Friday, August 29, 2008
I'm in Scrubs!
Literally. It's like I'm playing "dentist for a day".
I started work at the dental office on Monday. How is this possible? Unlike Texas, New York does not required dental assistants to be state certified, so dentists can train you from scratch themselves.
For the first two days, each of the two assistants (who are leaving to finish their degrees) showed me how to do things. On the third day I was left alone with the dentist - very hard. One assistant told me that all she could do for the first month alone was observe, and both told me that it took around 3 months to get the hang of everything, and there I was being thrown in the deep end on the third day!!!!!!
The only thing about working at a lab (already 10 years ago) which helps me now is understanding how the autoclave works and sterilization techniques and benefits. While there, I had my own routine down, but it was ongoing work and there are more patients than there were classes to prep for. It amazes me now to think how I used to mix solutions and pour plates. It was very zen-like work. I would read a list of what needed to be done, and I had notes to refer to for measurements and quantities.
Biology, chemistry, physics and geometry classes, also occurring a long time ago, help me now in a basic understanding of anatomy and physiology (the last science class I ever took!), as well as thinking in cc's and microns, degrees of angles, an axis vs a plane, enamel vs dentin, the behavior of acids and bases, and so on.
Although Monday was the first day, it wasn't too bad. Tuesday was scary because of the looming prospect of Wednesday. I was rushed off my feet on Wednesday but got to have a few minutes for lunch. However, one person cannot set up and break down two rooms, place patients, assist chairside, AND have time to wash and sterilize instruments. Every time I stood at the sink to wash and throw a load into the autoclave, I had to run off and do something else. So despite getting annoyed that things piled up on Wednesday, the Dr did try to help out with the sterilizing on Thursday since he knows what goes in short or long cycles, etc.
My two new best friends - I love Saucony! It will now be difficult on days off to wear normal shoes.
He felt that Thursday was not too busy, and yet I never got a minute to eat! It is a fact that new recruits in basic military training eat better, and healthier too!
So I spent half the day with a splitting headache, for which the Dr apologized and said it's not supposed to be like this and told me to ask the receptionist to schedule a lunch break. We're short staffed obviously, but a second assistant will start on Sept 8 so I will have more time to learn and get my routines down. At the moment I refer to notes in a binder and these photos you see, and I still have to think - the routines will not be automatic for a while yet. He said himself I'd be confused for the first month. This in addition to the solo work is like a baptism by fire.
The practice is in the midst of a changeover - in the next couple of weeks he hopes to scale back the number of patients (from 7-10 to fewer??), go even more high tech with lots of gadgets, and have shorter hours. So whereas I've been aiming to be in soon after 8.45 and leaving sometime before 6.30, it will hopefully soon be lights out before 5 pm, hopefully even around 4.30...he said....(by the way, can I just use 24 hour time? Typing am and pm looks silly though speaking it is fine).
So as regards this new schedule - let's hope! A new hygienist started on Wednesday. We're both slightly miffed at the current state of things, but we're going to stick it out to see what it's like when the dust settles.
Anyway, in the past 4 days I have learned how to:
1) set up a room (gloves not necessary) - relevant instruments and materials on tray and side table), set up syringes with lidocaine and needles and throw them into sharps later, draw bleach into squirting syringes, patient file with Dr gloves on counter, cup of mouthwash beside tray, headrest cover, bib, bendy suction tube on handpiece, small suction tube for root canal (to suck water out of tooth cavity), wide suction tube for any procedure requiring acid etch (to contain the tooth and take up the acid).
ROOT CANAL TRAY:
Tray setup for a root canal (by far the most common procedure and after four days I can nearly do this from memory) - R to L: mirror, explorer, college pliers, syringe, extra vial of Lidocaine, syringe of bleach (for flushing out tooth, syringe of emulsifier to clean interior, small red hand drill holder with measurements, "pin cushion" for holding used files - see how tiny they are - different widths with directional screw threads for extracting the tooth nerves from deep inside the canals. Two lengths: 25 mm or 21 mm depending on tooth length. Then the sensor which indicates how far the drill is from the apex of the tooth.
ROOT CANAL SIDE TABLE SETUP:
Side table setup for root canal. Cotton balls, small jar of cavity filler putty and putty scoop. Two small boxes of 1) tiny paper points for drying out cleaned roots, 2) tiny rubber points for melting into cleaned roots with a handheld device the tip of which heats to 500 degrees (F or C?), blue mouthpiece to keep jaw open without tiredness, sheet of green rubber (dental dam) fit around metal frame to isolate working area from patient's mouth; the two handled tool is used to make a hole in the rubber to fit around tooth, and small clamp is used to make seal around tooth.
I have also learned to:
2) call in a patient, set them in chair, place bib, ask questions
3) assist chairside - hold suction tubes behind tooth to collect liquid and material and also to block tongue, hold mirror to keep cheek out of the way, mix adhesives for crown repair, or prepare putty for impressions (requires clean ungloved hands), and also to grab anything from a drawer during a procedure whenever the Dr asks. I have to remember to keep a different pair of gloves going for each patient, and during a procedure to remove them from one or two hands in order to reach into a drawer (you don't want to contaminate all over) or prepare other materials). You have to be generally dexterous and good at doing things with one hand, and that's always been a forte of mine.
Impression setup - Two jars of putty which must be blended completely through kneading in under 1.5 min, and placed in the trays for impression of teeth. The putty guns contain a rubbery putty which is applied to top and bottom front teeth, patient bites down and lets it set - to show bite measurements. Three bottles of string of different widths which are carefully stuffed around the base of the tooth, compressing the gums, left for a few minutes, and removed so that the putty has space to go further up the tooth for a more complete impression. All is sent to lab for making crowns or bridges.
Bonding setup - Green syringe of phosphoric acid for etching tooth surface (after dentist abrades the surface with a drill tip), then three dropper bottles of tooth prep and bonding liquids - one drop of each in little white tray, using brush to apply - and dried with UV light for 10 seconds. Followed by application and shaping of composite material from the yellow syringes, and drying with the light. Patient bites down on a small blue indicator paper (forgot to lay that out) to show what areas of the teeth need filing down.
See descriptions under "bonding". For a short 6 gold post see upper right of tray - set up similar to bonding with flowable material, bonding droppers, tray and brush, UV light, green phosphoric acid, cotton wads for holding lips away from teeth, etc.
Only one so far. Usual basic setup of mirror, explorer and college pliers. Then larger pliers for removing loose tooth, two special tools which provide both lever and fulcrum which dentist places at base of tooth and twists to loosen. Long tool for scooping? Suture ready with clamp, small scissors for cutting suture, lidocaine needle and there is always a cotton bud which will be covered with numbing gel before Dr administers injections in any procedure.
There was also a bit of microscopy surgery during one particularly long root canal, something like this (courtesy of microscopy website):
I got to try it out too so I could see the debris inside the tooth
There is a lot of juggling on the dentist's part. He can work up to 20 mins screwing material out of a tooth root using the tiny hand drills (I bet it's like trying to turn a tiny screw all the way down using gloved fingers) or sometimes attaching them to a handpiece. Someone who has come in for a crown repair or a consultation may wait in the next room, fall asleep, or get restless wondering where the dentist is, or why assistants keep walking past. That would be me trying to get the sterilizing done, or running off to get more supplies for the ongoing root canal.
Back to the topic at hand, I learned to:
4) break down a room - while wearing same gloves used in procedure, throw out sharps (needles and vials) into sharps container, disposables like paper, gauze and suction tubes into trash, and biohazards (anything with blood on it) into waste container. Remove sterilizable instruments, brush debris off, and place in ultrasonic detergent bath. Use hospital grade spray detergent to spray down tray, sink, chair, and handpieces (like drills and suction/water thingies). Wipe down starting with cleanest and ending with dirtiest: chair, tray, handpieces, sink. Then wipe down handpieces with alcohol pads. Then it's back to step one for setup.
5) perform X-rays (still ongoing, I suck at this) - I hate this the most because placement of the film is so hard for me, deciding when to tell them to bite down, and then it shifts and you have to place it again. It's all about the axes of the tooth versus film angle, but then the cheek and tongue gets in the way. Also to get electronic film holders for upper left vs upper right, top, bottom, whatever. At least some holders have a ring outside so you know where to direct the beam. Place lead apron on patient. Also knowing on the computer software which numbers to assign different X-rays, three teeth at a time, grrrr. Go behind wall, wait for blue signal on computer screen, press button, hear buzz, let go button, then wait for image to process and see if you got it right. Yeah, I hate this aspect the most - even though it's the cleanest...go figure.
I work on a street which separates Chinatown from City Hall. Every day after work I've been walking out to Federal Plaza, where there is a nice tree-filled park with benches, surrounded 360 degrees by courthouses and federal and state buildings, and also New York's absolutely gigantic City Hall which faces down Centre Street (yes, spelled the English way). It's all quite pretty and serene. There are of course a lot of official vehicles, various uniforms, some dogs, guard posts and moving road blocks - mostly out of sight of the park but down side streets and entrance driveways. Interesting, but a bit hard for me considering how much I have always wanted a federal job! After work they're all out there reminding me!
Yesterday I was so exhausted from skipping lunch, and the resultant headache, that I sat in the park to devour some Fig Newtons, finish my bottle of Pepsi, and I felt about 50% better. I rested for an hour, then gathered the will to walk to the subway and head home. Popped some takeout Chinese from the day before into the microwave, ate it, had some water, and slept for a couple of hours, then woke up for a glass of milk and some Oreos. Oof............hope this does not happen again.........
So there, that's my new job. 90 day probation period. Eventually I will ask about bringing in my own scrubs so I'm not wallowing in size M, and also perhaps campaigning to get one Saturday off per month, since it's tough to never have two consecutive days off, and you all know how wonderful my Saturdays have been since coming to NYC.
In closing, next time you're at the dentist and it seems quiet and you feel neglected, you can be sure that it's not because the staff are sitting down.