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THE NEXTDDS Student Ambassador Blogs

Service in Dental School

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    During dental school, our experience is shaped by a multitude of areas – didactic work, clinical experience, and organizations. One area that I’ve come to find is essential for not only our time in dental school but for our futures as providers is service. I can still remember the first time that I heard about the Albert Schweitzer Fellowship program, a program that seeks to carry out sustainable community health programs to address health issues in vulnerable populations. When two Schweitzer fellows stood up to present their project on improving the oral health of local developmentally disabled residents, my attention was immediately captured by their enthusiasm and dedication to an underserved population. By creating a project that addressed the oral hygiene of developmentally disabled residents in our community, the two presenting fellows created an immensely successful project that helped improve the oral health of a population in need. But perhaps the most important characteristic of this need is that it is multifaceted. As I began my own investigation and learned more, it became clear that occupational therapy was another need of this population that has not been directly addressed. Occupational therapy has the potential to significantly improve the overall quality of life of a resident, and it is a service that when combined with oral health education, helps address each resident’s needs on a more holistic level. 

    During our project, my partner Carli and I, along with Monica, an occupational therapy student, visit local group homes and provide oral health and occupational therapy recommendations for each resident. It has truly been rewarding to work to improve the oral health of others in a setting outside of school. It is amazing to observe firsthand how much love the residents have for one another and the staff at each home. We usually arrive right after dinner which is a time of sharing and enjoying others’ company. As we walk in, we often hear happy voices and laughter, and it is clear that we are very lucky to be able to work with such houses. At our last visit to houses, it often evident that the staff and residents have really taken our suggestions to heart as residents who had previously hardly flossed are now trying out floss picks while others come up to us and excitedly tell us that they are now brushing for a full two minutes.

    My experience as a Schweitzer fellow has reminded me that the focus of service is not only about what you can do for others, but how you do it. When we come up with protocols for each resident, it is not enough to just suggest that the resident switch to an electric toothbrush or floss more. We need to make these suggestions in a way that fits into the resident’s needs, lifestyle, and desires. One resident had an electric toothbrush but never turned it on and used it as a manual toothbrush. After talking to the resident about why she didn’t ever turn the toothbrush on and the possible ways that doing so could benefit her, we suggested she try it once and see if it worked for her. By the last visit, she was using the toothbrush as an electric toothbrush by herself. Reverence for her and her lifestyle was really key to her change. I would encourage all dental students to spend time in service – my time in dental school would certainly not be complete without this experience.

Board Studying Strategies

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Part 1 of the National Board of the Dental Examiner is an eight-hour examination consisting of 400 questions probing across a broad range of dental and biomedical knowledge. Studying for this exam can be a laborious process enhanced by the infinite number of “resources” marketed towards first- and second-year students. Knowing where and when to begin is essential, and it can help dental students conserve their most precious resource, time.


                  While the task may appear daunting, remember that you have been preparing for this exam for years. All of your classes in dental school are topics that will be covered on the exam. The important part of board preparation is to schedule dedicated time and set short and long-term goals while studying. While there is no definite amount of time one needs to allocate to boards review, task completion can vary from person to person. Therefore, be realistic with yourself and have general goals set to determine what you need to accomplish with this process.

                  In order to establish a baseline, take a practice exam at least three months prior to taking the real exam. This is preferably completed in one sitting (I recommend a Saturday or Sunday), but can also be divided into two sections if it seems too overwhelming (200 questions in the first sitting of 3 and a half hours, and 200 questions in the second sitting of 3 and a half hours). Afterwards, review the answers in detail by reading the explanations and take note of your weaknesses and trouble zones in a notebook or computer. Reviewing the answers may take a while, even two to three times longer than the exam itself, so give yourself ample time.

                  Once you have a decent understanding of your strengths and weaknesses, begin to spend time reviewing the material that you’re least sure about. Start with a NBDE part 1 review book; I recommend First Aid. Use this as a guide to structure your studying around key concepts. Then, tap into other detailed resources and learn as much as you can about a system or discipline. Get to the point where most of the information can become intuitive. Memorizing buzz words and whatnot is a complete waste of time. You may pass the boards, but all the time spent will have been a complete waste.

The study material should flow from your brain in an eloquent manner. The only way to establish this is to dive deeper: learn why something behaves the way it does and ask how certain tidbits are related to each other. This is a thinking person’s profession and the board reflects it. Half of the exam is recalling information and the other half is being able to play with it and come up with a logical conclusion.

                  Now, once you’re all through studying, take a final practice exam a week before the real thing. During the week before the exam, review some of the less intuitive concepts and nuances that must be memorized. Don’t go too hard during this week, however. Relax, exercise regularly and get ample rest while you study to ensure that you have a clear mind before acing the NBDE!

Keeping an Open Mind During Externships

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         Dental school is similar to a really good movie, in my opinion.   Think about it, in a truly great film you are invested, you’ll laugh, cry, and wish there was more when it is over.  Being a 4th year student, I’m not sure if that last one really qualifies, but I’m sure the time will come when it does (I remember wishing I was back in undergrad around my second Gross Anatomy exam in dental school, haha).  As I look back, one of the main aspects that have affected every step of my dental school career is the fact that I am a member of the inaugural class and this has given me a unique perspective.  My final semester is approaching and I’ve recently completed an outside clinical rotation.  Being a newer program, our school has a different approach to the externship process.      

From friends at other programs, I’ve heard some students spend as little as 2 weeks on a rotation.  To give a reference, at UNE we complete 3 12-week rotations.  Now, not all 3 are external, but most students complete 2 of the 3 off-campus.  After learning the various types of rotations at other schools, I am very happy with the experience I received.  Of course there were some downsides- for instance finding housing was extremely stressful- but the good heavily outweighed any of the adversities.  I wanted to take the time to give the biggest piece of advice to anyone going on a clinical rotation- BE OPEN MINDED! 

Whether you are somewhere for 1 week, 1 month, or 1 semester, it is crucial to remain flexible and try to absorb all the information you can.  It will be challenging no matter where you go, and that’s okay- I promise, you’ll get the hang of it.  Confidence is key, but remember you will have a preceptor and never be afraid to speak up for yourself or ask questions.  Those being said, keep in mind your professionalism when speaking to the preceptor, staff, patients, and auxiliary team members as well.  More than likely, everything will be different from what you’ve grown accustomed to at your school- software, scheduling, materials, operatory set-up, radiographs, etc.  And this is why being open minded is of the utmost importance.

If you close your mind off, you’ll lose the opportunity to learn and grow as a clinician.  Not to say that you will want run your office exactly as your externship, perhaps you’ll observe certain aspects of a dental practice that you don’t want to implement in the future- you’re still learning and gaining experience.  It’s easy to go in with blinders on and not branch out, but as dental students we aren’t used to easy- getting here wasn’t easy, staying here surely wasn’t, and while I’m not there yet I assume post-graduation won’t be such a cake walk (cough*paying back student loans*cough).  I believe a part of any dental students personality is the ability to adapt and as long as you keep that in mind, you will be successful on any and all clinical rotations.  Best of luck to all of you and I strongly encourage you to take advantage of opportunities in communities you are unfamiliar with.  As they say “Life begins at the end of your comfort zone”.


Transitioning: A New Lifestyle

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 You study every waking minute for the DAT, you write draft after draft of your personal statement, and you proofread your application until your eyes glaze over. Many undergraduate students spend their entire four years with their eyes set on admission to dental school and think, “If I can just get in somewhere, all will be well.” Little do they know, one of their biggest challenges will come the first day of classes when they are bombarded by the workload that dental school entails. The transition from college to professional school has proved to be one of the biggest challenges of my life.

The perfect comparison between college and professional school is, “Undergrad is like drinking out of a garden hose, you can catch most of the water in your mouth but some may dribble to the ground. Dental school is like drinking from a fire hose, you just have to do your best to stay standing.” Between the workload, subject matter, and trying to discover hand skills you never knew were possible, it can be overwhelming and at first it seemed impossible. Multiple exams every week, classes 8-5 every day, practicals, wax ups. You name it, it was on my to-do list. There was simply too much to be accomplished. Not to mention that on top of school, I was supposed to be taking care of myself, working out, eating my vegetables, and sleeping 8 hours a day?! Impossible!

But during each and every late-night study session there was always a silver lining. I always knew that no matter how many pages of notes I needed to review or how many finals I had, there was always 48 other students going through the exact same thing. We struggled, but we struggled together. We became the biggest, happiest, craziest family you had ever seen. We formed study groups, shared tips and tricks, and of course had a few vent sessions here and there. Before we knew it, studying for multiple exams in a week became second nature, and we were acclimated to the dental student lifestyle.

For a few it was a smooth transition, but for most this process was full of anxiety, less than perfect exam grades, and many thoughts of, “Will I ever make it through this alive?” As we saw each of our classmates face their own personal hardships, we always made sure to send a smile and a lending hand their way. Although the transition from an undergraduate can be daunting at times, we all seem to find our own way of altering our lives to fit the dental student mold. Without the support, comfort, and reassurance of my classmates, this step could have seemed unreachable. As I look back on my D1 year, the memories that stick with me are sharing time with these people closest to me.

A Personal Story of Dealing with Grief During Dental School

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This blog post has been really hard for me to compose.  Grief is an incredibly individualized and personal experience, so I don’t claim to have any answers, I just want to share my experience with others. Maybe my experience will resonate with you, maybe it won't, and that's ok. 

I started dental school in the fall of 2013, about 2 weeks after my dad received a diagnosis of end stage renal failure.  His diagnosis was devastating, and it was even more challenging to have to move four hours away and start dental school right after hearing that news.  I tried to visit home as much as I could, but dental school is demanding, as we all know, and I had to spend a lot of time studying and working on hand skills so I could meet expectations in my classes.  It was hard.  I spent a lot of time feeling inadequate as a student and even more awful as a daughter and sister because my attention was pulled in so many directions.  As I progressed in my classes, my dad became more ill…he almost died the summer I started my third year of dental school, and he did eventually pass away in 2016, a day before I was supposed to finish my last required crown of junior year. I had to take the call from my sister at school, and then I had to stay that extra day to finish that crown.  It was hard for me to start senior clinic, on a new floor of the dental school. I had to work with new faculty who maybe didn't know why I wasn't there for the first week of school, or why I "randomly" started crying during yearly exams when patients I hadn't seen for a little while asked me about my family or how my dad was doing.  With time it got easier, but sometimes it's still very difficult. It hasn't been a year yet.  The holidays were so different. Sometimes I go days without thinking about my loss, and other times it hits me like a ton of bricks. I think I get the most choked up when I think about graduation, and my acceptance to a residency program.  I can't share those things with my father, and it makes me sad...but it also makes me happy because I know he would be so proud.  Grief is such a weird thing, isn't it? 

To be honest, sometimes I’m amazed I managed to stay in school and stay focused enough to be on track to finishing on time with my class.  I think some of the things I can credit with helping me stay the course were my friends, a supportive administration, and counseling services at Augusta University.  I never tried to hide my struggle; I was open with my emotions and my perceived shortcomings as a student, even if it was only to a few friends, a trusted faculty member, or my counselor.  Having those outlets really helped me keep progressing, even if I sometimes didn’t make the best grades in the class.

I think the main point I want to get across is that there are resources to help you make it through whatever problems you are having. It doesn’t really matter what your personal struggle is, maybe it is similar to mine, or maybe it is different.  It could be grief, mental illness, addiction, health problems, abuse, finances, etc.  We make a lot of sacrifices to do what we do. Dental school is expensive, stressful, and takes a long time, all of those things plus other personal struggles can take a serious toll on a person.  Dentistry is a great profession; even though we have incredible responsibility and face a lot of pressure, we also have such an amazing network through organized dentistry. In the end, it's all about getting connected, you aren’t alone. 

To Restore or To Remineralize? The Gray Area of Operative Dentistry

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As everyone knows, if you ask three different dentists for their opinion on how to treatment plan a patient you will get three different answers! Which brings me to the point of this article; there are a lot of different philosophies that can be considered when determining whether a patient’s lesion can be remineralized or if it should just simply be restored. Furthermore, with the ethics of live patient boards being scrutinized lately I believe that this topic is something that needs to be discussed and investigated nationwide. Some dentist may say they only restore when the lesion is cavitated, while others may say if it’s into the dentin then they will restore. However there are also dentist who believe that anything that is not cavitated can be remineralized. On the other hand, the “ideal” lesion for the live patient board examination is thought to be a lesion that is only 2/3 into enamel, which a lot of dentist would say could be fixed with remineralization. I personally do believe that remineralization can be done in many cases however, I also feel that there is no standard guideline as when to restore or not. I believe that the treatment plan should be patient dependent and should vary from patient to patient. For instance, a 14 year old Medicaid recipient with poor oral hygiene and a high sugar diet walks into the office and upon examination it is determine that the child has borderline E3/D1 lesions on almost every posterior tooth in the mouth. For this patient, considering his/her caries risk, I would more than likely just go ahead and restore the lesions because they will most likely progress into bigger ones.  On the other hand, if a 14 year old from a high socioeconomic background with good oral hygiene and a rather healthy/balanced diet presents for examination with E3 lesions I may choose to just review oral hygiene instructions with the patient and bring them in for regular cleanings and fluoride varnish/ gel trays, and possibly even prescribe a prescription fluoride toothpaste. The point that I am trying to make is that you simply cannot take the same approach with every patient as there are other factors other than the depth of the lesion that needs to be considered. On another note, there is beginning to be a rise in the use of silver diamine fluoride in the dental office. If you are unfamiliar with silver diamine fluoride it is a topical fluoride that can arrest active decay in the event that a patient cannot receive treatment right away. It works great in patients with multiple caries that will require several visits to restore, preventing the decay from going deeper towards the pulp before it can be taken care of. The consensus is that the disadvantage to using it as a treatment has to do with the technique sensitivity of its application. Silver diamine can stain almost anything leaving a black, very noticeable mark on countertops, dental chairs, and clothes if not placed carefully. Furthermore, its application may not be accepted well by a patient who is esthetically driven or has lesions on anterior teeth as it will also stain the carious lesions very dark and black sometime making them more noticeable than they were. With all that said, research is still being done on the risk/benefits of silver diamine fluoride application and its has not yet been approved by the ADA. So some institutions are providing the treatment for free since they cannot yet charge for it. Ultimately, the best way to avoid the dilemma of what to restore and/or not restore is to focus more on preventing aid. If we could minimize the occurrence of these “borderline” lesions it would be much easier to stay out of the “gray area”.


Healthcare and the Role of Funding Basic Science Research

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If you had a million dollars, what would you invest in: developing an affordable treatment for diabetes, or conducting research on how bacteria protect themselves from invasion?  The National Science Foundation and the National Institute of Health are two important government agencies that allocate tax dollars to scientists and allow them to delve into a basic understanding of human health. In the 1960s, these agencies decided to fund research that studied the mechanisms of how microbes protect themselves, simply because it was an interesting question. There was no way of knowing how such basic research could affect human health; they were curious about bacterial biology and pursued it with conviction.

Normally, when a virus enters a bacterium, it adds its own DNA to that of the bacteria, invading it and taking over. Researchers found that bacteria protect themselves from such viruses by selectively cutting the viral DNA. This finding lead to the scientific discovery of restriction enzymes—an enzyme that cuts specific chunks of DNA and uses this technique to move genes around. In fact, scientists quickly learned how to move human DNA into bacteria. Due to rapid bacterial replication, scientists can use them to make large quantities of human proteins.


Healthcare Applications

Why is this at all useful for modern medicine?After this discovery, researchers were able to efficiently produce human insulin, by introducing the human insulin gene into bacteria—a significant advancement in diabetes research. Prior to this discovery, insulin was expensive, unsafe, and less effective. In fact, it was harvested primarily from fetal cows. Because of heavy federally funded basic science research in the 1960s, human insulin is currently an effective and affordable treatment for diabetes.

Translational research is the buzzword of the moment, while basic science research has taken the “back seat” in research development and funding. Most obviously, one reason for this new emphasis is the political pressure on government agencies, like the NIH, to show tangible public benefit from all the basic science investment. Translational science research funding for the testing of new treatments, vaccines, and diagnostic tests seems far more valuable to politicians and to most of the general public. Furthermore, there has been an increasing impatience with the pace of basic scientific discovery that results in new products and cures.

Historically speaking, the past generation has been filled with revolutionizing scientific discoveries. Because of our current age of “instantaneous Google search results” and rapidly developing gadgets, we have far greater expectations for basic science advancements. The progress toward prevention and cures for widespread diseases, such as AIDS and cancer, has not been as rapid as we would like.

It is worth noting how such policy views and pressure on the NIH has directly affected funding. Every grant application to the NIH is evaluated on its practical merits—should this be an essential requirement for funding? In the 1970s, I don’t believe the practical application of basic research into the DNA polymerase of Thermus aquaticus could have been sufficiently justified. It is a simple thermophilic microbe with no medical or agricultural consequences. However, today, in retrospect, heat resistant Taq DNA polymerase is one of the most important enzymes in molecular biology because of its use in polymerase chain reactions (PCR). Similarly, how would one have justified the study of the practical application of fungal metabolism, which led to the discovery of statins? In hindsight, we know the clinical value of statins in lowering cholesterol and thus, we can reassure ourselves that it was a wise investment.

In the 1960s, the discovery of restriction enzymes, which has saved millions of lives by the creation of human insulin and other proteins, began with the simple question of how bacteria protect themselves. This has paved the way for scientists to ask other novel questions, create new knowledge, and further revolutionize science, with the discovery of DNA fingerprinting, biofuels, cancer drugs, vaccines, and HIV medications. Given enough funding to basic science, who knows what has yet to come. It is wise to consider funding basic science research as a critical investment in our future. Basic science provides the raw materials for clinical translation and will always represent humanity’s best hope at meeting a wide range of public health challenges.

The argument can be made that this system is wasteful, because although there are few fruitful successes, there are many more projects that yield no practical results. Consider a box of many particles, each trying to escape through a small door—they will randomly bounce around until they find the door. Finding the door is like finding its significant application to science and humanity. What do we do? Do we only choose to give all the energy to the small number of particles that are on track to hitting the door very quickly? Or do we allow all the particles to bounce around, each given less energy? Each particle, given enough time, will find the door, and since we have no way of knowing which particle (or basic science research) is the most fruitful, we must give all particles the opportunity to be energized (funded). This is because, after sufficient time, we will all reap the application of this research.

Given that this opportunity cost exists for any number of projects we exclude from our funding (even if we exclude one), we must fund them all. This argument makes no claim as to the distribution of funding; rather, it simply highlights the importance of funding basic science research.


Preparing for the NBDE I

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Well…I just finished taking the NBDE I just two weeks ago. The exam was certaintly difficult but mostly I am just feeling relieved to be done with it. It took a lot of hard work and preparation to get ready for it. At the University of Washington School of Dentistry, we have blocks called the “Foundations” that are supposed to prepare us to take the board exam. Each block covers a different body system. For example, we had one block called “Lifecycle and Reproduction”, another block called “Blood and Cancer”, and another block called “Cardiac, Pulmonary, and Renal”. Each of these “Foundations” classes goes into extensive detail on the topic, preparing us to answer any sort of question we may get. What is nice about these block classes is that we were divided into small groups to discuss all the topics. This allowed us to get more one-on-one help with certain topics and to feed off of each other’s knowledge. These classes served as a fundamental base for my board prep. We spent 1.5 years in these “Foundations” classes where I learned all the topics covered on the board exam. Then, in the summer before taking my board exam (I took it in December), I began additional preparation of my own. This consisted of reading the First Aid and Mosby NBDE I prep books…EVERY page of it! I also went through the Dental Decks and anytime I got a question that I didn’t know, I wrote it down so that I could come back to it later. Writing down certain facts that I don’t know really helps me to learn it…It may take more time to do this, but it definitely works for me! By the time the beginning of November rolled around, I had finished reading both textbooks and going through every question in the Dental Decks. The next month and a half consisted of just doing research. I would think of a certain topic that I knew I was pretty weak in and I would consult many different resources to learn all about that topic. For example, I knew I was missing every question involving the gastrointestinal system in the Dental Decks, so I took a few days to research it on my own. Besides doing that, I actually took the last month pretty calmly….I had been studying for months already and I didn’t want to psych myself out, so I actually didn’t do too much studying that last month…plus I had final exams for class to worry about at that time…This was pretty different than what a lot of my peers did…I know some people who told me that they didn’t start studying until after we finished final exams and only two weeks before taking the boards!!! Whatever works I guess! On testing day, I would recommend to stay calm and don’t study at all that day! It’s not going to help. Just relax, believe in yourself, and just be glad that in a few short hours it will all be over! And when it is, do what I did and go out and celebrate afterwards! You deserve it!