My First Patient

With your first patient just around the corner, we thought it would be useful to give some tips on how to deal with those first few appointments.

 

Broadly speaking, seeing your first patient can, of course, be nerve-wracking. You’re not the only one who is nervous, don’t forget that this is a new experience for everyone in your year and that your clinical tutors, year leads and colleagues are here to help you. It is useful to look up your patient on Salud before you see them, so you can do some research on any medications etc, this doesn’t need to be done massively in advance but familiarise yourself with their notes. You can do this by clicking on ‘find patient’, searching their name, double clicking the patient, using the yellow page to navigate paperwork under ‘documents’ and any clinical notes under ‘clinical’ (making sure to change the date to find the most recent medical history taken, bearing in mind some patients will have been waiting several years for an appointment).

 

On the day of seeing your first patient, go to the reception desk to check what time they patient was booked in for. It is unlikely to be 9am and these first appointments have been booked by the hospital staff so you will need to check exact times on the day. Make sure you turn up to clinic on time, or even a little bit before 9am so that you can set up your bay as much as possible before dispensary opens. Your tutors are likely to give you a small seminar on the morning of you first patient so that you know exactly how the day is going to run. Collect your clinical equipment from dispensary and log onto Salud, ‘take’ your patient and talk through your plan with your clinical partner. You and your clinical partner will be working closely for the rest of the year and it is very important to make sure you support each other as everyone will be having first patient nerves.

When taking your history and doing your examination, it is very important to take a H&E of the existing dentures, if applicable. We talked to clinical tutor Dr Mark Shupac, who sees denture patients when he’s not working at the university, and he gave us some top tips:

 

  1. Looking at the old denture, were they good once and have they just worn away? Assess its strengths and weaknesses and make sure you PLAN the new design.
  2. Was the patient initially happy with the appearance and fit? If so, then consider making a copy denture, making sure you compensate for tooth wear and any additional bone loss.
  3. ‘If it ain’t broke, don’t fix it’, when talking to your clinical tutor, you may decide that a full set of dentures is not needed, you may need to adjust one set chairside and construct only one new denture.
  4. Make sure you manage patient expectations, keep them involved the whole time and let them know that the construction will take several appointments and adjustments.
  5. If the patient is particularly old, consider relines and copy dentures. Avoid big changes to the entire mouth as they will find it hard to learn to manipulate the dentures again.

 

Eventually, you will need to take your first impressions. If you have a complete denture patient, you will most likely be using impression compound in your first appointment, after completing the history and examination, whereas if you have a partial denture patient, you will be liaising with your clinical tutor to decide how to approach periodontal treatment and denture construction. It is likely you will be doing these alongside each other. You will be using alginate to take your initial impressions. Dr Shupac gave us a brief overview of how to best take your primary impressions regardless of if your patient is dentate or edentulous:

 

  1. Always take the lower impression first, if the patient is stressed about gagging or is likely to have difficulty with impressions, then the lower is an easier way to start.
  2. When using the stock trays from dispensary, consider building up flanges with wax or greenstick (depending on tray type). This will make sure that full sulcus depths and undercuts for all teeth are recorded.
  3. Don’t be afraid to hold the impression in until you are 100% sure it has set, if the patient is okay, then there is no need to remove the impression too early and risk having to take it again.
  4. When removing the impression, check the patient is okay first and not covered in impression materials or is uncomfortable, before you check if the impression is workable.
  5. Don’t be afraid to get your hands involved, make sure to move buccal tissues around to check if you are getting full sulcus depths and make sure to pull the lip up to get labial sulcus depths.

 

These tips will all make sure you can get the impression right in the least amount of tries possible, so your patient is comfortable and that you won’t get too stressed out with retaking impressions.

 

If you have a partial denture patient, you may have to expect delays. This is because if any of the existing teeth need restorative work, work on the oral surgery clinic or radiographs, this may take a from one appointment to several weeks. Use the time you have to expand your skills and continue to look after the patient as a whole, not just in a denture related aspect.

 

You will be seeing this patient for the rest of the year, it is important that you communicate well with them. Even though you will try to keep the patient involved as best you can and explain every procedure to them, some of them will respond with interest and some of them won’t appear as interested. Do not take this to heart, this will be in no way a reflection of you as a future dentist. Every patient is different and you must be able to treat them as such. The dental school has every confidence in you to deliver care, you may think it’s a bit soon but we know that you’ll all be fine and you’ll be able to ask for help whenever and as often as you need.

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