Facultade de Odontologia de Bauru: FOB
And here comes the good stuff
August 5, 2013
Today I have to move into the student residences, and I have the big dubiety about how my roommates will be.
After moving all my stuff into my room, I went to ask about my schedule.. what was my surprise when the man that I asked give me this paper and walk me to a classroom (talking Portuguese really really fast).
He knocked the door, 1 hour and 20 minutes late!! (in my head I just had two things: the face of the Dr. Jorge every time someone is late and all my stuff in my room waiting for me to do something about it)
I was shy, but it was too late for me to do something about it... he talked: Boa tarde, she is mexican, and will be with you guys until december, please be polite and someone give her a tour around the school. I just smile and sit near a girl that moves all her things to the floor so I can sit.
The class
The name of the class was Implantes osseointegrados (until then I had time to see the white paper that the man gave me). Then magically everything was so clear, the Dr. was talking about all the things we saw in class last semester:
-Bone quality, Lekholm and Zarb classification
-Fallschüssel for maxillary
-Atwood for mandible
Then he talked about bone density;
-Low: posterior maxilla
-Medium: maxillary anterior and posterior mandibule
-High: anterior mandible
Squere-threaded implants for bone with low density
Triangular thread implants for high density
He continued talking about theoretical things, and then... he started talking about his personal experiences and put some videos some of his surgeries (all associated with increase of bone to put implants)
My favorite video was one where he takes bone from the parietal bone, he cut it into small pieces and then put it into the patient. The thing i liked about it is that I never imagine that someone will be happy doing that to a person, but the most interesting part is that he said that all patients after the surgery are so happy with the results that said that they do it again if its necessary and that is the less painful recuperation after a remotion de bone in bloc.
I just loved this class!
When the class finished they said that he is one of the best surgeons maxillofacial in Brazil... so next class, i will investigate his name
The next day I had some troubles finding my class, I went to the office where I found the guy that talks fast and gave me the schedule and said that i had to go with other girl in the other side of the campus... then the other girl said that i have to wait for a student who will show me all the school, introduce me to teachers, students, show me where the clinics are, and stuff like that.. but the student never answer the mail! So I asked and asked ..and found out how to get to my classes until the next day
On Wednesday I had all day clínica integrada reabilitadora II
Here are some of the things I saw at first sight at the FOB; I think some are better (+) here, other not that much (x) and some that are equal (-) to how things work in my school;
- They have 25 units (there are 39 students in 4th year)
x They all dress in white clothes, they don't use scrubs (I am the only one using them)
*Now they are liking my scrubs, are more comfortable and easy to use than normal clothes
+/x They always use white white coat to treat patients (they don't use gowns, just in surgeries)
+ They have lots of sinks
x Dental units are much older than ours and with spittoon
x They do everything on hand... not in computer like we do
+ They don't need authorization to take the materials
+ They have all materials ready to take them when necessary
- The materials box of the students have more quantity and variety of things than ours
+ School gives barriers of protection: gloves, masks and caps
- They also work in couples
+ They only study for 4 years.. then they can work
+ Students are young (20-22 years, I'm the old lady of there)
- They have good control of infections, they put many barriers and are careful to avoid contamination of instruments (the only thing I didn't like was that they don't use gowns with all the patients, just in surgeries).
+ Students do difficult procedures than in Mexico just the graduate students or specialists perform
+ They have clinics from 8am-12pm and from 2pm-6pm (they have at least 2 patients per day)
+/x They have one teacher for each 8 students (4 couples), a couple of graduate students or sometimes more, so there are always at least 5 professors in the clinic (lots of people at the clinic)
x There are always lots of people around the patient
x Its common that students are talking with partners or "visitors" about other things that have nothing to do with what they are doing to the patient (not everyone do that)
x They don't pay much attention to what the patient is feeling
x I have seen several times that when the patient says it hurts they just tell her/him "its almost done" and finish the procedure with pain. Teachers also do that. (not everyone do that, but its common)
+ Students stay 2 weeks during the year at the emergency area.. and they see lots of patients
+ Everyone have his own locker
x They are not allowed to leave the materials at the sterilization area
x They have to take the materials to the sterilization area one day before the procedure (not before)
+ All students have at least one research
+ When they are doing research school pays them for one year around 200dlls per month.
+ They have a 2 people in the clinic taking professional photos of all the procedures=
x Theoretical classes last four hours
+ Teachers give the classes, also in ppts and with videos of their works
Activities at the FOB
Week 1
- Basics of osseointegrated implants (class)
- Periodontal surgery: Gingiva movement to coronal area in a patient with gingival recession (watching)
(One week after the surgery)
- Temporary crown (I was the assistant)
- A student removed of a filtered resin then a famous Brazilian dentist (Dr. Mondelli) made the cavity and put pins intradentinarios in the molar... then the student puts the new resin and finished the work (I was the assistant and put one of the pins)
- Periodontal surgery: Crown lengthening done by a student (watching)
- Introduction to the fonoaudiologia; Importance and relationship with dentistry http://www.fob.usp.br/ (class)
- Introduction to the community health: Considered a major public health problem patients with mental illness and drug addicts
At my first week at the FOB I really love what they do... Students practice a lot, do complex procedures, I loved that they can take the materials whenever they need them, they have a line of patients waiting to be seen, it's really cool.
The classes are too long, but I liked that teachers explain with videos and clinic cases, that makes the topics more interesting. I was also shocked when they start talking about the public health problems and said that drug addicts are considered kind of patients with mental illness (they see drugs as something really common).
Week 2
- Uses of osseointegrated implants (with clinical cases)
- Epidemiology of the TMJ: Prevalence, incidence and etiology
- Influence of trauma from oclusion on the periodontum
- Final impression for a dental crown (I was the assistant)
- Emergency: Dental extraction (I was the assistant)
- Emergency: Patient with dental abscess came to the clinic, the student clean the root canal and put formocresol. Referred the patient to the endodontics clinic. (I was the assistant)
- Emergency: Glass ionomer placement in a tooth that lost previous restoration
- Emergency: Patient came with a premolar with an extensive caries that was hurting a lot, while removing carious dentin the student communicates with the pulp; so she removed the pulp, clean the conduct and put a small cotton ball with formocresol and gave him a pass to do the endodontia.
- Emergency: Patient came because she had a tooth with a marked mobility, she had periodontal illness, diabetes and hypertension.. so she was referred to the graduate area.
- Class to explain the management of the FOB's system: http://ead.fob.usp.br/
This week what I loved was the emergency area!! They saw a lots of patients. Students just sit, and start working... they have employed that after every patient clean the area and bring all the things that students need while doing the procedures... I think what I loved was that they don't have to clean the mess. Another thing is that in the emergency area they work alone, so it was better for me because I could assist the procedures I wanted to... the sad part is that to go there I have to be invited for the students that are going to stay there, and I don't know them all or sometimes just don't want extra help.
The clinic.... It's difficult because I don't have an specific task on the clinic, nobody told the students that I can go and see what they are doing... so I have to ask the students before and its not that comfortable. I mean of course I will ask even if the teachers say I can, but its different when someone make more serious the situation.
The classes are the same as the first week, teacher explains and puts interesting clinical cases at the end of the class. I liked that they talked a lot about the importance of not having a traumatic oclussion, both good periodontal health and a healthy ATM.
The FOB's system is weird... I don't understand how it works. Just some teachers use the system, and you have to guess whom is going to use it. Is not like the ITESM, that you register the classes and they appear on your account... here you have to go to the library and ask them to put the class on your account... BUT if the teacher don't use it they don't let you put. I mean you can not go with them and ask them to put all the classes you will have on the semester.. they won't let you do that... so I'm not using my account because none of my teachers has not put anything in the system (until now).
Week 3
- Techniques for implant placement
- Aggressive periodontitis: Clinical charaacteristics, evolution and response to treatment
- Bone graft
- Preparation for a removable prosthesis in a 21 years old female patient.
The students prepared the patient... then the periodontist came and did the hard work.
They worked in the first quadrant, the periodontist made crown lengthening in the 1.3 and 1.5 and removed little bit of bone so the removable prosthesis will have better stability.
It was sad that the patient was really young to use a removable prosthesis
- Class V resin in a patient with widespread dental abfraction. The abfraction was minimum but what I found interesting about this case was that they made such a fuss with a resin, I mean they do really really complex procedures to stay for an hour (literally) taking pictures of the procedure.
So I couldn't resist and went with the girls to ask why so many pictures of that patient, and they answered that they document all cases of the clinic, they take sometimes more or sometimes less photos but they have a register of all patients... but the most interesting is that students don't have access to the photos, is just for the teachers because they have lots of cases presentations and they need photos.
To be honest.. I didn't like that. The students of undergraduate and graduate course and the patient stay there literally for 1 hour taking pictures of a simple procedure and the teacher don't even went and check if the procedure was going well.
Once again I'm appreciating my teachers from ITESM, they are always helping us without having something in return.
- Final placement of a full porcelain crown (with Multilink from Ivoclar)
Now I'm having homesick.... I miss my teachers, my classmates, my patients, my CAAD, my two-hour classes, what I miss most is be working at the clinic... not just walking like a zombie watching what the others are doing.
Week 4
- TMD; Disc displacement with reduction and without reduction
- Characteristics of periodontal problems in patients with syndromes and systemic diseases.
- Placement of two implants in the 4th quadrant
It was my lucky day! I was at the clinic when a girl said: "Ann Leeeee I need your help" then I ran and help her putting all the sterile materials on the table. I didn't know how was the infection control protocol in that case but I was putting attention to every step.
The student prepare everything then the periodontist came, she checked that everything was ok and helped with missing things.
Then she started putting the anesthesia (btw they don't use local anesthesia), opened a flap and start cleaning the area to put the implants. It looks sooo easy.... she put them both in like 30 minutes!
AND I passed the implants to the periodontist, so i felt I had worked.
- Went to x-ray area to help taking periapical radiographs in a new patient (they always use x-ray film holder)
Week 4
Holydays from 02/09/13 to 06/09/13
Week 5
- Dental implant abutments
- Neuropathies of the TMJ: Diagnosis, monitoring and treatment.
- Characteristics and management of quadriplegic, paraplegic, autism patients and other disorders
- Testing and adjustment of a removable prosthesis
I just love this box!!
- Conduct impression (for a metallic tooth post) and acrylic provisional tooth post.
- Begining of my rotation in the odontopediatrics area of the Hospital de Rehabilitação de Anomalias Craniofaciais da Universidade de São Paulo or better known as Centrinho (http://www.centrinho.usp.br/)
Finally I got to see something of odontopediatrics!! And couldn't be at a better place... in centrinho only seem patients with cleft lip and palate.
(The parents always stay during the procedures, so I think I wont have pictures of the patients... I don't know if is possible or not to take pictures but I think its uncomfortable for parents and they are more receptive because of the facial defect that the cleft lip generates)
The area of odontopediatrics is really small, they just have 6 students at the speciality and the three doctors that are just checking the procedures... but in one day they saw about 15 patients or more! At the end of the day my legs were tingling.
Some of the procedures I saw were:
- Extraction of supernumerary and a 5.3 in a super cooperative patient (before the anesthesia they act like they are putting the anesthesia without the needle, after a minute acting, they put the real anesthesia with needle, note. they don't use topical anesthesia)
- Sealant and behavior management in a 4 years old patient, with a uncooperative conduct (she was crying and screaming like crazy)
- Extraction of a 7.4 and a resin in the 1.2
- Conditioning consult (they explain all the procedure and act like they are doing a real one, so the child lose the fear to the treatments) and after that they did a sealant.
- Restoration with glass ionomer
- Sealant with glass ionomer
- Amalgam in a 3.6 (In the 2020 the amalgam placement will be banned in Brazil)
- Extraction of a 5.4 and 5.5
- 2 pulpotomies in the crazy girl from the morning, this time she was the perfect patient! she was super cooperative! They do the pulpotomies without any complication, then obturated one with ZOE for a crown and the other one with amalgam
Week 6
- Fixed prostheses supported by implants
- Bruxism and his affections to the TMJ: diagnoses and characteristics of these patients
- Resin in a 3.5 and 3.6
I'm impressed about how they find the specific instrument while working. I rather like our large and organized dental cassettes!
- My second day at Centrinho was very different from the first one... the first one was crazy!! I saw all kind of treatments in a couple of hours... this week was different.. just a couple of procedures and very simples:
- 2 restorations with glass ionomer (they said that they use a lot glass ionomer instead of resin because they are patients what don't have access to pay a dental consult every time to check if the resin have a filtration or something, and that they only use amalgam when the lesion is big enough to use it)
- A pulpotomy filled with glass ionomer
- Amalgam preparation. The procedure was very simple, but it was the first time this kid was anesthetized, at the beginning he was very cooperative, until the moment he start feeling the effect of the anesthesia; he starts crying and don't let anyone continue working... they had to talk to him and explain what was happening but it takes 2 hours to finish the procedure. It was interesting this case because you don't expect that anyone can feel that uncomfortable to be anesthetized.
- Diagnosis in a patient with a syndrome, his file contains 8 big folders with lots of information, so the Dr. decide to see the patient, talk to the mother and then read all the most important information of the folders. The kid was very intelligent, but a first sight you could say that he has a very severe mental retardation. He could not close his mouth and had difficulties with the movement of his facial expression. I did not want to get that close because the mother was kind of uncomfortable with a lot of people next to his son. So i decide just to be close enough to hear how to treat a patient with that disabilities.
- Sealant with glass ionomer
Week 7
- In the class of osseointegrated implants we saw clinical cases, the Dr. showed photos of how the patient came and how was the treatment finished. He also talked about how he planned the treatment and why.
- TMJ class;
- First a phD student talked about some important concepts while planning to do a research (I don't understand why they gave that class, because all the students have minimum one research.. but was helpful to refresh those concepts)
- Then they talked about the different treatments for the different cases of dysfunctions in the temporomandibular joint
- Periodontia III; The teacher talked about when to catalogue a patient as with metabolic syndrome... when are normal and when altered the levels of triglycerides, HDL, LDL, blood pressure, waist circumference... And how the metabolic syndrome affects the oral health of the patient
- Clinic: Change an amalgam for a resin
- Clinic: Continue the treatment of the patient from the last week (the one that took the conduct impression for a metallic post). The thing was that she fractured the root, was after looking for options the doctors decide that was better to put an implant.. It takes all the morning for them decide what was better for the patient. It was sad, but it was also the best option for the patient. Ps. I think the provisional post, with the clip and acrylic was the problem.
The third week at Centrinho was with a lot of work!!!
-First came a patient with a little fracture in the 1.1 so they put a little bit of resin
-Then a patient with a big caries, they removed the caries and put amalgam in the occlusal area.
-An other patient came with a 6.4 and a 6.5 without mobility and caries so they removed them
-Then came a patient with a 7.5 with caries and while preparing the piece they communicated with the pulp.. so they did a pulpotomy and filled with IRM
-In the afternoon came another patient with extensive caries in the 4.4 and the 4.5; In the 4.5 they can remove the caries, did a pulpotomy and put an amalgam. But in the 4.6 the caries was subgingival so they have to remove the piece.
- Restoration with glass ionomer in a 2.5, this procedure take a really long time because of the conduct of the patient... It was like she was being exorcised
-An other interesting conduct control case. It was a 3 years old patient with caries in lower incisors; three of them have to be removed because of the extension of the caries. So they use the "Tecnica encimatica"; the mother put on top of the child and immobilized him with his arms and legs. It was crazy, the child crying and kicking, the mother holding him, the dentist working, blood everywhere, snot everywhere... but it was the best way to end the day! After all, the kid have a kiss to the doctors, hug his mother and i think he slept all day long.
- Public Health activity:
- We went to the "Casa dos Garotos" that is a house supported by the church where mothers that have to work with their kids.. they have different activities; have classes of football, kung-fu, jazz, and also teach them how brush correctly their teeth and have a clinic form the FOB inside the "school"(there have a Dr. that do some treatments, but is really sad that they have 6 dental units without people to work on them)
After a tour around the "Casa dos Garotos" the students start working, they have two activities:
1. To strengthen and correct brushing technique of a group of kids
The activity was that the kid brush his teeth, then to put plaque identifier and show the areas that have to clean better.
2. To calibrate the students to do a research in the school, they answer some questions of general oral health of the patients (6 patients for a 4 couples of students)... The propose of this activity was to see if all the students evaluate equal or alike the health of the patients.. if this activity have more than 80% of reliability.. the next step is start with the research. If not, the next step is to give a training course so all the students evaluate the same way.
Week 8
Week of midterm exams
-30/09/13 Osseointegrated implants
-01/10/13 DTJ
-01/10/13 Periodontia III
-05/10/13 27o Congresso de Odontólogico de Bauru
The symposium was based on the importance of the quality of life.
The first talk was about geriatric dentistry, she start comparing pictures of people form the same age just with a different lifestyle; The most shocking was the comparison between a monk and an indian, the indian look so much older!
Then the Dra. Maria started talking about how the body gets older, that is a normal procedure of life but you can get older in a healthy way... About what happens with the hearth, the bones, and all the internal organs. She talk about the classification of elderly and its importance when doing an research.
Then she start talking about the most common diseases in elderly patients; audiological impairment or hearing loss, visual loss, tooth loss (that produce higher risk of infections and body mass loss), gain of fat and higher risk to be obese. The importance of exercise and health diet to reduce weight and have less pressure in the knees, bones, blood pressure, cholesterol, lower risk to have diabetes, and so on.
Then she talked about smoking and how it affects the health of the patient.
The Dr. Heliton talked about the principal pathologies now days.
Cardiovascular disease, the exams to evaluate and the reference values, hypertension its exams and reference values, diabetes its exams and reference values.
Then about the most common kinds of cancer; of colon, prostate and lungs. After that he started talking about the intraoral cancer, how to evaluate, how to treat the patient, the remove the lesson and mention some of the cases he has treated.
The Dr. Alvaro talked about stress and happiness.
I loved his talk. He is vascular surgeon and he is the most calm and relaxed person i have ever seen!! Fist hi put a picture of a tiger attacking; he describe the physiological process of an animal when is going to attack, then compare with the process in a person under stress. The effects of adrenalin in the body; dilatation of pupils, accelerates the hearth rate, increases blood pressure, tachypnea (more oxygenation and glycolisis), secretion of gastric acid to digest food faster (but actually it produce ulcers and gastritis when a person live under stress).
He talk about how important is this process in our life but also talk about the disadvantages of being everyday under stress. He also said that the stress can affect on the immunological system, reduce the defenses and it can be a cause of cancer (but still not proven).
He close the talk giving some tips to have a better life; Free of stress...
-The most important is to do exercise; Minimum 3 days a week, the fat burning initiate after the first 20 minutes of work, he also said that is better to go 1 hour 3 days a week than half and hour 5 days a week! It is important to do everyday stretching (even the animals do that every morning).
-Have a healthy diet- he mentioned that the mediterranean diet with a lot of chicken, fish and olive oil and nuts is a good for a better health. An other tip was to divide the total of calories in 4 or more times. Eat a little bit but more times a day.
Avoid living fighting with the clock every day, to organize better our tasks and stop thinking that we are superman and we can do everything in a day, because in a long term it will affect our lives.
Also recommended to have a hobby, meditate, like our work (and if we don't like it, to search for something that we love to do and that requires an effort to do it, so we have everyday a motivation that makes us happy).
Its important also family, friends, religion, and love.
Learn to accept the things we can not modify and to do something about the ones we can modify.
I felt that this talk was more for the professors and students personal life than to the health of the patients. I feel that having dentist with a good lifestyle will make our service better, so the we can make good decisions about the treatments of our patients. The world will be better if we have people happy and free of stress... a better health, better lifestyle and better persons to live with!
Week 9
- Osseointegrated implants: Practice in the laboratory about the placement of screws of an implant and the final impression to do the prosthetic part. They give us a real implant and a typodont with the implant already there. We put the screws then take the impression with heavy and light silicone. Before the practice they explain how to do the work and the name of all the parts of the screws.
- Diagnosis by radiographic images; Interpretation of a temporomandibular dysfunction in a panoramic Rx, MRI, computed tomography (cone-beam), conventional tomography and transcranial Rx. The professor put some images and explain how a healthy TMJ look and the anomalies we can found in the radiographic images.
- Down Syndrome and its relationship with the periodontal disease. He also talk about behavior management (A tip he gave us was to bring cards with faces to have a better communication, he also said to always put attention of their face and how they are feeling because its common that they felt pain and don't way anything) He also talk about other characteristics of the health of these patients.
- Clinic. I helped a girl taking a impression of a screws of two implants (the same thing we did in the practice in the laboratory on monday). She immobilize the screws with acrylic and floss, then take the impression with heavy and light silicone.
- Clinic. Resin placement in a 3.6 with caries in the occlusal area.
- Clinic. Extraction of a 4.6 due to periodontal problem, without bone support.
- Clinic. Root canal treatment in a 2.4, he have periapical abscess so they leave it with formocrezol and next week will finish leaning the root.
Week 11
- Osseointegrated implants. Peri-impantitis. How it looks (pictures), how to diagnose it, and how to treat. She mention that is really really important while cleaning the area not to remove the surface of the implant because there are two objectives while treating periimplantitis: 1. Stop the periodontal disease 2. Have a regeneration of the damaged tissue. So if we remove the surface of the implant we can not get the regeneration of the tissue.
- TMJ. First he gave a general talk about pharmacology and then focus just in the treatment of the dysfunction of the temporomandibular joint when is a chronic or acute problem (with drugs).
- Periodontia III: She talk about the diagnostic test like blood count and its reference values, different exams to evaluate the health of the patient while, during or after a treatment. That is very important knowing the reference values to know when something is going wrong with our patient even if its doesn't affect directly in his/her oral health.
- Clinic. Extraction of all deciduous teeth in a patient with a several periodontal problem. They remove 8 pieces from her upper jaw; all of them with little bone support or nothing. She was talking and the pieces where moving, it was easy to notice that because most of the pieces where in the anterior area. After doing the extractions they put an immediate temporary prosthesis (una protesis transitoria inmediata).
- Clinic. Change an amalgam to a resin in a 3.4 just for esthetics (in the father of a student)
- Clinic. Impression of 8 anterior pieces with a interesting technique; he first put a layer of wax in all the pieces and then start doing kind of a helmet with acrylic. After doing this he put a number in all of them and when the patient came he put impression material inside and then take the final impression with alginate
Being honest I don't like this technique and he agreed but he said that its a more precise technique, ideal when need a impression of lots of teeth.... So now i know another way to take impressions for a lots of teeth.
- Clinic. Final impression of a 3.6 for a porcelain metal crown. With the technique I know, with light and heavy silicone.
Week 12
- TMJ: Practice to evaluate the TMJ between students. We identify the degree of mouth opening, then if while opening have a sound or not (with or without reduction), ask if feels pain and evaluate the masticatory muscles.
- Periodontia III: Oral manifestations of systemic diseases. Clinical characteristics of the lessons, characteristics of the histopathology, pathology, when appear and what stimulates their appearance (pemphigus, desquamative gingivitis, lichen planus, pemphigoid, lupus and diabetes.
- Clinic. Implant placement in the area of a 3.6
- Clinic. Root planing
- Clinic. Impression with alginate to do wax diagnostic in the pieces 2.3 2.2 2.1 1.1 and 1.2
- Clinic. Root impression of a 1.3 to do a metallic post.
- Corrective surgery: Congenital and acquired craniofacial anomalies. Examples, brief explanation of treatment and videos of surgeries
- Symposium by 4th year students from the FOB, topic: Relationship between cardiovascular diseases and periodontal disease.
- Clinic. Conduct impression and acrylic provisional tooth post of a 1.4
- Centrinho:
- Diagnosis in a patient with low develop of the maxilla, had bite class III, but without any caries or periodontal problem. They did a prophylaxis and then they will treat her in the surgical and orthodontics area
-Behavior management in a first time at the dentist patient (5 years old, in centrinho they start the treatments at the age of 3-6 months, so she was kind of old to not to have any treatment/surgery). She came to the consult without any cleft lip surgery (honestly at the beginning I was kind of shocked but after a couple of minutes I realized that she wasn't feeling any pain and had live like this for five years, so I relaxed and see her like any other patient).
They started with the conditioning consult part, then did a prophylaxis. Then the behavioral problems started... we have to ask the mother to wait outside and immobilize the girl, the dentist shut her up and talk strong in her ear that who rule is the dentist and she have to cooperate to finish the procedure quickly so she can go home (Generally it works with almost all the kids, but she was the exception and became even more crazy. We immobilize her again and then something happened: one of her shoes fly away and I saw her fused toes, I didn't understand why but after watching carefully saw that she had very little hair, watery eyes, fractured teeth, and dental hypoplasia. She had ectodermal dysplasia.
-Diagnosis and conditioning consult in a patient with creaneostosis frontonasal. She had lovely behavior but at the beginning it was difficult not to notice the abnormality of her skull. After a couple of minutes I get used to her and was enjoying how happy and smiling she was.
-Extraction of a 2.6 in a patient of around 9 years old, he had an extensive caries that was in the occlusal and distal area, and also subgingivally.
-Resin in a Japanese 5 years old patient, she was accompanied by dad. The interesting of her was that she didn't say a word during the procedure (and also before and after the procedure, not even a smile or angry face). The father said that she do talk and hear well, but she was kind of "shy". I think she shyest person I've ever seen in my life!! The only way to know if she was ok or suffering was by seeing her hands gripping the chair or relaxed in her tummy. Anyways even if she was shy or not, she was a great patient (I think the perfect pediatrics patient, loool cooperative and quiet)
-Diagnosis in a patient with cleft lip, he didn't have any caries, but anyways they ask the mother to take double care of his teeth because he have a marked hypoplasia.
- 7 years old patient, very attached to his mom (he came to the consult in her arms... literally). From the beginning I thought the behavior management it was going to be difficult... During all the consult the mother was taking his hand (even if was saying every 5 minutes that her back was hurting lool). At the beginning the kid was crying and wasn't hearing indications but after feeling the effects of the anesthesia he started being cooperative, friendly, talking and talking until he fall asleep. They just did an amalgam.
-The same patient with ectodermic dysplasia from the day before came in to the consult. She was smiling and very calm... so they took advantage of her good behavior to give another conditioning consult so then they can start with the procedures. But in the moment where the instruments touch her mouth she became crazy and start crying, creaming, kicking, and all the other exorcist attitudes. She didn't leave them do any treatment so they decide to do all the treatments together under general anesthesia (she didn't understand or hear while explaining, she have a really bad behavior, bad hygiene, she had never received a dental treatment, and she did need lots of treatments!!.. so I think was the perfect solution for her)
- Prophylaxis in a 10 years old patient
- The same patient that came into the mother arms came into the consult, but now with better attitude. He acts the same way that he acted the day before; came calm into his mother arms, sit in the chair (he tried to be cooperative but he failed), he started crying, moving, talking, they finally managed to put the anesthesia, and after a couple of minutes he started friendly talking and finally got sleep. This time they realized the placement of HCa and glass ionomer in a 3.5 with a huge caries and in the 3.6 while cleaning the area the communicate with pulp so they did a pulpotomy and then obturated with amalgam. It was difficult to wake him up after finishing the procedures, the mother was really happy that she didn't suffer this time.
- Five years old patient with decreased growth and micrognathia. They don't know yet what problem she have but she is under observation (I found interesting that when they find something different in a kid they left them in observation because they have lots of syndromes that are manifested after a couple of years. She was a very cooperative patient so they did two amalgams, this time.
-13 years old patient came into the consult because she was planning to start with orthodontics treatment. This day they put 3 glass ionomers in the occlusal area of the 3.4, 3.5 y 3.6. She was in pain, and Im sure she stand it because she was desperate to begin with the orthodontics. I only saw her bend the toes and grabbed strongly the chair. When the dentist ask her if she was feeling pain or want to finish in another date, she just said no and smile. A brave girl.
-The same patient with decreased growth came into the consult to do 2 pulpotomies (as I said before she was very cooperative). They did one in a premolar and other in a molar. After the pulpotomies they placed amalgams in both pieces. And she was free to go home and came just for her check-up's.
- Diagnosis consult in a 4 months old baby with cleft lip. He also have a syndrome but I couldn't find out what was. He was doing a weird noise and didn't have any control of his head. The dentist explain the mother how to do the intraoral hygiene, how to clean the palate, gum and recommended to use the paste malvatrikids without fluor.
- III Simpósio Internacional de Fissuras Orofaciais e Anomalias Relacionadas HRAC
-New evidence on the clinical results of Nijmegan Protocol for CLP.
Dra. Anne Marie Kuijpers-Jagman
-Managment of speech disorders in cleft lip and palate.
Dra. Kathy L. Chapman
-Advances in the area of stem-cells related to cleft lip and craniofacial syndromes
Dra. Daniela Franco Bueno
-Worldcleft: An international Task-Force of Management of Cleft Lip and Palate. Challenge and Organization for BrasilCleft Task-Force
Dra. Gunvor Semb
-Treatment protocol for lilateral cleft lip and palate
Dr. Willam Shaw
-Trask force BrasilCleft: Interdisciplinary activity between plastic surgery, fonoaudiology and orthodontics.
I really liked the symposium but it was difficult to understand everything they said, they talked a lot about protocols, about their organization, and obviously this symposium was for specialists (plastic surgeons, orthodontists and phonoaudiologists). But it was very interesting to learn about the work they do and have the opportunity to be in a international meeting in one of the the best cleft lip centers of Latin America.
Week 14
- Symposium by 4th year students from the FOB, topic: Relationship between diabetes and periodontal disease.
- Preparation of a 3.6 or a porcelain metal crown and acrylic provisional crown
- Scaling and root planing of anteroincisors
- Centrinho:
-Patient with bad hygiene and high rate of caries went to the consult. They remove caries of a 6.5, from the occlusal and distal and then obturated with glass ionomer. Then they did the extraction of a residual root of a 1.5
-Cooperative patient came into the consult. Due to his good behavior they did all the procedures at one time: Remove caries from the occlusal area of a 4.3, 4.4 and 4.5 then put HCa to protect the pulp and obturated with glass ionomer. In the 4.6 they also put HCa to protect the pulp but in this case use amalgam due to the extension of the preparation.
-Placement of glass ionomer the 5.3 of a two years old patient. Because of the difficulty of the management of his behavior while putting the glass ionomer was very difficult to control the humidity. But the most interesting of this case was how they immobilize him; they ask the mother to put his body in his legs and to hold his arms, another dentist take the head, and another put the glass ionomer.
-Prophylaxis in a 15 years old patient with severe crowding and absence of the 2.2 (she is in waiting list to start her orthodontics treatment)
-Extraction of a 3.3, 3.4 and 3.5 of a patient with high rate of caries. Complex management behavior (I think its because the parents are very very apprehensive). The procedure that should last 1 or 2 hours, was extended to 5 due to his behavior.
Week 15
- Presentation of a clinical case from the anamnesis until the results after the placement of the implants and the rehabilitation.
- Symposium by 4th year students from the FOB, topic: Relationship between metabolic syndrome and periodontal disease.
Lucy loves plants so she decided to put plants in every space she found, that gives the clinic an atmosphere of peace and quietness.
To remove it it helps to use air with pressure, that decrease the negative pressure between the plaster and the alginate
Define the limits of the preparation
Put resin but respecting the limits that were drawn before . Design whit the resin a thicker part on the top to have retention while taking the impression with silicone= that will be the guide crown
Remove the plaster, it can be also removed with the cavitrionPut the guide crown in the prepared tooth and then take the final impression with heavy and light silicone
