Child's Play

Today I had one of the hardest appointments I have ever had in clinic. I saw a 6 year old boy who was very impatient and had a very strong gag reflex. After the cleaning I went to place sealants on his six year molars. I etched and then the tooth got contaminated with saliva because he closed down. So I grabbed a bite block and etched again. Then the boy felt like he was gaging sat up and spit my bite block on the floor. I then asked the clinic assistant Megan to help me. She suctioned and helped keep his mouth open. It took a lot of effort and a couple of more times etching, because he kept closing down, but we eventually were able to get the upper and lower 6yr molars on the pts. right side done. We tried to do the pts. left side but it was not working. We had etched twice and both times he gaged and closed down. He began crying and said he didn't want to do it anymore. His mom came over and talked to him but he was still not willing to let us seal the teeth. I told Professor Wold what was going on and that I just needed her to scale check so I could send him home. In the meantime the boys mom had got him distracted playing a video game on her phone. Professor Wold sat down to do the scale check and while the boy was distracted she rinsed, dried and sealed the two teeth. I asked her why she didn't re-etch because we were taught to always re-etch if the tooth got contaminated with saliva. She told me "sometimes you have to improvise." The teeth had already been etched twice so the enamel was slightly demineralized where the sealant was to be placed. I think it was wise of her to place the sealant even though she could not etch again because the worst that could happen is the sealant may come off. I think it will hold pretty well though. I guess we'll see next semester when they come back. I felt like this was a good learning experience for me because in real life following the "book answer" is not always practical; sometimes you have to adjust for the situation.