White Coat Ceremony

I'm feeling slightly like a bad wife because I forgot to blog about Jason's White Coat Ceremony. He actually has had a really good first year at Dental School and I am so proud of him. He works very hard and it's been just a little bit stressful with a new baby (apparently Andres didn't pick the best of semesters to be born in), but he still has managed to do well in his classes and be a wonderful husband and father. There have been really exciting things going on in his schooling, but I'm pretty sure I would not do justice to them, so I'll let Jason tell you.

Jason: Am I writing about just the White Coat Ceremony, or do you want me to write about the whole year of schooling?

Jodie: Did you read the first part? Write about the things that have just happened recently that were exciting, the things people would actually care about.

Jason: Oh...so i don't really blog that often. Usually you see the husband writing what is happening during the time of childbirth. Oops. So instead, I thought I'd give you the thrill of pretending you're reading a script for a couple of lines. So find yourself a partner and go through it with me.

Jodie: You're stupid.

Jason: So it has been rather exciting, the White Coat Ceremony was probably just as interesting as me telling you about what was on my Biochemistry Exam. There were a couple of whoop-dee-do's and fliber-de-gibbit's that mean something to the dental community around here. They told us what it means to be a dentist, told some funny jokes, and gave some great analogies. Just like any graduation ceremony, boring. Except instead of getting our fake diploma, we got white coats that have the schools name on it (it would've been more personable if it had our personal name on it). It basically means we now have the privilege of working with patients and sticking things in their mouths. Since that time I have had my first anesthesia practical and my first (non-peer) patient.











Our anesthesia class goes something like this: We have a couple of lectures a week about what types of anesthesia we use, what its composed of, what the risks and what the indications you should not use it on patients. We have a written midterm and final. We watch a series of videos a couple of times through and then the last day, you are paired up with a group of 3 students to give each other a series of 9 (that's right, 9!) shots in the mouth. No practice on dummies, nothin'! Just jump in and swim. This was my experience:

(For those of you with weak constitutions, go get yourself a snack and then come back and read this. Its not that bad, we're just talking about shots here. For those of you who get bored easily...just read it, for heaven sakes you came to this blog to read about someone else's life, that sounds boring to me.)

I get to the clinic where our blood pressure is measured to make sure we are okay to receive the anesthesia. Since most of the students are freaking out about this experience, they often times were asked to cool down for a minute before they went to their groups. I sit down in the chair and the nurse asks if I'm nervous. I say, "Actually I'm pretty excited for this." She says well, we'll see about that... "118/72, wow, you are calm!"

I get to my group, 2 girls, one (who we will call Brumhilde) has asked to have the other (who we will call Gertrude) be her clinician because "she trusts her." Apparently Brumhilde passed out at her last dental visit when he gave her a shot. Each group has an instructor there to guide us and help us if we get stuck (literally, hehe). Brumhilde is the first patient. Gertrude is asked if she would rather do the quick, short, and easy shot (Superperiosteal- just anesthetizes a couple of teeth in the front on top) or the challenging one (ASA- feel right below the rim of your eye socket, ~2 cm from your nose). She chooses the easy one. Put some local anesthetic on, insert needle, inject, done.

2.) MSA (in between your front teeth and molars) same thing, done. 3.) PSA (behind your last molar) slightly difficult you have to aim up, back, and in. Inject, done. 4.) Nasopalital (feel that lump right behind your 2 front teeth) this is said to be one of the most painful. To avoid pain you place large amounts of pressure with a cotton tip on the site while inserting. Brumhilde was in pain, getting teary. 5.) Greater Palatine (stick your finger on either side of the roof of your mouth, before you feel your soft palate, there should be an indentation of your hard palate) same thing, apply pressure to avoid pain.

6.) Inferior Alveolar (the inner part of the thin part of your jawbone that connects to the skull) This is where it gets interesting. There are no visual landmarks of this site, so you have to go based on your surroundings, if you hit bone too early, you are not there yet. If you don't hit bone at all, you have gone too far. The first time Gertrude inserts the needle she hits bone too early. (you don't pull the needle out all the way because the most painful part is the initial stick. You just pull back a bit and adjust) She says "what do I do?" the instructor says "Pull the needle back..." before she could finish saying ..."a little." Gertrude had pulled the needle out all the way out. The instructor explained why you don't pull it all the way out, "Now you have to stick her again." (Keep in mind we have been tested on this already). The second time she keeps going until Brumhilde jerks. Gertrude not knowing what to do, says "I'm sorry" and pulls the needle out again. "No, No, you just hit the nerve, that's where you wanted to be...all you needed to do is pull back a little and inject. Now we need to stick her again. The tears are now FLOWING down Brumhilde's face. The instructor holds Gertrude's hand as she does this right, the last time.

7.)Buccal (easy, just right behind your lower molars) inject, done. 8.) Mental (on either side of your chin) it hurts, but its quick. 9.) Interpapillary (right in between any 2 teeth) easy. Done.

My turn. My patient is Gertrude. The instructor asks if i want the easy or challenging one. I say "shoot, lets get crazy!" I feel for my landmark, hit bone a little early (it doesn't hurt by the way), retract a little bit, boom, got it. 2.) MSA, bam! 3.) PSA, done. "Now open your mouth a little wider, so we can see your palate." She tries, but nothing happens, she can't open her mouth wider than a little bit (her jaw has dislocated because she has been holding it open for so long.) She starts to freak out "this has never happened before!" she says. Meanwhile, the instructor says "its perfectly normal" and tries to put pressure on her jaw to put it back in place. Brumhilde is not dealing well with this at all, and starts to freak out and says she needs to sit down. Her jaw is back in place, a little sore, but all is well. Shall we continue?

4.)Nasopalitine (the one that hurts) I press down hard and give her the shot. She says it still hurt a little. Meanwhile, Brumhilde is feeling light headed as she is watching her friend distort her face from the mild pain. And needs the nurses assistance to lie down. It isn't until this moment that I realize who will be giving me my injections......that's right, Brumhilde. Oh Great!!! 5.) Greater palatine, bam! 6.) Inferior alveolar, hit bone at first, then nothing, then bam, got it! 7,8,9.) bam, bam, bam! I'm done, the instructor is impressed.

As we wait for Brumhilde to come to, i am thinking to myself, "she can't, she wouldn't, how can you be a dentist if you can't..." 1, 2, 3) she does alright. 4.) Greater Palatine (the one that hurts) the instructor showed how much pressure to place on the site. She put MINIMAL pressure on it. Before she could inject, I grabbed her hand and pressed harder on that area until it was sufficient. It hurt, but its a shot. 5.) good. 6.)Inferior Alveolar (the tricky one) she hits bone, comes back a ways then back in, she feels nothing, goes back tries again, nothing. The instructor then grabs the syringe and tries to find it, she can't. Meanwhile i start to feel movement on the side of my neck. I try to say something but I've got a couple of hands in my mouth. I point to my neck and the instructor says that I've got an anatomical abnormally small jaw, it looks like we've gone too far. No puncture, but it felt close. They find it and give me the injection. All the rest goes well and Brumhilde never faints.

All in all, it ended well, except that I failed to remember that after I got my 9 injections (all on one side of my face) it was lunch time. I didn't think this through when packing my lunch. [almonds, granola bar, enchilada, apple]. I tried, it didn't work.

My first patient was suppose to be Jodie, but the babysitter ended up going into labor the day before, so I got a complete stranger. The routine we do with our patient is just a cleaning appointment. Check the depths of gums in between teeth. Check for tartar (or calculus). Check plaque with that pink stuff. Clean teeth with that rubber cup. Give instruction. Then give her Fluoride treatment (that foam stuff).

My patient was in her late-50's she had good oral health and nothing too sinister. A couple of places with calculus which I was able to correctly detect and the rest I did fine. The only problem I needed to work on is not talking too much. If there was a long enough silence I would explain to her what I'm doing and why I do it the way that I did. Most likely more information than she wanted to know. She did say that "this was the most educational experience [she] had ever had." And that she had no idea that she was my first patient. That I was very gentle and very precise. Always a good thing. So yeah, I feel pretty confident pretending I'm a dentist right now.

Now that I've written a book, Jodie is going to write how surprised she is at how much effort and time it took me to write this. Maybe this will teach her not to have me do this again. Well until I do, thank you for all of your prayers, they seem to be working.

The End