D3 Spring - Mid Semester Review

We're rounding up what was 3 weeks of midterms this week and finishing it off with a well deserved Spring break. I've personally been much less busy this semester compared to last, as I completed a few removable cases that are currently healing, and my implant cases are currently awaiting placement and healing. Nonetheless, the learning never stops as we have a quite a few classes to keep us busy. In most however, we seem to be going into a little more detail, and focusing on the clinical aspects of practice, while classes are also re-emphasizing important points that have been covered before. Luckily, we have one lab class in orthodontics that has been great.

Our lab instructor Brian Willison, is a renowned lecturer and orthodontic lab technician who is incredibly talented and helpful. Our first project in the top photo involved bending wires to a pattern on a piece of paper. The "snowman project" was given also as a supplemental project to get us used to bending wires around a model. The next project was a little more involved- bending wires to create clasps for a partial removable denture. We're currently in the midst of working on an active plate to reposition displaced maxillary lateral incisors that makes this project look terribly simple. But the first tim around, anything would be challenging. Its great learning through these projects because when we see patients in need of interim appliances, its great to know we are capable of creating something quickly and efficiently for them.  

Our midterms "month" comprises exams in: Special Needs Dentistry, Geriatric Dentistry, Surgical Periodontal Therapy,  Orthodontics, Anesthesia and Pain Control, Fixed Prosthodontics, Removable Prosthodontics and a take home exam in Temporomandibular Disorders. I don't think I've ever had this many exams, or been so mentally taxed, but it's going to be wonderful when we're through. 

Outside of this dental realm, I've managed to sign up for an online class in Social Entrepreneurship through the Social Work school here at UB. I caught sight of this opportunity via email shortly before my trip to Haiti and felt it was something I was meant to do. So far it's been a very enlightening experience, hearing the ideas and views of others who seek to improve society in their own special ways. As we're learning currently about the different models of non-profit and for-profit enterprises, it makes me feel as though any school hoping to breed dentists interested in community service should encourage students to take a class such as this. The class has definitely changed my perspective on non-profits and makes the prospect of giving back through an enterprise of my own seem more feasible. 

That's about it for now. Back to the books. 

Published!

I had great expectations for this month's issue of ASDA News and rightfully so! I submitted my first book review for the publication back in December and it's been published! Pretty excited. I really want to do this again. Here's the text:

If there has ever been a time to blaze your own path, take risks, and change the way we think, now is the time. In Linchpin: Are you Indispensable? Seth Godin inspires his readers to pursue their passions wholeheartedly. He asserts that this passion is not simply an option, but a requirement for success in a changing society. The former model of being trained to simply do a job is obsolete. Professionals as well as nonprofessionals are being called to solve unique problems. As dentists, we must not only be manually and intellectually adept, but also serve as team builders, community leaders, and more. The way I see it, the nature of the profession demands that we become linchpins. 

A linchpin is a pin placed through an axle that keeps the wheel in position while it rotates. Godin defines a linchpin as one who successfully combines passion with art. Great organizations and ideas arise from these types of people. Through historical anecdotes of his own life, artists and corporate leaders, Godin illustrates that we are all artists with gifts to share; and to not share them would be a disservice to society.

He describes art as, “the ability to change people with your work, to see things as they are and create stories, images, and interactions that change the marketplace.” We already see this in dentistry today where dentists are challenged to provide care in the face of barriers such as anxiety, or costs.  The innovation and evolution of sedation dentistry has changed the marketplace and brought care to those who may have been emotionally out of our profession's reach before . Moreover, dentists in Michigan are demonstrating linchpin qualities in reaching the underserved. They‘ve created a system where community service can be done in exchange for dental care. Dental related ER visits are down and patients who previously could not afford dental care, now have dental homes.  

All health professionals are required to do the “emotional work” that is one of the tenets of Godin’s linchpin. Godin rejects the idea of scripted courtesies and calls for genuine compassion in our interactions. He explains how JetBlue built their brand not by training attendants to be friendly, but by seeking out individuals with the qualities they wanted and encouraging them to make connections with customers.  “ The act of giving someone a smile, of connecting to a human, of taking initiative, of being surprising, of being creative, of putting on a show…we do for free all our lives.” These “emotional gifts” as Godin puts it, are essential to creating value in our interactions.

Linchpins are those who have conquered the “lizard brain”.  This lizard brain, better known as the amygdala plays a key role in anger, arousal, hunger and fear. Virtually all dental students can relate to the excited anxiety of our first operative procedure. Imagine the fear of failure in starting your own practice. We are wired to resist; but with some effort, we can be rewired. The first step is the decision not to feed your anxiety. Godin explains how simply acknowledging it, but not rationalizing the feeling eventually leads to its dissipation.  Realize anxiety is practicing failure in advance, it doesn’t protect us or help accomplish but rather inhibits progress. Banish procrastination, as this is the lizard brain keeping us stuck. Develop a “posture of challenging the resistance”; good habits can be fashioned just the same as we fall into bad ones. Conquering the resistance comes back to believing in your cause, “When you set down the path to create art...the path is neither short nor easy. That means you must determine if the route is worth the effort. If it’s not, dream bigger.”

Most importantly, Godin reaffirms us that,  “All of these attributes are choices, not talents, and all of them are available to you.” As future health care professionals we have the incredible opportunity to create valuable change in those around us. Linchpin encourages its readers to view your art as a gift; to be generous, bold, and creative. Health care is changing, and “Our passion for contribution and possibility, the passion we’ve drowned out in school and in the corporate world – that’s the only way.”

Surgical Guide Techniques - Triad & Vacuuform

I was fortunate enough to have an implant case this semester. At UBSDM, we're involved in every aspect of the implant treatment, from it's placement to it's final restoration. As we were taught in pre-clinic, implant treatment involves a team of practitioners and careful planning and communication is essential.

The Surgical Guide is a tool made by the restorative dentist and [hopefully] used by the implant surgeon to place the implant in the location dictated by the restorative dentist. Once placed properly, the restorative dentist can then select an abutment and crown to finish the restoration. The surgical guide is used in treatment planning as well. Once completed, the patient is brought back, the guide tried in and a radiograph (CBCT or PA) is taken to assess the angulation and planned placement of the implant.

At the initial evaluation, we take a medical and dental history, and address any chief complaints. The implant treatment planning starts here, where we take the necessary radiographs to assess bone, alginate impressions, a facebow and bite registration so that we can mount the diagnostic casts.

So this implant is being planned for position #29. 

[Left]So here's the cast of the lower arch. 

[Middle]We first do a diagnostic wax up of the tooth, with proper embrasures and [Right]occlusal contacts. Next, an alginate impression is taken of the cast with the wax up so that we have a template from which to make the vaccuformed surgical guide. 

[Left]Here's the duplicated cast, trimmed and after the vaccumform was made. The hole in the tongue space helps the template better adapt. The template is then removed from the cast somewhat carefully. The cast won't be needed anymore so it shouldn't be concerning if it breaks, but the template should be handled carefully.

[Middle] Here's the trimmed guide after removal from the cast. The area around #29 is trimmed to the gingival margin, however around all other teeth the guide is trimmed to half the occluso-gingival height of the tooth. The guide should seat on the original cast without rocking. 

[Right] Next we need to fill position #29 with a radiopaque material so that when the guide is tried in the patient's mouth, we can assess the angulation of the implant. Barium sulfate is combined with PMMA and the tooth to be restored is filled in.

A hole is then made to accomodate the metal cylinder. The vacuuformed template with PMMA and barium Sulfate is slide onto the cast, and the cylinder is secured into place with super glue. I'll need to get a photo up of the finished thing. But here is a finished TRIAD guide:

 

So with these guides the surgeon can make a pilot hole at an angulation that has been previously evaluated radigraphically. After the implant is placed we'll be going through the impressioning techniques to restore!

Jean's Miracia Hospital Story

Hope for Haiti from About Themselves on Vimeo.

This is a video of Jean telling his story and his work in Haiti.

FHI Haiti: 2013 In Summary

FHI Haiti Mission Team 2013- Club Indigo, Haiti

Back in the U.S. once again after my second medical mission in Haiti. Its wild that days ago I was waking up to roosters calling, children singing in Creole, underneath a mosquito net, in an unfinished hospital. This year's trip was just as eye opening, if not more so than last years. I'm again conflicted in my perspective, and am coming to terms with the drastic differences in lifestyle, and outrageous inequalities in the world. With some thought and reflection I hope to come to some sound conclusions and feelings. All things considered, it is an incredible honor and privilege to serve in Haiti alongside the Haitian medical professionals and translators.

FHI Dental Team 2013

Our dental team this year consisted of 9 people, which was an upgrade from the dental firestorm of myself and Ryan last year. The team included Christine, James and Sarah from NYU Dental, Katy, Amrita and myself from Buffalo Dental, dental oncologist Dr. Ryan Lee, Pediatric Dentist Dr. Esther Yang, and General Practitioner Dr. Shin Kim.  We worked wonderfully together as a team, and as usual, we had our most efficient day on our final day of clinic. Having a larger team allowed me time to experience more of Haitian culture, speak with the local people at our clinic sites, and gain a deeper appreciation for Haitian culture.

Dental Triage, Arcachon 32 Clinic

I spent New Year's Eve with Jean Filostin, the director of Institute of Grace in Merger, Dylan, a friend of mine from Buffalo, and Remy, a psychologist from the US who started an orphanage in Haiti after the earthquake. That night Remy and Jean shared with us things about Haiti and their lives that I couldn't have imagined. Jean's big project is Hopital Miracia, which is the hospital portion of Institute of Grace. Jean also runs a school nearby and cares for a number of orphaned children in the village. There are many children always running around the outside of the Hospital. I had always thought they went home to their parents at night. The truth was that most of these children's parents had died from infections, HIV, or other conditions that are endemic in Haiti. Jean takes these children in because these children also attend a school he also is involved with. Others who take in these children may literally enslave these children, and have them work in the house instead of attending school. Many of these children also have medical conditions that they cannot afford to treat, and may not receive any care if it were not for the NGOs involved in Haiti. I was floored that these things were happening, because most people I came into contact with are so welcoming and the children all seemed so happy to me. 

Remy's story was another inspiration in itself. Remy was born and raised in Haiti, and was one of many siblings. He was always involved in his church and missionaries had always been a part of his life. A missionary was actually the person who granted him the funds for his education. He stressed to us the importance of having a healthy relationship with money and never letting fear change you. His story and views on life are incredibly inspiring and is a testament to the things that can be achieved if one has a passion for helping others. His orphange is still growing and we are hoping to involve it as a site for future FHI outreaches. The children we saw in Haiti actually had relatively healthy dentitions. The amount of decay in adults however reflects a change in diet or behavior from childhood. 

1st Entrepreneurship Conference, Club Indigo, Haiti

Both Jean and Remy's stories about their ventures are the perfect segway into another experience that was particularly memorable: FHI's first Entrepreneurship Conference. FHI's vision is to see Haitian medical professionals reform their own health care system with their own ideas. Our approach involves educating the doctors, nurses and other members of the healthcare system to begin thinking of their problems as opportunities for growth and change. Over time, the hope is that ideas will arise, and a competition will be held where Haitians present their ideas. An international panel will judge the ideas and providing funding to the best business plan. The conference was held at Club Indigo, near Montroius, along the coast. The club was unlike any place I've ever seen in Haiti. Dr. Chen lead the conference, speaking about what entrepreneurship was, and how it could be used in Haiti to reform healthcare. Tim, a non-medical member of the FHI team presented a case study as an example of social entrepreneurship in India. The Avarind Eye Care System provides cataract surgeries to more patients in India than was ever thought possible. Through their system many of their patients receive free care.  Avarind's system is complex, but at it's core is the optimization of the cataract surgery process, minimizing cost without compromising care. Another case study was presented by Dr. Lee which focused on improving access to care in rural Africa utilizing a network of motorbikes. After the presentations we broke into groups and discussed different problems within Haiti's health care system. My group in particular kept returning to education as a core problem, ergo, a prime opportunity. Other issues such as transportation, access to materials, and access to doctors also came up. The interesting thing I found was that some of these problems, if not all are problems in the U.S. as well. I'm really excited to see where this leads in a few years.  

Fluoride & OHI - Fond Parisen, Haiti

Our visit to Fonds Parisen this year was focused more on Pediatric preventative dentistry, although we still did extractions. Dr. Lee's passion for public health and continually stressing "One child treated with fluoride is worth 10 extractions in my mind" definitely left an impression on me. In the US we sometimes take oral hygiene instructions for granted, but in places like Fond Parisen, these children have never, and would never have been shown how to properly care for their teeth, let alone by a pediatric dentist! The kids were excited and compliant in participating in our songs and games. We arranged a pediatric area where the kids sit on a few large branches and individually taught each child how to brush, provided fluoride treatment, and gave them toothbrushes and toothpaste. Dr. Yang was incredible to learn from and work with. Despite the language barrier, she engaged the children and I feel that our efforts will really make a difference. 

Fond Parisien, Haiti

Reflecting as a whole, I know that I surely took away more from my experience in Haiti than I could give. While our efforts to improve the health of these populations may or may not be appreciated, the magic of the experience is in the relationships fostered. My heart was touched by so many in the past week. The love shown to us by the Haitian people is overwhelming in the greatest sense of the word. 

Photos and journal entires to be posted in the coming days!
Happy New Year All! 

[Photo Credits: Kyungsik James Yang]

Glass Ionomers - The Fuji Bunch

So we had a pretty big final in Cariology, which includes treatment of caries, which is probably more than 80% of what we do in the clinic. Glass Ionomers are a material with many uses, and we use them all the time in the clinic. They release fluoride and some are stronger than others. I wanted to compile a little post to remind myself of what each one does so here goes:


Fuji Plus - Luting Cement 
Reinforced Luting Cement basically used to cement metal based, or all ceramic inlays, onlays and crowns. It can also be used to cement metal, ceramic or fiber posts.


Fuji II LC - RMGI
Resin Modified GI used for Class III and Class V lesions. It's good for the treatment of root caries, abfraction and cervical lesions. It's also used for restoration of primary teeth, as a base and a liner.
It is NOT used as a pulp cap.


Fuji IX - Heavy Body GI w/ Filler
Heavy Body GI w/ Filler Particles used on root caries lesions, or on roots of amalgams and composites with faulty margins. They can also be used in Class III and Class V lesions in patients with high caries risk. Fuji IX self cures (2.5 min).
It NOT used as a liner, base, pit and fissure sealant, pulp cap, a large core, or a definitive restoration in load bearing areas. It is NOT A RMGI, so does not handle loads well.


Fuji Triage - Flowable GI
Flowable GI used to seal pits and fissures when isolation is not possible, as a liner in deep restorations, or over CaOH, to fill an endo access or as a protective restoration. When used to fill endo access, Fuji Triage prevents Eugenol from the sealer from affecting the bond of the core. It's also pink and self cures (2.5min)
Triage is NOT used as a definitive restoration, base, direct pulp cap, core. It is NOT used to repair faulty amalgams or resins.


Vitrebond - Flowable GI
Flowable GI used as a liner in deep restorations, or over CaOH. It's used to restore endodontic accesses.
It is NOT used as a definitive restoration, base, direct pulp cap, to repair faulty amalgams/resins or as a core.

ECHM Town Hall

Our project of starting a community dental clinic is coming together, and is set to open to the public in February of 2014. On December 5th our group presented our progress thus far to faculty, students and staff in a Town Hall meeting. We wanted to give everyone an overview of whose involved, what's being planned, the location, population we'll be serving and how it's all going to come together. 

Kara, our project leader kicked off our presentation with introductions, and a summary of how we got involved, and an overview of what we all would be discussing. JoAnna then took it from there, discussing the surrounding area, and the need for a dental home at 1500 Broadway. She presented photos of the area, and elaborated on the fact that this is an underserved area. I discussed the collaborations that will be occurring at the clinic with LakeShore Behavioral, Catholic Health, Erie County and UB School of Public Health. We're hoping to be making many interdepartmental referrals, and seeing a different population pool than at Squire hall, which will be a great experience for students. Richie then engaged the audience with photos of our equipment and the blueprints and architectural renderings of the proposed facility.  Josh discussed when this would all be happening, and our plans for marketing and attracting patients. Since we're in an underserved area, we're expecting a large percentage of emergency-walk ins but we need to be prepared for many scenarios. By participating in the Buffalo Clean Sweep Initiatives, and marketing within the community we hope build some hype in the community prior to opening. Last but definitely not least, Hoda closed out the presentation with a discussion of how this clinic would fit into our schedules, what procedures would be done and our goals of going paperless. We plan to provide a broad range of palliative care procedures at first, however the vision is to become a comprehensive care clinic. More complex cases will be referred to Squire Hall, but simple operative, extractions and other procedures such as those could be performed on site. The logistics of how the rotation will work are being decided. Currently, the thought of having a vertically set up rotation, in which students rotate once a week through the clinic for the semester is gaining popularity as it would provide students with an experience that we do not already have. 

While we have made a great deal of progress, this is still a work in progress and the questions we received were all a great help. We're very excited to gain access to the building in January and begin our move in. If there are any other questions or concerns they can be directly to any of us via our emails. Hope everyone is as excited as we are about this new venture!