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THE NEXTDDS Student Ambassador Blogs

Oral Cancer: Will You Please Go Away!

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This year alone, approximately 46,000 individuals will be diagnosed with cancer of the oral cavity and pharynx. Of these, only slightly more than half will still be alive in 5 years. Given these statistics, coupled with the increase in technological advances in the field of dental medicine, why is it that the survival rates for oral and pharyngeal cancer have failed to significantly improve? It is not because it is incredibly difficult to discover or diagnose, but because this cancer is characteristically discovered very late in its development. To put into perspective the importance of early diagnosis, the 5-year relative survival rate for oral and pharyngeal cancer by stage is 83%, 61%, and 37% for local, regional, and distant, respectfully.


As current and future oral health providers, we have the ability to positively influence these numbers with merely 3 easy steps.


1. Identification. Oral and pharyngeal cancer does not discriminate, but several factors will increase an individual’s risk. It is important to identify these risk factors to better guide and educate the patient.

- Gender and Age: Oral and pharyngeal cancer is more than twice as common in men, and the risk increases with age.

- Lifestyle: Tobacco, alcohol, and/or betel quid use all increase the risk of oral and pharyngeal cancer.

- Genetics and Certain Health Conditions: Certain genetic conditions like fanconi anemia and dyskeratosis congenita, as well as conditions such as human papillomavirus infection, lichen planus, and graft-versus-host disease, increase an individual’s risk of oral and pharyngeal cancer significantly.


2. Screening. Part of what makes oral and pharyngeal cancer so difficult to diagnose is that there isn’t one standard or routine way of screening.

- Hand and Gauze: Using your hands and gauze and specifically checking the underside of an individual’s tongue, lips, cheeks, the floor of the mouth, palate, neck, and tonsils for any asymmetries, enlargements, bumps, lumps, or white and red patches. This is something that can be done fairly quickly and efficiently; it is something we should do on a regular basis with patients.

- Stains: After identifying areas of question, it is possible to use stains such as toluidine blue and fluorescence staining to verify abnormality of the tissue

- Biopsy: It is also possible to use exfoliative cytology or brush biopsy to gather samples of the cells and verify the abnormality under a microscope.

- Technology: Several companies have devised devices that emit various types of light used to inspect the mouth and tongue for abnormal tissue changes.


3. Education. Maintaining oral health is a joint effort by the dental practitioner and patient.

- We should educate patients on the avoidable risks such as tobacco and alcohol use and encourage them to quit.

- We should educate patients on oral and pharyngeal cancer and its warning signs. Although the early stage is often asymptomatic, individuals should watch out for difficulties with swallowing, lumps in neck, mouth or ear pain, and of course, changes in color and texture to the surrounding oral tissue.


Oral cancer is something that has been prevalent for many years now and has led to many avoidable deaths. By identifying, screening, and educating we can help save many lives by preventing or more quickly detecting oral and pharyngeal cancer. I encourage you to utilize them, and to go above and beyond by researching more as well.


Works Referenced:


Cancer Facts & Figures, 2015. American Cancer Society.





Communicating Effectively with Patients

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As a rising third-year dental student, I am finally getting the opportunity to interact with patients under the instruction of upperclassmen. In just about two months, I will have patients of my own and my communication with them is essential. For the past two years, I have sat through so many lectures where the professor has told us again and again, “you must be able to manage and communicate effectively with patients.” This point has been drilled into my head as patients can make or break us as dental professionals. 


Effective communication begins with active listening. Listening opens the door to understanding your patient and the views that they have. As dental professionals, we must be able to demonstrate sensitivity to the cultural, societal, and emotional issues of our patients. I believe that listening is one of the most important aspects of communicating with patients. I’ve observed upperclassmen as they sit down next to their patients and listen and communicate with them at direct eye level. They also make it a point not to rush the patient when he or she is speaking.


Another important aspect of communicating with patients that I have observed is getting to know the patient. As dental professionals, it is essential that we make an effort to get to know the person behind the chart and the x-rays. Knowing patients’ dental history is important, but so is talking to them like a friend and remembering what they told you about their life. In clinic, I observed many third- and fourth-year students that wrote down notes about their patients’ personal lives as they interacted. At his or her next appointment, the provider was better prepared to ask the patient about things they talked about at the last appointment without unnecessary repetition.


It is also important to allow your patients to be involved in their own treatment. We as dental professionals must explain a patient’s treatment plan in extensive detail and give a valid rationale as to why we are proposing a certain treatment over another option. This will allow your patient to know that you have proposed the best treatment plan possible, and it will also make your patient feel involved in the decision-making process. This is an important aspect of effective communication but it will also allow the patient to develop trust in you as a dental professional.


Before I begin seeing my own patients in clinic in two months, there is one aspect of effective patient communication that I believe is the absolute most important: always smile.


In dental school there are days that will be better than others, just as there are days that will be worse than others. It is important not to let these days affect how you interact with your patients. When seeing a patient, make sure that the patient is the only concern on your mind. Patients can sense how you are feeling, and it is your goal as a dental professional to make your patient feel comfortable and at ease. As I start the transition into clinic, these aspects are essential when communicating with patients of my own. 

Building a Relationship with your State Dental Society during Dental School

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State dental societies have the ability to play a role throughout your dental school career in a positive way.  It is essential to establish a relationship with your state dental society to gain a myriad of benefits, such as networking with dentists for future job opportunities.  Fortunately, the Indiana School of Dentistry has a lasting and close-knit relationship with the Indiana Dental Association (IDA), which has been a significant aspect of my dental school experience thus far. I encourage you to engage with your state dental society.  The following are some ways my colleagues and I have been able to build a relationship with our state dental society.


Student Trustee.  This past year, I have had the honor of serving as a Student Trustee on the IDA Board of Trustees.  Not only has this experience been rewarding, it has given me insight into organized dentistry and the opportunity to voice the concerns of my colleagues to the leaders of dentistry in Indiana.  If your school does not have a member representing your concerns at your state dental societies’ meetings, I encourage you to pursue this endeavor.  Many of the members of these societies are enthusiastic and welcoming of these concerns, and want to help improve your dental school experience.  These types of relationships will foster change and overall enhance your dental school capabilities.  Some societies give students a voting right, which provides dental students a strong voice at the state level. 


Volunteer Opportunities. Several dental state societies have multiple volunteering events to support the community.  This is an excellent way to get involved.  Dental students can participate while networking with established dentists in the community.  The IDA is hosting its first Mission of Mercy event and they have invited IUSD students to volunteer in this incredible event. My colleagues and I are grateful for these types of opportunities, because it allows us to have a positive impact on our community even as students. 


Lunch and Learns. State dental societies have a magnitude of resources on a variety of topics regarding dentistry.  They can provide your ASDA chapter or other organizations with speakers to discuss certain topics important to you and your colleagues.  For example, many of our students had questions regarding Medicaid.  Our ASDA chapter was able to contact the IDA, and they helped us organize a Lunch and Learn with the Medicaid director of Indiana to gain more insight on this particular topic.  The resources are endless, so why not take advantage of them?

There are many ways to be involved with your state dental society throughout dental school – the opportunities are infinite.  These experiences and resources can greatly enhance your dental school career in a positive manner.  Get your colleagues on board and utilize some of these suggestions to get a kick-start in building your relationship with your state dental society. It’s never too late to get involved with organized dentistry!


E-Cigarettes. Are they and Healthy Alternative

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 There has been a recent development of recreational use of electronic-cigarettes and hookahs assuming that they are healthier alternative to conventional cigarettes. Patrons are deceptively persuaded that there are no negative side effects and supposedly lesser harmful substitutions. The belief that these products carry no danger has stimulated smokers and a new generation of nonsmokers and young people to pick up the habit. Majority of customers have avoided any further research on these alternative products and have already allowed it to become a replacement to cigarettes. 

History is beginning to repeat itself and the cigarette manufacturers have taken on a new face in the form of Hookah and e-cigarettes. If you could think back to when majority of the nation were smokers of the conventional cigarettes. It was the norm; smoking was adored and, associated with being “cool.” However, we know now the negative impact smoking has ones oral system; furthermore, why those who do smoke are trying to find ways to quit smoking. 

 According to The Centers for Disease Control and Prevention (CDC) Researchers, a recent survey found that 6.8 percent of youth in grades 6-12 and six percent of adults consume e-cigarettes. That accounts for 14.5 million adults and approximately 5 million youth. Now let us talk about the facts: E-cigarettes, contrary to popular belief, do contain formaldehyde, propylene glycol, acetaldehyde, as well as carcinogenic chemicals that can lead to oral cancer. Now all the smokers that are hovering over the word can in that last statement. Let us just isolate the fact that e-cigarettes contain nicotine. Google nicotine alone and you will see the plethora of harmful impacts that this drugs has on the body. From the head: central nervous system is affected leading to sleep disturbances, to the feet:  causing joint pain due to poor circulation.  

I leave my audience with this question: Will e-cigarettes limit the amount of nicotine dispensed in their product? Only time will tell. Another thought is that neither the FDA nor the CDC supports the claims of e-cigarettes as a healthy alternative. The best thing to do is to quit! 



My top five favorite apps to get me through dental school

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Figure 1

I currently serve as a student ambassador for the NextDDS, and I also do the same for Figure1. The app has been called the "Instagram for doctors," which I find even more addicting than Instagram itself. The site allows real healthcare professionals to upload photos of clinical cases and explain outcomes or ask questions. Photos are organized into categories, including Oral and Maxillofacial Surgery which I find particularly intriguing. I must warn these images may be very graphic, but are extremely educationally helpful and interesting. The app has gone to great extents to ensure that patient privacy is protected, and even has the consent form on the app for doctors to use prior to posting. When learning about oral pathologies and oral medicine, the site has been really great at putting these rare diseases into context and proving real clinical photos and follow ups by doctors from around the world. Users can hashtag terms so that searching specific diseases diagnosis, signs or symptoms are more easily found. If you haven't already, check it out for yourself.

This language app goes beyond any other in which I have tried. The website, www.wordreference.com was introduced to me in middle school, many years ago by my Spanish teacher. Later, I found out that they developed an app! Although the are many apps out there specifically for dental Spanish or dental language translators, I like that this app is a general dictionary and not limited to dental terms or sayings. There are 16 languages available to use, but I have only tried out a couple. I must say that I have always had a freaky good and accurate response from the languages that I have used, and felt confident using the translations that the app provided me with. It is grammatically and and culturally accurate, offering several answers depending on the context you are using the phrase or word. This is an app I'll probably always have on my phone.

Dental Board Mastery by Higher Learning Technologies:
I am a huge fan of this app. While studying for the national board exam, I used several resources to enhance my learning. Aside from some textbooks and decks, I reed heavily on this app for studying. One of the main advantages in my eyes is that it is 100% mobile. My textbooks and decks were heavy and cumbersome, so they did not make it out with me everywhere, and mainly stayed at home at my desk where I did the majority of my studying. However the Dental boards mastery app was convenient, fun and credible. As I waited for the bus I could whip out the app and get some on the spot learning. It was such a valuable tool on the go. When you stop or close the app, your progress is saved and you can resume anytime. It is organized into categories and tracks your progress. One time, I had a cone negating the validity of a question, so I clicked the ask button and it took me to my email where I was able to inquire about the question and received an answer promptly. If you are a dental student interested in the app and have classmates who are too, you may qualify for a discounted fee as well through a higher education!

This productivity app is a must have in dental school. Now that almost all of my books are PDF versions, it's impossible to send them via email because they are mostly huge fire sizes with high resolution images. The great thing is by uploading large files to Dropbox, you can not only share them with others, but access them on your different devices. I can keep my 1,000+ page Endo manual in the Dropbox ans access it on my computer, iPad, and iPhone. Your files upload relatively quickly and stay in the Dropbox until you remove them. You can also earn more space by sharing with others, and that means taking up less space in your devices. Besides books, I have organized projects by requesting that classmates "turn in" photos to Dropbox for my project. Music, files, photos, videos- you name it! Create files to organize your data, and never worry about emailing files to yourself again.

Networking and making connections is everything. Even when in dental school, it is important to keep in mind that in four years or less, you will be out in the real world. By your last year of dental school, you may realize that unless you have a family or friend who you will be working with are graduation, then you need to start pursuing job opportunities. Keeping the app up to date allows you to have a running CV or resume of what you have accomplished. This makes applying to jobs easier, as long as your keep your profile updated and accurate. Already without much work, I have received some dental clinics interested in what I am doing after graduation. Thank you, LinkedIn! Keeping your LinkedIn life separate from your less-formal Facebook life allows you to maintain professionalism and career goals. Editing your interests also allows you to network with others who have similar interests or who are professionals in that field. For example one of my interests is Yoga, and I have had several yoga instructors in the Bay Area who have connected with me. Now I have options and confidence in finding studio near me where I can take yoga classes. Connecting with friends and colleagues allows me to keep in touch, as well as endorse them for their skills and positive experiences I have had working with them. Keeping your profile professional and accurate is important for the growth of your network.

Dentin Hypersensitivity

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A few weeks ago, I received a call from one of my patients who was set to undergo orthodontic treatment. He complained of having a sensitive tooth. My thoughts immediately reminded me of tooth #15, which needed a crown due to a fractured amalgam restoration. I scheduled him to come in for an exam. During the appointment, it became evident that other teeth were bothering him besides #15. The adjacent and the contralateral teeth were also sensitive. Also notable was significant gingival recession around all molar teeth. After vitality testing of #15, radiographs, and discussion with clinic faculty, we concluded the patient had dentin hypersensitivity. We suggested he use an OTC sensitivity toothpaste help alleviate his symptoms. The patient left seemingly dissatisfied with this conclusion.

Reflecting on this experience, I attribute that dissatisfaction in part to the fact that I didn’t sufficiently explain to the patient what was going on. I realize I hadn’t done so because I didn’t have a complete grasp on the subject matter. This experience has led me to dig deeper into the topic of dentin hypersensitivity, as this was my first encounter with this condition in the clinic. I wanted to find out what the signs and symptoms are, and what can be done to treat it.

The first area of consideration is what can cause dentin hypersensitivity. The current accepted theory attributes the hypersensitivity to a hydrodynamic mechanism. (Carranza 2012) According to Lin et al (2011), mechanical or thermal stimuli on dentin can lead to a flow of fluid through the dentinal tubules. This can result in a shear stress on nerve endings in the tubules, causing dental pain. For this result to occur, the tubules need to not only be exposed, but also open for fluid diffusion (Petersson 2013).

            The signs and symptoms often presented by patients align with this theory. Gingival recession and tooth wear are the most common signs. It is also typical to find a recent history of vital tooth whitening (Cohen 2010). Patients will usually complain of heightened sensitivity from hot and cold, toothbrush use, or even eating citrus-based foods. In addition, patients may also have increased sensitivity to air (Petersson 2013). These symptoms initially sound like an endodontic problem, such as reversible pulpitis. Therefore, it is important to first rule out pulpitis and other issues like caries or cracks, as these may be the true causes of the patient’s symptoms (Türp 2013).

After dismissing these possible diagnoses, one should then address the possibility of dentin hypersensitivity caused by the hydrodynamic mechanism. While it is difficult to exclusively diagnose the hypersensitivity, a close look at the patient’s dental history can provide important clues. As noted previously, gingival recession is a major player in hypersensitivity. Common periodontal procedures such as gingival surgery and periodontal debridement may have resulted in exposed dentinal tubules, especially in cervical dentin, to the environment. Orthodontic, restorative, and bleaching treatments have also been identified as a precipitation of hypersensitivity (Petersson 2013).

Possible treatment modalities are based on blocking the hydrodynamic mechanism of pain. After a diagnosis of dentin hypersensitivity, desensitizing agents may be used. According to Carranza, patients must understand a few things before pursuing treatment: 1) Hypersensitivity is the result of exposed dentin; 2) Even without treatment, the sensitivity may slowly disappear after a few weeks; 3) Plaque control is essential to reduce the hypersensitivity; 4) Desensitizing agents must be consistently used for several days or even weeks before producing results.

The desensitizing agents can be used at home or at a dental office. They work by precipitating crystalline salts, which then block the tubules and prevent fluids from stimulating the nerves (Carranza 2012). The “at home” products are dentifrices. They either contain strontium chloride, potassium nitrate, sodium citrate, or calcium sodium phosphosilicate (bioactive glass). Carranza lists several “in office” treatment options, such as simple fluoride varnishes, bonding agents, or laser “sealed” dentin tubules. He cites one in vitro study in which 90% of dentin tubules treated with a laser were still sealed after brushing with an electric toothbrush. Carranza also states that potassium oxalate and ferric oxalate have been highly favored materials for “in office” treatment.

Srinavisin et al (2014) made the point that “in office” treatments may not be superior to “at home” treatments. Many “in office” treatments, such as varnishes, may not last very long because normal brushing can wear away the materials. Thus, it may not always be best to prescribe an “in office” treatment, as it may lead to excessive costs to patients. Based on this rationale, suggesting the “at home” treatment with a dentifrice containing the most superior active ingredient seems to make the most sense to me.

From this experience, I have learned it is important to gather all necessary data before reaching a final diagnosis. This is a practice I will implement as I move forward, as I will likely face patients with dentin hypersensitivity in the future. After reaching a diagnosis of dentin hypersensitivity, suggesting the correct treatment is of utmost importance. Because materials and techniques continue to improve, it is imperative I remain informed as to which treatments have the most favorable outcomes. By doing so, I will be able to better educate the patient as to his options for treatment and potential for improvement, while also establishing realistic expectations.


Works Cited

Ananthakrishna S, Koshy S, Raghu T, Kumar N. Clinical evaluation of the efficacy of bioactive glass and strontium chloride for treatment of dentinal hypersensitivity. J Interdisciplinary Dentistry 2012;2(2):92.

Carranza FA. Carranza's Clinical Periodontology. 11th ed. St. Louis, Mo.: Elsevier Saunders, 2012. 531.

Cohen S. Cohen's Pathways of the Pulp” 10th ed. St. Louis, Mo.: Mosby Elsevier, 2010. 510, 521.

Lin M, Luo Z, Bai B, et al. Fluid dynamics analysis of shear stress on nerve endings in dentinal microtubule: A quantitative interpretation of hydrodynamic theory for dental pain. J Mechanics Medicine & Biology, March 2011;11(1):205-219. Accessed February 20, 2015.

Petersson L. The role of fluoride in the preventive management of dentin hypersensitivity and root caries. Clin Oral Invest 2013;17(Suppl1):S63–S71.

Srinivasan-Raj S, Khatri SG, Acharya S. Clinical evaluation of self and professionally applied desensitizing agents in relieving dentin hypersensitivity after a single topical application: A randomized controlled trial. J Clinical Experimental Dentistry 2014;6(4):e339–e343. PMC. Web. 20 Feb. 2015.

Türp JC. Discussion: How can we improve diagnosis of dentin hypersensitivity in the dental office? Clin Oral Investigations 2013;17(Suppl1): 53–54. PMC. Web. 20 Feb. 2015.

Oral Cancer Awareness

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April is Oral Cancer Awareness monthso I figured I would try to come up with an interesting and informative blurb about oral cancer. At my school some professors say we only deal with 3 diseases: caries, periodontal disease, and cancer.  Oral cancer isn’t something that we as dentists end up treating, but it is one of our primary responsibilities to recognize it in our patients and refer them immediately for appropriate care. Recognizing cancerous lesions early saves lives, and failing to recognize them in a timely manner can end up contributing to the death of your patient. 


General Statistics  


According to the CDC, oral cancer kills approximately 8,000 people each year and over 30,000 new cases of oral and pharyngeal cancer are diagnosed every year.  The problem with oral cancer is not that it is particularly hard to treat or diagnose, but that it is often missed and diagnosed in later stages after metastasis to other sites. This results in approximately a 50% 5-10 year survival rate according to the Oral Cancer Foundation.


How Often Are You Screening for Oral Cancer?  

Ideally, you should look for abnormal lesions at every appointment. Inform your patients, especially ones who engage in high risk behaviors such as alcohol/tobacco use and oral sex, to look for changes.  Oral cancer lesions can present as red, white, or mixed lesions.  They can be flat or raised, and have defined or diffuse borders.  Always ask about the duration of the lesion and if it is painful. Especially high risk areas are under the tongue, along the sides of the tongue, and on the floor of the mouth. Particularly troubling lesions include both red and white coloration with diffuse borders and are non-painful.  This website, http://www.oralcancerfoundation.org/discovery-diagnosis/screening.php, has some great information on screening for oral cancer.


HPV and Oral Cancer 


HPV, or human papilloma virus, is the most commonly transmitted STI in the United States according to CDC 2013 data.  Another statistic which illustrates the prevalence of HPV infection in the US is the fact that 4 out of 5 women, by the time they reach 50 years old, will have experienced an HPV infection at some point in their lives. In general, HPV, whether it is a high or low risk strain, is cleared by the immune system within 2 years of infection. However, if the infection is not cleared, the virus stays within the cells and can cause mutation into precancer or cancer cells, especially in the cervix, ano-rectal area, and oropharynx. The main types of high risk HPV which are associated with genital infections are HPV 16 and 18.  The primary strains of HPV associated with oral infections are HPV 6 and 11, which are generally considered to be lower risk.  There can be crossover between these primarily oral and genital strains, resulting in a higher risk of HPV related cancer in the oral cavity and pharynx.


How Can You Help Prevent Oral Cancer? 


Advise your patients of high risk behaviors and warning signs, increase your knowledge of the presentation of oral cancer lesions, and screen your patients thoroughly and regularly for oral cancer.


If you have the opportunity, participate in an Oral Cancer Foundation Walk for Awareness this year.  I have included the link to their events page:  http://oralcancer-screening.org/ 


As oral health professionals it is our responsibility to diagnose oral cancers. Together we can work to raise awareness for this deadly disease and help to raise the odds of survival with early diagnosis.  






Tools for Managing Fearful Patients

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According to a WebMD survey, roughly 20% of patients completely avoid the dentist unless it is absolutely necessary. Often this phobia is linked to an unpleasant past experience and can be difficult to overcome once the damage has already been done. As clinicians, we should focus on the key part of the Hippocratic Oath, which reads, “First, do no harm.” In order to target dental phobia at the source, we need to recognize our role in preventing patient fear before it starts. 


There are a lot of things in the typical office for patients to be afraid of. Sharp objects, strange smells, and the sound of a high-pitched handpiece are common. When you add all of the factors together, along with the fear of the unknown, it can be a scary environment. Regardless of our own familiarity with dentistry, I would argue that even a majority of us cringe when we are the ones in the operatory chair.


Dentistry has come a long way from the techniques used over a decade ago. One common snag that dentists encounter is overcoming a parent’s preconceptions when treating their children. If the parent is a phobic patient, it is likely that the child will come into the office just as fearful. This is not genetic, but rather an acquired fear developed from the parent’s comments on negative previous experiences.


So what can be done? The American Academy of Pediatric Dentists recommends that we spend time educating parents prior to the child’s first visit. Walk through each step with them to outline exactly what will be performed during each visit. Be sure to let them know how pivotal their role is in ensuring a great experience for their child. Performing lap examinations together with a parent builds trust and allows the child to relax. If there is ever a doubt as to patient compliance, do not hesitate to refer out to a local pediatric dentist. As we take care to ensure quality experiences at a young age, it will pay dividends years down the road to reduce dental phobia.


For fearful teens and adults, sedation is a powerful tool. Oral conscious sedation allows the dentist to get these patients comfortable (prior to any injections), while providing a highly amnestic effect. Since the patient will hardly remember the dental visit at all, even the most phobic patients can be managed. Oral conscious sedation can be easily implemented into any practice with a simple certification and through the purchase of basic monitoring equipment. Some clinicians find that IV sedation provides more control to treat tougher cases, but certification requires extended amounts of Continuing Education and equipment.


Many patients may not require sedation or be able to afford it. Innovations in laser dentistry allow us to give fewer injections and eliminate the shrill noise of a handpiece. Although cutting with lasers is often slower than rotary burs, there is a clear advantage to using laser dentistry to minimize a fearful dental environment.


Dentistry is a wonderful profession. New developments have allowed us to deliver quality care in a more comfortable way. We must see these developments as an opportunity to broaden our patient base and help those that are hopelessly fearful. Let us focus our goals today and “do no harm.” 

Are Mouth Gurads Benefecial to Patients and Practitioners?

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Mouth guards are coverings worn over teeth, and often use to protect teeth from injuries like bruxism and injuries caused by playing sports. Bruxism, or grinding of teeth, alone can lead to significant loss of tooth structure and even orofacial muscle pain in some individuals. Sports injuries to teeth can range from teeth being chipped or fractured to teeth being knocked out. However mouth guards can really protect teeth from these types of injuries if used properly and regularly. Furthermore, there are various kinds of mouth guards that can be used that will give similar results. A few types of mouth guards include stock mouth protectors, boil and bite mouth protectors, and custom fitted mouth protectors. Stock mouth protectors come preformed and ready to wear. In addition they are relatively inexpensive and can be found in many sporting good stores. Boil and bite mouth guards are also found in many sporting good supply stores, although they may be a bit more expensive due to the better fit and ability to customize at home.   The way the boil and bite mouth guards work is that the thermoplastic tray is boiled and then customized by the bite of the patient with the help of finger and tongue pressure. Another alternative to these store bought mouth guards are the custom fitted mouth protectors made by dentists. These mouth guards are more expensive than the other two mentioned, but on the other hand they provide superior fit and protection to the other two mentioned. Furthermore, although the thought of making mouth guards for patients may seem fairly boring and not very profitable this is not always the case. The inspiration for this blog post actually comes from a recent article released by the Washington Post that reports that the five division world champion boxer, Floyd Mayweather Jr., just payed $25,000 for his custom-fitted mouth guards which he had made by his dentist named Lee Gause. It is furthermore reported that these custom mouth guards are made with real one hundred dollar bills inside of them and some even flecked with gold or feature diamond dust. This is proof that even the most seemingly simple products of the dental profession can be a lucrative business. Especially if you get Floyd Mayweather Jr. to come in your office as a patient!

Jumping into Clinic: Tips for a Successful Start

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     During the past semester, my class and I entered our full time clinics. We gained our own patient pool and learned to schedule their appointments. We jumped into procedures with slightly uncertainty and high anxiety. We questioned and learned and questioned again. Many of my classmates would agree that this has been our most stressful semester yet, far exceeding the weekly exams we faced in the previous year. As the semester comes to an end, I am able to reflect on our time in clinic and realize that, though scary and confusing, finally treating a human being can be fun and exhilarating. For all the rising D1s and D2s beginning clinic in the upcoming year, here are some tips for a successful start: 


During treatment planning, be sure to get to know your patients. Ask them questions about their life, their family, the hobbies, and take notes. These individuals will likely remain in your care for the remainder of your time in school, and creating a meaningful connection with them will create a better experience for them and you. Plus, that Tx planning appointment can be pretty stressful if you have a complicated case and some side conversation can lower the stress and allow you to think more clearly and confidently. 

Plan ahead… like months ahead. The biggest challenge I faced when starting was organizing my time and my patients to address their concerns as well as my requirements in a systematic way. Clinical care can be complicated and whether it be a clinical credit requirement or a patient with tooth pain, your ability to systematically schedule procedures can make or break your experience in clinic.  

Understand that you don’t know a lot, and that's ok. As much as you can learn in preclinic, in a simulated situation, on a mannequin head, much of what you will experience in clinic is far from that ideal situation. The best advice I received from a D4 as I started was “Accept the fact that you don’t know, and ask questions so that in the future, you do.” I now appreciate the complicated case because it allows me to work with faculty to learn something I never would have considered during my time as a D1. Every situation is different and every procedure will pose a challenge, but don’t let that discourage you. Find excitement and opportunity in the unknown. 

Build relationships with your faculty.  Not only will they become your graders, your critics, and your sources for letters of recommendation, but they will be your future mentors. Be open to everyone’s teaching style and ways of “doing things” and you will quickly build an inventory of clinical skills and options to aid you in the upcoming years. 

Learn the landscape. The resources required for a dental appointment seem to be endless, and much of my time during my first few appointments was spent trying to find the tools in our clinic. If you take a few minutes to walk around, peak in drawers, ask upperclassmen, and observe other students, you will be more aware of the whereabouts of the much needed resources for clinical procedures. This will help to expedite appointments and also create a sense of confidence and comfort in your new environment.  


    Appreciate the first months in clinic for the excitement that they are and acknowledge the achievement that it is to have made it there. Your first procedures will be the first of your long clinical career. Start well and start strong, and you will set yourself up for years of success. 

Stress Management for the Dental Student

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Mental health is an area for many dental students that can tend to be neglected, but I cannot stress how important it really is. Given our recent loss of a previous ASDA president to suicide, it is a topic that should not be taken lightly. So many students get caught up with the demand of assignments, deadlines, labwork, studying, clinic and all the other stresses of dental school that they forget to take care of themselves. There have been semesters that I have been so busy, I couldn’t even remember what happened the day before.



Neglecting our mental health and overall health can have devastating long-term effects. It can set students up for developing poor coping habits that can carry on through out their careers. Excessive drinking and partying are common modes of stress relief among dental students which not all students progress out of once leaving school. It is important to try and find balance while going to school by maintaining both a healthy school life as well as social life. It can also be just as dangerous for the student who shuts themself out and avoids social contact.


Most campuses through either student health insurance or student health fees provide counseling services. Some schools may even offer specific stress relief clinics. These types of environments offer services such as stress management workshops, restorative yoga, meditation, nutritional counseling, and even sleep specialists. Any student that is struggling with trying to manage school and personal problems should reach out to counseling services. Often times these environments offer a great neutral atmosphere for students to overcome any difficulty they are having.


Aside from reaching out to counseling services, students can also focus on maintaining healthy dietary habits as well as engaging in physical activity. I encourage students to look into the fitness centers at their schools and see what they have to offer.


Sleep is also an important factor in maintaining a healthy mind and body as well as important for stress reduction. It is hard sometimes to get to enough sleep when students are staying up late at night to study and have to be in clinic early the next morning. However, it is important to try and get enough sleep as well as try and develop healthy sleep hygiene. Some habits to help develop healthy sleep hygiene include turning off electronic devices before bed, going to bed and waking up at the same time even on weekends, turning the TV off while sleeping, these are some examples.


No body is perfect and there will always be some form of stress, but minimizing stress can have many long-term benefits. Most of all it is important to try and find balance. 

Emergency: Some Beginners Knowledge

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Throughout my time in dental school, our emergency clinic brings the most interesting cases and different difficulties in patient management.  I have had patients try to barter prices of procedures, scream when I used an explorer, and even give a young adult their first x-ray.  My last rotation in emergency left me pondering the way I see patients and many of the assumptions that I make.  Here are some perspectives on those thoughts and some things I just learned or relearned.


Fall into a procedural order.  Usually in emergency the patient is throwing a lot of information at you with useful pieces in-between all the conversation. It is important to go through all the different questions and if the patient has already mentioned the answer make sure to clarify as you go through.  There are certain diagnostic tests that might be added or removed due to the situation but make sure to perform core tests like percussion, palpation, probing, and mobility.  Cold tests maybe unnecessary if the pulp is already exposed and a fracture detector maybe used on those with a possible cracked tooth.  It is important to go in order and it may be even helpful to make a checklist if emergency diagnoses are rare. 


Do not judge a book by its cover.  There are those that want to save their last four teeth or those that are ready to pull all 32 teeth.  I have not seen a true pattern to decipher which one a patient will be, which is why it is important to give all the options no matter what you are reading from the patient’s character. 


Not everyone knows what a tooth looks like.  This one was a new one for me.   Explaining that teeth have roots is something I have had to explain on multiple occasions lately. One of my patients could not understand that extraction meant that there was no more tooth structure there and therefore replacing the crown on her tooth was not an option.  It is important to practice explaining these scenarios since it is so elementary to the level of a dentist.  This is when models, videos, and even using the x-ray can help the patient understand what is going on.


Always be watching for drug seekers.  At my dental school it is taught time and time again about looking for those just interested in getting narcotics, putting each student on high alert.  Something that is very hard to decipher is if the patient is seeking a prescription or the patient has been tossed to many clinics due to insurance acceptance or even patient personality.  Be cautious but do not under-diagnose because of it.  Seek out alternative ways of removing pain.


I know that I still have a lot to learn in patient management but I believe that every patient interaction we learn something as clinicians and maybe in emergency it is two or three things we learn.  The most important piece that I am still trying to master in emergency is patience.  Most of the patients seen have neglected their teeth for years, making it hard to empathize with their urgency.  No matter what, they are still patients and deserve the same standard of care.


Dental Outreach Missions: Lessons Learned

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    As a bright eyed dental school interviewee, I was always so impressed with the outreaches that every school presented. Dental outreach missions go to every part of the globe to provide dental care to underserved populations.  I recently returned from a dental outreach mission to Chile, and I can vouch that these trips teach you invaluable lessons you cannot learn in a classroom. While some of the things I learned on this outreach mission had to do with technical skills, a great majority of the lessons I learned were not. I want to share a few of them with you, and how these lessons can be incorporated back here at home. 



Be a team player 


Whether on a dental outreach mission, working in a group project, or assisting a classmate in clinic, it is always important to remember that there is no I in team. Everyone is working together for the common goal of helping provide care for the patients. There will always be those people who are thinking about themselves and the experiences they will get rather than the good of the group, however it is important to keep your priorities straight and remember your true purpose. Back at home, it is important to keep this in mind when obstacles are thrown in your way when trying to provide care to a patient.  


Make an effort to meet new people 


The outreach trip that I went on was different from many other outreach trips in that it wasn’t just students from my own dental school. We also went with students from University of Connecticut Dental School and we worked with students from a dental school in Chile, Universidad del Desarollo. This enabled us to meet new people, hear about other dental schools, and most importantly learn from one another. This lesson applies at home as well. You may know everyone in your class very well, but what about the faculty, staff and students in other class years? You never know what lessons you can learn from those around you when you take the time to get to know them. 


Try to learn the language 

Being unable to communicate with your patient regardless of where you are always hinders your ability to provide quality care.  Thus it is important to learn the language so you are able to break down barriers. One thing I noticed while in Chile was that working in pediatric clinic was nothing like working in pediatric clinic here in the USA. Here, I use behavior management techniques such as tell-show-do, positive reinforcement, and voice control to help make my pediatric patients (and their parents) comfortable. While in Chile, this was not possible due to my limited ability of conversing in Spanish. Therefore, a pediatric patient was really just a smaller, less well behaved adult when you take all the behavior management techniques out of it! If you find that a large percentage of the population that you work with regularly speaks a language other than your own, it is a fantastic idea to do everything you can to learn it as it will make you a better provider for those patients. 


What outreach missions have you been on? What lessons did you learn that you were able to bring home to your everyday life? Let me know!

Preparing for the NDBE Part I

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Most second-year dental school students have either taken or will be taking the National Board Dental Exam this year. The good news is that the Boards are no longer taken for a score but instead, Pass/Fail. Read: “You only need a 75% to pass.” While I’m not supporting those who are preparing for the Boards to take it easy or procrastinate on their studies, the Pass/Fail system imposes significantly less pressure on students taking this difficult test. Below are some tried and true tips from upperclassmen that will help you study better.



The Basics: Resources to Help you Study

Dental decks, Kaplan Review Books, NBDE First Aid. You’ve heard upperclassmen taking about them. Not only are these resources a good place find a comprehensive review of heavily tested topics, but they also have tons of practice questions that will help you practice what you’ve learned. Getting the latest edition of many of these resources is not necessary but could be beneficial. A good portion of the information will stay the same year to year but some minor changes maybe change due to the ever-changing pace of our profession. 


The Hard Part: Actually Studying

I’m very picky about my study spaces and environment. For example, a table covered with papers or pen marks on the table from a previous occupant really drive me up the wall. Whether you enjoy studying at home or getting out of your house to study at a public space, find that coveted space that sets you in the mood. You have the power to change your environment so if you are hitting a wall from studying at home, change it up and go to your school’s library or even a coffee shop!


Food: Fuel for Your Body and Mind

Many of my friends can study for hours straight without eating even a nibble of food. Kudos to them because I definitely err on the side of stress eating. You’ve heard this a million times but remembering to eat 3 nutritious meals every day will contribute to the success of your studies. Your brain burns about 20% of your daily calorie intake and studying only increases that caloric exhaustion. Bottom line? Don’t skip meals! Eat foods high in protein and good fats to keep you working for longer. 


Upperclassmen: Superheroes do exist!

They took the test. They went through the study cycle. They know how to help you maximize your efforts. Find a third year who took the test at your school and quiz them on the topics that are heavily stressed on the boards. Upperclassmen are great resources to help you zone in on your studies.


Extra Tip

To avoid yellow teeth and unpleasant coffee breath, try this. Take organic apple juice, which has a ton of natural sugars and dilute it with water in a 1:1 solution. The sugar in the apple juice will help rev up your brain and keep you focused for longer. Research shows that the nutrients in apple juice actually enhance acetylcholine (ACh) neurotransmitter release in your brain. ACh is linked to memory retention. So if you want to pass those boards, try apple juice to fuel your long nights.



Good Luck! 

How To Survive Your First Year Of Dental School

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When I found out I had been accepted to The Ohio State University College of Dentistry a year and a half ago, I was not only overjoyed and thrilled to be attending school, but also a tad bit nervous about what to expect upon entering my first year of dental school. Now, with it being April and having almost completed my D1 year, here are a few words of wisdom and survival tips for those of you who are about to embark on this incredible journey: 



#1. Get to know your classmates. 

This survival tip, in my eyes, is the most important. Exactly one day before orientation was about to begin last August, I moved to Columbus completely on my own from Chicago via a Megabus. Although I was anxious about being in a new environment on my own, I knew how crucial it would be to put my best foot forward and befriend these total strangers. Whether your class size is 40 students or 110, your peers quickly become your second family and the only people who truly understand what you go through on a daily basis. You may think that constantly being around dental students would be boring and monotonous, but for once you’ll be surprised to find so many likeminded individuals in one classroom and that many of them will rapidly become some of your best friends.


#2. Don’t fall behind. 

As much as professors will warn you about this the very first day of class, it really is a valid statement not to fall behind in your schoolwork. Although we all worked extremely hard to get to where we are today, the dental school curriculum is one that many of us have not experienced before. Even though the rigorous schedule can be pretty intimidating, know that dental school is 100% doable as long as you manage your time and stay on top of your studies.


#3. Make time for yourself by staying true to your passions. 

Dental school has plenty to offer outside of the classroom and if you were the type of student to get super involved before, make that a priority while in dental school as well. With organizations like the American Student Dental Association and Give Kids a Smile, it is easy to get involved and continue doing the things you were always passionate about. Getting involved outside of class is not only extremely rewarding, but can lead to other opportunities you may not have even known existed. Aside from getting involved, it is also important to set some time aside for yourself, or as I would like to call it: “me time”. Whether you like to run outside, catch up on Netflix, or just spend time with your loved ones, make sure to continue doing the things that make you happy to take a breather away from school.


#4. Enjoy every minute of it. 

With countless exams and hours spent at the library, I know this survival tip may seem silly but even through stress and tough times, always remember why you worked so hard to be here in the first place. As long as you remember to keep the end goal of graduating with a degree in dentistry in sight, you’ll quickly see that all of those hours spent busy with classwork will fly by and be completely worth it.

Controversy Surrounding Live Patient Based Examination

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    In light of ASDA’s Legislative Week, various guests visited our school to discuss with us certain political issues that have been brewing in our dental bubble. One such topic was a discussion about the validity of the NERB examination, its importance for licensure, and the ethical issues it may present.  


    For those who are unfamiliar with this exam, it is a licensure examination administered by the North East Regional Board of Dental Examiners used to assess a dental student’s clinical skill and their competency as an entry-level practitioner. Unfortunately, there is no clinical licensure examination that is truly national. Instead, there are several board examinations to choose from, each that will grant you licensure in certain states. Complicating matters further, some states such as New York and Connecticut have amended their policies so that a PGY-1 can be used as a suitable replacement for the NERB exam. This means a graduating student in Connecticut and New York can attain licensure by solely enrolling in a GPR or AEGD program. In fact, since 2007, New York no longer accepts clinical examination as a pathway to licensure. A residency of at least one year is required of its graduating students. Dentists that have acquired licensure in another jurisdiction and have not completed an approved residency program of at least one year’s duration must practice for at least two years full-time before being able to practice in New York. These different criteria among states force graduating students to consider where they are likely to practice when trying to attain licensure. Not only is there a lack of uniformity across the board examinations and licensure among states, the test itself may not necessarily be an adequate measure of the student’s clinical ability and quality as a dentist.  


    Aside from hairdressers, dentistry is the only profession that requires a live patient component for licensure. This places unique and stressful demands on the student. For example, the NERB does not supply these patients. Instead, selecting appropriate patients is a key factor in the clinical licensure examination process. It requires students to find specific patients that fulfill the board’s criteria. While this partly assesses the student’s ability to diagnose a patient properly, factors out of the student’s control may impact their ability to pass the examination. For one, there may be a shortage of patients that fulfill these certain requirements. If no patient is secured, the student is fails the clinical portion of the exam. When students come across a patient that fulfills the board’s requirements ahead of time, there may be added pressure to withhold treatment so that the patients can be used for the examination. Furthermore, there may be pressure to actually withhold treatment in the hopes that one might better develop these criteria. Our mentors, faculty or practitioners alike, always emphasize the importance of “patient” centered care. Yet, during these board examinations, this may be jeopardized when patients are being used as a means to an end. They are treated in such a manner that is not representative of the way these patients would be treated in typical practice. The patient’s oral health and wellbeing are not necessarily in the student’s best interest. Even if an ideal patient is found, he or she may not show up to the appointment. In this case, the board rejects this patient as fulfilling the criteria and the student fails the clinical component of the NERB, an examination that is supposed to assess the quality and skill of the student as a practitioner.   


    Despite these issues, these board examinations continue to be essential for licensure. Currently, there is no clear solution. Even though several states have amended their policies so that PGY-1 can be used as suitable replacement, most students will continue to participate in these examinations so that they do not limit their employment opportunities based on location. While this pathway avoids the ethical pitfalls and expenses of taking the NERB examination, it does not address the problem of portability. This issue will not be addressed until change is adopted on a national scale. 


Killing it in Pre-clinic!

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Killing it in Pre-Clinic

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

Depending on the school, pre-clinic can start 1st year or second year.  At UBSDM we had a laboratory dental anatomy course where we waxed up teeth the 1st semester of dental school. That class was great and I enjoyed using my hands but second semester we had nothing of the sort. It was all didactic courses, which is what the majority of 1st year was and I hated it. We start 2nd year in the summer and started our 1st pre-clinical course, direct restorations, we learned how to work with composite resin and amalgam. Then, when we returned from summer break in August, Indirect and removable was added to or preclinical courses. Second semester of sophomore year is when the endodontic pre-clinical course was added.

Now that you know what I’ve been doing the past two semesters, I will provide some advice in enjoying pre-clinic and succeeding in it.

Once you get a syllabus make a schedule of all of your assigned projects.

This can be done by making a weekly checklist

Making a calendar

Any sort of system that works for you to ensure you never miss a project and always know what is coming up

Before you start a project make sure you get a general idea of what you need to do

Examine the slides given by the professors

Ask for demonstrations

Ask upper classmen

Watch YouTube videos

Everything will be generally new to you, so your hands will not be used to performing certain task. But, if you mentally prepare and visualize what needs to be done you will have more success then going in blind.

This will also assist in saving materials and not having to continuously start over because you are doing something wrong.

Stay Organized

I know its tough, but try to keep your drawers and lockers as organized as possible. The last thing you want to worry about when starting a project is not having all your supplies.

Organize your station with all the materials you may need for the project so you don’t have to constantly get up to get supplies.

This will maximize your time

Stay positive

Know that everyone is starting off new and everyone will have different skill levels.

DO NOT compare yourself to your classmates; just keep trying to improve on your own work. If you need help, ASK!

Take what professors tell you as advice for improvement not criticism.  Even if it seems that they are being hard on you, do realize, they have been doing dentistry for years not months, they know what they are talking about.

Practice, Practice, Practice!

Practice you projects as much as you need to become proficient in it. This may take 3-4 or 10-15 times but just know your capabilities.

Be able to realistically evaluate your work and know where you fell short or excelled.

List your strengths and weaknesses and work on what you need to.

Get help in your areas of weakness

Maximize your time

Get as much work done during class as you can so after class you can study, work of your weaknesses, catch up on other classes or go home and relax!

Enjoy lab

Lab will be difficult, it is the first time you are using your hands in a certain way. Appreciate why we are doing these projects; it is the start of what we are in dental school for, to become DENTIST and to help our future patients. We need to have the hand skills to be the best dentist we can be and what better way to start with a typodont head and plastic teeth!

Life After Boards

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 The time has finally come! You finished the most important exam of your life: the clinical portion of the dental board exam. You waited anxiously for your results and when they came (PASS!!) you were filled with relief and happiness. Professors have always told you that the two happiest days of your life would be when you were accepted into dental school and when you passed the board exam. And you couldn’t agree more. But after all the joy and excitement dies down, you are left with a very crucial question: what now? 

 Senior dental students are well known for disappearing somehow as soon as board results are released. The department chair of our general practice program at VCU School of Dentistry always claims that after boards, the odds of throwing a stone in clinic and hitting a senior dental student are very very low. Therefore, even before we begin to take our board exam, we are encouraged to not leave school as soon as our results come in. We are told that our hand skills and clinical assessment abilities are the best that they have ever been in our dental school career and we should be using these skills even during the last weeks of senior year. As I am experiencing this particular problem right now, I have found a couple ways to motivate myself so that I do not waste the last few weeks of my dental school career. 

 First and foremost, my patients are still there and still need me to complete treatment. Most of them should be nearing the end of the treatment plans I have provided for them. But for those who are right in the middle of treatment, I think it is important to begin the conversation of who will continue their treatment after I leave and to ease any worries they may have about this transition. I think this is an important part of dental school as going through this process equips us to handle these situations in the future as dental practitioners. I also think that it is our professional responsibility to always put the needs and our commitment to our patients first. They are the reason we worked so hard for four years and they are the reason we succeeded in our endeavor to gain our dental degree.

 The second important issue senior dental students should focus on is completing all steps to acquire our diploma. Usually, there are different surveys and exit audits which should be done in order to wrap up paperwork and loose odds and ends. These surveys allow the dental school to obtain important feedback from the four years of experience which only a senior dental student can provide. This is very important as the school can address certain problems with curriculum and courses.

 Another necessary step to take is completing financial audits. These can be painful but are very important as they help us realize the size and extent of financial aid we have asked for over the years. I will admit that seeing the total number and realizing how long it will take to pay off all these student loans was a little depressing. But it also helped put into perspective future goals and what I need to do to plan out the next few years of my life.

 Another important step to take as a senior dental student would be to thoroughly complete research on the dental license you will be applying for and what paperwork is needed to acquire this license. This can be a daunting task and sometimes, it is hard to know where to begin. I have sat down and looked up the different licensing processes for each of the states I potentially may live in. This information can be found by looking up the board of dentistry site for each state and printing out all the important pages. Organizing this information can help prevent any problems when applying for your license.  

 The last important part of finishing up senior year strong would be spending time with faculty, staff and classmates that have been such an important part of the past four years. It is always hard to say goodbye, especially to the people who helped you become the person you are. But I think it is important to spend as much time as possible with these people and to take the time to say thank you for all that they have done.

 The end of senior year will be here before I know it. And I certainly don’t want to have any regrets about how I spent my last few weeks at dental school. It would be great to end these four years just like I started them: with excitement and looking forward to the next stage of my life. 

Texas Dental Association Lobby Day

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TDA Legislative Day


Every other year, legislators across Texas meet in Austin to convene for the legislative regular session. The regular session begins on the second Tuesday in January and lasts 140 days. During this time, many bills are introduced that affect the state budget, education system, and various public policy.  The Texas Dental Association takes an active role in monitoring these newly authored bills and highlighting any that will affect the dental profession.  They also schedule the TDA Legislative Day, inviting dentists from all over the state to come talk to legislators about new bills and their issues that impact our future. I had the opportunity to attend this event during my first year of dental school in 2013. During that time, the significant bill that the Texas Dental Association was opposing addressed concerns of dental service organizations, or DSOs. The bill called on DSO’s to become more transparent and would require them to file ownership with the state of Texas. I teamed up with a fellow dental student, Allison Lossing, and Dr. Danette McNew. We talked with many legislators and received very good feedback. Unfortunately, our efforts did not match up to purchasing power of the DSOs. They hired 30 lobbyists who simply had more time and experience to better answer questions and address concerns of the politicians.

This regular session, the TDA returned with an equal showing of dentists and an even bigger showing of dental students. It was important that more dental students were present this year since we were lobbying for a bill to increase dental school funding. The other major issues included patient fairness, access to care, and scope of practice.

Just as in years past, the Dallas County Dental Society chartered a bus for everyone leaving from Dallas. Despite the freezing rain and 3a.m. departure time, most of us made it safely and on time to the DCDS office. A lengthy ride to Austin was shortened by the unavoidable sleep that overtook the bus. We rendezvoused with students from all three schools in Texas and with members from the TDA at a nearby hotel for breakfast, followed by an advocacy brief featuring members of the Texas state legislature.. TDA advocacy staff briefed us on major issues and bills the TDA thought were most crucial. Then we walked over to the capitol to talk with legislators for the rest of late morning and early afternoon. I will spare the details of the actual lobbying meetings to talk about the advocacy issues that we felt were important.

The first issue dealt with dental school funding. There are three dental schools in Texas, each with a patient clinic that provides dental care to the needy while educating students at the same time. State funding for clinic operations at the three schools is currently not standardized. During the time when funding was decided upon, only two of the three Texas dental schools were public institutions. Texas A&M Baylor College of dentistry was at the time a private institution. Therefore, the large majority of funding was distributed between the other two public schools. Now that all three schools are owned by public institutions, both the dental schools and the TDA are asking lawmakers to standardize the funding for clinic operations into a formula that is driven by patient visits. That formula has calculated that each school loses about $45 per patient visit. With this new standardized funding in place, the additional Texas budget cost would only be $8.8 million over the current funding levels. Considering the almost 100 billion dollar budget that the Texas governor proposes every regular session, this additional funding should not be detrimental to our state’s economy, yet largely beneficial to the workings of each dental school and the patients that benefit from this at cost dental care. Proposing this new budget spending to congressmen and women received good feedback in my experiences.

The next issue we discussed dealt with patient fairness. Sometimes patients have more than one dental insurance policy. Coordination of Benefits requires insurance companies to coordinate between one another to determine primary and secondary coverage. For example, if a husband holds primary insurance and his wife holds secondary insurance, the insurance companies I have found loopholes that allow the secondary insurance to get a way with covering nothing, despite the wife still paying monthly premiums on this insurance policy. We believe that patients should receive full benefit of all of the coverage that they have been paid premiums for. There is not yet a bill filed that addresses patient fairness. The TDA is working with lawmakers to require state regulated insurers to coordinate benefits so secondary insurances pay what the primary insurer does not cover.

Access to oral health care is an ongoing issue that we bring to each legislative session. Currently, the TDA is looking at reinstating dental loan repayment programs. These programs were once funded by the legislator, but past budget shortfalls resulted in the elimination of these programs. Dental loan repayment programs are proven, affordable programs that place dentists into areas of need and areas with a shortage of dental services. The TDA supports the funding of these programs in order to provide needed access to oral health care that does not rely on mid-level providers.

The last big issue we discussed with congressmen and women also dealt with mid-level providers. The bill, which was filed in the Senate as SB571 and the House as HB1409, would create educational shortcuts for hygienists to administer local anesthetic in dental offices. There are no shortcuts to being properly educated and trained to administer local anesthetic. This is an irreversible procedure with a pharmaceutical drug that has potentially adverse effects. Furthermore the procedures for which this local anesthetic is being called to use do not always require injections of local anesthetic. There are a large number of alternatives pharmaceuticals that achieve the similar, desired effect of numbness while only requiring topical administration. Thus, the argument that allowing hygienists to inject anesthetic would save the dentist time and money is not warranted. If anyone truly wishes to administer local anesthetic, they can do so through various educational pathways that currently exist and are available to all qualified individuals.

We will not know the outcome of our efforts until the regular session has come to a close. However, seeing the amount of dentists and dental students who sacrificed their time and money to come speak with legislators goes to show how dentists truly care about their profession. We will continue to protect the world of dentistry from misunderstood influence in legislation, and help lawmakers understand our side of the argument. From my experience, it is encouraging to see that the majority of legislators tend to side with dentists once we educate them on the issues from our side of the chair.

Welcome to Washington DC…National Dental Student Lobby Day!

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Last year I had a unique opportunity to attend ASDA National Dental Student Lobby Day. I was quiet nervous because I was the first person to represent Midwestern University-IL at this event. Last year, more than 300 students from all over United States came together for one goal of protecting the interest of our great profession. My favorite part of lobbying was having a one-on-one meeting with the representative from Illinois and getting his cosponsorship for one of the bills. We had multiple productive meetings with legislators regarding the bills ASDA was supporting. This year, ASDA is all set to host the 2015 National Dental Student Lobby day on April 13-14, 2015 in Washington, D.C. The agenda is as follows:


Day 1:

We will learn about the issues that impact dental students and get training on how to lobby to our lawmakers. Then we will breakout in our districts and develop lobbying strategies with other students. To end the day, we will be enlightened and motivated from a prominent keynote speaker.


Day 2:

It is the big day! We will visit with representatives and staff on Capitol Hill to lobby on behalf of dental students. The meetings are set and confirmed one week in advance with the staff members


We will be lobbying for two bills this year Action for Dental Health Act: H.R. 539 and Student Loan Refiancing H.R. 649. According to ASDA, Action for Dental Health Act: H.R. 539 will allows organizations to qualify for oral health grants administered by the Centers for Disease Control (CDC). And with these grants organizations will be able to provide dental services to underserved populations. This is important because this affects projects we work on all year like Give Kids a Smile, Missions of Mercy and many others.  Second bill is Student Loan Refinancing Act: H.R. 649, which will allow new dentists to refinance their federal student loans at any time during the life of the loan. Lobbying for cosponsorship on this bill is obviously important to all us as the average dental school graduates with over $247,000 of debt. More than 71% of us use federal loans to pay our dental school so we need to make the government aware of our large debt as new grads.


The beauty of ASDA is that you don’t have to be going in D.C. to raise your voice on these issues. It is important that all of us unite in our advocacy efforts through the Engage system. Engage is user friendly and allows you to write to your legislators to support the bills we are lobbying for via online. There are templates already written and just waiting your electronic signature to make a change! I look forward to being able to contribute in one of my favorite parts of organized dentistry, which is advocacy at the 2015 National Dental Student Lobby Day.

Assisting for Boards

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As a second year dental student at the University of Maryland, it’s hard to imagine myself being a candidate for The Commission on Dental Competency Assessments (CDCA) in just two years. The CDCA was formerly called the North East Regional Board of Dental Examiners (NERB). To become familiar with the CDCA process, I offered to assist a senior dental student as they challenged the patient clinical portion of the exam. Not only was I lucky to have the opportunity to assist a senior dental student for their exam, I was even luckier that the person I was assisting is my boyfriend of four years, Robert. 


Leading up to the CDCA exam, Robert had everything in order. All the paperwork was filled out and he had read the CDCA manual front to back with notes jotted in the margins. For the CDCA patient clinical exercise, Robert had to do one class two restoration, one class three restoration, and a periodontal exercise. In the few weeks before the exam, he had searched out three reliable patients with perfect “board lesions” that would fulfill the CDCA criteria for each of the sections.

The day of the CDCA exam started bright and early at 6:30 AM as Robert and I started to set up the operatory for his first patient. The first patient had a very small class two lesion. Robert prepared an ideal class two preparation on tooth #20 and when doing this he discovered that the lesion had started to extend slightly onto the occlusal surface. In order to extend the preparation onto the occlusal surface, Robert had to submit a modification of his preparation to the examiners before he could complete it. Once the examiners took a look at the lesion and agreed with the treatment plan modification, Robert was able to proceed with the rest of his preparation. When he was certain that his preparation was smooth and all caries were eradicated, the modified class two preparation was ready to be evaluated by the examiners. While the patient was across the clinic and behind a hung sheet being evaluated, I could see the uneasiness on Robert’s face and the restlessness in his body language. The waiting time while you are getting portions of the exam evaluated definitely did not help to make the day any less stressful. After about 25 minutes, the patient was brought back to Robert and they let him know that his preparation was approved and he was able to go ahead with the restoration. Once Robert was finished with the composite, the patient was again sent back to the examiners to be evaluated.


Robert completed his periodontal exercise in between treating his patients with class two and class three lesions. Roberts’s last exercise of the day was a class three lesion. It was a perfect “board lesion,” as the preparation was a standard G.V. Black preparation with a smooth composite filling. When this last patient came back from the evaluators with a stamp of approval on his paper, the Robert’s face showed more relief than words could ever illustrate.


After one of the longest days I’ve had in dental school, I can’t even imagine how long the day the day was for Robert. Robert’s only advice was to read the manual thoroughly. He experienced first-hand that the exam isn’t so much about whether you can prepare and fill a cavity, as it is about whether you can follow directions in a stressful situation. A few days after the exam, Robert received a passing evaluation on all portions of the CDCA and I couldn’t have been happier to be a part of this experience. 

Curriculum Vitae vs Resume

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So you have been asked to submit a Curriculum Vitae or resume.  What is the difference between the two?  What does each involve?  The three major differences between the two are the purpose, length, and layout.  Let’s start with the basics of each.  

Curriculum Vitae (CV)- detail, life, static

Curriculum Vitae, means “course of life” in Latin.  Therefore, a CV is a fairly detailed overview of your life: your education, accomplishments, publications, awards, honors, etc.  Because of this, CVs are documents that are edited and updated relatively frequently.  The length of CVs will vary depending on an individual’s stage in his/her life and career, but in general, they should be at least two pages.  CVs are “static”, meaning that only one document is used for all requests and is not altered for various positions.  

Resume- concise, specific, customizable

Resumes on the other hand are much more brief.  They give a concise overview of your experiences and skills applicable to a particular career or position that you are aiming to acquire.  Therefore, a resume needs to be catered to your audience, so to say.  You want your resume to emphasize particular skills and experiences that are most relevant to the situation.  In general, resumes are limited to one page and are accompanied by a cover letter, which identifies what and why the resume is being sent and to whom.  Because they’re short, the main goal of this document is to make a statement that allows you to stand out from you competition. 

So which do you submit when?  That depends entirely on the situation.  More often than not, the application will provide specific instructions regarding whether a CV or resume is requested. If you are unsure which is more appropriate, contact the school, employer, agency or committee who will be going over your application.  

If you are still confused or unsure where to begin, you are definitely not alone.  Here are some quick tips on how to begin:

  • Start Early | You can never start your CV too early.  As stated in the description of a CV, you want to have these documents updated so that when it comes time to submit, you don’t have to rack your memory and scramble to put something together.  After you finish volunteering on a Saturday or leave an awards reception banquet, add it to your resume.  If you don’t have your laptop on you at all times, chances are you have your phone.  Jot yourself a note to update your CV later to hold yourself accountable.

  • Edit | Reread your CV and resume several times before submitting it and try to have a friend,  faculty, family member or mentor go over it with you.  The more eyes that look at it before submission, the better.

  • Keep it Clean | Your CV and resume are reflections of you and your life’s work.  Keep that in mind when you choose your fonts, layout, margins, colors, etc.  There are several free templates online so that would be a great place to start.  Regardless of how you create your documents, your layout should be clean, concise, and easy to read. 

  • Categorize | Common categories include education, service, awards, publications, research, skills, and professional experience.  When choosing which to include on your CV or resume, think of what will showcase your strengths.  For instance, some individuals’ lives are centered a lot more around community service so they would want to showcase that under a category titled “Service” where as others focus more on research or writing published works, so they may want to have a category for “Publications”.  

Social Exclusion

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     Popay describes (2008) Social Exclusion as resulting “in a continuum of inclusion/exclusion characterized by unequal access to resources, capabilities and rights which leads to health inequalities” (p. 2). In dentistry, certain groups of people are excluded by lack of oral health knowledge, available nearby dentists, insurance coverage, transportation, and communication skills. During the two years I lived in Nicaragua I witnessed multiple families suffering with dental pain yet unable to see a dentist. Some of those families didn’t have the funds to visit a dentist. Others didn’t have basic oral health knowledge. For most of those families surviving each day was their main goal, oral health and dental pains were minor concerns. A lot of Nicaraguans are excluded from adequate dental care, but they are not alone in this struggle for access to resources. 

     While working as a dental assistant in Utah, I met a lot of Latino families struggling with Social Exclusion. Most of those families didn’t have insurance and could only afford the bare minimum of treatment. It was difficult to watch their children leave our office knowing they needed more care but couldn’t afford it. Furthermore, some of those families didn’t speak any English and had an impossible task of understanding all the important instructions from the doctors. It was even more tragic to watch multiple children receive dental treatment on all 20 primary teeth due to a lack of dental hygiene knowledge from the parents. More than just increasing access to care, dentists face others obstacles to decrease Social Exclusion as they try to run successful dental practices. 

     In Utah it seems like there is a dental office on every corner, like Subway or Starbucks. I understand that a lot of dentists prefer to stay close to where they grew up and have family. At the same time, dentists working in oversaturated markets usually tend to work extremely hard to compete against others just to survive and pay the bills. If these dentists spread out and traveled to rural towns and dared to serve underserved communities, then social exclusion would decrease. Furthermore, dentists can make a great living in small towns without the cutthroat competition of the oversaturated market in some bigger cities. Decreasing Social Exclusion is a complex process but worth the time and resources necessary to make a difference in the lives of people in need. 

     As clinicians we have the power and opportunity to help include these excluded communities. We have the privilege to care for those that would otherwise not be treated. In fact, a study by Lin, Huang and Zhang (2013) concluded that the “impact of social factors on social exclusion is stronger than the political and economical factors” (p. 641). If we build support systems and provide a welcoming experience in our offices, then we’ll help the excluded groups more than policy changing or financial resources.  


Lin, K., Xu, Y., Huang, T., & Zhang, J. (2013). Social exclusion and its causes in east asian societies: evidences from SQSQ survey data. Social Indicators Research112(3), 641-660. 


Popay, J., Escorel, S., Hernández, M., Johnston, H., Mathieson, J., & Rispel, L. (2008).Understanding and tackling social exclusion. Retrieved from http://www.who.int/social_determinants/knowledge_networks/final_reports/sekn_final%20re 

Facebook’s Unexpected Role in the Dental Curriculum

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    Typically when the words “social media” are uttered to a dental student, the initial thoughts surfacing in our minds involve protecting our professional reputations and upping our privacy settings. However, there is another component of social media that plays a large role in our dental educations, which we often fail to acknowledge: using social media as a learning device. We pay an arm and a leg for dental school curriculums, spend countless hours in didactic lectures, but often our best resources come from our peers.  

    Imagine it is the night before a big exam, worth a large percentage of your grade. The lecture material is nothing short of overwhelming and you are on the verge of throwing in the white flag of surrender. Yet like magic, your classmate with exquisite Microsoft Excel skills posts a file in your Facebook group, and suddenly the material all falls into place. A cascade of “thank yous” and “likes” trail from the post as your fellow classmates echo their gratitude. Does this sound familiar to you?

    Nichole Fishbeck, class of 2016 dental student at the University of Texas School of Dentistry in Houston, researched how her own class’s Facebook group played a role in the day-to-day lives of their dental education. Within the first two years of dental school, the students accumulated a total of 5,833 posts. Out of that,  ~30% was categorized as “educational resources” (reviews, links to YouTube videos, direct answers to questions),  ~32.5% classified as “confirmatory” (administrative aspects such as lecture times changed or assignment due dates), ~1% labeled as “collaborative learning module” (Google documents or polls), and ~38% social posts.  A strong correlation was shown between exam weeks involving 2 or 3 tests and an increase in the total number of posts. Before you decide to go on a Facebook hiatus to study for finals week, realize that this Internet resource could pose as a valuable study tool.

    From a psychological standpoint it was found that Facebook, as a learning tool, promotes self-efficacy, and the more students believe in their abilities to master a task, the more likely they are to succeed. Social networking sites provide students the opportunity to autonomously control and direct their studying. Enhancing autonomy is beneficial not only because it increases students' engagement, but also because it simultaneously reinforces self-regulated learning strategies (Bowers-Campbell).

    The classroom is simply a setting, while most of our learning develops outside those four walls. Many curriculums have evolved to incorporate more peer-learning, as literature indicates this arrangement promotes higher cognitive thinking. Thus, we as students get assigned mandatory group projects and clinical discussion groups, which can be deemed “unenjoyable” and “old-fashioned” (Havnes). What professors seek to achieve, but fail to reproduce, is the self-monitored environment that naturally occurs via social media. 

    Usually, this learning atmosphere is an unconscious phenomenon we do not notice is taking place.  A classmate posts a question addressing lecture material, and as peers work together to correctly answer, they take on a reciprocal role as “educator.” By collaborating, communicating, and contemplating the question at hand, students achieve a more thorough knowledge of the subject and may even seek supplemental resources for details. 

    Next time you accuse Facebook of being your ultimate tool of procrastination before an exam, remember it can also be your most valuable study resource (ironic, right?). 


  • Bowers-Campbell, J., 2008. Cyber “Pokes”: motivational antidote for developmental college readers. J.Coll. Read. Learn. 39 (1), 74–87. 
  • Havnes, A., 2008. Peer-mediated learning beyond the curriculum. Stud. High. Educ. 33 (2), 193–204.