The reasons a dentist needs to have a lawyer can be quite numerous and complicated. However, as a new graduate there are a couple of reasons which are important for new dentists to think about before practicing in an office.

First, if a new dentist is thinking of joining a corporate dental setting or joining a solo practice as an associate, they should have their attorney look over their employment contract. More so, the lawyer should be an individual familiar with laws and regulations associated with dentistry.  The lawyer should licensed in the same state a dentist is planning on practicing and, if avoidable, should not be a family member or friend. Some things a lawyer can help a new dentist with include negotiating the Term of the contract or its Termination provision, setting the Non-Compete (also known as the “Restrictive Covenant”) distance limitations on where a dentist can practice for a certain period of time. Some contracts will say a dentist cannot practice with 100 miles of their current practice for up to 2 to 3 years after a dentist has left a practice. These are some of the things dentists might not catch when reviewing their contract on their own.

As a dentist is getting ready to start his or her own practice, it also important to have a lawyer, especially when work working up leasing contracts or purchasing a practice. There are endless reasons why it is important for dentists to have a lawyer, and while it is impossible to describe all the reasons, these are just some key points to think about. New dentists can expect to pay about $2,000 to $3,000 in attorneys fees depending on where they live. Some lawyers are paid by a retainer fee and some are paid hourly. It will be important for the new dentists to carefully interview the prospective attorney in order to discuss several important topics:

Fees

Experience

His/her reviews and practice record

Personality

Becoming a new dentist includes many new responsibilities and can be quite overwhelming. If dental students start thinking early on about what they may need in the future, the transition from school to private practice can be a little smoother.

Aside from an attorney, a new dentist should also think about getting a financial advisor as well as an accountant. Also any opportunities for business courses or lunch and learns related to business management are also helpful for dental students.

Friends, coworkers, or relatives can often provide a simple source of referrals for counsel. Lawyer referral services or state dental associations may also be an excellent source for a dentist’s attorney. Lastly, it is important for new dentists to take their time before making any impacting decisions and consult with their team of advisors to make the smartest decisions for themselves as well as their careers.  

In a world driven by technology, we can’t avoid social media.  From Facebook to Instagram, Twitter and LinkedIn, we’re always connected.  We use it to get information, share pictures and keep in touch.  But the tricky question is, how do we keep social media fun while keeping it professional?  How do we use social media as a tool to complement our professional relationships without undermining them?  Striking a balance can be a challenge, but with these tips, you can figure out how to keep up with friends but still manage to be a professional dentist.

The Good

Keep in Touch

Many of us use social media to keep in touch with friends in the area, maybe a class Facebook page to share notes or an alternate way to message other than texting.  Beyond that, however, it’s a way to keep in touch with family and friends from across the world.

Networking

Social media allows us to connect with people whom we may not have prior.  It allows us to keep up with them in a less formal manner, making people more approachable.  It provides a simple way to say hi to someone or ask a question without filling up their voicemail or email inboxes. 

Disseminate Information

Life online also allows us to disseminate information as a means of education, advertisement as a practice builder or a way to share beliefs.  While in school, it helps students share study guides and keep on track for graduation.  For practices, it provides a way for patients to interact in contests and rewards programs or simply keep up with the practice. 

The Bad

Judgement

Let’s be honest, we are all fairly judgmental just by nature.  When you hear about that cute new D1, what’s the first thing you do?  You go “Facebook stalk” them and judge them based on their pictures, whether it be good or bad.

No Such Thing as “Private”

There are so many stories about people getting into so called “private” pages.  Treat your page like everyone has access to everything.  Regardless of someone’s privacy settings, people are connected.  Maybe your aunt’s friend is an admissions counselor at that residency you want to get into.  You never know.  Also, keep in mind that there are some super geniuses out there who can hack things.

Permanence

Anything you post on the internet is there forever.  Keep that in mind when you post something inappropriate or use foul language.  Would you want your parents, future boss, or patients to read this?

Distraction

We all have a relationship with our technology.  We need to learn to use technology for the good, but like everything else, in moderation.  Try to disconnect every so often.  It will not only give yourself time to recharge and get in touch with reality, but it will help with your interpersonal skills.  With interviews or when interacting with individuals, it is critical that you be respectful and put your phones away.  Especially with older generations, it is imperative that you have your phone on silent or turn it completely off to give them the respect they deserve.

The Balance: How to Use Social Media for the Good and Avoid the Bad

Realize You’re Always in the Spotlight

Keep it Classy

First and foremost, go all the way back to the beginning and filter through your pictures.  Avoid alcohol, obscene gestures or pictures that may not be considered professional.  Keep it G rated.  Choose a profile picture carefully that reflects you in a positive light.

Avoid using foul language or curse words online as it can truly diminish your character. 

If you want to be taken seriously, ensure that your grammar is flawless.  Double check for typos before you hit “post”. 

Remain Neutral

Try to avoid religiously, politically or emotionally charged statements.  Even if it doesn’t directly offend people, it may subconsciously taint their view of you.

Post statements you would be comfortable showing your faculty, boss, patients, or grandmother. 

Never discuss, complain or comment about work online.  It makes you seem unprofessional and in our business, can really get you into trouble with HIPAA.

Bottom line, is to remember that anything can be posted.  Nothing can be deleted.

CAD/CAM technology enables dentists to fabricate an esthetic crown in one or two visits. So 

long to the days of standard impressions and conventional model making! With CAD/CAM, a

digital impression is scanned with a camera or video, and its software designs a crown that can be modified by the technician. The crown is then milled out in the ceramic of your choice. Now that CAD/CAM has become so popular due to its convenience and efficiency, there are several new ceramics on the market and we must be knowledgeable of all the choices. The leading ceramics on the market today are leucite, alumina, zirconia, and lithium disilicate. Each material has its advantages and disadvantages. Knowing which ceramic to use in different clinical situations is vital to the success of the restoration. In this blog, I will be explaining their advantages and disadvantages and when to use each ceramic.

Leucite ceramics have high translucency and are very esthetic, permitting use in the anterior region. However, due to their high glass content, these ceramics have very low strength and should not be used in posterior regions or areas with greater occlusal loads. Alumina ceramics are extremely translucent, in fact, build-ups/core materials may be seen through an alumina restoration. They also have low flexural strength, and with the invention of other ceramics that more effectively combine strength and esthetics, alumina is slowly dying out as a restorative material.

Zirconia is one of the newest ceramics on the market and has been a very popular choice for dentists. Zirconia has impressive strength and therefore can be used in posterior regions with heavy occlusal loads. Zirconia can also be used as a bridge framework due to its increased strength--this has better esthetics than a metal framework. Zirconia can either be veneered or monolithic. Monolithic is the strongest and because of these physical properties, it often permits a dentist to use a conservative prep design, similar to a full-gold crown. Veneered zirconia is more esthetic and can be used in the anterior region. Veneered zirconia has decreased strength compared to monolithic zirconia and should be used with caution in posterior areas.

Finally, there is lithium disilicate. This ceramic combines many of the attributes of leucite and zirconia materials. Lithium disilicate has the translucency and esthetics of a leucite ceramic, yet a strength similar to zirconia. Lithium disilicate, like zirconia, can either be monolithic or veneered. Monolithic lithium disilicate is the strongest version, but not as strong as monolithic zirconia. However, it is more esthetic than the monolithic zirconia and can be used in the anterior region up to the first molars. Veneered lithium disilicate is more esthetic, yet weaker, and should be used in anterior areas only.

CAD/CAM is a growing technology that will only increase in success and popularity. Being informed about the different ceramics and their clinical indications is crucial to the success of the restoration and the success of your business. I hope this information was helpful and I would appreciate anyone’s input regarding the topic!

At the University of Florida’s College of Dentistry, we begin to see patients in the clinic at the beginning of the third year of dental school. The first two years are spent taking didactic courses and completing procedures in the simulation lab. As a new junior fresh in the clinic I can honestly say that what it takes to be successful in clinic is a lot different than what it took to be successful in the classroom. Some people say that once you get in clinic there isn’t as much work or studying as when you are in the classrooms. However, I believe that there is the same amount of work if not more, it just simply presents in a different form. With that said, here are a few suggestions on how to be a successful clinician versus a successful student.

1. Be Prepared!!!- Being prepared for the clinic is different than being prepared for a course. Every patient is a test of your knowledge and skill. In the classroom being prepared means reading the lecture ahead of time or practicing a certain procedure to perform in the simulation lab. When you are dealing with a patient being prepared means reviewing the patient’s chart the night before in its entirety. This means looking up medications, reviewing medical history, knowing what procedure you will be performing that day and any possible complications that may occur. And since every patient is different there is preparation to be done for every patient you will see.  
2. Be Efficient!!!- Being efficient is a skill in and of itself! Being efficient will allow unnecessary lost time to be saved to be used elsewhere as needed. One great way to be efficient and make extra time is to grab everything you need to perform your procedure at the beginning of the appointment. That means one must sit down and carefully recall everything that may be needed in the procedure that they are performing, it may be helpful to write everything down so nothing is forgotten. This will save you from stopping your work and leaving your operatory multiple times throughout the appointment, ultimately saving you a bunch of time to be used elsewhere.  
3. Be Thorough!!!- I can’t speak for every dental school in the country, but at my school we spend quite a bit of time waiting on faculty verification and approval throughout an appointment. For instance, if we are performing an operative procedure we have to get a start check, a prep check, a restoration check, and a dismissal check. With over 25 operatories in each clinic, the faculty have a lot of students to visit on multiple occasions. One way to help yourself minimize the time spent waiting on faculty is to be thorough with your work before calling them over. That means taking an extra minute to review your work in full and ask yourself if you need to do anything else before calling the faculty over for their approval. This will eliminate any extra visits form the faculty and give them confidence in your work.  

These are just a few simple suggestions that you can employ when you are in the clinic that can totally change the flow of your appointment.

Picture this - your grandfather comes to you with much regret because he just found out that his front tooth has to be extracted. It has been a long time coming as he had a traumatic accident as a child, which resulted in a root canal and crown. The tooth has given him a good, long life despite having had a poor prognosis for years. Grandpa isn't sure how he feels about a false tooth being put in there; after all, his front teeth are what give him that effervescent smile.

Not to worry grandpa! Your dentist can print out a new tooth for you, potentially an exact replica of your own tooth. 

Here is how it works: You go to your dentist who will extract the failing tooth. Next, he will scan that tooth with a 3D scanner. Using computer technology, further digital enhancement will be used to perfect the tooth. Next, the computer will send the information over to a printer--a 3D printer. This galaxial technology will print out a new tooth, root and all, and act as an immediate implant and restore your smile as if nothing had ever gone wrong!

While this technology may be some years from being a reality in mainstream dentistry, this type of scenario is what is driving researchers at the University of the Pacific to figure out better and more efficient ways to use 3D printing in dentistry. Specifically, they are looking at ways to print implants that will mimic the exact shape of the root, so that after tooth extraction, the tooth socket that held the bad tooth will house the replica implant, with the same shape, length, and contours. Obviously, there are many questions that will need to be answered before this becomes actuality, but it is clear that 3D printing is a field of material science and dentistry (and many other medical sciences) that has a bright future.

3D printing has already emerged in dentistry. The main problem, however, is that 3D printers have been terribly slow. This trend is changing, though, and printers are getting faster and more affordable every day.

The concept of coming to the dentist for a single-visit restoration has been around for decades. CAD/CAM technology has been incorporated into many offices for this purpose, using a milling process to essentially carve a ceramic block to the desired final product. Printing does just the opposite - it adds material layer by layer.

So why is there all the hype about 3D printing if CAD/CAM restorations have already proven to be successful? Dentistry works on the scale of fractions of millimeters. Any restorative technique or technology that enables dentists to be more accurate and exacting with their patients is a worthwhile pursuit.

Affordable 3D printing will also take impressions to the next level. Dentistry is already moving away from alginate and PVS (and all of the other "goop") towards digital scanning. Rather than waiting a few weeks to get those models back from the lab, imagine having those models printed out in your office 5 minutes later. Need a temporary crown? No problem. Essix retainer? Easy. 3D printing can cut down the monotony involved in these laboratory procedures.

The sky is the limit with 3D printing. Perhaps in our lifetime we will see 3D printers become a basic component of a dental office.

This topic is a controversial one that typically tends to upset several specialists but I have decided to touch on it because regardless this is the reality that we as dental practitioners face. While technology is a great thing, with advancements in available resources comes pitfalls. One of those areas of concern includes dental specialties. I have heard dentists say “why would anyone want to be a periodontist? It is a dying specialty…” and “with the advent of 3^rd generation Invisalign there will be a reduction in the need for orthodontists.” All things being considered, this is a worthy topic to discuss, particularly when it comes to periodontics and orthodontics.

Periodontics is defined by the American Dental Association as “… a specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues” Traditionally, periodontists utilized scalpels and hand pieces to execute periodontal surgeries. These procedures vary from crown lengthening, soft tissue grafts, gingivectomies, etc. With the increasing acceptance of lasers, periodontal surgeries have become minimally invasive and also provide hemostasis. These types of procedures do not require lengthy advanced training. Periodontists would argue that their specialty is much more involved than a course that lasts a few hours because their training allows them to first diagnose a situation that a general dentist may not be able to detect and then further treat the patient in an experienced manner to prevent the loss or deterioration of the teeth. There are also advancing periodontal surgeries that are currently not taught at the traditional dental school level so it would thus require advanced training to become competent in this arena.

Invisalign has been an excellent dental advancement for the field of orthodontics. It is considered clear braces or an alternative to traditional braces depending on the case. General dental practitioners across the board have been able to incorporate this aspect of dentistry into their practice. Not only can it be lucrative but from a marketing point of view this dental service is very attractive for individuals who are not moved by traditional braces. Orthodontics and dentofacial orthopedics is defined by the American Dental Association as “…the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures.” First generation Invisalign limited cases to those that did not encompass complex treatment plans, this is typically inclusive of individuals who have class I molar classification. With the introduction of the third generation Invisalign system, this is stated to increase the number of cases that can benefit from the product. Does this mean that orthodontists will be eliminated? I don’t think so; however it will allow general dentists to do a plethora of more complex orthodontic cases. This difference will be in the level of experience and understanding of the doctor.

In my opinion, dental specialties are still viable options for dental practitioners who enjoy a specific aspect of dentistry and would like to operate in a career path that is specific to that specialty. Where I do see things advancing is in the access that general dentists have to expand upon their specialty practice in house. Time will tell whether or not this access will have a negative impact on specialist in the years to come.

It’s no secret that most people are skeptical about spending a great deal of money on dental treatment. Despite our best efforts showing and telling patients they need crowns, inlays, onlays, composites, etc., most picture flushing money down the drain.  At dental school clinics, this is more of an issue because our patients are often on limited incomes, and our clinics may be the only care facilities they can afford. When we deliver a treatment plan, usually the next words out of a patient’s mouth are, “How much is that going to cost?”

The cost of dental care is daunting to most patients. However, there are ways in which we can coach them into spending their money appropriately over the greatest number of procedures so that they don’t run out of funds after two crowns while leaving untreated areas full of decay.

Prioritizing Areas of Need 

Before rendering any treatment, it is imperative to assess the current state and prognosis of each tooth. As a clinician you must triage the patient’s dental needs while keeping his or her chief complaint at the forefront of your treatment process. Sometimes the patient’s chief complaint is urgent, such as pain or swelling, in which case you would take care of it first. However, there are times when the chief complaint is not urgent at all, and you must explain to the patient that there are more urgent dental needs that need to be addressed. Once you have developed an accurate picture of the patient’s dental needs, you must get a sense of how and what they are likely to pay for treatment.

For example, say a patient needs three crowns and four fillings, Class Is and IIs. One of the crowns will be a retreat due to secondary decay seen around the margins, and the other two will be new crowns on teeth with large amalgams and fractured cusps. All of the other lesions are radiographically confined to dentin.  Assuming the patient would like to keep their remaining teeth, it is now your task to help the patient get the most dental treatment out of their available funds.

Ideally, the old crown with secondary decay would be addressed first by removing the old crown and assessing for restorability. If restorable, rather than taking the new crown to completion, a second option would be to put the patient in a long-term temporary after removing the recurrent decay and having them pay for one half of the crown. Utilizing this strategy would allow the patient to pay for some of the other fillings and possibly a build up to replace an old amalgam. Conversely, if the patient paid for the single crown in full, they would be neglecting all the other work that needs to be done until they were able to pay again. Round two of treatment would be similar. The patient could pay for the second half of the crown, another buildup, and a few fillings.

As clinicians, it is vital that we treat patients based on their dental needs and not by our own financial bias. We should help patients get the most out of their dental allowance. 

As a part of the Pittsburgh School of Dental Medicine graduation requirements, each student must spend two weeks in clinics that serves rural or underserved patients. I have spent one week in a clinic owned by the Salvation Army, and another week at a Federally Qualified Health Clinic.  Both clinics were relatively small but incredibly busy.  Several things that I took away from these experiences are the mentality of a patient, how it can be shaped, and how it can be extremely difficult to change.

One of the patients that I saw was 12 years old, and I was trying to do a sedative filling on a first molar. I did every injection, even an intrapupal, and I could not get the tooth numb since the infection was so severe.  The roots were still not even fully developed on the tooth.  I know that child will most likely remember that day for the incredible pain, and will compare it to all further dental experiences.  I did try to use this as a tool for talking to him about brushing his teeth every day, but I am unsure how much of it he took in--the social norm around him is not in favor of him keeping that tooth.

For most of these patients, removal of all of their teeth is inevitable.  Their dental insurance, if they have any, is limited.  Some state programs only cover extractions and dentures, and not even preventative treatment such as cleanings.  I was explaining to one of my patients that I was going to expand the preparation a little larger for her restoration, and her response was, “Why don’t you just take out the tooth?”  Seventy percent of her tooth was still remaining. Though some day she will most likely loose that tooth due to neglect, it is important to talk about prevention and the consequence of getting dentures earlier in life. 

As a student of public health as well as dentistry, I took this time as not only a time of learning but also of observation.  As in more urban communities, there are those in these clinics that value their oral health and those that do not.  Based on my experiences with these patients, I felt as though neglect of their teeth was a more expected part of life.  However, I am not sure if anyone is telling them any differently. Insurance companies will only pay for a tooth once, and that is for its removal.  Dentists are unwilling to move out to the middle of nowhere, where patients do not show, do not listen, and cannot pay.  Patients’ parents are satisfied with dentures, so why not them?

This problem does not have a clear solution, but I believe that it starts with a change in mentality.  People need to start seeing teeth as a part of their body and not a luxury item that only the wealthiest can keep. Patients need motivation to be able to practice homecare in a responsible manner.  I do not have all the answers, but I know that having dental students see the way rural and underserved dentistry works is important--and allows us to take steps in our careers to make changes in the lives of these patients. 

 At OHSU School of Dentistry, we as students are constantly advised to practice evidence-based dentistry. It seemed so simple when I first began school in 2013, but as time has passed and my understanding of dentistry has greatly expanded, it isn’t as simple as I thought. I am finding this to be true especially in the clinical setting now that I am practicing on patients with a wide variety of dental needs and can be treated with various restorative materials. My eyes were especially opened when I saw faculty have differing opinions on the materials and/or procedures to be used on the same patient. As a student, I respect the opinions of all faculty members, but doesn’t one have to be wrong in that situation? Answer--not necessarily. 

 Research done by schools and other educational institutions will typically be published and unbiased, but private businesses invest millions in the research of their products and may or may not publish their research at all.  One professor recently pointed this out to me and explained that although the business would like to show their products are the best, if the research shows that not to be the case, these results will probably go unpublished. Additionally, he counseled that many businesses manipulate the results to at least show their product in the best light. For a dramatized example, if the manufacturer found that their composite fractures just after the six-year mark 90% of the time, they could still publish the 5-year data instead of 6 years and tout that 95% of their restorations are intact to that point. This is obviously in their best interest, and such a business does not have any obligation legally to publish anything. Additionally, the data they do publish is still certainly true; the point is you can’t be sure of what exactly they left out from their total findings. To be fair, their ultimate goal as a business is to present their product in the best light possible to the public. 

What impact did this conversation with my professor have on me? Well, first off, it reinforced the value of meta-analysis or, in other words, a study combining the cumulative findings of multiple research studies. Second, it brought to light the importance of checking who executed the research. Was it a  school? A dental lab? Or was it a big name brand? I wouldn’t ever discount research done by a private company trying to show they have the best product, but I will absolutely take it with a grain of salt when I contemplate the implications thereof.  

Just about all dentists are doing their best to give patients the best care possible, and that means staying in the know and up-to-date on the latest research. I just hope that everyone also pays close attention to where that research comes from and sincerely takes it into consideration in their patient care. 

Recently, one of my professors told me that the right treatment plan for the patient is the one he or she chooses. As students, we are eager to give patients the best possible care, and sometimes we forget that not every patient can afford bone grafting, dental implants, and zirconia crowns. When we try to deliver the Cadillac of treatment plans in the same manner to everyone before assessing their personality and understanding their dental history, we are bound to have low treatment plan acceptance.

During patients’ first visit to the clinic, it is important to learn their dental history and assess their learning modality and personality type--easier said than done, right? One quick trick to determine a patient’s learning style is to watch his or her eyes. Visual learners will look up when processing information. Auditory learners will look straight ahead, and kinesthetic learners will look down at their hands. Once you assess your patient’s learning style, you can start to paint a picture of their information processing style. Patients will generally fall into one of four categories: D (Dominant), I (Influencing), S (Steady), or C (Compliant).

Dominant individuals tend to make decisions quickly and are goal-oriented--meaning they make decisions that take them toward pleasure. They want the big picture and are typically visual learners. When delivering a treatment plan to a “D” individual, it would be best not to talk about the treatment each tooth needs. Rather, it would be more effective to say something such as, “You need three crowns and have two cavities that need to be filled, Mr. Jones.” If the patient wants more information, he or she will ask.

Influencing patients tend to make decisions based on the opinion and testimonials of others. Delivering a Cadillac treatment plan to these patients would not be a bad idea, but they will probably need some time to think about the treatments and do their own research. Like Dominant individuals,  “I” patients make decisions that are outcome-driven and take them toward a pleasurable experience. They are big picture people and are also visual learners.

Steady patients will take time to make a decision about a treatment plan. It is best to show patience with these individuals and deliver all their possible treatment options. They use pros/cons to make decisions and typically require a lot of information to make informed decisions. They like detail and are auditory or kinesthetic learners. They are also process-oriented, and their choices lead them away from pain. A good strategy with these patients is to tell them what could happen if they decide to reject treatment.

Compliant patients are similar to Influencing patients in that they require lots of information in order to make a decision. They process every detail and will take their time to reach a final decision. However, once made, these patients are typically very loyal to their choices. These patients are process-oriented, like details, and are visual or kinesthetic learners. They make decisions that take them toward pleasure or away from pain.

Try using some body language cues and learn your patient’s information processing style to effectively deliver a treatment plan that they will use. 

Managing staff can be very difficult.  Our dental class often hears that performing dentistry is the easy part of being a private practice owner, but staff management is the most difficult.  How can this be so, if we all consider ourselves people lovers? Aren’t we in this profession because we love to be around people and help others? However, we are not all created equal.  There are four basic types of personalities—the Driver, Expressive, Pleaser, and Analytic--and each of us can have either one or a blend of two.   

Words to describe the Driver are leader, self-confident, adventurous, decisive, risk taker, restless, competitive, assertive, experimenting, and forceful.  Do you find yourself described in such a way? This group of people are results driven.  They see a goal and they do everything to see the goal met and results achieved.  It is in their nature to make decisions quickly without pondering too much.  Time is a top priority, where every second matters and these people feel most comfortable when they are in charge.  A Driver is hard to have as an associate, unless the other dentists are Drivers as well.  Although we may not all be Drivers, it is important to be able to communicate with a Driver in the chance that you are working with one.  Be clear and to the point, as time is of value to them.  Be cautious if you must repeat something, this may mean that they are on the verge of becoming irritated.  Prior to discussing a major subject, ask the Driver how much time they have.  Don’t waste their time, be wishy-washy, repeat yourself, or ignore their solutions.  An insurance position in your office would be a valuable place for a Driver personality, as they will get things done and want results.   

An Expressive personality type is the more outgoing and social person.  They are often the life of the party, being very open and friendly.  We all know friends who fit this category and it is very easy to spot them.  Expressives have great energy and are very enthusiastic about ideas.  They feel the need to matter and when their personal opinion feels violated, they will fight for their beliefs, not giving in.  Expressives value recognition and status, therefore a salesman is a good role for this type of personality.  If sales are good, their mood is excellent; if sales are bad, they will become defensive and fight for their position.  When communicating with an Expressive, be open and friendly, listen for viewpoints, make things exciting, and take time to socialize.  With their high energy, be enthusiastic and flexible as their conversations can jump to various topics throughout.  Having a front desk receptionist with an expressive personality is a positive aspect to your office staff.   

A Pleaser is empathetic and supporting of others, very people oriented, and considerate and cooperative in the face of conflict.  They are easy going and flexible and huge team players.  Pleasers are happiest when there is harmony in the workplace, with solid relationships, and are liked and accepted by all in the office.  They consider themselves experts in cooperation and harmony, yet if they are placed under stress, they will give in to temptation.  When communicating with a pleaser, be sincere and relaxed, show personal warmth, and listen for feelings.  Try to make things comfortable and take time to empathize with an informal, yet attentive, conversation.  Since Pleasers want to be accepted by all, don’t be critical of others around them, or be overbearing.  Never make communication one way as they like to be involved in communication and listen to their emotions.   

Finally, an Analytic is the cautious one, who is task oriented when dealing with communications.  They focus on details and facts, similar to a Driver.  Their main theme is to get the facts correct and value precision.  Analytics have a constant need to get it right all the time, and being wrong is difficult to connect with.  If something needs to be planned with many details, an Analytic will get the job done without missing a detail.  When communicating with an Analytic, be organized and specific and focus on the facts.  Listen to their concerns, yet request time for them when you need it; they do not like spur-of-the-moment decisions.  Communicate with formality and be logical.  Don’t get emotional because basically they won’t care.  Never jump to conclusions or ignore their questions.   

It is important to understand the personality of the various staff members in order to not only effectively communicate with them, but understand how others will interact with each other.  Prior to hiring an individual, it is recommended for the applicant to take a personality test in order to evaluate their cohesiveness in the existing practice.   

In shadowing many private practice dentists, I’ve gained insight into the area of practice management, particularly pertaining to the teamwork necessary to run a successful, efficient practice. Dental hygienists and assistants are a valuable resource when a dentist is looking to establish an effective flow in clinical work. When considering a dental hygienist’s scope of practice, it is important to note that dental hygienists are certified to perform many more procedures than one may expect. For example, hygienists can perform perio records and occlusal adjustments of restorations. While these procedures may seem small in the course of patient care, when this work can be delegated to proficient individuals, a dentist can better focus on providing focused care to more individuals. While we students are in school and treating only two-four patients per day, our full attention can be placed on our work, and while we don’t generally share our work with a clinical team, we don’t need to have extra hands in order to get everything done. During the course of a general appointment, we alone are responsible for setting up, seating the patient, local anesthesia, suction, prep, impression, temporary, checking occlusion/margins/contacts, and dismissing the patient. This situation is very different from a general private practice. Consider a day in the life of a private practice dentist where multiple patients are seated and the dentist must jump from room to room. It is important that everything can be performed with efficiency but also with great clinical quality. Delegation can be a valuable tool for the dentist to do just that. He/She can ask a hygienist to perform perio records or administer local anesthesia while he/she preps restorations or performs endo procedures, then switch to perform ScRP while hygienist creates a temporary or carves an amalgam. This system allows two patients to be seen at the same time, benefitting them as well as the practicing dentist. This may seem simple and straightforward, but, in practice, daily organization and delegation can be complicated and foreign to a new practicing dentist. We must be aware of the opportunities for delegation but also the limits of such delegation to our team members, and we must follow the limits of the law yet use our team’s capabilities to provide the best care to our patients.

Here are some ways, both in school and after graduation, to improve one’s ability to run an efficient clinical team:

1. Run for a position as a leader of an organization in school. Many organizations have presidents, VPs, committee chairs, etc. and this provides a perfect opportunity to practice your delegation skills. Organization leadership exposes students to the effort necessary to complete a task as a team, which will be fully applicable in future practice.

2. Have a clinical meeting in the morning before all patients. As I’ve shadowed successful dentist, I’ve found that many of them use these daily huddles to address each concern and assign particular providers to certain tasks. The scope of practice of each person on the clinical team can be volunteered as well as monitored.

3. Invite your team along for CE courses. The more you learn together, the more you will be willing to trust your team members and ensure that they have proper training for the tasks you assign them.

          According to the University of Illinois at Urbana-Champaign (n.d.) research tests assumptions, observations, creates new knowledge, and provides a theoretical framework for practitioners (para. 3). The Centers for Disease Control and Prevention (CDC, 1999) define research as “a systemic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge” (p.2). In other words, research uses the scientific method of testing hypotheses to develop theories which contribute to scientific literature and ultimately creates additional knowledge. Dental public health efforts are founded on evidence-based research. Without said research, the dental public health field would be just another voice in the enormous community of opinion. With evidence-based research however, dental public health efforts are reliable, powerful, effective, proven, efficient and founded on facts instead of voices diluted by opinion only. 

         When discussing how research applies to the dental public health field I think it’s important to define dental public health. The American Dental Association (n.d.) defines dental public health as: “That part of dentistry providing leadership and expertise in population-based dentistry, oral health surveillance, policy development, community-based disease prevention, health promotion, and the maintenance of the dental safety net” (para.1). This definition helps portray the importance of research to dental public health as every aspect of dental public health requires a foundation of research. Before any policy is developed or an community-based disease prevention program is established, policy makers and public health planners look to research to have an evidence-based foundation for decision making. 

         Research can mistakenly be described as studying and experimenting on exclusively new materials to find new conclusions. However, I think research, especially in the dental public health field, is also beneficial when it investigates old material to provide support to previously discovered findings. For example, it has been difficult in some areas of the United States to bring water fluoridation to certain communities due to a misunderstanding of the health effects of fluoride. Multiple studies over years of research have provided supporting evidence of the importance of water fluoridation in reducing the prevalence of caries. One of the most important things about research is that it’s reproducible so that other experts can test the results as well. This additional testing of old material can provide a stronger validity and reliability to a previous conclusion. 

            Research by Griffin et al. (2007) titled, “Effectiveness of fluoride in preventing caries in adults” has made a major contribution to the oral health literature. The authors used a meta-analysis to examine the effectiveness of applied fluoride and water fluoridation among adults. They concluded that fluoride does indeed prevent caries among adults of all ages. This article adds to the immense amount of research supporting the use of fluoride to prevent caries. Dental public health agencies have one more source to back their efforts in using fluoride to decrease the prevalence of caries among the adult population.  

References 

American Dental Association (n.d.). Dental public health. Retrieved from http://www.ada.org/en/member-center/oral-health-topics/dental-public-health 

Centers for Disease Control and Prevention (1999). Guidelines for defining public health research and public health non-research. Retrieved from http://www.cdc.gov/od/science/integrity/docs/defining-public-health-research-non-research-1999.pdf 

Griffin, S. O., Regnier, E., Griffin, P. M., & Huntley, V. (2007). Effectiveness of fluoride in preventing caries in adults. Journal of Dental Research, 86(5), 410-415. 

 As you may already know, for those interested in pursuing an oral surgery residency, there is an additional board like exam that is required to gain admission. It’s called the CBSE and it is very similar to the Step 1 USMLE board examination that is taken by medical students. While there are no specific study aids that can be purchased for the CBSE, due to its striking similarity to the USMLE, study material tailored to the Step 1 medical board exam will suffice. After researching study tools for the exam, and discussing it with several upperclassmen, I would like to share the best advice and tips that were given to me by those that scored exceptionally well. 

The most commonly used material among those that scored well were First Aid, Pathoma, and UWorld. 

First Aid- This book is considered a gold standard among medical students. It is a rapid review of all the subject material covered by the exam. It is probably the important resource to memorize and know cold. Multiple passes through the book is highly recommended.  

Pathoma- This resource consists of online video lectures and an accompanying book that cover pathology. Pathology is a large part of the CBSE and the lecturer likes to point out high yield material and presents it in a manner that is easy to understand. Multiple passes through this material is highly recommended.

Uworld- This is a question bank that features over 2000 high yield questions. There are other qbanks on the market such as Kaplan, and USMLE-RX, however UWorld came most highly recommended.  

Another theme included studying board material throughout the year. Students recommended supplementing your lecture notes with First Aid and Pathoma. They also recommended scheduled a longer “dedicated study” block for themselves.  Typically lasting between 1.5-2 months, the dedicated study block was a period of time where students tried to study 8+ hours a day and began to go through the Uworld question bank. They would do this every day leading up to the exam and also used some NBME practice exams along the way.  

Lastly, it is important to note that these students did not use too many different study materials. Resource overload is a common mistake made by most dental and medical students. By spreading yourself too thin, it may be more difficult to learn the concepts and memorize the minutia. High scoring students stuck to fewer resources and worked on mastering those resources. Be diligent and don’t forget to use other students as resources. Upperclassmen are usually willing to help as they first-hand understand how stressful the experience can be, especially on top of the many other demands of dental school!

Dental amalgam is a metal restorative material made up of silver-tin, copper alloy mixed with mercury. The restoration is silver in color and is usually placed on a posterior tooth rather than anterior. Nowadays dentists have concerns about the use of amalgam restoration because of the poor esthetics and are moving away from it. Dental amalgam preparations require greater removal of the tooth structure to reinforce its strength requirements.  As a result, amalgam has a greater potential for the weakening of the tooth structure resulting in tooth fracture. Also, the use of mercury in the amalgam mix has been a controversial topic. However despite the negative features associated with it, research repeatedly has shown the safety of amalgam and the success of the restoration. Amalgam has been used for over a century and has showed no harm to any patient with the restoration. Amalgams are easy to use and require less technique than composite demands.  It can withstand the forces of mastication and have higher compressive strength. It is recommended for patients with sleep bruxism and clinching problems. It has excellent wear resistance, which makes it favorable for long-term use. It is also economical and cheaper than composite. Nevertheless the primary disadvantage of amalgam restorations is that it does not look like the tooth and it is not appealing to the eye.

Composite restoration has the potential to blend and look exactly like the tooth thus more favorable by the dentists and the patients. Some of the advantages of composite compared to amalgam restorations are; esthetics, conservative in tooth structure removal, uniform depth not necessary, mechanical retention usually not necessary, insulating, bonded to tooth structure, good retention, and it is repairable if damaged. The newer composite resins are as strong as amalgam and have the same longevity if not longer than amalgam. Even though amalgam is a great restorative material, composite is becoming the choice for the majority of the dentists. Composites are esthetically pleasing to the patients and to the dentists. It is able to preserve the tooth structure without having to make a bigger preparation to have mechanical retention; as amalgam preparations require. 

     Dental school challenges us in many ways. Hours upon hours are spent in lab learning the technical skills necessary to become a dentist. Just as much time is spent in didactic classes learning the science behind dentistry. While college may have provided a good foundation for studying, it could not have prepared us for the 30 plus credit hours we take in dental school.  One of the biggest challenges in dental school is learning how to study the didactic material in a time efficient manner. 

     I have found that a good way to learn and retain information is to make a study guide. Here are my tried and true tips for making the perfect study guide to ace your exams.

1. Go to class and take good notes. Many professors will emphasize points that will be on the test.  Others will tell you which slides are not important to know. Beyond that, it’s much easier to write down what the professor is saying as you’re learning it than trying to puzzle over a diagram weeks later.

2. Keep your lecture slides and notes organized. Have a folder for each semester of dental school. Within the semester folder have a folder for each class.  Then have a folder for each exam and number the lectures within it. That way you can go back and easily find the lectures you need to review and go through them in chronological order. This is especially key in classes where the lecture material builds on itself from week to week.

3. Craft your study guide one lecture at a time. This breaks it into easier chunks than having all of the notes for an exam mingled together.

4. Start with an outline. If you’re lucky, the professor has given you an outline of the lecture with objectives to learn. Otherwise, review the lecture and form a rough outline to build your study guide from.

5. Reorder the lecture in a way that makes sense to you. If the professor tends to jump around between topics, order them your own way on your study guide. You don’t have to follow the order of the lecture slides.

6. Include all pertinent lecture material on the slides and the notes you took in class. You want this study guide to be your go-to resource for exam studying, so don’t leave off anything important!

7. Don’t be afraid to put in pictures and diagrams. If you’re learning about oral surgery instruments make a table with the name of the instrument and the picture next to it.

8. Bold or highlight what’s important. The day of the test you can go back and review the high points.

9. Trim the fat. Once you’ve put all the material from the slides and your notes on your study guide, you many notice redundant material. Get rid of it!  You just need it on your study guide once. Keep in mind, however, if it was presented several times it’s probably important and should be bolded.

10. Share with your classmates. You’ve just made the perfect study guide – they’ll love you for it!

Getting prepared for interviewing is key. How do you do it? Anticipate questions, prepare responses but remember to stay relaxed . Interviews are for them to get to know you but also for you to see if you will be a good fit. Interviewing in a lot of ways is like a first date. You have to see if you are compatible.

Be yourself. Easier said than done.

A good way to prepare is to reflect on what you’ve done, and how it’s equipped you to move onto residency. One of my favorite sites that offers advice on prepping for interviews is “the muse”. Even though their articles are not directed toward medical or dental residencies, the information is on point. Check out their article on how to answer the prompt, “Tell me about yourself,” which is often one of the first and more challenging prompts at an interview. https://www.themuse.com/advice/your-4step-plan-to-answering-tell-me-about-yourself-perfectly?utm_source=Sailthru&utm_medium=email&utm_campaign=Your%204-Step%20Plan%20to%20Answering%20%E2%80%9CTell%20Me%20About%20Yourself%E2%80%9D%20Perfectly&utm_term=Daily%20Email%20List

Look for compatibility.  In order to have a successful and satisfying experience in residency, you want to be at a program that jives with your expectations and values. There is no perfect program, but there are many which offer a variety of attractive attributes to prepare you for your future.

Balance is fundamental. In the interview, it is important to maintain professionalism and respect, without a doubt. However, do not be afraid to share your personality. If they don’t ask you questions directed at your hobbies, goals, or interests, find some way to work it in. Having a life outside of dentistry isn’t just practical, it is important for showing community, social skills and well roundedness.

Confidence with gratitude. Everyone at the interview has already demonstrated on paper that they deserve to be there. It’s important to carry yourself confidently and be clear in your answers, however also remember that it is a privilege to get an interview, that should not be taken for granted. 

Crash with friends or use house renting sites: I am a huge advocate for reaching out to friends or friends of friends to have a place to stay. However, when I did that I realized that sometimes your friend’s place is not as close or convenient, and can make your commute to the interview longer or more stressful. Just remember that you want to allow plenty of time the morning of the interview to allow for traffic, parking, public transportation delays, and finding your way around the building.

Take names, take notes: After your interview, be sure to make notes on what you liked and what you did not. Additionally, you want to remind the program of yourself even after the day is over. Make sure you write a thank you card or note to the program after the interview. Showing gratitude and appreciation is professional but also shows you truly care. Mention the strengths of the program and how you see yourself fit in.

Overall, interview season can be stressful. If you are well prepared, you will be more calm and focused when it comes time to interview. Good luck!