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Blogs

THE NEXTDDS Student Ambassador Blogs

What are the effects of inhalation therapy on the oral cavity especially in the pediatric population?

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Asthma is a chronic inflammatory disorder of the lungs characterized by obstruction of airflow that causes wheezing, breathlessness, chest tightness and coughing. The prevalence of asthma in pediatric patients in 2014 according to the CDC was 8.6%. In children, asthma accounts for millions of schools days missed and millions of dollars for caretakers to take care of their children and days lost at work.

Inhalation therapy has been the main treatment for patients with asthma. Albuterol (Proventil, Ventolin) is used for acute asthmatic attack (bronchospasm). The action of the drug is bronchodilation since it is a beta-2 adrenergic receptor agonist.  Studies have shown that inhaled drugs have effects on the oral cavity based on dosage, frequency and duration. Management of these drugs and the oral cavity is important to keep pediatric patients caries free.

The use of inhaled medications increase the risk of caries and xerostomia. Use of beta-2 agonist is associated with an increase risk in caries because it effects salivary production. Prolonged use decreases salivary flow because the beta-2 receptors in the parotid and minor salivary glands are inhibited. The decreased salivary flow, which causes xerostomia, creates an environment with low pH and bacterial changes. The low pH affects the oral cavity negatively because it increases the risk for demineralization, which makes teeth more susceptible to caries. The changes in the oral cavity with lack of salivary flow brings rise to more bacteria such as Strep. mutans, which attacks the demineralized oral tissue. The saliva that usually flushes out the food retained in the mouth after eating is reduced or absent. So the reduced pH, food retention and bacterial change ultimately creates the perfect environment for caries.

Clinical management of these patients can include daily changes to increase salivary flow and keep the oral cavity moist. Frequent sipping of water, intake of a sugar free moist diet, chewing xylitol gum, rinsing with chlorhexidine are some management methods.  The parents and patients should be informed of the possible effects of inhalation therapy, the patients should be placed on a frequent recall with fluoride varnish and sealant placement.  Oral hygiene needs to be greatly emphasized and rinses to keep the oral cavity moist should be used. 

The Power of Service!

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As dental students in California, we are held up to certain laws when it comes to community service. According to the new AB-880 law that went into affect this January, we are now allowed to have fourth year students see patients for screenings and procedures at health fairs through community service. In previous years, we were limited to only providing verbal health care. However, other than fourth year students, all other volunteers are constricted to oral hygiene instructions and nutritional counseling.

 

From the outside looking in, I think is there even a point to participating in health fairs? The answer is most definitely yes. It is unfortunate that we are limited to this but as they say, always make the most of what you have.

 

The power of small things such as teaching a kid how to brush their teeth or providing our geriatric population with agents to clean their dentures can go a long way. In order for us to make a difference, we always have to start small. This is where everything starts.

 

I have compiled a list to help any dental service organization make the most out of their health fairs.

 

Have a lot of props. Having those big mouth props to show kids how to brush and floss their teeth is really nice. After they practice on the model, give them a mirror with a toothbrush and floss to practice on themselves! Reward them with a sticker afterwards. Kids get really excited and enthusiastic with rewards!

 

Pamphlets! “How to take care of your kid’s teeth.” “When should your child first go to the dentist?” “How pregnancy can affect your dental hygiene.” These pamphlets are readily available from dental corporations or your school. They give parents a chance to take action for their kids and their mouths. They also give parents a chance to explain topics in much more depth if volunteers feel like they don’t know how to explain the topic to its fullest extent. Have giant posters with pictures of gum disease progression or cavities. This helps put a picture to a name so it becomes easier for patients to get an idea of some of the negatives that can happen from lack of oral hygiene.

 

Donations! Talk to your regional rep from Crest, Colgate, Johnson and Johnson, GSK and many more. Have a donation request letter ready to go with contact information. Being able to give these out at service events goes a long way. A lot of these people don’t have the means to afford some of these products, so this is just one way to help them with their oral hygiene care.

 

So how do you get involved? Talk to your local religious centers, health centers, schools, and recreational centers about any health fairs they are planning to put on and ask if they have room to put you on as a vendor. It is usually free of charge and students can gain community service hours from the event.

 

Dentistry is moving towards preventive measures. Be sure to know where you stand in this. 

21st Century Hiccups

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    In dental school you will have conversations with patients in which you have to deliver bad news.  It may be a tooth is nonrestorable and needs to be extracted, an area of recurrent periodontal disease requires surgery, or an asymptomatic, endodontically treated tooth your endo professor unhesitatingly determined needs retreatment due to a tiny void in the obturation. Whatever the problem may be, the news is unfavorable for your patient, and you have to sit down and help them understand the change in treatment.  

 

    This conservation is important.  Despite the general public’s skepticism about dental work, you want to maintain the rapport you built with your patient.  You want them to understand you are treating them with their best interests in mind. However, when a patient is told it is going to cost them $1300 to retreat and recrown a tooth that doesn’t bother them, patients tend to get skeptical.  

 

    In order to avoid this, we over explain procedures and the rationale behind them. I have found myself dragging on conversations and justifying treatment well past what is needed. Sometimes I will continue on well after patients have accepted the new treatment plan. More concerning, I found myself using phrases, or hiccups, which steal from the confident and professional chair side manner of an established provider. Upon this discovery, I began compiling a list to help avoid using these phrases in conversations with patients. The more I keyed onto my own hiccups, the more I heard them throughout my classmates’ operatories in clinic.  I was not the only person cluttering my speech these unnecessary phrases. The most notable that made the list are the following:  

 

  • kind of 
  • sort of 
  • probably 
  • possibly 
  • stuff 
  • I guess 
  • I feel like 
 

 

    Standing alone, they seem relatively harmless. However, when you tell a patient, “this tooth probably needs a root canal,” when you just diagnosed irreversible pulpitis and symptomatic apical periodontitis, “probably” isn’t a necessary word. In fact, it leaves the door open for the patient to question the treatment altogether. Most patients will not be skeptical or question your clinical judgment. But, eliminating the habitual use of hiccups will mature your communication skills and force you into thinking about what you say before you say it. 


 

Sound Body, Sound Mind

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There is a long-standing stigma that dentists are strong-willed, independent, and unwavering healthcare providers. We are even viewed as leaders in some communities. Day in and day out, we provide for others and put their needs before our own. However, we must also acknowledge our own needs and fulfill them accordingly. We must first establish our own mental and physical health before seeing to the health needs of our patients.

            Dental students experience some of the same issues as practicing dentists. Balancing dental school with life’s daily demands is not always an easy task. Extracurricular activities, applying to residency, doctor’s appointments, visits to the mechanic, catching up on lab work, and soon the 8 to 4 schedule turns into a 15-hour day. What previously was a manageable schedule quickly turns into a game of teeter-totter.

            I am a firm believer that if one doesn’t take care of his or her health, then they cannot adequately care for a patient’s health. On that note, it is important to start building positive and healthy routines while we are still beginning the dental profession. The same habits we build now will be the ones that bring balance to our lives and complement our life as clinicians. No matter if your balance comes from physical, mental, or spiritual exercise, find something that brings you sense of peace and incorporate it into your daily routine.

            The other component to taking care of your body and finding balance is fueling your body with the proper nutrients. In the busy life of a dental student, it is all too easy to eat fast food. From personal experience, I can attest that garbage in results in garbage out. I ate fast food for several days of one week this past quarter. When the weekend hit, I had no energy and crashed. Sticking to a strict diet is not necessary, but healthy, balanced meals and limited sugar intake will give your body and mind the energy to last the day. In addition, limiting alcohol consumption on the weekends and maximizing water intake will aid in mental focus.

            If dentists are viewed as strong leaders, it is only fitting that they act the part. In the same fashion, we as students should practice shouldering the roles and responsibilities that will soon beset us. Learning to live a balanced life and taking care of our bodies now will only prepare us for our future. Learn to incorporate whatever fuel your body needs for you to feel balanced and healthy. Practice healthy living now so that you can share that health and wellness with your patients. 

The Dental School Implant Experience: Too Much or Not Enough?

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Like many schools, the Advanced Pre-Doctoral Implant Program (APIP) at my dental school allows a select number of 4th-year dental students to place dental implants under postgraduate supervision. Some might perceive undergraduate implant training as an incredible opportunity to learn, while others might raise concerns about patient safety and outcomes. This blog post is designed to provide insight into the University of Illinois at Chicago College of Dentistry’s implant curriculum, and to assert that advanced implant education is an essential component of modern undergraduate dental education.

UIC’s first-year curriculum is composed of anatomy, histology, physiology, and fundamental principles of dentistry. Second year is largely spent in lectures and pre-clinic, where we are introduced to the science of dental implants among all other pre-clinical topics. Pre-clinical implant exercises are completed on stone casts. During third year, we assist in implant surgeries and complete the restorative process. During fourth year, UIC students are required to complete a specific number of implant restorations. Students accepted into APIP have the opportunity to place and restore implants. Implant cases must be approved and assigned by our implant committee, which comprises faculty specialists. Indeed, numerous levels of supervision nearly eliminate gross errors in implant treatment planning, thereby improving implant outcomes.

Early exposure to implant dentistry improves new dentists’ abilities to select cases appropriate for their level of training. There is no such thing as a “straightforward” implant. Treatment planning for implant surgery must take into account, among many factors, the individual’s anatomy, health history, quality and amount of supporting tissues, existing dental condition, space, and restorative plans.

Supervised implant training does not give recent graduates the idea that they are adequately trained to place implants. I believe that advanced implant training achieves the opposite, and helps new dentists identify red flags before considering implant therapy for patients. Therefore, as patients become more informed about implant therapy and the demand for dental implants increases, dental educators should embrace and incorporate pre-doctoral implant training in their curricula.

Licensure Exams: Getting Prepared

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Licensure exams are the terrifying but inevitable fate of all dental students. Financially, they cost thousands of dollars but they arguably cost more emotionally. The high stakes of this one-time, costly, patient-based exam is enough to give you a few grey hairs. Readying for this exam often requires many months of preparation.

First and foremost, decide which exam you’re going to take. There is no universal licensure exam; each state sets its requirements and its clinical component is your licensure exam.  Regional testing agencies, such as WREB (Western Regional Examining Board) and SRTA (Southern Regional Testing Agency), come into most dental schools and administer the examination. Not every school gives every exam, so check with your school to see which one it offers. Some students have to travel to other schools to take their desired exam. To find out what exam your state accepts, do some research in advance with the individual state boards.

Once you decide what exam you’re going to take, get to know the candidate manual. Eat and
sleep with that little guide, because more than half of the challenge is the paperwork and protocol. The guide will tell you everything from the time you can be in clinic to the way to handle a pulp exposure and the breakdown of treatments.


As far as what treatments are required, all exams vary. Some exams have treatment planning 
exams at testing centers, some require scaling and root planing, and some require crown preps.  Also, look at the endodontics section and determine if you need to start saving extracted teeth.  The WREBs are unique in that they require you to perform root canal therapy on two extracted teeth as opposed to plastic teeth in other exams. Once you decide what exam you’re taking, be sure to ask local dentists to save teeth for you.

Finally, and most importantly, is patient selection. Search for patients who have the qualifying lesions and calculus as noted in your exam candidate guide. Beyond the patients meeting this criteria, make sure you get a patient with a good personality. It’s just like dating! Someone who is great on paper could be a total failure once you get him or her in your chair. You need a patient who is reliable, calm, agreeable, and tolerant. If you can get a family member or friend who you know will show up on time, that is optimal. If not, try to look at the patient’s history for any red flags including no-shows, lots of bathroom breaks, chatty behavior, etc. The most important thing is to have an open dialogue with the patient. Letting them know up front how important this exam is and the time commitment involved will help establish communication.  Getting a reliable patient is just as important as getting a patient with a good lesion. Remember, your patient has to show up and stay the entire length of the exam if you want to pass.

Licensure exams are scary, but it’s something we all have to do if we want to practice. If you’re organized and prepared, you’ll be halfway there.

3 Dental Insurance Plans to Understand

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One of the most exciting things that many of us have to look forward to is being part of a private practice. This can come in many forms: ownership, associateship, or variations of the two. Whether you plan on buying a practice, starting your own, or just working for one, it will be crucial to understand the basics behind the business of dentistry. This will come into play every day of your practice. I recently had a class in dental school called Practice Management in which I learned some extremely valuable things that I thought would be useful to pass along. One part in particular is understanding the basics of dental insurance.

 

 

The Preferred Provider Organization Model

In order for a practice to run, there needs to be an ample supply of patients. There are several ways to attract new patients. One of the most common ways to do this is by accepting different insurance plans. In the Preferred Provider Organization (PPO), for example, the insurance company has a set rate for which it will reimburse the dentist for each procedure, with the patient responsible for the remainder. This portion is called the copayment, or simply “copay.” There are many variations of PPO plans out there, so it is important to read the fine print in these contracts. Here is an example of how one might look: If a dentist charges $1,000 for a crown, the insurance company might say that he or she can only charge the patient $800 for this restoration. The insurance will then pay 50% to the dentist, leaving the remainder for the patient to pay. In most cases, the dentist is responsible for collecting this fee from the patient. This scenario is a good example of how insurance companies get customers—promising lower rates for dental treatment. In this scenario, instead of paying $1,000 for the crown, the patient only has to pay $400.

 

Understanding Capitation Plans

Another style of insurance is called capitation. In a capitation plan, the dentist will receive a set dollar amount per patient per month. When a patient with this plan needs treatment, the dentist does the treatment at no extra cost to the patient. Sometimes, however, the dentist will receive additional payments per procedure, depending on the plan. Say, for example, that the dentist receives $10 per month per patient in this plan. They have 100 patients, which yields $1,000 coming into the practice per month. During this month, one of these patients needs a crown. The dentist's fee is normally set at $1,000, and at least one third of that fee is for the lab costs alone. That means if more than one of his or her patients needed a crown each month, they will quickly start to lose money. Taking also into account the regular exams, cleanings, radiographs, and fillings for these patients, it is easy to see that the dentist could potentially catch the short end of the stick and end up doing dentistry for free, which is not sustainable. Unfortunately, dentists often have to limit the amount of patients they will see in this plan, so it can be very difficult for patients to schedule an appointment. Also, patients may not receive the treatment they need, simply because it will cost the dentist money to do so.

 

Governmental-Sponsored Insurance

The last option is the government-sponsored dental insurance. This is administered on a state-by-state basis and can vary in what is covered. For example, in California, the standard coverage for adults is one FMX every five years and one exam and cleaning (adult prophy) each year, along with resin or amalgam fillings, extractions, and anterior endodontic treatment. Coverage can also vary by patient age and is an important topic politically as well. Unfortunately, the people who have government-sponsored insurance rarely have money to pay for anything else like crowns and posterior root canals. This results in many salvageable teeth getting extracted or oversized fillings being placed.

Obviously, we don’t live in a perfect world and insurance has a strong tendency of dictating treatment plans. However, with having a basic understanding of these plans, it can certainly help the dentist to guide the patient to make the best choice.

Faculty Influence on Professionalism in Dental School

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As a fourth-year student in the home stretch towards graduation, it was only fitting that one of our last assignments required students to compose an essay discussing ethical and professional dilemmas we have experienced in our four years of dental school. This assignment comes at a time of high stress when some students may be willing to push limits and cut corners in order to make deadlines work.

Like many of my classmates, I initially viewed this essay as an outlet for my emotions and was ready to start pointing fingers at peers acting in a “shady” manner. However, as I began to truly evaluate and analyze the scenarios of classmates, I realized the disconnect of right versus wrong stemmed from their surroundings Our most significant influence of professionalism in our beginner clinic years comes from the clinical faculty working alongside students.

            From the moment we step onto the clinic floor in our second year, we look to faculty for guidance in every department—including patient interaction and deliberating treatment plans. Those we respect the most tend to be the individuals from whom we develop habits, and even pick up a few of their quintessential phrases and jokes along the way. Admiration for such mentors fuels our own desire to be perceived as professional in our own patient’s eyes. The debate of whether or not ethics and morals can be taught in a classroom is an argument of psychologists dating back centuries. Yet, like most skill sets, habit formation is learned through practice and repetition. Thus, the need for faculty that drive students to form critical-thinking behaviors is imperative.

            In a tumultuous time of our dental education fulfilling requirements and deadlines, it is easy to succumb to the pressure and take a detour off the high road. Students need to have the strength to stop and assess their behaviors and possible consequences. Ask yourself, “Is this what is best for the patient in the long run?” or, “Is this what Dr. So-And-So would perform?”

Once across that graduation stage with diploma in hand, you are now granted the long-awaited title of doctor. No longer under the auspices of another person’s license, you (yes YOU!) are now responsible for every patient interaction and every treatment decision (No pressure!). It is critical to continue the positive development of professionalism and ethics as we advance in our careers. Our ethical foundation is established in dental school and continues to be influenced in the future by our colleagues or co-residents.

Dr. Timothy Kosinski advises: “What’s the trick in creating a successful and ethical dental practice? Listen to your patients; plan a course of action according to your clinical education; communicate your thoughts so your patient understands the process, benefits, and risks; and know that the treatment you provide is what you would give to a close family member in the same situation.” Now is the time to decide to be honest, professional, and ethical in all that you do. This integrity gains patient trust, which translates into more acceptance of treatment plans, your own peace of mind, and greater fulfillment in the care you deliver.

Overhead Expenses for a Dental Practice

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Budgeting for a dental practice is a delicate task that must be done properly in order to establish a lucrative business. Furthermore, it is critical to control overhead in order to achieve long-term success. The main components of overhead include 1) payroll, 2) lab costs, 3) occupancy costs, 4) supplies, 5) advertising, and 6) administrative fees.


Payroll includes employees’ salaries, worker’s compensation insurance, etc. Ideally, payroll should be kept at under 25% of the total budget. By keeping payroll under 25%, it is possible to give benefits or bonuses when deserved. This should be a fixed expense, but should leave room for flexibility when necessary.


Lab costs should be kept below 10% of the total. This varies depending on how much crown/bridge work is done at the particular practice. However, using an out-of-area lab (that may be cheaper than local labs) can reduce costs. Lab fees will vary greatly, depending on the practice’s emphasis on specific prosthodontics procedures.


Occupancy costs include rent, maintenance, mortgage, etc. This value should be kept at around 5% of the total budget. Occupancy costs are not variable. The cost of supplies is also fairly non-variable. Supplies, including both dental and office supplies, should be kept at around 10% of the total.


If an office chooses to partake in advertising, it should be kept at 1% to 5% of the total. This cost is variable since a practice’s needs may change periodically. Nevertheless, the benefits of effective marketing usually far outweigh the initial investment. Lastly, administrative fees include all miscellaneous costs not falling into any other category. These may include CE courses, equipment repairs, or professional fees. Although the month-to-month expense may vary, it is reasonable to estimate this category to remain around 10% of the total budget.


Once overhead is accounted for, approximately 20% to 25% remains for the doctor’s salary and another 20% to 25% remains for retirement/reinvestment. While this approach can be customized by each practitioner, keeping overhead as low as possible, without compromising quality, is an excellent approach for financial success.

Treating Patients with a History of Recreational Drug Abuse

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Mr. A is a 36-year-old Caucasian male who was eager to improve his dental health. He presented to the University of Maryland Dental Clinic in June 2015 with the chief complaint of, “My front teeth hurt and have holes at the gums. They bleed when I brush my teeth or eat.” He is a current cigarette smoker and stated that he has been smoking about one pack of cigarettes per day since 1998. Otherwise, Mr. A has a non-contributory medical history. 


Mr. A has a significant history of drug abuse. Currently, Mr. A states that he is two years clean, living with his mother, and trying to get a job. Mr. A revealed to me that his drugs of choice were meth, cocaine, and heroin. Mr. A’s disease control phase of treatment began with scaling and root planing for his chronic periodontal disease. The local anesthesia that I had administered was not effective and, being new to clinic, I thought it was my technique. After administering almost every anesthesia technique and block we had learned, multiple attending faculty doctors attempted to anesthetize Mr. A. Eight carpules later, Mr. A had hit the maximum dose for his weight and we had to re-schedule his scaling for another day.

 

At his next appointment, I thought I had a bad case of déjà vu, as Mr. A could not be anesthetized despite multiple faculty members and I doing everything possible. Difficulty with achieving local anesthesia for current or previous recreational drug users is common. There is no current scientific evidence for this observation, but it is hypothesized that these patients may have an altered sensorium and a lower pain threshold.[1] 


Due to financial concerns, having all of his dental work done in the surgical operatory under general anesthesia was not a possibility for Mr. A. Our last option was to use nitrous oxide. Mr. A stated that he had used nitrous oxide before recreationally. The first appointment with nitrous oxide was a great surprise as it, along with local anesthesia, was successful and allowed me to scale and begin Mr. A’s restorative work.


The difficulty that Mr. A experienced with anesthesia forced me to try new techniques and problem solve. Over the next couple months, Mr. A presented for his restorative appointments and was treated under nitrous oxide at every visit. I became proficient in the administration, side effects, and contraindications of nitrous oxide. Due to the experiences I had with Mr. A, I will feel very confident using nitrous oxide for my patients in the future.


I learned a lot from Mr. A’s case and, looking back, there is nothing I would have done differently. I am very thankful that we chose to use the nitrous oxide before sending Mr. A to the operating room for his dental work. This choice not only helped Mr. A financially, but it also was a better option for his treatment. Mr. A was able to be involved in his treatment and was presented with options and alternatives as it was performed. Mr. A is still being maintained at the dental school but his entire outlook on life has changed as a result of the dental care I provided for him. It really was an eye-opening experience to be able to see the improvement in Mr. A’s confidence every time he came back to the dental school throughout his treatment.

 

Reference 

El-Sisi RW, El-Bagoury EF, Mahmoud ET, et al. Pain threshold, C-reactive protein and efficiency of local anesthesia in addictive drug abusers with impacted lower third molar tooth. 2012. 1:430. doi:10.4172/scientificreports.430 

Why Everyone Should Get Involved in Organized Dentistry!

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   Over the past year I have had the privilege of serving as ASDA president for my dental school chapter. Through this experience one of the things that has become painfully apparent to me is a lack of understanding of what organized dentistry is, its history, and why it’s so important for dentists young and old to get involved. The American Dental Association was founded in 1859 and today serves as the nation’s largest dental association with more than 159,000 members nationwide. The American Student Dental Association was founded in 1970 and today represents the voice of 90% of all dental students in the country. Although I am partial to the ADA and the ASDA there are many other special interest dental groups and student dental groups to give voice to specific concerns. With these organizations and the umbrella organization of the ADA and ASDA we can present with a unified voice. 

    Organized dentistry is a platform that allows dentists and dental student to come together as a collective and give voice to our opinions to help shape the future of dentistry. Dentistry is such a distinct profession and only dentists or dental students can truly appreciate the challenges of practicing dentistry and it is our duty to the profession to voice our opinions to ensure a bright future for dentistry. Today the profession of dentistry is changing rapidly with the reform in student licensure, use of midlevel providers, introduction of corporate dentistry, and so many other changes. It is our job as dental students and dentists to join our local association and voice our opinion on these issues to make sure the future of this profession is protected.  Writing from a student’s perspective, one of the more recent issues that have really gained traction with both the ADA and ASDA is the concept of student debt. According to the American Dental Education Association the national average dental student debt is approximately $247,227 with many students reaching almost double that amount.  So why is it so important to get involved? With so much student debt many students are turning to different models of practice in order to pay of their student debts. The increasing amount of student debt is directly affecting how new dentists practice dentistry and where they practice dentistry. This high debt is preventing young dentist from pursuing careers in rural areas or public health due to financial reasons.

    So what is the ADA and ASDA doing about it? Currently ASDA and the ADA have been working diligently together to combine the voice of dental students and dentists alike to express the need to drive down the costs of dental schools and provider alternative payment methods for graduating dentists. The ADA has recently introduced the DRB student loan refinancing option, allowing students to refinance their debt with Darien Rowayton Bank at interest rates starting at 1.88% APR variable or 3.25% APR fixed. Although this option isn’t the solution to all our student debt issues it is a step in the right direction.

The above mentioned is just one example of how organized dentistry is working to improve the lives of dental students, dentists and the practice of dentistry. However, these efforts are all in vain if we as a collective do not become educated in the issues and become engaged in organized dentistry. A more educated and engaged group of dentists and dental students allows for a stronger voice in the ADA and ASDA, allowing our profession to have a stronger voice as a whole. 

Treatment Plan Compliance

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    As a third year dental student, I have learned that one of the toughest things to do as a provider is to get your patient to understand what their treatment plan means and why it’s so important to follow through with it. Many patients coming into the dental office are already on edge and often have their guard up. The general perception is that dental work is expensive and a lot of times patients have a hard time understanding why their dental work is required and why it costs so much. As a dental student I have the luxury of providing care at reduced fees, but even this can be a tough sell, I can only imagine how difficult it could be to have patient compliance when their bill is almost two to three times as much. 

 

    Here are the top three tips that I have begun implementing to increase patient compliance. The first thing is pictures, not radiographs but actual intraoral pictures. Too often, I see colleagues trying to explain the patient’s treatment plan with radiographs, something I am guilty of as well. The greatest response comes when the patient sees something they can understand, they are not trained to read radiographs and while you are pointing to the little black triangle going from white to grey, they become lost in the science. When I take a picture and show the patient the decay, it’s an immediate trigger; they never knew they had that hole in their tooth or that it had this black sticky spot. This “see it to believe it” method has really helped my patients understand the need for their treatment. The second tip is study models, takes an impression and uses the model to explain why their fractured tooth can’t be restored with just a filling. Finally, break the treatment plan down into phases. Explain to your patients the thing that need to be done immediately and things that can wait. The price tag associated with comprehensive dental care can be scary and can cause “sticker shock”. They see a $3,000 bill and immediately shut down, they can’t wait to get out of your office and never see you again. But if you take the time to break it down for them explain their first phase of treatment then the next chunk and so on, the patient can digest the total cost of care and will be much more likely to begin treatment.

    As we all progress from our time in dental school to private practice, we need to understand the causes for patient’s noncompliance with treatments and address the issues. Take the time to speak to your patients about what it is that worries them the most when visiting the dentist and slowly start to break down the barriers. At the end of the day we are all there to help our patients live a healthier and happier life. Getting them to understand their needs and committing to the plan you have set together will allow you to have a sense of satisfaction that can only come from knowing you have made a positive impact on someone’s life.  

Lasers in Dentistry

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One of the most intriguing parts of dentistry is the rise of technology within the field. Some of the most traditional materials and methods are being replaced by new technologies. We have all seen the rise of digital impressions, and although they have not completely eliminated alginate or PVS, they have definitely made their way into the arena. Who would have thought—no more “goop” or ear-piercing, nerve-twinging dental drills at the dentist! Sure, the complete elimination of the high-speed dental handpiece may never come, but some would argue that lasers may give them a run for their money. Nonetheless, lasers have entered the field of dentistry in more ways than one.

 

            The first time I saw a laser in action was during a final impression for a crown. The periodontist brought the diode laser over and told me to forget about packing any cord. He proceeded to trough the gingiva around the prepared tooth with the laser. Miraculously, the tissue was cauterized with no blood and crystal clear margins. It led to a flawless final impression. Even fancier, the next time around we used a digital scanner to take the impression.

            After seeing this, I couldn’t believe how simple it was to use this powerful little red light. I couldn’t wait to try it out again. Luckily for me, I had an anterior crown case that needed some gingival re-contouring. After a handful of sweeping strokes to the gingiva of the central and lateral incisors with the laser, the patient now had perfect gingival harmony leading to a better smile.

            While my experience has been very slim, my interest with lasers has certainly peaked. There are several applications that I have been taught in school, most of them dealing with periodontics. For example, sulcular curettage, Laser-Assisted New Attachment Procedure (LANAP), root planing, and, as mentioned, gingivectomy. However, soft-tissues are not the only ones to receive the laser beam. Hard tissues such as enamel, dentin, and bone are also being exposed. Why not cut that cavity preparation with a laser? Are implant osteotomies that far-fetched for lasers?

            There are several advantages and, of course, disadvantages with the lasers. They can significantly reduce the amount of anesthesia needed. Some even argue that wound healing can be faster and less painful compared to traditional surgical incisions. However, these little light beams can be expensive, and they certainly can’t be used in every case.

            What has been your experience with lasers in dental school? What other applications have you heard of?

 http://thenextdds.com/Videos/Soft-Tissue-Lasers---Gingival-Troughing-for-Impressions/

The Plight of the Fourth Year Dental Student

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During my fourth year I felt as though there was this overall expectation of excitement because the end is near! There is this perception that finalization of the 4 year curriculum of studying and sacrifice equates to happiness and success! While there may be some truth to this for some, this is not always the truth for all. Lately, I have been meditating and trying to gain an understanding of why one person may be truly happy verses others who are not and I have realized a few things. The areas of spirituality, organization and a purpose plan contribute greatly to ones perspective of moving forward and thus... if you make the CHOICE to embrace your current position in life, you can aim for true happiness in your career and overall life.

 

Closing a major chapter of one’s life and opening a new one can be exciting to some, while extremely scary for others. Yeah, we all know that as dentists we will be fine financially but everyone is not always motivated by money. This is where spirituality can be enlightening. The term spirituality can be touchy in this world because people automatically default to religion. I am in no way discussing religion. When I mention the term spirituality I am speaking on an internal source of who you determine your higher power is and the personal relationship that you have with that “source.” It is with that source that you find inner peace because of the constant interactions that you have with that source. Prayer, meditation, etc help you release the stress of the world and mentally you can move forward with an understanding that whatever happens next, you will be taken care of by that higher power.

 

People who are organized always seem to be less stressed. They have their calendars with all important days highlighted and they check it over and over again to make sure that they get things done. This has certainly been my year of the “to do list.” The problem is that I feel like there is so much to do with time literally getting shorter to achieve these things with each passing day! The key is to organize your thoughts. Write things down and/or enter them into your google calendar and pace yourself so that you hit all of the important major deadlines before time if not on time! There are several things to consider so make sure that you cover all of your bases prior to graduation and beyond.

 

A “purpose plan” is a plan that you make prior to graduating to determine what you plan to do in the foreseeable future that ultimately align with the plans that you reasonably see for your life. This is a short term plan that will allow you to organize your thoughts of what you want and determine the actions that you must take to get there. This is in fact setting “working goals” to keep you encouraged prior to and after graduation.

 

Life if full of ups and downs but the happiest people are those who are truly determined to be happy no matter what! Regardless of where you are in your journey today, that does not have to dictate where you will end up! Make the choice to be more organized and truly embrace this time in our lives because in all actuality, this is a time, moment, and memories that we will never get back! Congratulations on your achievements and I look forward to seeing you on the other side!

Have a Mentor, Be a Mentor

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Like many first-year students, when I first stepped into the clinic to see upperclassmen working so calmly on their patients, I was very intimidated. I could not believe that I would one day be running a handpiece as I drilled into the decayed tooth of a live patient. I even remember talking to other first-year dental students about our lack of confidence in the clinical setting. Each time I had to walk through the clinic, I remember that feeling of intimidation. One day, we were introduced to our third-year mentors. My mentor was the first person I assisted in the clinic. During the appointment, he explained the different steps of what he was working on, such as adjusting wax rims for a complete maxillary and mandibular denture.

 

While I had no idea what he was doing, the fact that he explained it to me in the simplest terms made me feel that maybe I could actually become a confident provider. Each time I passed him in the hall and had a short conversation about the clinic or how difficult my course load felt, my confidence increased. These short conversations really cost him nothing but a few moments of his time, but made a world of difference to me. When he graduated, it was disappointing to know that I wouldn’t get to see him and get his advice. Then something inevitable, yet surprising happened a few months later, as I was assigned to be a mentor for a first-year student. I have only seen and talked to him a few times, but I already feel like we have a special rapport.

 

Dentistry is complicated. There are conflicting opinions and thousands of research studies about different materials and procedures. I can only imagine how difficult it is for dental schools to stay on top of so much information and change. Having a mentor and being a mentor will always be necessary to the practice of dentistry. Every dentist needs to be constantly learning and growing as technology advances, but he or she also needs to be pragmatic. Ultimately, the focus must be on patient care. It is my belief that in order to do this we need to learn from those who have more experience.

 

The truth is, to provide the best care for patients, we should always strive to be both a mentor and a mentee. We should be humble and accept the reality that as long as we practice dentistry, we need to be learning. By having a mentor and being a mentor through school and career, we gain the benefit of experience, and give back by serving each other.