My Simple Tooth

What is integrity? For myself... simply stated, it’s how you behave when no one is looking. If I'm completely honest I can admit that I haven't always had the highest standards of integrity. I believe youth and lack of perspective had a lot to do with that. (Why is youth wasted on the young?!? #bigsigh...) However, after many years and some hard life lessons, my character has improved significantly. I fully realize the value of doing the right thing for the right reasons and it’s not even a difficult decision anymore. That being said, I work in a field where integrity and ethics are paramount. Dentistry is a unique discipline of healthcare in that, unless you are trained to understand oral pathology and the remedies, you can easily be deceived. When a dentist begins working in your mouth, no one can see what he is doing except for the dental assistant. Patients are at the mercy of his competency, dexterity, and moral compass. When your mouth is propped open, your teeth are in a state of “ground down”, and you are numb from your eyeball to your chin.... who is going to stop the dentist when he puts the drill down to spring an additional procedure on you because the problem is “more extensive than he originally thought”? In 27 years of assisting, I can't remember a single instance. My point is this: as a patient you have rights. You have the right to stop and ask questions. You have the right to get another opinion. You have the right to say no. You have the right to hear alternatives - and believe me there are always alternate options - even if that means doing nothing at all. Understand your rights and treatment which is presented to you. Be skeptical if you are not given multiple choices including doing nothing. Of course there are consequences, and that should be explained to you as well. You should not be made to feel guilty, ashamed, fearful, or inadequate if you do not accept the dentists recommendations. It is your mouth and your teeth. A dentist can opt to “fire you” as a patient but that should be a red flag as well. Be informed. Be aware. Be educated. Realize that dentistry is fairly predictable in most cases. A trust-worthy clinician will be thorough, insightful, compassionate, confident, and accommodating (within reason). They will not take your decisions personally. Prevention and education will be his (or her) top priority. He (or she) will be exhaustive in providing explanations, options, and consequences - long term and short term.  They will want you to understand and not be offended to show you evidence (x-ray or intra oral pictures). These are the hallmarks of a dentist with the highest integrity!

Here are a few other tips:

1. Read reviews.

2. Expect multiple options for every situation.

3. Ask for referrals from trusted friends or family.

4. Question unanticipated, “on the spot” procedures.

So recently I was introduced to Advantage Arrest in the practice where I work. A 38% Silver Diamine Fluoride used to halt and prevent dental caries used largely on children to treat lesions in primary teeth. It has been used in Japan and some other countries for decades and is apparently extremely effective. From my very limited knowledge, I understand the biggest drawback is aesthetics. It turns normally brown or yellow decay to dark black, which is obviously unsightly. However, it prevents children from having to endure the trauma of anesthesia, surgery, and emotional anguish of a dental appointment. Although my doctor does not treat children, we have found a number of circumstances it may be useful - if effective. We have used it to treat impossible to reach class V’s, such as in the furcation and distal of second molars. It has been approved by the FDA as a Hypersensitivity Varnish and a unique, stand-alone insurance code has been established: D1354 Interim Caries Arresting Medicament Application . I am including a number of links to recent articles for your light reading entertainment. It is definitely something to explore. Enjoy!

A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills

Silver Diamine Fluoride in Caries Management

Alliance for a Cavity Free Future

The dos and don'ts of silver diamine fluoride

SDF Facebook Page

Dentistry has come such a long way in the 27 years I have been assisting. When I first began, “cutting edge” and trendy meant wearing scrubs, using gloves for EVERY patient (not just the invasive ones), and pre-dispensed amalgam capsules. These days everything is color coded, disposable, and dosed for single use. Even burs are conveniently packaged and discarded after one or two crown preps. And although I am EXTREMELY conscientious of the environmental impact of waste - I must admit.... being able to toss certain burs rather than scrub them eliminates a lot of frustration from my day. Being a dental assistant in 2017 is not only easier - but a “helluva-lottta” fun thanks to innovations in technology, materials, and tools. And like any good, over zealous, obsessive dental assistant, I have a list of “must haves”. So without further adieu, here are the top ten items that make my life more simple and my job more enjoyable (*No particular order):

10. Teflon Tape. Absolutely ingenious way of isolating proximal contacts - among dozens of other uses including covering implant screws.

9. OptraSticks by Ivoclar and Pic-n-Stic by Pulpdent. When there is just absolutely no room for your fingers.

8. Isolite. Best Isolation device on the market besides Rubber Dam.

7. Microbrushes. What can’t you use a Microbrush for???

6. Bosworth Masque.  This silicone lubricant and separating coating agent is insoluble in the mouth.

5. OptraGate by Ivoclar. Great anterior retraction - but a little difficult to apply.

4. Consepsis Scrub. I like to call this the “operative prophy paste”. Better than pumice but without the fluoride. Perfect for cleaning preps prior to cementation.

3. Epitex Strips. Best finishing / polishing strips on the market, IMHO.

2. Stop Strips by Kerr. Never fumble with a mylar strip again when restoring class III’s.

1. LC Block Out Resin by Ultradent. Such a handy material for filing in voids, blocking undercuts, and just tacking things in place temporarily.

So yesterday I had applied a rubber dam to #31. We were doing some posterior composites on a talkative patient with tons of saliva. As we worked, I just kept admiring the isolation and ease of treatment. I was thinking, why don’t we use this all the time?? I mean, really? Why not? The doctor didn't have to put it on, I did. (It only took a couple of minutes and I actually love placing them!) Time saved alone is worth the cost of the dam... patient comfort (if applied correctly) is improved... they don’t swallow the trash - tongues are safe - I don’t look like an idiot fighting soft tissue.... etc, etc, etc. I mean seriously... What am I missing here?

I could list so many reasons to use a rubber dam but can think of only one to avoid it. Perhaps you are in a clinical situation where not one of the hundreds of types of clamps allow for service to the treatment zone.... #rollingmyeyes. In that instance, there is another amazing solution. Write this down: Isolite. https://www.isolitesystems.com/explore-dental-isolation-systems  In over 27 years of dentistry - I have seen and used almost every isolation device on the market and this thing is truly revolutionary.

I could go on and on about this topic. I guess it’s because I learned to write notes from a master. A prosthodontist. With a PhD in Biochemistry. Who taught at two different and prestigious universities. To say he had lofty expectations is a mild understatement. However I owe him a debt of gratitude I may never be able to repay. I understand the necessity of details and the value of being thorough. I appreciate proper terminology and take great pride when transcribing the clinical particulars of a dental procedure. He wanted my notes to read as if they were a literal transcript of what went down. And proper verbiage was a must. You don’t “take” impressions - you MAKE impressions!! I would frequently ask him “What are we doing to Mr. Jones today?” and he wasted no time correcting me. “We aren’t doing anything TO Mr. Jones, Jennifer, however we will be doing ...... FOR Mr. Jones!” What was I thinking?? #rollingmyeyes....  It took me forever to stop saying that.  However, in hindsight, I am incredibly grateful for all that he taught me. I am a far better assistant today because of him. I also have more patience than a kindergarten teacher and a heavily calloused tongue as a result. I take great pride in my notes and would confidently submit them to any board for review. It it my job and personal quest that when my dentist checks notes at the end of the day the only thing he needs to add is “Great job, Jennifer”.

For any assistants out there “making notes” (haha, see what I did there?), here are my top pointers:

1. Always begin your notes with “Patient presents for...”  This is just an easy and concise way to begin and gets right to the meat of the note.

2. CC= Chief complaint. This is another field that is critical. Even if the patient presents for a routine visit, document any or no complaints at all.

3. When documenting treatment options presented, always begin and include the option “To do nothing at all”. Like it or not, the patient does have this option and it should ALWAYS be presented and documented.

4. Always make sure to include the brands of your dental materials, ie Dentsply Integrity. It just reads better.

5. List the REF and LOT of all implant parts used, even if you have stickers in the chart. Charts get lost. Period.

6. Make sure your note reads in chronological order. Document it exactly as it happened.

7. What did the patient say and how did the doctor respond. If the patient was happy and satisfied at the time of dismissal, then make a note of it.

8. Auto-notes are a great tool, IF you read them each time and customize accordingly.

9. Use proper terminology and verbiage.