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THE NEXTDDS Student Ambassador Blogs

Prevention and Management of Periodontal Disease

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We’ve all heard of gingivitis. It’s the inflammation of gum tissues and it is also the starting point of periodontal disease. If left untreated, gingivitis can lead to more chronic forms of periodontitis. Nowadays, more and more Americans are developing periodontal disease, a bacterial infection that affects the gums and bone of the mouth resulting in loose teeth, bleeding gums, and swollen tissues. 

 

 

What is Periodontal Disease? 

Periodontal disease occurs in an individual when bacteria and their byproducts cause the gum to separate from the alveolar bone that holds teeth in place. This results in pockets around the roots of teeth and can lead to the accumulation of debris that eventually causes inflection of the bone. The body’s natural immune system will try to battle the insults by releasing its own defense team to fight the bacteria within the pockets but the inflammatory response actually causes additional destruction of the bone surrounding the teeth. A common symptom of severe periodontal disease is loose teeth.

 

The CDC estimates that a whooping 47.2% of Americans have periodontitis. To put the number into perspective, only about 11.3% of the US population has heart disease. That means you are more likely to get some form of periodontal disease before that artery clogging, high cholesterol diet will give you heart problems.

 

Risks and Prevention 

The risk factors of periodontal disease are exhaustive. Most are preventable by changing daily habits while other factors are non-modifiable. A few of the main risk factors are listed below.

 

Smoking and Tobacco Use – Smoking has been hailed as one of the biggest drivers behind periodontal disease. Smoking causes plaque build up on teeth and results in deeper pocket depths. Luckily, periodontal disease may be reversible if the habit is stopped.

 

Systemic Illnesses – People with diabetes, especially uncontrolled diabetes, are more likely to get periodontal disease. The reasons remain unknown. Other systemic diseases with high prevalence risk rates of periodontal disease are leukemia, HIV infection, and inflammatory bowel disease such as Crohns and ulcerative colitis.

 

Genetics – We are all born with a set of oral flora that protect us on a day-to-day basis from the chemical and physical stresses we place on our teeth. It is believed that up to 30% of the population may be genetically more susceptible to developing periodontal disease. While we cannot change what bacteria we have in our mouths, we can all practice good oral hygiene to prevent the start of periodontal disease.

 

Periodontal disease can be prevented by practicing proper oral care such as brushing regularly with a fluoridated toothpaste, using floss, and going to see your dentist every 6-12 months for check ups.

 

Management of Periodontal Disease 

If you already have periodontal disease, the best course of action is to see your local dentist. The most common and least invasive treatment for early onset periodontist is scaling and root planing (SRP). The purpose of an SRP treatment is two-fold. First, scaling and root planing will remove calculus and other bacteria build up on the crowns and roots of teeth. Second, after SRP is completed, the bad bacteria and their toxins will be displaced, allowing normal oral flora to once again flourish.

 

If you have more severe forms of periodontal disease and symptoms include swollen gum tissues and loose teeth, the best course of action may include extractions and implants. Talk to your local dentist to find out what the right plan is for you.

 

Remember, prevention is the modern medicine. Practice good oral hygiene and limit risk factors to keep your mouth clean and healthy. 

Flossing vs. Oral Irrigation for the Treatment of Gingivitis

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                 Having just shy of a year of experience in the clinic, it has become apparent that most of my patients do not enjoy flossing, nor do they floss as often as they should. They all seem to understand the importance of flossing daily, however, it seems rare that they actually do so. On one occasion, a patient asked me--somewhat cynically--why there hasn't been a better invention than a "piece of string" to clean between teeth. I mentioned that there actually are more high-tech devices than floss, known as oral irrigators and manufactured by Waterpik. My patient seemed intrigued and wanted to know if they worked better than floss. While I remember briefly learning about these devices in class, I didn't remember specifically if they performed any better than floss. Because of this patient's inquiry, I wanted to learn more about how oral irrigators compare to floss in plaque control and in the management of gingivitis.

 

                  In order to fully address this question, it is important to first consider whether or not flossing is effective as an adjunct to toothbrushing. Flossing has received a lot of attention in the discussion of maintaining the health of the interproximal areas because a toothbrush cannot access and clean these areas sufficiently. In addition, these areas often show an increased amount of inflammation and dental caries.1 In a systematic review from 2008 about flossing as an adjunct to brushing, the authors stated, "dental flossing provides no benefit above and beyond toothbrushing on removing plaque and reducing gingivitis. Based on the individual papers in this review, a trend was observed that indicated a beneficial adjunctive effect of floss on plaque levels; however, this could only be substantiated as a non-significant trend in the meta-analyses."2 At first this finding surprised me, as I have always been taught that flossing is a very necessary adjunct to brushing. However, the authors commented about patient compliance--saying that many people do not floss properly, which could skew results and portray flossing in a bad light.

In another systematic review, researchers found that there is some evidence that flossing as an adjunct to brushing reduces gingivitis (because it reduced gingival bleeding). They noted, however, that the evidence is weak because the trials were poor in quality and are unreliable.1 Based on these two systematic reviews, the consensus seems to be that flossing does not have a significant effect in plaque reduction and reducing gingivitis. The authors in these studies referenced other systematic reviews that had similar findings.3

                  Another interesting point that Berchier et al noted was that in a 21-day non-brushing study, it was found that flossing alone was able to reduce bleeding scores by about 40%. This shows that flossing isn't necessarily useless, especially if done with proper technique. However, as stated earlier, flossing as an adjunct to brushing may not provide much added benefit. Given these findings, it is no surprise that many other types of interdental cleansing devices have been developed to aid patients in their homecare.

                  With the previously stated findings as a baseline, a comparison can be made between floss and oral irrigators. Interestingly enough, a systematic review (done by a similar group of authors mentioned previously) found that oral irrigators do in fact show a positive trend in favor of improving gingival health compared with toothbrushing alone. These findings were based on plaque scores, gingival indices, and bleeding.4 One limitation in this study, however, was that they could not carry out a meta-analysis due to insufficient data. While this systematic review still provides important insights, it may not be complete. In another 4-week study from 2011 in favor of oral irrigation, evidence suggests that oral irrigators have a significant advantage over flossing in improving gingival health. The authors of this study claim, "When combined with manual toothbrushing the use of an oral irrigator...is significantly more effective in reducing gingival bleeding scores as compared to the use of dental floss."5 One important consideration within this study, however, was the involvement of Waterpik in its completion; therefore there could be some potential of bias although they claim that they have no conflict of interest.

                  I must admit that the results I found in the systematic reviews surprised me a little bit. I was somewhat skeptical about the oral irrigators because I thought they might just be marketing tools. At the same time, the data didn't show any overwhelming evidence that oral irrigators were highly superior to flossing. However, one thing that kept sticking out to me while thinking about the studies was that there may be a deficiency in the way in which we educate patients how to floss (and perhaps use the irrigators). This leads me to my first main take away: the importance of persistent and consistent oral hygiene instructions (OHI) for patients. Not only is it important to demonstrate the appropriate techniques to patients, but also for them to demonstrate back what they understand. Additionally, each patient will need individualized OHI and oral hygiene adjuncts to toothbrushing that cater to his or her specific needs and limitations (e.g., manual dexterity, time, and other intraoral factors of the individual). For some, flossing may be the best; for others an irrigator may be more effective.

                  Furthermore, I will share more with patients about oral irrigators than I have before, especially to those who abhor flossing.  Because the evidence shows the advantage that oral irrigators have over floss, I feel that this may give patients a better chance at achieving periodontal health.

 

References

1.              Sambunjak D, Nickerson JW, Poklepovic T, et al. Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008829. DOI: 10.1002/14651858.CD008829.pub2.

2.              Berchier C, Slot D, Haps S, Van der Weijden G. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: A systematic review. Int J Dental Hygiene 2008;6(4):265-279.

3.              Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ. Dental flossing and interproximal caries: A systematic review. J Dent Res 2006;85:298-305.

4.              Husseini A, Slot D, Van der Weijden G. (2008), The efficacy of oral irrigation in addition to a toothbrush on plaque and the clinical parameters of periodontal inflammation: A systematic review. Int J Dental Hygiene 2008;6(4):304-314.

5.              Rosema NA, Hennequin-Hoenderdos NL, Berchier CE, et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011; 13(1):2-10.

Selecting and Working With An Accountant

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As I begin my journey of becoming an associate and eventually buying out a private practice office, I am realizing that there is a lot of trust that is put into lawyers, accountants, and appraisers.  Specifically, I am currently looking into selecting and working with an accountant.  First, finding an accountant is often by word of mouth referrals, or referrals from a banker and/or attorney.  Some questions to ask when interviewing accountants would be:  

 

    • What makes you different than other accountants?
     

 

    • Will you do any tax planning?
     

 

    • What’s the typical year look like if I was your client?

    An accountant’s timeline during the year begins around the end of September to review the numbers from the year. December 1st begins year-end planning, and by February 15th, they are preparing your tax return--which need to be submitted on April 15th.   

    So, what are all the roles of an accountant? He or she should be well versed in many areas including, but not limited to, bookkeeping, payroll, tax returns, personal property returns, and sales tax returns.  Each accountant can provide as many or as few services as you prefer.  Some dentists request that all the work be completed by an accountant; others want to be more hands-on in their practices and prefer accounts to address specific areas. An accountant is typically paid quarterly or monthly, which allows you as a client to manage cash flow easier, rather than paying an accountant one lump sum at the end of the year.  Remember that their goal is to provide more value than you as a client are paying.   

    One major area in which an accountant can help is coordinating both the practice and your personal financial goals.  Accountants will help with savings goals, cash planning, and how to efficiently take money out from the business for tax benefit purposes.   

    Accountants will also help you set up an entity for your practice.  Why create an entity?  This is the cheapest insurance you can buy; it will allow you to essentially separate your eggs into separate baskets. If the practice fails you will only lose the money invested, and creditors look to the assets owned by the entity to satisfy their debts.

    S-Corporations and LLC are the two most common types of entities in the dental field.  An S-Corporation provides limited liability and protection from being personally liable for debts, shareholders are required to pay their share of income tax on income (whether or not they received money), there is 100 person shareholder maximum, and the owner must take a salary. An LLC allows flexibility with income allocation, there isn’t much paperwork, and is cheaper to create. Additionally, a self-employment tax must be paid on profits of $400 or more in an LLC, there are no limits on shareholders, and few fringe benefits (such as group insurance, medical reimbursement plans, and medical insurance).   

    As dentists we will go through many phases of life, and our goals will constantly change.  This is where it is important to have an accountant step in and help achieve those goals.  When we start out as an associate, we are focused on production, then our goal moves to paying down debt and saving money in a retirement account. After an established lifestyle is created, we are concerned with helping our children and spouses for their futures, then we look towards retirement and transitioning our practice for resale value. Finally, an accountant can help you with estate planning.

    There are many advantages to working with an accountant who shares the same values as you.  Accountants have the awareness of how our business work, the ability to understand revenue structures, and the understanding of equipment and how it will produce revenue.  Finding and continuing a relationship with an accountant will be a key piece in your ability to be successful.

 

“How Do You Get Your Teeth So White?”

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The title of this blog is a question I have been asked time and time again, especially since starting dental school a little over a year ago. Desiring to attain that “perfect, Hollywood, bright-white smile” began when I was younger and always noticed people’s teeth. I begged my parents to let me get braces to correct my severe overjet and anterior crowding in the eighth grade, which didn’t help the awkward pre-teen years. Thankfully, my treatment only lasted 15 months and after removing the braces, my orthodontist suggested that I whiten my teeth as well. My parents let me use over-the-counter Crest Whitestrips and I was convinced that these strips were something made from God himself. It amazed me how such a simple procedure of bleaching one’s teeth could drastically impact their confidence and overall attitude.

I’m sure it is no surprise that when I found out we would be making custom bleaching trays this year in our D2 Intro to Clinic course, I was extremely ecstatic. I didn’t know what to expect with the procedure but after having completed this exercise over the past two weeks, I learned that custom bleaching trays are much easier to construct than I thought. The first appointment in this exercise was to take maxillary and mandibular alginate impressions and to pour up casts in yellow stone. After trimming the models to solely include the teeth in the arches in a horseshoe shape (soft tissues, palate, and vestibules were trimmed away), we were ready for the next step in this procedure.

During our next class session, we came to the lab with our trimmed casts and were given a clear Sof-Tray sheet to be used with the UltraVac vacuum former. The Sof-Tray sheet is ideal because they are thin, tough, flexible and soft—all important qualities for bleaching trays. The sheet was placed in the UltraVac vacuum former, heated to soften the sheet, and then lowered over the casts in a controlled manner to activate the vacuum. Now that we had our stone models with well adapted thin plastic sheets over them, it was time to cut out the custom trays. We did so by trimming the trays with a heated knife instrument by scalloping around the incisive papillae in a v-shape, and about 1 mm beyond the neck of the tooth in a smooth continuous line. The final trays needed have smooth edges to aid in the patient’s comfort.

The final appointment was to seat the custom trays and dispense the bleaching material. After sterilizing the custom trays, we made sure that they adapted well to the teeth and that they didn’t cause any irritation to the soft tissues. The faculty then distributed the bleaching kits and instructed us on how to apply the bleach, about sensitivity concerns, and not to drink dark liquids directly after each bleaching treatment to avoid intrinsic staining. As you could expect, we all felt like it was Christmas morning and were super excited to receive these kits and test them out at home. Now that a week has passed since we received the bleaching kits, I can honestly say that I’ve noticed a difference in the majority of my classmate’s smiles. Custom bleaching trays are a great tool to whiten teeth and I am very excited to perform this simple treatment for my future patients in a few years. I look forward to seeing their reactions to brighter smiles and for them to have that same sense of confidence that I got to experience so many years ago.

 

Implant supported over dentures

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From my few years of caring for edentulous patients, I have noted one major trend: people do not like their mandibular denture! I have heard numerous patients tell me that they simply do not wear them unless they are in a public setting and need them for esthetic purposes. Common complaints among mandibular denture wearers include 1)they move when I eat 2) they fall down 3)they cause sore spots on my gums 4) my tongue lifts them up  

 
Dental practioners have been attempting to solve these problems for decades. Adhesives work for short periods of time but must be reapplied and can cause the intaglio surface of the denture to "gunk up" over time. Implant supported over dentures are on the rise in popularity and are making great improvements in the lives of denture wearers. 

 
The concept behind implant supported overdentures is that the implants can act as a "snap" or "locking mechanism" for the lower denture to aid in retention. The implants would be placed anterior to the mental foramen and be symmetrical. Some clinicians advise placing implants in the place of #22 and #27, but others suggest in the place of #23 and #26 to reduce fulcrum effects.  Implant supported over dentures are more common in the mandible, since dentures are less stable there. There are 2 types of implant supported over dentures: 1) ball retained and 2) bar retained. For both of these types, the basic steps for the dentist are identical. 

 
These steps include:
1) incision over the ridge in which the implants are to be placed
2) reflect a flap
3) make an indention with round bur to prepare for the guide drill 
4) use the guide drill to make the path for implants (normally 2 guide drills are used of different sizes, the smaller drill would be used first) 
5) check the drill path with a parallel pin to ensure the paths are parallel 
6) check the depth with a depth gauge 
7) use an implant driver to install the fixture 
8) remove any surrounding granulation tissue 
9) collagen application under tissues (or the grafting material of choice for your patient) 
10) suturing over the entire ridge where the incision was placed  
11) wait for healing
    * healing may take several months as implant oseeointegrates with bone, time depends on the patient's       ability to heal (diabetic, smoker etc) 
After the healing has been completed, the abutment may be placed and then the final restoration. The final restoration for implant supported over dentures would be a ball or a bar. In both cases, the complete dentures would "snap" on and off the bar or ball. The patient can take the denture out to clean it and while sleeping. Numerous studies and surveys have reported incredible patient satisfaction with implant supported over dentures. Perhaps someday we will no longer being doing complete dentures without considering implants first!

 
Definitions to know: 
fixture- part of the implant that becomes embedded in the jaw (artificial tooth root) 
abutment- sits above the gum line and securers the denture onto it, added to fixture after osseointegration has taken place 

 

Identifying and Communicating with Eating Disorder Patients

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            As rising dental professionals, it is crucial to remember that in addition to focusing on our patients’ oral health we may also be the first to identify and intercede with issues extending beyond their smile. Individuals tend to present to their dentist more regularly than their physician, emphasizing our role as advocates for patients’ overall health and wellbeing. These could involve eating disorders, substance-abuse disorders, obstructive sleep apnea, as well as domestic violence. Clinical signs and symptoms are apparent in some cases: erosion patterns of enamel due to acidic regurgitation, softened tooth structure and rampant caries due to “meth mouth,” fractured or avulsed teeth due to trauma. However, not all patients are forthcoming and willing to divulge the honest cause behind these oral problems. The question posed is how do we broach such a sensitive subject when patients are not forthcoming of their medical history or personal events, specifically the sensitive subject of eating disorders?

According to the National Eating Disorders Association, studies have found up to 89% of bulimic patients have signs of tooth erosion, due to the effects of stomach acid. Bad breath, sensitive teeth and eroded tooth enamel are just a few of the signs that dentists use to determine whether a patient suffers from an eating disorder. Other signs include teeth that are worn and appear almost translucent, mouth sores, dry mouth, cracked lips, bleeding gums, and tender mouth, throat and salivary glands.  

Kristi Hatfield, RD, MS, provides some tips on communicating with such patients you may suspect of covering up a history of eating disorder:

  • Start by asking if he or she has had a history with acid reflux. GERD typically affects the posterior (more so with maxillary) lingual aspects, whereas bulimia displays a pattern of mainly anterior lingual erosion. Trauma to the maxillary anterior may be evident (i.e. fractured incisal edges or mobility).
  • Don’t be afraid to use the word “bulimia.” Ask the question with compassion, but also with confidence. The more uncomfortable you appear, the more timid and closed off the patient will be.
  • It is essential to pose your discussion in a non-judgmental manner. Aim to build trust between you and the patient and avoid “coaching” him or her. Shame and denial are tightly linked to bulimia nervosa, and an individual may not be ready to open up to you at the initial exam.

It is critical to share your clinical findings with the patient and explain how their symptoms are linked.  Discuss with the patient the reason his or her dentition is in such state is due to a problem that needs to be identified. Emphasize that no dental work can be performed to permanently remedy their dentition until such cause is recognized and treated. The goal here is to cultivate motivation within the patient.  If a patient still appears reluctant to admitting a possible eating disorder, request a medical consult with their physician.

Compliance may be difficult to achieve, as an eating disorder can span many years. Eating disorders often goes through quiet and active phases, and dental professionals must be supportive throughout. Ultimately, communication is key to achieving any level of success. The sooner you can form a trusting relationship with your patient, the better your chances of aiding them in tackling this destructive psychological problem, and the better the outcome.

Cracking the Interview Process and Securing Your Spot!

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For many students, interviewing is not their favorite thing to do. Interviewing comes with a lot of anxiety because of the nature of the beast. The key is to understand the purpose of the process and make yourself marketable to the stakeholders who are interviewing you. If you understand the way that they think and the culture of their organization, you can better tailor the way that you sell yourself! I have compiled a list of “Rules of Preparedness” to help you check the box in preparing for the interview. 

 

Research: This topic is extremely key! If there is a program or several programs that you would like consideration, site visits are very important. Organizations like to have individuals who are engaged and express particular interest in their program to come. Some key tips are to find out who the program directors are as well as other important people to know. Networking is paramount! Do you know any students who are currently at that program? When you make site visits, capture the contact information of the directors and the residents and keep in touch! This will go a long way.

 

Interview Questions: Are there blanket questions available to you? Look into that! If there is something out there that exists, make sure that you can deliver solid answers to each of those questions when you practice!

 

Interview Skills: Ask questions about the interview process. Is the interview process traditional or casual? Make sure that you have a clear understanding of what you are walking into that way you can prepare as well as possible.

 

Practice Makes Perfect: This may sound silly but practice truly does make perfect! I worked for a Fortune 50 company for years and called on some of the best and brightest physicians. Every day I practiced my presentations from cover to cover to include practicing how I would address objections. The term “objections” would be things in your application that may be weak, or may raise questions. Make sure that you can confidently address and/or defend those points. Link up with another student who is interviewing as well. Critique that individual and have them give you feedback as well. Also, set up a meeting with the Dean of Post Graduate Affairs at your school and ask if you can have a “mock interview” with them so that they can give you solid feedback to help strengthen your interview skills.

 

Be yourself: Many people have the tendency to become robotic and sound rehearsed during their interviews. DO NOT DO THAT! Allow your personality to shine through! Watch your posture. Sit up straight. Get comfortable and have a conversation! Understand that the person interviewing you may have once been in your shoes.

 

Good luck on all of your interviews! Sell your strengths, maximize your personality, and seal the deal before you leave that room.

Financing Dental Care

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      As a dental student, exposure to different types of dental insurance is rather limited compared to private practice. So what is the best type of dental insurance plan for both dentists and patients? What makes the most sense for both parties? A lot of frustration can be avoided by both the dentist and the patient when dental insurance structure and benefits are understood. Hopefully this post will help you understand two of the most common types of dental insurance used in private practice. 
 

      The American Dental Association (ADA, 2012) defines Direct Reimbursement (DR) as: “A self-funded group dental plan in which the individual is reimbursed for dental care provided, and which allows beneficiaries to seek treatment from the dentist of their choice” (para.2). According to research by Paul (2001), the ADA has experienced a large amount of success in marketing Direct Reimbursement to dentists, employers, and patients. In 1997, only 22,000 individuals were covered by DR plans but by 1999 that numbered had increased to 270,000 individuals (Paul, 2001). There are a variety of reasons why the ADA is pushing the DR campaign so much and why more and more people are enrolling with DR plans. DR plans are easy for patients to understand and the process is very simple (ADA, 2012). Patients don’t have to worry about what is and is not covered because DR is based on expense, not on the type of treatment received (Paul, 2001). There is typically no exclusion on reimbursement for treatment except some cosmetic procedures. Also, patients have the freedom to choose any dentist or specialist they prefer without pre-authorizations or referrals. There are a lot of different options and DR plans for patients to choose from. Patients can choose DR plans with higher or lower annual maximum benefits, higher or lower reimbursement percentages, and anything in between.  

 

      Indemnity plans are also recognized as one of the best options for dental coverage by the ADA and are very similar in structure to DR plans. An indemnity dental plan “pays claims based on the procedures performed, usually as a percentage of the charges” (ADA, n.d., para.5). Indemnity plans allow patients to direct their own health care and visit most any dentist they want (eHealth Insurance, n.d.). Also, patients enrolled in indemnity plans don’t need referrals to visit specialists and can freely visit any dentist they choose. The indemnity plan is beneficial for the patient because it provides the greatest level of freedom. The dental insurance company will pay 50 to 80 percent of the dental service fee but the remaining fees are to be covered by the patient. Indemnity plans also require enrollees to meet a deductible and have an annual maximum amount of coverage (Delta Dental, n.d.). What patients gain in the freedom to choose any dentist or specialist they pay for through the fee-for-service system.  

 

     There are several reasons why DR is better for the contracted dentist than indemnity plans.  As mentioned above, indemnity plans typically cover 50 to 80 percent of the dental service fee while DR plans cover 100% of any dental procedure (excluding some cosmetic services). While this seems as an advantage for the patient, it is also an advantage for the dentist as it preserves the doctor-patient relationship (ADA, 2012). DR allows the dentist to determine the treatment with the patient, without interference from a third party or restrictions from coinciding fees. Both insurance options reduce time spent on paperwork from pre-authorizations and referrals but the DR allows for a better relationship between the dentist and patient because the patient isn’t concerned about resulting fees for service. With DR the patient’s clinical needs can be put at the center of focus without regards for the patient’s financial concerns because they are completely reimbursed. This interaction allows for better communication, improved trust, and enhanced dental experience for the dentist and patient alike.  

   

        There are several different dental insurance models. This post only discussed two, but it would be beneficial to understand the variety of dental insurance models used outside of dental school. It's definitely worth studying and very easy to look up using the internet!

 

References

 

American Dental Association (n.d.). Dental benefit plan models. Retrieved from http://www.ada.org/en/public-programs/dental-benefit-information-for-employers/dental-plan-benefit-models 

 

American Dental Association (2012). Direct reimbursement plan. Retrieved from http://www.ada.org/en/public-programs/dental-benefit-information-for-employers/direct-reimbursement-plan 

 

Paul, III, D. P. (2001, October). Direct reimbursement: The future for organized dentistry. Journal of the American Dental Association132(10), 1433-1441. 

 

Delta Dental (n.d.). Types of dental plans. Retrieved from https://www.deltadentalins.com/individuals/plans/plan-types.html 

 

eHealth Insurance (n.d.). Indemnity insurance plans. Retrieved from http://www.ehealthinsurance.com/health-plans/indemnity/ 

An Experience with Interprofessional Education

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   Recently I had the opportunity to help teach first year medical students how to perform head and neck examinations as well as oral cancer screening exams.   At first I was a little intimidated, since the MD proctors were in the room as well as the students, but soon I realized that they were as eager to learn from the experience as I was and even treated me as an expert in my field (as a third year student this felt like a big deal!  

 

  It was really fun to discuss intraoral effects of many medications, such as antihistamines, calcium channel blockers, etc. with the medical students as well as effects of chemotherapy and radiation treatments on the oral cavity.  Explaining that these common treatments can cause adverse effects that can severely impact a patient’s health and quality of life really hit home with them.  Another important thing we discussed is the prevalence of oral cancer, and how treatable it is when caught early vs. after metastasis. We also talked about many systemic diseases that can show initial signs in the mouth or in head and neck radiographs, such as HIV and multiple myeloma.  

 

  My favorite experiences were when the proctor was an emergency medicine specialist.  These MDs see a lot of oral pain, facial trauma, odontogenic infections, and multiple other conditions relating to the oral cavity in the course of their practice and had a lot of interesting cases to discuss. They also seemed to value the experience more than some of the other proctors.  I even learned a few new things that make my exams more thorough and my consults more relevant to my patients’ primary care physicians!

 

  One of the things that I noticed is that the medical students were amazed at my knowledge of head and neck anatomy, cranial nerves, and the myriad medical implications of dental treatment.  I think interprofessional education activities such as the one I participated in are extremely important in developing rapport and respect for different healthcare professions and reinforcing the idea that dentists aren’t just “toothists.” We are physicians of the head and neck who have to have an extensive knowledge of how to handle patients who may have complex medical conditions and are experts in our specialty fields. 

 

   The four hours I spent with the medical students will most likely be one of the few experiences that they receive doing intraoral examinations, but I feel that I left a good impression on them as future doctors about the importance of oral health and evaluating the oral cavity for signs and symptoms of systemic disease or from adverse effects of medical treatment.  I also walked away from the experience with a positive opinion of interprofessional education.  

After all, one of the best ways to learn something is to teach it to someone else, isn’t it?  

The Downside of Digital Dentistry

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In today’s world electronics and technology are taking over in aspects of everyday life. When you go to the grocery store there are self-checkout lines replacing cashiers, when you go to the bank there are ATMs replacing tellers, when you go to the car wash there is a drive through machine that does everything for you. Well I remember when you had to stand in line to checkout at the grocery store with the cashiers, I remember when you had to go to the bank and stand in line to wait for the teller, and I remember when you went to the car wash and there would be like 5 guys working together to wash your car as quickly as possible. I mean, don’t get me wrong, the increase in technology has made most tasks more efficient but it has also taken away from the interaction and communication that occurs between people, not to add taken away jobs from the economy. Digital dentistry is no different! Yes, it does decrease chairside time with patients making certain procedures more efficient and allowing dentists to see more patients in a day in addition to allowing dentists to avoid taking impressions, pouring casts, and laboratory fees for production. But as you gain these things as a dentist you also lose personal face time with your patients which is the reason a lot of people like the dentist they go to. They like their dentist’s personality or how their dentist treats them, but by decreasing the chair time you make patients feel less of a personal connection and have less time to establish rapport. Digital dentistry also decreases the need for dental assistants and dental laboratories which ultimately takes a toll on the economy as their opportunities for work and business decrease. In conclusion, I would just like to say that although I do think digital dentistry is great, I also believe that as dentists who are trained to do these procedures we will lose the value of our education and before you know computer specialist will all of a sudden become dentists. So while it is ideal in some situations to use digital dentistry versus manually performing the procedure don’t let computers and technology take over your practice. Otherwise one day people will walk in the dentist office and we as dentist will simply become an assistant of the computers with no real use of the education we paid so much for! Just food for thought!

An Experience in Interprofessionalism

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        As a dual degree student at the University of Pittsburgh School of Dental Medicine and Graduate School of Public Health, I had the opportunity to participate in the Pittsburgh Bridging the Gaps Program. Bridging the Gaps is an interprofessional internship for health professional students.  The program in Pittsburgh is organized through the public health school and includes public health, social work, pharmacy, nursing, medical, and dental students.  Students are paired and assigned to a not-for-profit organization to work with and create an intervention in eight weeks.  Most of these organizations have limited staff and time to create new programs from the communities they work for.  The idea of Bridging the Gaps is to create an intervention that will be self-sustaining and can remain in-use after the interns have left in that specific community.  Some interns made curriculums for summer classes while others organized materials that were already available to make them more accessible for the organization.  With required clinic hours over the summer, dental students are only able to interact as oral health consultants; however, each intervention is required to have an oral health component whether through an oral health talk or handing out instructions about oral hygiene.  As an oral health consultant, I worked with several interns helping them prepare for their oral health component or in some cases, I gave the oral health talk myself. 

An interesting observation I made was the knowledge in which I have, as a dental students, about other health professions, but the lack of knowledge other health professions have about oral health.  Medical students spend one lecture on the oral cavity and dental students have several classes devoted to physical medicine.  It was important to keep this in mind when working with the interns.  But I enjoyed their energy surrounding oral health.  All the interns realized that in most of the populations they were working with, oral health was lacking in their lives.  Oral health is an incredibly large inequity in those with low socio-economic status, in the immigrant populations, and with the specials needs populations.  Most of the interns wanted to learn more so they were prepared for the questions that might come to them while at their sites.  It was my job to help make those resources available so they could answer those questions.  It truly made me feel part of a team. 

My most enjoyable moment during the summer was doing an oral health talk at one of the sites.  All the people that came to the talk were extremely interested in asking more and more questions about their oral health and the oral health of their children.   You could tell that many of them had had these questions for months and finally had someone around that could answer them.  It was a night of dissolving folklore and enhancing understanding.   

The entire summer was an unforgettable experience, but something that will always stay with me is the idea that since we all come from different backgrounds, we are passionate in different ways on how to make the health of communities or individuals better. My summer with Bridging the Gaps was a true example of combining different mindset as a team and creating a better community of health with it.