Buffalo Niagara Dental Convention 2013

Talks of 2013 were great. This year we got to stay for the full two days, rather than just one. Normally I'd lean toward hearing speakers outside of UB since it's nice to hear different perspectives, but this year I checked out Dr. Panteras Everyday Endodontics, and Dr. Brewer's Digital Dentistry. More than the talks, the vendors really appealed to me this year. Spending 3 days a week in the clinic, doing our own lab work and working with patients puts us in a much better place in terms of what we're looking for in materials and products. In the school we're using Straumann's Implants, but it was great to hear what else is out there. I spoke with AstraTech and got some interesting information on their system. I learned there are a ton of other bur distributors out there and I'm curious to try their products before graduation since one is a local company,

What I really loved though about this convention was the labs that were there. Spent some time talking to Vincent Martino Labs, which I got the impression was a small lab up around Buffalo. What I really was impressed with was Evolution Dental Science Labs. I have this intrinsic admiration of lab techs for what they do. Most of the magic in dentistry is all in the lab. The beautiful restorations all come from them for the most part. As dentists, we decide what is in the patient's best interest, and how to handle the case, but the technicians actually fabricate the solutions, and that's something incredible. Anyways, they're a bigger lab, that always has a presence at the convention. They're cool new thing this year was a system for digital dentures. The dentist takes upper and lower impressions and bite registration, and sends it in to them. They then have a digital scanning system that scans the impressions, digitizing them and allows them to create a denture virtually with sockets for the teeth to later be cured into. The design is then milled into a material denser than the usual denture acrylic. This material is denser, thus houses less bacteria and is stiffer, leading to a better, healthier fit. Since the denture is milled, there is no shrinkage to account for which alters the fit of traditionally made injection molded or compressed dentures.

The dentures they had ready made as models were great, normal looking dentures, but what I found really cool were these wooden dentures they had just for show. Not the greatest quality picture, but pretty cool having machines that can mill different materials.

I really admired the techs that were there that I had the opportunity to talk with and spend some time with later on at their sponsored event. They're passionate about what they're doing and willing to share their knowledge. Since we do our own lab work at the school it also was great to get some feedback from others doing the same work at a much higher level. A couple invited me out to the lab to check things out which I'd really love to do. Hopefully in the near future. 

Dr. Paul Farmer visits Canisius College

Dr. Paul Farmer was amazing last night. I think I might have been a little lost in the hype at first but he’s an incredible person. For everyone who doesn’t know, Dr. Farmer is one of the founders of Partners In Health, a large non-profit that works to bring medical care to the poorest places in the world. Dr. Farmer started PIH while he was a medical student at Harvard Medical school. He's also one of my personal role models and an inspiration as an aspiring health care professional. According to Kidder’s biography, Mountains Beyond Mountains, Farmer would skip classes during the week his first couple of years to work clinics in Haiti, and return to Boston for exams and clinical rotations. His passion for people and health were evident. 

Dr. Farmer premised his talk with a overview of the health care system in general. There were three parts in his eyes: Discovery, Development and Delivery. Discoveries made in labs, such as vaccines, medical equipment etc, need to be developed into products that can be utilized in the delivery of care. As a physician, Dr. Farmer sees the system in realm of delivery. He spoke about the enormous amounts of people in the world without access to care and sought to change that, and to a great extent, he has.  He mentioned the negative mentalities that people in high places had for years in terms of providing care to the poorest nations. Statistics about how it could never pay off, and was completely unfeasible. My favorite part was definitely his citing of  a couple quotes from a couple government agencies, which basically was them giving excuses why these poor nations are not worth even trying on. Dr. Farmer responded to these quotes with fervor, tearing them down and totally disproving them with his entire career. 

Issues of cost in health care came up as well. The vast disparities between cost of drugs and medical supplies in the U.S. is obscene. He mentioned that health care is a strange field in that aspect. If any other good or service ranged in cost to the extent that health care does, heads would be turning, but given the complexities involved in health care, somehow they get away with it. Nonetheless, even in the face of cost, Dr. Farmer was able to raise money and secure medications for his patients abroad in order to treat AIDS/HIV, Tuberculosis and even cancer in the poorest nations in the world. 

The motif that we can learn from these nations was recurring. The idea of “community based healthcare” and how in some parts of Rwanda, higher percentages of people are gaining access to health care than in parts of the United States. 

All in all, Dr. Farmer was inspiring. Despite what people say about him not being a great family man, he’s an incredible person. He found something worth fighting for and changed the world. Given the unbelievable turnout I know many others agree. After his talk he took 8 questions, but stuck around to speak with the long line of guests that waited to meet him. 

All Dr. Farmer spoke about medicine is even truer in dentistry today in the U.S. Costs of oral care are often too expensive for people, and insurance has not done much in the way of solving this problem. This article on DrBicuspid.com talks about America's Dental Care Crisis, and the people of Wisconsin, Minnesota and other states who are in pain, suffering from a lack of dental care. Dentistry as a whole requires a change if care is to be extended to the underserved populations in this country. Overhead for dental care in general is miles above that of a primary care physician's office. Progress is being made in the way of Community Dental Care Coordinators, to aid in the access to care issue. Today dentists, possibly even moreso than physicians should be concerned with our delivery of care, and how we can extend care to those in greatest need. 

Soda and Teeth

This intense video popped up on a LinkedIn dental group. The ominous music and narration really get the point across: drinking soda frequently will destroy your teeth.

Implant Dentistry

The UBSDM boasts an impressive 98.2% success rate for dental implants. I feel we've been getting a great education with regard to implant dentistry as a whole. Last semester we went through the treatment planning process,  risk factors, biomechanics and theory. At the start of this year, we went through a demonstration and hands on simulation of the surgical placement of the Straumann dental implants we will be working with.

A little bit about these implants - they're pretty awesome technology. Medical grade titanium, acid-etched and sand blasted surface chemistry that makes them very biocompatible. The surface is apparently so hydrophyllic that there are images of blood seeping up onto the implant surface as it is being placed. Sounds gross, but in dentistry, that's incredible.

The procedures I've followed thus far were pretty straightforward. Patient presents with either a tooth to be extracted, or an edentulous ridge desiring an implant. Space has been the primary consideration. Once a tooth is lost, the other teeth in the mouth begin to shift mesially, or toward the midline, to close the space. The opposing tooth, above, or below the edentulous space also supraerupts into this space. In some cases we can make a removable prosthesis with a tooth to maintain the space before implant placement and during healing. Treatment planning is essential from the start for a successful implant case. As I mentioned, space is critical. There are a number of different diameter implants and the diameter chosen is based on the mesio-distal space, amount of bone, and tooth to be restored. Ideally, we also want the implant to be at least 1.5mm away from any adjacent root structures. 

At UBSDM we utilize Cone Beam CT scans to analyze bone density, and locate critical anatomy such as the Inferior Alveolar Nerve that runs through the mandible. An implant must be placed away from this nerve, to minimize the risk of damage. After placement, the implant is given 3-6 weeks to osseointegrate, before being restored. In order to restore the implant a careful impression procedure is followed, and a temporary crown can be made in the lab prior to the placement of the definitive.