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Blogs

THE NEXTDDS Student Ambassador Blogs

Informed consent in Dental School

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 Finding the perfect balance of informed consent can be a challenge, even to the most qualified of dentists. As a D3 student, I have found many obstacles in balancing: education of patients with appointment time and the patient’s personal preference. And in the end all of these efforts can be unhinged if a professor does not agree with your treatment plan. Informed consent is a process I take very seriously and will always present the possible options to a patient before the patient makes a final decision. I want to run though a stressful scenario I have encountered during my time in dental school and hopefully prevent this from happening to you.   

 

Scenario #1: 23 year old patient with poor oral hygiene, poorly controlled type 1 diabetes, rampant decay (every tooth in the mouth has caries with many hopeless teeth). The series of treatment plans we came up with included: 1. Extraction of hopeless teeth, implants to replace teeth, crowns on remaining teeth, 2. Extraction of hopeless teeth, partial denture to replace teeth and crowns on remaining teeth or 3. Extraction of all maxillary teeth, full maxillary denture, extraction of hopeless mandibular teeth, crown remaining mandibular teeth and mandibular partial denture.

The patient choose treatment plan #2, but this was the treatment plan that the faculty was in favor of and so the patient was inclined to choose it. This treatment plan is a good option, but the patient was supposed to make the decision not the faculty. As we progressed to operative to excavate and sedate caries on multiple teeth the faculty that day did not agree with our treatment plan and believed that a full denture would be a better fit for the patient. This upset the patient and no work was completed that day. The following operative appointment with a different faculty member, the patient now told me that she wants to go with the option of a full denture after discussing it with a relative that has been through a similar experience. But the faculty that we worked with that day did not agree that she should get a full denture. The patient and myself are frustrated and confused by this back and forth treatment plan.

This scenario is a major problem in dental school and many students have had a similar experience. As students we do not make the final decision and this can be frustrating to both the student and the patient. We spend the time explaining the cost and benefits of each treatment plan then in the end if the faculty we are working with takes a glance at the patient and does not agree with what the patient and the student have come up with then the entire process gets halted. The patient should make the final decision, but many times they do not feel they are in a position of power so they will yield to the faculty’s decision. The best advice I can give is to stick with the same faculty (especially in complex cases) and empower our patients to let them know they have the final say. The patient’s decision trumps all, in the end it is their mouth and their choice. 

ASDOH Cares

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     After 21,521 steps or 10.29 miles, my feet hurt and body ached, but spirits were high because we had treated over 500 children in one day. The annual Give Kids a Smile event had come to an end, but the memories will be cherished by all for a long time to come. For the last two years, I’ve had the opportunity to work on the student-run Give Kids a Smile committee at Arizona School of Dentistry and Oral Health (ASDOH). Once a month all year long we meet to collaborate with administration, alumni, local universities, dental professionals, clinics, and businesses. Each meeting grows with importance and anticipation for the day we get to forget ourselves and work hard for underserved children.   

 

     With such a large operation, each class has different responsibilities on the day of the event. Whether they’re treating patients, assisting local volunteering dentists, leading operations and preparation, setting up supplies and entertainment tents, coordinating pre-dental volunteer efforts, escorting children from check-in to check-out, screening hundreds of children throughout the year, comforting anxious or nervous children, guiding busses/transportation, or even translating, every single student has a very specific and important role.   

 

      It’s incredible how much good can be accomplished when so many people are dedicated to work together for the same common goal: to give kids a smile. The Give Kids a Smile day means more than giving over $250,000 of dental services to underserved children. The event is more than a public health intervention or opportunity for students to treat hundreds of kids. That day is a culmination of an entire year’s worth of planning, preparation, and fundraising that ends with a reward far greater than the cost. Give Kids a Smile is the essence of dentistry; to use our gifts to change others’ lives and in turn change our own.   

 

     For most ASDOH students, administration, and local volunteers the Give Kids a Smile day started before 5:30 am. Entertainment tents needed to be set-up, supplies dispersed, breakfast provided, and operations ready to function at a high rate. Some of the games for postoperative children to play included: bowling, basketball, fishing, cooking, face-painting, dancing, and photos with Pixar legends and Disney princesses.  Operations within the dental school were intricate and well-organized enough to treat over 500 underserved children in just six hours.


      The energy of volunteers and children alike was tangible. Laughter from both parties could be heard throughout the day.  Healthy smiles were given to the kids, but lasting smiles were given to the volunteers. Anyone who helped even just one child smile has a memory worth more than any currency. While many volunteers dressed up as Superheroes, the real heroes were those that gave their time, their hands, and their hearts all year long to lift those children up for at least one very special day, and who helped flip their fear and pain into confidence and comfort.  Give Kids a Smile all started with one idea and Dr. Jeff Dalin’s desire to make a difference. What’s the next great idea?   

  

 What legacy will you leave behind in dentistry?  

  

 Tyler Hanks  

 DMD, MPH Candidate  

 ASDOH 2017  

 Social Entrepreneurship President   

The Road to Specializing

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When asked on the first day of school who had an intent to specialize, I bet at least half of your class raised their hands.  If you are one of the many individuals beginning their dental school journey with your hand in the air, these tips may help you along the way as you contemplate a career in a dental specialty.

1. Explore.  Start off by getting to know the specialties.  From prosthodontics to pediatrics and endodontics, there is a wide range of options.  If you are fortunate enough to go to a school that has specialty programs, go check them out.  On your virtually nonexistent spare time, pop up to the clinic and shadow or assist.  This will not only give you a better idea of what goes on in that specialty but it will give you a chance to pick the brains of the residents.  Also, see if your school has a mentor program to connect with dentists of varying specialties in the community to get a better view of what life is like in the particular field.  Shadowing or doing an externship is very important and required for some programs like oral surgery.  Shadowing will also expose you to the practice and business aspects of the specialty which are not commonly taught in depth throughout dental school. This is your time to figure things out.  Discover what you like, what kind of grades you need and whether or not you think after four years of dental school, you will be okay with more school.


2. Study. Study.  Study.  Study.  That’s the number one thing you can do early on in your dental school career.  Find out how you study best, whether it’s rewriting notes, camping out at the library, quizzing with a friend or even cramming.  Dental school is a whole new game, one which may take awhile to figure out, but in the end, you need to do what works for you.  Whatever it is, get good grades to be competitive for specialty programs, especially if you’re looking into programs like orthodontics.


3. Network.  Knowing people is everything.  Make connections in all settings, from your  classmates to your upperclassmen, faculty, administration, and residents.  You will interact with these individuals every step of the process so you might as well develop a good relationship early.  Most importantly, do not treat your peers going into the same program as competitors.  It will consume you.  Work together, build each other up and use each other’s strengths to improve yourselves as individual candidates.  Making friends with people with similar goals will be extremely beneficial for you as they can be your study buddies, research partners, and emotional support when you are stressed.  These relationships will also help in the long run because residencies want cool people that are team players, not individuals that are first in class but gunners and keep to themselves.  Also, make sure to get to know residents— they were in your shoes only a few years ago and have some great advice!  Don’t brown nose but don’t forget they are people too.  Most of them are probably new to the city and would love to make new connections just like you.


4. Research. Check out specific programs’ websites and statistics, ask faculty or friends in the field, or scroll through Student Doctor Network.  Do whatever you need to find out what the requirements are for the specialty.  This includes deadlines, required grades and even specific tests.  Both oral surgery and orthodontics require special exams so make sure you prepare for this and put it on your to-do list well in advance.  At this point, you should also re-evaluate if you’re ready for more school.  Some students are a little more ambitious their first year of dental school than their third when it comes time to apply.


5. Apply. Decide on how many schools to which you want to apply and make a list based on your preferences.  Start asking professors and dentists for your letters of recommendation early so you give them ample time to write a well-constructed essay to reflect your qualities.  Also, set aside enough time to write your personal statement and make several drafts before you submit.  Check to see if your classmates, relatives, professors or one of the faculty in the specialty program will read your essay and give you feedback. 
 

Whatever you decide as your final destination, specialty or general dentistry, work hard, stay ahead of the game and enjoy your dental school journey. 

Drinking Your Teeth Yellow

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We are all familiar with the classic science experiment of leaving a tooth in cola overnight. Not only will that tooth look discolored the next morning, but in many cases, the tooth will also exhibit some level of dissolution.

 

 

There are many ways that the chemicals and dyes in a drink can affect the aesthetic quality of your teeth. What most people see when you smile is the enamel of the tooth. Enamel is a hard substance that is made of 97% inorganic material and 3% organic material. The inorganic content is mainly composed of hydroxyapatite, which contains calcium and makes your teeth look white. Drinks other than water often have chemicals that are able to breakdown the major components of enamel resulting in discoloration and yellowing of teeth. So who are the culprits?

 

THE BAD GUYS

Coffee – That rich, warm aroma comes at a price, and I’m not just talking about the $2.00 you’re shelling out for tall cup of Starbucks. Coffee contains chemicals such as tannins, which are very acidic in nature. The acid in coffee naturally breaks down the bonds in enamel resulting in thinner and more translucent enamel. Not to mention, coffee is darkly pigmented. This combination of factors greatly increases its staining power on your teeth.

 

Tea – Yes, even that lighted pigmented white tea you love has the ability to stain your teeth. Much like coffee, tea is also high in tannin content, which means your teeth are subject to an acid attack. In fact, tea is known to have greater tannic acid content than coffee! The same principles of staining apply here. As we drink tea and other beverages with acidic content, the acid attacks our enamel, degrading the inorganic material that keeps our teeth looking white and pearly. One of the reasons our teeth look more yellow is the fact that the dentin lying beneath our enamel becomes yellow tinted.

 

Wine – We all know how great wine is when paired with food. Despite its great taste and antioxidant power, wine is also one of the top teeth staining drinks. In addition to tannins that both tea and coffee have, wine contains chromogens. Chromogens are colored compounds that have a penchant for enamel. Paired with the acidity of tannins, your favorite Cabernet could be a leading contributor to darker teeth.

 

HOW TO MINIMIZE STAINING

Rinse your mouth – Following a meal or beverage intake with heavy pigmentation and/or sugar, rinse your mouth with a swish of water to loosen up the particles from sticking to enamel.

Use a straw – Using a straw will help decrease the exposure of the facial surfaces of teeth from the damaging components of beverages.  

Eat cheese – The protein content in cheese acts as a barrier for your teeth and prevents heavy acid attack on enamel.

Dental Student Debt

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We all know going to dental school is by no means cheap! Many of us will graduate with around $200,000-$500,000 in student loans to pay back. While this may seem like a gray cloud looming overhead, there are some repayment programs which can help those large sums seem slightly less daunting.  Below are two of the payment plans which maybe most beneficial to dental students:

 

Income-Based Repayment Plan (IBR): Your maximum monthly payments will be 15 percent of discretionary income. Your payments change as your income changes. This plan is up to 25 years, and any outstanding balance after 25 years will be forgiven. Keep in mind you may have to pay income tax on any amount that is forgiven. Eligible loans include direct subsidized and unsubsidized, subsidized and unsubsidized federal Stafford loans, all PLUS loans made to students.

 

Pay As You Earn Repayment Plan: Your maximum monthly payments will be 10 percent of discretionary income. Your payments change as your income changes. This plan is up to 20 years, and any outstanding balance after 20 years will be forgiven. Keep in mind you may have to pay income tax on any amount that is forgiven. Eligible loans include direct subsidized and unsubsidized and direct PLUS loans made to students.

 

For more detailed information on these types of repayment plans you can visit: https://studentaid.ed.gov/repay-loans/understand/plans

 

While the payment plans listed above are two options there are also many other ways to help alleviate student debt. Some of these options include military scholarships while attending dental school as well as military repayment programs after graduation. There are also different types of public health scholarships which may repay up to a portion of your student loans.

 

Ultimatley, there are many different options to explore and before deciding to choose one make sure you explore all your options. So what is my best advice as a current dental student? Do as much as you can to educate yourself about your loans and interest rates. Also make sure you find out all the details about any type of repayment plan before signing an agreement. While in school live frugally and maintain that lifestyle once you graduate until you have your finances under control. Also if your thinking of buying your own practice after graduation try to set money aside and don’t put it all towards student loans, this will help you when trying to take out a loan to purchase your practice. Also if you have any credit card debt try to pay it off prior to graduation. I know dental school is expensive, but in the long run it will all be worth it as long as you manage your finances wisely!