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Blogs

THE NEXTDDS Student Ambassador Blogs

Student Involvement in Dental School

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Dental school can be a tough but rewarding experience for many of us. It can be an emotional rollercoaster of ups and downs with varying levels of stress and pressure. With that said, the key to a pleasant dental school experience is balance.  The involvement of students in extracurricular activities is very important in the overall dental school experience.   Dental school is definitely not a place where you want to feel alone and isolate yourself because no one will understand your struggles like another dental student. There a lot of opportunities and different ways to get out there and get involved. Community service event are always a great way to mingle with people while doing something for the greater good. Involvement in activities and events are also a great way to take a break from the curriculum and to release some stress Involvement in student organizations is another great way to be active outside of school. Student organizations give students the opportunity to learn skills that aren’t exactly integrated into the curriculum including but not limited to leadership experience, event organization experience, and a sense of family orientation within the dental school. I believe that involvement in these types of things enriches the whole dental school experience. There are organizations like ASDA (American Student Dental Association) and SNDA (Student National Dental Association) that offer insight of dentistry from a political standpoint as well as knowledge of how organized dentistry works. Large organizations like these can also offer unique opportunities and discounts through their membership including but not limited to discounts on car insurance, free disability & life insurance and more. In addition to all of that these organizations offer plenty of networking opportunities with practicing dentist and dental relate companies through social events and conferences. Specialty interest groups offer unique information tailored toward different aspects of dentistry as well as help students to navigate the residency application process for their specialty of choice. Other ways to relieve some stress and take your mind off the books is to exercise. Exercising can burn a lot of energy and help with focus. There are often times where you can find classmates to work out with you and make it a group effort and regularly scheduled activity. The bottom line is too much of anything can harm your health, even school. So having some balance between school and life is very important for success. While good grades are very important so is good mental health. Having something to distract you from the pressures and stresses from school is critical. There are so many ways to do this that it should be easy to find something to get the job done. Just don’t be scared to step outside the box and try something different.

The Ethics of the Short-Term Volunteer

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For years, dentists have provided free clinics and screenings for underserved and low-income populations. Free cleanings, procedures, treatments – how could any of these be considered harmful to a patient? After all, we’re discussing people who would otherwise not receive any care.  

 

 

The ADA’s recently published paper, The Ethics of Temporary Charitable Events, addresses possible adverse outcomes that many would never even consider regarding short-term volunteering. Nonmaleficence is an ethical principle that states dentists have a duty to refrain from harming a patient. One major concern involves the lack of follow-up care. Patient abandonment is a definite possibility at these temporary outreach events, and providers should ensure that the patient has been treated well and has the opportunity to have all work completed (Raimann et al., 2015). A temporary fix may result in greater harm if proper patient education and follow-up care isn’t provided.

 

Similar to nonmaleficence is the principle of beneficence. It’s the duty of the dentist to service the patient and act for the benefit of others. These temporary charitable events are a great opportunity to increase access to care as well as provide oral health education. However, lack of training and coordination, possible language or cultural barriers, and the lack of sustainability are important things that need to be taken into consideration.

 

This was a major issue in the aftermath of the 2010 earthquake in Haiti. So many health agencies tried to dispatch workers to the same area, leaving other areas with no access to care. Many patients were left without follow-up care for amputated limbs, wounds, or fractures because referrals weren’t well established (Langowski & Iltis, 2011). Similarly, a language or cultural barrier could significantly impede delivery of proper care. If a patient doesn’t fully understand why a cavity is being filled, what the possible dangers are, or how to prevent another one from occurring, establishment of a long-term dentist-patient relationship is more challenging. After all, one of the goals of these short term volunteering projects is to stress the importance of having a dental home and maintaining dental health on a regular basis (Raimann et al., 2015).

 

This brings me to the point of sustainability. Large organizations like Medecins Sans Frontieres  or Operation Smile receive significant funding and support for their endeavors. They have enough money to train volunteers and develop a plan for working with local communities. But what about regular local health agencies who just want to help? Is setting up a free clinic worth it if there’s no foreseeable long-term plan? (Langowski & Iltis, 2011)

 

Finally, veracity and transparency are other concepts that should be considered. Dentists should honestly educate their patients about treatment options and the limitations of a temporary charitable event. A dental disease can’t be cured or prevented at a single outreach event, and the patient should be made aware of this. Even though the care provided today is free, there may be potential follow-up fees to consider. Patients should also understand who exactly is providing care – students, specialists, or general dentists? (Raimann et al., 2015) Patient education is arguably the most important aspect of any service a dentist can provide. It increases the chances a patient will return for follow-up care and decreases the chances of treatment complications secondary to noncompliance.

 

Free clinics and screenings – are they good or bad? It’s hard to say; nothing is wrong with wanting to help people. But we should ensure that execution of such community outreach events meets the standard of care that’s expected of us as dentists. 

 

 

References 

Langowski M, Iltis A. (2011, June 15). Global Health Needs and the Short-Term Medical Volunteer: Ethical Considerations. HEC Forum, pp. 71-78. Retrieved May 10, 2016, from http://link.springer.com/article/10.1007/s10730-011-9158-5 

 

Raimann T, Reynolds E, Ishkanian E, et al. (2015). The Ethics of Temporary Charitable Events. Retrieved May 10, 2015, from http://www.ada.org/~/media/ADA/About the ADA/Files/ADA-Charitable-Event-White-Paper

 Please define this acronym

Becoming a Clinical Master: Perfecting Your IA Injections

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    Everyone who's experienced their first “stab lab” knows that injections can be nerve-racking the first few times around. There is a lot going on and, when you have a real patient in the chair, the complexity of the situation increases even more. In order to successfully practice “pain-free dentistry,” it is essential that you learn to be systematic and consistent in your local anesthetic administration. 

 

    The inferior alveolar (IA) nerve block is arguably the most critical injection to master, as it is more technique-sensitive than simple periosteal “infiltrations.” It must be used anytime invasive dentistry is being performed anywhere on the mandible. Even for experienced dentists, achieving profound anesthesia with an IA can be less than straightforward—with failure rates ranging from 5% to 30% depending on the design of the study1 

 

    It is imperative that you are well-acquainted with intraoral anatomy if you are to be successful in administering an effective IA block. However, this will only get you so far, as every patient varies anatomically. For example, if you are attempting to administer a block on a patient with drastically flared mandibular rami, there will be a certain amount of impromptu adjustment required before you will be able to locate the mandibular foramen and deliver the anesthetic.

 

Here are some tips to help you perform a successful and comfortable IA block:

 

     1. Palpation is key. Do not put a needle in the patient's mouth until you have palpated and identified the key anatomical landmarks.

          A.Palpate the mid-coronoid notch. This landmark determines the level on the axial plane at which you will insert the needle.

          B. Palpate the pterygomaxillary raphe. Insert the needle just lateral to this border, at the level of the notch.

   2. Ensure that the window of the syringe is facing towards you. If not, you will be unable to visualize aspirate. 

     3. Ensure that the bevel of the needle is towards bone. If you are not depositing your anesthetic towards the mandibular canal, you will have a lesser chance of delivering enough anesthetic to properly block the nerve.

     4. Be aware of your angulation. Start out with the barrel of your syringe just over the contralateral mandibular premolars, just above the occlusal plane. In many cases you will have to adjust the angulation, but this is the most reliable starting point.

     5. Don’t forget to aspirate prior to injecting! Never inject without first achieving a negative aspiration. You DO NOT want to inject the local anesthetic intravascularly!

     6. Patient comfort is the main goal. You can perform a perfect injection, but if the patient is in pain the entire time they will not appreciate it. Stable and gentle needle control and tugging on the cheek during administration will help keep the patient comfortable.


 

    It’s my hope that you’ll keep this advice in mind and be a bit more confident the next time you deliver an IA block. Also, always keep in mind that a calm and collected demeanor goes a long way in assuring your patient that there is nothing to worry about. Happy anesthetizing!

 

1. Milles M. The missed inferior alveolar block: a new look at an old problem. Anesth Prog. 1984 Mar-Apr; 31(2):87–90. 

Finding What Works

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In clinic there is a multitude of patients that come by in the clinic. It’s been through experience that I have witnessed patients different comfort levels and experience at the dentist. Only by understanding each scenario can we become better student clinicians. There are many times when I have seen patients become more calm as treatment plans are presented on paper, or when they are told exactly how a procedure happens which helps comfort them. Only through experience and caring can we develop a better student patient relationship.

 

 

Patients come into the clinic scared and not wanting to truly come to the dentist. They feel as if this is an elective yet important decision but constantly dread it. We as students want to try and change this perspective and achieve a higher vision for our patients.

 

Finding what works is key in clinic and something that can be transferred into the private practice. This is not only limited to procedures but to also things such as marketing and advertising. Going above and beyond is something that will help patients want to refer, whereas doing what is adequate will get your patient to come back. Little things like this is key to realize because we are not only developing our clinical skills during our school time, but also our business skills.

 

Coming out of my second year there are so many things that I have picked up from patient experiences. I found that explaining procedures works when the patient is totally up on the chair and not laid down. I’ve also found that going above and beyond for the patients is amazing in the aspect of giving patients calls to check up on them after procedures and making sure they have been satisfied. These are true principles that will eventually build practices and create lifelong relationships.

 

This time in dental school training something that also works is speaking to those professors around you. They are there for you and want to guide you and train you. You can never over train. Over training is something that is key because as you go above and beyond in everything you do there will less stress and strain on working with patients who are more complicated. Working up medical history and vitals, and understanding what anesthetics work and don’t’ work are results of overtraining. Although sometimes it may seem difficult or repetitive, it’s interesting to see how much better of a clinician students are as they work above and beyond for all their patients.

 

Another small but simple concept that can be applied now during training is reading research articles, and participating in groups such as THE NEXTDDS to help keep skills fresh. I have been doing that and have had such awesome experiences understanding procedures and materials better and learning from those what works and what doesn’t work. Although there is so much variability in dentistry, it’s never bad to try and learn more. Learning equates to progress, and progress equates to a happy and healthy patient. After all, our patient’s happiness and health is what we want to work.

3 Tips for Working on Sedated Patients

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Working on sedated patients is an experience that can be very useful in a clinical learning experience, but can also be a challenge. Here are three factors that I learned can be important in a case dealing with sedation, specifically general anesthesia. (Note that I am only a student and have learned most of these skills with a dental anesthesiologist or nurse anesthetist present at the University of Pittsburgh Center for Patients with Special Needs.)

 

 

Communication. This should be the first thing in any situation when working with multiple doctors in treatment, but nonetheless I believe that clear communication is most important. First, make sure that the anesthesiologist is ready for you to begin. Make clear that you have finished treatment. If you can, give updates as to where you are in the procedure. Often in the Center for Patients with Special Needs we use handheld x-ray systems for taking radiographs. It is important to let everyone else in the room be aware of the radiation exposure that is occurring.

 

An airway is an airway.  Whether intubated or open, the airway is something to always consider. It takes up more of the focus when the patient is not intubated because there is a higher risk of aspiration. Even with a throat pack, it is still an airway when they wake up. This is when your assistant plays an important role. Especially when working with a new assistant, it is important to state your expectations. Communication comes into play again in that the anesthesiologist will sometimes need to communicate when oxygen stats are getting low and some type of chin lift needs to be performed. Makes sure your assistant and anesthesiologist are also communicating as well.

 

Be ready for wake up. Though the dental part of the procedure is completed, wake up can either go very easily or with complications, especially working with an anxious or special needs patient. It is important to be ready to help the anesthesiology team if the patient wakes up in an aggressive state. My most memorable wake up occurred early in my clinical experience when I was just told to be ready in case the team needed help putting the patient in the wheel chair. About five minutes later, there were six of us wrestling her into the wheelchair after she woke up!

 

Sedation can be a very useful part of dentistry, especially for patients with special needs.  It is important to use caution and make sure the techniques that you are using are correct. Dental anesthesiology is an expanding field in dentistry and is worth exploring for your own patients.