Aside from clinical proficiency, becoming a successful practitioner after dental school will require excellent interpersonal skills. Proper patient management would allow a dentist to have a steady flow of new patients as well as retention of pre-existing patients. Having a good understanding of the different behavior types may improve interpersonal relationships between the clinician and patients. Behavior assessment includes several benefits. For example, it would permit greater self-knowledge, strengthen communication skills, facilitate more effective communication, and most importantly, increase treatment case acceptance (production). The Levin Group, a reputed dental consulting group, simplifies behavior analysis using a matrix to categorize individuals as one of four behavior types. The four behavior types (doer, controller, supporter, talker) are discussed below; recognizing a patient as one of these behavior types would ultimately allow a dentist to know how to manage each patient type most effectively. 

The first group is categorized as “doers.” Doers are high-energy people who tend to exhibit impatience. They usually value results and only seek the bottom-line. They may be direct, forceful, fast-paced, driven, and/or outspoken. Approximately 15% of the population falls into this personality category. As a dentist dealing with patients who fall into this category, it would be important to focus the discussion as much as possible and rely on solutions rather than problems. Doers do not appreciate wasting time, so suggesting the immediate solution would be most effective.

The second group is categorized as “controllers.” Controllers tend to be logical, deliberate, careful, cautious, and/or tactful. They usually value accuracy, quality, and competency. Due to their cautious nature, controllers tend to ask many “why” questions. Approximately 15% of the population falls into this category. Dealing with controllers, it would be important to answer ALL their questions (as they may have many questions). In order to communicate most effectively with controllers, it would be beneficial to focus on facts and details, while minimizing emotional language.

The third group is categorized as “supporters.” Supporters tend to be low-energy, loyal, and methodical. They enjoy cooperating with others, and as a result, tend to be sincere, dependable, patient, predictable, supporting, and accepting. Supporters are more likely to ask “how” questions. Approximately 40% of the population falls into this personality category. Supporters, due to their people-oriented nature, tend to feel the need to establish trusting relationships. When managing patients in this category, it would be important to build a trustworthy relationship with them prior to requesting any treatment decisions. Additionally, patients with this behavior type would benefit most from having a spouse or significant other present during any important decision-making.

The fourth group is categorized as “talkers.” Talkers, like doers, are also high-energy. However, talkers generally exhibit enthusiasm, warmth, and are not solely seeking a solution. Talkers also tend to appreciate connecting with others; they are friendly, outgoing, and people-oriented. They value teamwork and personal relationships. Approximately 30% of the population falls into this category. Due to the nature of talkers’ personalities, focusing on positives and making a genuine effort to connect with them would allow for the most effective management.

In conclusion, identifying patients as one of the four aforementioned categories would allow for the most fruitful interactions with each patient, and thus a step towards improved patient management in the future. Effective patient management will become essential for succeeding as a practicing dentist. 

Student debt is a hot topic for many dental students as well as for organized dentistry. It is estimated on average that most dental students graduate from dental school with around $200,000 in student loan debt. I personally feel this average is low and a more realistic student loan debt for dental students is closer to $400,000. Coming to the realization upon graduation that you owe over $400,000 while also trying to start a practice, by a house, or maybe start of family can be overwhelming to many students. While there are many people as well as organizations advocating for student debt relief there are still many changes which need to be made.

However, recently the ADA announced an exclusive student loan refinancing offer with DRB (Darien Rowayton bank). This offer allows ADA members to refinance existing federal and private student loans at a lower rate. This new offer could potentially save members tens of thousands of dollars in interest. The DBR refinancing rates currently start at 1.90 percent APR for variable loans and 3.50 percent APR fixed for existing federal and private undergraduate and graduate school loans. More so, ADA members receive an additional 0.25 percent rate reduction as a member benefit. Ultimately this refinancing offer may save dentists around $30,000 with a fixed rate refinance loan.

This refinancing offer from the ADA is a big step for the dental community. Student loan debt is a huge burden for new dentists and programs such as this are a start in the right direction. I believe involvement in organized dentistry and advocating for issues such as student debt relief will help more programs such as this become available to new dentists. I encourage all dental students to get involved with organized dentistry while in dental school and maintain their involvement throughout their career. If we as dental students and dentist do not advocate for issues that affect us we will loose our voice on these issues. 

     Last June, I had the opportunity to travel to Haiti for a dental international service learning trip. My experience was monumental.  Over the course of one week, I gained a myriad of memories that impacted my dental education in a profound manner.  I received many benefits from my service trip, and I highly encourage each of you to embark on a dental international trip to learn about other cultures, expand your clinical experiences, and break barriers to care. 

            Often times we forget there is a world beyond our dental realm.  There are a variety of people, cultures, and customs all across the globe that all can broaden our horizons as long as we maintain an open mind.  Participating in an international service trip provides dental students the opportunity to submerge into a new culture and environment.  Personally, I did not know what to expect from Haitian culture, but I was thrilled to experience it firsthand. It was rewarding to practice dentistry, but even more rewarding to discover a unique culture.    

            Prior to my trip, I lacked the confidence and clinical experience I had hoped for by the end of my third year; however, this completely changed by the end of my trip.  Within the week, I gained a tremendous amount of experience from restorative to oral surgery, and my confidence was completely restored for the start of fourth year clinics. My colleagues and I were able to increase our speed and diligently improve our clinical skills with the guidance of our supervising dentists, which has dramatically improved my efficiency in clinic.  An international dental service trip can only improve your clinical skills, so go for it. 

            Access to care is not only an issue in America.  Many individuals in countries across the globe face the hardships of obtaining medical and dental treatment due to a variety of reasons – lack of access and/or financial adversities. By actively going into communities in these countries where there is a severe lack of dental healthcare services, you are breaking barriers by providing some form of treatment to individuals who may never have the opportunity to visit a dentist. This aspect of the trip was the most beneficial for me.  The Haitian people overwhelmed our group with gratitude and appreciation.  Many of them were in severe oral pain and were grateful to finally see a dentist for treatment.  It warmed my heart to provide a service to individuals who desperately needed it. 

            International service dental learning trips have the potential to revolutionize your dental school education.  They not only give you the chance to travel to another country, but allow you to plunge into a new culture and experience dentistry beyond the walls of dental school.  You will be able to noticeably improve your clinical skills by performing exodontia and operative treatments for a large group of patients.  Most importantly, you will be able to provide dental care to individuals who need it the most.  The combination of these benefits is the reason I encourage you all to participate in an international service dental learning trip – it was an experience I will never forget nor regret! 

My experience so far in my dental education has allowed me to the see the power in collaboration while providing the best care possible to patients. The faculty, assistants, students and staff are all invested in getting to know the person behind the charts and x-rays. Much of the success that I’ve experienced in the field of dentistry is due to a teamwork approach and I am eager to see the success that can be achieved with interprofessional collaboration. I believe that educating future professionals to prioritize interprofessional collaboration is essential to breaking the limits of success.

As the future of many diverse professions, it is important that as students, we utilize the impact of interprofessional collaboration and work together towards a common goal of improving patient outcomes. Working together now as students will only make our interprofessional collaboration stronger in our future work environments. This collaboration is characterized by teamwork, mutual respect, and shared decision-making. The interprofessional collaboration that I have experienced in dental school thus far has allowed me to acquire a heightened mindfulness of the importance of skillful communication and a gratitude for the constraints to interprofessional teamwork.

Healthy Smiles for Baltimore Kids is a student group at the dental school that is focused on educating inner-city Baltimore kids about various health topics. This group is now working towards utilizing interprofessional collaboration and getting other schools within The University of Maryland involved such as the school of social work, school of pharmacy, and the school of medicine. The goal is to help children improve their overall health and prevent them from making poor lifestyle choices. This student organization provides a semester-long after school curriculum at local elementary and middle schools as well as participates in local health fairs where we provide games, oral health information, and oral screenings to children in the community. The different topics included in this curriculum emphasize that many different components impact a child’s oral and overall health.  

As a dental student, I am very passionate about not only educating young children about their oral and overall health, but also acting as a mentor for them and guiding them to fulfil their goals. Learning this important lifestyle as children will help them to continue healthy choices and habits as they grow up. These children will be able to receive education and mentoring not only from dental students, but also from students of other professions. I believe that incorporating students of different fields will give these students role models to emulate and broaden their education. The dental students involved in the group are looking forward to an intriguing collaboration with social work, pharmacy, and medical students.  

As future oral health care providers, we are learning through this program to look at the big picture and not only a patient’s teeth. A close interprofessional relationship established between professionals in diverse fields is an intriguing aspect that I am very eager to experience further during my dental education as I represent the future of patient healthcare. 

Emma J Guzmán- University at Buffalo School of Dental Medicine

      This past summer I went on an international dental mission to the Dominican Republic. I went as a member of BOCA, which stand for “mouth” in Spanish but at UB Dental it stands for Buffalo Outreach and Community Assistance. Outreach is one of the most important aspects of student life at Buffalo and BOCA is one of the largest organizations on campus that allows us to do so. There are weekly outreach events in the Buffalo community and this organization gives students the opportunity to attend outreach trips in the underserved parts of the United States such as Tennessee during the RAM (Remote Area Medical) trips and internationally. Students at UB have gone on trips to the Dominican Republic, Guatemala, Senegal and Thailand to name a few. 

       The experience I had was one that cannot compare to another. The trip was absolutely enriching and I was able to learn so much when it came to the culture, people, dentistry and various methods of care. Upon arriving to the Dominican Republic, I immediately felt welcomed. All the people I encountered whether it was the drivers, hotel workers, the security or other staff were extremely helpful and treated us like family. Being of a Hispanic background it was nice to be with people who are culturally similar for a change. The neighborhoods looked similar to the town my family is from in Guatemala, so it felt like home. The food, the music, the heat, everything was just amazing.   

     But, the most enriching part of the trip was the amount of people I was able to help.  With helping many people came improving my hand skills and more exposer to dentistry. We set up a clinic with multiple rooms and we worked on a rotation schedule. The rotations allowed us to do hygiene, oral surgery, operative and pediatric dentistry. I was exposed to more dentistry in that week than I have seen in my over two years in dental school. I got over my fears of finally working on patients and not a typodont. There was no time for me to hesitate because ever morning when we got to the site there were tons of people waiting on line for us to take care of them. Not only did I give back to these people but also the patients helped me improve my skills, become more confident and gain knowledge due to the different cases I faced. The patients were extremely appreciative of the work we did and that made the long days worth it.  

     The trip was more than I expected and I would recommend it to every student. This was not my first international mission trip, I participated in one during my senior year of undergrad. I attended the trip to Mexico with a team of dentist, residents and other students. During the trip I sterilized instruments and assisted and back then I saw the impact that these trips have on the community. Many of the people will not see a dentist until another organization goes to their town to provide free care. It is extremely important that students and dental processionals give back to their local and international communities. I plan to continue doing work like this throughout my career but for now, my goal is to graduate dental school in one piece.   

Ever since I officially started clinic over 3 months ago, I have been called upon several times to fulfill the role of an unofficial translator for my colleagues and their Mandarin speaking patients. Although I speak Mandarin conversationally, my level of medical/dental Chinese proficiency is at an elementary level. When I was translating for my colleagues and their patients, I found the simplest of things to be difficult. For example, forming coherent sentences, finding the right terminology to use, and speaking professionally in a foreign tongue were a few struggles I encountered in Mandarin. In order to communicate effectively with the Chinese-speaking patients, I relied on hand gestures and strings of broken phrases to dictate my thoughts.  

The general patient population at New York University College of Dentistry is so diverse that it’s not uncommon to hear our front desk staff announce, “Available students that can speak [XYZ Language], please come to the front desk.” Unfortunately, the need for bilingual student dentists and the availability of bilingual professionals do not adequately match the needs of the public. If you are a dental student and speak another language, I strongly implore you to brush up on dental terminology. It will come in handy in school and in your own practice.

Below is a list of useful phrases and words I wish I had in my arsenal when treating Chinese patients. It’s not a comprehensive list but one that will create some understanding between you and your Chinese patient. Translations are in pinyin for those who cannot read Chinese characters.

General Greetings 

Hello! Ní hǎo!

How are you? Nǐ hǎo ma?

Good bye. Zài jiàn.

Collecting Histories 

Do you smoke? Nǐ chōu yān ma?

Are you allergic to anything? Nǐ duì shén me dōng xī guò mǐn?

Dental Hygiene  

How often do you brush your teeth? Nǐ jīng cháng shuā yá ma?

Do you floss? Ní yòng yá xiàn ma?

Patients in Pain  

Where does it hurt? Nǎ lǐ téng?

How long have you had the pain? Nǐ yǒu tòng le duō jiǔ?

Is it sensitive to hot or cold? Nǐ duì rè huò lěng mǐn gan ma?

Giving Post-Op Instructions 

Do not eat or drink for 30 minutes. Bù yào chī huò hē 30 fēn zhōng.

Do not brush tonight. Jīn wǎn bù shuā yá.

Do not rinse tonight. Jīn wǎn bù yào chòng xǐ

Diagnosis 

You have a cavity. Ní yǒu yī gè chóng yá.

You have gingivitis. Ní yǒu yá yín yán.

You have periodontitis. Ní yǒu yá zhōu yán.

Commands 

Open. Dǎ kāi.

Close. Guan bì.

Bite. Sī yǎo

Grind left and right. Yán mó zuǒ yòu.

Turn your head to the right/left. Bǎ nǐ de tóu xiàng zuǒ/yòu.

I have struggled with it most of my life. I am sure many of you can relate.

Ever since I was younger, I would compare myself to others. At first, it was more materialistic, but it eventually grew into comparing sports and school. Although comparing is beneficial at times, it can also hinder our progress and growth.

As dental students, for most of us, our undergraduate education was filled with numerous credit hours with many nights spent studying. In everything that we did, we would strive to do the best that we could, and we would judge by comparing our scores with those of our peers. Our grades would be top tier, and we would get frustrated when we missed silly questions.

So what happens with dental school? Dental school is composed of individuals that are at the top of the top, the cream of the crop. We are individuals that have worked tirelessly and have gotten excellent grades. We are used to perfection. However, even in dental school there is inevitably an individual that will be at the top of the class and an individual that will be at the bottom.

Having survived my first two years of dental school, here are just a few things that I wish I learned sooner in my dental school career.

1. Most comparisons are inherently unfair. We tend to focus more what is the worst in ourselves and what is good in others; however, we don’t know the complete picture.

2. Time is our enemy. Each day, we are limited by the number of seconds we have available. Comparing robs us of valuable time that we can use to do much more. It takes away the joy we feel because no matter what, when we see the worst in ourselves and the good in others we will never win.

3. If you still feel the need to compare, always compare to yourself. Comparing to yourself ensure that you reach you maximum potential, while also not getting frustrated. What you have to offer in terms of successes and talents is very unique to you and can never fairly be compared to anyone else.

That being said, enjoy your time in dental school. For many of you, this is the last bit left before we start actually working. So work hard, take care of yourself, and strive to grow each day by just comparing to yourself. 

Clinics present many challenges for students, but are just a small preview of what they will encounter in the real world. As we learn that not everyone’s pain tolerance is the same and that it is nearly impossible to achieve an ideal prep in a carious tooth, we first and foremost need to be able to communicate effectively with our patients. It is extremely important that they understand post-op instructions and the possible risks and complications of the procedures before they are performed. How thorough can we be with a patient who does not speak English or even when English is not their native language?

In the short time since I started clinic, I have experienced situations where many of the patient’s concerns, or essential information provided by the student dentist, have been lost in translation. No one could have anticipated the volume of Spanish speaking patients we see in our school’s group practices. So it is not rare for me, or the few other bilingual students in my class, to be called by another student to help interpret the dialogue with their patient.

Several weeks ago I was helping another student deliver a denture. While making the adjustments, the patient stated “¡me lastima!” which means “ it hurts!.” The other student, who knows some basic Spanish, recognized this word but mistakenly associated it with another meaning, and thought the patient was saying “me da lástima” which means “I feel shame/sorry for.” This was just a small incident and luckily did have drastic consequences. What about when we need to counsel the patient to avoid lip or cheek biting while the local anesthesia wears off, not to suck on straws after extractions and to avoid sticky foods while they have temporary

crowns in place? During the very first appointment when medical and dental history is collected, I notice my own patients misinterpreting some of the Spanish terms I use. I have to keep searching for a word they recognize in order for them to understand. This makes me wonder how other students would handle these instances and the gravity of any circumstances that could result from improper patient communications.

Fortunately, steps may be taken to aid non-English speakers. My school is giving this issue very serious consideration and has recently hired more multilingual Patient Care Coordinators (which is the name given to our receptionists). Some students have an increased interest in taking Spanish classes, and many of them use Google translate or other translation methods to communicate with their patients. All of the patients’ forms, documents, and oral hygiene education brochures are translated into Spanish. Still, Spanish is just one language and there are many others that need to be taken into account. Even though we cannot be proficient in all languages, we must not assume that all patients we treat are proficient in English. Hopefully, this is something we can take into account when planning and building our own practices. We owe it to our patients to give them the best care we can, and the most important factor is communication.

While we all hope that our clinical expertise will help us build our practice in the future, these skills alone may not be enough in today’s world. A dentist’s ability to efficiently and attractively market their self and their skills can make or break a dental practice. In attending CE courses on this material, I have come across a wealth of information and resources on easy ways to build a brand and spread a message throughout the community, without going broke in the process. While it may be easier to hire a marketing firm to do this work, it can be much less expensive and more authentic, let alone more fun, if you do it on your own. Below are 4 resources to use when looking to start or take over a practice and build your presence in the media and market of your community: 

1. fiverr.com 

Fiverr is a website that allows you to pay independent contractors for their work. They offer many services from logo design to radio voiceovers to website building, often for as inexpensive as $5. Bonus: many of the individuals will send you drafts and accept your comments before editing and sending you the final copy. 

Wix is a website builder and domain host that offers a variety of template designs that are incredibly easy to use. No longer are the days of hiring a computer engineer to type up a code for your website. You can add, remove, and change content as often as you like, or better yet, find an employee in your office that is talented at graphic design and have them update it with current information and news. 

3. Social media 

Often dentists shy away from Facebook, Twitter, and Instagram, as they feel that these channels can be unprofessional or tacky. In reality, patients connect with what they see, and if you are present on these feeds and you post professional, educational, newsworthy things, your patients and community will connect with your business on a higher level. Keep posts to less than once per day but stay up to date. Also, don’t engage in negative dialogue over these channels. Address those that criticize you privately, and keep everything in the public eye upbeat and positive. 

Perhaps one of the most important factors in public perception, besides your website itself, is your websites rank when you search for dentist on Google. SEO is a process you can utilize to ensure that your business reaches the top of the page and is the first that potential patients see when searching for a new dentist in their community. This process involves factors including Facebook likes, comments, and post, website keywords and updates, and backlinks to your website. As soon as you understand the concept of SEO, optimizing your online presence can be both easy and incredibly rewarding. 

    Remember, patients will not walk in your door if you don’t introduce yourself to the community. Use these tools to build your brand, back it up with your clinical acuity, and watch your practice flourish. 

Now that I have had some clinical experience through my third and into my fourth year, I have discovered the true value behind informed consent. Informed consent if different from consent. Someone giving you consent to do something solely implies that they are giving permission to perform a certain treatment or action. Informed consent implies that the individual has gone over the risks, benefits, and alternatives, and understands them. Understanding the components are the most important part of being informed and making an informed decision. From there, the person can decide what is best for his or herself, without bias and in comprehension of outcomes related to their decisions.

A challenging part of achieving informed consent is remaining without bias. As a dental provider, it is difficult to not just think that we know better than the patient and therefore should encourage them to choose one treatment option over another. Even though we may have a deeper understanding for the technicalities of a problem and possible treatment options, it is our job to explain these components in laymen’s terms. Having a foundational understanding of the risks, benefits, and alternatives of each option should be made simple enough so that the patient can feel comfortable making the decision. Over complicating a problem or treatment option will only confuse the patient and make it challenging to get a consistent informed consent.

A good practice in obtaining informed consent would be using the teach-back method. By having the patient repeat back what you explained using their own words, you get a very clear sense of how the patient is thinking and understanding. This also prevents you from getting too far ahead of yourself in an explanation and just leaving the patient behind and overwhelmed with thoughts. I have done a better job of this step lately. Mainly, I try to break it up into pieces and concepts for the patent to follow and repeat back to me.

One aspect that new dentists may not think about is that it our legal duty to receive informed consent prior to treatment. This does not just mean having them sign the consent form. Having a template for consent forms is great, but reviewing the contents with your patient is vital. What complications could arise? What risk factors are we dealing with? If something does take a turn for the worst, what could be done then? Essentially this is not something you want to find out the hard way. If patients do not feel they were given substantial information regarding the risks, benefits, alternatives and costs of each treatment, they may feel you are taking advantage of them. By covering your bases early on, and giving the patient the 100% opportunity to decline treatment or proceed, you will save a lot of time, money, and litigations.

In several literatures, it mentions how a dental provider bias strongly effects the patient’s eventual decision. However, why the dentist had a bias may vary. The most common bias that I sometimes admit to, is significantly highlighting what I consider to be the better option. Sometimes I may say, "If this was my tooth, here's what I would do." However I understand that's what I would do with my teeth may not be an option or even relevant to the patients opinion. Other biases which are even worse would include a provider who stresses the patient toward the more expensive option, as a more lucrative procedure. Actually, there is something to be said for the opposite motion as well. Sometimes dentists do not provide appropriate informed consent because they assume a patient cannot afford the more expensive option. Instead, they focus on the less expensive option as an inevitable. Not only is this an act of prejudice, but it is inappropriate for the dentist to assume anything, regardless of a patients insurance, clothing style, gender, race, etc.

Lastly, and very importantly, is the fact that patients prefer informed consent. Even though it may seem that you are moving quicker and getting the patient out the door faster, they actually prefer to have a full understanding. Ethically, having an informed patient gives them a better feeling of dignity and self-control. A key principle in patient management is autonomy, and allowing the patient to make decisions for themselves. Having informed consent is honoring that principle and building a stronger relationship between the patient and the provider. 

I collaborated with my classmate, Chris Berguia, UCSF c/o 2016 to complete this posting. 

We have experienced challenges in life and felt lost and had no idea how to keep moving forward. Whether it was in a relationship or a life and death situation that shook us to the core. The reality is that at some point in life we all go through struggle. But we get to choose how we respond to it. We have the power to build an unstoppable mindset. Anyone that made it to dental school or any professional school is a testament to that infinite capacity of the human potential.

1. Know your weakness

Whether in work or in life, everyone has weaknesses. Weaknesses are common enough that many dental schools ask during interviews. Your weak area may be something you have struggled with throughout your life, such as shyness or procrastination. While a weakness can get in the way of your dental school goals, with focus and dedication you can work to turn it into strength. So find your weakness and work on it.

2.  Seek the right path

            Never compromise your believes or standards of care. In dental school, you’ll be faced with many questionable paths. Do I accept the possible class II patient even though the tooth might have a chance to remineralize and you are in need of Class II patient for your requirement? Or delay perio treatment because you’re in need of another requirement? Dental school will test your limits. Think back to the day you decided to apply to dental school and you spent countless hours editing your personal statement. Is that still who you are? Challenges may come in different forms and we have to learn to face the ethical situations and do the right thing so that we will gain trust from our patients.

3.  Know that you may not be the best at everything

            One of the biggest things I struggled with in Sim labs was learning the precision and dexterity dentistry demanded. It’s a difficult task to learn how to manipulate your handpiece inside a manikin mouth and even more challenging when you have to use indirect vision. You’ll face many challenges in dental school simply because you’ve never been exposed to working inside the mouth. You have to learn to accept that you might not get it right the first, second or even the third time. Practice makes perfect and with time and countless practice dedicated to the art, it can be mastered just like anything else in life.

I can list many more topics about dental school challenges but the key thing is to move forward consciously thinking of ways to become the best dentist that you can be.

    In order to further our understanding of different cultures that we may encounter in the clinic, our dental school has included a module on diversity.  We’ve been provided with a variety of readings and articles to supplement our learning. After reading the articles discussing Chinese culture, I have mixed feelings for what has been presented and suggested.  

    The article suggests that healthcare providers should use the Chinese language to communicate when possible. If this isn’t possible a translator would be ideal. If communication in English is required, health care providers should be cautious about their voice volume when interacting with Chinese in English so that intentions are not misinterpreted. Another thing noted was that the Chinese invariably answer yes, even when they do not understand the question or instruction. Because of this, it is essential to have patients repeat instructions they have been given. The articles also states that negative inquiries are difficult to understand and to not use complex sentences with ands and buts because the Chinese have difficulty deciding what to respond to first.  

    Other observations include that the Chinese have a reputation for not openly displaying emotion but will share information freely with health care providers once a trusting relationship is developed.  It states that the Chinese also like to maintain a formal distance between people as form of respect and that some are uncomfortable with face to face communications especially when there is direct eye contact. They also prefer to sit next to each other rather than across. As a healthcare provider, we may be able to rearrange the seating to promote positive communication. To Chinese the word “privacy” has a negative connation. It means something underhanded, secret, and furtive. This belief may present itself in conversation with a health care provider. They may ask the health provider personal questions about their salary, age, children, and life at home. They are not meant to feel invasive. The Chinese also do not understand the need “to be alone” and may not understand when a Westerner wants to be alone. A mutual understanding of these beliefs is necessary for a harmonious relationship. The topic of sex is also taboo. Patients may feel uncomfortable discussing anything related to sex. Perhaps they may feel the need to conceal important information from the health care provider.  

    An interesting issue of autonomy was also discussed. In Chinese culture, autonomy is limited and is based on function for the good of the group. When something requires an independent decision, many times the Chinese do not take action until a leader or superior gives them permission. This may have implications in consent or decision making of treatment.  

    In many ways, I believe that these observations and recommendations bring along a certain insensitivity. It should be limited to heuristic thinking at best. While they may provide a good rule of thumb, it is difficult for me to adhere to advice based upon someone else’s depiction and study of a particular culture. I understand that it is not feasible to gain a complete understanding of all cultures from one’s own experience and that we must rely on help from other sources. To me it is a matter of keeping an open mind, to ask a patient how they feel and  to determine what makes them most comfortable. Each individual among each culture will differ to varying degrees, being cognizant of their needs should always be a priority. I am interested whether my experience in clinic will match what has been described in the article. For those that have been in clinic, what have your experiences with other cultures taught you?  

As of two Fridays ago, I had the pleasure of performing a Caries Risk Assessment on one of my classmates in our Intro to Clinic class. The Caries Risk Assessment is a tool that one of our professors, Dr. Sharples, is extremely enthusiastic about. For those of you who do not know what this is, the Caries Risk Assessment is a preventative tool used to help prevent the demineralization of tooth structure. In the past, using traditional GV Black dentistry, dentists were preventing cavitations and treating existing cavitations surgically and the mentality was “to cut is to cure”. Now, in addition to treating existing caries surgically, dentists are also preventing the progression of caries with a therapeutic model of managing the disease which is where this assessment comes into play. 

The Caries Risk Assessment is a series of questions that takes about five minutes to complete and review but helps the dentist determine the recall interval and course of preventative measures. The first five questions are designed to identify indicators that are commonly associated with a high risk. These include: frequent or prolonged between meal exposure/day to sugary or starchy food or drinks, visibly cavitated lesion or radiographic penetration of the dentin, 3 or more cavitated or non-cavitated lesions or restorations in the last 24 months, teeth missing due to caries in the past 24 months, and severe dry mouth (xerostomia). If a patient has any of these, an “x” is placed in the box to the right of the category and will count as 10 points towards the total risk score. The remaining 14 questions indicate factors that can contribute to increased risk but are not as significant. These include: no fluoride exposure through drinking water, does not receive regular dental care in a dental office, special health care needs (over age 14), eating disorders, smokeless tobacco use, medications that reduce salivary flow, drug/alcohol abuse, 1 or 2 cavitated or non-cavitated carious lesions or restorations in the last 24 months, deep pits and fissures/unusual tooth morphology, exposed root surfaces present, visible plaque, restorations with overhangs and/or open margins, dental/orthodontic appliances (fixed or removable), and interproximal restorations (1 or more). These factors score 1 point for each “x” and require multiple yes answers to lead to moderate or high risk if no high risk indicators are present. The total score is then derived by simply adding the number of indicators (10 points each) and factors (1 point each) to determine if the patient is at low (total score of zero), moderate (score 1-9) or high risk (score >10).

Once the score is determined, the dentist must make recommendations to the patient to help prevent the demineralization progression. Patients at low risk are recommended to get bitewing radiographs every 24-36 months, recall exams every 6-12 months, and OTC fluoride toothpaste twice daily. Moderate risk patients are recommended to have bitewings every 12-24 months, recall exams every 4-6 months, xylitol gum or candies, OTC fluoride toothpaste twice daily, and OTC 0.05% NaF rinse daily. High risk patients should have bitewings taken every 6-18 months, recall exams every 3-4 months, xylitol gum or candies, Rx 1.1% NaF toothpaste twice daily, and Rx chlorhexidine gluconate 0.12% rinse once daily. At the bottom of the form are additional recommendations which include varnishes and other prescribed treatments if the dentist feels they would be necessary. The patient receives another sheet to take home with their recommendations and each assessment has four columns for the dentist to make additional changes during recall appointments.

Although there is no way to eliminate caries, I believe that the Caries Risk Assessment is a great tool to begin the process of minimizing caries progression. Through completing this assessment and having my partner complete it on myself, it was evident that almost everybody has at least a moderate risk to caries. However, with the recommended guidelines and through promoting great oral hygiene, we all can help slow the progression of caries one tooth at a time.

Its that time of year…fall semester! Fall means new classes, new teachers and a bunch of exams! The key I have found to success is trying to have a balanced schedule above all. I believe it is important to do fun things, talk to family, hang out with friends etc. But like everyone in dental school, I do have quite a lot on my plate, academically, and learning how to manage time efficiently was one of the best things I can do for myself!

The main part of managing time efficiently is assigning the appropriate amount of time to each task, and sticking to it. Of course, not everything is predictable, and sometimes your scheduling will be thrown off. To avoid the problems that come with that you need to set priorities. And finally, the last part, the easiest to say but hardest to obey, is to be honest with yourself. I have learned that if I give myself little more time to get started and not throw off the schedule then I am not running behind as much. But we are human, and sometimes I spend a little too much time hanging out with my friends.

On a typical weekday with classes, I like to familiarize myself with the material that will be covered and skim through lecture notes. Then comes the hardest part…I would go to classes, try to pay attention as much as possible! I know easier said then done. But not paying attention in class makes you lose twice: once for wasting the class time, and then a second time because you will have to spend that much time, if not more, to cover the material at the same depth as it was covered in class! So this is a double whammy I try to avoid. Actively listening will pay off when you have more time later to do something you enjoy.

During lunch, I give myself a break. Eating time is pretty sacred for me. Why? I just love food so I take the time to appreciate it. After classes is the time when you have to be very organized with your assignments, projects, responsibilities. You have to develop a notion of how important things are, and how long they will take you. You should know that a certain task will need you to dedicate "X" hours, so keep "X" hours separated for it. And you should know the importance of each assignment. Trust me getting organized early, pays off in the end.

So usually when I am done with class or clinic, I pick a setting where I know I won't be distracted. For some people this is your room, for others, the library. If you like are me, you like background noise and will head to Starbucks and will leave when it closes! Last tip: know your time constraints. You have so many hours until your next commitment, so set goals for what you want to accomplish during those hours. Try to always start by your most pressing or most important task.  It's always a great feeling to cross things off the big things on your to-do list.

Last thing, respect your body, if you feel tired, then fine, just analyze how much you have accomplished. The more organized you are with your tasks, and the more honest you are with yourself, the better you become at managing time. So let study time be study time. Disconnect, and give your total attention to your task. You will accomplish more, and have more free time!

Happy studying everyone!

A population that often gets overlooked in the dental school curriculum is the special needs population. This can include individuals with intellectual and developmental disabilities, medically complex patients, and geriatric patients. Once we enter private practice, however, we will be tasked with providing care to these patients.  In order to provide exceptional care, we need to be able to deliver the dentistry we’ve learned in school to these populations while taking into consideration their unique needs. Some patients will require shorter and more frequent appointments. Others will require you to spend extra time obtaining medical consults in order to fully understand complex medical issues. How can we start developing these skills while we are in dental school? 

Connect with Faculty 

Some dental schools are fortunate enough to have a special needs clinic. Take full advantage of that resource. Chances are that clinic sees more special needs patients than you will in your whole career, and those faculty can help you through complex cases. If you do not have a dedicated special needs clinic, like at my dental school, you may need to take more initiative. Ask around and see which faculty are most interested in special needs patients. The pediatric dentistry faculty are likely to be heavily involved with those patients, particularly the O.R. cases. I have come across many general dentists and dentists from other specialties that have also dedicated a significant part of their practice to special needs patients. If you’re interested in being a general dentist and seeing many special needs patients, these will be the people to reach out to for mentorship.

Reach Out to Your Community 

A good way to understand how to best treat individuals with intellectual and developmental disabilities is to spend more time with those people. Contact your local Special Olympics and see if you can get involved with a Special Smiles or other event to do dental screenings or provide oral hygiene instructions. You can also just volunteer to help with a sport – while it’s not specifically dental you’ll get more exposure to the special needs population and have a lot of fun being active with them!

Network with Your Peers 

A club dedicated to focusing on special care dentistry was founded recently at my dental school. Since its founding, a lot of my classmates have shown interest in the club. Special needs dentistry may seem like a niche field, but in reality many people are interested in learning more about treating individuals with different healthcare needs. Ask around your school and gauge interest in starting a club or study group. The more people you get involved the more perspectives and experiences you can bring together! 

Research Residencies 

Many GPRs and AEGDs spend a part of their program on a special care rotation. If you want to go beyond just treating a special needs patient every now and then, look into these programs. They can give you valuable knowledge beyond what you’ve learned in dental school.

Special needs dentistry may require some extra time and patience, but at the end of the day it’s some of the most rewarding dentistry you can do!

Throughout dental school, we live from one exam to the next, our noses buried deep in mountains of books or Dental Decks, wishing every day was Friday.  But if for one minute, we exchange this tunnel vision for an opportunity lens, we can see much clearer.  We see that the key to everything is relationships.  From the guy sitting next to you in biochemistry to the girl who holds the door open for you at Starbucks, every individual you come into contact with is an opportunity.  It is an opportunity to make connections.  It is an opportunity to network.

Networking is a huge buzz word nowadays.  When you deconstruct it, networking is simply thoughtful engagement between individuals.  However, networking is highly strategic and can be considered a very challenging full time job.  For some, it comes easily.  But for others, it takes hard work.  Networking requires you to be on your toes and ready to present yourself in an appropriate, professional yet relatable manner at all times.  The best kind of networking is not forced, it happens naturally.  Networking allows you to expose your personal brand and make life long relationships which prove to be helpful now while in school or in the future when you start entering the work force.  Here are a few tips to help you tone up your networking skills.

Start Early
It takes time to build friendships.  Don’t wait for a crisis to hit to network.  When done correctly, networking takes awhile and results in long-term, meaningful relationships.

Know Your Audience
Just like you learned in eighth grade English, cater to your audience.  The person on the other end of the conversation will affect your approach.  Do a bit of research so you are aware of types of topics to discuss.  Also being aware of your audience will dictate how you follow up.  A 75 year old won’t use Facebook messenger any more than a 21 year old is to call you on the phone just to chat.

Learn to Listen
Yes, you want to promote yourself but don’t brag.  Don’t be that guy who goes on and on about his life and doesn’t give you an chance to speak.  Work on listening attentively.  Be engaged and interactive.

Keep an Open Mind
With every conversation, there is an opportunity to learn.  Whether you network with an upperclassman, classmate or dentist in the community, you can learn something from each and every one of them. 

Chill Out
Focus on communicating with the person, not her or his title.  Titles can be intimidating and cause us to go into panic mode.  Although it may alter or direct your conversation, rank should not define it.  Try to be yourself and remain calm.  We are most effective at communicating when we are ourselves and not lying or trying to go over the top to impress someone.  Remember to have fun.  Networking is work, but it’s also a fun way to advance yourself both now as a dental student and in the real world when you start to seek jobs.

Be Pleasant
Try to be yourself, but remember that you are being watched constantly.  Keep it classy and professional.  Smile, practice good manners, and maintain eye contact to show your respect for the other individual in the conversation.

Follow Up
First and foremost, remember the person’s name!  If you don’t remember her or his name, there is no way you are going to further the connection.  If you receive a business card, write a few notes about the conversation you had on the back as a reminder.  Then, follow up in a method of your choosing.  Continue the conversation via social media, text, email or phone.  While some methods may seem more “professional” than others, you have to always keep your audience in mind and do what is best for the particular situation.  If it’s another student you’re networking with, the email you send may get lost amongst the seven hundred others she or he received that day.  Regardless of how you follow up, try to meet again.  Grab lunch, coffee, study together, maybe set up shadowing— do anything to continue developing the relationship.

Building relationships takes time, effort and a balance of strategy and spontaneity.  Networking can be an extremely powerful tool, especially in today’s world.  So put on a smile and get out there! 

    Dental schools have different ways of running their clinic, whether it’s rotation-based, team-based or individual-based. All systems have advantages and disadvantages. In this blog, I will be exploring these advantages and disadvantages. Currently, my school is considering changing their old ways of having an individual-based clinic and moving on to a team-based system. I’m interested in knowing how your dental school runs their clinic and if you like their system. I encourage you to comment below!

    With rotation-based clinics, students rotate through all of the departments (fixed, operative, removable, etc.) and they see different patients practically every day. With team-based clinics, students are placed in a team and that team has a pool of patients who rotate amongst the team. With individual-based clinics, one patient is assigned to one student and that student completes all of the patient’s treatment. The dental school I attend has an individual-based clinic system, and it has been this way for quite some time. There are many advantages with this system, but there are also major disadvantages. One advantage of this type of system is that you can develop a good rapport with your patient by seeing them throughout their entire treatment. Also, by completing their entire treatment plan, you do not have to worry about another student’s work being done on that patient. Imagine trying to insert a set of dentures on a patient whose final impression was done poorly by a different student and the dentures don’t accurately fit the patient. This patient is going to complain to you and you will have to redo the impression which wastes the patient’s time and the patient will not be happy. Depending on the length of rotations in a rotation-based system, this could occur because removable prostheses take a while to complete. Although the supervising dentist should ultimately approve of the impression, there are some professors who have too much faith in students’ work. Another advantage of the individual-based system is that you can schedule your patients whenever you want and with the professor you want (seeing that their chairs are available). With rotation-based systems and team-based systems, the front desk schedules your patients and you don’t always have a say when it comes to picking the professor you like to work with. However, scheduling your own patients can be time-consuming, so having the front desk take care of this for you can be advantageous. The individual-based system does have its downfalls though. One major downfall is the unequal distribution of patients. One student in your class could hit the jackpot by having several “good” patients who show up and cooperate, while another student isn’t as lucky and has patients who cancel on them. This will greatly affect your ability to finish your clinical requirements in time for graduation. There are some people in my class who have full schedules and there are other students who cannot fill their schedules because they don’t have enough patients. With rotation-based and team-based systems, time isn’t wasted as much because you will always have a patient in your chair (as long as they do not cancel). 

    So as you can see, there are advantages and disadvantages with each system. Knowing that my school is in the process of changing the way they run the clinic has me interested in hearing how other schools are ran. I’d really appreciate any comments you may have regarding this information!

As a dental student, you will be asked to interpret just about every radiograph that you take, especially if you are formulating a treatment plan for that patient. The panoramic image has always been a bit trickier for me to interpret than the periapical images. After 3.5 years of dental school, I have finally formulated a sequence of structures to evaluate and describe for a panoramic image. Although everyone has their own way of interpreting images that works best for them, I would like to share with you what has worked for me and hopefully reach a few others struggling with panoramic images.

There are a few items to remember about panoramic images. First of all, they are NOT to be used for caries interpretation. The teeth may overlap or be distorted, which makes the interproximal surfaces difficult to see. Also, remember that the resolution is lower than that of periapical images. Finally, panoramic images are 2-D images and therefore a 3-D image (such as a CT scan) is needed to determine the exact spacial relationships of teeth with vital structures.

This may sound silly since we are studying to be physicians of the teeth, but when you first look at your panoramic image do everything in your power to avoid the teeth! Do not look at any teeth when first looking at the panoramic. You need to look at the larger structures. Check the condyles. Are they symmetrical? Are they the same size? If one condyle is missing or shortened, is it possible that the patient experienced facial trauma early in life? Then check the maxillary sinuses. Are they the same size? Are they enlarged? They are not always the same size or symmetrical, and that does not imply pathology. Pneumatization of the maxillary sinuses often occurs with age as the maxilla thins and fills with air spaces. The most important aspect of the maxillary sinuses is that the borders are present and intact.

The midfacial region is rather complex on a panoramic image. There are many bones and air spaces that you need to ensure are present in the image. These structures include the temporal bone, the zygoma, the mandible, the frontal bone, the maxilla, the sphenoid, the ethmoid, the vomer, nasal bones, nasal conchae, and the palate. Until you are comfortable identifying each of these structures, I would keep a diagram with you while evaluating panoramic images. I had to keep a diagram with me for about a year!

When evaluating the mandible, it is most important that you see the mandibular borders are smooth and have no interruptions. The widths of the right ramus and left ramus should be about equal, additionally the condyles and the coronoid processes should be symmetrical.

Of course if your patient did not take off earrings, glasses, their tongue rings or other miscellaneous metallic elements, you will see ghost images and artifacts on your panoramic image. It is very important to be able to identify these artifacts to rule out pathology! 

Whichever way you choose to evaluate and interpret your panoramic images, I advise you to be systematic and have a consistent sequence of structure identification. This will prevent you from leaving out important parts of your interpretation and from missing pathology.