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Blogs

THE NEXTDDS Student Ambassador Blogs

Preparation Tips

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In my first 3 years, dental school has been full of stressful situations, cram sessions, surprise quizzes and joyful rewards. I have taken boards, skills assessments, exams, and fulfilled requirements (all with the associated stresses and challenges). This past week my school hosted CITA (counsel of interstate testing agency). It is the organization that administers testing for dental license exams for certain states. Although I am only a D3, I have taken part in this exam in various ways over the past few years. I would like to share some insight into one of the most stressful and challenging events that dental school has to offer.

 

CITA is broken into two parts: the manikin portion and the patient portion. As a D2 last year, I had the opportunity to be a "runner" for the CITA exam, which involves shutting the patients for the patient portion from the grading station back and forth to the testing station. From this, I learned to appreciate patients! They are willing to give up an entire day of their lives to be carted around, poked and prodded, examined and re-examined all while wearing a rubber dam. I also realized that the phrases "time is money" and "preparation is the key to success" could not be more fitting for this exam. There are certain time points you must hit in order to pass the exam. If you do not pass, you must pay to retake the exam. Preparation is what kept everyone on their time points. Those that had read the manual, filled out paperwork in advance, and set-up their operators early were those that hit their time points at ease. 

 

This year, the D4 class at my school took their patient portion. I had the opportunity to be an assistant for a schoolmate. Here, I learned the key to patient selection. Dependable patients that will show up on time, are willing to stay as long as you need them, and are committed to only you for the day are essential. Patients who committed to more than one student, although had the best of intentions, caused a few students to fail due to missing their time points.

 

Also this year, I challenged my own manikin portion of the CITA exam. My advice for this is: 1) read the manual 2) know the manual 3) practice the manual! That proved to be key for me and my classmates this year. Anything you could possible question about the rules, the criteria and the timing of the exam is answered in the manual. I started reading it and memorizing it a few months before the exam and allowed it to guide my practice. I attribute focused and concentrated practice time in the simulation lab to my success on the exam.

 

Best of luck to all the "younger" dental students as you embark on the dental school journey. Whatever challenges and stresses you have, just know that it is part of the ride and that you will get through them. 

 

Interprofessional Patient Care

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While we hear all the time in dental school about “treating the whole patient” and “comprehensive patient care,” I learned a lot today at a required Inter-professional Meeting involving several other student healthcare professionals at UNLV.  While we are all aware of the connection between oral and systemic health, and we have open lines of communication with the patient’s physician, cardiologist, etc., implementing a care team that routinely includes the dentist in the plan is a challenge.

In my assigned group at the meeting today, there were student professionals from the fields of Social Work, Nursing, Psychology, and Physical Therapy, as well as Dentistry.  All of the other professions expressed their surprise at our presence at this meeting and wondered aloud what we as dentists could contribute to a complex patient’s medical care plan. 

Many false assumptions that we all had about each other’s professions were rectified and we all left with a greater understanding and respect for what each contributes to our common goal which is the health and well-being of our patients.  When presented with a complex case study, it was natural for all of us to approach it from our own area of specialized training.  Combined, we were able to synthesize care plans with breadth and depth that none of us could have come close to on our own.  It is surprising the things we don’t think about because we are so focused on our specific piece of the puzzle.

While we all agreed that this meeting was enlightening and inspiring, we struggled to come up with ways to actually implement a care team involving all of us on a regular basis.  While a care team that focuses on health and prevention can save money in the long run by minimizing ER visits and deteriorating health conditions…  How would we all make time to consult with each other?  How would reimbursement work?  Is this even economically feasible for a patient to have access to this many providers?  What we came up with is that while patients are unlikely to seek out care from a “team” of healthcare professionals one appointment at a time, utilizing technology can make it more plausible.  Online consults between professionals on the Team, with one person as the coordinator of the Team who is ultimately responsible for overseeing that all goals are being accomplished as well as acting as the liaison to the patient is the only realistic option. 

When asked how WE, as new graduates, the future of our professions, could facilitate this type of care model, lots of ideas were tossed around and they all seemed kind of vague.  I think just as general dentists routinely form relationships with dental specialists for whom they can refer and confer on patient care, so should they form relationships with other professionals.  I would like to establish a relationship with a social worker in my community who can put my patients in touch with available resources.  I would like to work closely with a nurse practitioner, a physical therapist, and a psychologist that I can send my patients to or confer with on common dental issues such as diabetes-exacerbated periodontal disease, TMD, chronic pain, stress-related bruxism, nutritional problems, eating disorders, xerostomia, etc.  Sharing in the total health care plan of our patients builds value for the patient and dramatically increases the quality of care being delivered by each of these professions.  

The Importance of Obtaining an Orthodontic Consult at the Correct Age

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According to the American Association of Orthodontists (AAO), 3.8 million children received orthodontic treatment in 2008. This number represented a 46% increase over the course of the preceding decade. The rise in the number of these cases (among individuals 17 and younger) may be attributed partly to the initiation of treatment at earlier and earlier ages. Traditionally, braces were loosely associated with middle and high school students. However, their prevalence among elementary school children has been continuing to grow. There is no doubt that parents’ wishes to obtain perfect teeth in their children at a younger age is a contributing factor to earlier initiation of treatment; many parents believe that earlier intervention may reduce treatment later, or prevent the need all together. Other contributing factors include better diagnostic technology and increased insurance coverage. With the number seeming to creep lower and lower, parents with children or general dentists with a wide pediatric population may be uncertain about the correct age at which children should obtain their first orthodontic consult. Furthermore, parents may be left wondering why it is even important. Both of these issues are addressed below.

 

Orthodontists currently appear to agree that an occlusion/orthodontic assessment should be done before a child reaches age 7. This allows specialists to determine whether the child needs no treatment, early treatment, and/or late treatment. The terms “early” and “late” themselves are controversial. Some define “early” treatment as one that is started in the primary or early mixed dentition stage (permanent first molars and incisors present), while others consider it “early” if it is initiated in the late mixed dentition stage (before eruption of second bicuspids and permanent upper canines). This ultimately affects whether children receive a one-phase vs. two-phase treatment.

 

Research has shown that certain conditions are treated more effectively using early treatment. On the other hand, for other conditions, there seems to be no benefit via implementation of early treatment. Orthodontists generally prefer early treatment for most functional habits, which include thumb sucking, mouth breathing, and tongue trusting. Proactive treatment for these conditions are favored since lack of treatment may lead to unfavorable growth of jaws and/or protruded upper anterior teeth capable of trauma or speech problems. Aside from treating functional habits, early treatment is also effective for correcting anterior crossbites, lateral crossbites, and arch constrictions. These problems are best targeted early since it permits orthodontists to take advantage of the still-growing child. Once a child’s main growth period is completed, for example, it becomes very difficult to compensate for narrow maxillary arches. In contrast, one of the most common conditions, class II malocclusions, sees no benefit from early treatment. Patients with class II malocclusions (even if they obtain early treatment) will frequently require a second phase of treatment, so studies have shown that it may just be better and cheaper to wait until the late mixed dentition stage.

 

Indeed the research is controversial, and every case needs to be assessed individually to determine the best treatment protocol, yet it is prudent for children to receive their first orthodontic consult by 7 years of age. Pediatric/general dentists should be aware of this recommendation and instruct parents accordingly. While early treatment is by no means appropriate for every child, it may be extremely beneficial for some.

 

References

 

Aldrees, A., Tashkandi, N., AlWanis, A., AlSanouni, M., & Al-Hamlan, N. (2014, December 8). Orthodontic treatment and referral patterns: A survey of pediatric dentists, general practitioners, and orthodontists. Retrieved January 24, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273289/

 

Al-Shayea, E. (2014, October 1). A survey of orthodontists’ perspectives on the timing of treatment: A pilot study. Retrieved January 24, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238079/

 

Keates, N. (2010, November 16). The 8-Year-Old With a Perfect Smile. Retrieved January 24, 2015, from http://www.wsj.com/articles/SB10001424052748703326204575616460332062620

 

Pietilä, I. (2007, October 25). The European Journal of Orthodontics. Retrieved January 24, 2015, from http://ejo.oxfordjournals.org/content/30/1/46.long