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THE NEXTDDS Student Ambassador Blogs

Which toothbrush and toothpaste should I be using?

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Ever since starting dental school over a year and a half ago, my family and friends have all come to me with their dental needs and questions. Although I am not an expert, I have acquired a ton of dental knowledge in this quick year and a half. One question that I have been asked quite frequently is what type of toothbrush you should be using. First and foremost, you should buy a toothbrush with soft bristles only. Medium and hard bristles can cause abfraction and attrition of enamel and can lead to gingival recession. Small-headed brushes are also preferred since they can reach all areas of the mouth, like deep grooves and hard to reach posterior teeth. Brushes come in many different styles with different shaped heads and different styles of bristles so it can be difficult in deciding what will clean your teeth the best. However, the best toothbrush is one that allows you to access all of your teeth and that will fit comfortably in your mouth.

Powered toothbrushes are also a great choice for people who cannot adequately remove plaque with manual toothbrushes. As a dental student, we were very fortunate to receive powered toothbrushes from both Sonicare and Oral-B to test out and I can honestly say that powered toothbrushes make a world of a difference. Not only do most contain a built in timer to make sure you brush for a solid 2 minutes, but they have oscillating and rotating heads to help breakdown the plaque biofilms that build up on our pearly whites. Every time I brush for the full two minutes with my powered toothbrush, I feel as though I just left from a dental cleaning. Needless to say, my powered toothbrush is an essential even when I go out of town for a weekend getaway.

Believe it or not, there are also many different methods in brushing your teeth. This semester in our periodontology class we learned about these methods and which ones are better than others. The modified Stillman’s method is the top choice in which you angle the bristles at 30 degrees toward the gingiva and brush in a coronal direction with a rolling stroke. Another option is the Charters method which is the best for patients with open interproximal spaces. This option is hard to do correctly because you need to angle the brush at 45 degrees with bristles pointing toward the occlusal surface which is opposite than how most people brush their teeth. The horizontal scrub should only be used on occlusal surfaces to avoid damaging both soft and hard tissues at the cervical areas.


Whatever brush you prefer and whatever method you use is really up to the individual as long as you are adequately removing the plaque that has built up on your teeth. With all of this in mind, go find a favorite brush and remember to replace it every three months to maintain that healthy smile!

The Importance of a Stable Occlusion

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 When you see a patient for the first time and are in the process of developing a treatment plan, one of the most important steps to evaluate is the patient’s occlusion. Often, in order to completely evaluate the occlusion, the practitioner will take impressions of the teeth, create models, and mount them on an articulator. Evaluating the occlusion is a critical step in treatment planning because problems can arise when a patient does not have a stable occlusion. In this post, I will be discussing the proper method of recording the patient’s occlusion and the importance of achieving a stable occlusion. 



Centric Relation 


Recording the patient’s occlusion should be done with a centric relation (CR) record. Centric relation is a maxillomandibular relation in which the condyles rest on the articular disc in a superoanterior position.  


In order to get patients into CR, I have them lift their tongue up and back to the roof of their mouth and close down on a piece of soft wax. Mounting the models in CR allows the practitioner to evaluate whether the patient’s CR is the same as their MI (maximum intercuspation) or if the teeth slide from CR to MI. In most cases, patients do not have a CR equal to MI, thus it is important to have a CR record. The ultimate goal would be to have the patient’s CR equal to MI.  


When CR is the same as MI, the muscles of mastication work properly together and the condyles are in the most stable position each time the patient bites down. Also, when the patient bites down, most (if not all) teeth contact at the same time. When CR is different than MI, the patient can place a lot of force on the first tooth that contacts when they function in CR. This CR interference can eventually cause a tooth to fracture. 



Correct Unstable Occlusion 


When a patient demonstrates having an unstable occlusion, problems can arise and worsen over time. For example, when a patient has a deflective contact on a tooth, this can first cause fremitus and gingivitis in that area and, if not corrected, the tooth can become mobile, demonstrate wear or abfraction lesions, and ultimately fracture.  


Additionally, patients with occlusal instability may develop parafunctional habits, such as bruxing or clenching. These parafunctional habits may cause headaches or TMJ problems. Simply equilibrating their teeth and improving their occlusal stability can eliminate these issues. Also, making an occlusal guard for the patient to wear at night can help alleviate the problems that arise from parafunctional habits.  


Overall, it is important to evaluate your patients’ occlusion before treatment in order to assess and possibly correct their occlusal stability, and to prevent any problems that may come from having an unstable occlusion. 

A New Patient Experience

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As students get into clinic and experience the realities of dentistry it is important to be prepared. Not only is dentistry sometimes difficult per procedure, but also can become emotionally draining. Nevertheless it is one of the most fulfilling experiences that can happen to a student dentist. In my own experience I remember distinctly thinking about seeing a new patient, how to go through all the protocols needed to provide excellent care, and how to engage the patient into a calming environment so that he or she enjoys going to the dentist rather than despising it.


It seemed like a lot to handle at the time. The new patients come into a clinic and want the best experience possible. Common fears that that have include pricing, pain, and time. These are common themes that have been seen by many other dental students in various universities. The goal should always be to provide excellent patient care and to create a learning environment for that patient for their oral healthcare


Outlined below are some of the ideas that have happened to impress me as time has gone on. These ideas are ones that can be implemented by any student to create that excellent patient care and experience. By trying out these ideas, the student dentist will be able to see a change in their experience with patients, and understand in a greater manner what it will take to become that super dentist that we all can become.


Prepare beforehand


It’s time. You have seen your patient on your schedule, the excitement builds, now what? It is important to review the patient’s medical history, and any other information pertinent to their upcoming visit. This is where you can take charge and help the patient experience something incredible and comforting.


Be thorough


Sometimes there will be the stress of time or amount of work that needs to be done on the patient that can be overwhelming. It’s important at those times to remain calm and continue to be thorough.  By being thorough the student doctor can become a better clinician and will provide better care for their patients.


Know your limits


This is an important life lesson. Dentistry is composed of many things, which scale in range form easy to difficult. Although a student may want to start on a procedure that seems fun, it could easily turn out into a difficult experience. Do not be afraid to ask for help from upperclassman or professors at a school or surrounding area. Growth comes from learning from many different sources including those around you.


These are some principle or concepts that have helped me grow and learn. Being trained to become a dentist in the future is sometimes a daunting task. Nevertheless if students can be prepared prior to seeing new patients, continue to be thorough, and recognize their limits, there will be exponential growth for that student. New patient experiences are always a wonderful opportunity to become better and improve.

Simple Steps to Developing Better Patient Rapport

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Nearly 9-15% of Americans avoid routine dental check ups due to dental anxiety. The reasons cited by this group of individuals for avoiding the dentist are varied, but common themes exist. Most people report their fears of the dental office stem from 3 major areas: 1) loss of control 2) embarrassment and 3) inattentive dentists and staff.



While it may be difficult for us as dental students and future clinicians to reduce our patient’s internal anxiety of visiting the dentist, we do have the power to make their office/school experience a pleasant one.


When your patient arrives, greet them. At NYUCD, our patients come from all 5 boroughs. Some even travel from New Jersey to seek dental care at our facility. They take the train, bus, cabs for upwards of an hour to get to our facilities. One of the easiest things you can do when you see your patient is to exchange pleasantries in the form of, “Hello, how are you?” or “It’s great to see you again. How have you been?” Some mistakes I have see from my peers are:

Directly leading the patient back to the clinical areas without even a simple “Hello”

Saying things like: “Hi Patient Z, let’s go, we’re running behind schedule.”


If you’re running behind schedule, respect their time too. Everyone has busy professional and personal lives. Sometimes, our patients have to deal with inattentive or sluggish administrative staff when their initially arrive at our clinics. If you are behind schedule with your previous patient and your next patient is already in the waiting area, excuse yourself from your current patient (if possible) and quickly present yourself to your next patient. Explain kindly that you are running a little late and will attend to their appointment as soon as possible. Believe it or not, patients who are greeted by their practitioner, even if the wait time is long thereafter, are generally more forgiving towards their provider during the appointment.


Understanding CCs and taking histories are important. Be a good listener. The most valuable pieces of information you can obtain from your patient are their chief complaint (CC) and medical/dental histories. Let your patient dictate the conversation and ask open ended questions. Give them the opportunity to paint the picture for you before establishing your own opinions and drawing up a treatment plan.


Don’t say whoops. We all make mistakes but verbalizing them during treatment is a no-no. Saying words like “whoops” or “oh no” can cause heightened sense of helplessness in patients who are already highly anxious or phobic. In your patient’s eyes, you hold the needle to that local anesthesia. You hold the drill that’s going inside their mouths. But you also have the power to appease their nervousness. If egregious mistakes occur, and they may, it is in your ethical good standing to explain to your patient what happened and how you will fix it.


After an invasive or complex procedure, follow up with your patients. Root canals are still faced with stigma of a painful and unpleasant dental procedure. The patient may be out of dental pain but they may require additional emotional recovery after the procedure. A good provider will prescribe painkillers following the root canal but a great provider will call the patient a few days following treatment to ask how the patient is doing.


Many of these tips are common sense, but you’d be surprise by the vast number of dental students who forgo these simple yet vital aspects mannerisms during patient care. Interpersonal skills are learned through practice. So next time you see patients, try to incorporate the advice above to increase your patient satisfaction.  

5 Things to Consider When Applying for Residency Programs

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As a third year dental student, I'm really beginning to think about where I want to do a residency. I know I want to be a general dentist, so that narrows my choices to AEGDs and GPRs. But there seem to be hundreds of them, all with very similar websites.  Sorting through all of them I think I've come up with a few criteria to help narrow the search down.
1. Location. I always thought I would stay in the same state my whole life. And while my state has several good residency programs, I've realized that 1-2 years in another state could be worthwhile if the program is strong.  Looking at all 50 states seems a little crazy, however, so I've narrowed my search to the states that I would enjoy living in and that aren't too long of a plane ride away from home.
2. Passion. What is your reason for applying to a residency program? Do you want to learn how to do more pros or perio surgery? Do you want a boot camp for private practice? I want to gain more experience working with special needs patients, and that has really helped me to narrow down my residency choices.
3. Breadth of experience. Some residency programs have you focus on getting really good at a few things (like AEGDs and fixed pros) or having a lot of experiences in different things (like GPRs and hospital rotations). Do you feel like you want to speed up your skills in areas that will be really helpful in private practice? An AEGD might be right for you. Do you feel like you want to experience a different side of dentistry that you might not see often in private practice? Then a GPR might be a better fit.
4. Money. Not all residencies provide a salary. And not all salaries are the same. If you have a lot of debt, it might be better to apply to residencies that will help you pay back that debt sooner.
5. Community. This is the hardest aspect of a residency to determine. I think the best way to find out what the community is like at a particular residency program is to talk to a resident. Ask them if the residents all get along for the most part and if the faculty go above and beyond to support their residents. Every website will have you believe that their program is the best, but find out if the people teaching and leading the program have the same values and interests that you do.
Best of luck on your search! 

Shifting Gender in Dentistry

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There has never been a better time to be a woman in dentistry. Up until the mid-1970’s, dentists were almost exclusively male. Women struggled to go to school, obtain a degree, establish practices, and to be respected as professionals by those in their community. However, all of that has changed over the last few decades as we experience a gender shift in dentistry. In the mid-1970’s, only 11.2% of US dentists were female. Now, that number is nearly 50%, and it is estimated that within the next few years, women will make up the majority of dentists in America. Two key factors led to this gender shift: the women’s liberation and civil rights movements of the 1960’s and 1970’s with federal grants to encourage increasing enrollments of women in professional health schools, and the impact of birth control on opening the doors for women to a professional career. No longer willing to be discouraged from seeking careers equal to their male counterparts, women have seized the opportunity to enter any profession of their choosing. This gender shift is changing the face of the dental workforce and raising many questions along the way, including how feminization will affect work hours, practice models, incomes, dentist-patient relationships, clinical philosophies, specialty practice, academia, and leadership.


Throughout history, women have chosen dentistry because it is intellectually challenging and improves people’s health. Additionally, women have found that setting their own hours as a dentist allows them to better manage both a practice and household demands. Dentistry offers a flexible job, especially for working mothers, but how might a shift from a male to female majority in the dental field affect dentistry in the future?


According to statistics and evaluations of dental practice patterns, women are less likely to own their own practices, more likely to work in urban areas, and are less prominent in the dental specialties.  One of the main reasons contributing to this specialty gender gap is that the duration of specialty education conflicts with child-bearing years. In an article posted in the Journal of Dentistry, it states that a staggering 17.9% of female specialists have no children versus only 0.7% of male specialists. Additionally, a study in Washington state found that female dentists, particularly those aged 25-40, work 10% fewer days, treat 10% fewer patients, and perform 10% fewer procedures. This would mean that for every 5% increase in female dentists in the future, 1.2% fewer patients will be treated annually. Furthermore, because on average, women work less, the same study found that women’s total annual income is 10% less than men’s. These statistics suggest that, given the patterns of the female workforce in dentistry and the increase in females in the field, the profession of dentistry may shift in the future to less entrepreneurship, more urbanization, and fewer clinical hours. These changes will entail increases in student enrollment, formal incentives for practice relocation to rural communities, and more business education and policies to modify advanced education and training for women with children.


Despite these statistics, studies have also shown that women favor a more preventive philosophy, take a more conservative approach to restoration, and encourage more preventive strategies in early stages of caries development. They also display more empathy and better communication skills, and are less rushed and more likely to discuss ailments and procedures with their patients. Women have been found to have better social skills, be more humane and caring, and are more responsive to patients’ needs.


It’s clear that men and women differ in a number of ways. Whether these differences will have major implications in the field of dentistry in the future is unknown. The current data is too robust to draw any conclusions in regards to the effects of this pattern of feminization. Future research, including surveys of US dentists and US dental students, will be necessary to identify differences in work patterns and to determine goals and barriers in the dental field. Despite how uncertain the future of this career may be, I am extremely proud to be a member of The University of Washington School of Dentistry’s first majority female class, and I look forward to continuing to challenge the perceptions society has had on women in dentistry.

-Nicole Antol


References: http://www.jcda.ca/article/c1

Dealing with Demanding Patients

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It is an all-too-familiar story, one that we all encounter at some point of our professional lives. We have patients who are a difficult to manage--patients such as scared children, anxious adults, and those that are not too thrilled to visit the dentist. Then we have dissatisfied patients, aggressive patients, and patients with physical difficulties such as an overly sensitive gag reflex. Here are some tips to manage such patients that I have collected over four years of school:


Dental offices can be seen as anxiety-provoking environments for patients who have any level of fear of the dentist. Slow down and listen. The key is taking the time to listen.

Communicate effectively. Many patients are really just looking for someone to communicate with them on their level. They often just want nothing more than to feel validated and someone to empathize with them.

Explain the procedure before you perform it. Don’t surprise your patient. Explain the treatment plan and procedure in a confident and calm voice.

Stand firm. We have those patients who are hard-driving individuals--direct and decisive. They want results, but also to control those results. To work effectively with dominant personalities, respect their time and their fear of being disadvantaged. Be brief and to the point in responding to their questions with to-the-point answers. Make them aware of the your qualifications and expertise and how it meets their desired results or bottom-line concern.

Sometimes you have to Just Say No. Patients who have unrealistic expectations—either to look like a movie star or their younger self—are trouble. Despite our best efforts to accommodate even the most challenging patients, there are times when we have to suggest the patient receive treatment elsewhere. 


Remember, unhappy patients will find a way to communicate their negative feelings. Don’t be one of those busy private practitioners who feel they can’t afford to waste time attending to these individuals. Doctors who take the time to get to know their patients' issues and make an effort to build the relationship right from the start have fewer issues related to miscommunication—including lawsuits.


So you want to specialize, is it worth the time and cost?

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So my fellow dental classmates and I entered a heated debate about the pros and cons of specializing the other day, and I thought this would be a worthy subject to talk about. There haven’t been many papers analyzing the nitty gritty details of a dental career, like internal rate of return (IRR) or net present value (NPV). But I think these are factors everyone needs to consider when they apply for residency and fellowships in the future.

The American Student Dental Association states that roughly 75% of dental students will have more than $100,000 of debt. The average student graduates with $241,097 of debt. According to the American Dental Association, there is notable variable in the average tuition and stipends for each residency program. They state the average general practice residency tuition is $3,579 while the stipend is $47,017. For OMFS programs, the average tuition is $14,105 and the average stipend is $44,874. Orthodontics has the highest average tuition, coming in at $14,105, with stipends of around $44,874.

The economic returns of specializing can be better understood by looking at net present value (NPV) or internal rate of return (IRR). A paper by Cordes et al. (2001) specifically analyzed the NPV and IRR for orthodontists and oral and maxillofacial surgeons.

The NPV uses discounted cash flows to evaluate investment proposals. This method accounts for the time value of money and can be represented by the sum of the present values of future net cash flows minus the initial investment. In Cordes’s study, the NPV was defined as the current value of the future wage difference between a dental school graduate and an age-matched graduate with further training in one of the two specialties. It subtracts all educational expenses from the additional training and assumes that general dentists have an NPV of $0. The IRR essentially looks at the “attractiveness” of an investment, such as specialization. The IRR was defined as the interest rate for which the NPV becomes zero. The acceptability of each investment depends upon the comparison of its IRR with the investor's required-rate-of-return. Ranking of investments is based on the relative sizes of the IRRs, with the largest favored the most.

The NPVc, is the working lifetime cumulative NPV, not adjusted for hours of labor, and it came out to be $271,536 for the medial group of orthodontists and $578,563 for oral surgeons. The IRR gives an estimate for the annual return over a working lifetime, and it was found to be 10.36% for the cost of investing in orthodontics training and 25.30% for that of oral and maxillofacial training. Compared to orthodontists, oral surgeons often spent twice the amount of years in training and on average 198 more hours per year in practice, but the breakeven point occurred 1.5 years earlier. They recovered their investment 2.3 years after finishing residency, while orthodontists took 5.9 years to recover.

Now I realize that ortho and OMFS aren’t the only specialties available. There’s still pediatric dentistry, endodontics, prosthodontics, and many others that weren’t discussed. But in general, the majority of dentists who choose to specialize are able to recover their specialty training costs. So don’t rule out a specialty that you love because of the additional years in training and tuition. Just as much, don’t go into a specific specialty because of the money. Match into something you think you could do for the rest of your life because money doesn’t always buy happiness.



Cordes, D., Doherty, N., & Lopez, R. (2001). Assessing the economic return of specializing in orthodontics or oral and maxillofacial surgery. JADA, 132, 1679-1684 







Pediatric Dentistry- What do we need to know?

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Treating pediatric patients in dental school can be daunting. As a dental student you are still learning the basics of operative, treatment planning and endodontics. Now you are asked to perform these on an uncooperative, unpredictable patient with a much smaller mouth! Before starting any pediatric rotation, there are some basic things every dental student should be aware of concerning pediatric patients and their teeth.


First of all, pain control is an absolute priority for pediatrics. If children feel pain during a dental procedure, they are likely to become traumatized and form a negative opinion of dental visits. The obstacles for pain control are that 1) most pediatric patients do not react well to a needle and 2) pediatric patients can receive less anesthetic than adult patients (normally 2mg/ kg weight). Doing your best to hide your needle and using distraction methods such as talking to the child about their toys, ice-cream and their friends usually helps. Ensure profound anesthesia before attempting to begin a procedure by testing soft tissue around the tooth many times. Limit the amount of anesthetic you give 4.4mg/ kg for Lidocaine and 7.0 mg/kg for Septocaine. 


Primary teeth also pose obstacles that permanent teeth do not. For example, the primary teeth have thinner enamel and dentin layers, which can make restoring them a challenge due to the proximity of the pulp. Caution must be taken to avoid the prominent pulp horns! Primary teeth should be restored quicker than permanent teeth since caries reach the pulp quicker in primary teeth. 


A stainless steel crown is a common pediatric treatment. It is indicated when multi surface caries are evident. For example, an MOD preparation on a permanent tooth would be better as a stainless steel crown on a primary tooth. Also, if a primary tooth has a developmental issue, such as hypoplastic enamel, a SSC is indicated. If the caries approximate the pulp of a primary tooth, a pulpotomy and stainless steel crown is always indicated.


For a pulpotomy, the pulp chamber should be removed to the level of the root canals, be sure to remove all infected and affected dentin. Hemostasis should be obtained using dry cotton pellets, probably several pellets. Then, a single pellet with 1:5 Buckley’s (formocresol) solution should be placed in the chamber for 5 minutes and then removed. Formocresol is a controversial material, but it is still used by many pediatric dentists and dental schools to clean the pulp chambers of primary teeth for pulpotomies. After the 1:5 Buckley’s (formocresol) pellet is removed, a ZOE paste, such as IRM should be placed in the chamber. Now the crown preparation is finished. Using a football shaped bur, the occlusal surface should be reduced about 1.5mm. The interproximal surfaces should be “sliced” to removed interproximal contacts and create feather-edge margins. Any buccal or lingual surface structure that needs to be removed for crown fit can now be removed. Next, the stainless steel crown is placed. It should be tried on for a secure fit before cement is added. It may be necessary to crimp and/or trim the crown to get a proper fit. A test for a secure fit would be to use the tip of the explorer and make sure that there are no gaps between the crown and tooth structure. The crown margin should be placed about 1mm subgingival.


A pulptomoty should NOT be used if there is visible swelling, mobility, a fistula, root resorption, periapical radiolucencies or signs of pulpal necrosis. In these cases the tooth should be extracted.


As you can see, pediatric teeth and adult teeth have several differences. Caution and care, plus a thorough review of pediatric characteristics should be done before treating a pediatric patient.


Smooth Sailing During Finals

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Smooth Sailing During Finals Week


At this point, I think it’s safe to say we are all familiar with the ins ands outs of finals week.  It is like an inevitable dark cloud hovering over us toward the end of the semester.  But like with the rain and clouds, once finals are over (usually) we too can expect a rainbow of our own … usually in the form of a break from our academic responsibilities.  Regardless of how many finals weeks I go through, I always enter the same vicious cycle of procrastination and feeling as though I’m barely surviving.  ‘You are your own worst critic’ is a phrase I’ve heard time after time and while I completely agree, it doesn’t stop me from getting down on myself.  However, this most recent finals week I made a list for myself to help make for a smooth finals week.  A lot of my friends thought I was wasting time compiling this list, but I have to be honest it really helped me!  I thought this list might help others as well, even if just by inspiring them to make their own list.  So, without further ado, here is my list of the top 4 tips for smooth sailing during finals week:

To-Do Lists

Making a daily to-do list is crucial for finals week.  By the same token, having a master to-do list is important so you make sure everything that needs to be studied/practiced gets accomplished.  Take this master list and break it up into days.  This will keep you from being overwhelmed with one list that seems endless, even after hours of studying.  Also, having smaller daily lists will grant you more satisfaction when you can mark off all the items for that day.

Stay Connected

This might seem counter-intuitive as most people cut off social media and all outlets during finals week to “focus”.  However, I am a firm believer of taking breaks.  During these breaks it’s important to reach out to friends and family.  Finals week is stressful even for the most prepared person and it’s vital to be able to connect to your support system.  Staying connected to the outside world will keep you grounded and allow you time to recharge your batteries.

Make Plans

I’m sure you’ve heard the saying “failing to plan is a plan to fail” and it’s absolutely true for finals week.  However, it isn’t about making plans during finals week, but rather making plans for after!  Whether it’s a photo of your vacation destination, a stack of books you want to read, or a nice bottle of merlot you’re waiting to pop open, having something ready for when your exams are complete is perfect method for staying motivated.  By reminding yourself of the post-finals rewards, you will be able to concentrate better at the tasks at hand and have a more successful finals week.


This recommendation for appropriate sleep shouldn’t come to a shock, and while it may seem redundant, I feel it is one of, if not THE most important tip for finals week.  Too many times I’ve witnessed friends and even myself falling victim to the monster known as an “all-nighter”.  These are never a good idea and with proper planning (#1 to-do lists) these can be easily prevented.  Having the appropriate amount of sleep will not only aid in your retention and understanding of material studied, but it will make you feel better leading to better performance on your exams.  Also, a well rested you will be much more pleasant to be around.  The world can always use more happiness, especially during finals week, so if I can add to that by simply catching a few more zzz’s, sign me up!


There are a million and one different ways for having a successful finals week.  This list is comprised of the top 4 I found to work best for me (for finals and exams in general).  I encourage you to try some of these out or create some of your own methods.  Most importantly, if you find something that works really well- please share!  Remember, sharing is caring. J


Ergonomics, fundamental for a healthy life

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While browsing Facebook, an ASDA post captured my attention. The post showcased a “posture break” as part of a wellness challenge for the month of January. At the same moment, I realized how I had been lying on my couch with my laptop for hours; my neck was bent and my lower back was starting to hurt. We often become so focused on daily activities that we disregard the importance of maintaining an adequate posture throughout the day, and then we wonder where is that back pain coming from?

Early in my first semester of dental school, one of the faculty members from simulation clinic asked me, “Do you want to practice for 4 or 40 years?” He then suggested if I do not wish to retire early, I should correct my posture. I often hear that dentistry is an ergonomics nightmare, and various studies show that dental professionals have high incidences of work-related musculoskeletal problems such as back problems, neck pain, tension headaches, and hand and wrist injuries.

After the first ergonomics lecture at school, I always try to be mindful of my posture when treating patients by using indirect vision when necessary, sitting with my back straight, avoiding tilting my neck, placing both feet flat on the floor, and using the adequate clinician clock position depending on which teeth I am working on. It is also important to remember to adjust your chair first, and then adapt your patient’s chair to your position. Also, kindly request your patient to turn their head instead of having to bend your back. Loupes have also helped me to avoid leaning over the patient in an effort to see more clearly.

We must take care of our bodies to avoid injuries and missed work, but also to live a healthier life in general. Poor posture inflicts extra wear and tear in muscles and ligaments. Prolonged static positions lead to muscle fatigue and imbalance. We have to be mindful of these prolonged positions throughout the day. It is important to be proactive by performing counter poses and taking breaks from stationary positions in the daily routine. There are multiple postural break exercises and quick stretches that can help to prevent pain. Also, regular stretches and activities like yoga can help relax tightened muscles.

In today’s world, as we spend long periods of time sitting in awkward positions looking at computers or staring at our phones, it is important to keep good posture. Remember to adapt your surroundings to your position and to keep moving to constantly stimulate your muscles. ASDA’s monthly wellness challenge invites students to change behaviors to positively influence their well-being. This month, I challenge you to pay attention to your posture and to incorporate counter poses into your daily routine.










What to Tell Patients Concerning DIY Dentistry

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Oil pulling? Homemade toothpaste? Soothe a toothache from your pantry? I am sure you have seen these same ridiculous internet sites claiming dental issues can be absolved via DIY methods. Chances are your patients have seen these too, which leads to the predicament of how to respond when patients inquire your opinion of these methods. We spend four years learning evidenced based dentistry, but rarely addressed are the less scientific techniques found on sites such as Facebook and Pinterest. After doing some digging on the most popularly questioned “do-it-yourself” treatments, here is what I have discovered:


1) Oil pulling took over social media and news sites the last two years, a practice involving swishing a spoonful of coconut, sesame, or olive oil for lengths up to twenty minutes. Supposed benefits include improved systemic health, as well as enhanced oral health and alleged whiter teeth. The American Dental Association released a statement in 2014 saying there is lack of scientific evidence to prove such a regimen has any impact on oral health and emphasized continuation time-tested modalities of brushing and flossing.


2) Homemade toothpaste recipes are abundant across the World Wide Web, seeming to rest on the premise that the acid in certain fruits plus the addition of baking soda creates a “simple and easy whitening method.” Researchers at the University of Iowa College of Dentistry published an article reporting that homemade pastes (in this case strawberry), while not necessarily harmful for teeth, did not contribute to whitening. Another popular ingredient combination is that of hydrogen peroxide and baking soda. While it is true these are ingredients in commercial whitening toothpastes, it’s important to realize that gum tissue exposed to hydrogen peroxide at high concentrations or long lengths of time become ulcerated, sensitive, and can start to recede. Encourage your patients to use dentifrices bearing the ADA seal to ensure quality ingredients.


3) Patients can become desperate when it comes to curing a toothache and seek ingredients found around the home in attempt to alleviate pain.  For example: the antibiotic properties found in garlic and onions, the analgesia of guava leaves and clove oil, and the pain-killing potential of cayenne pepper paste are prevalently mentioned routes of relief.  My personal favorite suggestion I stumbled across in my Internet search: eating raw butter to prevent the spread of decay. While I cannot argue that these nontraditional preparations may help some patients (perhaps the foul taste created by these foods distracts from the discomfort), it’s undoubtedly crucial to emphasize none of these techniques will permanently fix a tooth and professional dental care is necessary.


Self-proclaimed experts who in reality have no dental or healthcare background post many of these web blogs. In a society with simple ease of accessing such Internet sites and social media posts, it’s vital to steer patients in the proper direction of treatment and confidently explain why such DIY procedures are not the safest nor most effective approach.