Noriega's Blog Week 6: Post 2

This blog is the second part of the case I discussed in the previous blog. After fixing tooth #1 in question, Dr. Powers went on to snap a picture for me of tooth #2 in question. This tooth had split right down the middle! (All this damage is just the result of the patient being an aggressively heavy biter). One side of the tooth, the buccal side, was wiggly. Dr. Powers decided that this tooth was no good (I mean, it was ripped in half...) so he yanked out the wiggly side. Then he spent 10 minutes trying to wiggle out the anchored in, other half of the tooth. There was a lot of blood even though Dr. Powers had injected a blanching liquid that was supposed to reduce bleeding. This move had been a reaction to the excessive blood just seen while dealing with the other side of the oral cavity. He was trying to yank it out gracefully for awhile until finally he "won" and pulled it out. There was a lot of blood but luckily cotton gauze clears it right up. He went on to wash the teeth halves and inspect them with me and the patient. It turns out that one of the halves seemed to be missing half a root. This could be a growth defect or it means that part of the root/tooth is still in the huge gaping hole in the guy's mouth! Anyway, this guy is going to need to replace the temporary filling on the other side of his mouth and get a crown implant to replace the split tooth. Hopefully the crown doesn’t succumb to the guy’s heavy bite too or maybe I just hope he actually wears his night guard.

Noriega's Blog Week 6: Post 1

On my last day at the dentist's office, I was blessed (and someone was cursed) with coming into the office with the most interesting case! The guy had called that morning complaining of pain in multiple locations in his mouth; Lillian set him up to come in at 10. So anyway, he came in and got settled in the chair. Dr. Powers ordered a couple of X-rays for him (a periapical of tooth #12 and I forget the other.. maybe a bite wing of the other side). After 10 minutes, we analyzed he x-rays. Let me just say that this guy was a CASE! So we went back to the patient, and Dr. Powers got out his little camera thing that can take pictures inside the mouth easily. He snapped a picture for me of the first tooth in question. A part of the enamel (top, hard part) had chipped off his tooth. The reason the patient was in pain is nasty: a lot of food debris had gotten caught inside the tooth and all around it; thirty seconds of Dr. Powers picking away and his gums didn't feel as inflamed! Afterward, Dr. Powers spent awhile trying to restore the tooth (give him a filling) except it was nearly impossible because the guy was bleeding so much. His gums were SO inflamed from having gunk stuck in them that it got that bad. So Dr. Powers finally gave up, put in a temporary filling, and decided to schedule him for a permanent filling later that week when his gums were recovered and blood wouldn’t interfere so much with his work. Tooth #2 will have to be another blog post.

Noriega's Blog: Week 5, Post 1

I watched the most gruesome appointment today. The woman had the tiniest stub of a tooth and Dr. Powers wanted to "lengthen the gum" and give her a temporary crown. It sounded like something a periodontist would typically do, so I was very excited to sit in on it. Unfortunately, I ended up being 4 inches away from Dr. Powers physically pushing a woman's blanched gums up towards her eyeballs. Her upper gum was blanched from a drug he gave her so there wouldn't be so much bleeding (understandable, if he didn't use it it would be a brutal shower of blood!). His device was an instrument with mini-spoons at the end; perfect for pushing gums! If she wasn't numb I bet she would have died. I never want my gums to be treated like so. On top of the pushing (he was trying to make room for the crown, it wasn't out of cruelty), he "packed cord" aka put chemically enhanced strings around her tooth and under the gum to widen the gap even more. The cords were BLACK with blood by the time he pulled them out. After the yucky part though he made her a fake tooth out of acrylic! By the time she walked out of the office, her smile looked beautiful! Good thing she didn’t take a sneak peek during the procedure, she would have fainted. Luckily I don’t faint at blood or gore but if I did I would have. I am so grateful to have good teeth you guys should be too.

Noriega's Rough Draft

Dominique Noriega

Analyzing the Fear Factor and Its Effects in Dentistry

    The dawn of dentistry failed to consider the comfort and feeling of the patient. Unfortunately, this inadvertent negligence blossomed dentistry into being stereotyped as relentlessly painful. As a result, the industry must focus significant resources and efforts into defying its negative image and justifying the financial burden it creates or else face the risk and valid possibility of losing clients to more holistic dentistry options or simply to outright ignorance.

    Nothing could hurt an industry more than having a widespread phobia against it: dental repellency is a major obstacle in the industry. There are three degrees of being afraid of the dentist: dental anxiety, dental fear, and dental phobia. Dental anxiety is more so fearing the unknown, dental fear is facing the known and possibly already experienced, and dental phobia is dental fear except amplified and much more intense. Dental phobia is typically considered irrational or exaggerated but unfortunately any of these repellents can inhibit business in a dentist’s office (Dental Fear Central).

    The negative stereotype of dentistry is common thought; while unfortunate to the highly compassionate dentists and hygienists that work in the industry, there are many reasons that explain society’s reaction. A primary reason is the most personal: “the mouth is one of the most intimate and sensitive parts of our body, so it’s small wonder that as many as a third of the adult population fears going to a dentist” (Friedman, Consumer Reports). One’s teeth can be sensitive to different temperatures. Those who fail to floss daily can have sensitive, “out of shape” gums that bleed when tempered by a silly floss thread. Not only is the oral cavity sensitive but it can also be associated with more personal situations. For instance, the only time an interaction between two people is related to the mouth is when the duo’s relationship is very close if not intimate. Friends share chapstick or lip gloss. Siblings may share toothbrushes in a desperate situation. Couples kiss. Facing a dentist in an appointment can be intimidating because the oral boundary is crossed; it is unusual for someone seen once or twice a year to be putting his or her hands in one’s mouth. Patients often feel they have no control over the appointment, which can also bring about anxiety: “Many people are terrified of the loss of control they experience in the dental chair” (Dental Fear Central). When asked about the dentist, librarian Lori Dumont shuddered “I think about the dentist’s office and I want to curl up into fetal position”: society simply does not tolerate such intrusive behavior so people simply fear it as means of facing the situation (interview). This invasion is not so offensive if the dentist is friendly. If the dentist appears uncaring or even embarrasses the patient, he or she will feel uncomfortable and the oral boundary would build up even more so: perhaps to the point of skipping appointments. Social interaction can contribute to dental fear.

    Having acknowledged that dental phobia can sometimes be derived from an invasion of personal space, it is evident that in the 21st century, pain is rarely the cause of such a phobia. With technological advancements and the evolution of techniques used by dentists, dentistry has actually become nearly harmless: ”[a] 2010 survey found that... severe pain was uncommon. only 6% reported severe pain following a tooth extraction, the most painful procedure” (Friedman). The needle used to numb a patient has the tiniest gage: one can hardly feel it. For children, pediatric dental offices often keep a supply of nitrous oxide or laughing gas as an easy anesthesia. The fact that anesthesia is used at all is a clear patient-oriented advancement. Modern dentistry takes the patient’s comfort into account exponentially more than historic dentistry.

    History plays an influential role when thinking of dentistry. While pain is a rarity at this point in history, dentistry did not begin as a harmless practice. What is ironic, however, is that in the past dentistry began with brave people (unofficial dentists) who would put people out of their pain by extracting decayed teeth, which was a common problem before hygiene was held as a priority. These “blacksmiths, schoolmasters, or druggists with more courage and ability than his neighbors” would use brute force and perseverance to end a friend’s toothache (Dental History). Additionally, procedures even half a century ago were significantly more brutal. Just in the 20th century, receiving a gingivectomy was not uncommon; a gingivectomy is the cutting out of one’s gum if deep pockets between the enamel and gum tissue formed. Luckily, dentistry has drifted away from considering gingivectomies for deep pocket treatment and instead a deeper cleaning from a periodontist is the common recommendation. Not only did dentistry seem painful, but it was even dangerous in the past. In the 1970’s, people began to question mercury fillings and their effects. One case included a young girl with a mercury filling who seized a couple days after receiving it and then died. Unfortunately, the American Dental Association handled the situation poorly: ”the ADA did not provide a single valid scientific study to support their position [that mercury fillings aren’t dangerous]” (Whole-Body Dentistry, 6). One can only imagine the stories about tooth extraction that would get passed down through the generations.

The rickety beginning of dentistry may scar its evolution, but the individual person can also develop dental phobia from his or her own poor experience. One patient of Dr. Powers’ in Manchester spoke of her experience getting a tooth extracted by another Dr. Powers, who was nicknamed Dr. Pain: “his face was beet red and he was pulling so hard his foot was on my chair. No anesthesia.” Clearly this woman had a memorable and scarring experience because she had the moment memorized and she switched dentists. The bad experience faced in the past does not have to one related to dentistry; if a patient has a history of domestic or sexual abuse it is likely he or she will be very repellent towards dentist appointments. A bad experience can scare any patient away from revealing another toothache or cavity.

    Society and the media also play a significant role in the public’s dental phobia. Upon hearing the harsh sharpening of a pencil, a student at Hamilton-Wenham commented “it sounds like visiting the dentist.”. The common thought associated with drilling and loud, scary noises aside from carpentry is dentistry. The dentist in Finding Nemo, a children’s classic, is portrayed as a pain-inducing man who even pulls out the wrong tooth in an extraction at one point!  In fact “some adults.. use the threat of a visit to a dentist to make children behave” (Consumer Reports). By instilling these images into children’s minds, these scary sounds and manic men, and associating them with dentistry leads to a public fear of the industry.

The final investigation of the roots of dental phobia focuses on the cycle that begins when fear takes a hold. Even though most patients know that ignoring a problem will only make it worse, ”many delay going to a dentist...[which] paradoxically increases the likelihood that they will experience some discomfort during treatment” (Friedman, Consumer Reports). Going to a biannual cleaning is necessary to combat the inevitable build up of plaque and calculus that can cause further problems. By avoiding cleaning appointments which are the most harmless, one is dismissing preventative action. If a patient only goes to the dentist when there is a problem such as a toothache or a cavity, he is viewing dentistry all wrong. Dentistry is almost completely preventative action: cleaning and polishing teeth to prevent cavities from forming and leading to needing crowns or implants or dentures in the future. When a patient is too afraid to visit his dentist until a final moment of desperation, he will inevitably hate going to the dentist because he waits until the only treatment is a root canal or a filling!

In order to defy the public’s opinion of them, dental offices must work extra hard to appear friendly and harmless. This effort is not to be localized on the dentist: receptionists, hygienists, and even dental assistants must work collectively to ensure a returning visitor.

    Of all the employees in the office, the dentist is the most feared. The dentist is the one who pulls the teeth, injects the numbing agent, and fights the cavities. The best way to defy the fear is to come off friendly. The dentist should appear easygoing: the kind of guy who couldn’t hurt a fly much less yank a tooth. Dr. Powers D.D.S will talk about gardening or even architecture with his patients before numbing them before a filling; reminding the patient that the dentist is a normal person can help ease any anxiety. Dr. Friedman D.D.S describes what he says just before the appointment commences: “‘It’s OK for you to be nervous. But you really don’t want to make me nervous. So relax’ These simple words often work better than any tranquilizer” (Consumer Reports). All dentists have a trick for calming patients with words, it’s a staple part of the job. Words aren’t the only trick. During a filling, Dr. Powers will have the noisy suction running in the mouth just to have some background noise that can hide the sound of his drilling. Music also plays during appointments to fill silence or to blot out scary noises. Because dental fears are so abundant, some dentists are trained to deal with anxiety right in dental school. Including one in University of Washington, “some dental schools have ‘fear clinics’ that offer cognitive behavioral therapy to reduce dental phobia” (Friedman). For those who suffer from severe dental anxiety, specialist dentists exist that can treat the most anxious patients. One example is Dr. Krochak who preaches about the philosophy of care and how the patient must be very informed throughout the entire appointment and course of treatment. Even in dental school, dentists prepare to fight not only plaque and bacteria but also public fear.

    When soothing conversation still cannot help ease the patient’s anxiety, dentists can turn to prescribing medication for the patient to consume before the appointment.  Typically, a dentist might prescribe drugs or administer nitrous oxide or intravenous sedation to the anxious. Some patients like to be tranquilized for their appointments: “[it] is painless, or at worst feels like a tiny pinprick.. will numb [the patient’s] mouth in about 5 minutes” (Friedman). Medicated, anxiety dissolves quickly for a few hours which is more than enough time to undergo an appointment.

While medication might seem to be a quick answer to anxiety, repeated use has its negative consequences. One reaction can be addiction, which is never healthy. In the case that the patient accidentally double doses, the act of taking multiple medications at once, consequences can include overdose, death, or simply a “hazardous drug interaction” (Friedman). If a patient involves himself in this type of medication, his dentist and doctors must be sure there will be no complications. The use of general anesthesia or intravenous sedation can lead to hospitalization in extreme cases. While medication is the easy way out of dealing with an anxious patient, the practice should clearly be a last resort in facing the afraid.

    Dentists face pressure when determining courses of treatment: will the patient agree or disagree? Is the plan too intense or too mild? Is the treatment even right? Not only must a dentist appear to be friendly, but he must also be good at his job. Malpractice will only confirm why a patient should feel anxious; what if the dentist does not know what he is doing? In order to avoid malpractice, it is important for a dentist to be thorough in examining a patient’s oral cavity; this is often done with x-rays. There are a few common types of x-rays that dentists use in making a diagnosis and course of treatment for a patient. A panorex, or “pan”, is an expensive x-ray that gives a clear image of the entire mandibular region (upper teeth, lower teeth, jaw, etc). Pans are taken every few years, especially in orthodontia. A periapical, or “PA”, is an x-ray that focuses up close on just one tooth; it is typically used if the tooth has been acting up lately. The most frequently taken x-rays are bitewings, which focus on the molars and are used for checking for cavities. All x-rays cost money, expel radiation, and help dentists be accurate.

    X-rays are great ways to inspect teeth for the dentist but not so much for the patient. As explained by Consumer Reports, x-rays “can expose patients to unnecessary radiation and expense in exchange for little or no benefit.” Bitewings are done every two years to check for cavities and abnormalities; however, they fail to do much for the patients that have “boring” teeth except expose them to radiation. The results of a case study expose a negative effect of x-rays: “[there is an] association between higher exposure to dental X-rays, especially during childhood, and the development of meningioma [, a type of brain tumor]” (Dental X-Rays and Risk of Meningioma, Cancer). Taking x-rays can be the difference between risking malpractice and risking the effects of radiation.

    The hygienist may not be the person to tackle the most feared work, but he or she does deal with the most common work, cleanings. Like the dentist, the hygienist must exude friendliness and comfort in the face of an appointment full of scalers, floss, and blood. The hygienist will try to converse, allowing for the patient to take many mini-breaks throughout the appointment to respond with a laugh or insert his or her own story. The reason for so many mini-breaks is that during the first half of a cleaning the hygienist is scaling the teeth: she is scraping plaque and calculus off the teeth, causing bleeding and discomfort. Luckily, many dental chairs have a cuspidor close by. Cuspidors, or spittoons, enable the patient to take frequent breaks to rinse and spit out blood or polish throughout the appointment. Although dismissed as unsanitary in the 1980’s, cuspidors have remained a staple in most dental offices. As Dr. Powers notes: “I’ve never seen a patient lick the cuspidor.” Having the opportunity to take breaks in an appointment is key to remaining calm in any cleaning; extended intervals of intrusion of the oral cavity will only result in heightened anxiety and discomfort.

    Whether the cleaning went well or not does not matter in the end: everyone walks out with a goody bag. The goody bag has many purposes. Primarily, the package encourages better oral hygiene. Getting to choose a toothbrush of one’s color of choice (silver, purple, blue, or green), a sample of dental floss, and toothpaste is the perfect way to motivate even the most stubborn patient to brush and floss daily. The goody bag alone does not promote good hygiene; however, it is the perfect final touch to hearing about the importance of cleaning teeth for an entire cleaning. Throughout the appointment, many hygienists and dentists take the opportunity to talk about the benefits of clean teeth: flossing daily has the potential to increase one’s lifespan by 6.3 years (Dr. Powers). After hearing such information, a goody bag full of floss may be able to perpetuate this awareness and translate it into action. For children patients, the animated tooth characters on the bag may be cute enough to motivate brushing by making the idea more child-friendly. The toothbrushes that children choose for their goody bags are made specifically to motivate the demographic: they have cute animals on them and come in playful colors including pink and yellow.

    Goody bags also promote the friendly mood at the dentist’s office. Children whose opinions are tainted by the media or by parents who use the dentist’s office as a threat are quite misguided. Before walking out of a cleaning, the little girls are always offered rings and the boys get stickers and trinkets. Being offered a goody bag with a fun toothbrush, kids toothpaste, a sand timer, and even some toys can easily transform a child’s perspective; however, it is important to note that they are not solely for children. Adults that suffer from a case of dental phobia are also targeted by the bag: such a souvenir may quiet any anxiety to miss the next appointment. Unfortunately, dental offices face many broken (missed) appointments throughout the month with up to 3-5 on average; broken appointments “are headaches for everyone in the practice, and no practice appears to be exempt. It accounts for decreased production and profitability. Losing two simple hygiene appointments per day can result in a significant loss of annual practice revenue” (Dental Economics). While many patients are simply forgetful even after receiving several reminders by several types of communication, a significant few are too afraid to go in. A hygienist describes the role of the bag:

Offering a goodie bag is not exactly advertising (creating awareness of a product, dentistry in this case), and it’s not exactly marketing (creating demand for a product). What a goodie bag does best is help create goodwill toward your office. In business, goodwill is defined as ‘an intangible asset that provides a competitive advantage, such as a strong brand or reputation.’ The value of goodwill can’t be underestimated. Goodwill is what keeps a family loyal to a dental home, and what spurs them to recommend your office to others (RDH).

While the immediate effects of the general public’s fear of dentistry are seen more at the level of individual businesses, the long terms effects are seen in the industry as a whole. Dentistry is losing popularity; as a patient of Dr. Powers’ put it: “who wants to be a dentist anyway?” The stereotypes have had quite the impact: “The number of dentists per 100,000 persons declined from 60 to 59 between 1995 and 2000, and is expected to decline more dramatically — from 59 percent to 54 percent between 2000 and 2020. This decline could result in a shortfall of 16,046 dentists by 2020.” (Dental Economics) Being afraid of visiting the dentist has become so common that most people do not want to be in such a hated career all their life.

Upon reaching the end of one’s career, a dentist will typically sell his practice to a fresh young dentist in need of both a practice and an extensive list of patients, which is actually the most important part of the practice. This transaction is vital: “Most dentists depend on the sale of their practices to fund a majority of their retirement income” (Dental Economics). Because of the shortage of people becoming dentists, retiring dentists are having a harder time finding young dentists who will buy their practices: “the growing shortage of dentists already is affecting the value of dental practices in areas such as North Dakota “(Dental Economics). Unfortunately, some dentists have had to resort to donating their practices to dental schools and losing a lot of money.

For those remaining in the industry, one would imagine that business would be booming. With less dentists to compete with, each practice takes on more patients. Unfortunately, however, the prediction is far from the reality: “this can be deceptive because it looks like [the dentist] would be getting more demand for [his or her] practice but actually [he or she is] just getting too busy and losing quality in [his or her] work” (Dental Economics). More stress from an increased caseload and access to care can lead to a decrease in quality which can include forming poor doctor-patient relationships and even risk of malpractice due to having too much on one’s plate every day.

Not surprising based on the crisis created by dental phobia, a dentist is characterized as a suicide-prone career. The fact is, however, that this is not a completely valid statement. Firstly, suicide-by-occupation research is very difficult to conduct; it just so happens that most dentists are white males and that males are more suicide-prone than women. It should be noted though that: “a 2005 study published in the Journal of the American Dental Association claims that 10 percent of the 560 dentists surveyed suffer from [dysthymia]” (Medical News Today). Dysthymia can easily be brought out by the daily transfer of stress and anxiety from patient to doctor; the condition is characterized by “loss of appetite, low levels of energy, desperation, excessive anger, social withdrawal and working long hours to compensate for declining performance, troubles in concentration, guilt and suicidal thoughts” (Medical News Today). Dentists are not factually the most suicide-prone career; they are, however, susceptible to the variable effects of persistent stress.

Dentistry is not to be feared anymore. As civilization progresses, oral hygiene is becoming more of a priority which requires more dentist appointments yet luckily dental companies are keeping up with the modern demand. The industry has transformed in the past half century: the techniques and materials have advanced and become more efficient. The process of numbing a patient is now done more carefully than ever, the syringe moving very slowly and calmly as to not overwhelm the patient in one second. The most gruesome appointment may result, at worst, in some tenderness or faint sensitivity which is a pyrrhic victory compared to the massive toothache or extraction the procedure prevented. Dentists have the patient and his/her teeth in mind; they do not intentionally harm their patients or else they wouldn’t get business. Although fearing the dentist may seem like what the rest of society does, the sentiment is absolutely inapplicable and wasteful in such a compassionate industry.

Noriega's Blog: Week 4, Post 2

One cool thing about doing SCORE at the dentist's office is that I can compare it to my experience working at the orthodontist on the other side of the building! At the orthodontist, I clean instruments and watch what's going on (it's pretty laid back). I notice that the orthodontic assistants do the manual work on braces and headgear and whatnot while the orthodontist actually supervises and plans what happens next. I think that orthodontia is very intense because one has to predict bone movement and line teeth up just right according to plan. I can't really word it, but the point is that it is a lot more difficult and thoughtful that one would originally assume, because it's so commonly seen nowadays. In contrast, at the dentist's office I see that the dentist has a lot of hands on work while the assistant more so just helps with suction and paperwork and prepping filling material and whatnot. Another difference between the two is scheduling. The orthodontist sees SO MANY PEOPLE A DAY. An appointment can be as long as five to sixty minutes. The Dr. Nelson office is also very computerized. The dentist's office is much more calm, with a partially computerized system and a big fat appointment book that is pencil-ed in. A dentist may see one person every hour or forty-five minutes; he is very focused on the one patient because he doesn't see him or her often (typically). An orthodontist is jumping patient to patient though very often and he sees his patients very often as well. It's a lot more hectic there I can't emphasize it more!

Noriega's Blog: Week 4, Post 1

Today I watched a lot of cleanings. Cleanings tend to be boring, which is actually a good thing because if I thought it was interesting it would mean that the patient has a problem. First, Dr. Powers greets the patient warmly to ease any anxiety. Once situated in the chair, which may take several minutes if either the dentist or patient has a good story to tell, the appointment officially begins. The dentist (or hygienist, it just so happens to be that today Dr. Powers' did a lot of cleanings) will begin scaling. Scaling is essentially scraping off plaque and picking off any hardened plaque (calculus) from the teeth. Everyone manages plaque buildup differently because it depends on several factors including personal hygiene, saliva chemistry, and diet. Some people have "boring" cleanings every six months. Others, however, have to come in every four months or with more frequency to tackle build up more often. Dr. Powers recommends to those with tendencies to really build up plaque biannual visits to the periodontist AND the general dentist. Insurance tends to cover two cleanings from both types of dentist because the patients that utilize this need serious preventative action that can in fact save money in the future by preventing cavities and crowns and all that bad and expensive stuff that the insurance company will have to cover later. Another big part of the appointment is polishing, Dr. Powers’ favorite part of the appointment. Polishing smooths out the teeth, inhibiting bacterial growth or even stuck food particles in any nooks and crannies. In fact, Dr. Powers was telling me today about how in the 1980’s polishing was seen by dentists as frivolous. It was something just to make the patient feel like something important was happening. It wasn’t until the 1990’s that a dentist finally did a case-study on the issue proving that polishing does effectively reduce buildup and risk of cavities.

Noriega's Blog: Week 3, Post 3

When one walks into the office, he might think about dentists and hygienists. This patient might appreciate the front desk's reminder system or old-fashioned appointment book. Let's pull back the curtain! The real Wizard here is Jen Powers. She does not look at teeth or old people. She deals with the nitty gritty: money in and money out. Oh my goodness it is so overwhelming to peek into her corner office. She went over everything with me the other day, summarizing each file cabinet. So she covers paychecks. She covers paying a myriad of insurance companies. There is life insurance, liability insurance, workers insurance, etc. On top of that, she deals with the tenants that live up stairs: rent, emergent needs, etc. In fact, recently Dr. Powers and the orthodontist next door Dr. Nelson have contemplated renovating the garage and adding an apartment on top. It'd make more money to pay for them paying for the building's mortgage. While this makes sense, I look to Jen's reaction: a laugh, sigh, and probable headache. On top of THAT, she also ensures that everyone has proper licenses and that they are valid/ don't need to be renewed. Dr. Powers has a dentist license. I'm pretty sure he also has a license to run his office. Catherine and Dawn and Valerie all have hygienist licenses, etc. They get expensive too! It's a real pain in the neck and all this information is the kind of stuff that nobody tells kids. I never knew running a business was so complex!

Noriega's Blog: Week 3, Post 2

I got lucky the other day and was able to sit in on a 3 year old's first examination: her first appointment! The hygienist in charge was a nice lady named Valerie; she usually only comes in once a week or so because she already works at another office. Dawn, the hygienist who is usually there, is actually on a cruise in the Caribbean and Catherine, the other hygienist, wasn't available. Nevertheless, Valerie did an amazing job at keeping the girl calm throughout the appointment. She explained everything in a high-pitched voice to the excitement of the girl. While she scaled the teeth, she counted them out loud to distract the girl from the scary instrument. Scaling is physically scraping the calculus (build up) and plaque off the teeth to prevent cavities and make up for what is beyond the capability of the toothbrush. While polishing the little tooth nubs, Valerie dismissed the buzzing sound and vibrating feeling by yipping "doesn't that feel funny?" The little girl was so content! One would never imagine that she was at the dentist's office; unfortunately, the dentist's office does not have a good reputation. In fact, I plan on expanding on that topic for my research paper so stay tuned! Dental offices have to put a lot of energy and resources into friendliness. They have to combat the stereotypes of fear and terror that dentists in the past inadvertently set up. Although dentistry now is painless and way more chic, dentistry 40-50 years ago was scarring. It's up to modern dentists to reverse the effects!

Noriega's Blog: Week 3, Post 1

I had a day that proved that knowing more than just front desk work can be very valuable. In the morning, the receptionist and part-time assistant, Lillian, received a call from a guy who was in serious pain! He asked her if one was supposed to feel a heartbeat in one’s own tooth: Lillian knew right away that this was a serious toothache. Although Dr. Powers was busy at that moment, the guy on the phone was in good hands because Lillian is like a dental nurse and was able to understand and help him. It appears that the man had just gotten a crown redone and never felt right afterward. He even came in for a cleaning just a couple days later and even the hygienist could tell his gums were inflamed and abnormal. It turns out he has an infection! So Lillian got Dr. Power’s permission to prescribe him some antibiotics to ease the situation over the weekend (it was Friday) and hopefully finish off any infection. Also, Lillian called the endodontist to schedule an appointment. Because of the severity of the pain and the fact that the pain was more so within the tooth, an endodontist is necessary and he will probably need a root canal. I just really liked how Lillian was able to handle the emergency case so easily. Had I been the one to answer the phone or someone who kept to behind-the-desk activities alone, the poor guy would have been in pain for a longer time because all the dentists are so busy!

Noriega's Blog: Week 2, Post 3

I’m learning about a lot of cool things at the dentist’s office! So this one guy came in recently for a filling, but he had a miniature surprise as well. He had a fibroma!  Yes, it sounded scary to me too but fear not because it’s actually nothing to be afraid of. The guy opened his mouth and revealed a big bump on his inner cheek. It looked like the result of biting on one bit of cheek excessively and that’s actually exactly what it was. His body finally got sick of being bitten at and formed a callus, which is basically a big hunk of cells. He wasn’t in pain so much as he was slightly concerned by its appearance and annoyed by its interference in his bite. Dr. Powers assured him it was nothing malignant and all he has to do is visit an oral surgeon to get it removed.

After seeing a fibroma, I am eager to see another oral abnormality. I want to see a fistula!  So  when there is a blockage in the tooth’s nerve, pressure escalates within and can create discomfort. When the pressure gets really great, a pus bubble called an abscess can form.  It’s gross! The body sometimes will respond by making a tunnel, almost, that goes to the gum that gets all pus-filled. It’ll look like a pimple... in your mouth! Anyway, I want to see a fistula get dealt with because I guess it’s really cool and they have to stick this thing called a gutta percha into the tunnel to find out where the infection is stemming from. Wow!

Noriega's Blog: Week 2, Post 2

On the fifth day of my internship at the dentist's office, I filled my day with fillings (ha ha). Every situation is unique: is it tooth #1 or #31? To be a general dentist, one must be flexible for every case that walks in through the friendly, front door is different. To capture the “gist” of an appointment, I’ll give an example.

    So let’s say that the patient has a deep cavity on the back of tooth #1 (most posterior upper right tooth). It had originally been filled with amalgam (the metallic looking silver filling), but recently part of the filling fell off while the patient was eating clams and there was a pearl in the middle. Dr. Powers will first use an abnormally huge syringe to numb the gums around the tooth in the spotlight. After waiting a few minutes for the numbness to kick in, the work begins. Dr. Powers will use a drill to erode away the last bits of amalgam filling and decay. The assistant (let’s say it’s Lillian) will put together a little tray of resin that lacks filler particles; this liquid just bonds to the tooth to ensure a secure filling. Dr. Powers will rub the resin on the affected area, and then Lillian will pass to him composite paste that he will dab onto the tooth and thus “fill”. What’s cool is that composite comes in several different shades, all designed for different teeth. Then Dr. Powers will do final touches on the filling, polishing away excess and ensuring that the articulation between that tooth and the one opposite on the lower jaw is flawless. After that, our clam-eating patient will merrily walk out the door!

Noriega's Blog: Week 2, Post 1

Today I spent my hours observing fillings. The first one was a bit difficult to watch just because at the beginning it's a mini drill thing drilling into someone's tooth (ow!), but after that first impression they all went by like a breeze. In fact, I enjoyed seeing the resulting filling because the tooth looked SO much better than before like wow. I started to look at the appointment as a whole: the symbiosis between dentist and dental assistant. Working together for years, the duo works as one unit; it's actually quite amazing to watch. While we were in between appointments sterilizing instruments, Maryann told me that it has gotten to the point where she knows what he's thinking before he even thinks it! During the appointment, she works with his idiosyncrasies and habits. She continues to use suction even if the filling is happening in the upper jaw, an area that doesn't get too wet as compared to the lower jaw (where saliva and whatnot can accumulate thanks to gravity): the gurgling sound can be a nice distracting noise as opposed to the sound of scratching and attacking teeth. She knows exactly when he needs a hemostat to hold up boundaries in a filling, even if she's working on paperwork on the other side of the room! She even knows to put a clear, "non-stick" liquid on the corner of the composite tray because she knows that Dr. Powers always rubs his filling instrument in it and then rubs the excess on his right glove (he's a lefty). They are such a team!

Noriega's Blog: Week 1, Post 3

I have the front desk down. It's 8 am. First, Lillian and I check out the routing slips of each appointment from the day before. We analyze each neon green sheet: did the person get a filling? If so, which surfaces and what number tooth? For example, if the sheet indicated a "3 MOF" next to composite then it means that Dr. Powers filled with tooth-colored composite filling the frontward, top, and cheekward sides of the third tooth which is the third one out from the far top right. We insert this information on the computer's database, just to be organized. Around 9am, Lillian calls each of the day's patients to confirm their appointment. So many people forget to come so it's best to offer as many reminders as possible! Throughout the morning I file all the files of patient's from the day before. It's funny because the filing cabinets near the desk are only a fraction of all the files the office owns! There are zillions more in the cellar, but we only pay attention to the ones of recent patients; those files downstairs may be people who haven't had an appointment in years. When the mail comes, we go through all the insurance claims that come in as well as document each check that comes in as well. We total up the deposits from the day before as well. Finances at the dentist can get complicated, because sometimes people have insurance that will cover the appointment but often times there is still a remainder for the patient to pay whether it be because he/she doesn't have insurance or because the company only covered a fraction of it. The front desk runs this office!

Noriega's Blog: Week 1, Post 2

The other day I got to witness my first procedure! Of course, I haven't been watching every filling that comes in: those are boring! That morning I got to see a crown implant! At first, I thought it sounded weird too. I learned, however, that it is actually a modern marvel and very complicated. First, a periodontist (one who specializes in gums) inserts a metal thing in the spot of a tooth. For this particular patient, it was done just after extracting the last tooth. Instead of a tooth, there is a metal hole in the gum. This was the state of the patient when the general dentist and I saw him. Then the fun begins! So Dr. Powers had already had a lab create impressions and little bits that will help the crown implant go smoothly and personalized to the patient's mouth. He had a little key that was used to help attach a mini titanium tooth to this metal hole in the mouth. After fine tuning, the patient now looks like he has a little metal tooth protruding instead of a normal tooth. After a half hour of polishing and shaping, the fake, porcelain, hollow tooth is finally fitted on top of the small metal part. Now the tooth practically blends in with the rest! The only problem, however, is that the gum is a  bit receded. The tooth has an awkward space where gum needs to grow in, so it looks more natural. This patient has already had another crown implant, however, so we refer to his former implant and see that the gums healed nicely. I'm sure his implant will adjust swimmingly!

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