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What Kind Of Patients Do You Meet As Dentists?


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 i'm an OMFS resident, in the middle of my residency, at the moment.

- it can be very rewarding to remove a tooth and have the patient be amazed at how painless the entire process was. They quickly become very thankful with the knowledge that they will no longer be in pain. 
- sedation is a great tool we offer patients, and it really puts patients at ease. patients who would have otherwise been sweating through a procedure and grasping the dental chair with dear life.
 

I don't like complaining because I mostly like what I do but....

- I get irked by patients who say they were never told that a tooth needed a RCT, and present 3 years later with an abscess or a broken down, non-restorable tooth.

- I get frustrated by patients who feel like they know what treatment they need and don't keep an open mind. Sometimes people will come in saying the need a tooth taken out - when in reality they may only need a filling. These patients think that "fillings don't work" because all of his/her fillings have fallen out, or have had recurrent decay.

- it bothers me sometimes that people go years without getting cleanings or seeing a dentist, sometimes decades, and then they come with their teeth in shambles, expecting a denture the same day we take out all their teeth. 

- it is very frustrating when we bend over backwards for patients, sometimes give free treatment, and do so much legwork to make sure a procedure is ready to go to the OR, and then for the patient not to show on the day of surgery and ask to be scheduled for next week for a silly reason. In NY we have a program where patients with HIV/AIDS get ideal dental treatment. We often do full mouth rehabilitation with 8+ implants, and these patients are notorious for not showing up, or cancelling at the last minute. I guess when you are given something free - you are less likely to value it? Besides, they know they can get it free next week anyways?

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Yep. There's risk.

That's why infection control is important, but Truthfully I worry more about getting seasonal flu from patients than HIV.

 

The only time I was nervous about HIV was when I was in dental school and the d bag supervisor at the community clinic was yelling at me to keep scaling the homeless guy with untreated aids who kept biting me while I had sharp scalers in his mouth, which was full of blood from his horrifically inflamed gums.

That pissed me off, but I had the sense to refuse to continue even while getting yelled at.

 

Literally, that was the one and only time I was ever stressed about HIV, and I worked on plenty of HIV patients.

 

That is terrifying...

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Yep. There's risk.

That's why infection control is important, but Truthfully I worry more about getting seasonal flu from patients than HIV.

The only time I was nervous about HIV was when I was in dental school and the d bag supervisor at the community clinic was yelling at me to keep scaling the homeless guy with untreated aids who kept biting me while I had sharp scalers in his mouth, which was full of blood from his horrifically inflamed gums.

That pissed me off, but I had the sense to refuse to continue even while getting yelled at.

Literally, that was the one and only time I was ever stressed about HIV, and I worked on plenty of HIV patients.

Wow, that's terrible ;(

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I'm just slightly concerned about one more thing. When you work on patients who have AIDS, is there any risk of getting infected? I feel like dentists are put into a potentially risky situation when it comes to infectious diseases.

 

Anyone who is exposed to bodily fluids is. Follow standard precautions and protect your fingers (use a mirror/Minnesota to retract, not your finger), and your risk isn't any higher than other health practitioners or surgeons.

 

I poked myself in the palm with a suture by accident because I wrapped the free end of the suture up too quickly and wasn't mindful of the needle. Luckily the patient had an undetectable viral load (I double checked) and the risk with a solid delivery vehicle (ie. a suture vs. a hollow-bore needle) is exceedingly low to the point of being immeasurable. But these things will happen more than once in your life. If you're not willing to deal with that risk, you should find another career. It's not just HIV either, but Hep C is a big one.

 

To answer your original question, in my limited experience, my most difficult patients have been the ones who are inconsolably indecisive and need constant reassurance/guarantees during treatment. These are the patient who don't understand, no matter how much you emphasize it to them, that there are no guarantees, and that ultimately the decision is theirs what they would like to do. They're the patients who often treat dentistry as a commodity service rather than a health service, and are exceedingly demanding or unrealistic. They want to keep a tooth that's M3 mobility and about to fall out when someone looks at it wrong. They don't want clasps on their RPD (any). They want a guarantee that a tooth with a questionable prognosis is going to survive 20 years after crown lengthening, post, core, and crown. Maybe I just haven't yet learned to cut through the denseness and get through to them (I usually eventually do, but it involves literally hours of talking, which can be an intense drag when you are repeating yourself over and over), but it can drain you. At the end of the day I've learned that much of being a 'good' dentist (at least in your patient's eyes) is talking. You can do a lot of things wrong (or not incredible) clinically but as long as you communicate well, you and your patient are on the same page, and you've spent a lot of time educating them and being on their side, they will love you. An issue I've run into is when I don't love them back. That's when you refer. :)

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