I'M HAVING PROBLEMS DETECTING CARIES

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newgradbc in Surrey, British Columbia

43 months ago

hi everyone.
im a new grad and i am having problems detecting caries and watches. like whenever the dentist does the rc exam he asks me if i saw anything and i tel him but i'm still missing some of them sometimes. any tips?? help a a girl out!! :)

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1RDH in Airdrie, Alberta

43 months ago

newgradbc in Surrey, British Columbia said: hi everyone.
im a new grad and i am having problems detecting caries and watches. like whenever the dentist does the rc exam he asks me if i saw anything and i tel him but i'm still missing some of them sometimes. any tips?? help a a girl out!! :)

Its his job to detect caries. Unless it's something obvious (which he should note) don't stress about it. Focus on the hygiene; tell him your periodontal findings and he'll catch on.

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Anys6 in fort collins, Colorado

43 months ago

Yes, it's Dr's job to dx decay. You can help out by discussing problem areas to pt before exam. Old fillings that are leaking, soft areas around crown margins etc. 4 eyes are better than 2. Ask your doc what to look for.

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Grace Kelly in South Dakota

42 months ago

yeah the doctor expects me to diagnose dental caries in the mouth I'm like well I'm not the doctor.

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Skitch33 in Littleton, Colorado

42 months ago

I always let the doctor know before she comes in for an exam, any obvious signs of decay or fractures, but when they patients ask, "Do you see any cavities?", I'll reply, "well I'm going to let the Dr. take a look!" :)

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marie in Houston, Texas

42 months ago

that's what i say too

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exp in Exeter, New Hampshire

42 months ago

Grace Kelly in South Dakota said: yeah the doctor expects me to diagnose dental caries in the mouth I'm like well I'm not the doctor.

Grace, I think that many Dr.'s like you to scan and check for areas they might not see that when you were scaling and polishing, doing the i/e. exam , checking teeth and perio...that there was something that you felt...so, yes you are not allowed by law to diagnose, but with the Dr. you are working with, to keep your job and also, use the skills and expertise you have now to help them to see, maybe not the obscure areas... This may work in your favor to keep your position, because, as you know...the field is oversaturated now...don't jeopardize your position. Go with what that Dr. needs...anticipate what he may ask above what you do. GL in this office...do the best you can to work with the needs of that office. If you are not happy there, start looking elsewhere...but be careful as to how you are looking for more or other work...rem. oversaturated, easily replacable in 2011 and for yrs. to come....VET

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exp in Exeter, New Hampshire

42 months ago

Skitch33 in Littleton, Colorado said: I always let the doctor know before she comes in for an exam, any obvious signs of decay or fractures, but when they patients ask, "Do you see any cavities?", I'll reply, "well I'm going to let the Dr. take a look!" :)

Good approach, no diagnosis, but you can inform the pt. of areas the Dr. has been watching and any areas you found today that you want him to check. Use your best judgement as to the Dr. and pt. personality and approachability.

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skrrrrrr in Victoria, British Columbia

42 months ago

Good doctors are very good at finding the decay. But when they first graduate they can be poor at doing it just as we are poor at doing it when we first graduate. A DH will get better with years of experience, just as docs do. But since docs also focus on decay and get to see what the decay is really like once they cut open a tooth, they gain much better understanding of decay than we can possibly learn.

I used to really suck at finding decay on rads, and still suck at finding it looking into the mouth. But when we hired a new grad doctor, I was better than him at finding decay on the xrays! That's when he really relied on us DHs to help him learn his trade.

The other issue is avoiding contradicting the doctor's diagnosis. It is better not to tell the patient our own personal diagnosis of their decay - leave that to the doctor who is responsible to diagnose it. Patients will lose their trust of the doctor if you tell them one thing and the doc tells them another thing. I will show them the signs of decay on their digital xrays, especially if the decay is obvious and deep, but I will just say 'oh this looks suspicious,' or 'this might be decay, we'll let the doc determine what is going on here because she is a lot better at it than me.'

If you disagree with the doc's diagnosis (yes this will happen), do not discuss it in front of the patient. Instead, pull the doc aside in private later on to review the decay diagnosis - still can be problematic after the patient has left. Ideally, you would discuss what you think is going on before the doc comes.

In our office there is less need for the DH to look for decay because of our digital xrays. The doctor can casually review the xrays on the imaging software while you do the cleaning because the instant the xrays are taken, they are available at any workstation in the office. Doc can check it before coming in for the exam.

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skrrrrrr in Victoria, British Columbia

42 months ago

As for 'watches,' two doctors will give you two different opinions. I would not even suggest them. You can't expect to know what they are going to suggest either way unless it is deep decay with RCT involvement .. even then you won't know if the doc will Rx an extraction or an RCT. There are different practice philosophies out there, and it is the doc's responsibility to choose the way he practices.

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skrrrrrr in Victoria, British Columbia

42 months ago

As for 'watches,' two doctors will give you two different opinions. I would not even suggest them, just tell the doc 'I see suspicious dark areas here and here'. You can't expect to know what they are going to suggest either way unless it is deep decay with RCT involvement .. even then you won't know if the doc will Rx an extraction or an RCT. There are different practice philosophies out there, and it is the doc's responsibility to choose the way he practices.

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RDHCJ in Connecticut

30 months ago

Honestly I still have problems finding the tiny caries. I look for black or brown spots and if they don't polish off I check them with the explorer for "stickiness". BUT don't press hard. I was told by professors that pressing too hard could actually turn a watch into a deep caries by puncturing it! So as a hygienist I don't want to make it worse. Checking xrays on radiographs can be difficult. If you have a dentist willing to teach you then just let them teach you what they see and feel. Many hygienists have a problem detecting small caries also.

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