Future in Prosthodontics

I have to relate a funny story that happened the other day in the clinic. It was actually two days ago. I thought I should write it down before I forget the funny details of the experience. Anyway, I was schedule to see one of my patients for a 24 hour denture check. To better appreciate the story I'll provide a little background; I received this patient about 1 year ago next month from a graduating senior. As part of his treatment plan with her she elected to extract her remaining upper teeth and replace them with a complete denture. She was missing a couple of teeth on the lower and we suggested to make a lower partial denture to help support the upper. She didn't want to do that. I got everything ready to go by making her an interim denture that she would be able to wear during the healing process immediately after the extractions. I informed her that I placed her denture teeth slightly forward to cover up her lower teeth a little more due to their crowded nature. Immediately after her extractions I inserted her interim denture and saw her the next day. I was sure to explain to her multiple times that there would be a huge learning curve going from natural teeth to denture teeth, especially with interim dentures. She actually handled the interim denture process very well. I saw her as often as she needed to be seen to make adjustments to the denture to make them as comfortable as possible during her 6 month healing period. She at first thought her teeth looked different, but after a while she liked them. The healing time passed and it was then time to fabricate a final denture. Making a denture requires multiple visits. She missed several visits along the way for different reason, but eventually we were able to get all the visits in she needed. One of the visits required what is called an anterior try-in. During this visit I place the anterior teeth onto a denture base and try-it in the patient's mouth. At this visit the patient has the opportunity to personalize/adjust what she likes or dislikes regarding the dentures appearance. I told her that this time I set her teeth a little differently, not as forward. She told me that she liked it and "it looked more natrual." I made sure that things were the way that she liked them. She insisted that they were fine. I finished up the dentures and finally inserted them after a couple more canceled appointments. She loved them. They fit very nicely and looked really good. My instructor thought they looked very nice as well. She went home very happy, so it appeared. As I mentioned above we like to see denture patients 24 hours later to make sure they fit ok. She missed her next appointment so I saw her 48 hours later. I was pretty excited to see her, due the past experiences I've had; she seemed pretty pleased. I greeted her in the loby and as we walked in the clinic I asked how she was doing. She said "Not so good." I then asked her what was going on? She said, "Well, everyone says that I look like I don't have any teeth!" I asked her what she thought and she said "I don't know, I can't really tell, I just don't want people to think that about me." We sat down in the operatory and I began to try and find out exactly what the problem was. She informed me the "everyone" was her daughter. Her daughter said "Mom, you look different." Then she told me her what she first told me when I asked her how she was. Then she told me that her grandaughter told her that her teeth looked small. I said "Ok, lets have a look and see." I examined her appearance and her soft tissue profile looked pretty good. I could notice that her lip wasn't as full as when the interims were in, but she still looked pretty good. I tried to explain that maybe her family noticed the difference between the interim and the finals and they might get used to it. She then said "Well, my interims look more natural than these do. I don't want to look like I don't have any teeth." I explained the process why we did the dentures the way we did and then explained that if she wasn't happy with the way they look now then I would do my best to correct the problem until she was happy. I started to explain the different options we might have to correct the perseption. One option might be to thicken the plastic above the teeth, another might be to make a new denture. When I mentioned that option she wigged out even more. She said, "I've been driving all the way here for almost a year now. I'm not doing that again. I just won't." I said Ok lets look at the thickening option first then. I grabbed some soft wax and placed a thin layer abover her teeth and had her place the denture back into her mouth and then look at herself in the mirror. She looked and proceded to tell me, "I'm not the expert, I don't know how to fix it, I just don't want people to look at me like that." I tried to explain again that I wanted to help her and the different options she might have. She looked at her wax adjusted denture and didn't comment. She just got more upset and repeated the previous complaints again. This time she kept trying to get out of the chair and started telling that she just wanted to leave. I tried one more time to explain that I was there to help her and I was tring and I would do all that I can to help her. Then she threw up the arm rest grabbed her purse and stormed out of the clinic. I was blown away. I was somewhat at a loss.

Morals of the story:
When making a denture invite the patient to bring someone along who they respect their opion (daughter in this case, she broke the success of this case)
Explain to the patient that other might see a difference in their appearance when they receive a new denture
There is a good chance that if something else is going on in a patient's life you might be the scape goat for them to release their anxiety

What we did for Valentines... (a little late, I know)

Lynn and I had the opportunity to go out alone for Valentines Day. Thanks to some great friends. I had an idea to go and get our pictures taken professionally. We haven't had this done in a long time with just the two of us, so I thought that it would be fun. We had a great time! The photographer made us do the most cheesy poses, but we did get a couple of good shots. Here is the one we chose...

3 more months...

We only have 3 months until we move and Lynn graduates, yikes!!! I was just feeling the sadness yesterday as a friend and I were talking about how quickly this time in Omaha has gone by. I am really starting to get sad, yet excited for something new. Lynn and I are going to be out in Ohio to look for housing in a week. So far we have almost gotten scammed a number of times on Craigslist, so we are very excited to actually go and see what is out there as far as housing goes. Hopefully we can find something quickly because we only have two days to do it. I have also been feeling the urgency to start packing. I guess that I feel like I am running out of time, but really I have quite a while. Oh well, it will all get done.

Snow Day!!!!

All week we kept hearing about the "big storm" that was going to hit Omaha on Friday. I thought it was really funny because the weather has been so nice all week. I've only worn a light jacket to school every day this week. It was starting to feel like spring might be coming. Anyway, Friday came and we awakened at 5:30 AM by the phone ringing, it was Porter's school and they were announcing that his school had been canceled for the day. I looked out the window and it still looked nice outside, no snow, just cloudy skies. I drove to school just in case it did snow. At about 8:30 or so it did begin to snow. By about 11:30 it was snowing pretty hard. I had a very important surgery to perform at 1:00 and the teacher I was working with found me and asked if I might be able to call the patient and ask him to come in earlier before things got worse. I did and the patient said that would be no problem. No sooner did I hang up the phone after talking with him the Dean of the clinic announced that we all needed to call our patients and tell them the clinic was told by the school to close for the afternoon. My patient just laughed at the whole ordeal, which I was glad he understood. So, I went home and enjoyed a wonderful snow day with my family. Erin and Peyton slept most of the afternoon, while Porter and I played his new game. Once everyone was awake and about 7 inches of snow had accumulated we all bundled up to go outside and play. We grabbed our sled and found the hill just outside our apartment and made a sledding run. Porter loved it, Peyton not so much. He liked being pulled in the sled, but not sledding down the hill. Erin and I had to laugh at Porter because last year I was all excited to go sledding and he fought me the whole time. This year he loved it. It was a great day. One of our favorite things to do on a snowy day is watch all the crazy drivers try and drive up our hill in the snow. It just makes me glad that I didn't have a reason to drive in the snow next to people who really have no clue what their doing in the white stuff.

First Dental Visit

Well, I know that it might be a bit past the "recommended" first dental visit (around a child's 1st birthday), but Porter finally made it to the dentist. I didn't really want to see him, because I don't really want to see him until he's older. Besides some "ethics" classes recommend not treating immediate family members for fear of interfering with personal privacy or autonomy issues. Anyway, we tried to prepare Porter a couple weeks in advance on what to expect. Key thing is trying to keep everything as positive as possible to increase the chance that everything will go smoothly for him. I sat down an explained to him several times how the dentist would take a close look at his teeth, how he would tickle them, place a mirror in his mouth for a closer look, explained to him how the dentist will take some really cool pictures of his teeth that he can look at afterwards, paint his teeth purple, and then how the dentist would use a really neat toothbrush and clean his teeth. After a couple of days talking about it he was actually pretty excited to go to the dentist. The only concern he every voiced was having his teeth painted purple. That made me chuckle a bit. I sat and explained to him that his teeth would only turn purple if he had bugs on his teeth and no to worry because if by chance his teeth showed some purple the dentist would get it off in no time. I think for the next couple of day Porter has never asked to have his teeth cleaned as much as he did just prior to his visit. I was able to brush his teeth for howeverlong I wanted. Usually I feel pretty good if he lets me brush for more than a minute. Lately he's let me brush for closer to 3-4 minutes. He did not want his teeth purple. At the dentist he did very well. A little nervous, but he did really well. He was able to see our close friend Jeff and that helped too. Porter loves Jeff. There were also some other friends in the clinic that came over to say hi and I think that helped as well. One time I went in to check on him and there were about 4 students and a couple teacher laughing and having a good time with him. The best part about the whole visit was Porter's beeming smile at the end as he said to me with the proudest voice he has..."Dad! I have no cavities!" His teeth never did show any purple...that is pretty amazing in and of itself.

Learning the Importance of Responsibility

Erin and I have been thinking of ways to help our kids learn responsibility. One day we decided that maybe we could use Porter's passion with video games to help him learn the importance of responsibilities; like cleaning his room, making his bed, reading books, chores, etc. The things that need to be done each day before the fun things. Erin made a sticker chore chart, Porter's showing it in his picture, of many many squares. The idea behind is was for every chore he did around the house if got a sticker to put on his chart. Then when the chore cart was filled he could get his first lego video game. He actually took it to heart. It was pretty fun to hear him, almost everyday, ask..."what else can I do today?" He took a little over a month to fill the chart out completely. Towards the end he seemed to get even more motivated as he noticed the squares to fill were less and less. I think the last two days he did 6-8 chores per day. He was a great helper. The deal now is he can earn playing minutes by doing his chores prior to playing each day. So far so good. He's doing pretty well with the whole idea.

Sunday Evenings are Back

It's nice having a Sunday evening as a family again. Last year church was so late that by the time we were done, returned home, and finished dinner it was time for the kiddo's to go to bed. This past Sunday was fun. Porter rode home with me from church and we made some visits to some families that needed someone to come say hello. Porter made sure that we visited a certain family. He kept asking the whole time if we were going to stop in and see them. So, I thought it might be a good idea to do so and it was a great time. They were glad to see us and Porter had a great time. When we all were finally home we dressed down to our PJs, made some popcorn, and watched a Disney movie.