Wednesday, April 05, 2006

That's DOCTOR Caveman to you, Bub!

The latest from Yahoo News:

9,000 Year-old Dental Drill Found

Somewhere, a bunch of hungry Sullivan-Schein reps are placing eager calls to Pakistan, hoping to make a sale. "Oh, that doctor is BOUND to want the NEWest Kavo handpiece!"

My favorite part of the article is where the anthropologist says, "I showed the pictures to my dentist and he thought they were amazing holes."

To my patients: If you ever want to share "amazing holes" with me, I'd just as soon you not.

Anyway, I know that ancient Native Americans (and perhaps Egyptians?) used to hold their heads over incense to "smoke out" the evil spirits or tooth worms which presumably caused toothaches. It turns out that the herbs in question had hallucinogenic properties or narcotic properties, thereby "curing" the toothache, or at least relieving it for a short time. I'm not sure when hashish was discovered, but it's mentioned in Arabian Nights, so who knows how those people may have relieved pain prior to fillings.

Depending on the age of the patients, too, a minutes worth of drilling, up to 2-3mm, might not be SO bad.

I had a 16-year-old yesterday w/ a small amount of decay on a molar. I said, "OK, let me know if you feel anything; this isn't worth getting numb, but if it bugs you, I can do so." Soooo, being all hepped up on Mountain Dew and such, he didn't say anything. "You OK?" "Yeah." When I was done (maybe 2mm, which is 1/2mm into dentin, and therefore probably sensitive), he says, "Oh, Dude, that, like, hurt the entire time. But I didn't say anything."

Tempted to cite one of my mother's favorite sayings, "So do you want a medal or a chest to pin it on?" I replied, "OK. Nice work, bud."

Days without patient swallowing precious gold restoration: 13!

Monday, April 03, 2006

Spitting is better than Swallowing

Fun and games.

Went to ER last week due to Rachel having a Pilonidal cyst (check out for gory details) - nothing like being asked "Does this look infected to you?" OUTside of work. So that's all better, having had it drained. (Gooey!)

(Aside to Rev. Wallick - now a higher risk of Crohn's, acc to the ER phys. asst - interesting)

Monday there was a bat in the house. Always fun to toddle over to the neighbors (hi Matt!) and say, "Um, yeah, have you got a fish net?" at 11pm.

The most FASCINATING thing to happen to me was an experience with a patient who ate a crown. (actually an onlay, but we won't get into that)

This is a fascinating lady who is a hoot at cocktail parties, I'm sure, but, by her own admission a "pain as a patient." (I did NOT say it; she did....) Anyway, upon trying this crown in, I put cement on it, seated it, had her bite and said, "Stay biting for a few minutes." For SOME odd reason, perhaps it was the nitrous, she elected to OPEN a few seconds later. As she moved her tongue around, and I looked on in horror, I saw the crown (onlay! less retention..duh...) dislodge and float around her pharynx area for a few fateful seconds.

Springing into action, I whipped off the nitrous, pulled her head to the side and encouraged her to cough. "Turn! cough! couch couch! Go aaaugghhkk!" (the latter word is MUCH better when I tell the story in person, as people say, "oh, how was that again?" in a facile attempt to make me go aaaugghhkk again)

She did not aaaugghhkk. She went, "glug...gurrr...ack....GULP!"

Down it went, as I futilely attempted to fish it out with a cotton pliers (dental tweezers to you lay people).
"Oh," she remarked, "a piece of something went down my esophagus!"

Oh, not just a piece, but THE something. After making sure she was breathing ok, I walked out of the room so as to avoid the temptation to either grab her by the throat or bash my own head against the wall in frustration. Certainly I could have been more watchful that she didn't open and sure, I could have had a 2x2 gauze there to catch it if it fell. (although, YOU try to leave gauze adjacent to #2 AND have the patient close and then you'll really see gagging!) Nevertheless, I thought, "Oh dear Lord, I SAID to BITE!"

After returning, I encouraged her to eat plenty of fiber, Metamucil, what have you. We'll get her back in 2 weeks after the lab makes a new restoration. "In the meantime," I said, "you will be pooping out gold. We should all be so lucky."

"What if I get it back?" she asked. Er. You mean....retrieve, AFTER? "Sure!"

Actually, I DID recement a lost aka swallowed crown back in school....just ran it through the autoclave, tho I learned that when a patient hands you ANYthing you want to probably have a glove on.

Well, on Monday, she called and reported that after dining sumptuously on Mexican food all weekend, she RECOVERED the restoration. All I could think of was Trent Reznor of Nine Inch Nails singing that one line, "I wear my crown of s---/ upon my liar's chair/ full of broken thoughts/ I cannot repair." (of course, the Johnny Cash version is not only a more powerful song, but he manages to clean it up, "I wear my crown of thorns.")

So, after some sterilization, we cemented the bugger right back into place. Only took 2 hours this time. I was careful.

Adios, amigos.