D3: Onwards and Upwards

Officially checked out B28 Preclinical Lab today, marking the end of the second year of dental school! I'd say I'm half a dentist, but it doesn't feel like half way just yet. After Part I of the NBDE, then I'll assume that title. Nonetheless, it was bittersweet handing in the key to my drawers after having spent so much time right there, developing skills that I'll take with me into the clinic and away after graduation. We often see upperclassmen in the lab so it's not so much a "farewell", than a "be back later" kind of deal, but it's a definite change.

We are issued a giant, heavy, white box of supplies, which serve as our new "lab drawers". Back in the day when students had their own chairs in the clinic, the boxes easily be brought to your chair and left there for easy access. These days, I dont think I've seen one person carrying those huge things around. Instead, we've donned "clinic bags" of sorts to bring up whatever supplies we'll need.  I was lucky enough to find a nice black cosmetics box in our attic at home, which fits my supplies perfectly! But like most things in school, people do what works for them. Some like the freedom of having everything on hand. So after unpacking the white box into my clinic bag, the box will sit nicely in the closet, probably until graduation.

Reflecting on D2, I'd say was way more fun than D1. Tons of lab work, but also a lot of dentistry. Constantly cramming just became a way of life. There's quizzes in every class, which keep you on your feet. At first I definitely remember feeling overwhelmed by the 5 or 6 casts we had to have poured, impressions and wax-ups that were due, and preparation for tests and quizzes, but all was well. Looking back on individual courses:

Endodontics I
Endo was awesome. Probably one of my favorite courses so far. The class is divided up into groups of about 8, and assigned different instructors who grade projects and teach technique. You can of course ask any professor for their opinion, but asking the one whose grading you is usually most wise. But preclinical endo is great. Dr. Pantera plays Pandora, or the occasional movie and we go at it on our extracted teeth. The projects are on different teeth each week, and the lecture part of the course correlates really well. Although I feel like I've learned a lot, I can see clinical endodontics being quite challenging. Visualization in posterior teeth, or even anteriors may be a challenge, since they are fixed, rather than in our hand. The only improvement I could think of is having a typodont where mounted teeth could be placed, to simulate clinical endodontics. Working with extracted teeth was a great experience though, to teach the complexity of the root canal system, how instruments feel cutting actual tooth structure, and tons of other things.

Ethics and Law

Awesome class, and I hope we get more of this because it's really important. Dr. Gary and Dr. Maggio are really passionate about the subject, and it doesn't hurt that Dr. Gary is also a lawyer AND a dentist. The class touches on a lot of subjects that will definitely arise in practice, and teaches the ethical and legal obligations to dentist. We also covered a bit of social media, which gave me some guidelines for this blog.  I personally thought quizzes and the class was overall fair, although like any ethics class, there are subjective areas that will encourage more discussion than probably was intended. Aside being amazingly relevant to dentistry, I liked the information the class taught about how the clinic at the school runs, and Dr. Maggio's survey results about successful students in clinic, and patient interaction. Simple things like communicating clearly, being more accommodating and courtesy can help dentistry run much smoothly and improve the patient experience a ton.

Indirect II

Indirect was a challenge for me at first. This class really showed me how important attention to detail is, and the professors drive that home over and over. Cheers to everyone for getting through the infamous 3-unit bridge project. Luckily, the competency was a #30CCC rather than a #18-20 FDP prep. But the bridge definitely got it's fair share of attention. I think I must have waxed, broken and rewaxed it 5 times, and casted it twice. We're not required to cast our own, but I'd suggest it for anyone with any interest in the casting process. We had a lecture from Dr. Conny about lab work and dental school which gave me some basis for constantly being in B28 second year. Dr. Conny is an incredible prosthodontist who has done his own lab work for many years in private practice and stressed the importance of dental students understanding the process lab technicians go through to fabricate restorations and dentures. Dentists these days are placing more indirect restorations thanks to CEREC and increased demand for more esthetic, tooth like solutions, yet, dental students are doing less lab work. He presented examples of dental lab work authorizations with outrageous requests, clearly showing that the dentist did not understand the process which must be followed to fabricate the crown/bridge/denture/etc. So if you're a dental student drowning in lab work thinking, "This is pointless, I'm not going to be a lab tech", know as a future dentist, you'll be a customer, and a supervisor of a dental lab one day. And supervising something you've never done before, might be quite difficult.

Removable II

Went through partial dentures this semester. Now those mysterious tooth replacing apparatuses in patients mouth's make a lot more sense. I can see removable being really tricky, but amazingly rewarding when things come together. Lecturers were again great, and Buffalo has really helpful prosthodontists that are really passionate. For my own future reference the process for removable includes: Primary impressions, secondary impressions, pouring of a diagnostic cast, surveying, determining the need for survey crowns, preparing guide planes, heights of contour modifications and rest seats, then taking an impression for the master cast. If a survey crown is indicated, we've learned its better to make your modifications before taking the impression of the crown prep, so that the lab can fabricate the crown according to the modifications. The specs of the crown should also be clearly communicated on the work authorization.  Some upperclassmen mentioned they hadn't had the survey crown experience so I'm really glad we had the opportunity to work on one. Survey crowns are crowns that are made to fit the partial denture framework. They're usually indicated on teeth that are excessively tilted, or that may require a crown due to caries or other pathology.

Oral Sciences II

Learned some valuable knowledge here and Oral Sci was really well run. Not really much to say about this course, except that brute memorization only goes so far. Dr. Cho really emphasizes understanding the material, for your own benefit as well as that it's on the board exam. So the three hours on Monday afternoons spent in a basement other than Squire's, was well spent. The coolest things I thought came out of Oral Sci was learning about the science behind periodontal treatments like  PDGF, and the experiments our own faculty went through to develop advances in their field.

So that's about it for D2. D3 starts full swing on Monday with a full day of clinic! #letsdoit

Lawnchair Denstistry - Good Neighbors Clinic Outreach

Today began at 6:50AM with an alarm that might induce a heart-attack in someone not as accustomed to vibrating mechanisms under their pillow. 6:50AM isn't a time most dental students see on Saturdays, but I was lucky enough to be selected to volunteer at my first REAL dental outreach!

On Jefferson Ave in downtown Buffalo, the Good Neighbors Clinic provides free dental, optometric, chiropractic and medical services to the area on designated days. Today was a purely dental day. Along with a handful of local area dentists, twelve dental students and staff of the clinic we provided care to upwards of 30 patients in the span of 8 hours! Of the twelve students, first and second years were assigned to assist third and fourth year students who would perform procedures. Upon arriving there at 8AM was already a line of patients waiting outside in the snow.  Much work had to be done to set up operatories with the necessary instruments, personal protective equipment and more. Rooms designated for surgery were equipped with reclinable lawn chairs, forceps, gauze, elevators, syringes, carpules of anesthetic and dental bibs. Once a triage system and front desk were set up we were on our way.

I was assigned to a third year student, who was overseen by a dentist. The three of us were placed in room designated for extractions, where I assisted in the extraction of some three or 4 molars.  I quickly learned that during outreach events, conditions are far from ideal.  Watching my third year (Susie), who is a few inches taller than me, extract upper and lower molars from incredibly uncomfortable positions was amazing.  Even moreso was the fluidity and confidence of Dr. Hattin, the designated oral surgeon of the crew. Upon being presented a case he deemed "very difficult" to all onlookers, he would proceed to remove bone around the tooth with the surgical drill and in minutes the tooth that we had struggled with for much longer would be out - next patient.

Not everyone had this much luck, as I witnessed others with more difficult patients. It was through their experiences I learned that patients may sometimes require anesthesia prior to having x-rays due to sensitivity or anxiety. Nonetheless, even though some extra time was needed, quality care was achieved.

When I wasn't showing patients to their rooms, bibbing them, dabbing blood from teeth, collecting freshly extracted ones from Susie and Tom, or bringing supplies back and forth from the sterilization/x-ray room, I spent most of my time learning about taking and developing Panorex X-rays. A dental hygenist who basically ran that room was a great help to me with this. Today I took one periapical and 3 Panorex X-rays - solo! The procedure for pans was:

- Prep the X- Ray machine with a small plastic wrapper that goes over where the patients teeth contact the machine
- Retrive patient from waiting room,  walk to the X-ray room.
- Explain to them what the X-ray machine does, since pans are not your average x-ray and the machine can be somewhat intimidating and complex
- Have patient remove all jewelry from their head and mouth, and jackets if they may get in the way
- Place the lead apron on the patient and have them step forward into the machine
- Have the patient bite onto the peg, with their chin comfortably seated and forehead forward against the headplate.
- Ensure proper tooth positioning on the biting peg by having the patient smile slightly and observing the peg reach back about to the canine
- Have the patient place their hands on the handles and ensure the machine will not be obstructed by the patient's shoulders when it moves.
- Once you let the patient know to remain completely still, you're set!

Lucky for me all of my patients were calm, collected and sociable. I loved sharing stories about my own tooth extraction and my first panorex x-ray that I saved in my room for months since it made a nice window decoration. Not sure what they thought of me after that but at least it made them smile.

I also learned to develop films and pans. The pans were a little more involved in that the room needed to be closed, the machine off and lights off. The film is kept in a cartridge which needs to be opened, then the film must be placed in the developer. Chris helped me reload the cartridge and place the unexposed films back in their package before the lights were turned back on.

For a first time assisting and actually serving in a clinic I feel like I learned a ton. The day flew by and before I knew it, it was 3:00PM and we were cleaning up. While technical skills are important and necessary, the most important lessons of the day were those in patient communication, as well as colleague interaction. Providing care is always, always, 100% focused on the patient. In my mind it's a privilege to treat any patient, since they could have gone to anyone else. In this case, these patients needed any care they could get, but I was still gracious to have interacted with them since they could have ended up in other student's operatories. Every effort should be made to create a positive experience for the patient (which reminds me for future outreach events to definitely bring a radio!) Additionally, patients are people and people love to socialize, especially when they're nervous and need to feel more comfortable. I learned more about patient's children in college, struggles with drugs, favorite movies, hometowns and more than about dentistry today and recalling all that would be an accomplishment. The take away is that the patients are what makes it all so rewarding.

One patient's husband who was a minister told me something that stuck with me. When I expressed an interest in his preaching and mentioned the name of the pastor of my church in Binghamton, he recognized the name and shared that he was actually from there. He then told me it sounds like I have a calling on my life and wished me blessings. Despite the conflicts it's caused, I'm happy that faith still brings us closer together.

Fourth Molar Takes Root.

Welcome! I've been blogging for years now and I've always wanted to start a blog that may be of meaning to others, rather than just rant about random topics. So here goes- first a little background.

I'm currently an undergraduate student at SUNY Binghamton University finishing up my B.S. in Bioengineering. This Fall I'll be attending my top choice school - SUNY Buffalo's School of Dental Medicine! I'm a little late starting this blog, as I wanted to document my studying for the DAT as well but as anyone studying for a major standardized test knows, its unbelievably time consuming. I don't expect dental school to be very time friendly either, but I feel posting about material will not only enrich others but may help my understanding as well.

It's funny how you think getting in is the hardest part when you haven't yet, but the devil really is in the details later on. I've recently overcome the first of many administrative hurdles - where and whom to live with. After frantically emailing other students in our Facebook group, and not having much luck, I came across another student's post looking for a roommate to fill a house of four. A couple phone calls and emails later, a deal is made. The main attributes I was looking for were cost, safety and distance to the school. This place I think has all of those, although it is a bit on the pricey side, nonetheless, I'm excited. A few things I learned through this whole housing search:

1. Visit! At LEAST once. If you're a dental/med student you've had an interview at the school already and you have some idea of what things are like. Hopefully you began thinking about potentially living there during your interview.

2. Scour the Internet - Facebook and Craigslist were my best friends honestly. I have a friend whose attending medical school next year and he's yet to have found an "Accepted Students" group for his class, which I think is nuts. Every school (especially professional schools) should have these. Students generally start them so if there isn't one, might as well start one! If all goes well, current students will join as well and connecting with them is perfect since they're the best source to go to. Craigslist helped me get an idea of what else was out there, if it did come down to my finding a place on my own. It also gives you an idea of what you'll be spending on housing. Google Maps street view was also quite handy to check out if houses I was considering were in super sketchy areas or not.

3. Shop Around - With housing there's always options. I know in Buffalo I heard of a number of student plazas, apartment complexes and communities where students are known to live. All these falling into a wide price range. Take a look around, but not for too long...

4. Be Open  - Everyone's got preferences. Ideals for themselves, the people they want to be around, where they want to be, the list goes on. Regardless, what's more important than what we want is the attitude we take toward what we're presented with. Be positive, and positivity will likely follow along. As my professors have drilled into my head the past four years - embrace change - there's opportunity in every change.
 
UB has already sent out a "To-Do" list for us incoming students, which I am yet to get on, thanks to some intense senior level engineering courses. I think that's all for this first post. Looking forward to a fabulous next four years :D!