stuff to look foward to!
so i'm really excited about work next week - my schedule's packed at the downtown office, the long weekend's coming up so i'll have a saturday off for the first time in forever, and crazy-boss-lady's on vacation, yippee! i'm looking foward to a productive yet uneventful next couple of days. tomorrow i go into the city again, and it'll be good but i do have a case that i'm kinda dreading a bit.
one of my patients is a very, very nice girl, but extremely phobic of the dentist. she's from bulgaria, where she said when you have a toothache you basically have to decide which is worse: staying at home with the pain or going to the dentist where you knew the pain would kill, maybe even worse than leaving it alone. my predecessor completed RCT on #27 and she had a very difficult time freezing, which is suprising for a site that you can pretty much 100% successfully infiltrate (septanest usually does the trick for me). i vowed to send all RCT that she will (hopefully not) need to a specialist because of this - just something my gut tells me. anyways, she has a ton of interproximal caries and her schedule is limited to saturdays (of which i'm there only twice a month), so we've been working by quadrant very, very, very slowly. uppers, not a problem. but the lowers, what a disaster! very difficult to give an IA block and when i do, she just eats through it like crazy. and on saturdays, i get tons of interruptions from all the emergencies and hygiene checks that i got to do, so i have a very limited window of time that i can work with her. she's so sweet, very understanding and extremely apologetic, and i'm like, no, it's my fault, i failed to numb you up, and she's like, no, it's my fault, i'm a freak of nature! and we go on and on for hours. after two appointments of extremely short duration and/or complete failure to obtain profound anesthesia, i gave her a script for 5 mg valium a half hour before her appointments. i heard that often does the trick in a pinch. i also have an intra-osseous anesthesia (stabident) system, but i'm not all that comfortable using it yet and i don't want to experiment on this person. right now she's in temporaries on her lower right and still has 2 cavities on her lower left. so if the drugs don't work, i don't know what on earth will. needless to say, i'm keeping my fingers crossed.
after tomorrow's over, canuck and i are going to see a bluejay's game! so even if tomorrow's craptastic, i at least have something to look foward to. there's always something to look foward to ;-)
one of my patients is a very, very nice girl, but extremely phobic of the dentist. she's from bulgaria, where she said when you have a toothache you basically have to decide which is worse: staying at home with the pain or going to the dentist where you knew the pain would kill, maybe even worse than leaving it alone. my predecessor completed RCT on #27 and she had a very difficult time freezing, which is suprising for a site that you can pretty much 100% successfully infiltrate (septanest usually does the trick for me). i vowed to send all RCT that she will (hopefully not) need to a specialist because of this - just something my gut tells me. anyways, she has a ton of interproximal caries and her schedule is limited to saturdays (of which i'm there only twice a month), so we've been working by quadrant very, very, very slowly. uppers, not a problem. but the lowers, what a disaster! very difficult to give an IA block and when i do, she just eats through it like crazy. and on saturdays, i get tons of interruptions from all the emergencies and hygiene checks that i got to do, so i have a very limited window of time that i can work with her. she's so sweet, very understanding and extremely apologetic, and i'm like, no, it's my fault, i failed to numb you up, and she's like, no, it's my fault, i'm a freak of nature! and we go on and on for hours. after two appointments of extremely short duration and/or complete failure to obtain profound anesthesia, i gave her a script for 5 mg valium a half hour before her appointments. i heard that often does the trick in a pinch. i also have an intra-osseous anesthesia (stabident) system, but i'm not all that comfortable using it yet and i don't want to experiment on this person. right now she's in temporaries on her lower right and still has 2 cavities on her lower left. so if the drugs don't work, i don't know what on earth will. needless to say, i'm keeping my fingers crossed.
after tomorrow's over, canuck and i are going to see a bluejay's game! so even if tomorrow's craptastic, i at least have something to look foward to. there's always something to look foward to ;-)
posted by Dr. Mommy, D.D.S. at
9:50 PM
5 Comments:
You can also try an anti-inflammatory (eg. Toradol) an hour prior to the appointment. If she's really nervous, it's likely she's not sleeping well the night before the appt, your choice of sedative that you Rx for the appt is also a good idea the night before to ensure she sleeps. There's a good correlation between lack of sleep and increased perceived pain during the appt (I will have to look the study up if you really need to have a reference).
Shorter duration, rapider onset sedatives like Triazolam are often a better bet than Valium for dental visits. Anterograde and retrograde amnesia are more significant with Triazolam, but that often can be a good thing to help patients forget most of the appt. I usually give 0.5mg of Triazolam the night prior to the appt, then have the pt arrive an hour early for the appt and give them another 0.5mg in the office.
By
Unknown, At
Saturday, August 26, 2006
i do have a patient that premeds with attavan, 1 mg prior to appointment. i've had success with valium in the past, which is why i suggested it this time. unfortunately, it did absolutely nothing for her. rather than keep wasting her time, i refered her to an office that does dentistry under IV sedation. she's so anxious about coming and has worked herself up into such a panic that i don't think any type of pharmacopia will help her.
despite all that, she's very happy at our clinic and still wants to see me for her checkups. i just feel bad that i wasn't able to help her. at this point i think i'd be doing her more harm than good to keep re-appointing her. but i'll certainly take your suggestions to heart for next time (which hopefully there won't be a next time).
By
Dr. Mommy, D.D.S., At
Saturday, August 26, 2006
Hi Doc mommy, hope that this case will go well with Valium. I too have used it quite a bit, especially on younger females and it seems to work. They aren't sedated, but they are less anxious, which in turn makes you less anxious and the procedure just goes more smoothly.
LOL you know, I read this post of yours a few days ago but didn't have time to comment. The very next day, I got a Canadian exchange teacher from Alberta! And she used the term "freezing the tooth" I had to smile under my mask because I understoof from your context what it meant. Over here in Australia, we usually just use the term "numb the tooth", for kids it is "put the tooth to sleep for a nap".
By
Rachel, At
Wednesday, August 30, 2006
rachel, it's really funny because i never used to use that phrase when i worked in new york and the canadian dentists that were in my residency said it all the time. i used to be like "what the heck does that mean? you mean numb, right?" but patients here always use that phrase and say "huh?" when i say "numb" so i just kinda went along with it.
but one thing that will never change: it will always be "soda" and NEVER "pop"!
By
Dr. Mommy, D.D.S., At
Wednesday, August 30, 2006
To me "numbing" makes more sense than "freezing". I did my training in the US also so I got used to saying "numbing" then had to change over to "freezing" when I got here.
By
Unknown, At
Monday, September 04, 2006
Post a Comment
Subscribe to Post Comments [Atom]
<< Home