6/25/2016

DHY 281
Karlee Rainey

Journal # 2: Summer Semester

Kadyn was my patient on Thursday, June 23, 2016. He is 6 years old. Kadyn had no
known allergies or health issues. He was not taking any medications. His blood pressure was
89/49 with pulse of 96 with the radial cuff. He came in for an assessment, x-rays, and sealants. I
attempted to expose x-rays, but Kadyn could not tolerate the size 0 phosphor plate with a bite
tab, therefore, I couldnt proceed with sealants. His most current x-ray was a pano in Nov 2014
at his normal pediatric office. During this appointment I did a full mouth debridement using hand
instruments, polished, flossed, and fluoride varnished all teeth. Kadyn pointed out that tooth Q
was wiggly, but did not present a chief complaint. Kadyn brushes twice a day with parental
guidance at night. During the intra/extra oral exam I found bilateral linea alba and two 1mm
traumatic lesions on his right cheek. He also had bilateral mandibular tori as well as torus
palatinus. He had 3 loose primary teeth: Q, E, and F. Tooth 26 was partially erupted. Kadyn has
not had any fillings, or sealants. His papilla was puffy on the facial of 23 due to being newly
erupted. Kadyn was classified as a bilateral class I. His PHP was 1.8, which is considered fair.
Locations that disclosed were cervical margins, mandibular anteriors on the facial surface, and
his tongue. He had no calculus formation which put him at a class I for deposits. I described how
x-rays give dental professionals a better idea of the health of teeth. I also explained to him how
important sealant placement is to protect our teeth to prevent future decay. He was instructed to
maintain six month recall appointments to maintain health of his oral cavity. Bitewings and
sealant placement will be attempted at his next visit.

This day was a true learning experience for me. Kadyn had visited the DMACC clinic at
a previous time in November 2015. He already had background knowledge of what to expect as
far as what the clinic looked like, the use of disclosing agent, and other things that are different
from his regular dental office. I knew the last time he had been in the clinic they had attempted to
do x-rays, but his mouth was too small. Since that previous visit, #3, 14, 19, and 30 had erupted,
so I was really hoping to be able to expose bitewings and place sealants. I believe he had a little
bit of anxiety. I had him sit in the dental library with his legos and books while I prepared his op
and I think all the girls that he didnt know asking him questions made him a little nervous. He
was really cooperative throughout the process until we got to x-rays. He was really
uncomfortable when I put the phosphor plate in his mouth and the edges of the barrier were
poking his palate to the point where he couldnt tolerate the lack of comfort. He would gag as
soon as he bit down. I was really calm and tried my best to persuade him that we really needed
the pictures of his teeth to make sure his teeth were healthy and that there wasnt any disease
present. He thought I said sneezes and we both got a giggle out of that one! I tried distracting
him by counting and racing to see if we could get it done really fast. I told him his sister got it
done last time she was in the clinic and that we should show her and Daddy when we got home. I
even bribed him, but it just wasnt working. I knew that I couldnt push it or he wouldnt want to
come back. I knew he wanted to do it for me, but he just physically couldnt, and he told me not
today Mom, but I pinky promise we can do it next time. I spent a lot of time trying to get the x-
rays, but had to accept that it wasnt going to happen that day. He was squirming during scaling
6/25/2016
DHY 281
Karlee Rainey

and kept complaining of a stomach ache. I frequently had to pause treatment to get him a drink
of water to ease his stomach. He also kept telling me he was really hungry. I really just wanted to
complete him so he could go play, but he insisted that he needed to eat. At that point I was
willing to try anything to calm his nerves. I paused treatment and went to the library and fed him
a few bites of watermelon. Then, he was ready to sit again. That experience showed me that I
needed to think about my patients feelings and not just the task at hand. After several drinks of
water, a failed attempt at x-rays, a snack, two trips to the bathroom, and placing a pillow
underneath him; I managed to finish Kadyns treatment. That day I learned to be patient and
really listen to the patient and read body language. The patient is more likely to come back if
he/she feels comfortable and not forced into something he/she doesnt want to do.