So I've been scheduled for the exam for a while now, studying on and off lackadaisically, but this week starts the high gear learning. The exam basically covers all of the basic sciences we'ved learned up to this point. Gross Anatomy, Dental Anatomy & Occlusion, Microbiology & Pathology, Biochemistry & Physiology, and Ethics/Professionalism. I scored a set of the 09-10 Dental Decks off a friend, in addition to the First Aid for the NBDE Q&A which has a ton of practice questions. I'm still figuring whether I want to get the First Aid Review Book, or the Board Busters. The current plan involves getting through the decks for a foundation, then studying the details from a book and old lectures. Having gone through a handful of Dental cards, all Biochem and about half of Micro, things aren't too bad. I really feel like our classes have prepared us well for the exam, since most of the questions on the decks have been covered on previous exams and lectures. The craziest part about the exam to me is the length - 8 hours. Should be exciting.
So to set a plan in stone:
May 27th - 31st: Finish Micro/Path
June 1st - 7th : Gross Anatomy Decks
June 8th - 14th: Dental Anatomy/Occlusion Decks
June 15th - 18st: Review Biochem/Physio
June 19th - 21th: Review Micro/Path
June 22nd - 25th: Review Gross
June 26th- 29th: Review Dental Anatomy/Occlusion
June 30th - July 5th: Nonstop Practice Questions
Ethics will be thrown in there every time I'm totally exhausted from sciences. Been through those cards and they aren't bad. Power month coming up. God help me.
Cheers.
A dental student's journal.
Monday, May 27, 2013
Saturday, May 11, 2013
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
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
Monday, April 1, 2013
Sensitive Teeth?
Teeth are composed of a fewbasic tissues. Enamel, the hardest substance in the body covers the crown of the tooth, which is what we see clinically. Dentin underlies enamel, making up a bulk inner portion of the tooth. Cementum, which is normally under the gums, covers the root of the tooth and helps anchor the tooth into the jawbone. And finally, the pulp, which houses nerves and blood vessels is within the dentin and extends down into the root.
Gingival recession may occur in some patients due to mechanical or biological irritation. When the gums recede, this exposes the less mineralized cementum, and sometimes dentin. These tissues are more sensitive and when exposed to the oral environment may produce pain. The Hydrodyanmic Theory of dentinal sensitivity is an accepted mechanism that explains this sensation. Dentin is made up of tubules, containing fluid. Changes in osmolarity (concentration), or temperature, causes this fluid to move either inwards, or outwards, which is perceived as pain.
Treatment for dentinal sensitivity is focused on plugging these tubules, or covering them somehow. Colgate's Duraphat Fluoride varnish is a remarkably easy and effective treatment option for patients with sensitive teeth at UBSDM! It's a 5% Fluoride paste that's basically painted onto surfaces that are sensitive and is left on for the rest of the day. We advise patients to avoid hard foods for at least two hours.Restorations may also be placed subgingivally in some cases to treat sensitive teeth. It should be noted that every case is different and may require alternative treatment.
Gingival recession may occur in some patients due to mechanical or biological irritation. When the gums recede, this exposes the less mineralized cementum, and sometimes dentin. These tissues are more sensitive and when exposed to the oral environment may produce pain. The Hydrodyanmic Theory of dentinal sensitivity is an accepted mechanism that explains this sensation. Dentin is made up of tubules, containing fluid. Changes in osmolarity (concentration), or temperature, causes this fluid to move either inwards, or outwards, which is perceived as pain.
Treatment for dentinal sensitivity is focused on plugging these tubules, or covering them somehow. Colgate's Duraphat Fluoride varnish is a remarkably easy and effective treatment option for patients with sensitive teeth at UBSDM! It's a 5% Fluoride paste that's basically painted onto surfaces that are sensitive and is left on for the rest of the day. We advise patients to avoid hard foods for at least two hours.Restorations may also be placed subgingivally in some cases to treat sensitive teeth. It should be noted that every case is different and may require alternative treatment.
FirstCare* Dental
Clinic-in-the-making Update!
In the past couple of weeks we've made some progress on our start up community dental clinic at 1500 Broadway! We'll be known as UBDDS: FirstCare Dental. Great name since we're literally one of the only dental institutions for the community in that area, and we're anticipating a great deal of urgent care patients. ECMC also has had patients coming in with dental emergencies, so we are hoping to intercept those patients via referral or directly once people know who we are and what we do.
Marketing-wise we'll also be working on a presentation of sorts, to present to those interested in our start-up. Once that is underway, I'll be touching base with someone at the school who is experienced with grant writing. We'll be looking to find additional funds, being that we are a non-profit in an underserved area.
Fridays's meeting consisted of an awesome discussion of the potential services we'll be offering at FirstCare. Since we'll be primarily Medicaid based, our offered procedures will be heavily influenced by what is covered. But we will also have to strike a balance between what's covered, and the demands of patients.
In the past couple of weeks we've made some progress on our start up community dental clinic at 1500 Broadway! We'll be known as UBDDS: FirstCare Dental. Great name since we're literally one of the only dental institutions for the community in that area, and we're anticipating a great deal of urgent care patients. ECMC also has had patients coming in with dental emergencies, so we are hoping to intercept those patients via referral or directly once people know who we are and what we do.
Marketing-wise we'll also be working on a presentation of sorts, to present to those interested in our start-up. Once that is underway, I'll be touching base with someone at the school who is experienced with grant writing. We'll be looking to find additional funds, being that we are a non-profit in an underserved area.
Fridays's meeting consisted of an awesome discussion of the potential services we'll be offering at FirstCare. Since we'll be primarily Medicaid based, our offered procedures will be heavily influenced by what is covered. But we will also have to strike a balance between what's covered, and the demands of patients.
Monday, March 18, 2013
Source: http://www.dentalcaretoday.com.au/patient-education---tooth-decay.html
Saturday, February 23, 2013
1500 Broadway: Community Clinic in the Making
1500 Broadway. Future home of UBSDM's first student run dental clinic! Five other classmates and myself have had a couple of meetings with the administration already and things are finally starting to take shape.
This building was a community health center some years ago, but then was shut down, and has been closed up since. As a community health center, it not only provided health services, but also served as a place for people in the community, to socialize, and relax. Ideally I'd personally love to see it turn into something like that again.
Today our agenda included a detailed tour of the facility, to gain a better idea of what we will be working with, as well as checking out the equipment that has been purchased to be used once the renovations are complete. Our dental area of the building is situated next to what will be a mental health facility on the first floor. The second floor will be a medical clinic and the basement is mainly used for storage and other machinery. Since the building has been closed down for some time, it's not in the best condition, but we were all really excited to see the space, and I couldn't help imagining how awesome this will be once we're open. While in the basement Kevin (our dental repair expert) gave us a brief rundown about the dental equipment. The heart of any practice is in the vacuum pump and the air compressor. In setting up a dental practice these are two pieces of equipments that one should not look to take a cheaper option on, because without suction, or compressed air, there isn't much dentistry. According to Kevin, generally air compressors run ~$6K and vacuum pumps around $5K.
We also paid a visit to a storage facility where we're currently keeping the dental chairs, and furnishings for the clinic until it's renovated. I was thrilled to see the chairs were top of the line, all the usual instruments, attached sink, but also an LED monitor! All the more reason to push for intraoral cameras, and some other awesome gadgets. The chairs are made by Adec, which is a state of the art brand and go for around $17K -$25K.
We're now focusing on creating the business plan. We've divided up the project into parts so that we all have something to work on ourselves, although we will be involved in every section. The picking of sections could not have worked out better, since we all had interested in different things. I'll be taking on the technology role, and I really can't wait to do more. I'm considering talking to a local dentist to see what their opinion would be on reasonable technology.
Last week we met with the architects, and Erie County representatives, to discuss renovations which will be taking place. Our current projected floor plan includes 5-6 operatories, an IT room, break room, waiting area, reception, file room, sterilization, potential dental lab, and more.
This whole project takes me back to the bioengineering entrepreneurship days. Creating value, seeking out opportunities in change, and serving people. The big change up here has been the closure of many public health care facilities, leaving people to seek private care. So, we have the change, the people adversely affected, and now the funds to innovate. I see the vision being to improve the health and happiness of the people in the community, and there are so many ways to do that. Clearly, as an oral health care facility we will be providing care, but deciding what specific services remains to be determined. We'll need to be ready to embrace any population that may present, and be willing to adapt to their needs as well. The greatest challenge and most exciting part of new ventures - nothing is for certain, except our commitment to the cause.
Tuesday, February 12, 2013
Crown Lengthening
When restoring a tooth with a crown, we strive to have at least a 2mm ferrule for proper retention. A ferrule can be thought of as the surface which the crown engages the tooth. Sometimes when there is little tooth structure left, a crown lengthening procedure can be done to gain the necessary tooth structure needed for the tooth preparation. The procedure can be broken down into five steps: (1)Achieving proper anesthesia, (2) opening an full thickness envelope flap, (3) debridement/gingivectomy, (4)osseous reduction and (5) suturing.
Primarily, the patient is administered lidocaine with epinephrine, or a suitable anesthetic and adequate time is given for the anesthesia to be achieved. We then make an incision on the buccal and lingual aspects of the tooth being lengthened. The incision however spans from the mid-buccal aspect of the tooth mesial and distal to the target. For example, If we are lengthening #4, the primary incision is made from the mid-buccal of #3 , along the gingival margin to the mid-buccal of #5. It's important to be sure that the incision is made straight through the periosteum for the creation of a clean flap. An identical incision is also made on the lingual aspect and the gingival full thickness flaps are freed from the bone using a periosteum, or curette. This step can be quite time consuming, as we want to be sure to clear all interproximal tissue before initiating the osseous reduction. Next, an end cutting bur is used in the reduction of the alveolar bone surrounding the tooth. The end cutting bur allows us to remove bone, with less risk of damaging tooth structure. Once the reduction is complete, two 4.0 silk sutures are placed, introducing each from the buccal aspect of the interproximal areas.
Post operative instructions are similar to those given in the case of an extracted tooth. The patient is advised that they will be sore in that area, and may ooze some blood, which may look like more than it is actually due to the blood mixing with saliva. They should brush the area, only very gently and avoiding flossing the area for a couple of days. Ibuprofen is recommended to control pain, every 4-6 hours as needed.
Primarily, the patient is administered lidocaine with epinephrine, or a suitable anesthetic and adequate time is given for the anesthesia to be achieved. We then make an incision on the buccal and lingual aspects of the tooth being lengthened. The incision however spans from the mid-buccal aspect of the tooth mesial and distal to the target. For example, If we are lengthening #4, the primary incision is made from the mid-buccal of #3 , along the gingival margin to the mid-buccal of #5. It's important to be sure that the incision is made straight through the periosteum for the creation of a clean flap. An identical incision is also made on the lingual aspect and the gingival full thickness flaps are freed from the bone using a periosteum, or curette. This step can be quite time consuming, as we want to be sure to clear all interproximal tissue before initiating the osseous reduction. Next, an end cutting bur is used in the reduction of the alveolar bone surrounding the tooth. The end cutting bur allows us to remove bone, with less risk of damaging tooth structure. Once the reduction is complete, two 4.0 silk sutures are placed, introducing each from the buccal aspect of the interproximal areas.
Post operative instructions are similar to those given in the case of an extracted tooth. The patient is advised that they will be sore in that area, and may ooze some blood, which may look like more than it is actually due to the blood mixing with saliva. They should brush the area, only very gently and avoiding flossing the area for a couple of days. Ibuprofen is recommended to control pain, every 4-6 hours as needed.
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