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THE NEXTDDS Student Ambassador Blogs

Timeframe and communication in the dental school clinic

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    My last blog post I spoke about what to expect in the dental school clinic and the different types of professors. In this blog post I want to talk about treatment timeframes and communication mistakes to avoid with patients and what to do in order to succeed in the clinic.  

Most mistakes I have made were not related to the actual procedure in dentistry, but instead were related to the treatment plan execution and the way I communicated with my patients. The first mistake everyone will make multiple times is giving the patient an unrealistic timeframe. Everything in dental school goes EXTREMELY slow, sometimes patients come from private dentists and do not realize that at the school treatment will take significantly more time to complete. For example a root canal with a dentist will normally take from 1-3 hours depending on the tooth. For students it can take as many as 4 appointments that are 3 hours each, so literally they will spend 12 hours getting one root canal and that doesn’t even include the post, core and crown. No wonder patients don’t like root canals. But if patients are willing to spend the time it will also be significantly cheaper. The timeframe for completing all treatment is therefore extremely long. Here is an example of one patient that it has been over a year and treatment is still not completed.  

The patient started out by getting x-rays, two weeks or so later I called her to set up an appointment for treatment planning. We tried to schedule an appointment every week. First appointment was December 2014, the treatment plan took 2 appointments and then we had winter break. We came back in January 2015 and did a periodontal diagnosis (1 appointment) and scaling and root planing (3 appointments). February, multiple cavities, 1 extraction and spring break (7 appointments). April root canal on a tooth that did not need a root canal but the professor insisted. May  prep and temp for 4 crowns (5 appointments). June impression for crowns, lab work and sent out to lab (4 weeks). July one crown missing contact send back to lab to fix and summer break. September prep teeth for partial take impression for partial, send models to lab for framework (5 weeks). Mid October framework try-in, adjustments and competency. November jaw relations, altered cast and wax try-in (3 weeks). December wax try-in and send to lab, lab unable to send back case before winter break. Plan: insert partial January 2016, prophy and done.  

This is the longest I have ever worked with the patient and I made the mistake of giving her an unrealistic timeframe because she kept telling me she wanted to be done by a certain date, first it was her birthday in August 2015 and at the beginning of treatment I thought, of course I will be done by then, that is like 8 months from now, when I was not finished she was upset. Then she told me she wanted it done by Thanksgiving and I thought, yes I can do that, then it was by Christmas and I was pretty certain we would be done, but here we are and she will not get it until January.  

So I cannot stress enough, it will take EXTREMELY long to complete treatments. You must factor this in when trying to determine if you will complete your requirements on time as well. And tell that to the patient the first day, if they are okay with it great, but if not the school may not be the place for them.  

Communicating with the patient in a way they can understand is important as it will determine how satisfied the patient is at the end of treatment. Patient expectations need to be evaluated and corrected if not in line with what the student is able to do. In this example I should have communicated better with the patient and told her that I cannot give her a realistic timeframe because I simply do not know how long it will take because I have never worked in the school clinic and there are too many variables to consider. Communication and a better understanding of the time needed to complete the treatment plan would have made the patient more satisfied during the course of treatment.

Choosing a brand of product at the GNYDM

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As a second year student at Stony Brook School of Dental Medicine, attending the Greater New York Dental Meeting was a new experience for me. Out of the numerous observations that I made while there, there was one specific question that stuck with me:


What is the most influential factor to a dentist when choosing one brand over another of the same product?


I am still struggling to answer this question myself, but I will need a strategy when making purchases in the future. For example, if I need new loupes, hand pieces, hand instruments, etc., what brand do I chose? Coming to the Greater New York Dental Meeting with the desire of buying one of these items, I could get lost very quickly between countless brands.  


When wanting to make a smart and cost effective purchase, how does a dentist choose a brand? The options are infinite. Some influential factors could include marketing strategies of the company, word of mouth by colleagues, cost, customer service, online reviews, or even having the desire to stay with familiar brands. Below include my opinions on each of these strategies and how they would influence my decision of buying a product.


-      Marketing strategies of the company:


  • How well can they sell me the product?
  • How knowledgeable is the sales person on their product?
  • How well do they prove the value of this product?
  • Are they able to assist me with every question I have? Do they give me enough information to even ask questions?
Surprisingly to me, I ran into a number of salespeople that did not answer all of these questions, which to me was a “turn off”.

-      Word of mouth by colleagues: More often than not, a friend or colleagues advice on a specific product can have the greatest influence. I know this person well enough to trust their judgment and trust their advice. This alone can sometimes be a deciding factor for choosing a certain brand of product.


-      Cost:


  • How much does this product cost, and is it worth the cost? 
  • Can I find the same exact product for a lower price, or would I be paying for a better product? 
  • If it is a higher price, am I just paying for the brand name?

Cost is also a very influential factor when considering to buy a product, but rather than going with the lowest price of something, to me it is more important to shop “smart”. I have to make sure that if I am paying more for a product, it is because it actually holds more value.

-      Customer Service:


  • If my product is damaged or broken, how fast is this company to fix it for me, and at what cost will this be to me?
  • Does this product have some type of warrantee?
  • Am I able to easily approach the company when in need?

This can also be a deciding factor of buying a product, and also relates to cost. If I am paying a certain amount of money for a product, I want to be sure that the company will be quick to help if I am in need.

-       Online Reviews:



Online reviews can very influential as well, yet I am sometimes skeptical of this. How reliable are these sources that are giving the reviews? These reviews could be highly opinionated based on factors that are unknown because I simply do not know these people. 

In my opinion, a review from colleagues would be a more credible source for me to make judgments of buying the product or not. However, if the reviews are almost all leaning toward one answer of yes or no, this may heighten my opinion, and be more important to me when making my decision.

-       Staying with familiar brands:


Some people may choose to stay with brands that they know due to the familiarity or comfort level. For example, if your dental school has a certain brand that supplies the students with all of their tools, in some cases these students will graduate and continue buying from this brand because it is what they know. They may not change brands in the future because they have never had problems, or do not want to go through the effort of finding a new brand. In some schools, students are taught the names of a certain product that is specific only to that brand. This could be used to the company’s advantage when wanting to keep a client in the future. 

I am guilty of this in some ways. With certain brands, I stay true to them unless something goes wrong. Sometimes I find that this is not necessarily the right thing to do- maybe there is a better brand that I am not aware of, but I find myself staying with it because it is “comfortable” to me.



Preventing dental pharmacology mistakes

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Know your medications: Avoid receiving an embarrassing call from the pharmacist regarding a miss-labeled medication or a prescription by knowing your stuff. Prescription writing and prescribing is a topic we cover in dental school, however it is not until you write your first prescription that you really understand the weight of the responsibility you are taking by prescribing a medication that can affect someone’s health for the better (hopefully) or worse. Studying for the NBDE part 2 boards exam really helped me to nail down some key points in prescribing appropriately, and knowing when to make treatment modifications. For example, if the patient has liver problems, avoid acetaminophen. If they have a history of opioid abuse, do not prescribe codeine/vicoden/norco, etc. If they’re allergic to penicillin and it’s derivatives, avoid cephalosporin drugs. If they are allergic to penicillin and have GI issues, you also would not want to prescribe clindamycin, so consider a z-pack. For patients who are pregnant, avoid NSAID’s and recommend acetaminophen for pain. For children, be keen on knowing mg/kg conversions or visit the American Association for Pediatric Dentistry guidelines on their website.



Check all the boxes: Doctors are notorious for writing quickly and sometimes unreadable scripts. It is our duty to write legibly and make sure all of the necessary components of the prescription are filled. Much of this is becoming computerized, with each box containing a field that needs to be filled before sending to the pharmacy. However, for scripts that still need to be written, we can often overlook the important details that make up the order. Be sure you have the accurate date, patient name and birthday, and signature and DEA number. In school, I have all of my prescriptions written out manually, and then my attending will come over and review it and sign it with their number. Even with a double check, things can be over looked. One time we accidentally ticked the box that says “Do no substitute with generic” and had to go back and fourth with the pharmacy in order to undo our mistake. Supplementing generics save patients tons of money and for many medications do not make an efficacious difference. Take the time to review all of these components.


Give your patient written and oral instructions: Many patients complain of GI upset upon taking codeine or other analgesics. Often times, this can simply be relived by suggesting that the patient eat food before/while taking the medication. These instructions “p.o. with food” can be written on the prescription. However, don’t rely on the pharmacist to do all the work for you. Pharmacists have an extremely important job and are handling not only your patients but every other dentist and doctor’s prescriptions as well. By giving your patient written and oral instructions on how to take the medications, when to take them, and any adverse reactions, you save the pharmacists a lot of time and in the end help your patients significantly.


Follow up with the patients: As good practice, it’s always a good idea to follow up with your patients after surgery, infection, or any time you have to prescribe a medication. Call them to see if they picked up their prescription and see how it’s working for them. If they are having adverse reactions, instruct them on how they can fix their issues. Having a quality assurance plan in place will make your patients feel better cared for, and may save you an emergency call later that night. 

Happy New Year! Dental school resolutions- what is yours?

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Get organized: Knowing your plans and goals for the year starts with getting organized. I like to use my planner on my phone, that way it is always accessible and easy to edit and create associated alarms or reminders. Having a whiteboard in your home can be a nice way to jot down reminders and stay on top of tasks that need to get accomplished. Make a to-do list. Finished with your patient early? Have a running list of little things you need to do, such as calling patients, running to the pharmacy, emailing a professor, ordering something online, or picking up a package, so that way you can use your time as efficiently as possible.



Find an outlet: What makes you happy? Having an alternative outlet to distress and foster your interests is key to self-awareness and happiness. Sports, music, dance, art, or even Netflix-nights can be essential in keeping your sanity while going thru high stress months of schooling. Don’t forget that it’s appropriate to make time for these activities. Socialize with friends at the gym, call your family, or write letters to your college roommates to keep grounded. By blocking out a bit of time each day, you can help balance your work life and your social/relaxation time which in the end will make you a much healthier and more effective student.


Make personal goals: What is life without dental school? Take a moment to realize that you are probably in your 20’s or 30’s and have a lot of life to live despite being in a full time professional school. Having goals outside of dental school helps keep you motivated and balanced. Remember that during your fall, spring, or winter breaks, you have a few weeks where you can travel, spend time with family, or try new things you never imagined you could while in school. Remember that there is never going to be an “ideal” time for some things in life, such as taking boards, traveling to a foreign country, getting engaged, or starting a family. These are all huge life events that can definitely happen while you’re in school. Share your personal goals with others.


Create a long-term vision: Where do you see yourself after dental school? Even though you may not be graduating this year, it’s important to have a sense of your longstanding goals. New years is a great reminder to keep in touch with our future goals. Do you see yourself in a residency program or going right to work? What location do you want to eventually live in? How will you continue to learn after you are out of dental school? Do you have a plan to pay back your loans? Perhaps making connections and getting answers now will help you make those steps later on. It’s never too early to have a post-dental school goal.


Major Keys for Veneer Success

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Without a doubt, patients will walk into your practice asking about veneers. At times, this question will come from a mouth of bombed out molars, and you must educate the patient on disease control and an ethically scheduled treatment plan. However, there are other patients whose “social six” chief complaint should be a priority. Being familiar with the different applications of veneering treatment is essential to a successful practice. In this post, I will not discuss ceramics, although Molly Stice has written a great blog post on this very topic, which was published on November 24, 2015. Instead, we will look at the different types of preparations for veneer restorations.

In all these cases, it is good to take initial impressions for a diagnostic cast, and then identify regions that need preparation to achieve the desired result. A diagnostic wax-up allows you to see the extent at which contours are possible. Areas where wax is too thin or absent will need reduction. It is important to have a plan prior to the arrival of the patient. Also when deciding the length of crowns, it is important to assess lip line when patient is smiling.

Although somewhat controversial, no preparation veneers are the first type (or lack thereof) of preparation. In this scenario, teeth are simply impressed and sent to the lab for fabrication. Ceramics can be processed to very thin dimensions (0.3mm), which is sufficient to block out even dark stains from tetracycline. However, margins will never be ideal in this preparation. This is why many clinicians do not believe this to be a proper technique. Advantages include shorter chair time due to no provisional restorations and optimal bonding to all enamel (given erosion has not removed most enamel already). No prep veneers have improved drastically due to improvement in technology and materials, but ultimately they lack a flush margin that will cause future problems with soft and hard tissues. No prep veneers are only utilized when existing teeth are in optimal position and the clinician wishes to change length/shape or cover over stain.

Selective preparations include shallow (into enamel) and heavy (into dentin) chamfers. The most important aspect of preparing teeth for veneers is proper treatment planning. By doing a diagnostic wax-up in conjunction with a diagnostic preparation, you can determine the proper alignment of the teeth. Sometimes, lower teeth need to be modified as well to achieve your goal. A lot of times patients who have high expectations can be difficult to manage and it is difficult to make them happy. It is important to have sufficient preparation prior to the appointment to achieve a good result. Without the time put in before the appointment, it is difficult to achieve the desired result. You must pay attention to details to achieve sufficient results.

            Most clinicians prefer shallow preparations into enamel. Enamel is most abundant in the incisal edge. As you move toward the CEJ, where your margin will be, there is less enamel. When preparing the tooth, it is important to be careful around the gingival area to not prepare more than 0.4 mm, otherwise you will end up in dentin and lose the bonding potential of enamel. At the incisal edge, you can prepare up to 0.8 mm in enamel, which may be needed to reduce the length of a tooth. A reduction of 0.3mm is desirable for all depths of the veneer, as this is adequate thickness for the ceramist to block out stain and fabricate an esthetic restoration. Remember to reduce your facial surface in 3 planes: gingival, middle, and incisal. Extend your preparations proximally without breaking contact. Reduce the incisal edge up to 1-1.5mm, placing a moderate chamfer on the incisolingual line angle.

The other type of veneer preparation involves heavy chamfers into dentin. In certain cases it may be necessary to prepare into dentin to achieve a desirable contour as decided by your wax-up. Bonding to dentin is significantly weaker than enamel, and should be avoided if at all possible. In order to add retentive strength, it may be necessary to extend your preparation through the proximal contacts. This is also necessary if any proximal decay is present. When preparing into the proximal areas, you need break the gingival contact by 0.3mm and ensure that your preparations draw from a facial point of view. In the event proximal decay is not removed, do not extend your axial walls pulpally. Leave this decay until it is time to cement the veneers. At this time, a slow speed handpiece is used to remove decay and the luting cement will fill the round preparation. In the event that retentive strength is compromised, retentive grooves can be placed interproximally to prevent restorative failures from mandibular protrusive forces.

Remember that enamel bonding is your best friend in veneer prepartions. Do not reduce teeth beyond what is necessary. Diagnostic preparations and wax-ups are imperative to a successful case and stress-free appointments. Good luck!

Purchasing a Dental Practice: Quick Tips to Become an Owner

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Purchasing a Dental Practice 


    This blog post is intended to provide an introductory resource into practice acquisitions. I recommend forming a team with the appropriate consultants before starting your journey into buying a dental practice. However, this outline may help you familiarize yourself with some important considerations.


  • Pre Purchase Planning
  • Obtain your personal credit report
  • Contact potential lenders to determine loan criteria
    • Find out what the banks want from a lender
      • Do they require you to have 1-2 years of clinical experience?
      • Clinical production history, i.e., the number of days per week you are working in an office.
      • Is a down payment required? We are lucky in this day and age to often not need a down payment.
      • Do you need a parent or spouse to co-sign onto your loan? Again, today this is not usually the case.
      • Student loan debt is not entirely a problem when seeking out a practice loan
    • Student loan debt is not what lenders are concerned about. They are more concerned with your credit health.
  • Identify Lifestyle Goals
  • Size of your community
  • Your desire for future community involvement
    • Smaller communities have more opportunity for involvement i.e., mayor, school board, etc.
    • Style of practice desired: suburban, urban
    • Schools/Housing
    • Cultural access/entertainment options
    • Commute distance to practice
    • Family proximity
  • Identify the Type of Practice
  • All Fee for Service
    • No insurance is taken at these practices
    • Doctor sets the fees
    • Managed Care/ Reduced Fee/ PPO
    • Blended Practice (FFS and PPO)
    • Most common and usually are transitioning from fee for service to gain more access to patients
    • Some patients are fee for service; others have insurance
    • Capitation and DMO
    • Medicaid/CHIPS
  • Identify Ideal Practice Physical Attributes
  • Visibility and signage
    • Is your practice in an office building vs. side of the road
    • Size of facility and number of treatment operatories
    • Technology
    • Workstations in operatories
    • Digital radiography
    • CBCT
    • Crown fabrication systems
    • Talking points:
    • Be a sponge during a transition. Do not change many things, even the music playing in the operatory, to maintain patient retention.
    • Have the retiring dentist available for a while, even in spirit, during the transition.
    • Buyer vs. seller relationships are extremely diverse. A lot of it is personality. Does the new doctor comprehend the environment the existing patients enjoy? Is he or she willing to maintain a similar environment to keep that patient in the chair one more time?
    • You want to know what you are getting into when you buy into a practice. On the other hand, retiring dentists want to know who is buying into the practice. Working it out later has never gotten people anywhere.  


Initial Practice Research 

  • Transition Expectations
  • Prepurchase associate period
    • Very conducive to improving your hand skills, speed, patient communication skills, etc.
    • Outright purchase with short seller transition
    • Most common. There is not enough business for both dentists to try a prepurchase associateship.
    • 80% to 90% of transitions
    • Desire for seller to be a long-term associate
    • This is hard due to economics. New dentists have considerable debt and want to earn now.
    • Associate to partner
    • Dentist is 10 years older, and wants to slow down but not retire for some time.
  • Search for Prospective Practices
  • Dental school placement service
  • Dental association services
  • Online classified ads
  • Colleagues
    • Most buyer referrals come from other potential buyers
    • Practice brokers/consultants
    • Dental equipment companies
    • Direct solicitation
    • Seen often in specialty practices


Acquisition Process 

  • Initial Meeting with Current Owner
  • Identify compatibility of goals – how do you want to transition
    • Timing of sale
    • Seller plans post-sale
    • Assess owner’s practice philosophy
    • Scope of treatments
    • Comprehensiveness of treatment – some dentists do not let anything out the door. Dentist does ortho, places implants, etc.
    • Determine staff knowledge of transition
    • They need to be aware and active in the transition!
    • Keeping the staff involved makes for a smoother transition
    • Obtain any available information
  • Retention of Professional Assistance – Form Your Team!
  • Secure referrals from colleagues
  • Interview CPA, attorney, consultant
  • Review of seller’s appraisal/proposal
  • Determine need for independent valuation/appraisal
  • Identify any areas of concern
  • Prepare list of questions/needs
  • Follow-up Office Visits
  • Interview staff of seller
    • Sometimes you can give staff member 90 days to see if you are compatible
    • Observation of daily routines and office personality
    • Is this an environment you see yourself being a part of?
    • Additional interviews with seller
    • Due diligence – practice research
    • Meet spouse of seller
    • Maybe the spouse does not want the dentist to retire!
    • Third party visits/evaluations
  • Prepare the Offer (Letter of Intent)
  • Purchase price
  • Terms for purchase – financing through bank vs. seller?
  • Transition of seller – need a definitive timeline of how long they will be working
  • Seller’s covenant not to compete
  • Contingencies for purchase
    • Financing, office lease (this is a big one!), staff retention
  • Prepare for Assumption/Transition
  • Letter to patients/referral
  • Set up business accounts
  • Additional meetings with staff and seller
  • Be prepared to be an owner/administrator – this is the big part!! Some people are simply happier being a dentist and not an owner. Being an owner takes a lot of time! You need a team around you to help you, including CPA’s and other consultants


    The purchase of a dental practice is a huge milestone in your career as a dentist. It has many moving parts that you need to consider, and the more you prepare the better your decision-making will be. Remember to form a team before you begin on this journey. Find a trustworthy accountant, lawyer, and/or financial advisor. The latter are best if they specialize in dental practices or practice acquisitions. Good luck to everyone finally entering into the real world!


It’s OK to Ask for Help

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Earlier this year, I went through some significant life changes. My perfected life routine gradually became an uncontrollable seesaw between my academic responsibilities and personal life.


Once my peers and instructors confronted me about the change in my demeanor and performance in clinic, I realized that I needed to take initiative. I contacted my clinic manager and explained that I needed help. He offered helpful suggestions that included:

Don't let that rain cloud follow you wherever you go. Continue to spread positivity into your environment no matter how you feel. It's hard, but you can train yourself to do so.

Focus on what's most important. Focus on what's affecting you right now. Focus on what you can control.

Cut the source of bad stuff out of your life. Today. After clinic. As soon as possible. Even though it hurts.

Ask yourself, "What do I really want?"


Three months later, after communicating my needs and progress with my clinic manager, I have regained a sense of stability in my school and life balance. My clinic performance has improved remarkably, and I am finally myself again.


I’m writing about this incredibly personal experience to remind everyone that we are humans who each need a dependable, carefully selected and nurtured support system through friends or family or group therapy. Almost all of us will face some sort of life crisis that has the potential to eat into our happiness and the quality of care we provide our patients. It is for the latter that we must ask for help when we truly need it. Neglecting your own mental and emotional health is unacceptable if it means that you run the risk of neglecting your own patients.


If you begin to feel like you are losing an uphill battle and it’s time you asked someone for help, please do it for yourself and your future patients. Consider confiding in the people closest to you. If you don’t have close friends or family, consider counseling or mental health services available at your university. Even though our schedules are incredibly packed, you can block out clinic time in advance to make it to counseling sessions.


You can make this work, and you can take steps to make things better. You don’t have to do this alone.

Tips for Treatment Planning

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Treatment planning is a key component in dentistry.  It provides a clear outline of the patient’s treatment needs, and how the dentist should tackle the patient’s oral health.  In dental school, treatment planning can feel a bit overwhelming in clinic.  I found treatment planning quite challenging at first, but I have gained some tips and knowledge, which have helped me tremendously to better serve my patients.  I hope these tips will help you when treatment planning for your own patients in clinic.

First and foremost, think comprehensively.  Comprehensive treatment planning should be the basis for how you approach your patient. For example, several of my patients came to the dental school wanting a specific treatment, such as implants or veneers.  As a newbie in clinic, my first notion was to give the patient what they wanted; however, there are other aspects of oral health that need to be examined before implants and veneers are an option.  It is important to establish the patient’s oral health is stable, which means examining the patient’s oral health in all aspects – periodontal, restorative, caries-risk, etc. In addition, evaluate and consider the patient’s overall health when formulating a comprehensive treatment plan.

Options – give your patient all their options.  In the beginning of clinics, I was nervous to give my patients certain treatment options, such as extractions because I was afraid I’d upset them.  However, an extraction might actually be the best decision for the patient depending on different variables, such as finances. Along with options, give your patient the pros and cons of each option. Help your patient make an informative decision by giving them as much information as possible, which can include price comparisons and a long-term vs. short-term outlook. Remember, doing nothing is always an option too.

Involve your patient in the treatment-planning phase.  Respect your patient’s autonomy by listening to them and understanding what they want out of the treatment.  By giving your patient a role in treatment planning, you will be able to address their needs while providing them with comprehensive care.  It is critical to acknowledge you are the expert in dentistry, not the patient, so be wary of patients who want to dictate treatment planning.  Be sure to uphold the ADA Code of Ethics while treatment planning with your patients.

Treatment planning can be difficult and perplexing; however, do not let that frighten you.  As you continue to see a variety of patients in clinics with different needs, you will become more proficient in treatment planning.  Remember to approach the patient comprehensively to provide them with the best treatment options.  Give your patient all treatment possibilities and allow them to be involved in the process.  I hope these tips will further your success in clinic!


Public Health Literacy

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Oral health literacy is defined as the “degree to which individuals have the capacity to obtain, process, and understand basic oral health information and services needed to make appropriate health decisions”. Generally, it can be agreed that a direct relationship exists between literacy and health outcomes.  

It is a multidimensional concept and a shared responsibility between many sectors, including the patient and provider. At most U.S. dental schools, dental students provide care to many patients that are state insured, those with limited education, minorities, and having limited English proficiency – many of the determinants of oral health literacy. The students try to independently educate and positively influence so many of these individuals by providing messages to improve health literacy among patients and promote their health and wellbeing. However, there are many important factors to consider when teaching patients.  

As health care providers, we must be able to provide “science-based education to patients at all [literacy] levels about their oral health needs.” (Alice Horowitz) Imagine a time when you or a loved one was ill or had something wrong, and you have to depend almost entirely on someone else’s knowledge of information. It’s a daunting feeling and can leave us feeling very vulnerable. This is how many of our patients feel on a day to day basis. There are a few things that we can do to help them help themselves, however.  

Acknowledge the difference. We go through four years of dental school to get to where we are; our patients do not. Each individual is unique, and while some may have very high literacy rates, the reality is that patients we see in dental school often do not. We must be fully conscious of this in order to guide our patient education to be the most useful for our patients.  

Let them tell you how to teach. Personally, there are many times were I run through the same education spiel for each patient and ask at the end if that made sense or if there are any questions. However, what I have found to be more effective is having the patient practice how they would teach someone else what I just taught them. This way I am confident that they have understood the important concepts.  

Develop trust. Although educating on prevention is key, trust is what will help individuals practice it. Take the time to get to know the patient, their background, and the value they place on oral health. A perfect example is water fluoridation. Although we know fluoridation as a beneficial substance, not everyone feels the same way. By developing trust, it is easier to alter people’s mindset and educate them on the science behind it.  

Nationwide, there are many individuals that lack the understanding of oral health in the depth we do. Although there are other ideas that may help us better educate our patients, try utilizing some of the ones above and/or sharing with your peers by commenting below.  


1. U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services. 

Gummy Vitamins and Pediatric Patients

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Emma J. Guzman, University at Buffalo School of Dental Medicine 


Getting children to eat healthy and be aware of their health is often a difficult task. Ensuring that they eat their fruits, vegetables, brush their teeth, take their baths and get their vitamins is not that easy.  The start of gummy vitamins, which came to market about 30 years ago, has made at least one of those tasks easier. Gummy vitamins taste similar to gummy candies with the added benefits of containing vitamins. This is great, if we don’t think about the dental implications. 

Gummy vitamins are essentially vitamin-enhanced candy. The gummies, which are thought to be healthy because they contain vitamins, are a variation of a mixture of sugar, starch, food coloring, citric acid and gelatin.  Besides the “health” factors of containing vitamins these supplements have the same dental implications are any old gummy candy.  

There are three major issues with gummy vitamins that can effect dentition.  The ingredient of citric acid in gummy vitamins is problematic because it is an acid. Citric acid is contained in certain fruits, vegetables and is used as a preservative. Acids are an issue because they break down the enamel, the enamel in primary teeth is softer than permanent teeth and more susceptible to erosion form acidic foods. The acidity in combination with the sugar content of gummy vitamins is the prime environment for caries formation. Most gummy vitamins contain some type of sugar to make it sweet and appealing to children.  That sugar feeds the bacteria that is now working on the acid weakened tooth.  The last and most problematic factor is the “gummy” of gummy vitamins. These vitamins are sticky and cling to teeth. Rinsing and saliva does not get rid of the small pieces that get in the interproximal region, in the grooves and fissures. The gummy vitamins sticking to teeth for long periods of time allows the acid, sugar and bacteria to cause damage.  

Changes can be made to reduce the risk of a child getting caries due to gummy vitamins. One major change could be switching to non-gummy chewable vitamins. The vitamins should be given during meals and not in between. During a meal the saliva content is high so that gives the saliva a better chance of getting rid of any residue. Another importance in given vitamins during a meal is not constantly changing the pH of the oral environment by giving anything with sugar in between meals. This goes for anything that contains sugar, juice, a dessert, etc.  Emphasizing oral hygiene is always going to be beneficial.  Brushing and flossing those gummy particles out will prevent them from doing the damage they do when they sit in the oral cavity and wreak havoc.  

Brief Overview of Oral Complications of Cancer Treatment

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It is a popular humorous saying at DCG that dentists diagnose three conditions: cancer, infection, and ugly.  As far as the management of infection, we have entire courses on operative dentistry, oral surgery, periodontics, endodontics, etc.  To treat “ugly” we learn principles of esthetics and develop an eye for creating and recreating a patient’s dentition.  And, for cancer, we learn to recognize what is not normal and refer the patient for appropriate continued treatment.  However, I have noticed a gap so far in my program and in some of my friends’ programs at other dental schools.  This gap includes learning basic biopsy techniques and tissue handling as well as training on the management of patients who have received chemotherapy and head and neck radiation.  


Now, I am in the middle of third year, so these topics could very well be covered in upcoming courses, but as a student who is particularly interested in oral medicine, oral cancer, and management of patients who have oral complications of cancer, I thought it seemed about time that I started seeking out training in these areas.    


I won’t go too into depth about biopsy techniques here, but some great information can be found in this publication by the Oral Cancer Foundation:  http://www.oralcancerfoundation.org/dental/pdf/oral_biopsies.pdf 

The main takeaway is that biopsies are a useful and valuable service you can provide for your future patients, but training is necessary to be able to perform a high quality procedure, provide an excellent specimen for the pathologist, and discern when a patient should be referred for more advanced biopsy techniques.  


Often, patients who have undergone cancer treatment, even treatment not focused on the head and neck area, can experience some severe and debilitating side effects.  Common oral problems occurring after radiation and chemotherapy include mucositis, dehydration, malnutrition, difficulty swallowing, and increased susceptibility to infection, bleeding, and pain.  Specifically, radiation therapy to the head and neck can contribute to xerostomia, hypovascularization of the maxilla and mandible, trismus, osteoradionecrosis, and cause an increased risk of caries and periodontal disease.   It is routinely recommended for teeth in the path of radiation to be extracted prior to starting therapy in order to avoid post therapy extraction complications, which can be severe and life-threatening.   Proper management of these conditions can drastically improve the quality of life experienced by cancer survivors.  


These patients also present unique challenges in restoring function after treatment. Head and neck cancer patients often have areas of tissue resection that can present an impediment to proper speech and nutrition.  Removable prosthetic devices called obturators and other advanced maxillofacial prosthetics can help fill areas of tissue resection and give the patient some measure of improvement in speech, nutrition, and esthetics, once again improving quality of life.   


In summary, patients who have received treatment for head and neck cancer may not be your usual patient in dental school, but we all will likely see at least one or two in our lifetime of practicing.  Understanding the multifaceted nature of oral problems experienced by these patients can help us to better serve these individuals and provide a measurable impact on their quality of life.  

A Unique Interdisciplinary Pediatric Experience

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It is a special opportunity to be the first dentist that a child will encounter in their lives and, in turn, have the ability to shape a child’s view of dentists. Pediatric dentists are at the forefront of oral health, as they affect the upbringing and hygiene of young children as they grow up. Over the past two years in dental school, I’ve become exposed to working with pediatric patients. The ways in which each child learns and grows are very diverse from one to the next. My aspiration to work with children is fueled by my desire to teach my patients and their parents and to be able to learn something new from them as well.

At the University of Maryland School of Dentistry, third and fourth year dental students have unique opportunities to join the campus president, Dr. Perman, and his team in President's Clinic, where students from other University of Maryland graduate programs evaluating pediatric patients together. This interdisciplinary approach is an essential experience for dental students because it is not just pediatric dentists that treat children. General dentists treat a lot of children and it is important that general dentists experience behavior modifications needed to ease and treat children.

During the President’s Clinic seminars, students from various disciplines not only have an opportunity to learn more about pediatric patients, but also incorporate interprofessional collaboration. When I arrived at President’s Clinic last week, I was greeted by a medical student, a nurse practitioner student, a pharmacy student, and a social work student. The five of us would be working as a team with equally important roles. Our first patient was a baby boy, only 6 weeks old, and had episodes of frequent vomiting. Our team’s collaboration was essential as we gathered medical, dental, and social history from the mother. Each student asked questions related to their field and once a through history was obtained, the medical student conducted a physical exam. After a through discussion, a treatment plan for the baby boy was agreed upon.

Even though the patients seen were being evaluated for digestive disorders, our primary focus was on interprofessional practice. It was really interesting to see the way the child could be evaluated in one visit from all aspects including medical, nursing, pharmacy, social work, and dentistry. As the future of many diverse professions, it is important that as students, we utilize interprofessional collaboration and work together towards a common goal of improving patient outcomes. Working together now as students will only make our interprofessional relationship stronger in our future work environments. This approach is characterized by teamwork, mutual respect, and shared decision-making. I believe that educating future professionals to prioritize interprofessional collaboration is essential to breaking the limits of success.


As future oral health care providers, we are learning through this program to look at the big picture and not only a patient’s teeth. A close interprofessional relationship established between professionals in diverse fields is an intriguing aspect that I am very eager integrate into my dental education as I represent the future of patient healthcare.

The Polished Pre-Dental

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Your whole life has been centered around becoming a dentist. You worked hard through high school to get into a good college. Studied day and night to get those good grades. Took endless amounts of practice exams to ace that DAT. You woke up early every Saturday morning to get in some community service hours. Spent all your breaks shadowing dentists. Joined numerous amounts of clubs to show your leadership abilities.  Welcome to the life of just about every dental student. So how are you going to make your application stand out from anyone else?


Here are some tips to help out in your process!



  1. Start off by making a list that will distinguish you from others. They don’t have to be science-related or even dental-related. Maybe you are part of a religious group or part of a sports team? Everything that you put into your application does not be dental-related; show that you have other parts to yourself and that you have adventured into other fields. Remember, school administrators are trying to find a well-rounded applicant. 
  2. The format of your personal statement is your next step. There are many examples you can read online or from friends that have applied in previous years. The trick is to just be simple and concise. Don’t add any fluff simply to take up space in your essay. Make sure to use spell check and grammar check. Have a few people read your essay and make sure to read it with a new set of eyes after the first draft. Ask your former literature professors and even maybe a family member or friend who knows you well. Your statement should have a very consistent flow to it. This is one of the few things that schools have to be able to get a sense of personality from each applicant, so keep that in mind. 
  3. Your letters of recommendation are also key components of your application. This is something you have to plan much in advance and carefully. Always be on the lookout for the professor that you feel you can have a good relationship with, and who will be able to write you a strong letter. Make sure to ask professors early; they all have a lot of work to do as well. Be sure to have a transcript, resume, and personal statement ready to give to any of your professors to help them write your letter. Also be very thankful, by maybe getting them a token of gratitude after getting your application in--and especially after any acceptance. 
  4. We all have something on our transcripts that we aren’t necessarily proud of. Don’t discuss your bad scores and grades; focus instead on explaining why your grades did not achieve your own personal standards. Explain what you have done differently since then to be able to improve yourself. But be sure not to make excuses for any bad performance your transcript might be showing. Use this time to also show your strengths through dealing with your weaknesses. 
  5. Start EARLY! It is never too early to start gathering your transcripts together, getting your letters in, or writing your personal statement. Every dental school will always advise you to get in your application early.  
  6. Last but not least, stay calm and confident in your application. Don’t go round and round with your application. Once it is done, take a few more glances and submit it. 


Move on secondary applications as quickly as possible. As soon as these are submitted and read, you will start getting interviews. Nothing feels better than early interviews. Your chances of acceptance are higher, and you have less anxiety than those who are still waiting because their applications were sent in late.


And there it is! You application is in and ready to go. Now just sit back and stay calm!

Good Luck!





Dentistry & Social Media Marketing

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Social media marketing techniques reach highest efficacy when a particular audience is targeted successfully. As technology has improved, consumers’ reliance on Internet sources has increased. Consumers are far more likely these days to turn to the Internet for researching healthcare providers’ reviews. The exact role of marketing has evolved, too; recent studies indicate that patients are “60-90% of the way to a buying decision before even talking to a dentist” (1). Social media marketing is affected by numerous factors. Even though there are associated risks, social media may be utilized carefully in order to have a positive impact. With care, a constructive “webutation” may be developed. 


Marketing via social media is a relatively new concept. While individuals have been using social media to communicate with friends and family for years, its application to healthcare/marketing is innovative. Overall, social media use is spanning generations and becoming more accessible due to increased mobile capabilities. More specifically, according to the Pew Internet Project (January 2014), 85% of American adults are using the Internet and of those, 74% are utilizing social networks (2). Social media marketing may take place via a number of different platforms, including Google, Facebook, Twitter, YouTube, Instagram. The diversity of platforms that are available is an important factor; each platform typically attracts a specific audience. Additionally, each platform may emphasize a certain feature. For example, Facebook, YouTube, and Instagram all highlight visual appeal via photographs or videos. Since consumers tend to appreciate visuals, these three sites are often beneficial to use in order to increase visual appeal.


Certainly, social media may enable targeting of a specific audience, or increase the visual appeal of an individual’s web presence; however, several problems may arise. Five of the more common or serious issues are: 1) unprofessional behavior, 2) if blogging, accidentally including too much patient information that may lead to patient identification, 3) receiving friend requests from patients on Facebook, 4) the fact that web footprint is permanent and/or public, 5) the posting of photos without patient permission (which may lead to significant HIPAA fines).


By handling appropriately or avoiding altogether the problems mentioned above, social media may be used to enhance an individual’s web reputation, or “webutation.” A good web reputation may be created by utilizing blogs for industry updates or educational discussions (not specific patient advice). Facebook may be used for story-telling, or a way to connect with readers. Last, while negative reviews are unpleasant, they may be balanced by a larger number of positive reviews. Therefore, it is important to remind patients who have had a good experience to write reviews speaking highly of their experience.




1. Sell How Your Customers Want to Buy | CEB. (n.d.). Retrieved October 10, 2015, from https://www.cebglobal.com/exbd/sales-service/challenger/new-decision-timeline/index.page


2. The Web at 25 in the U.S. (2014, February 26). Retrieved October 10, 2015, from http://www.pewinternet.org/2014/02/27/the-web-at-25-in-the-u-s/