heyday

assalamualaikum wbt

it has been quite long since my last post.its a week ago.

Cerita-ing the whole week i've gone through...hm, lets start with fisrt clinic, which is..

Radiology

The current went out, we went back home. Hey!

Prosthodontics

My patient came at 1030 coz i thought there'll be patient for my partner who share the unit with me, but unfortunately there's not. So then, with Mr KS, which i called im 3mmu, the best patient ever, we did lower jaw registratio. it goes like this : check does the lower and upper block occlude correctly (touch each other), then trim if there's excess until they occlude correct ; mark incisal and canine line ; register his RCP(rest centric position) which is his centric relation, by asking the patient to close/open his mouth while we put thumb and index at sides of his mouth. Seal that relation between upper and lower ; send that block to lab!

And the lab procedures was setting teeth and THAT was horrible, its like overtime working.no money paid except if u done with ikhlas, pahala awaits.

Paediatric Dentistry

comella ape lagi. Jumpa this 11 years old boy who had malocclusion and that cause trauma to his anteriors.

Perlu buat fluoride gel application. For surface caries, treatment is PRR, while teeth 4,5,6 without surface caries, do fissure sealant. Fill in diet sheet and write oral hygiene Instruction for the patient.

Surgery

Secara kasarnya, i didnt do anything , just see....coz i had done almost everything required. Bagi peluang kt org len..

Conservative Dentistry

Did replacing of temporary fillinf, restored with composite. Need more patients pleasee!

Baru-baru ni rasa kosong tetiba, call rmh then ok pulak. Alhamdulillah. Ye la, family tie kena jaga wherever u r.

so now, c ya bloggie!

4th appointment - complete denture

assalamualaikum

Hari ni saya perlu buat jaw registration. Pakaikan record blocks yang dah dibuat bersama technician sebelum ni pada patient, dan sesuaikan beberapa aspek mengikut urutan :

(maxillary)
1) labial fullnes. Sentuh dengan jari pada bahagian flanges (dari luar mulut patient), dan lihat dari luar....wax/acrylic pada bahagian luar terlebih atau kurang. Trim sampai sesuai. Kadang-kadang kita perlu buang terus bahagian labial . Its okay, sebab actually pada lingual/fitting surface between plate and cast ada space yang terbentuk lepas kita letak wax for block out...so space ini akan bertukar jadi acrylic masa last procedure untuk membentuk denture nanti.

2) cek ala-tragus line using fox plane. Tengok sama ada plane tak parallel dengan fox plane. Betulkan dengan mencairkan wax. Masa guna hot plate, pastikan menyentuh semua bahagian wax pada plane, sebab nak bagi wujud plane kat situ.

Kadang-kadang, fox plane rosak. Kita tengok muka patient dah ok, tapi bila guna fox plane jadi tak ok. So leave it. kalau patient ada old denture, amik denture tu dan compare.

Guna fox plane untuk cek - betul-betul hadapan patient, kiri dan kanan.

3) Vertical dimension. Tandakan point pada nose, tandakan juga pada satu pembaris/tongue depressor. Minta patient relax, tandakan pada chin pula(dan pembaris). This is vertical dimension at rest (VDR).

VDR-VDO = Freeway space, about 2-4mm.

So tanda siap-siap 3mm(average), the estimated VDO, then cek lagi pada patient.

Visibility of upper denture juga kena tengok. For old patient, about1-1.5 mm is visible.
19-20 years old, about 3-5 mm is visible.

4) Check lower record block. Height should be at the level of 2/3rd of RMP. Check juga kalau posterior border of record block hit the upper one, so should trim if there's any.

5) Mark incisal line (middle of face, not middle of nose) and canine line ( distal of canine is at angle of mouth, while cusp tip of canine is marked from line connecting middle to ala of nose).

6) Pilih mold (bentuk gigi) and shades yang patient nak dan sesuai untuk dia.

Let the technician to do setting of teeth and mounting.

Next, leh buat appointment baru!!!

Tapi tadi, saya tak habis pun. Biasalah, first time buat denture, macam-macam perlu belajar. Nasihat untuk diri sendiri, pandai-pandai cari assistant. A good assistant is :

- seseorang yang mendengar kata
- cepat melaksanakan tugas mengambil barang dan kerja-kerja membantu(hence, assistant the name)
- tidak membuat sesuatu yang dentist tidak suruh
- tidak cuba mengambil kesempatan terhadap patient (the patient is for the dentist, not assistant)
- tidak berlagak seperti dentist (bagi isntruction pulak dia)
- mempercepat kerja dentist.

so, hati-hati ya!

first pedo clinic and first extraction

yesterday i had paedodontics clinic.
Mula-mula tak dapat patient, so we decided to ask our arab friend, Madiha to translate the form for paediatric clinic. Jom blaja arab :
كم طولك؟
كم وزنك؟
من معك؟
ليش ما حدا جي معك؟

متى بدا
قوة الألم
تأخذ أدوية بالعادة
أخذت أدوية موءخرا
أشيأ تقوى الألم أو تخفف (تقلل)

كيف كان طباع مرة ماضية بالعيادة؟ كان يبكي أو عادي؟

عندك حشوات؟
كم مرة تفرش أسنانك باليوم؟
اسمك دل
شو مادة مادة أنت تحب أكثر؟
تلبيسة
بالدار

Berapa tinggi kamu?
berapa berat kamu?
Who accompanied you?
(.. ma hada jay ma'ak) Why there's nobody come with you?
When does it started?
Severity
Do you take medication regularly?
Did you take medication recently?
Apa aggravating and relieving factors?

Apa perangai sebelum ni di klinik? Menangis ke, biasa je.

Ada restoration ke?
Berapa kali gosok gigi sehari?
your nickname?
Subjek apa paling suka?
Crown
(Biddar) Di rumah. Jordanian sebut camni. (sama je maksud ngan bil bayt)


Really interesting, blaja bahasa arab 3ammi ni, pasal kita terus praktis lepas tu.
My first paediatrics patient is a 13 years old boy. He doesnt own a tooth brush and we had to teach him how to brush and all that. He is from a poor family, and i feel lucky to get a case like this.
Bukan senang kita nak jumpa dengan kepelbagaian jenis manusia. Tahts why sy suka amik kos medical/dental yang deal dengan manusia. Kita akan lebih dekat dengan chance untuk membantu banyak orang. Kita akan lebih dekat dengan orang susah dan peluang membuat kebaikan itu lebih banyak, di samping perspektif masyarakat yang selalunya akan dengar cakap doktor. Betul tak?

Budak ni, ada cam problem family. He smoke.Heavily. Although baru form 1 kalau kat msia. Well, dia still bagi good co operation, dan wajah dia bagi saya, innocent. Siap risau-risau lagi lama sangat ayah dia tunggu.

Kat luar lepas habis, budak tu kena marah sikit ngan ayah dia. I just stood behind him, hoping that i can do something, and tell the father that we are suppose to be scolded, not the kid bcoz we worked too slowly. (apa nak buat, first time buat fissure sealant kan)

Next time, i really wanna be a kindhearted dentist, dan nak menyelamatkan keadaan-keadaan yang zalim seperti tadi.

Fissure sealant : senang je..1) moisture control 2) acid etch, leave 20 second 3) wash with air and water 4) moisture control again, suction. 5) apply fissure sealant, cure for 20-60 seconds 6) check with articulating paper....if there's bluish spot marked on that teeth, trim it with white stone bur.

lagi bahasa arab : tedrusi kathir 3ashan lamma tekbari, siri duktur. (belajar banyak2 supaya besar nanti leh jadi doktor!)
Pedo clinic sangat bahagia pasal kerja senang, pstu leh main ngan budak2. eeiii...comel banget!

Today, surgery clinic

Saya jadi assistant for history taking. Then saya buat extraction. Oh fuhh..

This case, there's remaining root after broken crown. Remaining root sangat menakutkan sebab takde root mass utnuk grasp, dan fracture akan lebih tinggi possibility. And THAT what's happen just now. scary!

Belaja arab jap:

Jordanian panggil Paracetamol as Revenin.

First is detachment. That Majister Duktur did almost everything as it is my first case. kerja robek-merobek pun bermula. Masa nak cek dah bius ke tak, doc tu just cucuk gingiva with probe yang tajam. Ei, rosak anak orang! hehe...but u know, kita yang terlalu sensitif, padahal patient tak rasa apa, and the healing process will be like 5 minutes mayb. So start detachment, guna tweezer. Masuk dalam sedalam yang mungkin, sampai boleh agak-agak forccep for remaining root bleh masuk and grasp the root. Palatally pun buat gak. Sangat perlu berani dan campak rasa takut patient, pasal kalau takut, tak tercabut ar gigi tu.

Pastu dah grasp, rotate that root. Then move buccally and palatally, masa ni lah saya ter tarik gigi tu.....fractured root! Adess...

And the rest is done by that doc. Ada sampai satu ketika, tweezer tu masuk sampai gingiva tu timbul-timbul pasal tweezer kat dalam. Ngeri!
Lagi satu prob yang menyebabkan susah sangat root nak kuar is ankylosis. Sebab tu lama, tapi akhirnya kluar gak ar.
Support mesti ada guna tangan yang lagi satu, pada alveolar bone. Masa usaha mencabut gigi tu, the bone around the root memang membesar sebab kita dah expand that bone.

Pengalaman lagi satu ialah tengok anxious paediatric patient yang nak cabut gigi. Psychology sangatla penting pasal kids takut dentist okay. Kalau dia takut ngan kita, panggil big boss(kononya)...contohnya rakan dentist yang agak besar badan dia ke...baru budak takut. Lagi, biar dia main-main ngan instruments yang ada. Jangan bagi budak tengok darah, diorang takut!

Next is, kena baca buku laaa! Especially surgery, rasa cam persoalan mamin banyak bertambah-tambah kat kepala bila dah buat praktikal nih...
Jom study!

half a smile - second attempt border molding

hari ni sambung border molding. Dah boleh senyum sket sebab kat rumah dah practice tangan kawal sticky wax. (very the sticky!)

so sebenarnya green stick/sticky wax tak boleh dipegang guna tangan/glove/apa-apa yang kering sebab akan melekat. especially the gloves that you are wearing. Susah nanti kalau terlekat. Air perlu warm, supaya sticky wax tak cepat keras, but at the same time boleh buat masuk dalam mulut patient without burning his gingiva.

So sebenarnya the key is, tenang. Tenang saja dalam mengawal sticky wax.

Kemudian, border mold using your hands, pull the patient's cheek, lips and muscle gently dan biarkan muscle dan segalanya dalam keadaan normal. Ask the patient to relax.

For lingual side (lower) : protrude tongue, move sideways.
RMP (for recording massetric notch) at lower : open and close mouth, also close mouth while preesing the denture at RMP (closing under pressure)

To record coronoid process, (upper) : move mandible sideways
Buccal frenum : move cheek anterior and posterior

lepas dah buat kat semua site ikut Boucher's sequence, panaskan semua green wax yang dah di border mold kan untuk last touch up. Masukkan lagi sekali kat patient's mouth. Pastikan semua sticky wax kat tray tu smooth, dan record aspect penting : massetric notch, frenum etc.

Kalau ada bahagian yang not smooth, mesti salah, so ulang balik by panaskan the wax and masukkkan dlm air then masuk dalam mulut patient.

Fuuh, siap pun border molding.
next is preparing for secondary impression.
Zinc oxide eugenol. Campurkan zinc oxide and eugenol , satu line setiap satu. Gaul cepat2, then letak kat tray. Masukkan tray dalam patient's mouth dan border mold patient's tissue and muscle macam sebelum ni. Kita tak mahu ada zinc oxide kat bahagian green stick. (sebab kita dah buat seal yang betul sebelum ni). Jadi, tekan betul-betul tray supaya lebihan zinc oxide akan keluar dari tray, tidak duduk di bahagian green stick.

(sebelum ni, masa da habis border molding with green stick, tray patut stay kat mulut bila dibiarkan , dan tidak jatuh bila ditekan kat handle)

Thats all, next is jaw registration. (but before that, kena buat..bite block?-- yang tak perlukan patient.. study dulu!)