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THE NEXTDDS Student Ambassador Blogs

PASS Application Bloopers

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Going through this year’s PASS application cycle, I learned a lot about myself. I did a lot of things right, but I also made some mistakes. In retrospect, I would have done a lot of things differently. I feel like all of my mistakes were not ones anyone was willing enough to share with me. Hopefully, you can use this blog to avoid making the same mistakes.



First of all, I did a lot of things right.


What I did right: The legwork. I studied hard and made good grades. I was involved in extracurricular activities that I enjoyed, and not just to add to a resume. I started my PASS application early. I updated my CV to look professional and effectively represent my qualifications, taking Colleen Greene’s CV writing workshop 3 times.


I got to know my faculty, and asked the right people to write strong letters of recommendation that would portray me well to an admissions committee. I wrote a personal statement that reflected my goals and passions. I tailored my application to my strengths to make me stand out. I portrayed myself as accurately and honestly as possible. I practiced mock interviews, wrote thank you notes, and follow up emails to all the programs for which I interviewed.


All of this would have set me up for success, if only I had been honest with myself.


Mistake 1: Letting faculty influence what specialty I wanted to pursue. You need to be true to yourself and pursue your goals because you love what you do. Don’t do anything for just money or prestige. The average dental school debt is $250K, and my debt approaches $500K from attending a private dental school. Debt should not define what you do. Do what you love.


How do you know you love something? This leads me to my second mistake.


Mistake 2: Externships. I didn’t go on externships early enough. Our school only allows us to go on externships in our 4th year. I started planning early, scheduling myself for 8 weeks of externships at 4 different residency programs. When I finally went on my externships, I was days away from the PASS application deadline. By day 6 of my externship, I realized that I did not want to go into that specialty anymore. Now what do I do?


Start early so this won’t happen to you. Once you are set on a specialty, choose to go on externships at programs you are interested in closer to the application cycle.


Everyone always warned me that externships were week-long job interviews. Most importantly, you get the inside scoop on what life as a resident is like at that program—an invaluable asset that you won’t necessarily get at just the interview.


Remember, externships are auditions. If you do well, you already have a leg up on your competition since the program knows and likes you. If you do poorly, don’t expect to get an interview. Below is a list of best practices on externships to help you land the interview:



You have to be on your A-game.

Arrive early. Show up when the first year residents are expected or 5 minutes before them.

Don’t act like a know-it-all.

Don’t be in the way, but don’t be invisible.

Don’t stay on your computer or phone throughout the week. Be engaged in what the residents and faculty are doing.

Ask relevant questions at appropriate times.

Be helpful as often as you can.

Don’t critique a procedure you observed.

Don’t brag.

Be prepared. If you know you will be observing a procedure, read up so you know what to expect.

Do not point out your flaws. If you did poorly on the CBSE, in a class, or have a low GPA, do not harp on it. Make sure your performance makes them overlook those flaws.

Dress professionally and groom well. Don’t let your body give away just how anxious you are, even if you are trying to be confident.

Don’t lie or oversell your qualifications.

Be you!



Mistake 3:I was uninformed about the specialty. I thought I knew what the specialty entailed, but in reality I had no clue. If I had to do it over, I would have observed many different specialties in both private practice settings and on externships at different programs to help me understand each specialty better before deciding if I wanted to specialize. I had shadowed programs on one-day externships, but I had not spent a substantial amount of time investigating the specialty. Do your homework.


Mistake 4: Making a Game Plan. Throughout most of the process, I called a lot of audibles. I didn’t know to ask the same questions at each program. I didn’t know what I was looking for in a residency program. I didn’t know what to do because some of the programs I had applied to were non-match programs.


Establish a game plan for what you would do if you get a non-match offer. Typically, non-match programs give you 24 to 48 hours to make a decision. If you are not going to accept a non-match offer, then don’t apply to a non-match program.


Having to make a quick decision can be stressful, so go ahead and think about what you would do if you were given the position. Know exactly what you are looking to gain from doing postgraduate training before you start the process. Don’t discover it along the way.


Applying for postgraduate programs is stressful, expensive, and time-consuming. It is very easy to make mistakes throughout the process. Remember to trust your gut. When it comes time to accept that non-match offer or submit your rank list, make decisions knowing you will have no regrets.


Good luck!

Social Media Dentistry

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      Zarrella (2009) explains how more people are connected through social media than ever before and every second your public health agency is not engaging them in social media is a wasted opportunity (p.1). According to the Pew Research Center (2015) 58% of the entire American adult population uses Facebook and 19% of the entire American adult population uses Twitter. What’s even more astounding is that nearly 2 billion people worldwide use their phones for social media platforms and 12 new active mobile social media users are added every second (SocialMediaToday.com, 2015).  Public health planners and health professionals have an opportunity now like none ever imagined before in regards to public health efforts through social media to reach large populations around the world. The purpose of this paper is to identify and discuss three potential uses of social media in community health, describe the corresponding tasks and associated forms of social media and describe the ethical concerns each form of social media presents 


    First, the Centers for Disease Control and Prevention (CDC, 2014) describe how personalization is one of the most important uses of social media in community health. Personalization through social media is providing content tailored to individual needs (para.3). Social media can be used to provide unique populations with important health information that is tailored to their individual needs. Whether it is oral health instructions or general health reminders, social media efforts in dentistry should be personalized to engage the target population.  


    Second, the CDC (2014) describes how presentation is another important use of social media in community health. Presentation is providing timely and relevant content accessible in multiple formats and contexts (para.3). Dentists’ social media efforts need to provide real-time information to community members in order to provide relevant, up-to-date information.  

     Third, the CDC (2014) describes how participation is another important use of social media in community health. Participation is providing partners and the public who contribute content in meaningful ways (para.3). Dentists’ social media efforts should be focused on promoting participation from community members in order to improve community health.. Almost every social media effort should be focused on promoting participation, especially among the under-represented. Social media platforms can give the underserved and under-represented populations a powerful voice. Dentists should work hard to meet the needs of its community members by actively engaging in discussion through social media efforts.  


     In conclusion, some social media efforts are more successful than others. Research by Lister et al. (2015) explains three important uses for social media in community health. First, using empowering and engaging techniques are more effective than educational techniques. Second, using multiple social media platforms can enhance collaboration, interdisciplinary strategies, and campaign effectiveness. Third, social media efforts should focus on communication rather than mass media (p. 2245). Dentists’ social media teams should keep these important tips on hand as they build their social media presence. Lastly, no matter the platform, social media efforts should focus on building trust within the community. 


Centers for Disease Control and Prevention (2014). CDC social media tools, guidelines & best practices. Retrieved from http://www.cdc.gov/socialmedia/tools/guidelines/socialmediatoolkit.html 

Pew Research Center (2015). Demographics of key social networking platforms. Retrieved from http://www.pewinternet.org/2015/01/09/demographics-of-key-social-networking-platforms-2/ 

Lister, C., Royne, M., Payne, H. E., Cannon, B., Hanson, C., & Barnes, M. (2015). The laugh model: Reframing and rebranding public health through social media. American journal of public health105(11), 2245-2251.  

SocialMediaToday.com (2015). 10 amazing social media growth stats from 2015. Retrieved from http://www.socialmediatoday.com/social-networks/kadie-regan/2015-08-10/10-amazing-social-media-growth-stats-2015 

Zarrella, D. (2009). The social media marketing book. " O'Reilly Media, Inc.". 


Conducting Research During Dental School

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I’ve heard many dental students express interest in conducting research. Whether a first-timer, holder of a PhD or Master’s Degree, former lab assistant or a student who worked on research during undergrad, like myself, I recommend going for it! Why? Dentistry is a field of continuing education. Conducting research helps us future dentists stay abreast with the advances in the field and learn about new materials and techniques that could possibly become the standard of care.


Although our course loads are rigorous and most free time is spent either studying or maintaining sanity, conducting research is not much of an additional task. In fact, I believe that research both enhances and compliments our dental education. In Operative Dentistry for example, we learn about the use of dental materials and instrumentation to complete restorations. My research focuses on bioactive dental cements, a material used for cementation of crowns.


Presently, resin modified glass ionomers (RMGI) are predominately used as cements in dentistry; however, one disadvantage of RMGI cements is lack of adequate strength and toughess.1 Bioactive dental cements, on the other hand, contain numerous oxides which help to produce a strong bond with tooth structure through production of hydroxyapatite.2 Bioactive dental cements are hypothesized to greatly increase in shear bond strength over time and my research tests this. We are using two bioactive dental cements new to the market and the knowledge that we gain could possibly influence the future standard of care for our patients.


On top of building a relationship with faculty members, research has allowed me to learn about an exciting new dental material. So why not do research? There’s so much to gain, and so little to lose!


Khoroushi, Maryam, and FatemeKeshani. "A review of glass-ionomers: From conventional glass-ionomer to bioactive glass-ionomer." Dental research journal 10, no. 4 (2013): 411.

Hench, Larry L. "The story of Bioglass®." Journal of Materials Science: Materials in Medicine 17, no. 11 (2006): 967-978.

Tips for Communicating Effectively in Your Future Dental Office

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It’s no secret that effective communication is vital to a successful practice. Miscommunication in the office leads to a tremendous amount of stress for you, your staff and your patients.



Communication Basics

Communication can be broken down to it’s core components:

  •        Sender: the person who initiates or sends the message
  •        Receiver: the person who is interpreting the message being sent
  •        Message: the content or idea of the sender
  •        Medium: the means used for the message exchange (ie. e-mail, text, face-to-face)
  •        Feedback: the response to the message
  •        Context: an important but often forgotten component of communication. All communication is influenced by the context or situation whether it be cultural, chronological, social or physical.







Everything outside of these core components can be considered “noise”. Noise is anything that interferes with the interpretation of the message and can be literal such as the sound of your handpiece, but also can be derived from the above components. Understanding these basic components can help us be more aware of what we’re trying to get across and reduce the noise.


Choosing the right team

If you have the luxury, this could be one of the easiest ways set up a foundation for success. Some applicants may be highly qualified for the position but their personality just simply won’t mesh well with you or the team you’re trying to build. Consider these types of personalities adapted from Hippocrates:

  •        Driver: this person is a strong leader and planner and thrives on challenges and respect.
  •        Expressive: usually very social, care-free and/or talkative. They can be a good source of new ideas, but may also struggle with following through on tasks.
  •        Amiable: a steady personality that prefers to work alone and may need additional time to respond to change.
  •        Competence: traditionally a strong introvert and makes decisions based on logic and facts.





These personality types are also the foundation for most modern day personality assessments such as Myers-Briggs Type Indicator and Keirsey Temperment Sorter.  Keep in mind, usually no one is purely just one personality type but a combination of them. Using the interview and early trial period to get a feel of his or her personality will make a huge impact on productivity and help create an enjoyable work environment by minimizing conflicts. Additionally, people’s personalities may change over time or you don’t have the luxury of hiring everyone. Simply understanding the personality make up of your staff will also help you manage them more effectively as well.


Setting clear expectations  

When talking with practicing dentists, one of the seemingly most common places for frustration is when a team member doesn’t meet expectations. In my own experience, this usually happens not because the team member is incompetent, but because my instructions weren’t clear and I had no idea they weren’t clear. To combat this, I’ve incorporated a simple rule that I use:




  •        Specific: what exactly do you need done?
  •        Meaningful: why is this important? Who else is depending on this to get it done?
  •        Action Oriented: what additional steps might need to be taken?
  •        Realistic: is this too much to ask? Get feedback from your team member as well.
  •        Timely: when do you want it done by?



Following this simple set of rules really can make a huge difference in helping your team understand what you need done, why, when, and how. Sometimes balancing all this information and trying to avoid micromanaging can be difficult. These rules can really help with that as well by making sure they have all the essential information to get it done without additional follow up.


Remember back to your waxing days? Some advice I remember getting was something along the lines of “just make it look like the contralateral”. It wasn’t exactly very helpful. You can use this method to give better and more specific feedback as well. For example, your assistant made a “bad” alginate impression. What specifically is wrong with it? Are there voids, the vestibule not accurately captured, etc? Why is this problem, how does it affect the treatment downstream? What can be done to fix these types of mistakes? Is it realistic to capture the structures you want? And lastly, Timely in this case refers to delivering this feedback as soon as possible, but never in front of the patient.


Final Words


Hopefully this can serve as a good starting point as you try and figure out what’s going to make you successful later in private practice. There are certainly volumes of information out there and the best thing to do is just start applying them now, while you’re still in school. 

Oral Manifestations of Gastrointestinal Abnormalities

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    They often say that the dentist is the first person to diagnose a severe clinical finding like oral cancer. Since we are the experts of the oral cavity, this makes total sense and seems like a no-brainer as to why we would be the first to diagnose such a severe condition. However, oral cancer is not the only severe finding that the dentist can diagnose and be the first to find. Gastrointestinal (GI) abnormalities can often be first detected in the oral cavity because the GI system technically originates and is continuous with the oral cavity. Here are a few GI abnormalities with oral manifestations that I recently learned in my general pathology course. 

            One gastrointestinal abnormality that has an oral manifestation is GI reflux. Gastric acid enamel erosion can be seen in patients with chronic gastric reflux including GERD (gastric esophageal reflux disease), hiatal hernia, chronic alcoholism, and bulimia. Enamel loss often affects the lingual/palatal surfaces of teeth and the extent of loss may reflect reflux duration or frequency. The mouth is not equipped to handle acids that are commonly found in the stomach and enamel is especially prone to degradation due to these acids that have a severely low pH compared to that of saliva.

            Another GI abnormality that has an oral manifestation is malabsorption. Malabsorption consists of a wide range of issues all of which deal with the GI system not being able to absorb critical nutrients that the body needs. One of the most critical malabsorption problems is iron malabsorption which can lead to iron deficiency anemia, vitamin B12 malabsorption, and pernicious anemia. If severe, the initial oral sign can be atrophic glossitis—a bald or reddish tongue. This can be seen clinically as rough patches on the tongue or can involve the entire dorsum of the tongue. Overt tongue lesions are usually tender and patients often complain of a burning sensation, or glossopyrosis. These findings can revert back to normal if the patient is treated with the correct vitamins and nutrients needed.

            Familial adenomatous polyposis (FAP) also can be seen clinically arising in the oral cavity. This is an inherited capability of developing polyps/adenomas within the bowel and if these polyps are left untreated lead to a 100% risk of cancer. The reason for this risk is because with FAP, a patient can develop hundreds of polyps and any one of them can undergo malignant transformation, thus leading to cancer. Gardner syndrome is often associated with FAP in which a patient can develop epidermoid cysts, jaw osteomas, supernumerary and/or unerupted teeth, and increased odontomas. These can be seen both clinically and radiographically. These oral manifestations can contribute to early recognition of the condition and allows for appropriate screening for bowel disease and other potential neoplasms.

            These gastrointestinal abnormalities are just a few pathological findings that can arise in the oral cavity. When in doubt, if something looks out of place or looks abnormal, the best advice is to take a biopsy and send it off to a pathologist who can better diagnose your findings. Although it may not be oral cancer, it can still be a serious condition in which you could potentially save a patient’s life.

My Experience of giving my very first injection

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      Its been a long time coming, from countless hours of studying the theory of  administering local anesthesia injection to actually doing it on a live human patient. It is the first step to most procedures and the most important task by the dentist. However, it is considered mundane task by many dentists. But for a newbie like me, the excitement was fresh and high on the scale with getting accepted into dental school or receiving my white coat  in the presence of friends and family.  Moreover, The experience was a rite of passage to me to perform the procedure by ensuring the patient's comfort.  


       Training to give local anesthesia for me started my first lecture on local anesthesia along with the lengthy anatomy and physiology class. I felt ready after the back to back lectures on ester and amide based local anesthesia agents. I learned which had the longest half life, and the possible interactions of drugs and so on. In addition, I had to master the detailed anatomy of the intricate human body and cadaver dissections lab. However, the gained confidence was tested in oral surgery class when the professor told us to pick partners to give injections on each other.  I was excited and nervous at the same time.  In fact, all the possible doubt flooded my head; What if I miss completely?  What if my hand starts shaking and I break the needle in the middle of the injection?  What if I hit an artery and cause hematoma to my patient? The more i thought about it the more i got nervous. But there was only one way to find out if I was up to the task or not and that was to just do it. 


      Finally, the time came to give injections on each other and my partner wanted me to go first. So I started just like i practiced in my head. I showed my instructor with a cotton swab where to place the needle for the inferior alveolar nerve block and began to advance the needle to the targeted area. The countless hours of lectures and shadowing sessions came flooding into my brain to help me focus. My instructor whispered to me that no one has died from injections before. I guess my nervousness was obvious enough for him to see. Half a carpule later I was ecstatic by my newly acquired skills. I had delivered my first inferior alveolar nerve block followed by PSA and infiltration injection techniques. However, my joy quickly turned into anxiety when i realized it was my partners turn to give injections on me.    


Interview Tips!

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It is almost here! Graduation! Some of us are doing residencies, join the military and others working in corporate and private practice. As you start this exciting part of your life, here a few tips for your upcoming interviews.  

  • Be open to different opportunities. Go to every interview you can! It never hurts to talk to a possible employer and explore the options. It is always good to have a backup. Also, be open to other locations. Many of the best opportunities are located in communities just 45 minutes to a few hours away from major cities. Typically, you will see an increase in your earning by settling in a city or community that is underserved rather than in downtown of major city. 

  • Get your references ready. They can be former employers, classmates, or teachers. Contact them to let them know to expect some calls if you write their names. 

  • Be yourself! Say hello the staff and treat each person with respect. Be enthusiastic and share your story of why you are there. Your fun personality needs to shine through!

  • Ask questions to show your interest. Few possible questions to ask the practice:

1.     Can you tell me about the patient population? 

2.     What are the major amounts of clinical procedures at the practice?  

3.     What qualities are you looking for in your next hire? 

4.     What type of equipment is used in this practice? 

5.     How would you describe the culture and management style here? 

  • Lastly, consider a folder with copies of important documents like your resume, accomplishments, letters of recommendation and references. It shows you are an organized person and makes a great impression.

How to succeed in the clinic

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My first dental experience was truly scary. I saw the radiographs and quickly learned that I needed to do a simple composite restoration. However it seemed very daunting to me and when I saw the patient’s mouth I was even more scared. It was a point in my learning experience where I really wondered how dentists did this all day, how they overcame challenges and how they maintained their composure when things seemed tough. It was obvious that my difficulty was on a very small scale compared to what normally occurs in a dental office. Nevertheless it was something that stayed in my mind and helped me figure out something’s that can really help any student or clinician in a bind.

Success is not only something that every student or clinician should strive for, it is something that can be achieved. In a dental school setting, it is very common to see patients and to become overwhelmed quite quickly. Nevertheless it is important to be able to adapt and work hard to help those patients in the best way possible. In this blog post there will be two points that will be outlined for an awesome patient clinician experience. These patient experiences can and should be replicated as time goes on and on they are adapted and applied there will be a large patient satisfaction. These are simple principles and ones that can be applied immediately.

Preparation. It is very important to prepare for every patient that will walk in the door or under the schedule. Key items for preparation are radiographs and health history. If there are patients with severe allergies or other items of importance it becomes vital to pay close attention to those things as you review each patient in a normal daily procedure.  Without preparation it can become very easy to put yourself in a situation where there can be a compromised experience with the patient or even oneself.

A second point of interest is being calm. Where there is a procedure that has been planned out and prepared for, the actual event may be more daunting than thought out. This is where it becomes important to stay calm and to work through the procedure in a manner where you can provide a quality treatment and not get caught up in a rushed experience where procedures can become compromised. This has been some of the most important points that I have had in my short clinical experience so far.

When students or clinicians can prepare and remain calm under pressure or a daunting circumstance then excellence and success can arise. This is a tried and true principle that occurs daily in a clinical setting. Nevertheless one of the biggest challenges that students or clinicians have when seeing patients is becoming overwhelmed and not knowing what to do when the situation arises. But as soon as one can realize that preparation and calmness are key factors in treatment, one can then reach the point of success quicker.

My Research Experience

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Between first and second year, students at UCONN are off from about mid-June to mid-August. Never having participated in research before, I thought it would be a good opportunity to expose myself to something I was unfamiliar with. However, I was intimidated in initiating the process and thought that my lack of experience would hold me back. If you have similar reservations, don’t let that hold you back. As soon as I began to contact the faculty, they were more than receptive and understanding. The faculty have been doing this a long time, and they understand that everyone has to start somewhere. After finding a mentor, I was fortunate enough to work in the craniofacial department and partake in developmental biology basic science research. 


The main focus of the lab was to study tooth development, pulp differentiation, and tooth repair. The lab has been using a number of transgenic mice that express fluorescent proteins due to promoter specific genes. This transgenic mouse allows the lab to identify different proteins and cells by looking at fluorescent signal under a microscope with various filter cubes for specific wavelengths. The lab found that many of these fluorescent proteins were expressed by both ondontoblasts and osteoblasts, but the lab didn’t have a good marker that distinguished the two. We knew that bone Sialoprotein (BSP), is a non-collagenous protein (NCPs) and a member of SIBLING family with essential roles in skeletogenesis including the initial formation of hydroxyapatite, mineralization and turnover. In bone, BSP is expressed in abundance by osteoblasts. In the developing teeth, although the expression and function of BSP in the formation of acellular cementum and periodontal attachment is well documented, there appears to be uncertainty regarding the expression and function of BSP by odontoblasts. Several studies have reported expression of BSP in dentin and pre-odontoblasts, whereas other reported the lack of expression of BSP in these structures Given the uncertainty regarding the expression of BSP by odontoblasts and important roles of BSP in mineralization, in my study I examined the expression of BSP and BSP-GFPtpz transgene in the developing odontoblasts and osteoblasts of the alveolar bone. Long story short, the study was a success. The data supported the BSP-transgene was a marker exclusive to odontoblasts. This transgenic animal can now be used to better understand the differential effects of various growth factors and reagents in dentinogenic vs. osteogenic differentiation of dental pulp stem cells.  


Fast forward six months and a little bit more work, I was able to present a poster at the UCONN Health Center Student Research Day.  This experience gave me the confidence to bring the poster to a national meeting. Last week I was able to attend the General Session and Exhibition hosted by the American Association of Dental Research in Los Angeles (all on the school’s dime). The experience was invaluable. It allowed me to see other research and network with other students and faculty from all over the country. It really gave me an appreciation of a whole other facet of dentistry all while having fun and visiting the West coast. If you’re thinking about doing research, or are hesitant about it, my advice is to jump in.  


Painless Dental Appointments

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A whooping 15% of Americans fear going to the dentist. It doesn’t help that one of the major factors instilling dental phobia in our patient pool is the dreaded dental injection. Our needles are long, shiny, and above all, pointy. As dental students we rely on local anesthesia to ease our patient’s feeling of discomfort in just about every procedure – from simple restorations, to aesthetic veneer preps, to tooth extractions. 



Listed below are several injections that all dental students should have in their toolkits along with a few tips on reducing anxiety and pain in your patients pre-injection and during the injection.



Greater Palatine Nerve Block  

Needle: 27 short

AnatomicLandmarks: Greater palatine foramen

Technique: Locate the greater palatine foramen – located around the maxillary 2M/3M. Use the blunted end of a mirror and place pressure on the tissues adjacent to area of needle injection.

Why? The greater palatine nerve block anesthetizes the palatal soft tissues distal to the canine.

Maxillary Infiltration  

Needle:  27 short

Anatomic Landmarks: Roots of teeth, mucobuccal fold

Technique: Aim the needle at a 45-degree angle at the mucobuccal fold of the maxillary teeth that are going to be anesthetized. Make sure the needle hits bone. This will prevent the mucosa from swelling too much from delivery of the local anesthesia.

Why? The maxillary infiltration anesthetizes the pulp and mucoperiosteum of the selected tooth.



Inferior Alveolar Nerve Block  

Needle: 27 long

Anatomic Landmarks: Coronoid notch, pteygomandibular raphe

Technique: With your thumb, feel for the coronoid notch. Then aim the needle along the occlusal plane lateral to the pteygomandibular raphe from the contralateral PMs. Your needle should penetrate 20-25mm before hitting bone. If the needle hits bone too soon, pull out slightly and redirect the needle slightly more medially.

Why? The IABN anesthetizes mandibular teeth up to the midline, anterior 2/3 of the tongue, buccal mucosa anterior to mental foramen, and lingual soft tissues.



Apply topical anesthetic. This will reduce the twinge of needle penetration. For the “numbing jelly” to work more effectively, dry the mucosa prior to application to allow better absorption.

Stretch the mucosa or tissue to ensure tautness, ensuring comfort as the needle moves further into the soft tissues. 

Apply a vibrating motion or pressure with the back of a mirror to the periphery of the site of injection to distract your patient from the needle movement.


During the Injection  

Slow and steady delivery of anesthesia will reduce post-op soreness of tissues.



Good Luck! 

10 Things I Learned at the Hinman Dental Meeting

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This weekend I attended the Hinman Dental Meeting in Atlanta, Georgia. I was impressed by the wide variety of classes!  I had the opportunity to take several, and here are ten things that I learned.

1. You can't run a practice alone. To be successful, you'll need to work with an attorney, banker, CPA, insurance, agent, dental supply rep, dental lab, and a mentor.

2. Create value. People buy what they want, not what they need. Nobody wants a crown, but if you educate them on the benefits of a crown they may want the outcome it can provide.

3. Get to writing. You have a 100% better chance of achieving a goal if you write it down and have accountability to a person. Write down what you want to accomplish and share that with your mentor to make sure it happens!

4. Ask the right questions. At morning meetings with your staff, ask "What was the best thing that happened yesterday?" instead of "How are you?" It pushes your staff to think about what went well so you can build on that and keep the good things going.

5. Find your passion. It's important to find your true calling within dentistry. Only 20% of people in the workplace are fully engaged. 60% of people could take it or leave it, and 20% of people despise their jobs. Let's be in the top 20% and find something that we're excited to do every day.

6. Recruit patients continually. The average practice loses 10% of patients each year to "natural attrition" (death, moving, personality differences). In order to maintain your patient base, you need to bring in 10% more patients each year. In order to grow, you need even more!

7. Check your location. A good rule of thumb when starting a practice is that you need 2000 people per dentist. Scout out the area you'd like to go to and see if the area can support you.

8. Hygiene can help. Expanding the role of your hygienist can double your revenue. Hygienists can perform around 20 functions - utilize them all.

9. Think beyond the mouth. Dental erosion is a huge issue. Work with your local G.I. doctor to help your patients be their healthiest. What should you be looking for? Palatal cusp wear on one side and buccal wear on the lower anteriors - your patient is sleeping on their side and acid is entering their mouth.

10. Be careful when suturing flaps. As you get further from the base of your flap, the tensile strength decreases. Start your suture needle 3mm from the edge of your flap.


I'd like to thank the wonderful speakers who taught me so much - Dr. Wayne Kerr, Mr. Steven Anderson, Mr. Wes Moss, Mr. Joseph Jordan, Dr. Gordon Christensen, Dr. Parag Kachalia, and Dr. Lee Silverstein. I highly encourage everyone to attend the Hinman Dental Meeting held annually in March in Atlanta, GA!

Event Ideas for National Pre-Dental Week

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Along with being a student ambassador for The NextDDS, I am currently the ASDA Pre-Dental Liaison for my local ASDA Chapter. Through this role, my goal is to provide knowledge and insight to pre-dental students about dental school, whether it is about the application process, resume building, DAT studying, etc. Keeping this in mind, I wanted to create a new event that would allow pre-dental students to experience a hands-on class in dental school, while being able to network and socialize with faculty and dental students. 


This February I was able to create my desired event. It was the first annual Pre-Dental "Wax and Relax" that was held for National Pre-Dental Week. The goal of this event was to introduce pre-dental students to waxing up teeth, which would be their first hands-on course in dental school. This allowed them to improve their manual dexterity skills, while learning and appreciating dental anatomy. 


This event was a huge success. There were 14 dental student volunteers and 26 pre-dental students from Stony Brook University that participated. The pre-dental students were each given a crown prepared tooth (donated by second years), and a plastic tooth, which was unprepared. The purpose of this was to compare and recognize what they needed to replicate in wax. The dental student volunteers provided their waxing instruments, as well as their knowledge and insight to the pre-dental students, to help them properly perform the wax up.


Along with this event, ASDA has hosted numerous successful events throughout 2015 and into 2016 at Stony Brook University School of Dental Medicine. Some of these events include mock interviews, application process Q&A, and dental 101 held at the undergraduate campus. Currently, we are in the process of planning ASDA Impressions Day for 2016. This will be an all day event, giving pre-dental students the opportunity to speak with faculty and students from the dental school, take an impression of a typodont, and pour up a model to take home. 


The enthusiasm and innovation seen through our ASDA leaders at Stony Brook helps to make all of these events possible. If anyone is a fellow Pre-Dental Liaison, or looking to hold pre-dental events at their dental school, please feel free to contact me for any help with future ideas!


A Reflection on my Time as a Member of THE NEXTDDS

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    If you ask any dental student to sum up his or her dental school experience in one word, you will most likely receive a myriad of adjectives encompassing everything from “stimulating” to “sleepless”. Other popular adjectives may include words such as “involved”, “dynamic”, and “demanding” because as dental students, we are active by nature. We are active participants in our classes, active providers for our patients, and active advocates in our community. As dental students, our impact on dentistry is dependent on this kind of activity and passion, which I believe is essential to driving the future of dentistry forward.  

My experience as a member of THE NEXTDDS has challenged me to pay attention to just that - the activity and passion for dentistry around me. Listening to podcasts, reading articles on current topics in dentistry, and participating in online forums where members discuss issues related to the future of the dental career have opened my eyes to the opportunities for communication and collaboration that THE NEXTDDS offers all of its members. As a second-year dental student, I find it especially rewarding and exciting to connect with other students who are experiencing many of the same challenges, worries, and excitement that I do as a dental student on a daily basis. Every conversation and every discussion is relatable, and it is incredibly energizing to be in the same place with other students who share the same career goals and vision.  

The feature that I like most about THE NEXTDDS is that it fits the lifestyle of the average dental student in this day and age. That is to say that as dental students who are constantly busy with studying, community service, and patient care, we need a resource like THE NEXTDDS that is both easily accessible and relevant to our lives. With just the click of a mouse, we can find an article on a topic we are looking for or connect with someone at a dental school across the country who has experience with what we are seeking to learn more about.  

Above all, all of the interactions on THE NEXTDDS remind me that dentistry is about the people – the patients we see, the people next to us in class, the dentists who have come before us, and the dentists who will come after us. I would encourage all of my fellow NEXT DDS members to not lose sight of this. Take the time to engage on the site and experience all that it has to offer in terms of knowledge, networking, and advice because I truly believe that putting in the time and effort now to utilize this great resource will help shape the kind of providers we will become in the long term.

Josh Linkner Inspires Student Leaders at ADEA in Creative Disruption

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This past weekend was the American Dental Education Association’s Annual Session in Denver Colorado. On Wednesday morning, the keynote speaker was Josh Linkner, a successful entrepreneur, author, musician, and motivator. He covered a few topics that are worth sharing and seeing how we can apply it to our position as dental students and as future dental providers. Josh Linkner is the author of three books, Leaning Forward: Surviving/Winning in the Future of Interactive Marketing, Disciplined Dreaming: A Proven System to Drive Breakthrough Creativity, and The Road to Reinvention.



What does it mean?

Innovation: (noun): the act or process of introducing new ideas, devices, or methods

-Meriam Webster


As he was speaking I began to apply his theory to my situation in dental school. We must challenge ourselves to relate these principles to our lives.

Josh introduces his Five Obsessions of Innovators:

Get curious. –

Why? The first step to being an innovator is having the innate wonder of why things are the way they are. If we never ask why, then we cannot begin to think of alternative solutions to problems. Josh compared this point to conversation with children, who have curiosity about everything. A child asks a question and you answer. Then the child asks why that is the answer, and why that answer is the answer, and so on. This leads to a convoluted journey of understanding the basis for why we do what we do. Keep the curiosity of a child to find chances for innovation!


Always look for what’s next. –

What comes next? How could this be better? These questions could also lead you back to the first obsession of “why?”

How can we change our sequence? Can we rearrange what we currently do to make something more efficient or more productive? All of these questions might lead to you find what could be next in your situation.


Defy tradition. –

 Dentistry is a practice build on tradition, experience, and evidence. However, doing what has been done all along might not be good enough anymore. The field is constantly changing, not only in treatment, but in methods and practice. Although change and progression can be exhausting and in some ways intimidating, change is actually very beneficial for your practice. Change means  you are constantly bringing the most up-to-date treatment to your patients. It means you have the the best care, and are able to do the most good. Changes keep your practice relevant and competitive. Additionally, change keeps your team members engaged, and safe.


Get scrappy. –

Being a student is a great representation of when and how to be scrappy. From my personal experience, and many students involved in organized dentistry, we know the struggles of bringing change to a very conservative field. Being passionate about your ideas is the utmost most critical part of sharing innovation to a not-so-enthusiastic audience. Using resources available to you can lead to more opportunities for progression and innovation. Not all ideas are accepted at first proposal, so part of being scrappy means being persistent.


Push the boundaries. –

As dental students we have many boundaries. Boundaries we experience as students and will experience as future dentists are increasing dental student debt, lack of water fluoridation, barriers to access to care, and licensure reform. Anyone who has lobbied on the Hill knows how much effort it takes to make national reform, and how boundaries must be challenged in order to see any changes.



Eat Like a Caveman

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Teeth whitening. Porcelain veneers. Teeth contouring. Braces. Invisalign. When it comes to designing a perfect smile, dentists have an infinite number of tools to work with in their wheelhouse. Because of the tremendous progress made in cosmetic dentistry over the last few decades, people are walking around with much brighter, straighter, whiter, and more shimmery teeth than ever before. But even though individuals today probably have better teeth than their grandparents and possibly even their parents, their teeth may not be as healthy as those of their prehistoric ancestors.

Researchers have examined thousands of fossilized humans from 20,000 years ago and estimate that fewer than 2% of teeth show evidence of cavities. Simon Hillson, a UCL bioarchaeologist, says that “you can count the number of cases of dental caries on one hand” in any particular individual. Furthermore, gum disease and malocclusion, such as overbite, were very rare in prehistoric teeth. So without the surgical and cosmetic procedures performed in the dental chair today, how did these prehistoric people keep their teeth so healthy? A new study of calcified plaque on 34 prehistoric skeletons pinpoints the exact moment gum disease and tooth decay began to proliferate—and shockingly, it was when man learned to farm.

The bacteria that are responsible for the development of caries and gingivitis, such as Streptococcus mutans, Treponema denticola, and Porphyromonas gingivalis, all require carbs to survive. These bacteria digest carbohydrate debris left on the teeth after you eat. When digesting these carbohydrates, the bacteria in your mouth produce an acid that combines with saliva to form plaque. As plaque begins to build up, it starts to erode the enamel, leaving tiny holes on the tooth surface. If left untreated, these holes become larger, resulting in a cavity. Due to their hunter-gatherer lifestyle, prehistoric people didn’t have this problem because they ate mostly meat. However, upon the advent of farming, man began to eat starches and simple sugars, allowing for an environment in which these harmful bacteria could thrive. Now the tables have reversed, and it has become rare to meet any individual who has not had a cavity filling or sealant at least once in their lifetime. In fact, modern day populations “experience a rate of 92% of dental caries”, and that percentage is only taking into account those who have any teeth remaining!

About 10,000 years ago during the Neolithic Revolution, our ancestors began to steer away from a hunter-gatherer lifestyle to one of farming. They discovered how to cultivate crops and to domesticate animals. Our ancestors collected certain seeds, started to plant them in gardens, and eventually produced crops that could sustain them in their more sedentary lifestyle. They weren’t aware of which genetic variants they were choosing or how these variants could evolve into new plants over time. All they knew was that some plants grew better than others and some tasted better than others as well. Over time, our ancestors could see the changes that were taking place within their crops; however, hidden from view were the other changes taking place. New species were also evolving in the wake of agriculture. And these were the oral microbes that fed and thrived on the nutrients they were receiving from the crops that our ancestors were now eating. Now, fast forward several thousand years, and the situation is even worse. The vegetable and grain diet of our ancestors has been replaced with a high-sugar, high-fat diet full of processed foods and artificial flavors. And to make matters worse, not only has our diet favored the existence and progression of harmful oral bacteria, these very same bacteria have evolved as well to withstand the challenges they may face in the oral environment.

So is it necessary for us to revert back to the lifestyle of hunter-gatherers in order to preserve our teeth? Well, this might be too extreme. However, there are diets in existence today that are more favorable than others for proper oral health. For example, a diet low in sugar, and subsequently carbohydrates, such as the Paleo Diet, is one of the best ways to maintain good oral health—on par with good oral hygiene, such as brushing and flossing. But it’s important to note that not all carbohydrates, such as wheat, corn, and sugar, produce cavities at the same rate. Almost all foods, including vegetables and other components of a nutritious diet, contain some type of sugar, making it nearly impossible to avoid it altogether. To help control the amount of sugar you consume, read food labels and avoid food and beverages high in added sugars. Also try to stay away from acidic foods and opt for more basic foods instead. According to the American Dental Association, the seven best foods to eat for good oral health are cheese, yogurt, leafy greens, apples, carrots, celery, and almonds.

So before you grab a slice of pizza or have a bowl of pasta for dinner, stop and ask yourself, “What would my ancestors do?”.





Freeman, Amy. “Healthy Foods List: Seven Best Foods For Your Teeth”. Colgate Oral Care Center. http://www.colgate.com/en/us/oc/oral-health/basics/nutrition-and-oral-health/article/sw-281474979265631


Gibbons, Ann. “An Evolutionary Theory of Dentistry”. Science Magazine. Volume 336. 25 May 2012. http://huntergatherer.com/wp-content/uploads/Gibbons2012-An_Evolutionary_Theory_of_Dentistry.pdf


Thaler, Casey. “The Perfect Teeth of Hunter-Gatherers?”. The Paleo Diet. 23 June 2014. http://thepaleodiet.com/perfect-teeth-hunter-gatherers/#.VusYIk8UUdU


Zimmer, Carl. “The Evolution of Cavities”. National Geographic. 21 December 2012. http://phenomena.nationalgeographic.com/2012/12/21/the-evolution-of-cavities/

Crown Lengthening and Site Preservation Importance

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Two surgical procedures that are not usually performed by dental students, include crown lengthening and site preservation. Many general dentist do not believe either of these procedures is even necessary. I would like to explain, from a 4th year dental students’ perspective why I believe them both to be necessary.

Crown lengthening is a surgical procedure, often performed by Periodontists, to protect the tooth from the consequences of violating the biologic width. The biologic width is the junctional epithelium plus the connective tissue attachment of the tooth to the root. Once the biologic width has been impinged upon during a crown preparation or any restoration, the consequences can include: chronic irritation, inflammation and bone loss around the tooth. The patient can also experience pain. The amount of biologic width differs from patient to patient, but on average the measurement is 2-3mm.

In an ideal world, we would be able to leave 3mm between all restorations and the crest of the alveolar bone. Unfortunately due to caries, existing restorations and anatomy this is not always possible and therefore violating the biologic width is unavoidable.  In these cases, crown lengthening is indicated. During this procedure, soft tissue and/or alveolar bone are removed. First, a mucogingival flap should be laid. Then, bone will be removed so that at least 3mm of root surface separates the margin of the restoration and the alveolar bone. After suturing, approximately six weeks of healing time is necessary for the periodontal fibers to rebuild an attachment. Therefore, the dentist should wait six weeks before a definitive impression for the crown is taken.

Site preservation, or socket preservation is a technique used when a tooth is extracted and the patient is contemplating implant placement eventually. If all factors are right and the patient is willing, an immediate implant can be placed after extraction. However, this is not always possible due to infection, lack of bone, patient wishes or financial reasons. If site preservation is desired then the following steps should be taken. After the tooth is extracted, irrigated and curetted well, a grafting material is placed. Examples of bone grafting material include bovine bone, mineralized allograft, demineralized allograft, autogenous bone, tricalcium phosphate and many more. Specific brand names that my school uses include BioOss and Colatape barrier. The goal of socket preservation will optimize the bony fill of the extraction site. Having sufficient bone in the site will allow for eventual implant placement with more stability and osseous-integration. Vicryl sutures should be placed over the site once the graft material is placed and then the site should be allowed to heal for about ten weeks.

Site preservation is a simple procedure, yet can be overlooked if the dentist does not think ahead in the treatment planning process. Even if an implant is unlikely to be desired by the patient in the future, having sufficient bone in an extraction site can increase the esthetic appearance of a ridge and increase the functional ability of a removable prosthetic device in the event that one day the patient needs dentures.

Both of these are surgical techniques that, although rarely done by general dentists, I believe can and should be performed in a general dentists office in the best interest of many patients!

ASDA Annual Session

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The 46th ASDA Annual Session just took place this past weekend (March 2nd-5th) and I had the pleasure of flying out to Dallas, Texas to attend this meeting on behalf of The NEXT DDS. The conference began on Thursday morning with a keynote speaker, Chris Bashinelli—an actor-turned-activist who was born and raised in Brooklyn, New York. His presentation was focused on “ignoring the noise” and discovering your true passion. I felt like this was such an appropriate way to open the weekend by having us really think about what we wanted to accomplish over the next few days, whether that have been networking with colleagues or even just self-reflection. Next in line were the first speeches from the candidates running for National ASDA President and Speaker of the House. With 6 incredibly influential leaders running for President, it was extremely difficult for each chapter to narrow down their choices with a limit of 2 votes per chapter represented. The afternoon was spent attending different sessions on topics including what practicing in the “real world” is like and secrets to being a successful dentist. Thursday ended with the Dental Expo where over 60 vendors held booths and advertised their companies with plenty of giveaways for students to take home, along with recruiters to network with. 

One of ASDA’s initiatives this year was to “be well” and thus Friday began with an early morning yoga session to help clear everyone’s minds for the rest of the weekend’s activities. After breakfast, chapters broke out into their district caucuses where the presidential candidates and speaker of the house candidates attended and answered questions on a more personal level. This gave each of the chapters further insight as to whom they would want representing their voices as dental students on the national level. There was a poster viewing during lunch which included several students’ research abstracts. I felt that this was a great addition to the conference as it highlighted individuals who do even more outside of the typical dental classroom/clinic setting. Friday afternoon consisted of a few more breakout sessions including topics on trends in dentistry and triaging for dental emergencies. Friday concluded with the ever-popular Gold Crown Awards. Each chapter strives to be the “Ideal Chapter” by working hard all year and compiling an application that is reviewed by the national ASDA editorial board. The Gold Crown Awards ceremony is a great event highlighting and recognizing those chapters that worked exceptionally hard all year.

Saturday was off to a refreshing start with an ASDA Fun Run followed by a networking breakfast. Chapters split up into their district caucuses for a brief meeting and the first ballot was cast which narrowed down the candidates for president from six down to three. A House of Delegates meeting was held to discuss final resolutions and the second ballot was cast for the presidential election. After lunch, the winners were announced as follows: Sohaib Soliman as President, Jordan Telin and Aaron Henderson as Vice Presidents, and Matthew Bridges as Speaker of the House. The last district caucus meeting was held where we got to vote for our District Trustees to serve on the Board of Trustees, which represent the 11 national districts of ASDA. This incredibly eventful weekend ended with the President’s Gala which was themed Under the Sea. With plenty of delicious food and attendees letting loose on the dancefloor, it was truly a fantastic ending to yet another memorable Annual Session.

One of the biggest takeaways from this meeting was the ability to network with not only dental students from other schools, but with vendors and other dentists as well who have made their marks in organized dentistry. Stepping out of your comfort zone to interact with strangers can be extremely difficult and something I had personally struggled with in the past. Wondering if someone is going to judge you for saying something ignorant or coming off as pompous are things people often worry about. However, just being yourself and asking quality questions can sometimes reap great rewards even on an internal and personal level. Attending annual session last year in Boston was how gained interest in The NEXT DDS. All it took was a simple handshake, a business card, and a follow-up email thanking them for taking the time to meet me and after filling out an application, I was lucky enough to become the Ohio State University Student Ambassador. Attending the meeting this year as a representative of The NEXT DDS was not only rewarding, but also gave me a different perspective on networking and reaching out to others. Anytime I would meet someone new, I would ask about their chapter back home and then follow up by handing out a flyer or business card with “thenextdds.com” for them to take home to their chapters in order to facilitate an increase in enrollment. I received lots of positive feedback and students seemed genuinely excited about what this website has to offer.

Also, meeting influential students from across the country and hearing about successes at their individual chapters helped me gain insight for potential new ideas to implement at my own local chapter at The Ohio State University. Shooting a text or email is a great way to gain knowledge and advice, but actually interacting on a personal level makes such a greater impact. For those of you skeptical of attending ASDA National meetings, I encourage you to get more involved and attend if you are able to. These meetings have helped influence my future aspirations in organized dentistry and have helped me make connections and friendships that will last a lifetime. After such an inspiring weekend in Dallas, I can proudly say that I have caught the #ASDAFever and I can’t thank The NEXT DDS enough for this amazing and unforgettable experience.

Are Traditional Dental Licensure Examinations Unethical?

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    Life as a fourth year dental student can be particularly stressful! If feels like you have come so far, but have so far to go. This stress is brought on by the struggle to complete all clinical competencies on time and the pressure to pass dental licensure examinations prior to graduation. Whether it’s CDCA (NERB), CITA, CERTA, WREB, etc most of these licensure examinations have a similar format. Most people do not complain about the endodontics or prosthodontics portion because it is done on a manikin. However, the practices done on the patient portion have been a topic of much discussion in recent years.   

    For the patient based periodontal and restorative portion of the examination, students get 9 hours to complete ScRP of 12 different sites, prepare and restore a Class II lesion and prepare and restore a Class III lesion. Each section has criteria that you are graded on. The student must score a 75 or better to be considered “passing.” The issue that many people have is the patient aspect of the exam.

    Take me for example, most of my stress surrounding my licensure exam did not come from my ability to perform that day but it came from my fear that my lesion may not be accepted, the patient would be late or heck, not show at all!  So many things happen beyond the control of the student but regardless if you are unable to complete the requirements of the examination that day it is considered a fail.

    Another ethical question has grown around “patient hoarding.” This term deals with the fact that you treatment plan a patient for a procedure, see radiographically that it is an “ideal boards lesion” (ideal boards lesion – one with a radiolucency extending ¾ through the enamel to the DEJ) and you sit on it and/or reserve it until the time of the examination. If you treatment plan a patient in November but hold onto the lesion until February or April a number of things may happen. The lesion could advance, or get worse or the patient could decide altogether that they will forgo treatment since you are making them wait to be treated.

    Either way you look at the situation, these licensure folks know that this is a problem because we are seeing things shift slowly but surely. The state of California is now allowing its dental students to be licensed by the portfolio method, of which I completely support! The CDCA is now allowing institutions to adopt the “Buffalo Method” which gives students 5 days to complete the requirements of the patient based section of the exam. This gives your patients multiple options of time to come so that you can fulfill your requirements.

    I am happy to see that the board examinations are trying to be more accommodating to students and patients alike. Based on the situation surrounding the practice of ethical principles, this is a good start but there is still a long way to go to before these examinations can be deemed fair balanced.

Pulpotomy Techniques

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For anyone who has studied pediatric dentistry, you know that there are about one hundred different ways you could perform a pulpotomy and stainless steel crown. Between the different techniques, materials and instruments, it can be confusing as to what is best for the patient. Most of the commonly used techniques and materials have scientific evidence to back them up and plenty of anecdotal evidence as well. 

Different burs and steps for reduction are used. Some pediatric dentists advocate removing all caries first, and then worrying about the form of the preparation. Others have a precise sequence to follow, which they never stray from. Most pediatric dentists advocate flattening the occlusal table at first if they know a pulpotomy will be performed. This reduced the amount of tooth structure that must be penetrated before reaching the pulp chamber. Also, most pediatric dentists advocate reducing inter proximally, buccally and lingually prior to entering the pulp chamber. In this way, different sizes of crowns can be tried on and fitted before the pulp is exposed.

 The reduction of the buccal and lingual surfaces can vary drastically as well. It will also depend on which tooth one is preparing. For instance, the primary first mandibular molars have cervical bulges that need to be reduced before a crown can be fit. Many pediatric dentists report that for most teeth they will simply have a 45 degree bevel on the buccal and lingual surfaces, and this bevel remains within the occlusal third of the tooth. Other pediatric dentists will perform this 45 degree bevel, and then slightly reduce the remaining middle and gingival thirds. 

The “Viscostat and Tempit technique” includes reducing the occlusal surface with a diamond bur (donut shaped diamond reportedly works well), then reducing interproximally with a 557 and a finally a thin diamond for buccal and lingual surfaces. Next, the pulpotomy procedure begins. Unroof the pulp chamber with a slow speed bur (round) and then scrub Viscostat in the chamber for 15-20 seconds and rinse. Then place Temp-it and cement the crown. The dentist should hold the crown while the assistant rinses the excess cement off and flosses to remove cement between the tooth and the adjacent teeth.

Formocreosol is a compound consisting of formaldehyde, cresol, glycerin, and water used in vital pulpotomy of primary teeth and as a temporary intracanal medicament. When used as an intracanal medicament, it is normally put on a cotton pellet and the cotton pellet is placed in the chamber for about 5 minutes. The cotton pellet is then removed and the chamber filled with an IRM. The stainless steel crown is then cemented over the IRM. Formocreosol is controversial because Formaldehyde has been shown to be distributed systemically after pulpotomy. The long term systemic effects are still up for debate, but some studies label it as a carcinogen. For this reason, Europe has banned Formocreosol. Diluting Formocreosol to 1/5 its strength (Buckley's solution) is the most common way that dentists in the United States use this compound.

No matter the pulpotomy technique, following the pulpotomy a stainless steel crown should be placed. Stainless steel crowns, also known as pre-formed crowns, are the restoration of choice for compromised primary molars, although esthetically they are not pleasing. They have superior longevity to amalgam and composite restorations. The most common method of cementing stainless steel crowns contains glass ionomers. These cements are advantageous because they contain Fluoride, which will protect against future caries. These glass ionomer cements also provide chemical retention to the tooth, while still maintaining mechanical retention to the crown. 

Although there are many different ways to prepare for and perform a pulpotomy and then place a stainless steel crown, they all aim to serve as a primary tooth restoration to keep the child out of pain, keep them infection free and to maintain the space for the permanent tooth to erupt in its proper place.

Treatment and Expectations for Dental Students

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     When dental students begin to treat patients, they are eager to implement everything they have learned in didactic courses to provide each patient with an award-winning smile. They want to provide the Cadillac of treatment plans and meet every patient's highest expectations. All crown margins will be silky smooth, there will never be flash on any restoration, the shade match on every composite will be flawless, the gingival architecture between every crown will be ideal, every patient's centric relation will match their centric occlusion, and every patient will have an aesthetic smile.

     With these in mind, students often upsell treatment to try to match patient expectations of a flawless smile rather than portray what realistic outcomes the patient can expect. While all these results are the high standards for which we strive, we all know that achieving a truly perfect result is often more difficult in reality. In addition, how a patient presents to a clinic will largely determine what their optimal treatment can be. 

     On top of these clinical challenges, we must first manage patient expectations. Not every patient presents in the same condition, but it seems like the majority are seeking a “Hollywood” smile. Before sharing treatment options with the patient, it is important to gather all the necessary diagnostic information. Even then, we must assess patient dental IQ and determine if what they are expecting in their dental experience matches what can be accomplished in a school setting. This is often a critical point to determine whether a patient accepts treatment or not.

     One common practice is to set the highest achievable result lower than what can realistically be achieved. If patients are unhappy at this stage, then it will be nearly impossible to meet their expectations and they will be better off treated elsewhere. These are “red-flag” patients. If patients understand that you can only take them to specific results given their current situation, then they are more likely to be accepting of treatment and satisfied with the outcome. These are “green-flag” patients. 

     Only after we know where we can realistically take a patient is it appropriate to present him or her with treatment plans. At this point, it is okay if patients begin to ask questions. For example, if you deliver a treatment plan for full upper and lower dentures and a patient begins to ask about implants and other means of support, it is acceptable to venture down this route of treatment options. However, before committing to treatment, it is important to explain that there are tests and consults, which require a time and financial investment.

     Successfully managing patient expectations is almost as important as the treatment we will eventually deliver. Once patients accept realistic treatment plans, they will not be disappointed when the results they receive are better than what was projected.