Tag: 18LayneW

As I write this a little bit of sadness looms over me as I realize that today was my last day at the office as an intern rather than a patient. Today was not particularly action packed but it was a nice ending to my time there because I got to see several patients walk out completely satisfied with smiles on their faces.
Buried in all of the routine cleanings I observed today my first case of a full set of wisdom teeth. I have seen various patients who had some or no wisdom teeth. I have slash seen patients who had wisdom teeth that were peeking through the gums in various ways and at various angles. The case I saw today was a case with all four wisdom teeth so Dr. Sims took a panoramic x-ray to see if the teeth needed to be removed. The x-ray revealed that the teeth were not currently effecting any of the other teeth in a negative manner. And although the teeth had no negative effects at this moment, Dr. Sims informed the patient that she should probably have them removed to prevent any pockets in the mouth where cavities could form. Other than the wisdom teeth in the patient’s mouth, this patient had the most perfect set of teeth that I have seen (even better than the patient yesterday!). There was not a single cavity or dark spot or crack throughout the patient’s mouth nor was there any sticky areas or discoloration. This patient came today with other family members and all of them had spotless teeth, and I was amazed at the genetics that this family had.
Before today I have seen multiple impressions be taken, whether it be for an implant or for a crown I have watched impressions be taken for all four quadrants of the mouth. Today I watched one impression and it was for a specific brand of implant. Three impressions were taken, one of the upper teeth, one of the lower, and one of the bite. I found the impressions for both the lower teeth and the bite to be interesting. The lower impression was interesting because two separate materials are used to make the impression. A thick layer is placed all over the teeth and a thin layer is placed directly over the part where the implant is. This thin layer molds into the thick layer, but because it is thin it dries in a more detailed shape to allow better precision when the implant is being made in the lab. The bite impression is also interesting because rather than it being placed into a piece of plastic and then into the mouth, it is placed directly on the teeth and molds into the bite mark in less than 15 seconds. The ease with which impressions are possible amaze me and I think what the lab is able to do with these simple impressions is amazing as well.
I would also like to shortly discuss something that I have been learning about ever since my first day at the office but I have not taken time to discuss yet: patient and doctor interaction. Dr. Sims is extremely personable and welcoming, and this is evident throughout his office. He knows every patient that walks into the office and he is always interested in what is happening in his patient’s lives. I think that this contributes to the professional relationship that is established between patient and doctor in an extremely positive manner. I have been extremely impressed with the interactions between Dr. Sims and his other employees and his patients. Within his office it is almost as if there is a small village of people who all know and help each other. This small business vibe is something that I think is extremely important in trusting health professionals and Dr. Sims is extremely successful in running a business that is strongly geared towards family.
I am so thankful for my time at Sims Family Dentistry, and I know that I learned things about dentistry and about the workplace that no textbook could ever teach me. I am glad I will be able to carry with me not only a small bit of knowledge about dentistry, but also a lot of knowledge of interacting with people. Thank you Sims Family Dentistry for being so welcoming and helpful in my journey of learning about dentistry!

PS- The radio came back on today, so it lives!!! 🙂

Besides routine cleanings today, all the other patients were there for fillings. I got to witness fillings in various places on teeth, and see how older fillings made of certain material eventually chip or cause other problems.
Some patients have older fillings that are made of silver. Silver fillings, especially in the back teeth can cause cracks in the tooth because the repetitive movement of chewing and biting causes the silver to move down and out within the tooth. This movement causes horizontal cracks in the tooth, which can then indirectly reach one of the four corners of a tooth and cause an entire corner to chip off (see diagram below that illustrates this cracking process). When this happens the entire silver filling must be replaced, and then the part of the tooth that chipped away must also be filled. Dr. Sims replaces and fixes these fillings with composite fillings rather than silver because this material will generally last longer and not chip and it also has a more aesthetically pleasing appearance.

Today I also got to see a patient who has a filling in the same spot in all but about 8 teeth. After numbing the patient Dr. Sims took me to review the patient’s x-rays. These x-rays along with the patient’s chart obviously showed that there was a reoccurring pattern the patient was following to cause these cavities to happen. Dr. Sims informed me that this problem was in fact a constant usage of drugs. Dr. Sims explained to me that this continued use of drugs caused. The small cavities at the base of almost all of his teeth were caused by continued drug use, and the majority of these fillings have been reopened and refilled numerous times. This problem will persist and without the stopping of drug usage and without proper hygiene care these cavities will continue to happen. Out of all the cavity fillings I have seen, these were the first where an extra step was required in filling them. Because these cavities are located directly next to the gum line, a coated piece of string is temporarily placed between the tooth and the gum line. This string is coated in a layer of chemical that attempt to prevent the gums from bleeding (out of irritation) during the filling. The string’s main use however is to push back the gum to provide more space to fill the cavity and to ensure that the entirety of the cavity is filled as well. This tiny string was removed from the patient’s gums as soon as the filling was complete, but I was intrigued by the level of ease with which the gums swallowed the string and then put them right back out when the procedure was finished. This patient only had three cavities filled today and still has several that need to be filled, and will need to be treated in the near future.

In other news today besides all of the fillings I witnessed, I was able to watch Dr. Sims provide a patient with a new crown for one of his front teeth. This patient has crowns all across his upper mouth, and also has a partial on either side of his lower mouth. Last week I saw this same patient receive a crown that was not the right color match. So, to see the lab change the color of the crown was quite interesting to me as I got to see the difference it can make in a patient’s mouth when the crown has a color or shape change.
The final patient that I saw today had the most beautiful set of teeth that I have witnessed up to this point in the office. This patient was just in the office for a routine check-up and cleaning, and I was astonished at how perfect her teeth were. This patient is a 21 year old female and on her chart she had not a single cavity anywhere throughout her mouth or anything that would be considered bad. I was able to look at her x-rays and I thought it was amazing that she was able to not have a cavity all of this time.
Today I saw both the very best, and the very worst set of teeth that I have seen so far at the office. Dr. Sims placed fillings in several teeth in several locations throughout the mouth, and it was interesting to me that although all the treatments were for fillings, different materials and tools were needed for each respective filling, depending on where the tooth was throughout the mouth. Besides my learning about dentistry today, I witnessed something slightly tragic at the office. The trusty radio that has been continuously providing background music throughout the office ever since the office opened has been only receiving some signal and the sound has been going in and out since I have been in the office. And today, I believe we might have seen the end of the old trusty radio. I am sad that tomorrow is my last day working at the office, and I am sad that there will be no music to go along with it, but I hope that tomorrow is the best day yet!

As I mentioned last week Sims Family Dentistry is closed on Tuesdays. So today, I will not be going into the office and I decided to focus my research for the day on something that delves a little deeper into the world of dentistry: orthodontics.
Orthodontics requires the same knowledge of the mouth and skull that is required for dentistry, but to a deeper extent. An orthodontist must complete dental school and receive the same degree that a dentist would receive, but they must also complete three to five years more of specialized training regarding specifics of how teeth move and how teeth movement and the bite can be changed. This specialized training involves several exams throughout the time period to ensure that a student has a wide knowledge of the topics they are being tested on. Students pursuing orthodontic certification are also presented with several cases and are to discuss how they would treat these certain cases and a time frame for the treatment. All of this may not seem like much but the schooling is quite rigorous and only 6% of dental school students progress forward and become orthodontists.
This 11 years of college (4 undergrad, 4 in dental school, 3 in orthodontic study) comes with a somewhat hefty price, but pays off when a starting orthodontist receives their salary. Orthodontists who own their own practice can also decide their own hours and many of them, like dentists, are only open four days a week and they sometimes practice at several locations. The salary is dependent on the geographical location where the orthodontist works, much. Like any other job, but in my opinion the salary they receive is much worth the education required to get there.
A few short years ago, I finished my time in the orthodontist’s chair. I had two sets of braces, a retainer, three oral surgeries and it took around 6 years, but it was all worth it. Orthodontists have to work with people, mostly children, every day and interact socially with both them and their parents. Along with understanding what it is like to be a patient in the orthodontic experience, I also love interacting with people and I have a passion for children.
These past few days I have seen a few kids in the office who had braces. I have been able to witness their treatment from the dentistry side of it all and understand why they have difficulty in cleaning their teeth along with why they have frequent and slight bleeding in their gums. I have found that the way orthodontics effects the oral cavity and the bite of someone’s teeth is quite interesting and I think that it is important to have braces because from what I have seen in several patients is that it can prohibit certain problems from occurring in the future.
Orthodontics seem interesting, and I find it interesting how closely they relate with oral hygiene and the problems a dentist deals with on a daily basis. I am interested in hopefully seeing more kids in the office this week with braces, even though that is not my primary focus. After today it will be goodbye orthodontics, and hello again to dentistry!

 

Photo Citation: “Youtube.” Youtube, m.youtube.com/watch?v=4Wp37UanAOs.

Today was a bit of a hectic Monday, with patient after patient coming in and out of the doors. Many of today’s appointments whether they were routine cleanings or other cases, went by quickly and today was absolutely problem or challenge free. And although many of the appointments passed by quickly, there were two appointments in particular that I found interesting.
The first interesting appointment was a sort of precursor appointment for a patient who will soon be treated with a root canal. While this patient did not receive a root canal today, what Dr. Sims did was basically clean out the canals and the tooth overall in general so that it would be ready for the root canal. Dr. Sims took several x-rays in between completing several measurements in order to identify how deep the roots of the tooth were (where the empty canals are now located). Dr. Sims placed a medicine within the canals once he measured how deep they were in order to completely rid the canals of all bacteria prior to the actual procedure. After the appointment Dr. Sims noted that this patient walked in and out with much ease because the specific tooth being worked on was completely dead so that made it easier to work with for this particular operation. Obviously, it has been assumed that the tooth was dead because the patient is on the verge of receiving a root canal, but this tooth had no bleeding whatsoever when operated on today, and that is rare in the sense that the tooth was completely dead. This patient will now be allowed time for the medicine within the canals to do its job before the root canal in a few weeks.
The other most interesting appointment today was with a patient who will soon be receiving a metal partial for her lower right mouth. Today’s appointment only consisted of taking several impressions for the partial, but the appointment was interesting because it was the first partial that I had been exposed to that would not be a normal plastic partial but rather made of metal. The patient did not mind that it would be made from metal because she originally had a metal bridge in the area, but due to a tooth decaying the bridge failed, so a partial was suggested instead. The decayed tooth was removed at a prior appointment and today I was surprised at how well the gum had healed in the area where the tooth was removed. Anyways, the impressions were taken so that her partial can be custom made and fit properly within the patients mouth and a 3D mold of the patient’s teeth was made into office today to be sent off to the lab. What was also interesting about this patient was that I was able to learn what a Nesbit partial is. While this is not the type of partial she was taking impressions for today, the patient has one lower tooth missing on the opposite side of her mouth and Dr. Sims explained to me that the Nesbit partial would be the best fit for her because of the other dental work she has already endured. A Nesbit partial is a partial that hooks to other teeth, but it small and only has one actual tooth. I found it interesting that I was able to learn about two other types of partials that I have not yet seen in action.
The final news I have about today is not about a particular patient but rather a new piece of equipment Dr. Sims received information about. Dr. Sims showed me a new panoramic x-ray machine that not only takes the 2D picture scan but also creates a 3D model of the skull, places the nerves throughout the mouth along with their respective measurements, and can identify other measurements throughout the mouth. This would be particularly helpful in placing implants because it would give more information about each particular patient since all patients have different bone structures and their nerves are in various places. Dr. Sims told me that if he were to purchase this machine it would be likely that he would place more implants than he does now because he would be able to do that more precisely.
After learning about more types of partials that I did not know existed along with watching an impression turn into a 3D model, I thought today’s busy day was a great learning experience. I am looking forward to share my own research that I encounter tomorrow.

Model of an implant from the lab.

Everyone in the office today was glad that it was Friday, well, except for the fact that Friday means opening an hour earlier than usual! So, we started our day nice and early with a variation of cleanings and only one “special” case. Everything was smooth sailing and just when the office was almost empty, two urgent cases were called in, and these two cases were by far the two most interesting of the day.
The first urgent case that came in was what I like to call an “arts and crafts” case because Dr. Sims built an entire temporary tooth on the spot. Unfortunately, this patient was missing an entire front tooth and had already undergone surgery for an implant and was waiting on her permanent tooth to place in her mouth. However, she had a temporary tooth that Dr. Sims sculpted by layering acrylic material and setting it with a light tool. He worked from each surrounding tooth inwards and created what looked to be a real front tooth. This patient can now have a regular and fully functioning bite until she receives her permanent partial for her front tooth (which is only a few weeks away!).
The second urgent case that came in today was a patient with severe gingivitis who was complaining of a pain in the upper right area of her mouth. The area where she complained of pain was in the rear of her mouth at the gum, so Dr. Sims took an x-ray to see what happened. The gingivitis caused a gap in the gum between two teeth, which caused a tooth that had already been treated with a root canal, to crack in a sideways manner. What made this crack particularly interesting is that the crack was a complete split in two of the root of the tooth. This is quite rare but the x-ray showed how the tooth had split into the hole in the gum caused by gingivitus. The next step was extracting the tooth to avoid further damage and prevent more infection of the gums from occurring. The tooth did come out in the two pieces that it split into, but it was with much difficulty. It was not difficult in the sense that the tooth would not move but rather difficult because of severe bleeding that took place. The patient had severe gingivitus and it was difficult to work because there was a constant need to remove blood from the mouth. Dr. Sims was able to successfully remove the tooth, but did have to go back to find a piece that was lost in the infected gum in the deepest part of where the tooth was lodged. It was through an x-ray that Dr. Sims was able to find this missing piece, and send another satisfied patient on their way.
While those two cases were definitely my favorites of the day, there was one regular cleaning that I found interesting because the patient’s x-rays were unique. This patient had several implants and crowns, some of which were done by Dr. Sims and others were not. With this variation, in the x-rays I was able to see the different types of implants and how they vary in brand, size, shape, height, and detail. I found it interesting to be able to explain and discuss with Dr. Sims the reasoning for why each type of implant was suggested and used for each different tooth scenario. I was also able to explain and understand why certain methods were used to insert these implants because of the initial situation. X-rays may seem like simple white and black photos, but in reality they are fascinating photos that tell a million stories.
Looking at several x-rays and a lot of implants today, along with the sculpting of a tooth from scratch, I’d say today was the best yet. I was amazed by the level of ease that it took for Dr. Sims to sculpt a completely new tooth and have the patient walking out the door in less that fifteen minutes. I loved to be able to continue analyzing x-rays and identify patient progress through the x-rays and see how far they have come from whatever their initial diagnosis was. I can’t wait to see more cases next week and continue to grow my knowledge of dentistry.

The office was busy and full of all kinds of cases today! Today there was one sort of extreme case and several routine cleanings. My favorite two subjects that I learned about today included implants and X-rays.
A specialist places implants in a patient’s bone with a protein coating around the implant to allow the bone to grow around it to secure its placement within the mouth. Then before placing the denture in the patients mouth, the implants are given around three months to heal. However, it is possible (while rare) for the implant to not heal properly, and a gap to remain present between the implant and bone. Ultimately, this causes extreme pain when the denture is placed into the mouth as the metal implant wiggles when it is not supposed to. And here comes the importance of essays. Unfortunately, this did happen today at the office and it was through an X-ray that Dr. Sims was able to identify that the implant did not heal properly. An X-ray showed a gap in between the implant and the bone, which was likely caused by a weak bone and had nothing to do with the healing process at all. With this x-ray, Dr. Sims was able to communicate with the specialist doctor to identify a solution for this patient moving forward.
This case was not the only one which I was able to learn about through x-rays. There were several pediatric patients today, who all came in for routine cleanings, and lucky for me all of them were due for x-rays. Through the x-rays Dr. Sims explained to me how to identify if teeth were developing at a normal place and also how to identify any reasons as to why baby teeth may not be developing at a normal pace. While it is sometimes genetics, as was the case twice today, it is also common that the placement of baby teeth can prohibit permanent teeth from coming into place in the mouth. I was able to see this in different views today through x-rays.
It was interesting today to see the differences in developing teeth and permanent teeth, and witness first hand what can happen if permanent teeth are not properly cared for. I also loved watching the kids proudly walk out of the office today, as they had no cavities after their check-ups. Their smiling faces along with all the satisfied adults that were treated today really warmed my heart. It was especially interesting to watch a young child endure a dental problem that I also experienced as a child. For me to tell him how everything worked out for me, and see the hopeful look on his face, this connection honestly made my day. I loved seeing first hand how dentistry had such a positive impact on these peoples lives, and I can’t wait for more tomorrow!

My first day at the office was light but action packed. While there were not a ton of patients today, there were two emergency cases first thing this morning. After a long holiday weekend this is typical and not surprising.
First thing this morning a severely cracked tooth was treated. I learned the methodology for this procedure along with the necessary requirements to do the procedure in the first place. Since there was not much tooth left to work with, the root and small remainder of the tooth was removed. This tooth had previously had a root canal performed on it, so it was quite brittle and difficult to remove because it broke into several pieces and chipped as it was removed. Eventually the whole tooth was removed successfully. This was a fun challenge to start the week at the office!
The rest of the morning was routine cleanings and small fillings performed on teeth. However there was one case where a partial denture was adjusted. This was an interesting learning point for me as I learned about the difference in building both partials and full dentures with a computer and its differences with that process and that of the process of building 3D models and sending them off to a lab in order to make the dentures. I also learned about the attachment of partials in contrast with dentures, and how it is important for them to not irritate other already existing teeth.
My favorite part of today was watching the usage of a tool that I had never seen in my trips to the dentist. Dr. Sims has a probe with a tiny light and extremely clear camera attached to its end. This allowed Dr. Sims to probe around a specific tooth and capture clear images of the tooth from different angles, at a level so zoomed in that the human eye can better see cavities or even the slightest cracks. I was impressed by the quality of this camera and its quick usage that allowed Dr. Sims to identify the causes of mouth aches and pains that patients complained of.
Today was eye-opening for me into the world of dentistry, and I cannot wait to treat different cases and learn about different techniques and tools in the upcoming days!

Continue reading Day 1- Dentistry Basics and Background