Internship Report 1 [PDF]

Zitiervorschau

AT GOLDEN JUBILEE MEDICAL CENTER IN

MAHA CHAKRI SIRINDHORN DENTAL HOSPITAL

REFLECTION PAPER

CAPSTONE PROJECT

ACADEMIC YEAR 2019-2020 CAPSTONE MENTOR: MR. FLIP

YANISA CHANOTRAN 6161103

CAPSTONE INTERNSHIP PROJECT DAILY REFLECTION at Golden Jubilee Medical Center in Maha Chakri Sirindhorn Dental Hospital (โรงพยาบาลทั น ตกรรมมหาจั ก รีสิ ร น ิ ธร) during Decenber 23th - 27th and January 3rd - 4th by Yanisa Chanotran (Prim) 6161103

ACKNOWLEDGEMENT First of all, I would like to thank Dr. Wariya Chinwanno, the director of Mahidol University International Demonstration School,

for

allowing

myself

to

have

an

opportunity

to

experience the internship at Golden Jubilee Medical Center in Maha Chakri Sirindhorn Dental Hospital.

I

also

thank

the

MUIDS

facilitators

in

helping

me

contacting with the medical center. I would also thank Mrs. Nattasuda through

Yawai,

my

the

struggle

in

capstone the

teacher,

period

of

for

guiding

internship

and

me the

conducting of the internship report. Lastly, I would like to thank

Golden

Jubilee

Medical

Center

in

maha

Chakri

Sirindhom and it's member for allowing me to experience this internship.

A

I N T R O D U C T I O N

I N T E R N S H I P

D A Y

S C H E D U L E

1

INTERNSHIP EXPERIENCE 

D A Y

2

INTERNSHIP EXPERIENCE 

D A Y

3

INTERNSHIP EXPERIENCE 

D A Y

4

INTERNSHIP EXPERIENCE 

D A Y

5

INTERNSHIP EXPERIENCE 

D A Y

6

INTERNSHIP EXPERIENCE 

D A Y

7

INTERNSHIP EXPERIENCE 

C O N C L U S I O N

CONTENTS

A C K N O W L E D G E M E N T

TABLE OF

A 01 02 03 06 09 10 12 15 18 20

INTRODUCTION In this internship report, I had an opportunity to work  at Golden Jubilee Medical Center in Maha Chakri Sirindhorn Dental Hospital. This internship project allow me to learn how different type of dentists work, how the hosptal treat patient,

and

what

is

the

process

to

be

come

a

dentist.

Coming in to this internship, I hope discover that if the life of dentist suitable for me and prove if I want to continue pursue this career. This internship at the Golden Jubilee Medical center allow me to see with my own eyes the life of dentists. I had an opportunity

to

use

some

of

the

equipment.

I

also

had

a

chance to talk and question the dentist who was in charge of me about a career in dentistry. 

01

INTERNSHIP SCHEDULE: ISSUED BY GOLDEN JUBILEE MEDICAL CENTER SOME CHANGES ARE MADE DUE TO REPOSITIONING ON THE WORK DAY.

DAY 01 23/12/19

8:30 -

SCREENING POINT

12:00

Ms. Saranchana Muangman Mr. Wutipan Rerklob

13:00 17:30

DAY 02

24/12/19

INTERNSHIP SCHEDULE

SPECIAL DENTAL CLINIC Sirikarn Jenwattanavej D.M.D

8:30 -

SCREENING POINT

12:00

Ms. Saranchana Muangman Mr. Wutipan Rerklob

13:00 17:30

SPECIAL DENTAL CLINIC Mr. Rutsamee Duangchai D.M.D

DAY 04

26/12/19

8:30 -

PEDIATRIC DENTAL CLINIC

12:00

Araya thetsali D.M.D

13:00 17:30

DAY 03

25/12/19

SPECIAL DENTAL CLINIC Mr. Rutsamee Duangchai D.M.D

8:30 -

SCREENING POINT

11:30

Ms. Saranchana Muangman Mr. Wutipan Rerklob

DAY 05 27/12/19

8:30 -

OPERATIVE DENSITY AND

12:00

ENDODONTIC CLINIC Vipaporn Srisukwattananan D.M.D

13:00 17:30

DAY 06

03/01/20

SPECIAL DENTAL CLINIC D.M.D

8:30 -

PEDIATRIC DENTAL CLINIC

12:00

D.M.D

13:00

ADVANCED DENTAL CLINIC AND

-17:30

IMPLANT CENTER Napas Meeprasert D.M.D

DAY 07

8:30 -

ORAL AND MAXILOFACIAL

17:30

RADOLOGY CLINIC Mr. Wisit Phathomchatchawarn

04/01/20

02

Internship reflection

DAY 1  23/12/19  8:30 am - 12:00 pm

Screening Point Supervisor: Ms. Saranchana Muangman and Mr. Wutipan Rerklob

What is Screening Point? Screening Point is a room where both new and registered patients come in. Patient will be ask about what service they want to have on the day, their medical record, particular behaviors (drinking and smoking), their weight and height, their blood pressure, preference on doctor, and their regular medication. All this information will be record in hospital's system by both nurses and inhabitant staffs. 

The Experiences I had have Once I arrived in the screening point of the hospital, I noticed that there is a lot of people waiting. This hospital is known for dental clinic and their reasonable  cost so patients come to the hospital very early in the morning to line up for their queue. The busiest time is in the morning. When I enter the room, I was greeted by the staffs and right away, they teach me how to serve the patients. First, I have to call a patient first name out loud. Due to patient's privacy, I am not suppose to say their last name out loud but to confirm it when they got to the table. Then, I have to take the patient's blood pressure and evaluate it if it is in the above or below average. The normal blood pressure is 90 - 140 in systolic mm Hg and 60-80 diastolic mm Hg. Next, I have to record the patient's weight and height. If the patient is new, the patient have to be asked what type of clinic do they want to be treated in; General Dental Clinic or Special Dental Clinic. With the information taken in, I have to print out a form which the patient will take to process to their next step. (Figure 1) In the form, I have to record more information about the patient that can affect the dental process. For example, the patient's medical record, regular medication and drinking and smoking behavior. While I was working, I noticed that there are abbreviation being used to indicate the patient's  congenital disease. "HT" is a abbreviation for Hypertension, long-term medical condition in high blood pressure.

This disease is taken seriously because a patient with hypertension medication dental

will may

bleed

process.

Dyslipidemia, amount

of

a

very

cause

some

"DLP"

is

medical

lipids

in

quick.

a

the

in

the

abbreviation

of

condition the

Moreover,

complication

with

blood.

abnormal

"CAD"

is

an

abbreviation for Coronary Artery Disease, a condition which

Coronary  Artery

is  narrowing.

"CLD"

is

an

abbreviation for Chronic kidney, a medical condition which patient gradually loss kidney function over a period disease

of

months

most

or

patient

years.

These

have.

If

are the

common patient's

medication affect the dental procedure, the doctor

Figure 1

Figure 2

will contact another doctor that write the prescript if the patient can pause the medication. 

03

Internship reflection

DAY 1  23/12/19  13:00 am - 17:30 pm

Special Dental Clinic Supervisor: Mr. Rutsamee Duangchai and D.M.D

What is Special Dental Clinic? Special Dental Clinic is a large department inside the hospital where dental procedures is being done. This department include teeth filling, teeth cleaning, non-complicated teeth pull, and denture making. Patient can request for this special clinic. All appointed patient will be treated in the special clinic. 

The Experiences I had have In this afternoon, I first assigned to observe a consulting dentist then was introduce to some equipment used in Root canal treatment. With this opportunity, I realized that there is many type of dentist to perform in various role in the hospital. As in my observation, one of the most common type of dentist is endodontist that will give consult about which teeth can be pull out. In the dentist room, there is several patient come in. Most of the patient are elderly with teeth decay. The dentist always want to save as much teeth as possible but if the teeth is beyond repair or reparable but will cause more problem later on, they strongly recommend patient for removal. In this hospital, the pulling teeth process will not be perform in this consult session. The patient will have to make an appointment or they can be a walk-in queue another day.  There some case which a physical observation by the dentist isn't enough so the dentist have to order an X-ray to take a look on the side of teeth which can not be seen previously. After the observation in the dentist's room, I have a opportunity to learn some equipment. I was introduce

to

K-file

and

H-file.

These

files

are

surgical instrument used while root canal treatment. They are used to both clean and shape patient root canal. K-file is a type of hand file with a twisting rhomboid-shaped have

less

tip.

potential

in

It

is

the

strongest

separation.

K-file

file

but

have

a

rather high flexibility. It can easily bypass obstacle. H-file is used in both  grasping canal obstructions and  extraction of debris. In my observation, it have a sharper and finer tip. 

Figure 3

Figure 4

After I know the tools, I am assign to arrange the files. These files come in many size. This time, I am presented to 21 mm and 25 mm . I have to arrange the files into a cotton pad. While I was arranging I notice that some of the K-file is dirty and misshaped so I told the supervisor which he order me to put it in a waste container (Figure 3). When I finished arranging and packing K-file, I am assigned to arrange H-file. I have arrange in a given color order. Then, plug the file into a cotton pad (Figure 4)

04

Internship reflection

Moreover, I am also presented with dental reamers. Dental reamer is a stainless steel surgical instrument with triangular blades. It is also used for root canal treatment. There is majorly three type of dental reamer: Helix Reamers, Standard Reamers, and Special Reamers. Helix Reamers is a reamer with a very high cutting capacity and smooth cutting. Standard Reamers is known for its long lasting performance. Its size is indicated on the shank which the line is presented. Special Reamers can be divided in two type which are Dentatus Probos I Pathfinder and Dentatus Probos II Reamer. Dentatus Probos I Pathfinder is a tool used to initiate and remove root filling material. Dentatus Probos II Reamer is a special designed reamer that allows it to create indents on dentinal wall. 

Standard Reamer Special Reamer (Dentatus Probos II Reamer/Router)

Helix Reamer

After the explanation of my supervisor. I was assigned to arrange reamer in to a seal bag. Each bag contains four reamers with consecutive size. I was presented with a box containing both Helix and standard reamer each in 6 different sizes.

05

Internship reflection

DAY 2 24/12/19  8:30 am - 12:00 pm

Screening Point Supervisor: Ms. Saranchana Muangman and Mr. Wutipan Rerklob

The Experiences I had have On this day, I got the opportunity to record patient history in to the hospital's system. The height and weight of the patient is also crucial because the proportion of drug that will be used is determined by the patient's height and weight. I used the abbreviations that I have learn on the first day on a patient. The patient came in for teeth filling. I measured her blood pressure and warned her that her pressure

is

high.

I

then

record

her

information

and

ask

for

her

congenital

disease.

She

have

Endocarditis, a problem with heart valve. This disease is taken seriously because while the procedure is performed the bacteria within teeth can go to the heart and infected it. The solution is to have the patient take Amoxicillin. 

13:00 am - 17:30 pm

Special Dental Clinic Supervisor: Mr. Rutsamee Duangchai and D.M.D

The Experiences I had have In this afternoon,  I went to observe one of the dentist in Special dental clinic. This dentist opens for basic cases. For instant tooth filling, oral hygiene consulting, non-complicated tooth pulling and dental check up. Between cases and after all the patient treated, I have an opportunity to talk to the doctor about dentist life. I have learn that being a dentist will allow you to regulate your own time, good to high income and gain acceptance of Thai society which these character really suit my preference. In my observation,  before any case not including first time - patient, the dentist will review patient's history first. The dentist will be looking for previous treatment, patient's congenital disease, and other medical history. One of the chart I see is a dental chart (Figure 5.). This Chart will allows the dentist with a specific idea of which tooth has decayed and which  tooth is already treated. The chart is on both computer and physical paper.

In this chart, dentist is suppose to fill the box which

complement

to

the

patient's

teeth

with

different color to represent different problem. The color red represents that the dentist want to plan treatment. Blue for treatment completed. Green for recommend to pull the tooth out.

Figure 5 06

Internship reflection

Case 1 : Teeth Filling In this case, I walked in between treating so I didn't have a chance to listen to patient's symptom. However, in my observation saw the dentist filling the tooth in the upper right part which bring me to a conclusion that this patient have tooth decay and cavity. Tooth decay can be triggered by many factor for example; poor oral hygiene, dry mouth, eating or drinking sugary food or drink etc. Tooth decay will leave a hole, because part of the tooth is damages, that is called cavity. If cavity is left untreated, it will continue to decay the tooth. The dentist clean the bacteria which cause decaying usually by drilling and then filling the hole using filling material. Filling material comes in many type. It is up to the dentist to decide which type of filling he/she will use. After filling, the dentist will shape the filling material to suit with the surrounding teeth. After the treatment finished,  dentist will give the patient information about the procedure he performed and teach the patient on how to prevent the problem happen again. In figure 6,7,8, are what I saw in the treatment room. Figure 6 are tools use for teeth cleaning. Figure 7 is where the treatment is performed and Figure 8 are tools used in teeth filling.

Figure 6

Figure 7

Figure 8

Case 2 : Teeth Filling and teeth pulling consulting  This patient is a woman in teenage year, She have three teeth to be filled . With this patient the dentist decided to use a composite resin - type of filling material to fill the patient's teeth.  Composite resin is one of the most common type of filling material the dentist uses. This composite resin can replicate the color of the patient's teeth. It is highly recommended because it is hardly noticeable and have a high efficiency. It can last up to 15 years with good care. It came in a paste from. After the teeth was filled, the dentist will cured it. This process is done by using a bright ultraviolet light that will make the composite resin harden. This process is called photo-polymerization. After the process of filling is done, the patient consult the dentist that there is one of her teeth she always have a problem with because she accidentally chew her Cheek bulge and it always left her with a wound. She ask the dentist if he can do anything about it. The dentist told her that get the tooth pull she want because that tooth isn't do any benefit for her.

07

Internship reflection

Case 3 : Teeth Filling and Teeth cleaning This patient is a man in his elder. He have teeth decay which were treated by the dentist. Then, he got his teeth clean. The

dentist

stated

off

by

examine

the

overall

oral

condition,

see

any

major

problem

to

be

concern.Then, he started to remove plaque and tartar using small mirror to view and scaler to get rid of the particle. After that, the dentist will clean the teeth using high-power electric brush to grind on the teeth. This will clean deeper than scaler. Some dentist may use toothpast in this process. Then, the dentist will floss patient's teeth.

08

Internship reflection

DAY 3 25/12/19  8:30 am - 12:00 pm

Screening Point Supervisor: Ms. Saranchana Muangman and Mr. Wutipan Rerklob

The Experiences I had have Today, the hospital open only half day. This rule apply to every week even though this day is Christmas. For today, people knows that this hospital will be close on 12 pm so not many people come in. I have a chance to ask and fill in patient's history again and use the abbreviation the nurse taught me. The rest of the day is not pack with people. So the nurse taught me some fact she think that is crucial. I have learn that patient with Osteoporosis can not do a teeth pulling because it will make the patient's bone die and this is caused by the medication which is  denosumab. She also taught us that patient with Cleft palate can be treated by implanting a bone behind our ear. I have learn that sometime it was the dentist's role to fix patient with Cleft palate. This disease might sound not dangerous but because most of the patient is an infant, it will make the patient unable to be breast milked. This will result the infant to be malnourished or even die. Another thing that I have been taught that is very get me interesting is about Le Fort fractures. It is basically how human skull break and categorize it in types. Le Fort type I is a horizontal fracture separating the teeth from the upper face. Le Fort type II is a pyramidal fracture with the teeth at the pyramid base and part of nose as a apex. Le Fort type III is a transverse fracture nose and many other part of the face.

09

Internship reflection

DAY 4 26/12/19  8:30 am - 12:00 pm

Pediatric Dental Clinic Supervisor: Dr. Araya thetsali

What is Pediatric Dental Clinic? Pediatric

Dental

Clinic

is

an

age-defined  specialty

for

children

clinic.

It

is

a

large

department full with specialist and practiced medical student. This clinic open for patient 12 and under

aged

patient.

This

clinic

is

open

for

teeth

pulling,

oral

check

up,

teeth

cleaning

and

consulting.

The Experiences I had have Today, I have to go to the Pediatric Dental Clinic which I am very looking forward to because I like kids. When I arrived at the clinic, I see many kids queueing on the treatment. The clinic was not as crowed as the special dental clinic. I have an opportunity to observer the treatment of  Dr. Araya thetsali. One of the many useful thing I have learn is that children usually scared by the dentist or most of the medical staffs, so the dentist have to come up with a way to  approach the kids. The reaction of each patient can be very different which can be categorize in 3 level.  The first level is cooperative patient. A cooperative patient is a patient which do not resist the consented treatment. The second level is potential cooperative that the patient is a little frightened by the tools used by the treatment but if the dentist find the right way to approach, the patient may turn to be cooperative. The third level is lacking cooperative patient. It is a patient who resist the consented treatment.

Case 1 : Removing Roots This patient is an eighth years old boy. His guardian book an appointment for him and his brother but they were late so the dentist moved on to the next patient. Fortunately, the dentist finish treating the remaining patient fast so she able to re-appoint the first patient.  This patient came in with root problem. Earlier, he experienced a fall that cause his teeth to fall out but his guardian suspect that there is some part left in the gum. Children usually scared by the dentist or most of the medical staffs, so the dentist have to come up with a way to  approach the kids. From my observation, I would say this patient is in a cooperative level. Either way, the dentist have to explain the procedure

she

will

be

performing

before

she

start

the

treatment.

To

draw

attention  the

patient

attention  from the procedure, the dentist start to open a conversation with the patient. It is mostly a yes or no question because the patient cannot talk during the treatment is performed.  The treatment start by the dentist apply a pink viscid numbing cream on the targeted gum. Then, she inject the gum with Anesthetic. Next, she use a clamp-like tool to pull the left over root out.  The dentist order an x-ray to check up any dental problem. When the result came, she found out that the patient have teeth decay on the upper right side. She decided to treat it right away because the teeth is permanent teeth. From the x-ray, the dentist also find out a strange formation of tooth on the fifty-five tooth and warned the guardian to keep checking this tooth.

10

Internship reflection

Case 2 : Oral Check Up The patient is a eleven years old boy. He came in for a oral check up. From the observation done by the dentist, we found out that he has four  permanent teeth growing on his lower part of teeth and we found a Cyst in his oral. The cyst caused by the bacteria from tooth decaying in the gum. Apart from that, the patient did not take care of his oral properly which an be indicated by the bad breath. The teeth also show the indication of Bruxism which is a condition of grind, gnash or clench on the teeth unconsciously. The dentist also concern about tooth decaying on the front teeth so she order an x-ray. 

13:00 am - 17:30 pm

Special Dental Clinic Supervisor: Mr. Rutsamee Duangchai and D.M.D

The Experiences I had have Case 1 : Teeth Filling The patient is a 63 years old man. He came in to treat teeth decay. He has four decayed teeth. The dentist decided to use composite filling material. 

Case 2: Teeth Filling The patient is a senior man. He also has a teeth decay needed to be filled. After the observation done by the dentist, he decided to fill the teeth with amalgam because the teeth decay has been so deep it nearly reach the dental pulp.  This is a special case for me. In this case, I have an opportunity

to

help

the

dentist

do

the

treatment.

I

did

the

suctioning of saliva and hand many tools to the dentist. At first, I am very nervous and my hands are shaking. But. It got better as the time fly. I have learn that the suctioning can be done in two places in the mouth which is the behind the deepest teeth of both side.

Case 3: Teeth Filling The patient is a senior man. He also came for teeth decay treatment. But for this patient, he take a type of Antithrombotic which will make he bleed very easily and continuously bleed. So, the dentist have to be very gentle but at last he can't avoid a little bleeding. He tell the patient that next time he will have to stop this medication before he go to the dentist.

11

Internship reflection

DAY 5 27/12/19  8:30 am - 12:00 pm

Operative Density and Endodontic Clinic Supervisor: Vipaporn Srisukwattananan D.M.D

What is Operative Density and Endodontic Clinic? Operative Density and Endodontic Clinic is a department that take on more complicated cases from the general and special clinic. In this department, the dentists perform variety of treatment. For example, pulling teeth, tooth impaction removal, and many other. This clinic has to be specially clean because some time surgery is performed.

The Experiences I had have Case 1 : Stitches Removal The patient came in to remove the stitches she has from the impacted wisdom teeth removal. First, the dentist clean the wound area with a saline. The left over liquid is sucked out by the suction performed by the assistant. Then, the dentist use a tool with a blade cut he string and stitches sometime along she also use a scissor. Lastly, the dentist check for any sign of infection and other problem. For this case, there wasn't any problem. The procedure was quick and quiet simple.

Case 2 : Check Up This case is very quick and simple. The dentist look at the wound see if there was any complication or infection. the dentist ask question about the symptom if there is anything out of the ordinary.

Case 3 : Stitches Removal A patient is a working age man.The dentist cut the string and stitches. She ask the patient some question and he said he have a hypersensitive teeth-symptom. He also tell the dentist that when he got back home, he bleed. Because he bleed so much, he went to a local dental clinic to make some additional stitches. The dentist warn the patient that after the procedure was done, the patient should not push the wound with tongue or anywhere. This case cut stitches at three places; two at lower part and another at upper. He also has a evidence of boning because his cheek has a bruised.

12

Internship reflection

Case 4 : Wisdom tooth removal A patient is a teenage woman. She wants to get her wisdom teeth remove. The interesting thing is that she was wearing a braces. She 3 teeth to pull out; two teeth n the lower and one on the upper. She was already pulled the tooth on the upper out. So, today she wants to pull out the right lower side. The dentist start of with cleaning the target area around the tooth. She use a tools in Figure 11 which specially sterilized. Then, she began to apply numbing cream. Next, she inject an Anesthetic and wait for a while for the injection to work. During the injection, the patient bleed a little but the assistant suck the blood and extra saliva out to a special machine (Figure.9) Because the treatment is a painful procedure and the patient is considered as an adult, the dentist inject three injection. When the Anesthetic work, the dentist began to cut open the gum. This  procedure caused the patient to bleed so suctioning is performed again. Before pulling any tooth, the dentist have to make the tooth crack first. It is depending on cases on how different teeth have to be cracked. She use a tool in figure 10 to for cracking. After the cracking, the dentist pull the pieces out, making sure there is nothing left in the gum for example root. The dentist put pieces  of the tooth together to be really make sure that all of it came out. Lastly, the dentist stitch the wound an tell the patient how to take care to avoid any infection on the wound.  

Figure 9

Figure 10

Figure 11

Case 5 : Teeth Pulling The patient is a senior woman. She came in for a tooth pulling. It was a tooth on upper right. The patient have a Osteoporosis.  The patient told the dentist that the she have a hypersensitive tooth on the

targeted

tooth

and

she

also

have

a

very

dry

mouth.

In

the

dentist's observation she saw that on the inner wall of the patient's mouth

there

is

a

little

red

bumps

so

the

dentist

recommend

the

patient to get a doctor to look at that. The dentist recommend the patient to take a medication that will help the patient's body to produce saliva. With less saliva, it will increase the rate that fungus will grow in the mouth. On the targeted tooth, the patient use to do a root treatment. So, pulling it out is extremely hard. The dentist has to use very string pull to get it out.

13

Internship reflection

13:00 am - 17:30 pm

Special Dental Clinic Supervisor: D.M.D

The Experiences I had have Case 1 : Teeth Printing The patient is a senior man. He want to make his teeth Crown. The dentist use a jell like liquid to record the printing of the patient's teeth. Another technique that interest me is that the doctor tell the patient that if he feel any pain or feel that the water coming down his throat just raise the hand. It a signal to tell if anything goes wrong.

Case 2-4: Appointment to try and get the teeth crown These three cases are just the patients came in and try on the teeth crown. If it doesn't fit, the dentist may fix it right away or if it seriously out of shape, the dentist have to send it back to the other department to do it again.

Case 5 : Consulting The patient is a senior woman. She came because she wants to consult because the tooth on her lower part is lose. The dentist look at the problem tooth and tell the patient that it can be pulled out but it wasn't necessary. She has many teeth problem in her mouth to fix but the dentist

say

she

should

save

which

ever

she

can.

At

last

the

dentist

decided to make an appointment for her to pull out four teeth from her upper part after the x-ray.

14

Internship reflection

DAY 6 3/01/20  8:30 am - 12:00 pm

Pediatric Dental Clinic Supervisor: D.M.D

The Experiences I had have Case 1 : Check Up A patient is 5-6 six years old. He has a history on teeth decay between the gap of his teeth. His permanent teeth didn't fully grown within his mouth. In the last check up, the dentist already warned the patient to use dental floss but the decaying still happen. The dentist decided to fill in the decayed teeth to make the patient easier to brush. From my obsevation, I would say the patient

Case 2 : Check Up

is very cooperative. 

The patient is a 4 years old boy. He came in for a dental check up. The patient was very scared by the tools and the treatment. I would say he is lacking cooperative. After the inspection of the dentist, she discovered that the patient have tooth decay at the lower left. The patient wouldn't stop crying during the procedure. So first, the dentist open the TV. in the treatment room and show the patient cartoon. This doesn't work. The patient continue to resist the treatment so the dentist have to threaten the patient a little. She tell the patient that if he wouldn't stop crying and resisting she will make his guardian leave the room. Then, the patient start giving up to resist. After the physical observation, the dentist order a xray. When the result came, she discovered more teeth decaying. So, she fill in some of them but she have to make more appointment with this patient. The dentist also perform teeth cleaning.

Case 3 : Check Up A patient is 1 and a half years old girl. She came in for a dental check up. Because she is really young, she didn't know what happen then. She was a little bit scared but she only cried not pushing any tools out of her mouth. The patient cried but when the cartoon is shown on the TV. she jut keep focus on the cartoon.  There is not a problem with her teeth but the doctor clean in for her. The patient is a little scared by the sound and start crying again. The dentist have to speed up the procedure.

15

Internship reflection

Case 4 : Teeth Filling The patient a nine years old boy,  He came in because in his last appointment for check up, the dentist told them that there are teeth need to be filled caused by tooth decayed. From physical observation by the dentist, she discovered that within his mouth there is a lot of wound. The patient also has a fever. The dentist suspected that the patient might be infected by some type of virus. The patient's tooth at the upper left side is very deep decayed. The teeth is no longer able to be filled. The patient needed to go for a root treatment. And for the other decayed teeth, the dentist will not be performing the filling that day because it is too risky if the patient have some type of contagious desease.

Case 5 : Check Up The patient is related to the patient in case 4. This patient have several decayed teeth. The dentist warmed the parents to have to be really concern about their kids oral hygiene. The dentist filled in the teeth that was decayed. She also warned the parents to keep their two kid apart for a little while because one of them is sick.

Case 6 : Check Up The patient is a 5-7 years old girl. She came for a dental check up. From the x-ray and physical observation, the dentist noticed that the patient's primary tooth is smaller than her permanent teeth. This may cause a collision among teeth making them bend. The patient have a permanent teeth on her molar teeth so the dentist warned the parents to keep a close eye on those teeth. Clean it properly.

Case 7 : Falling Accident The patient is a 2 and a half years old boy. He came in because he fall down to the floor and his teeth bend backward. His

teeth

also

change

to

grey

which

is

very

concerning.

The

patient is very scared by the dentist because he is so young. I would say he is a lacking cooperative patient. He cried very loud and resist the treatment. The dentist ordered a x-ray. While the patient went to x-ray at the x-ray department, the assistants started to prepare a Papoose. Papoose is a

boar shaped as a

human.  It is used for keeping the patient in place by wrapping the patient with it. (Figure. 12)

Figure 12 Looking from the x-ray, the dentist discovered that his teeth "melted" with his permanent teeth. The dentist strongly recommend to pull that teeth right away. The reason way the tooth change color is

because

the

nerve

and

vessel

in

the

tooth

is

damaged.

If

the

tooth

wasn't

meted

with

the

permanent teeth, it is up to the parent if they want the tooth to be pull out or not. It is safe to leave the tooth as it is if it wasn't melted. On that day, because the patient have some teeth decay so the dentist fill it up. The pulling of the tooth have to be done in the next appointment.

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Internship reflection

Case 8 : Space Maintainer The patient is under 10 years old boy. In the last appointment, the patient already measure and order a space maintainer. But the patient missed the appointment to get and use his space maintainer. So, that they, he came in for applying his space maintainer. Unfortunately, the patient waited too long to get

his

space

maintainer.

His

teeth

already

moved

closer.

So,

the

dentist

have

adjust

the

space

maintainer to be more fitted to the present situation. It was a little hard because the space maintainer made of steel. The patient also cleaned by the dentist using fluorine. Then, the dentist pull out his tooth in the lower right becuase the decaying is so bad. There is no way to save it.

Case 9 : Removing Root This patient is 7-8 years old boy. He came in because his tooth is lose so he pulled it out. But, the root is still in the gum, he didn't get the root out. During the procedure, the patient cried but he still give us an opportunity to treat him. I would like to put him in the potential cooperative leve.

13:00 am - 17:30 pm

Advanced Dental Clinic and Implant Center Supervisor: Napas Meeprasert D.M.D

Case 1 : Root treatment This patient is a working age woman. She came in for a root treatment.  She already have two of her root treated. The third root found to be already filled but with an unknown material. The dentist and the patient don't know what it is so the only thing she can do is clean it with Disinfectant. The dentist try to drill down to the root and continue treating the two root. The drilling take very very long so the entire afternoon she can only do one case.  Because the root is very small, there have to be a tool to look in and zoom to make it easier. The dentist use a machine in figure 13 to look. And the drilling is done using the same type of files I organized in day 1. The deepness of drilling is measure by the tool in figure 14.

Figure 13

Figure 14

17

Internship reflection

DAY 7 3/01/20  8:30 am - 17:30 pm

Oral and Maxillofacial Radology Clinic Supervisor: Mr. Wisit Phathomchatchawarn

What is Oral and Maxillofacial Radiology Clinic? The Oral and Maxillofacial Radiology Clinic is a department that services; Intraoral radiograph and  Extraoral radiograph. Many other department sent their patient here to have a x-ray because they don't have their own x-ray.

The Experiences I had have On this day, I have an opportunity to go visit Oral and Maxillofacial Radiology Clinic. The staff there teach me many interesting thing about X-ray.  X-ray is imaging test that help us to be able to look at bone and masses inside our body by using radiation. In the x-ray image, it is depend on how think the objects are; it there is the air in the image, it will present as black. If there is a gum, it will show grey. If it have a teeth, it will show a lighter grey. If there is an steel or iron, it will show as white.  X-ray has two type;  intraoral and extraoral. Intraoral is when the film is inserted inside the patient's mouth. In the opposite, extraoral the patient do not have to insert the x-ray film. The film have many size depending on what type of x-ray the dentist wants. The size can vary from 0 to 4.

Figure 15

Figure 16

There are two major techniques of X-ray which are bitewing and periapical.  Periapical is a type of image that allow us to see the hole anatomy of teeth. It can be used for looking for a disease at the root and also used for  abscess at the root. The abscess is presented in the image as a black ball.

18

Internship reflection

In figure 17 is a film that is mentioned earlier. The film size zero usually used for young children. The film size one is used for taking the image in the front teeth. The film size two is used to take a image in the back teeth including molars and premolar. This type of film used in bite wing technique. The size three film is not commonly used because it is too long. The film size four is used for biting. 

Figure 17

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CONCLUSION In conclusion, my experience in working at Golden Jubilee Medical Center in Maha Chakri Sirindhorn Dental Hospital make me learn many things. I have learn the process of treating patient. I have learn how the information is record by the hospital. I have learn about the life of dentist. I,ve learn how is the process of becoming a dentist. I am glad to be in this internship program. Because I have seen the real

life

suitable

of for

this

career,

me.

This

I

realized

doesn't

that

mean

this

that

career this

is

not

internship

program failed. This program is a big push for me to pursue other career that I really want and more suitable for me.

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