My first mentally disabled patient =)

Friday mornings in Oral Med isnt exactly what I enjoy most, to say the least.

HnEs, intraoral, extraoral examinations, followed by loooong empty chats whilst we students wait around for the ONE consultant and ONE specialist running the whole clinic that morning to attend to our patients...

B.O.R.I.N.G.

But yesterday morning, Dr. Pemberton said to us,

"Who's up for a challenging case?" *with a naughty twinkle in his eyes*

I was curious and in desperate need of some excitement to wake me up, so I volunteered, not knowing what I've got myself into!

^^

" Ok, Kathryn and you, Pei, shall see James, a Down Syndrome patient. 45yrs old, complains of bleeding from his gums, and pain. Ask your usual questions, and look into his mouth and see if you can find anything."

OOOh this would be INTERESTING. I saw this patient in the waiting room whilst I was walking into the Oral Med dept this morning!

As we were walking out of his clinic into another room, Dr. Pemberton called out to us, saying,

"You might want to note that he has this unusual habit of sucking his socks."

=S Oh OK.

Heheh. So James came in with his carer, and it was quite a task to get him to sit on the dental chair even!

A different level of communication altogether =) I did feel like I was doing Paeds again, even tho he was a 45yr old grown man. =)

Kathryn did the history, asked the carer questions about James, the usual whats wrong, medical history, dental history, social history etc.

James was bleeding from his gums, and his carer only found that out when the socks he was sucking on is always covered in blood.

Then it was my turn, to examine his mouth!

James is very scared of needles, and I had to show him the 2 mirrors that I was going to put into his mouth to have a look around, and only then did he settle in the chair!

Asked him to open his mouth, but he kept looking at his carer, saying " Brew. I want a brew."

"Ok, James, you will have your brew. Open your mouth for this young lady to have a look first."

His carer had to bribe him with alcohol for him to BEHAVE on the chair!

HAHAHAHAHAHAHAHA.

After we recorded our findings, came the very challenging part of keeping him in the chair until Dr. Pemberton could come n examine him! OMG the amount of time we wait around till a consultant/tutor is available is ridiculous in Oral Med, and I was getting worried that James would just walk out and leave the room without being seen first!

His carer told us that James has a very difficult behavioural problem, and he would start swearing any minute if he was agitated.

I asked James if he could be patient with us, and that the 'doctor' would come n see him as soon as possible.

For the entire 15minutes we waited for Dr.Pemberton, James turned to me every 2minutes, saying, "WHERE. DOCTOR WHERE."

This increased in frequency and I was getting desperate.

"WHERE. DOCTOR? WHERE."

I frantically ran to the nurses and told them I think my patient has very little patience left. Haha, in a few minutes Dr. Pemberton came out from his room, whilst James was still saying to me, "WHERE doctor WHERE." ( I swear it was sounding more and more like a chant at that time hahahaha)

"There James, he's coming. He's walking here to see you, can you see him?", I said to him.

Phewwwwwww. =) More talking and 'questioning' by dr. pemberton to the carer, at that point i swear james looked as tho he was ready to run out of the clinic anytime.

"Open your mouth, James. Let me have a look." DrPemberton says to him. James turned to his carer, said" BREW. After this. " and only when he got a nod of agreement that he willingly opened his mouth.

HAHAHAHA at this point I was cracking up like hell inside. SO CUTE!! =)

Bcoz dr pemberton wasnt sure what was the problem at first, he had to ask James to bite together and open his mouth a few times.

And James kept asking him, "Last one?"

"yes, last one"

Apparently not hahaha he was asked to open and close his mouth more than 3times so poor thing, and every time he was lied to, saying " LAST ONE!" >.<

As it appeared, James was traumatising his edentulous ( 'toothless' ) ridge with his upper existing teeth when he bites down, and he gets ulcers and bleeding from it. Doesnt help that he bites and sucks on his socks too!

Treatment planning for a Downsyndrome patient was not easy.

My consultant spent ages trying to figure out the best possible way to solve this problem. Cant exactly stop his habit of sucking socks, if he has the rest of his teeth extracted he wouldnt be able to eat, James might not be able to cope with dentures or anything we could provide him with..

IMPLANTS? Apparently not, too.

Last option, extract all his remaining teeth, and hope that he will cope without any teeth. Patients do cope without teeth, you'll be surprised!

^^ it was quite a morning^^

Afternoon clinics didn't go so well though. Dentistry can be rewarding, but OMG so stressful at times. >.<

So the week ENDs, with a good night out in M2 with my flatmates! And BT's here to visit ^^

Have a HAPPY HAPPY weekend, everyone! =)