D3 Fall Post Midterms

Crazy as it sounds, and as much sacrifice that this year has taken so far, D3 is great. Class all day Tuesdays and Thursdays is brutal, but seeing patients Monday, Wednesday and Fridays makes up for it. This past week we had exams in Fixed, Removable, Pharmacology and Endo. Pharm is the obvious killer. Public Health class is getting better, just hard to debate things at the end of the day. The other week we had an interesting talk about dental therapists. Talking about this issue in dental school makes me feel that I need to put in a little extra effort to get the whole story. For anyone just reading for fun, dental therapists, or mid level providers are dentistry's equivalent to physician's assistants and nurse practitioners in medicine. They would work under a dentist to provide care in uncomplicated cases. Simple restorations, preventative treatments and patient education would be their primary roles. The thought is that these practictioners will bring down health care costs in dentistry, and increase access to care in underserved areas of the nation. The concern about this strategy among dentists is that dental treatment is often irreversible, and complications arise without warning at times. Having a provider with less training and experience puts the patient at more risk than it benefits them. The issue has many more angles than I understand at my current position, but it's all very interesting. I've seen videos from states like Minnesota that are very appreciative of programs such as these and that patients that normally would not be seen, are receiving treatment.

The access to care issue is really interesting to me and it's disheartening to hear stories about the dental care crisis in the U.S. Again with many of these issues, there is are always many factors at play. I read an article the other day where dentists in Michigan are doing something really cool. Since dental insurance isn't as widespread as medical insurance, people often don't seek out continual dental care and end up in ERs with dental problems. The ERs are generally not prepared for these types of problems, and there is little that can be done many times, beside a referral to a dentist. Dentists in Calhoun County Michigan have set up a program where uninsured patients who have dental emergencies can recieve treatment, in exchange for community service. Since private offices established the program, there isn't as much paperwork as government run programs and they can run the program as they wish. The Medscape article can be found here. I'd encourage everyone to check it out.

But back to actual school. I've completed my first set of Interim Dentures! They'll be off to the lab tomorrow (fingers crossed). I set a lingualized occlusion, where the maxillary buccal cusps do not make any contact during excursions. There is 1mm of overbite and 1mm over jet. The next steps will be to finish and polish them once they are processed, then bring the patient back for extractions of the remaining anterior teeth, and insertion of the interims. Next semester we'll go through fabrication of the definitive upper and lower dentures which I'm looking forward to.

My first crown is finally back from the lab also! Upon initial evauluation on the cast, the mesial contact was actually open, but our lab in school was able to fix that no problem. There were no positives on the intaglio (inside) surface, the margins looked clean, and occlusion was correct. Moreover, the porcelain appears to be completely intact and sound. I can only hope the definitive restoration fits the natural tooth as well as the cast.

Also getting started on my implant case for this semester. Primary impressions were taken a while back. in the school the next steps involve meeting with an implant fellow, waxing in the tooth to be implanted, and creating a surgical guide. So far I've got the tooth waxed in but the guide needs to be done under the implant fellow's supervision because the machine we use is newer than the one we initially learned this with.


So in short, third year is great. Oral path exam this week and Medical Emergencies is finishing up also. More to come.

Cheers.