Yet another downpour of rain today, they only last a few minutes but the heavens truly open and forcefully throw down buckets of water, flooding parts of the road but leaving the street slightly cooler than the sweltering heat that builds up throughout the day.
Anyway, the last couple of days have been choka-blocked with dentistry......
Something I have found is that the dentists here seem a lot less concerned about continual patient care such as thorough charting and special inestigations (X-rays, pulp vitality testing etc) - they are more concerned about the presenting complaint eg pain. In effect, they are a pain clinic. I had one patient who needed an extraction, and when I asked to do a full dental chart (to find out if any other teeth needed fillings, extractions etc), the supervisor just took a quick glance in the mouth and said "yes yes everything fine, now extract tooth" hmmm I'm sure there were some small carious lesions in there, but I guess they don't have time for that here. They just need to deal with the presenting complaint - even if it does mean having tunnel vision to everything else in the mouth. I try to do a quick intraoral examination, just so I can reassure myself there's nothing sinister going on. Today I felt like I was being rushed by the dentist, I feel bad either way: there are so many children to see in a day and I do need to speed up, but I just feel like I'm doing a botch job when I'm against the clock........can't win :-(
Another difference between the dentists here and at BDH (bristol dental hospital) is the level of confidence, or maybe carefree laid back nature......for example, when extracting a tooth at BDH, if you're concerned some root has fractured or is left behind in the socket, you would thoroughly check in the socket for any root remnants by cleaning, irrigating, suction-ing etc.....but yesterday after I extracted a primary molar, and thought I felt the root crack, on delivery one root was half the size of the other...now, because this was a primary (baby) tooth, it may have been due to root resorption, but at BDH you would still double check in the socket, which is what I did, but I don't know if I was feeling the root or the permanent successor. When asking the dentist if she wanted to check, she just replied "no no I am 100% certain that is root resorption. I know this. I know." Haha well that is confidence!
It was quite nice to have a cooperative patient the same age as the one in the horror experience I had the other day (4yrs). This time, I was able to inject him and extract his tooth without him crying or screaming or wriggling. And afterwards he was giving me high-fives :-)
We have been asking a lot of questions to the dentists and nurses about dentistry in Cambodia, and also their training etc. they don't seem to read any evidence based literature such as journals or papers. So they don't really know the best evidence based treatment options. And when asked how they learn/get their teaching, we found out they mostly get lectures from volunteers.....so here was a surprise, we are expected to give them a lecture!! On any topic, so we've been asking what they'd like us to cover. With one patient, we showed them how to fit a stainless steel crown which they were grateful for, probably because it took us a while to trim down the crown and get the perfect fit. So we might cover the hall technique, as it would make treatment much quicker and less painful for the kids if they didn't have to give injections and drill away caries.......
The stainless steel crown we fitted.
They would also like us to lead a discussion on child management, and the behaviour management techniques we use in our country...they were quite surprised to hear that we aren't allowed to restrain the child during dental treatment...
In other news, we went to an aspara dance and buffet the other evening - a type of traditional Cambodian dancing, very slow beautiful movements and controlled balancing....great bit of Cambodian culture dipping.
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