D2 Begins

Today was the official start of second year and it's got a good feel to it so far. D1 ended with a bang all around I think, since for the most part our averages were really high throughout. Definitely a needed "break" after the shock treatment of first semester.

Here's a snapshot of the ever changing spring extension schedule courtesy Tricia Hackett-Swanson from class. Physical Assessment is about 2 weeks so that'll be out soon. The class was divided into 4 groups, so that we have our final examinations at different times. I totally lucked out making into the group getting tested last.

I spent most of today practicing putting a rubber dam on my typodont. Since we'll have to use one for every operative procedure in class, and in the clinic I figured this is something I should be pretty efficient with. Those things are much trickier than they appear, and from spending some time in the clinic with upperclassmen, I already knew they were tricky. Although Dr. Sabatini taught us to place the ring around the tooth first, then place the rubbed dam over the ring and tooth, I found it much easier to place the ring through the dam before placing the ring in the patient's mouth. I shadowed an endodontist who I remember placed rubber dams with ease this way. Still need to work on not tearing the dam while placing it through contact areas. A friend suggested using a piece of a spare dam to push the dam through the contact area, which I'll need to try. Floss can also be used but it might cut the rubber. As with many things in dentistry - "whatever works best for you".

All we've got is Nutrition tomorrow, but given the 14 chapters we have to read for Physical Assessment, that time is anything but free. All in all I can see myself spending hours on end in B28 since I'm really loving this stuff so far. Placing and removing a dam for 4 hours was actually pretty fun and I'm sure most everyone's going to love when we start restorations. Here's to second year!

Friday Afternoon Endo

When I see the "C" for Clincal Rotation on our Integrated Dental Practice schedule I'm never sure how to feel. The last clinical rotation I had was spent talking to a fourth year friend for a few hours about impressions, casts, dentures, patients and dental school in general. All very, very useful stuff, but while in clinic it'd be great to do something clinical which is exactly what I got this time around

I had the privilege of working with an awesome third year, named Joy whose name perfectly fits her personality. Our patient was an elderly woman in need of RCT on tooth #11. She had many other dental problems, however the canal in this tooth had been previously treated and needed to be completed. Joy began with a few anesthetic injections before removing the IRM (temporary filling -Immediate Restorative Material), while I manned the suction. Once cleared she then cleaned the canal with the slow-speed and filed and shaped it with different files. Despite some trouble we ran into with excess saliva, and placing the rubber dam, the patient was amazingly patient and understanding. Looking back, I think that situation was exactly what Dr. Goldberg in Orofacial Neurobiology was talking about. Our patients will react to our demeanor and attitude. While competence is vital, compassion and empathy for our patients is also critical.

Once we had a clear canal, the next step involved cleaning the canal with a bleach solution, measuring the correct gutta percha length and filling. While the bleach rinse was fairly painless, measuring the correct length of gutta percha can be tedious. Once measured the apex could then be filled and checked via radiograph to ensure that the apex really was filled. I familiarized myself with the digital radiography program and developer the clinic uses and some protocols for the x-ray room which was nice. Once the apex was filled we could then fill the remainder of the canal then finish it off with more IRM since this patient would need another appointment to crown off the  tooth since so much of it was lost to decay. 

This was the first appointment I got to assist in entirety at UB's clinic and I can say I completely understand  how 3 hour appointments can fly by, how amazingly helpful the professors and assistants are and how great our patients can be. Next week we've got an Orofacial Neurobiology Midterm on Tuesday and Microbiology on Thursday. Group presentations for Community Dentistry are also coming up fast. On a more fun note, I've been keeping up with the weekly Capoeria classes and it feels like I'm getting the hang of it. There's also a couple of bike rides for Diabetes and Cancer that I'm  getting excited for. Never a dull moment! 

Post Spring Break

It's been a week since we got back from Spring Break and it seems like Spring just decided to descend on Buffalo. We've had basically 4 days of consecutive 80 degree weather which is uncharacteristic of Buffalo for this time of the year. It's supposed to cool down a bit, but before it does, some classmates and I have been taking full advantage of the weather. Being super bogged down in work all the time, its hard to find time to explore the other campus at UB North, however we got to the other day which was great. It almost makes you feel like UB South is the somewhat neglected campus.

Aside from the fabulous weather, there has been work. Third Micro Test was challenging, different from the past though since the material was divided up between a bunch of professors. And questions from the longest lecture (81 slides on Staphylococcus) were left off. Thankfully I saved that lecture for last :). Physiology is the next exam coming up next Wednesday, where we'll be evaluated on our knowledge of the lungs and respiratory system. The book work continues...

Integrated dental practice though has proven to be an awesome experience. On Monday we took our first alginate impressions on one another, and poured up casts. Our overseeing faculty had sympathy on us since they realized how long this would take, and our group had one hour less than the other groups would have, since we lost an hour to lecture. Even with that sympathy, and the added stress of the Microbiology exam the next day, the process took hours. Taking impressions is probably something we'll do many, many times in our careers, and we've probably seen dentists do flawlessly, without hesitation. Learning the procedure on the other hand is another story. First you need to measure out the powder, and water. They both then need to be combined and mixed throughly in a mixing bowl with a spatula, and within that same minute that it is mixed the impression material must be placed in a tray, and into the patient's mouth properly. Spend too much time mixing and your material polymerizes and you'll have to start all over. Spend too little time mixing and the material won't set correctly and you risk gagging your patient with dripping alginate down their throat(which I may have experienced lol). Once the mandibular and maxillary impressions are taken, it is rinsed, sprayed with Cavicide, wrapped in a wet paper towel and stored in a sealed plastic bag.

The next step, which is normally done in the same day, is to make the cast out of castone. This involves mixing water, and the stone powder, then filling the impression carefully. Once full the rest of the castone is neatly placed on a paper towel which becomes your base. The impression tray is then placed on top of this and set to dry, which takes about an hour. Once dry you can then remove the stone from the tray, trim the model and be set to go.

The whole process took a couple of days since none of us really wanted to wait around for an hour when there was a 10 lecture exam the next day. This made removing the stone a little more difficult than it should have been, but removing the stone from the alginate in a pool of water made things a little easier.  All in all, a great experience to have! I'd hope to do it again sometime, before having to be evaluated, but I'm not sure if we'll get that opportunity.

D1 Spring Semester Post Midterm Update

The semester's just about halfway through and despite not having any lab work this semester, it's busy as ever. Just last week I finished up 6 tests in a matter of a week and a half. Neuroanatomy ended and Orofacial Neurobiology has taken it's place. Not much to say about this class yet but from the Pre-test it seems interesting. We're given the option of testing out of the class if you can score high enough on the pretest given on the first day of class. While taking it it seemed like the kind of thing you could study and totally test out of, but according to those who actually did study, they didn't find any detail in the readings on some of the questions. Case studies II has also began which is just a continuation of last semester.

One achievement I'm particularly proud of is being the first dental student to take courses in the medical school! At my interview for Buffalo I asked a question that I thought blew my interview right there -"Are there any opportunities to take courses outside the dental school? I'm really interested in spanish and would love to learn and become a bilingual practitioner." The professor interviewing me responded asking me if I had any idea how much work dental school was, to which I answered "Couldn't hurt to be ambitious." The class has been going great so far and it's really nice to interact with some other students, and learn something outside of the sciences for a couple hours a week.  This Wednesday I'll be heading out to a clinic to speak with spanish speaking patients and take a patient history. It should be a great time:).

Although we have no lab classes this semester, we do have one class that puts us in the Clinic a couple of times a week. This semester is the first time the school has introduced Integrated Dental Practice into the curriculum. The purpose of the class is to get us more comfortable in the clinic and introduce basic dental procedures so that we are more competent when the time comes for us to treat patients. Thus far we've done exercises in infection control, fixed prosthodontics where we poured jadestone models, removable prosthodontics and a few others. The best yet have been clinical exercises where we learned how to do comprehensive oral exams, tooth charting and placed and cured our first composites on one another. Since it's a class in the making there are plenty of issues being worked through but kudos to Buffalo for taking the initiative to provide a dynamic curriculum.

Spring break starts this Friday and I think we're all ready for a week off. That's all for now.

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.

Alpha Omega - Ellicottville Trip

Ever since starting dental school I've picked up a ton of new hobbies and this past weekend I just added another to the list - snowboarding. While my body sufficiently ached from falling countless times, the weekend was a blast.

Alpha Omega is the dental fraternity I joined last semester in an effort to get involved early on. This weekend was one of the first trips that I've attended and it was a trip to Ellicotville, a small skiing town an hour and a half south of Buffalo. We were lucky enough to stay with Dr. Stern, a generous alumni, at his winter home, which included beds, lots of food, drinks and fun. We arrived on Saturday evening, and went tubing at the Holiday Valley Tubing Company, which was my first tubing experience and I'd say it was nothing short of thrilling. Accelerating down an ice and snow chute for 900 feet is something that doesn't get old too quickly. That night we went out to eat at a restaurant called Kabob, which was also not bad. Dr. Stern's place was prime location, being walking distance to the bar scene, and restaurants. It was also no more than a 10 minute drive to the tubing location and to the ski slopes. After an awesome dinner we proceeded to have a night out, where we danced the night away, despite having to wake up early the next morning to hit the slopes.

We got the the Holiday Valley Slope around 11:00AM, decked out in my new snowpants, sunglasses, hat and layers of clothing. I rented my first snowboard, and spent the first 3 hours or so mastering the bunny hill. After flying down a few times, Laura and I progressed to our first green slope. To our dismay, or more so mine than hers, I ended up sliding down the slope on my back,arm, butt, rather than snowboarding down it. Control is the main thing I need to work on which will definitely be the focus next time! Nonetheless, the day was awesome I'm totally going back again.

Spring Semester: The Start of Something New

Been back for a little less than a week, and things are already in full swing. This semester's schedule is MUCH easier than last, since nothing can really compare to the workload of Gross. Here's a look at the start:

Integrated Dental Practice will be added Mondays and Fridays from 1-4PM on the 31st and a couple other changes will happen as well. For now things are totally manageable and it seems like there's a general sense of optimism in the class.  I'm personally a little bummed that we have absolutely no dental lab courses this semester after just starting waxing and using our handpieces last semester. I'm toying with the idea of bringing home my supplies and waxing on occasion since hand skills are vital. Nonetheless, classes are still interesting. 

Next week we have our first outreach trip for Practice, Profession and Community Dentistry. We'll be talking to middle school aged children about oral health and mentoring them later on. Buffalo was apparently the first to implement this type of program into their dental curriculum and since then a few schools have followed. Opportunities such as these are what made Buffalo so appealing. I really hope to take away new perspectives and a deeper comfort with people from this class.

Physiology is nothing spectacular, I'm thinking about it as just another biology class.  Surprisingly, much of the material we are covering in the first unit on action potentials, is material I spent hours on in Autonomous Agents, in my fourth year of Bioengineering.

Neuroanatomy, while another biology class, I find really interesting after the first lecture. The professor appears extremely knowledgable and teaches clearly and emphatically. High hopes for this one. Microbio, another bio class also is great thus far. Great professor, interesting material, also should be good. 

The much feared Occlusion class being one of the few actual dental classes we have this semester has gotten off to a good start. I can definitely see spending a ton of time memorizing definitions. Not sure how a class this important could end up getting only one credit hour. 

Oral Radiology, another important class also potentially could be somewhat time consuming, not only material wise but due to the interest level. I'm hoping we go into so much depth that we really are competent radiograph readers by the end of the semester.

I think the most anticipated class for me this semester will be Integrated dental practice, where we'll be assisting third year students in the clinic. This is another new implementation for Buffalo so hopefully all goes well and it sticks for the future.