know now who they are how good i cleaned them last time! Good luck.
what if I was to say I was playing with the idea of nursing school?????
Ok super ninja what does it mean when I have a puss pocket on my gums above that tooth that you did not like when you cleaned my teeth at moms? I can not afford to go to the dentist! That will deffinatly cut into our going to the coast fund!
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