#16 What I Learned Today

Essentials of Clinical Practice

Today's lecture moved away from infection control and focused on the importance of keeping good patient records and progress notes. The legalities of record keeping for the state of Michigan is stated in the Dental Practice Act, which can be found via Google.

The act states that a treatment record is required for each patient, regardless of their relationship to the dental practitioner. Each record requires:

• procedures performed
• dates of procedures
• who actually performed the procedure
• charting of clinical finding
• any medication, prescribed, dispensed, or administered
• radiographs

The dental healthcare is responsible for the physical custody and security of the record. The dentist is responsible for keeping information confidential, and must obtain consent from the patient, unless disclosure is for purposes of treatment, payment or healthcare operations. This is all governed under HIPAA. The dentist is obligated to keep all original records to at least 10 years from the date of last treatment. The dentist must keep the original record, and can only distribute a copy of the record if requested by the patient.

All record content should be about personal information/demographics, patient history, examination findings, consultation and referral letters, appointment information, treatment planning, laboratory work, and patient education. Financial information and personal opinions should be kept out.

Lastly, the dentist should avoid using record templates, as they tend to not give the specifics of the case in question. You should be able to go back over the record at a later date and recall what happened with the recorded case.

Gross Anatomy I

Today's lecture focused on the structures found at the root of the neck; the area bounded by the body of the first thoracic vertebra, the first rib, and the manubrium of the sternum. This can be described as the area between the thorax and the neck.

A number of arteries branch off the arch of the aorta and pass through the root of the neck, including the brachiocephalic trunk on the right side, and the left subclavian artery and left common carotid artery on the, you guessed it, left. A number of smaller arteries branch off the thyrocervical trunk, including the transverse cervical artery, suprascapular artery, and the inferior thyroid artery.

The sympathetic trunk also runs up the root of the neck, and you find three sympathetic ganglia:

1. superior cervical ganglion
2. middle cervical ganglion
3. inferior cervical ganglion (lowest)

The phrenic nerve, vagus nerve, and ansa cervicalis are also evident.

You also find a carotid sheath in the root of the neck, and it engulfs the common carotid artery, the internal jugular vein, and the vagus nerve.

Also important to note is the presence of the carotid triangle, which is bounded by the sternocleidomastoid muscle, posterior of digastric muscle, and the superior of the omohyoid muscle. The carotid triangle contains:

• superior laryngeal nerve, which divides into the internal & external laryngeal nerve
• pharyngeal plexus of nerves
• common carotid artery
• internal carotid artery
• external carotid artery

A number of muscles can be found in the root of the neck, some of which include:

• stylohyoid muscle
• sternohyoid muscle
• sternothyroid muscle
• omohyoid muscle
• anterior scalene muscle
• middle scalene muscle

And to finish up, two major glands are found in the region: the thyroid gland, and the parathyroid gland.

Gross Anatomy Lab

After lecture, we headed over to the lab to identify structures in and on the heart. We isolated the main coronary arteries and cardiac veins. These supply blood to the heart structure itself, then dump it back into the right atrium via the coronary sinus. You see two major coronary arteries, shooting off to the left and right, just off the ascending aorta. The left coronary artery branches off into the circumflex artery and the anterior interventricular artery. The right coronary artery branches off into the marginal artery and the posterior interventricular artery. The coronary sinus has three major branches of veins coming off, including the great cardiac vein, the middle cardiac vein, and the small cardiac vein.

We also made incisions to gain access to both of the atriums and ventricles. We further identified structures inside, all of which can be found on Google. The neatest structures to note was the complexity of the pectinate muscles and trabeculae carnae lining the atriums and ventricles, respectively. As well, the setup of the semilunar and cuspid valves were interesting. The bicuspid/tricuspid valves have cusps that are collected to papillary muscle by chordae tendinae, which stops regurgitation of the blood back into the atriums from systolic pressure. This differs from the semilunar valves, which sit freely in the openings, and catch any flowback blood that occurs in the pulmonary trunk or aorta.