Thursday, March 22, 2012

Another Day In Paradise

Hey all,

Hope you had a good weekend. I did. Did anyone watch the Gators put a beatdown on Virginia and Norfolk State? SWEET SIXTEEN, BABY!!!! I am wearing my orange and blue today because our dance continues tonight. Our game starts at 10:17pm, my time, so I am going to be really angry and tired tomorrow or on cloud 9. Let’s hope for the latter.

I watched a couple of movies this week. ("When do you have time?" you might ask. Well, when you are up at 3:30am worrying about life and dentistry and kids, you find a lot of time.) I watched Kinky Boots. No, it wasn't an adult movie. It was foreign film (in English, thank goodness) and I have to say that it was pretty good. I also watched The Beaver. This had a star-studded cast: Mel Gibson, Jody Foster and Cherry Jones. This is a movie that Hollywood loves but I HATED. It was everything I could do just to finish it. Don't even waste a slot in your queue.

Okay, I just finished reading the latest AGD Impact , and it had an article in it from a 4th year dental student, Maggie Law. And as I sit here exhausted from a very tough day, I don't exactly know if Ms. Law really knows what she is getting into. I had a day that you read about, a day where you go home and just sit on the couch until you fall asleep.

It all started with a snow bird. Snow birds are northerners who come down to the south for the winter. She came in last week to ask me my opinion on a broken tooth. She had broken #29. The tooth had an MOD amalgam in it, but the filling fell out and the buccal cusp went with it. And the ling cusp was also loose. I took an x-ray. On the x-ray, she had a military grade amalgam build-up on #30 with decay under it and #28 had a huge DO on it with decay under that (oh, she had just gone to the dentist about 3 months ago).

I told her that I thought she needed three crowns. By the time we were done discussing, I told her I could do huge fillings on #30 and #28, but #29 was going to need a crown and whether or not she was going to need a RCT and post and core was going to be a game-time decision.

This morning she came in to do the work. Things were going great. I took out all the amalgam and decay and was going to start on the build-up on #29. The tooth looked like a small teepee. I wasn't going to get a build-up on there. I thought a second. I had heard from Gordon Christensen that he is doing more pins again, and I thought this would be the perfect case. I was just looking for a couple of mm of core material. The tooth had ferrule, but no retention.

I put a hole in the buccal and the ling. I put the pin in the buccal and when I went to put the pin in the hole in the ling, I saw the tooth break right before my eyes. The ling part of the tooth between the gums and the hole sheared off. And it didn't just break; it broke below the level of the bone.

I felt like this was a great time to go and check hygiene. I was so mad, my blood was boiling. I came back, much calmer, and proceeded to do the fillings on #30 and #29, which both turned out tres magnifique, if you ask me.

But I still had this broken tooth to deal with. I gave her options. I was very up front with her and told her everything that happened. I looked in the x-ray and the tooth was very long. The first option was to send her for a crown lengthening procedure. Or I could take it out and do a bridge on the two teeth she needed crowns on anyway

She asked me what I would do. I told her I would do the crown lengthening and then just do one crown. She agreed. But now she is only here for about 3 more weeks and we all know that after you do a procedure, you can't mess with the tissue until it matures and that takes longer than three weeks. Arrrggghhh. We decided to do a build-up, and prep the crown prep in the build-up and put a temp on that.

Then, a second patient. A patient I have had since I was a rookie out of school. I had a lot of patience then. She is a crier, a mover, and a talker. Don't get me wrong; I really like her and she really likes me, but she is a tough patient to work on. She lives in Washington state and comes to see me when she is visiting her brother that lives in town. Last week, she came in for a "get reacquainted" exam and today we were going to clean her teeth and deal with the three spots of decay she had.

I guess I don't have as much patience as I did back then. Working on someone that is sucking nitrous as hard as they can, kicking off their shoes, shaking their feet and talking, all at the same time, is very difficult for me. I mean, when I was done with these things, I was totally spent and she was only my second patient.

My day calmed down but revved back up when little Billy ended up in the chair. Billy, who is 8, started asking me why I felt like I needed to take an x-ray. He then proceeded to tell me what Dr. Oz told him about protecting the thyroid when taking an x-ray. Billy needed a filling and we were going to do it today. BBut after a local of Septocaine, it appeared he wasn't numb. I then gave him a block, much to his dismay, and he still wasn't numb. By now, Billy no longer wanted to be in my chair. But Billy had a big hole in his tooth. This was not going to the easy, 15-minute appointment I told his mom it would be.

Billy made it, but I am not sure about me or my assistant. I think I saw her with a 40 wrapped in a paper bag coming out of the 7-11 across the street.

Man, I had a tough day. Now add that to a day when your bill payer is in (yes, that was today) and she is telling you that payroll is next week and it is not looking so good. And a day when you had three hygienists and a bunch of hygiene checks on people that want your best. They don’t want the tired, just broke a ling cusp off a tooth trying to put in a pin guy that you feel like.

I know dental school is hard. It was the best and hardest 4 years of my life. Until now. I don't even know how to prepare the young dentists of today. But I can tell you one thing: as soon as you start working here, I have three patients I am sending your way.

Have a great Thursday.


Dr. Andy said...

Man have I had days like that. NOT fun. thanks for sharing. It is good not to be alone.

Bill Payer? I'm not trying to be funny here but how does that work? Why do I need one? Why would they know how much money is in the account?



gatordmd said...


At our office we have someone that comes in and does our "books".
She pays all the bills for us.
She makes sure the deposits are right.
Everything we buy or upgrade or anything goes to her. She categorizes it all.
Then she sends us a report and then sends our accountant a report.
At the end of the quarter, we go to our accountant and we all have a hub bub about money. NO FUN lately.

Hope that helps,

Dr. Andy said...

Thanks John.

Interesting. I do all that myself.

I pay all the bills, balance deposits, and categorize everything. I'm always interested to learn how others administer their practices.

Hopefully, today was a better day for you.



PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.