Friday, December 18, 2009

Oh Me Oh My!!!

I haven't done a 'clinic' blog in a while. I haven't had a whole lot to blog about because I've been back in my general dentistry zone- so 90% of the patients I'm seeing now are patient's who are assigned to me and I'm their primary dental care provider, they craziness is pretty much gone. HOWEVER- today and yesterday I had a bit of an 'adventure'!
Yesterday: I decided to help out my co-resident by taking her call shift until she got her car fixed. I was the only dentist in the clinic PLUS if any call came in, I was responsible for handeling that too. Everything was find until about 10am. I get a call from the ER. The ER doc says: 'hi Dr. I have a 26 year old here with significant swelling to her lower right cheek. Her teeth don't seem to look too bad though'. I say, 'okay, well send her on up, I'll get an x-ray and check it out'. About 20 minutes later the patient comes up with her sister, brother, and the brother's girlfriend. The radiograph was taken, visible infection present (which caused the swelling of course, and probably primary contributor to the pain.) I walk into the treatment room and INSTANTLY the sister tells the patient, 'uh ohh, here comes the pain'. (LOL) Now, typically this would be just laughed off, and the exam began, but this lady wasn't having it... SHE WAS ALEADY SCREAMING AND CRYING! I asked her to let me take a look, she did- reluctantly. THe tooth in question was on the LEFT side and NOT the right side as reported by the ER (LESSON: always do your own exam..never take anybody's word only!) . I explained everything to the patient- how with infection, the lidocaine won't work as well, but the goal was to get her out of pain and to take the tooth out with as little pain as possible. I give the first injection and she slides almost completely out the chair. I got her numb (her tissues were blanched, and she said her lip felt fat). I begin to extract the tooth... I put the forceps on and she grabs my hand (Lesson: a NO NO- never grab the dentist's hand during a procedure..can cause more problems than not, just RAISE a hand and typically the dentist will recogonize it as a sign of distress) I stopped, asked what was wrong. SHe said 'I don't want to do this no more, I'm leaving'. I explain it would be benificial to get the tooth out ESPECIALLY because it was now loose, and because this was her 2nd time in the ER for the same tooth in 2 months. She refuesd about 10 times, so I let her go. (Lesson: stop being a baby!)

Today: Interesting case. 26 y/o male needs 6 extractions. Problem- severe hemophelia A. Which means he had to be admitted last night for fibrin therapy then to us today for teh extractions. I hadn't seen the patient before today. I HEARD a patient asking the nurses 'man, is this gonna hurt, I can't take much pain, awww man, this finna be baddd'. The voice happened to be my patient. I get him in the treatment room, go over paper work, and explain the injections and what not. I give him 4 injections on the right and 3 on the left. After the first injection, you're numb enough to not feel the others... I start trying to move the tooth, adn he starts to tear up! I ask if he was okay- his answer 'yeah, go head'. I try to elevate the tooth, he jumps, moans, and wiggles. I stop adn ask 'are you okay sir'. His answer 'yes'. After doing this for 30 minutes I said, 'Sir, let me ask you this... why are you wiggling all around becasue of an extraction and you got allll these tattoos on you'? He said 'beacuse I be drunk when I get these'. (LOL) I was able to get out 1/2 of the last tooth on the lower right. I had to readmit him to the hospital until tomorrow. We will CERTAINLY sedate him tomorrow morning- if not, we'll NEVER get those root tips out.

WHEW- long day!

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