Tales from the clinic floor

Today was rough. Next time you have a dental appointment and maybe you're not really looking forward to it, just think to yourself, "at least it's not an 8-hour appointment."

That's right, today's patient drives from far away so to keep his trips back and forth to a minimum (insert token gas-prices complaint here) we decided it would be a good idea to book him for my morning and afternoon sessions. I prepped three teeth for crowns and tried (and failed) to have that be my bridge competency required for graduation. When attempting a competency, I do all the steps without help and then have two faculty members grade my work. Things kept going wrong and I seriously think I made about 20 temporary crowns before I had three that worked and I was happy with. Ugh.

Anyway, since I'm on the topic of dentistry, here's three amusing stories that happened to me lately:

Sidewalk
A couple weeks back I was getting ready to place a space-maintainer in the mouth of a really curious seven-year-old. He had been asking questions all along and I was happy to answer them, but he really threw me for a loop when he asked why I was going to put sidewalk in his mouth. Sidewalk? I was so confused - then I remembered that I had told him the next step was to "cement" the space maintainer onto his molar. It's funny how kids think sometimes.

Ipod
Recently we had mock-board exams and were required to find a patient had a specific type of cavity - a class II lesion if you were wondering. The week before the exam I was doing a pediatric rotation and came across a 13-year old with the perfect class II lesion. I convinced her and her mom to help me out but was a little concerned about whether the patient's attention span could last the whole 4-hour exam, so I told her I'd bring my video Ipod and she could watch stuff while I worked.
When exam time came I had her take a seat while I finished setting up and she started watching the Andy Milonakis Show and some stand-up comedy. The resulting scene was pretty funny - to appreciate it you have to picture the tense exam atmosphere with 100 dental chairs and hardly anybody talking. Except for a few dental drills whistling in the distance, everything is silent. Then you have this loud teenage girly giggling happening like clockwork every 20 seconds coming from cubicle 74. Soon people started turning their heads trying to figure out what was going on. All I could do was shrug my shoulders and say, "Hey, I'm that good."

What's that smell?
Working on a crown competency last week, I determined that I needed to do a minor electro-surgery on the patient's gums. To do this, there's a machine you plug in and have the patient hold a metal plate, and when the end of the handpiece makes contact with the tissue it completes the circuit and basically fries the tissue. (Keep in mind the patient is numb so it's really not that bad). After doing this for a minute I explained to the patient (who grew up in El Salvador) that I was using the high volume suction so that it didn't stink. Having already caught a whiff of his own crispy gums, he smiled and told me he thought it smelled like carne asada. I told him it sort of was.

Sorry this post was all words and no pictures! I never read posts like that. Here's a totally awesome picture to try to get you to read:


(click for the bigger, more awesome version)

Puffer fish underwent emergency dental procedure

Crazy as it sounds, I'm not making this up. It happened in England. Here is the full story detailing how the fished damaged his dentition in a bout with a sting ray. It sounds like the fight busted off part of a tooth, which in and of itself would have been ok, except that puffer fish are like rats in that they need to constantly be gnawing to keep their teeth worn down. After the fight the lazy puffer fish did all his gnawing on the side with the broken tooth, allowing his other tooth to grow to the point that it started damaging his lip.

Crazy.

After the procedure the fish was relocated to Germany - I'd like to think that it was part of some sort of fish witness protection program to keep him safe from the sting rays.

Baby Epiglottis

Ever wonder how babies can drink and breath at the same time? Think about it - you can't drink and breath at the same time (try it if you don't believe me), and nursing babies don't come up for air once they "latch on".

I was studying this very concept for my board exams just over a year ago, at the same time my son was just a wee infant. The answer lies in the epiglottis. Here is an illustration of the epiglottis of an infant:
The key difference is that the shape of the baby's throat allows the epiglottis (the green shaded area) to come into contact with the soft palate (yellow), thus allowing air (shown in light blue) to enter the trachea, while milk (shown in pink) can flow around on either side.

I was recently reminded of this concept during our summer break at my parent's house when Jordan was drinking from a sippy cup and started coughing. I looked at him and asked if he got some down the wrong pipe and then realized that this had never happened to him before. I realized my little boy is growing up - his epiglottis is no longer touching his soft palate when he drinks! He'll just have to alternate between drinking and breathing just like the rest of us now. I think this is a milestone in toddlers lives that most parents are unaware of.