Colville

Before my RUOP, I never considered community health as a serious option for a place to work, but working in Colville has helped me to see the bright side of community health dental clinics. Now, I could see myself working in a community clinic. Colville is a unique and great place - both the town and the clinic. I have really enjoyed my time here. The staff has been really good about letting me jump right in and participate, which has been great. I just wish I was further along in my education, so I could do more. The clinic is busy and there is plenty of work to do.

I have really enjoyed my associations with the patients. The population is quite diverse here. I have met people from all different backgrounds. Sometimes it is a fun challenge to try to get patients to smile at least once before they leave. Some of the people I have met have really tugged at my heart, and I wish there was more I could do. There are some neat experiences that I have had, while visiting with patients, but I don't know how much I can say about patients on here. I will share more later.

An interesting thing has happened to me, as I have been working here. I have come to see things differently than I had seen them before, in regards to the need for rural dentistry. Colville has 10 different dental offices (9 private practice offices and 1 community clinic). That is a lot more dental offices than I expected, and some offices have multiple dentists in them. I have come to see that the problem (at least in Northeastern Washington) isn't that there aren't enough dentists here, but the reimbursement is so limited that most dentists can't afford to see many state insured patients. Here at the clinic, the reimbursement is different for DSHS patients than what private offices receive, so the clinic is able to see a lot of DSHS patients, which is great, because there is a huge need here (there are a lot of state-insured patients in this area). The problem here isn't that the number of dentists is insufficient, which differs from what I have been told about rural dentistry. There are plenty of dentists, and most of them want to serve DSHS patients, but few can afford to do so.

I hope to be a part of the solution to reaching the underserved, but it is a really complicated problem, and I have a lot to learn still. That is something that I have been thinking about and trying to learn more about, while working out here.

RUOP is going good - better than I expected.

Ellensburg

I figured I'd give you all a little insight into Ellensburg life. I really like it, a completely different vibe than Yakima and I'm not sure which I like more but it lets me see a completely different side of community health care which I like (Ellensburg has a candy drawer, definitely tugs at my hear strings). The drive is a little brutal and it's a late night but it's worth it.

Today I was going to do a child recall exam and had the mind set that it was going to be "easy", just another prophy. I soon realized that nothing is "easy" or "routine" each procedure has new obstacles and challenges to work around.

This young girl spoke English but her mother did not. When I reviewed her chart before bringing her back I noticed that she was recently in for an emergency exam for a tooth ache. She had an infected primary tooth that she refused to have removed. When I brought her back and looked in her mouth my heart broke. All of her gums were swollen many missing and decayed teeth, basically her mouth was just in really bad shape. Her primary tooth that was causing her pain was still in there, it was black and falling apart but she refused again to have me touch it let alone wiggle it. As I was doing her prophy I noticed that 2 of her PERMANENT molars were complelty bombed out, worse that I had seen in most of the adults. The entire distal buccal surface was gone, like caved out. I'm not making a ton of sense here but my point is that it is so tough to see young children whose oral health is already in such poor shape. She needed a root canal on a tooth that had been in her mouth for only 3 years. Her 1 year old sister was also there alternating between bottles of milk and juice. It just made me want to do more. The mother clearly didn't know the effects of what her children ate, drank, etc on their future health. One of the hygienist asked to look in the baby's mouth only to find decay on her teeth, she's 1!

This experience has made me, more than ever, want to help kids. They are helpless to what their parents know, and unfortunately many parents don't know what is right. This has definitely inspired me, I guess that's a good thing!

Pasco RUOP

I am having a great experience in Pasco! The first couple days were filled mostly with shadowing and standing. After the first couple days, I have really jumped in with both feet. I have had a lot of assisting experience during extractions, root canals, and fillings. One thing I've discussed with the doctors here, is how difficult it is for them to have to extract "savable" teeth. I put savable in quotations because it takes money or insurance and patient compliance to obtain the proper treatment to save the teeth. To combat this issue, the clinic has really focused on teaching parents and young kids to prevent decay and periodontal disease.

As far as dental procedures, I worked as a left handed dentist today, well maybe not a dentist, but I was in the operator's chair on the patient's left. I finished an IRM temporary filling for #8 and then a chemically cured RMGI temporary filling for #31, which was similar to the temporary filling we did in applied dental materials this year. We also have a lot of ER patients come through the clinic. Most of them have large abscesses and need extractions. I'm learning a ton from the doctors. I've been reviewing a lot of dental materials with them, a.k.a. being quized - I knew it would useful someday, just didn't think it would be so soon.

Overall, RUOP has been a great experience so far. I think it has brought together a lot of what we learned this year and given them practical application. The anatomy has come back, the micro, some of the histology, definately physiology, dental anatomy, dental materials, basically there has been a reference to all the classes we took this year (even MIDM) while I have been here in Pasco.

First week in the beautiful Okanogan Valley!

Having worked as a dental assistant prior to dental school, I didn’t know how much I would learn in my RUOP in Okanogan. I felt comfortable with procedures, I felt there wasn’t much more to “see” as an assistant, and I felt I understood in general how a dental office would run. On the other hand, I hoped I would get to apply the things I learned in my first year of school. For the other RIDE students, I figured assisting was going to open an entire new realm of dentistry, a completely new experience that will bring them one step closer to becoming a dentist. I questioned myself, “what realm will open for me?” With this in mind I took a different focus on what new things I would get out of my time spent in Okanogan.

Composites, amalgams, extractions, RCT… I have spent many hours assisting these procedures. After spending a short 4 days at my RUOP, I have come to realize that there was something I could bring from my training as an assistant to this office. Most of the doctors are fresh out of school, 1-2 years. We all know that students don’t get assistants while in school and therefore, where do we learn how to utilize one to the maximum? The dentist I worked for prior to dental school was good. He was really good. He utilized his assistants to extreme efficiency! He let us feel like we were contributing to the team. I never realized how well I was trained until now. I have noticed in my RUOP that these new dentists are not used to using assistants thus do not know how to utilize assistants in an efficient manner. They grab instruments from our hands in a risky manner, they twist and contort their bodies to grab what they need, they won’t ask for something, it is just plain awkward. Out of the 10+ assistants in the office, all were trained on the job within the last ~8 months, besides two. Therefore, they have much to learn still and if the doctor is not communicating with the assistants, there won’t be systematic interaction. After seeing this unproductive and unskillful system, I decided to “discretely” help the doctors use me to the fullest. I have asked them to tell me what they want and I would have it for them immediately. As simple as my design sounds, it worked within one amalgam procedure! The doctor rarely grabbed from the tray, he anticipated the instrument to be placed in his hand, and the entire appointment ran very smooth! I hope that the doctor I worked with today will begin to realize that we are there to help, not to be a burden to his task at hand. I can’t wait to continue to contribute back to the people who are helping ME learn!

On another side, there have been experiences that are new to me, ones that have shown me the importance of treating my patient as my priority, ones that have shown that compassion is a significant part of being a dentist. Many times the patient is not addressed by their name, there is no personal interaction between the patient and employees, or there is no concern for the feelings of the patient. Almost like an in-and-out, no smile, no goodbye sort of thing. A positive experience that helped me see the importance of compassion was while working on a RCT on a man. The dentist and I were chatting away, talking about why and what he was doing, talking about life, just talking. The patient said, “I like this. I like this a lot.” We were confused. He continued on, “usually the room is silent, almost like there is tension. But this is the first time there has been interaction between the dentist and assistant. I actually feel part of the team!” (Note that I’m not implying all patients feel this tension at the office, but he certainly did.) This clearly showed that there needs to be a positive energy, even if there is no talking!

I have learned more in my RUOP, not about procedures and assisting, but about the magnitude of having an excellent interaction between the dentist and the team.

Day 3 Spokane

More and more learning today.

I got to observe an alveoloplasty today..... don't worry, I didn't know what it was either. I think it can be performed for a few different reasons. The reason today was due to a sharp alveolar ridge following an extraction. The dentist had me palpate the alveolar ridge before we got started. Normally this ridge is smooth, but on this patient there were sharp line angles underneath the gingiva. It was no wonder the patient was in pain. So the doctor took a scalpel to the gingiva and flaped the gingiva up, clipped the sharp edges with bone cutters, and then used a bone file to smooth it out. It was REALLY cool to watch. I was pumped that I got to see this today.

One other cool thing I learned today is that if #20 or #29 have roots with apices close to the mental foramen they can appear to have apical cysts due to the radiolucency of of the foramen. It was funny, because the dentist was telling me how this an exception to a rule but he has never seen it. One of the assistants over heard us talking and ran over and told us that she just saw one that morning. So she brought out the X-ray and I got to see a real life example. It was pretty cool, and it would be easy to make that mistake if you didn't know the exception.

Spokane Falls continues to be a great experience.

Brad

Walla Walla--Day 2

I decided not to write my first day, I was just too exhausted. I realized I’d been standing and observing for 8 hours…that will take it out of you! I didn’t expect to be observing so much, but it makes sense since it was my first day. The observing was different than my experiences prior to dental school. It was MUCH more interesting to observe when you know something about what the doctors are doing and the materials they are using. I called on so much information from my first year of dental school; it is amazing how much you learn in one year! I found I could also ask questions about procedures or materials and I would understand what they were talking about. It was great! Very different than shadowing before school where you may ask questions and think you sort of get what the doctor is talking about, but really you are befuddled. Observing was useful; however it tends to get boring after a full day of it so I was really hoping to be more hands-on the following day.

Today, Day 2, I was thrilled to be thrown in more and I’m told I will be more so soon. It was a busy day at the clinic because we were missing 2 assistants, but I managed to get in there. I was VERY excited to get to place anesthetic for my preceptor. I also assisted in a composite filling as well as a porcelain crown and veneer seating on 8 and 9 which were proving tricky. Beyond that I did lots of helping out with little duties around the clinic and was happy to help in any way I could to make a difficult day easier.

Yakima Day 2

Today was great! The doctor let me do an IA. I was so scared but the young girl was really sweet and I got it first time--no bone! I also did a lot of child prophys and observing a lot of procedures. I really like all the doctors there. Either during or after each procedure they take time to talk to me about it. I have had so many questions and learned so much so far, Brad I'm with you there will the pages of notes. Want something for to do--look up a Talon cusp. This little boy's x-ray looked funny to me so I asked the doctor what it was and he told me it's a Talon cusp that he sees often in Hispanic children. How I understood it was kind of like a big cingulum that is a cusp. The doctor thought that this one might be near the height of the incisal edge. It was really neat to hear him talk about it and crazy to see. I wish I was going to be there to see how it finally looks once the tooth is erupted.

The children in the clinic always bring a smile to my face, I love having them there! This young boy today was so cute, he kept "biting my finger" during the prophy and I kept fake screaming and telling him I needed to keep those so I could clean more teeth. He thought it was so funny and his 2 year old brother soon caught onto the trick and made his mom do it to him. It was really cute. It was just so neat to see the little boy so scared to be in the chair and by the end so excited to be there. He told me that today was "super cool" with 2 thumbs up.

I got frustrated today with the language barrier. I hate that I can't speak Spanish. All the assistants are great about translating for me but I hate that I can't understand. This one mother told me that I should learn a few words in Spanish--so that's my goal. I'm heading to Barnes and Noble this weekend to find and idiots guide to Spanish. I just want to communicate with the patients a little better. The 10 year old boy I was with today taught me a little (I tend to hang out with them when we are waiting for the doctor, they make me laugh and teach me lots).

We'll see what tomorrow has in store for me, last day in Yakima then off to Ellensburg for a few weeks!