Baby girl became a dentist today

[Smitty]

I went to her graduation ceremony.

I ain't much on ceremony,...but what ya gonna do? So I sat there for 2 hours while they went through alla the pomp and circumstance.

It was a very multicultural group getting their degrees,....Asians,..Indians,...garden yariety white people, of course. Even had a fair sampling of Arabs.

Of course, every time one of the graduates walked across the stage their family would applaud and cheer loudly. But when an Arab graduate got their diploma, these women would start hollerin' that "LA LA LA LA LA LA LA LA" stuff they do with their tongue. (how do they do that?)

I'm just an old redneck boy, yanno,...and it scared the $#@! outta me.

I'm sittin' there thinkin', "Holy $#@!!,...I hope nothin' blows up!"

[angelatc]

I am cracking up! Too bad you couldn't fire off a shotgun when they announced your young un's name. Yee Haw!


Seriously, congratulations to both of you! Getting one through college is no small task!

[tangent4ronpaul]

LOL!

Congrats!

-t

[mad cow]

Congrats!You must be proud.

[tangent4ronpaul]

Smitty,

now that you are over the sticker shock of college, you get to experience the sticker shock of setting up a dental practice...

Might I suggest a starter kit as a graduation present?

RECOMMENDED DENTAL SURGICAL PACKS


This assumes proper training and understanding of anatomy, the principles and practices of wound repair and surgery, sterile technique, sterilization of instruments, anesthesia, and postoperative care. Do not assume that because you have an instrument set and a book on the shelf that you can effectively make use of these supplies in time of need without prior training study and practice.

Note that each level builds on the one before it. This instrument list reflects my own preferences and experience under austere conditions. I update it periodically as I find a better or easier way of doing something. There are many other instruments that could be listed, but I do not consider then necessary and have included only the bare minimum. The instrument numbers are considered standard numbers but many companies have their own numbers or variations, so check if you are unsure.


Level 1: Minimum Kit
This is the bare minimum that should be available in each individuals personal kit. Note that all of this is obtainable at Wal-Mart and similar stores.
1 Dental mirror, plastic
1 Explorer or plastic pick/cleaner
1 Cavit or temporary filling material
1 Dental floss
1 Baby teething gel
1 Super Glue gel



Level 2: Basic Dental Kit
This is the minimum needed for basic dental work, fillings, and extractions. All supplies are high quality and reusable for many years with proper care. Pretty much everything here is required for this to be of value.
1 Dental mirror
1 Explorer/probe double end #5
1 Angle point tweezers
1 Excavator double end #38/39 or 38/40
1 Plugger/filler double end #1/2 or 1/3 or similar
1 Elevator #301
1 Extraction forceps #150 universal upper
1 Extraction forceps #150 universal lower (can use #75 also)
1 Eugenol (oil of cloves) and zinc oxide powder or IRM permanent filling material
1 Cavit temporary filling material
1 Scalpel handle and #11 & #15 blades
1 Needle driver 4-5”
1 Scissors, Iris curved
1 Copalite cavity varnish
Sutures, 4-0 or 5-0, silk or Ethilon and chromic or Vicryl, cuticular needle
25 gauge stainless wire
Dental floss
Baby teething gel
Super Glue gel
Anesthesia, lidocaine 1% or 2%, syringes, needles
Irrigation syringe
Cotton balls & 4x4’s


Level 3: Advanced Dental Surgery Kit
This is the advanced kit for those with some dental training and can do most needed dental work, fillings, and extractions. All supplies are high quality and reusable for many years with proper care. This is pretty much what I take to Central America on medical missions. Note that this list can be added one at a time to the basic kit, starting with the Flag or Cryer elevators and Fuji IX ionomer cement.
1 Dental mirror
1 Explorer/probe double end #5
1 Angle point tweezers
1 Excavator double end #38/39 or 38/40
2 Plugger/filler double end #1/2 and 3/4 or similar
1 Elevator #301
1 Elevator #34
2 Flag/Cryer elevators 30 & 31 or 39 & 40
1 Extraction forceps #150 universal upper
1 Extraction forceps #151 universal lower (can use #75 also)
1 Extraction forceps #23 universal large molar
1 Extraction forceps #17 lower anterior
1 Extraction forceps #18 or #53R or 53L upper anterior, see note below
1 Curette, Gracey scaler 11-12
1 Curette, Gracey scaler 5-6 or Ivory C-1
1 Bone rongeur
1 Bone rasp
1 Fuji IX glass ionomer ARM material
1 Eugenol (oil of cloves) and zinc oxide powder or IRM semi-permanent filling material
1 Cavit temporary filling material
1 Scalpel handle and #11 & #15 blades
1 Needle driver 4-5”
1 Scissors, Iris curved
1 Copalite cavity varnish
Sutures, 4-0 or 5-0, silk or Ethilon and chromic or Vicryl, cuticular needle
25 gauge stainless wire
Reinforcement bars
Dental floss
Baby teething gel
Super Glue gel
Anesthesia, lidocaine 1% or 2%, syringes, needles
Irrigation syringe
Cotton balls & 4x4’s


Note: Extractors 53R & 53L are mirror images of each other if you get the model with the straight handle. If you are nimble with your weak hand and can change sides on the patient you can get by with one or the other of the pair and save money and weight.

Note: Forceps # 18, 73, 75, 87, 201 and deep root elevators are of value also if you want to be really complete.

There are some suppliers in the following:

surgical123.com
www.fragoimpex.com

2011 quote from Xcelinnovative.com
920-626-6222

Dental Set

Qty. Description Price Amount

1 Dental Mirror $ 5.00 $ 5.00
1 Explorer/Probe Double end # 5 9.99 9.99
1 Angle Point Tweezers 2.00 2.00
1 Excavator D/End 38/39 or 39/40 5.00 5.00
2 Plugger/Filler double end # 1/2 and 3/4 5.00 10.00
1 Elevator # 301 4.25 4.25
1 Elevator # 34 4.25 4.25
2 Flag/Cryer elevators 30 & 31 or 39 & 40 4.25 8.50
1 Ext. Forceps # 150 12.00 12.00
1 Ext. Forceps # 151 12.00 12.00
1 Ext. Forceps # 23 12.00 12.00
1 Ext. Forceps # 17 12.00 12.00
1 Ext. Forceps # 18 12.00 12.00
1 Gracey Curette 11-12 6.00 6.00
1 Gracey Curette 5-6 6.00 6.00
1 Bone Rongeur 20.00 20.00
1 Bone Rasp 6.75 6.75
1 Scalpel Handle 2.50 2.50
1 Surgical Blades # 11 9.99 9.99
1 Surgical Blades # 15 9.99 9.99
1 Needle Holder 5" 3.75 3.75
1 Iris Scissors Curved 2.25 2.25

Discount (17.62) (17.62)

S & H 10.00 10.00

Total $ 168.60

Some items listed are part of the general surgical packs - I didn't list the breakdown, as she's a dentist, but here is the quote:

Surgical Set

Qty. Description Price Amount

1 Needle Holder 4-5" $ 3.75 $ 3.75
1 Needle Holder 6-7" 4.50 4.50
1 Scissors Sharp/Blunt 5" Straight 2.50 2.50
2 Mayo Scissors 5" Curved 2.50 5.00
1 Metz. Scissors 6-7" Curved 3.75 3.75
1 Mayo Scissors 6-7" Curved 3.75 3.75
1 Iris Scissors Curved 2.25 2.25
1 Mosquito Forceps Str. 2.25 2.25
1 Mosquito Forceps Cur. 2.25 2.25
2 Kelly Forceps Striaght 2.50 5.00
2 Kelly Forceps Curved 2.50 5.00
2 Pean Forceps 7-8" Curved 3.50 7.00
1 Adson 1X2 Teeth 2.00 2.00
1 Adson Serrated 2.00 2.00
1 Splinter Forceps 2.00 2.00
1 Russian Forceps 6-7" 2.50 2.50
2 Senn Retractors Blunt 7.00 14.00
2 Allis 4X5 Forceps 3.00 6.00
1 US Army Retractor 9.99 9.99
1 Ribbon Retractor 9.99 9.99
1 Weitlaner Retracor 12.00 12.00
2 No. 3 Scalpel Handle 2.50 5.00
2 Surgical Blades No. 10 9.99 19.98
2 Surgical Blades No. 11 9.99 19.98
2 Surgical Blades No. 15 9.99 19.98
1 No. 4 Scalpel Handle 2.50 2.50
1 Surgical Blades No. 20 9.99 9.99
1 Surgical Blades No. 22 9.99 9.99
1 Thin Probe 1.00 1.00
1 Gigl Saw Wire 1.99 1.99
1 Adson Bone Rongeur 25.00 25.00
1 Bone Rasp 6.75 6.75

Discount (22.96) (22.96)

S & H 10.00 10.00

Total $ 216.67


Here are some additional notes and references that I had sent to RR some time ago. I'm not going to go into techniques discussed, but rather cover equipment, supplies, and plants. If you are going to put together a dental kit, I highly recommend that you track down the references. You can get journal articles via Inter Library Loan (ILL) easily.

Equipment and supplies:

From [1]:
Dental mirror and probe
Pair of tweezers
Excavators and filling instruments
Hypodermic syringe
Extracting forceps
Zinc oxide powder
Oil of cloves
2% procaine or lignocaine
1/1,000 adrenaline hydrochloride
Absorbable homeostatic gauze
Codeine tablets

From [2]:
Universal type tooth extraction forceps
Needle holder instrument
Cotton or dressing pliers (tweezers)
Surgical sutures - silk or catgut, w/ needle size 4/0 x12
Soft ligature wire, stainless, .020" x50' (wiring jaws together/splinting teeth)
Dental floss x200 yd.
Zinc oxide powder x1 lb.
Oil of Cloves (Eugenol) x4 oz - 1 lb.
Dental cement, "IRM" brand
Toothbrushes x144
Oral pain tablets

Note: source for dental supplies, mail order:
Henry Schein, Inc.
Dept. SV
5 Harbor Park Drive
Post Washington, NY 11050
(Keep in mind that address is from 1984!)

Here is another supplier w/ a current address and great prices. I've ordered from them and have been very happy with their service:

http://www.dentalfuntoys.com/index.html
Dental Fun Toys
1040 E. 33rd Street
Hialeah, Florida, 33013
800-437-6455

Med tech Iowa is also carrying some dental supplies, write RR and ask about this.

http://medtech.syrene.net/

From [5]:
Some items not mentioned in other sources:
Orabase w/ Benzocaine
Sensodyne toothpaste
Hydrogen Peroxide
Salt

From [6]:
Cavit:
+ no mixing, easy to use
Tx provider squeezes small amount of material from the tube and places on tooth. Dental packing instrument (or cotton tip applicator or toothpick) is wetted to prevent sticking. Pack well and remove excess. Bites down to displace excess. Filling sets a few min after contact w/ saliva.

Zinc oxide/eugenol cements:
+ soothing effect of eugenol on teeth w/ pulpitis, significantly stronger than Cavit, can be mixed to a doughy stage for filling or less thickly for use as a cement.
- liquid tends to leak from its container leaving a pervasive odor on backpack and tent, difficult to mix, sticky mess to insert into tooth. Mixing begins w/ addition of a powder to a few drops of liquid, keep adding powder to make a dough that is as dry as possible, more powder is used on the instruments to
prevent sticking. Material is inserted and shaped as described for Cavit.

Barbed broaches are tiny instruments used to remove vital pulp tissue. Profound anesthesia is necessary. Anesthesia may be injected directly into the pulp as a last resort. A broach is inserted into the canal walls. The broach is turned clockwise 10 turns and then removed with the attached pulpal tissue.

More complete kit would include:
151 universal extraction forceps
Straight elevator (both for extracting teeth)
Bite registration putty (Express, 3M Co.) can be used to fabricate temp crowns and semirigid splints. With clean, dry hands (not letting powder from latex gloves contaminate the putty) kneed together equal amounts of components A and B. The material is molded into the desired shape, and any excess is trimmed with a sharp knife or scissors after 4 minutes setting time.
Mouth mirror
Syringe
30 gauge needles
Anesthetic carpules

A custom dental first aid kit is preferred over commercial dental "travel kits" which contain unnecessary items and lack essentials.

In an outdoor situation, techniques must often be adapted or improvised depending on the items available. For example, Fig. 13-19 shows how a suture can be used to splint and avulsed or extruded tooth. (txt from that illustration: …lacking adequate materials … use ingenuity and improvisation in splinting teeth. Suture can be used. A crude arch bar can be cut from a SAM splint and dead-soft wire obtained from copper wiring or twist ties). A temporary filling can be fashioned from soft candle wax, a hickory twig can be chewed to form a makeshift toothbrush and a Swiss army knife can be used to perform a drainage procedure. (Note that the coverage of drainage and applying drains is very good).

Additional coverage is given to anesthesia, w/ lidocaine recommended, all sorts of trauma treatment and selection and use of antibiotics, with penicillin and erythromycin recommended as the most commonly used in dental Tx, but noting that the broad spectrum antibiotics commonly carried on expeditions are acceptable.


Plants - from [5]:
Hercules Club (Xanthoxylum clava-herculis), a.k.a. Tickle tongue, toothache tree or Novocain tree. The white inner bark, when placed against the tongue, gum or inner cheek has a numbing effect. Boiling down larger quantities and applying directly to the problem tooth or gum can make stronger potions. Easily identified by its rough thorny bark. Found growing along fence rows and under power lines.

Western red cedar - chew buds to relieve toothache. Found in NW part of US

Arizona Cypress - chew leaves to relieve toothache. Found in SW part of US.

Dogwood as expedient toothbrush, peel bark, chew, brush. Somewhat bitter, but is supposed to have an anti-bacterial effect.

Wild mint or sassafras root may be chewed raw or boiled into a tea and used as a breath freshener or antiseptic.

Other plants w/ dental applications: wild asparagus, sweetgum, birch and yellow dock. (No additional information provided - anyone know more about these?).


Misc. notes and questions:
Analgesics: I do remember that aspirin and eugenol applied to vital pulp will cause necrosis (tooth death).

Drill speed: slow HURTS!, fast is good!. The old foot powered ones are slow… [10]

Antibiotics: seem to remember that some types of antibiotics are bad for the teeth, esp. for kids - anyone know which ones and why?

Abscesses: sewing needle applied between tooth and gum is one way to relieve them. Sterilize first.

Oral assessment: any dentists or dental techs out there that can give a summary of this? (hot/cold/sweet) sensitivity? I asked my dentist about this and got a rundown, but can't find my notes. Do remember that palpating a tooth that was going south will cause the pt to levitate… just like palpating certain abd conditions.

Refs:
[1] Emergencies in General Practice; Dentistry for the Ship Surgeon, by E. Joseph, F.D.S., British Medical Journal, p679-681, March 1956. This is one of the best articles available. Things have not changed much since it was written, and the info is still good.

[2] Expedient Dentistry; Experts Outline Emergency Procedures, by Dr. Devore E. Killip and Dr. John F. Nelson, p34-37 and p64-68, Survive, January 1984. This is a suprisingly good article for a mass-market publication, highly recommended.

[3] SF 31-91, SF Medical Hbk, ch. 19. This book should already be on your shelf, go fetch and re-read that chapter while your waiting for your ILL requests to come in. I like to xerox related chapters and put them in a file folder w/ articles. You don't overlook things later, that way, and it makes putting references and information together easier.

[4] Where there is no Dentist - a MUST HAVE book, if it's not on your shelf, go get a copy. Tells you how to make some of your own equipment. (Ditto the companion volume "Where there is no Doctor").

[5] Field Dentistry, Teeth, by David M. Knots, p8-11 and 68, Survival Guide, March 1984. This article focuses on use of the commercial temporary filling kits, however it does discuss other problems and the discussion of plant use is excellent. I have summarized the plant info above.

[6] Wilderness Medicine; Management of Wilderness and Environmental Emergencies, 3rd edition, 1995, by Paul S. Auerbach, editor. This is a large book - about the size of a phone directory, but well worth borrowing from your local library. P343-354 covers dental emergencies and the coverage is outstanding! Those who have not had medical vocabulary will want to keep a medical dictionary handy, but the
language is not so highbrow as to discourage the lay reader. The book is 1506 pgs long and heavy - not something you want in your BOB…

NOTE: I have not seen refs {7-9] yet, they were listed in the refs from [6], but look very promising. The core info from these refs looks to be summarized in [6], as it seems to cover the "meat" of the topics in a very hands on, loaded w/ info, fat free way. You still might want to see the primary source articles for a bit more depth.

[7] Dental Emergency: incision and draining technique for non-dental personnel, by DD Antrium, US Navy Med 75(1):20, 1984.

[8] Treatment of traumatic dental injuries by non-dental personnel, by DD Antrium, US Navy Med. 74(3):18, 1983

[9] Kit for temporary treatment of dental emergencies by laymen found useful, by Christiansen, G., Clin Res assoc Newsletter, 11(2):4 1987

[10] Personal correspondence w/ RR

Q) lidocaine vs. other anesthetics - any comments on pros/cons?

Q) Does anyone have any experience or tips on enalgum(sp?) or silver for permanent fillings?

Another ref. And I'm sorry to say, I don't have a good reference for this. Here's what I have: It's an
Article by Nick Williams, D. O., dated March 1993, that was published in the proceedings of NASAR
(National association for Search and Rescue). It's 18 8 ½ x 11 pages and the best article on putting together a disaster, SAR or relief org medical kit that I've ever seen. I don't have a publication date on the proceedings or even a title. This was later expanded and went through 2 editions as:

The Wilderness Medical Kit; Selection and Use of Field Medical Supplies, by Nick Williams, D.O., Second Ed. 1998, 5x7, wirebound, soft cover, ~120pgs. Published and available through NASAR. OK, "available" is a misnomer. They sold out and even their library copy disappeared, so they can't even reprint the second edition. They have been after Nick for a couple of years to finish his revisions and get the third
edition out the door, but to no avail. Nick is supposedly living in NM or AZ - if anyone can track him down, please kidnap him and FORCE him to finish this - it's too good to not have available! At the minimum, please call NASAR (703-222-6277, bookstore@nasar.org) and bug them about the book so they will put more pressure on him. Ask for a catalog while you are at it. They have many books of interest.

He's what he has to say about dental supplies in the 18-page version:

Dental Module:

1) Cavit or Eugenol/Zinc oxide for temporary dental repair or re-cementing of loose dental work. Cavit is easy to use but Eugenol/zinc oxide is stronger.
2) Bupivicaine (Marcaine or Sensorcaine 0.5%) can be applied topically to painful area, often with good, long lasting results.
3) Dental floss
4) Small, sharp bucks curette - for scraping out cavity material after anesthesia.
5) Consider a small dental burr mounted on a pin vice to further clean and slightly undercut cavity prior to filling with Cavit or Eugenol/zinc oxide. (My personal experience has been that any fillings that are not completely dry will be lost within hours and any that are not undercut will be lost within days).
6) Consider a small pulp removal tool if skilled in use.
7) A very complete and compact dental emergency kit is available commercially. (No source given, the commercial kits I've seen are not good).

Off topic, but while I'm looking at it, another resource given in this paper is: Margaret Cole specializes in miniaturized equipment for field laboratory work.

Margaret S. Coles, M.T.
R.R. 1 Box 43AA
Delhi, IA 52223
(319) 927-3152
(1993 address)


from the Special Operations Forces Medical Handbook:

SUGGESTED MINIMAL DENTAL KIT FOR THE FIELD
Surgery:
1 each: Tooth extraction forceps #150 - universal maxillary forceps
1 each: Tooth extraction forceps #151 - universal mandibular forceps 1 each: Tooth extraction forceps #17- mandibular "cowhorn" forceps
1 each: Tooth extraction forceps #53R and #53L- maxillary "cowhorn" forceps 2 each: Periosteal elevator - Woodson #1 and Molt #9
2 each: Straight elevator - #301 (small) and #34 (large) 5 each: #15 Scalpel blades
1 each: Bard Parker blade handle 5 each: 4-0 Chromic gut sutures 5 each: 4-0 Silk sutures
2 each: Dental aspirating syringe 50 each: 27 gauge dental needle 25 each: .5% bupivacaine (Marcaine) with 1/200,000 epinephrine anesthetic 1.8 ml carpule 10 each: 3% mepivacaine (Carbocaine) without epinephrine anesthetic 1.8 ml carpule
15 each: 2% lidocaine (Xylocaine) with 1/100,000 epinephrine anesthetic 1.8 ml carpule 1 each: Topical benzocaine 20%
Operative/General Dentistry: 2 each: Explorer #23
2 each: Periodontal probe 2 each: Spoon excavator 2 each: Dental spatula
2 each: Plugger, plastic filling, dental-Woodson #2 1 each: Intermediate restorative material (IRM)
1 each: Glass ionomer (Ketac-fil, or Fuji IX-GP) 1 each: Cavity varnish (Copalite)
1 each: Calcium hydroxide (Dycal)
20 each: Cotton rolls and cotton gauze
1 each: mixing pad; parchment paper, dental

-t

[osan]

I went to her graduation ceremony.

I ain't much on ceremony,...but what ya gonna do? So I sat there for 2 hours while they went through alla the pomp and circumstance.

It was a very multicultural group getting their degrees,....Asians,..Indians,...garden yariety white people, of course. Even had a fair sampling of Arabs.

Of course, every time one of the graduates walked across the stage their family would applaud and cheer loudly. But when an Arab graduate got their diploma, these women would start hollerin' that "LA LA LA LA LA LA LA LA" stuff they do with their tongue. (how do they do that?)

I'm just an old redneck boy, yanno,...and it scared the $#@! outta me.

I'm sittin' there thinkin', "Holy $#@!!,...I hope nothin' blows up!"

Congratulations! I am pleased for you, though I admit the thought of a career poking around the mouths of strangers is the stuff of mystery to me.

[Nirvikalpa]

Congrats to her

My fiance was awarded his Doctorate yesterday, too, though the only people hollering were the rednecks

[oyarde]

Congrats Smitty.

[William Tell]

Of course, every time one of the graduates walked across the stage their family would applaud and cheer loudly. But when an Arab graduate got their diploma, these women would start hollerin' that "LA LA LA LA LA LA LA LA" stuff they do with their tongue. (how do they do that?)

It's really weird when they make that noise.

[Todd]

It's really weird when they make that noise.

stick your tongue out of your mouth and then move it from side to side while yelling ahhhhhhhh!

You'll get close

[69360]

That was a smart choice. She'll always be able to provide for herself now.

My daughter has mentioned wanting to be an eye doctor. I think it would be a smart choice.

I don't really think there is much value in college degrees anymore except medical and law degrees.