Private Clinic T&T Odontologia

Week 16

Visit to a private clinic where combined odontology and psychology:        

               

   

The Dr. Mauro Teixeira gave me lots of helpful tips while doing restorative procedures:

• While doing a final impression 

• Take impression of the piece with light silicone 
  
• Then put it into a small piece of plastic to manipulate it better
• Then fill it with plaster using a sharp object to avoid bubbles
• 
   Fill it with plaster leaving a way to manipulate and avoid that the plaster get all around the silicone so it have less retention
  
  
  
  
  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 cavitrion 
  
  Put the  guide crown in the prepared tooth and then take the final impression with heavy and light silicone
  
  

• Tips while taking a impression with alginate
• It it helpful to use a thin instrument while putting the material into the patients mouth, use the instrument to retract the cheek.
• While taking the impression ask the patient to breath by the nose and to lift one foot so it decrease the risk of feeling nausea
• While removing the impression its helpful to use pressure air under the alginate so it reduce the negative pressure between the teeth and the alginate 
• Always wash the impression after taking it out of the patients mouth 
• If you don't have time to go and put the plaster in the impression, to keep the humidity it helps to put the impression into a plastic bag

• Remove the excess of alginate to make the impression easier to manipulate and more beautiful. 
• To avoid bubbles it helps to put fluid plaster in the impression then shake it a couple of times, the Dr. Mauro calls it plaster shower  

After that put the plaster slowly leaving time to the bubbles get to the surface 

• While doing absolute insolation 
• A glove can act like the gum, if you don't have a gum or having troubles with it you can replace it with a glove 
• To perforate the gum/glove you can use a clip, first put the clip tip on the fire and then put it in the are where is going to be the clamp. It decrease the risk of smudging. 

        

• Tips to do a accurate and beautiful provisional 

Take the impression of the piece and put it into a small piece of plastic to manipulate it easier 

Put a conducting wire because its going to be in a solution of chromium sulfide 

Put silver powder in all the preparation and one line outside that links the conducting wire and the silver inside 

Put in into the chromium sulfide solution 

 

Fills the cavity with acrylic  

Put in the middle of the acrylic a metal stick so it will be easier to manipulate it  

 

 

Acrylic shell  

• I also saw how a caries, a dental calculus and a fracture looks with the optical fiber.
• He showed me how to do the anesthesia without any pain!!!! He did the morpheus anesthesia technique. Put the needle super angled and put very slowly the anesthesia, in the palate. The patient dont even say a word, she taught that was the topical anesthesia (btw he didn't put local anesthesia). I couldn't believe that that was possible, in the palate, don't feel a thing and he did with that anesthesia by the palate, the preparation for a crown of a superior premolar. 
• The Dr. Mauro also teach me how to talk to the patients, how to treat them in the first time consult, how to explain correctly their treatment, and how to make them understand the importance of following up their procedures and preventing the appearance of new problems. 
• I was also impressed with the organization at the clinic. All the employees know exactly how to do their work. All the rooms have the same organization of material and instrumental. So if he have to work in one or another room he wont be lost. 

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• Beyond being a clinic with a excellent doctors, employees and an amazing organization, the clinic is also characterized for their biosafety (biossegurança). They have an strict protocol in the way they sterilize their instruments, the way they work (they use an upon glove, that is a plastic bag that stay all the time in non contaminated area, it is used to take the materials of common use without contaminating them)
• The protocol the employees have while putting the barriers and while removing its amazing. There I saw the importance of lots of details while putting and removing the barriers between patients. For example I love that they put a plastic bag in the back of the dental chair that after the procedure they use it to put all the contaminated materials (the contaminated part -where the patient was laid, so they put it in a way where they just take the clean area and carried out of the room to the garbage)

• While I was in the clinic the Dra. Liliana Junqueira (biosecurity consultant from the company Cristófoli http://www.cristofoli.com/cristofoli/en/pdf/lilianacurriculum.pdf ) went to the clinc to supervise how biosafe a new employe was doing her work. I was impressed because I thought she was doing it perfectly, but she wasn't weren't. She found that they were putting one soap and it have to be another one, that the thing to cut the bags to sterilize wasn't cutting well, she put a stick to evaluate how the autoclaves where working, and I thing that was all. 

• In that moment I learning the correct way to do the sterilization of the instruments, that the contaminated material have to be in one side, when it comes to the room its important to put it into the chemical solution, then clean it with an specific soap, then in the ultrasound, when its dry to put it in to bags, and cut it properly (waiting 10 seconds to get well sealed), look for bubbles (if it have bubbles do it again) , them put it in the autoclave without touching the walls and with the blue part looking to the floor (and don't  superimpose them). After finishing there put them into the clean area. 

                                      

• The Dr. Mauro has been interested in this topic such a time ago 

• Another characteristic of the T&T Odontologia is that they combine the psychology and the odontology 

The Lic. Lucy Texieira is the wife and administrator of the clinic. Beyond doing the administrative part of the clinic, Lucy is responsible of the decoration and organization form the clinic. 

She loves plants and as a psychology saw the importance of make feel comfortable their patients. The patients I saw at the clinic T&T have years going there (all I saw where patients like 10 or more years ago). That is a good sign, it means that they are happy with the service. She said that they have to be strict with the patients, that the Dr. can not loose time when the patient decide not to go to his date. I have never thought that part, the patient just decide not to show into the consult and the Dr. is who lose his time and the clinic in that moment is ready to attend another person... So she said that when they have a patient that love to lose his/her date, they tell them that the next time will have to pay a ticket (half of the price of the consult), so thats how they have a little bit more control with the missed dates.

She also teach me the importance of making the patient feel special , to take note in the phone list of which day is better for him/her to have his date, send a detail or a call in their birthday, to be kind and always give an a personalized attention to all the patients.

I fond the areas so comfortable, for the patients, for the doctors, and for the employees. I was surprised with the control they have of the stock and the organization.

Lucy loves plants so she decided to put plants in every space she found, that gives the clinic an atmosphere of peace and quietness.
They have free internet for the patients (like a restaurant, jaja but I loved it) and when the patients arrives they offered him coffee, cookies, tea or water.
The chairs are so comfortable that makes you want to stay there all day long, and the magazines in the waiting room are also very interesting. Its a room that makes you want to stay there (that is perfect when the procedure is extended so the next patient don't get mad)

Another thing really cool thing is that they have the option of doing massage during the consult. I didn't try it but they said that it is amazing.

I love to met this clinic.. the Dr. Mauro and the Lic. Lucy are an amazing team! If you addition to that that they have the better biosafe consult it makes the perfect clinic.
The employees are more than a employees a family, they have a kitchen where generally they have a short talk and drink a coffee or tea and go back to work, but everyone there is happy. I found very kind of Mauro and Lucy that they have an space where their employees can sleep (because some of them have to wake up at 4am to be at the clinic on time -7:00am... its difficult while living in such a big city)

It was an adorable and amazing experience to know from the inside how a family clinic works, and that with studies, effort, organization and lots of love success comes alone.

I'm a lucky to have a family of such successful dentists