Comeback?

Are you ready for my next post after my sabbatical? If you are still there waiting for me to write again, I thank you for being patient. To be honest, I do not have more time in my hands than before but I have decided to make an effort to write every once in a while.

A revelation to reward you for your loyalty. I am still in the dental business even though I would love to spend my time solely on writing. It is my passion. I must say that I have had a difficult year of ups and downs. Highs and lows. Times when I believe in myself and times when I have lost all the self-confidence. I have realised that I have an impostor syndrome which tries to demolish all my achievements by persistently telling me

Who are you kidding? You’ve achieved nothing! Shame you if you even think so!

This syndrome keeps on reminding me that I did not get feedback on my novel from THAT person I so much admire, and making me forget I got feedback from ten other people who are as important as that one person.

But I’m working on it. I am trying to remind myself that in this world of haste and demands, I am good enough. As mother, as wife, as dental professional, as writer and most importantly as myself. Being merciful to yourself is a difficult skill to master. But I am learning.

So, watch this space. There might be something coming up soon!

 

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Guest Bloggers Welcome

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Guest bloggers warmly welcomed

While I am still not active with blogging (but hopefully will be soon), Dental Revelations Blog is open for guest bloggers. Mind you, I am quite picky and have allowed only one guest post so far. Will you be the next one?

Disclaimer – Dental Revelations Guest Post Standards

Dental Revelations aims to maintain certain standard for the content posted on our blog – it is of benefit to everyone. Therefore Dental Revelations:

1. Will proofread posts and amend them if needed.

2. Will not accept posts of low quality in content or grammar (certain errors will be corrected).

3. Will evaluate the content and writing style which should have the similar approach to dentistry as Dental Revelations Blog has.

4. Will not accept posts with links to spammy websites.

5. Will not accept posts with links to irrelevant sites (e.g. site selling car parts). The links need to provide additional value to the reader.

6. Will check the originality of the post (Copyscape) to avoid overload of the same approach to the same topic in the blogging world (e.g. one can write about implant surgery with unexpected, humorous way instead of just plain old why patient benefits of having an implant).

7. Will own the rights to the content on the moment the post is sent to us providing it is published. If not published, the rights to the content are with the author.

8. Will expect the posts to have at least 1000 words.

Further requirements:

1. The guest post should include an author bio. Author bio can have maximum of 2 links to the following sites: to the author’s blog/website/Twitter handle.

2. Guest author should reply to any comments made in their post as soon as possible.

3. Any image attached to the article needs to be royalty-free image.

3. Be creative. Write about dentistry in a way no-one has written before. Forget being polite and politically correct if something is bugging you. Pour your heart out and type away. People will love the genuineness and honesty.

 So if you feel you are up for the task, you will find my contact details here.

Shared from WordPress

I simply must share a fellow blogger’s, Back To The Tap, post on Fluoride. It’s always a pleasure to read posts from a talented blogger. Hope you enjoy it too (the subject is also important).

Fluoride in water: Nature’s toothpaste or communist conspiracy? – http://wp.me/p7QijM-2T

Are You Telling the Truth about Your Health When You See Your Dentist?

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Interview Is the Most Important Part of the Check Up

When you see your dentist for a regular check up it should always start by interviewing you. No matter how long you have known your dentist and you think they know you inside out, the same questions should be repeated every time. These questions make the treatment you might need safe to perform when it comes to your health.

If the dentist or dental hygienist does not ask about your medical history when you see them for a check up or an emergency visit, I would advice you to change the practice. In worst case your life might be at risk.

If your dentist or dental hygienist does ask about medical history, you are in good hands but only if you are honest. Do not hide anything even if  you think something is not relevant or you are embarrassed about it.

The most important ones to mention are

  • anticoagulants (all of them – even aspirin and omega 3-products) and why you have been prescribed these
  • allergies – all of them! The ones the patients often fail to disclose are food allergies and allergy to latex. One might think that why would food allergy make any difference to dentist but it does. There is milk protein in a product called GC Toothmousse that is used e.g. after teeth cleaning
  • antidepressants – you don’t need to be embarrassed about them, we are professionals and will take matters as they are
  • eating disorders – the past and current ones. There is no reason to hide them from the professionals. It might be actually a relief for you to share it with somebody (believe me, I have witnessed this several times during my professional life)
  • excessive alcohol consumption – even if you won’t tell us we can often see it from your mouth or how you response to the treatment. Heavy alcohol consumption may affect the effectiveness of the local anaesthesia – it might be difficult to get your tooth numb. Also certain drugs won’t be effective enough like antibiotics. These are just two examples. If you are interested to read my post about alcohol, please click here.
  • if you have artificial joint
  • all the systemic diseases
  • if your immune system is impaired – HIV, hepatitis A or C. This won’t change the way we treat you as we should treat all the patients in such way that no cross-contamination can happen. But we need know in case we see something in your mouth (e.g. soft tissues) we do not understand unless we know about your illness. Also the information will help us in the case of unfortunate accident if one of us professionals cut ourselves by contaminated instrument

It Is All about Trust

Everything you tell us at the dental office is confidential. Even if you are a public figure.

I must tell from an experience that I felt utterly disappointed and mistrusted once when a well-known person who had seen me for years, told in the press that she has had hepatitis C for a long time. You tell this publicly but not in a place you should. Why o why? Trust us god dammit!

Repost with Forewords: Alcohol – The Feared Subject

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Acute pancreatitis is life threatening illness

Today I went to see a man who for my children is very dear despite his dependency to alcohol. They never defined him as an addict and never thought anything but the best of him. This man is their grandfather who fell gravely ill several months ago with acute pancreatitis caused by lifelong abuse of alcohol.

Having spent over five months in hospital of which he spent four in an intensive care (2 months in coma), he was finally at home. But he was a shadow of a man he used to be.

This man used to be proud. He was a kind and pleasant (when sober) man. He was very skilled and was ready to help others when needed. He loved kids and knew what would make them happy.

Today when I went to see him he was lying in bed barely recognisable weighing just 50 kg. He had tubes coming out of his stomach leading into a bag that was filling up with brownish secretion from his organs that were riddled with a spreading necrosis. He was unable to obtain any food or drink inside, taking several medications many times a day, dependent of his wife who was looking after him. His voice was like he was speaking from the grave.

It was the saddest sight I have ever seen. There was no need or desire to say I told you so. No gloating over being right all these years about his future. It was just simple sadness over a kind man, father, husband, grandfather who would have had so much more to give to so many but instead now was bed-bound waiting the imminent death. Slow death that took away all pride and dignity and which every day reminded him why he is where he is now. Alcohol.

But even more sad than seeing him now is the fact that he never got the help he would have needed for his drinking which started at his twenties. No-one intervened when there was still a chance to turn the tables. Instead of this a troubled sensitive soul was taken over by the numbing comfort of an alcohol that took a firmer hold of him as the years went by. He faced many misfortunes in his life and he dealt with them by alcohol. He had happy times and he dealt with them by alcohol. Before he reached his fifties everything he did, everywhere he went the alcohol came along.

He was told by all the close relatives that he cannot continue drinking like this. He was told he has a problem with the alcohol. One day he admitted he does, the other he declined. He never seeked help. And no-one could force him. Instead he came a master in finding excuses to visit his hidden bottle. Taking the garbage out, checking something from the garage, fetching firewood for the fireplace. Everyone who was witnessing this knew that he went for his hidden bottle. This too was heartbreaking to watch.

When he finally fell ill and the house needed to be emptied of all the alcohol there was altogether 30 litres of strong spirit.

This man’s story is not unique. There are plenty of similar fates in the world.

The longer the alcoholic carries on drinking the harder it is to intervene. I mean that the intervention we can do at the dental practice has less impact than it would have in the early days of an addiction. That is why the early intervention is very important and us dental professionals have a very easy and natural way to intervene.

Please read my post below and hopefully it will bring you courage to ask about patients’ alcohol consumption.


About 60 year-old man came to see me one morning and complained that every once in a while a layer of skin comes off inside his mouth and no-one has been able to tell why. He was concerned and felt…

Source: Alcohol – The feared subject

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Not Truly Gone

Eeny Meeny Miny Moe – Which Type of Tooth Wear?

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There are four types of tooth wear that we diagnose from patients’ mouths. Erosion, abrasion (I’m sorry for a missing link – I did not agree with any of the images of abrasion), abfraction and attrition. The easiest ones from these to diagnose are the erosion and attrition. You can’t go wrong with them. But it is completely different case with abfraction and abrasion. I run into this very often with my patients.

When a dentist or a hygienist sees tooth wear on the neck of the tooth they diagnose it by default as abrasion caused by too vigorous brushing. They recommend softer toothbrush and this silly brushing technique called Bass (it is so silly that I think I am going to dedicate one post entirely to this technique).

This normally leads into a situation where patient begins to be too careful with the brushing because she doesn’t want to cause further damage to the teeth. That’s when the plaque starts to build up to the gum line, gum gets inflamed because of the plaque and the patient begins to notice bleeding when brushing. Now she’s even more careful with the brushing as in her mind bleeding means she’s doing something wrong – brushing too hard like the dentist said she is.

But what if the dentist/hygienist misdiagnosed the tooth wear? What if the correct diagnosis was the abfraction?

Tooth wear – What to Check?

When you see a tooth wear that you are tempted to diagnose as abrasion, stop for a moment before you proceed giving advice on brushing. Instead do the following:

1. Check if there is mobility on the teeth affected by tooth wear

2. Check if there are interferences on side movements and protrusion

3. Check if there are shiny facets on occluding surfaces

If you get positive answer to even one question the chances for the tooth wear to be abfraction are great. And in this case telling patient that the tooth wear is caused by her brushing can be damaging in many ways:

  1. It is hard to convince a patient that they are not actually brushing too hard and that they have not damaged their teeth by it. I have my ways of convincing the patient but life would be soooo much easier if I didn’t have to.
  2. The dentin will decay very easily (as I’m sure you know) and plaque accumulating and staying there undisturbed for longer period of time because of too careful brushing will very quickly cause decay. And we all know how these fillings in the cervical area are pain in the butt. Somehow they always seem to have overhangs or they come off when scaling. Sound familiar?
  3. The teeth where the surface of the root (dentin) has been exposed by receding gums will get sensitive if the plaque builds up.
  4. If the tooth is mobile and has already bone loss the plaque building up to the gum line and inflaming the gum can be disastrous. Please memorize that

MOBILITY + PLAQUE = RAPID BONE LOSS

The Cause for Abfraction Needs to Be Dealt With

When a tooth interferes with full closure, it will trigger deflective interferences6-8 and cause any of the 7 signs and symptoms of occlusal disease such as hypersensitivity, abfractions, mobility, excessive wear or fractures, and muscle or temporomandibular (TM) pain.

There is no consensus amongst the dental professionals over the right approach to occlusion. Is this the reason why signs of interferences on occlusion are ignored or unchecked and the tooth wear is so easily made as patient’s fault?

The quote above is from an article The Three Golden Rules of Occlusion in dentistrytoday.com and you can read a full article here.

But by Whom?

To be honest – and like I have expressed in my previous post – I would not let just anyone touch my occlusion. I would love if the dentists would refer patients to the specialist in prosthodontics and stomatognathic physiology because they have the best knowledge and skills to treat the occlusion. And that’s something every patient is entitled to.

Guilt Is a Heavy Load to Carry

I have often noticed that patient feel unnecessarily guilty over damaging their teeth. They feel guilty and desperate over the fact that the damage done by brushing is irreversible. And that they are not sure if their brushing technique is still damaging their teeth hence too careful brushing to make sure they are not.

I believe that guilt does not lead us forward in life, it does not bring anything positive into our lives. Therefore I always try to relieve my patient’s guilt whenever it is possible.

In the case of tooth wear and some dental professionals way of putting the blame on patients’ brushing technique I always have the same conversation with a patient. It goes like this.

Me: Have you been told that you brush too hard?
Patient: Yes I have.
Me: I thought you might have. You see when a patient is told this, she starts to be too careful and then the plaque starts to build up and there is actually plaque in the gum line of your teeth. (I take a mirror and show the plaque to the patient)
Patient: Eww..
Me: I personally try not to tell patients that they are brushing too hard because this leads to too careful brushing which will cause more problems like decaying and gingivitis. Instead I interview the patients about how they brush their teeth and correct it if necessary. You see the tooth wear can be caused by other things than just vigorous brushing… 

Prior to this conversation – in the beginning of the treatment – I have interviewed the patient and asked about her oral hygiene habits. Which brush she uses? How often? How often does she replace the brush head/brush? How does the brush head look like before replacing it? Spread or still like new apart from colour fading? This is why I can continue the above conversation like this.

Me: In your case I doubt it that the tooth wear is caused by your brushing but I will just in case show you the right technique. I will first just check couple of things…

And then I check the mobility, the interferences and the occluding surfaces. I feel great satisfaction when the teeth affected by tooth wear have mobility on the side movements. I am on the right path!

The patient is visibly relieved when they can stop worrying about their brushing. Well who wouldn’t be! There is enough to worry about in life even without worry over brushing.


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Don’t Let Just Anyone Touch Your Occlusion

 

Ever Seen a Patient with an Implant? Read This!

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Today I saw a patient who had had an implant done to replace upper right first molar. The implant treatment was finished a year ago in another practice.

Since then the patient had seen hygienist twice in my practice. The implant crown itself looked immaculate but the gum was very red and puffy and it bled heavily after probing.

I knew what to ask next and I even knew the patient’s reply to this.

“Were you told how to clean the implant at home?”

“No I wasn’t” replied the patient with is-it-supposed-to-be-cleaned-expression on his face.

This happens too often. Almost every time I see a patient who has recently had an implant done.

Note for all the dental professionals who make the implant treatment’s final stages and do not give oral hygiene instructions (OHI) for the patient:

You should always tell and show how the patient can clean these costly pieces of metal and porcelain. It is your responsibility as a dental professional and the paying patient’s right!

Can you give me any other excuse for not giving OHI than the fact that you are too busy making money and forgetting the basics? I believe you cannot.

And you hygienists who see patients with implants:

  1. Always check how the patient is cleaning them. More so if the gum around the implant is either bleeding or there is plaque around it
  2. Advice if necessary and show in their mouth how it is done
  3. Check if the patient understood your instructions by asking them to show they can do it. Teach them if they struggle
  4. Check on a follow-up visit that the gum has healed. If not, refer to a dentist

Why Is It So Important?

With the implants it is vital that there is no bleeding in the surrounding gum. They will get an implant’s equivalent to gingivitis – peri-implant mucositis which can lead to the peri-implantitis (same as periodontitis with teeth) very rapidly. The worst case scenario is that the implant will lose it’s integration to the bone which could have been easily prevented.

The patient I saw today left home with instructions on how to look after his implant. And I will see him for a follow-up visit to make sure the gum has healed (can you see the shining halo around my head?).

Honestly, it’s not that hard to do your job properly so shape up please!


Here‘s further reading on the subject.

New Natural Remedy (Fluoride-Free) for Decay

Dental Revelations

Just kidding. Just wanted to have your attention.

Today I am going to write about fluoride. And the reason for doing this is that I keep on running into articles and websites promoting fluoride-free toothpastes (and water). Not only they recommend non-fluoride toothpastes but also they tell that the fluoride is toxic or poison when entering body.

It is rather entertaining to read these articles but sooner or later the amusement turns into annoyance. Especially after comments like this

I love the look on dental hygienist’s faces when I refuse the fluoride treatments or toothpaste for me and my kids

When the adults practice their anti-fluoride beliefs on their kids it is simply heart breaking. I have seen kids whose milk teeth were so badly decayed that most of them had to be removed. I have seen kids in pain because of the decay. Why would you want to put your kid through such experiences? They wouldn’t thank you if they knew what caused their bad teeth as an adult. But they will never find out the truth because they have been told that it runs in the family to have weak teeth… yeah right. There is no such thing as weak teeth that are hereditary. It’s all about oral hygiene habits and lifestyle habits. What could be called hereditary is the bacteria in mouth that you might get from your parents as a baby. If the parents neglect their teeth (poor oral hygiene and lifestyle habits) there is great amount of cavity causing bacteria in the mouth and if that bacteria is transferred to the baby there are big chances the child will struggle with decaying. And this means this child needs fluoride. And if the parents do not offer it… pain, screaming in fear at the dentist, sedation/general anaesthesia, fillings, extractions, malposition of the permanent teeth because of the loss of the milk teeth… So unnecessary!

To be honest, I can understand the worry over the fluoridated water to some extent. After all it goes into your body.

But the fluoride toothpaste! You are not meant to swallow it, are you? With young kids you can’t prevent them swallowing the toothpaste but that’s why you use only very tiny amount of it.

But you adults, come on! The local effect of the fluoride is important in prevention of decay. You brush for 2 minutes (hopefully) and that’s the time the fluoride stays in your mouth. Then you spit it out and rinse with water (I don’t but that’s why I glow in the dark…ha-ha). No fluoride has entered your body.

But still some people mix all sorts of things with “healing properties” to be used as a toothpaste. Herbs, clay, coconut oil etc. I just read an article about coconut oil that was recommended by Dr. Somebody to be used instead of fluoride toothpaste. And as if the article wasn’t full of baloney but the comments at the end of the article were even more so.

…I laugh when dentists tell their patients not to brush for an hour….. why leave the acidity on your teeth to do damage for an hour – five times a day – seven days a week etc…. it adds up!

This person refers to a previous comment where somebody said he vigorously rinses his mouth with water after eating anything (which is fine). I’m sure all the professionals know what will happen to the teeth if one brushes every day after every meal – five times a day – seven days a week etc.

Erosion or to be precise it is abrasion that will happen to the teeth and that is irreversible damage which will lead to hypersensitivity of the teeth and make the teeth more prone to decaying.

Facts Simplified

There are minerals in the enamel of the tooth (hydroxyapatite). Minerals like calcium are lost everyday from the enamel because of the acids the bacteria produce from the carbohydrates in the diet.

The saliva tries to minimise the loss of minerals by neutralising the acids (remineralisation) but saliva can’t do magic if the host’s lifestyle is giving it too much to handle. Snacking (eating more frequently than 5-6 times a day), drinking acidic or sugary drinks in daily basis between the meals, eating sweets the wrong way (yes, there is a right way of eating them), adding sugar to the tea/coffee (even milk contains sugar) and consuming them between the meals. All these habits produce too much acid for the saliva to handle and it is not able to return all the lost minerals back to the enamel.

Loosing too much minerals from the enamel means decaying.

So to prevent that you need to find a way to compensate the lost minerals. The most important one is the calcium. And when combined with fluoride it repairs the enamel with very strong fluorapatite that is hard for the acids to break. It is much stronger material than hydroxyapatite that the enamel is originally made of. Some professionals even say that area of the enamel that has been replaced by fluorapatite won’t ever get decay.

But even if you do use fluoride in some form you will get decay if you have poor oral hygiene and your eating habits are harmful to the teeth. The fluoride will only slow down the decaying process.

There are exceptions of course. There are individuals who neglect their teeth and never get a decay. They might not use fluoride toothpaste or they might not brush at all. I will emphasise that they are exceptions. Average Joe will get decay I’m afraid. I have already written about this on my previous post. I wrote that it is very rare for people to have good enough oral hygiene habits. It is about one in thousand patients who do not need my interference in looking after their teeth. So most of us need minerals (calcium and fluoride) to protect the teeth from our laziness and unhealthy lifestyle.

Fluoride we cannot get through our diet unless you eat fish with the bones but even then there is no localised effect on teeth. So we need it from somewhere else. And the fluoridated water is simply not enough as it passes through the mouth and does not provide long enough localised effect (so don’t use that as an excuse). That’s why we use the toothpaste.

Right Way of Eating Sweets (Thought You Might Want to Know)

You can eat sweets without getting decay. Us dental professionals are a living proof of that. You see we looooove to eat sweets but rarely get decay. I will tell you how we do it.

  1. If you buy pack of sweets eat them in one go and have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished. If you eat one sweet every 10 minutes for the next two hours you will have an acid attack in you mouth for approx. 2 hours and 30 minutes. Or even worse example. If you take one sweet every 30 minutes for the full working day it means you have had an acid attack the whole time you were working. Acid attack means losing minerals. And I have already told you earlier what happens if you loose too much minerals which you certainly will do if you have 7-8 hour-long constant acid attack.
  2. Eat sweets as dessert. You get acid attack already because of eating and you can avoid getting an extra acid attack by eating the sweet in one go after a meal. Have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished
  3. Whenever possible and if you stomach can take it, buy sweets that are sweetened by xylitol. Now people often blame the xylitol for the laxative effect of sugar-free sweets. But it is often not the xylitol that causes the upset stomach. It is the maltitol syrup. So seek products that are sweetened 100% by xylitol.

 

Please note: This post is directed to healthy adults. People whose saliva flow is impaired through illness or medication need more intensive fluoride treatment on their teeth.

About Me, Myself and I

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Before I will release the Part III of the series of posts I will tell you something about myself.

I have not written a lot about myself in this blog but this post will be an exception. And the reason for doing this is that you – my dear reader – would understand why I haven’t been and won’t be writing new posts as often as before.

Let me first tell you about the time when I decided to start writing this blog. This was in March this year. I had finished writing a novel in December last year which left a void in my life. More time in my hands. Thoughts that I wanted to put on paper (so to speak). Endless ideas for books.

But.

I have a family. Small children who need my time. I have a spouse who needs my time. I couldn’t begin another massive project of writing a novel. So I decided to put all my creative energy on this blog. But little did I know how time-consuming it would be. All the researching, writing, editing and advertising. It consumes as much time as writing a novel.

But I am not a person who gives up something that I have started. I will see things through until the (bitter?) end. So I made time for blogging and it went well up until now. You see my littlest one is about to begin nursery and I am about to return to practice my dental profession. And to be honest I am not looking forward to it. If you have read my posts you might have a pretty good idea why I feel this way.

As if all those things I have written about in my blog weren’t enough to make me wish I didn’t have to go back to my profession. On top of all those things I also work in a dental practice that have been dysfunctional for decades and even though people have come (including me) and gone it has made a very little difference to the atmosphere. But as a thoughtful and problem solving person that I am I have started to see this fast approaching and unwelcome life change as an opportunity. You see I won’t be out of post topics whilst working in there. Nope, it will be a horn of plenty!

So bear with me whilst I go through this hectic time in my life. Keep reading, sharing and commenting my posts. I have reached readers in every continent which I believe proves that people in dentistry go through the same problems all over the world. Let’s keep on changing the problems by discussing about them.

Part II: Just Another Day at the Office

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“The most dangerous irony is, people are angry with others because of their own incomptence” – Jar of Quotes

Goodness gracious me! It has been too long since my last post. Hope you are still there and reading my posts!

It is time for the dentist’s point of view as a team member of dental practice.

At 8.45am

Oh no, not the Ms. Flumsy again” thought the dentist in the morning when she entered her surgery. Apparently her regular nurse was off sick or something as the practice manager (PM) had called in the temp. The one that had visited the surgery before.

The dentist was disappointed at the PM who clearly had not listened to her when she said she would not want to see this temp again.

You see, everything was wrong with this one. She had long and colourful nails. She had heavy makeup and strong perfume. She didn’t have any idea of assisting a dentist. She thought that using the suction was the most important thing as a nurse. And every task she did took ages to do. And she did them in wrong order. And knew nothing about cross infection control. And went for a cigarette when she should have called a new patient in.

Even though the dark cloud hanging above the dentist head was obvious she forced a smile and said with overly sweet voice “Good morning. How are you?”

“I’m good. And you? Okay?” replied the nurse with a wide cockney accent sending shivers down the dentist’s spine.

The dentist took a look at the day’s schedule. She could feel panic increasing the further she read the day’s treatment plans. Check-up, root canal treatment, crown work, extraction of wisdom tooth, check-up… And of course the time-table had been planned so that the dentist would have her regular nurse assisting her. It was a tight schedule but manageable when the nurse knew her business.

Nevertheless the dentist made a decision not to cancel any patients.

At 9.05am

The first patient was sitting in the patient chair with the bib and safety glasses on. She was about to have a check-up done.

“Oh, I didn’ remember yew ‘ave dis computer software! Don’ know ‘ow ter use it” the nurse says suddenly. The dentist sighs and gives a piece of a paper to the nurse to record her findings.

Then she begins her check-up routine and after checking the teeth with a mirror and a probe she reaches for the fiberoptic. Only it’s not there. She turns her gaze at the nurse who is at the front of the computer screen cleaning her fingernails and looking disinterested.

“Could I please have the fiberoptic?” she says with overly calm manner.

The nurse begins to go through the drawers but cannot find the device. The dentist waits. The nurse checks the autoclave.

“Gawdon Bennet! There are instrumun’s ‘ere from yesterday but its not ‘ere, innit.”

The dentist remembers that her colleague sometimes borrows the fiberoptic as the practice has only one of them. She asks the nurse to go and check from there. She examines the patient’s soft tissues meanwhile.

“Here i’ is” the nurse says triumphantly when she returns and waves the fiberoptic in the air and attaches it to the unit. The dentist notes that the nurse did not wipe it with disinfectant but she thinks it’s not that big deal especially now when she’s running 5 minutes behind the schedule.

She completes the check-up and sends the patient to the reception. Then she records her notes to the computer as quickly as she can.

“Exam” she writes. No time for all the gibberish.

Then she updates the chart from the piece of paper and checks the next patient’s records. A root canal treatment. She notices that the nurse has placed only the basic instruments on the tray and disappeared somewhere – probably for a ciggie. The dentist starts to collect instruments she needs and calls the patient in. She feels her blood pressure raising.

I really cannot be doing nurses duty, simply just cannot…” 

She is numbing up the patient when the nurse walks in.

“Oh, yew ‘ave already taken da patien’ in! Wasn’t da appointmen’ at 9.45?” 

The dentist does not reply and carries on with the treatment.

At 10.10am

The dentist is done with the filing of the root canals and is about to rinse the canals with the sodium hypochlorite for the last time. The nurse grabs the suction.

Silence.

The nurse places the suction back to its holder and takes it off again.

Silence. Not a sound.

The dentist realises that something is wrong and it cannot be fixed quickly. She asks the nurse to inform the practice manager about the malfunction.

Meanwhile she tries to figure out how she can finish the treatment without the suction. Luckily she wasn’t born yesterday and she takes a sterile gauze and places it close to the root canal treated tooth before she rinses the canal with the sodium hypochlorite. The gauze absorbs the liquid. She puts the calcium hydroxide to the root canals and seals the canals with temporary filling.

She escorts the patient to the reception in an intention to ask the PM what she has done about the suction but then she sees two practice’s regular nurses entering her surgery. She goes after them to see if they can fix the problem.

The nurses try to figure out why the suction is not working even though all the other suctions in other surgeries are fine.

The dentist checks the time. She’s now over 10 minutes late from the schedule. And the next treatment is crown work and that cannot be done without the suction.

The nurses need to return to assist their dentists and the PM needs to call in repairman. This means the dentist needs to cancel the next patient’s appointment. Zero income for the next two hours or so or until the suction is fixed. She walks to the reception to meet the patient and break the news.

The patient is not happy. He has taken two hours off work to come to the appointment. In a fear of losing the patient to another practice the dentist promises a discount from the treatment.

At 12.30pm

The dentist has tried to make a use of the spare time and goes through laboratory bills in her surgery. The repairman has not been in yet and it is soon lunchtime at the practice. Things are not looking good. She won’t be working until the late afternoon.

The surgery door opens and the hygienist pops her head in.

“Great, you don’t have a patient. Would you mind coming in to my surgery to check something? I have your patient in the chair and I think I found a decay on the lower right 6 and also something on soft tissues…”

The dentist walks in the hygienist’s surgery and greets the patient. She puts the gloves and face mask on.

Dentist: When did I do the last check up?
Hygienist: Err, yesterday…
D: And where was it that you suspect a decay?
H: On lower right 6. On the buccal side just below the gum line. There is another one as well but I think it is still in early stages…
D: Where is this?
H: On upper right 2, mesially. I don’t have a fiber optic so I couldn’t check it properly.
D: There is one in my surgery.
H: I know, but the turbine attachment is not working in my unit.
D: Ok then, let’s have a look…

The dentist takes the probe and checks the lower right 6 first while the hygienist stands on the nurses side and watches.

D: It seems to be ok…
H: It’s more subgingivally. You need to push the gum aside slightly.

The dentist feels this unpleasant feeling in her stomach when the probe sinks inside the tooth on the site hygienist mentioned.

D: Yes… yes, you are quite right. This needs to be repaired. Let’s see what we can do about it as it is quite deep… How about the other one. It was the upper left 2?
H: Upper right 2 mesially.
D: You are right it is decay but hard to say without the fiber optic if it’s advanced. I will check it on the next visit.
H: There is also something on the soft tissues I’d like you to have a look. It’s on the cheeks and under the tongue. Could it be lichen planus?

The dentist takes a look.

D: I can see what you mean. Hard to say for sure without biopsy but it does look like lichen.

Then she goes on informing the patient about lichen and asks the patient to book an appointment to decide what can be done to the lower right 6.

The patient looks shaken. Yesterday she got all clear and today she hears there is something seriously wrong with one of her back tooth plus something – possible cancer – on her soft tissues. She is not convinced when the dentist says there’s nothing to be worried about.

The dentist leaves the surgery and feels like going home. Or to the pub. This day is just one of those days she would like to forget. But she must stay to treat the rest of the patients – providing that the suction is fixed before this.

But it is time for a lunch first and she decides to go out for the full hour.

At 2.30pm

The dentist returns to the practice after the lunch break and chats with the receptionist before going to the surgery. The receptionist tells her that the repairman came in and did his magic in 15 minutes. The suction works again. Whoopty doo!

When the dentist reaches the surgery she can see through a glass tile window that the surgery’s lights are off. She opens the door and sees the unit lifted up to the highest position which the nurses do at the end of the day.

“What the hell?” comes out of the dentist’s mouth.

She walks back to the reception to see the PM.

“Why is my surgery closed?”

“Oh is it?” replies the PM and walks to the surgery.

“Oh lord” she says when she sees the surgery, “the temp must have gone home… I thought she went for a lunch!”

“I cannot believe this… this is unacceptable… did I or did I not tell you that I do not want to have this temp assisting me ever again?”

“I’m sorry but I did not have…”

“I don’t care. Your job is to keep the surgery running and I have seen only two patients today which is outrageous. And those two I have had to treat practically alone as the nurse is useless…”

“I understand. I see what I can do… I will try to reach the temp. Maybe she’s somewhere close by. I don’t understand how she thought she could go home.”

The dentist was fuming. She did not want the temp back but she did not have other options if she wanted to see the rest of the patients. But she soon learned that the temp was nowhere to be reached. The PM offers to come in to assist her.

“Well it’s better than nothing” she replies.

After she had seen the first patient for the check-up she was much calmer. She took in the next patient who had just seen a hygienist for a scale and polish.

When the patient opened the mouth she started to get annoyed again. The hygienist had not rinsed the polishing paste properly. It was in every between the teeth, this gritty blue paste.

“Seriously, who uses this much polishing paste!” she thought whilst her cheeks were getting red from the annoyance. You see, this wasn’t the first time. It happened with every patient who came to see her after the hygienist treatment. Soooo annoying!

At 5.30pm

When the day was over the dentist felt like she was the only one in this practice who knew her business. How was it possible that she was surrounded by so many incompetent people? She thought about changing jobs.

But would the patients follow? Some probably. Would it go from bad to worse? Yes possibly. Should she start her own practice? Definitely not, too much stress. Should she quit dentistry? Yes, it would be the wisest thing to do but she wouldn’t afford it as she’s still paying the student loan.

She went home fearing what the next day would bring. One thing she has learned in these couple of years of practising dentistry was not to check the next day’s patients. It was about minimising the stress. But there were so many other things she had no control over that sometimes just felt too overwhelming. Way too overwhelming.


You might also like these posts:

Part I: Is It a Skyskraper? No, It’s Your Ego
Part III: I’m Sorry but I Did Not Get Qualified So That I Can Make Coffee for You