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THE NEXTDDS Student Ambassador Blogs

My First Extraction

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    Last week, my patient presented to dental clinic for the extraction of tooth #12. As this was my first planned extraction, I was a bit anxious. The instruction I had to go off of was a vague, old PowerPoint. I thought to myself, how crazy is it that I am really allowed to perform such invasive procedures? I consulted with the faculty beforehand to calm my nerves and to get some tips. Overall, the procedure went smoothly. I’ll share my experience step by step in the hope this will assist other dental students in their first extraction. 

    Oral examination revealed a carious tooth #12 with class III mobility and horizontal and vertical bone loss on radiographic imaging. The patient’s medical and dental history were reviewed; no contraindications to treatment were identified. Vitals were taken. The treatment plan, risks, and benefits were reviewed with the patient, and the patient consented to treatment. 

    Next, the patient’s soft tissue surfaces were cleaned and dried using gauze. Topical anesthetic (benzocaine) was applied to both the palatal and buccal mucosa in preparation for local anesthesia. I anesthetized #12 using local infiltration of both the buccal and palatal soft tissue surfaces. I used two thirds of a carpule of 2% Septocaine (34 mg) with 1:100K epinephrine (0.017 mg) on the buccal and the remaining third was injected palatally. A bite block and posterior pharyngeal curtain were inserted to prevent aspiration. The overhead light and patient were positioned at a 60-degree angle, providing good visualization and access of the field. If I were to work on the mandibular teeth, I would position the occlusal plane parallel to the floor. 

    I used a periosteal elevator to help release the soft tissue around the tooth. I then positioned a straight elevator between the tooth and the bony wall socket, my finger placed along the shaft of the elevator. I rotated the elevator along its long axis to help luxate the tooth. The #150 extracting forceps was positioned as far apically as it could be seated. I knew that the further apically I could seat the forceps, the less risk I would have fracturing the crown from the root. The beaks were parallel to the long access of the tooth. The tooth was displaced by applying pressure buccally, then palatally, and coronally. Pressure was applied by moving my trunk and hips instead of my elbow. Once the tooth was loose, a rotary, figure-8 movement was used to remove the tooth from the socket. Excessive force should be avoided. The surgical curette was used to remove any granulation tissue, and the site was irrigated. No bone filing or suturing was necessary. 

    The patient tolerated the procedure without any complaints or discomfort. The patient was asked to bite down on a piece of moistened gauze at the extraction site and post-op and pain management instructions were given. A one-week follow-up appointment was scheduled. I answered all patient’s questions and they were dismissed.

    Overall, I think that my first extraction went smoothly. However, the tooth was pretty mobile to begin with so I’m sure that had a lot to do with it. I anticipate more struggle in the future when dealing with more stubborn teeth. Despite my nerves, I followed protocol, listened to my instructors, and I now have an additional experience under my belt. I will be sure to walk into the next surgical procedure with a bit more confidence.  

Junctional Epithelium

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The junctional epithelium surrounds the tooth. It is composed of stratified squamous non-keratinized epithelium. It is attached on one surface by the tooth and on another one to the gingival connective tissue. It is composed of the internal basal lamina or suprabasal layer, which extends to the tooth surface, and of the external basal lamina or basal layer, which faces the connective tissue. The junctional epithelium forms when the reduced enamel epithelium still lines most of the crown surface and it is eventually remodeled into the junctional epithelium. It extends from the base of the gingival sulcus to approximately 2 mm coronal to the alveolar bone crest. The attachment of the junctional epithelium to the tooth is mediated through the epithelial attachment apparatus. This consists of hemidesmosomes at the plasma membrane of the cells directly attached to the tooth (DAT) and the basal lamina on the tooth surface. The density of the intercellular junctions is less than that observed in the mouth, which makes it more susceptible to mechanical disruptions.

The functions of the junctional epithelium are first to form an epithelial barrier against plaque and bacteria. Secondly, to allow access of the gingival crevicular fluid, inflammatory cells and components of the host’s defenses to the gingival margin. Thirdly, the cells exhibit a rapid turnover, which contributes to the rapid repair of damaged tissue and equilibrium of parasites. During disease, the junctional epithelium allows the emigration of polymorphonuclear cells and the migration of microorganisms from bacterial plaque and associated toxins to enter the tissue. This process results in acute inflammation and epithelial ulceration, which allows the damaging agents to penetrate deeper into the periodontium. In addition, the gingival crevicular fluid that passes through the junctional epithelium provides the nutrients necessary for the directly attached to the tooth cells to grow. During health, the amount of gingival crevicular fluid is minute, but during inflammation the amount present increases and it becomes something resembling an inflammatory exudate.

The junctional epithelium is the first line of defense against microbial invasion in tissue. Even though it provides a barrier many substances such as lipopolysaccharides pass through, but have only limited access since both the internal and external basal layers act as barriers. Another aspect of the defense mechanism is the rapid turnover, which provides an effective removal of bacterial clinging to the epithelial cells. Moreover, the junctional epithelium has enzyme rich lysosomes such as matrilysin, cathepsin and alpha defensing. In addition, the junctional epithelium cell surface receptors respond to extracellular molecular changes by producing intracellular adhesion molecules (ICAM), and chemotactic substances such as C5a, leukotriene B-4 and IL-8. 

Continued exposure of the junctional epithelium to bacterial challenges may lead to subgingival plaque formation, transformation of the gingival sulcus into a periodontal pocket, and an increase in the inflammatory focus in the connective tissue. The consequences stated are reasons to encourage the understanding of this structure of the oral environment and to encourage the maintenance of oral health. 

How to Build a Strong CV

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It’s hard to put your entire life’s accomplishments and activities on one piece of paper. At first, building your curriculum vita (CV) may seem like a daunting task, but the earlier you complete the initial steps, the easier it will be. During dental school my resume would be continuously updated as I made it through another year. A resume and CV are different in that a resume is used when applying for a job and gives a brief summary of your work history. A CV is used when applying for a residency or fellowship. A CV provides a summary of your education, honors, awards, work, research, publications, presentations, teaching experience, and personal information.

Throughout my process of making a CV, I have gathered essential key points for how to build a strong one. First and foremost, an honest and accurate CV is so important. You will get asked on interviews about things on your CV, so it is important that you have a personal, memorable, and honest story about certain experiences. The first section on your CV should be education, where you list your undergraduate and dental school GPA/class rank. Following that section, the most impressive or relevant section should be listed next. If you are applying for a specific dental specialty, make the title of that specialty you next section. In this section, list any experiences pertaining to that specialty. It is also important to have a section for professional memberships (where you can list a membership to AGD, ASDA, or any other special membership). I also had a section for honors/awards where I listed honors, community awards, and merit-based scholarships. 

I also had a section on my CV for leadership. It is important to demonstrate that you can be a leader and work on a team. Make sure you include activities to highlight your communication skills, organizational skills, and team skills. Employment and volunteer experiences should also be included on your CV. Included experiences can be both medically and non-medically related. These experiences should demonstrate versatility and responsibility as well as social responsibility and continuity. A skills and interest section can also be included on your CV to include licenses and certifications, languages you speak fluently, and extracurricular activities.

One of the most controversial issues I encountered when writing my CV for post-graduate programs was whether to include accomplishments from my undergraduate experience. Most programs ask that your CV be limited to one or two pages. Taking that into consideration, I only included experiences in my undergraduate career that were relevant and important to dental school. I think mission trips taken before dental school should definitely be included, even if you were just there to observe, because they show your dedication and interest in the field.

If you write the backbone of your CV before you really need it, the process for applying will be much easier. Make sure to keep it updated with the most accurate information. Draft, have someone edit it, then edit it again. This practice will make perfect!

The Dental Home

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In 2006, the Council on Clinical Affairs coined the term “dental home” to describe the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way (AAPD 2015). Many new parents have limited experience and knowledge about how and when to establish a dental home for instilling good oral hygiene habits in their children. This is extremely important in caries prevention and the maintenance of adequate oral health practices from a young age through proper techniques and routine visits to the dentist, building a strong bond between patients and dentists.

There are many common misconceptions about the primary dentition, including the premise that baby teeth are less important because they are not permanent. However, many do not realize the importance of maintaining oral health from a young age. Dental abnormalities can occur, and parents may not see them coming.

Ideally, the dental home should be established as early as possible, and the child should visit the dentist by his or her first birthday for routine exams and follow-ups. This way, abnormalities can be noted and issues can be prevented or fixed in the future. Radiographs should be taken per patient's needs before teeth are restored, and the tooth bud should be protected from any harm.

One reason that it is imperative to maintain oral health in the primary dentition is the incidence of congenitally missing teeth. If the primary dentition is not maintained well, and the permanent tooth is congenitally missing, the dentist should emphasize the importance of oral hygiene maintenance because this tooth cannot be replaced later in life. Therefore, it is important for the patient to put forth their greatest effort to maintain the primary tooth for as long as possible, otherwise the patient may need a prosthetic device in the future.

Another reason to establish a dental home is to make parents more aware of fluoride and the various sources that the child may receive it from. Although fluoride has been strongly marketed, it is important that the parents know that inadequate fluoride intake may cause damage, and that it may be damaging in high concentrations as well. The issue of fluorosis is extremely common in areas where children are overly exposed to fluoride in their food and water, causing craters in the child’s teeth due to hypomineralization when the enamel is forming. These unaesthetic craters may become the source of psychosocial issues in the child’s future, and it is important to maintain parental awareness of their child’s ingestion of fluoridated products to avoid unnecessary cosmetic complications.

New parents have extremely limited access to resources for building a dental home and becoming proactive about instilling good oral health practices in their children. Many new parents inadvertently transmit cariogenic microorganisms to their child by sharing utensils with their child or giving them kisses. This disrupts the balance of the child’s oral microbial flora, and may increase the likelihood that the child will accumulate cariogenic bacteria. Another factor is when babies fall asleep with bottles of milk or sugary drinks, causing rampant caries. This can be prevented by raising parental awareness of these issues.

Establishing a dental home is essential for oral health maintenance and should be an integral part of a child's upbringing in order to prevent future issues. It is imperative to educate new parents about oral health and hygiene maintenance for their child. Establishing a "dental home," in which the child regularly practices proper oral hygiene techniques and visits the dentist for regular check-ups, is the key to prevention of future problems. Offering educational programs to teach new parents how to make their home a “dental home” can have a vastly positive impact on the health and comfort of all members of the family.

How Dental School Curricula is Misunderstood in the Health Profession

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As aspiring dentists, we’re taught to observe and recognize patterns, both in and out of the classroom, lab, and operatory. I’d like to take the time to discuss a phenomenon I have experienced that I feel has concerning indications: There is evidence that the dental school curricula is drastically misunderstood and underestimated in the other healthcare professions.



On the rare occasion that I step away from recorded lectures and plastic teeth, I enjoy catching up with friends outside of the dental profession, be it at parks, restaurants, or parties. I have quite a few friends in school for other healthcare professions, and it’s nice to share the taciturn understanding of odd schedules, non-existent income, and the normalcy of discussing infinite factoids about the human body (regardless of the occasion!). I most enjoy the conversations that highlight the incessant overlapping of the healthcare professions. Many if not most of these conversations, however, consist of at least one moment where a medical colleague turns to me with a surprised, wide-eyed expression and asks, “Why do dentists even need to know that?”


At first, I found this experience laughable and somewhat understandable, but throughout my academic progression I’ve grown slightly impatient. Time and time again, we’ve heard dentists and professors remind us that although we are primarily focused on treating the oral cavity, we are responsible for understanding the systemic health of the entire patient (just as one would expect a dermatologist to understand more than just the skin). As one of my professors aptly put it, “That mouth didn’t walk into your office on its own.”


Finding a Common Ground

I admire the intensely thorough curriculum of medical school, pharmacy school, and optometry school, and I understand why most students only learn the bare basics of the oral cavity. I am not asking for my fellow health professionals to know the dimensions of a Class II amalgam preparation and the rationale behind them. It would be appropriate for these healthcare professionals to instead appreciate why we too spend multiple semesters conquering anatomy and neuroscience, and can fully comprehend the unique location and function of each branch of the cranial nerve. For example, patients with congestive heart failure should not be reclined in the dental chair as much as those without the condition to avoid dyspnea. Why shouldn’t we as dental students understand all of the manifestations of this and other cardiac conditions?


On the reverse side, I do not expect my colleagues to list all the teeth in the mouth with transverse ridges or cingula, but I do hope that they could differentiate between a posterior and anterior tooth. Pharmacy students and dental students shouldn’t be the only ones to understand which drugs cause xerostomia or gingival enlargement. I expect my fellow students to be fully versed in the symptoms and side effects of diabetes, from increased risk of vision problems to increased risk of bleeding and infection from periodontitis. As there are literally hundreds of systemic conditions (including multiple malignancies) with oral manifestations, I’ve been surprised and disappointed at how confused people outside the dental field respond to our working knowledge of systemic diseases.


This is not a negative shot at the education of healthcare professionals at all. We are all lifelong learners, and we undoubtedly are absorbing as much information as we can through our curricula and our individual research. I am sharing my thoughts on this phenomenon in an effort to raise awareness of how we interact with our fellow healthcare professional colleagues. We all joined this field because we love to heal and help patients. By entering the health professions, we made a commitment to improving the wellbeing of our patients through our specialties. All I ask is that we expect more of one another. We owe it to ourselves, our colleagues, and our patients to be prepared to recognize and refer pathology to the appropriate healthcare specialist, even if it’s on the opposite end of our expertise. Yet another professor once told me, “The eye cannot see what the mind does not know.” The fruits of early diagnosis and proactive treatment begin with a commitment to interdisciplinary knowledge and communication, and I hope that as students we can push each other to educate and understand our patients and colleagues as thoroughly as possible. 

Learning a New Skill as a Dental Student

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Growing up, parents and mentors always chirped in my ear—the best time to learn something new is now. Looking back on it, I wish I had listened. In the trenches of dental school, it is so hard to find time outside of pre-clinic, academic and extra-curricular work. After 12 hour days spent away from home, the most logical use of my time is spent examining the back of my eyelids. But at the start of dental school, I also embarked on other passions in my life—I began learning the bass guitar. Many of my classmates and family have questioned why I would choose to pick an instrument up that requires a lot of time and effort to become proficient. As I learned growing up, there is no better time than now. While I chose the bass, picking up a new hobby of any sort during dental school can be advantageous for a number of reasons.


            The first two years of dental school leaves any student drowning in academic work, but one could make the argument that developing our hand skills is the most important aspect. Picking up any musical instrument, learning a new craft, or even learning how to cook—all of these activities improve dexterity. There is often this misconception that you can only improve by spending hours upon hours in the pre-clinic. Hand skills do not solely come from holding a drill for hours upon hours. Any hobby that challenges you to fortify hand strength and acuity will ultimately make you a better clinician.

            Learning something new demands attention, but I have found that keeping my brain active during my free time helps me with my dental school studies.. I think it is safe to say that if you could do better in school without having to study, you would jump at the opportunity. By keeping the mind active, there is a better propensity to absorb and retain information. Using spare time to embark on a new passion is a fantastic way to ensure that time is not wasted on mindless endeavors.   

            But learning something new, as most dental students come to find out, is no easy task. It is, however, an incredibly rewarding experience.  Playing bass for a year now, I have struggled and asked myself “why am I doing this?” many times. I have asked myself the same question regarding dental school. The small triumphs make it worth it. When I learn a new bass line, or figure out a new technique to properly seal my margins on a crown preparation, the feeling of triumph makes all the difficulties worth it. Regardless of what your passion is, becoming good at something requires time and effort. I found something I really love, and while it still is a struggle, I manage to find successes every day with my playing. It has motivated me in dental school as well. For every bad day, there is a good day, and I do my accomplishments rather then my failures. Whether we like it or not, dental school is a time to become an adult—“a real person.” Neglecting a passion now might mean never exploring it. Pursue something you love, and find time every day to become better. You’ll become better at it, and may even bolster your dentistry skills as well.