Patient: Benjamin Peel
What went well:
I think I did well in preparing for this patient. I was well acquainted with his medical and dental history as well as why he was assigned to me. This let me zero in on his problem quickly and be able to diagnose it. Most of the 011 went well, I was able to accurately identify caries and restorations as well as examine the I/O and E/O soft tissues. I also think the bitewing radiographs went alright, especially considering the universal holder was used and not the much smaller and more efficient yellow bitewing system.
What could improve:
- BPE and Periodontal Probing:
During completion of the BPE I didn’t find any pockets greater than 3 mm. When the tutor came to check she was able to find pockets up to 5mm. I think a big mistake I made is that it was obvious by the contour and consistency of the gingiva in the areas where the 5mm pocket was found that something was going on (I even thought it as I was probing because it looked so different from the rest of the mouth) , but I didn’t take my time and investigate it more deeply. I really need to work getting more precise with the probing, especially interproximal areas.
- Periapical radiographs
I was positioning my bite block too distally, when the tutor moved it medially, the PA came out very good. I’m going to keep this in mind for future sessions.
- Crack Finding and Occlusion:
I had the crack finder upside down which is silly! I won’t make that mistake again
I wasn’t and honestly am still not really sure how to identify centric and eccentric occlusal interferences from articulating paper marks. Most of my knowledge is also edentulous related so I’ve got to brush up on what to do with dentulous patients. Fixing this point requires some self-study and finding example cases.
Overall I think I learned a lot this session and I am slowly making my way to becoming a more competent clinical decision maker, that being said I still have a long way to go and should work on improving my skills.
Tutors Feedback
[Paraphrase] you misunderstood and the xray should actually be further away ! also the occlusion stuff just means that the marks are heavier
Patient
First Peads Patient!!
Radiographs:
Seeing behaviour management for a patient who was gagging was very useful for connecting the dots between theoretical technique and actual practice.
Speed and efficiency:
Patients tolerate a lot less, so it was evident how important it is to be fast and efficient. Even though the patient I performed an exam on was very well behaved, I would still have liked to be more efficient.
Exam details:
Today I learned a lot about getting the patient’s jaw relaxed to check their occlusion. Although I’ve seen it done before, it has normally been on geriatric patients, and I just didn’t think to apply the same concept to paediatric patients.
Inter-practice communication and treatment planning:
It was informative to see the treatment decisions the tutors took and how they correlated with the patient’s behaviour and oral hygiene. Some examples include:
- Using smaller films for a nervous patient
- Double-checking the patient’s previous external dental history to ensure we weren’t unnecessarily exposing them to radiation
- Basing fissure sealant retreatment on OHI and history
While I understood the theory behind these decisions and feel like I could make them if presented with the question for consideration, I don’t think my clinical judgement is fast enough for me to be confident making these decisions in a live environment. That is definitely something I would like to work on.
Miscellaneous:
When completing my exam, although I think I did okay, I was very nervous, especially since the patient’s mum was accompanying her. I really want to work on getting past that.