pulling teeth

Until yesterday, I was going into my third week in the clinic without having an interesting story to tell.  Many of my classmates have been posting on facebook about all the cool procedures that they have done....cone-beam CTs, extractions, root canals, and restorations.  I have done new patient exams, lots of new patient exams, which are really boring.  And I have done a fair amount of assisting, which is also boring (especially since it is nothing new to me).  I have not picked up a handpiece in 7 weeks!  So needless to say, I was getting a little disappointed that I had not been able to do some new and interesting procedures.  (I admit, I even complained a little at lunch to my friends.  They are such a good bunch for putting up with me.)  Then Jackie (my temporary D4 partner that has been showing me the ropes) told me that I was going to do an extraction.  Yikes.

Taking out teeth is not something that you can practice over in the sim clinic.  My experience with extractions has been limited to a few oral surgery lectures and seeing it being done a few hundred times.  That does NOT prepare you for actually doing it.  First I numbed the guy up.  (I was able to use the ASA and MSA injections.  They are pretty simple, which means I didn't need to try and remember all sorts of tricky landmarks.)  Thankfully, Jackie was a good teacher.  She showed me which instruments to use (there were like 6 elevators), how to hold them (always with a finger forward to act as a brace if your hand slips), and how to use them (lots of pushing and rotating).  The tooth I extracted was pretty badly decayed.  I loosened the PDL and then used the elevator to loosen the tooth.  Then I tried to use the forceps to gently pull the tooth out.  Because it was so badly decayed, the crown broke off.  Luckily, there was still enough tooth to grab onto, so I went back in with the forceps.  And then the tooth snapped in half along the roots.  I was able to get one root out, but the other stayed firm.  Jackie tried wiggling the other root tip out with the elevator, but it was just not happening.  We called the professor over and he suggested using a bone bur to "trough" the bone.  In non-dental speak, we drilled a little trench in the bone surrounding the tooth.  That allowed us to get the forceps back down in the space and grab the tooth again.  Finally, it came out.  But, then there was a bigger hole left in his mouth than we intended.  So he needed sutures.  And I got to sew him up.

All in all, it was a good experience.  It wasn't nearly as hard as I expected.  It is just a matter of putting the right pressure at the right location.  So I certainly don't know where the phrase "it's like pulling teeth" came from, because pulling teeth was not as hard as pulling teeth.  And now I can brag about the cool thing I got to do before returning to new patient exams and consults.  Sigh.  At least we get to practice using laughing gas on each other tomorrow.  That should be fun.