It had been a long week; looking back, it had been a long few months and I was ready for a vacation. I was in (middle) seat 22E, American Airlines headed for the Tropics with my family. It was an overnight flight and I had just closed my eyes when a classic P/A line awakened me: “If there is a doctor on the plane, please immediately identify yourself to a flight attendant”.

OK, for us general dentists this can be an awkward moment. We’re “doctors” but not the highly exalted M.D. variety. So I decided to wait a bit to see if a “real doctor” swaggered up the aisles. No movement. After a long 10 seconds, I left my seat and walked to the front of the plane.  An obviously concerned flight attendant greeted me. “Oh doctor, thank you so much for coming, the man in 4F has passed out”. I had to come clean with her so my answer was “I’m a dentist,  I’ll see what I can do”. I’m very awake now and wondering what the odds are of me being the only person onboard with some form of medical training. The man/patient in 4F had apparently lost consciousness trying to get out of his seat. His first class neighbors helped him back into his seat and I found a semi-conscious obese male approximately 50 years of age.

Cue the amazing phenomenon of “crisis acuity and slow motion”. Many of us have experienced this; in a crisis, time somehow slows down and you are acutely aware of actions and details.

ABC. Airway, Breathing, Circulation. As dentists we are mandated to know this and our basic life support training so that’s where I started. 4F’s seat was already back which, aside from him having no discernable neck, helped in opening his airway. Though shallow, he was breathing. Excellent, that means he’s circulating as well. 4F’s wife now makes herself known with “oh doctor, you can save him can’t you?” Great, at least there’s no pressure…

An interesting side note at this point. All U.S. commercial airlines carry A.E.D.’s, portable oxygen and a fairly extensive emergency medical kit. The attendant hands me the kit and another helps me start some oxygen. I locate the blood pressure cuff and stethoscope. After some difficulty (I really could have used an extra-large cuff) I obtained a reading of 120/90. Not great, but quite alive at 35,000 feet. 4F’s breathing now starts to stabilize, color returns to his (and his wife’s) face, and I’m able to ask some basic questions- General health, medications, allergies, what happened before losing consciousness and most importantly: did he have the fish or chicken for dinner (sorry, old Airplane joke).

I next had the privilege of meeting our flights captain who asks, “Do we need to declare a medical emergency and divert to the nearest airport”? Interesting dilemma: carry on over water to the tropics assuming 4F is stable or land the plane ASAP for definitive medical assessment? After gathering all available information, my differential diagnosis led me to a fairly strong conclusion: orthostatic (postural) hypotension. 4F had “a few” Scotches after take-off, enjoyed wine with his dinner (fish), finished with a hot fudge sundae, snoozed a little and rather urgently arose from his seat to answer natures call. The big man in 4F apparently fainted. I was about 90% sure of my diagnosis which I explained to the captain and the flight proceeded to its scheduled destination without further incident.

As dentists, we are trained to deal with a variety of clinical situations. With time and experience, we learn how to listen to, and gather appropriate information from our patients. We are here to help and above all “do no harm”. Check the meds in your emergency kit and know how to use them. Know where you’re A.E.D. is located. Practice a “mock emergency” with your staff on a regular basis. Make sure you are current and proficient with your BLS/CPR. You never know when you may be in 4F with a problem and the only person around to help is a dentist.

I remember the morning quite well. It was the middle of winter, it was raining, and the lobby of the Children’s Dental Health Clinic was full of children and parents. The appearance and mood of the room was best described as somber- with one shining exception, Erika. “Hi Dr. Blake, do you want to see my teeth?” she said, as I walked by. This one patient was a ray of sunshine that made me, and most of those in the waiting room smile. But like many of our patients, Erika’s easy and confident smile was the result of an extensive “dental journey”.

Our first contact with Erika was two years ago in the hospital emergency room. Erika, then 7 years old had an upper front tooth knocked out in a bicycle misadventure. Our dentist on call was able to re-implant and stabilize her tooth. As she returned to the CDHC for a follow-up visit we realized that she had never been to the dentist! She was terrified to walk through our doors and ashamed of her multiple cavity-ridden teeth. Erika literally put her hand over her mouth when she spoke so that no one would see her teeth. Our staff quietly and carefully guided her from the front to the back office. Our dental treatment team calmly used a “tell, show, do” approach to communicate what was going to happen at her visit. A few tears rolled down Erika’s cheek but she understood and was brave through the rest of her first “real” dental appointment. Her subsequent visits were each progressively less fear-filled as Erika gained confidence and understanding in our restorative team’s goals and approach. At her fifth and final visit, her hand remained in her lap as she spoke and we saw a glimpse of a beautiful smile!

Our dental treatment team did an excellent job in arresting her many cavities and restoring her teeth. But that was only part of her overall treatment. Over the course of her many visits Erika, her two brothers and her mother spent over two hours reviewing and demonstrating proper oral hygiene and eating habits. At the CDHC, we continue to believe that family education and prevention is the key to sustained oral health.

It took about two years for Erika to grow from a “dental phobic”, insecure patient to a confident, beaming 9 year old. Along the way she learned a lot about her mouth and more specifically her smile and how to keep it bright and healthy. Erika is now among that wonderful group of people that have sincere contagious smiles. Her future is indeed bright.

Many of us are blessed to grow up with well-maintained healthy smiles. Many of the children we treat are not so fortunate. All of us at the Children’s Dental Health Clinic know that each day may be the day we help another “Erika” along in their dental journey.

--JB

Oscar is a gregarious, healthy 9-year-old boy who loves baseball. He is the star first baseman on his North Long Beach Little League team. Like many boys his age, he has an easy, big smile with protruding upper front teeth. The cloudy 2nd Saturday in May would, unfortunately, be one Oscar would never forget.
 
Oscar was at “Opening Day” of Little League Baseball. He was waiting for his turn “on deck” when his teammate swung and missed a pitch, losing control of the bat. The bat went flying through the air, striking Oscar in the face. Oscar was wearing a helmet but not a mouth guard and the blow knocked out his upper right front tooth. After much panic, confusion and shock, Oscar’s tooth was located by a spectator who knew what to do: he bought some milk from the refreshment stand and, picking up the tooth carefully from the enamel/crown area (not the root), placed it in the carton of milk for transport.
 
One of our pediatric dental residents received the emergency call and met Oscar at the Children’s Dental Health Clinic. After easing Oscar’s (and his parent’s) concerns, our dentist re-implanted Oscar’s front tooth and placed a thin, clear splint to hold the avulsed (knocked out) tooth in place. Oscar’s prognosis was good as the surrounding bone or tooth root was not fractured. Our resident explained that there was a 50/50 chance that the tooth may still need a root canal in the future if it necrosed (did not remain vital/alive).
 
Oscar returned to the Clinic the following week for further evaluation of his tooth and healing progress. He reacted normally to testing and had returned to his usual (somewhat sugar-rich) eating habits. One month later his examination revealed no necrosis and almost complete healing of the surrounding tissues. The splint was removed and, to date, Oscar’s front tooth remains vital and fully functional.
 
Oscar’s tooth is one of the countless “saves” that happen regularly here at the CDHC. To the many dedicated professionals that work and volunteer at the CDHC, saving a knocked out tooth is almost routine. To Oscar, it meant the difference between a tentative, self-conscious grin and his big, restored tooth-filled smile.
 
For more information on how to handle a knocked out tooth please click on the following link:  http://www.aae.org/patients/symptoms/knocked-out-teeth.aspx

The year was 1982. My twin brother and I were college freshman on Spring Break. No, we were not packed into a trendy bar in Mexico. Instead we were in a well-used 22-foot sailboat making our first un-escorted passage from Alamitos Bay in Long Beach to Avalon on Catalina Island. Armed only with a compass and a healthy dose of free spirit, we arrived in Avalon a bit soggy but still afloat. We anchored the boat, paddled our cheap raft to shore and headed for the only pizza place on the island - Antonio’s. The original Antonio’s was a “hole-in-the-wall” restaurant with peanut shells on the floor and mini jukeboxes at each table. We sat down to celebrate our successful voyage and selected the song by the Four Preps, 26 Miles (Santa Catalina), a catchy tune about the beauty and romance of Catalina Island. Little did I know that eight years later I’d be making the trip to Catalina, not for pizza and beer, but as a dentist treating the island’s children.

Today, we send a dental team 2-4 times per month to care for children from birth through high school, the only game in town for many of our patients. We offer the best quality care; so if these children have very complex medical or therapeutic issues, we refer them
“over town” to our main clinic in Long Beach. Our dentists and staff members that have
made the journey will attest that it can be a long but very rewarding day.

If you are ever on Catalina, head up to Avalon school and look to your left – you’ll see our humble little clinic. And, if you want a great pizza, Antonio’s is still a short walk through town, jukeboxes and all. Go ahead and select that Four Preps song and listen closely to the lyrics. When you hear “forty kilometers in a leaky old boat... any old thing that’ll stay afloat,” take notice of the local children’s smiles - there’s a good chance that one of our CDHC dental teams helped make that smile just a bit bigger.

--JB