Posts in Dentistry
Happy Beginning of November and Thanksgiving!

 

In the spirit of Thanksgiving this month of November I thought it would be fitting to write about what I’m thankful for in dental school.  And what I’m most thankful for and what has struck me the most since I started school, is the community here at CU. 

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Starting school last year was a bit intimidating, trying to get in the flow of an unfamiliar school and routine.  I still remember the upperclassmen those first few weeks who went out of their way to introduce themselves, make us feel welcome, and show us the ropes.

 

As school has gone on, I continue to be really inspired by the generosity of people here.  Some students are amazing in the organizations that they’re involved in, how they give their time even with an extremely busy school schedule, to set up events for other students and the community.  Others are amazing in how they help in less noticed ways, like taking an extra moment to ask how you’re doing or being there to help if you need it. 

 

I can’t count the number of times over the past year that someone in school has seen me fumbling with a waxing or lab project, and have sat down with me, even if it’s 10pm on a Friday night, to give me some tips (or to just sit with me and laugh about how frustrating school can be).  There’s the many lunch and learns and mock practicals put on by upperclassmen and classmates in their spare time to help others with school.  There’s the faculty who spend their lunch break or after school tutoring, and those people in class who never forget to buy everyone Valentines or Halloween candy. There’s the numerous times someone has offered me their last fresh plastic tooth or #330 burr to practice with in Sim Lab.

 

There have been a lot of really cool experiences in dental school so far, from Anatomy Cadaver Lab to learning how to drill an ideal Class V preparation.  But really when I go home and people ask me how I like dental school, I end up telling them I love the community at school.  It’s what’s made dental school so fun, and what’s helped to keep my head above water during the challenging times.  I truly have been touched and inspired by the generosity here.

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Mallory Mayeda is a second year dental student at the University of Colorado School of Dental Medicine.  She grew up in Golden, Colorado and went to college at the University of Denver.  She enjoys most things including musicals, Italian food, and traveling, but most of all being outside.

Meet Sybil Hill!

Meet Sybil Hill! This interview took about an hour and a half because her jokes and sense of humor had me laughing throughout, and we kept getting distracted watching music videos and Googling our celebrity crushes. Read on to see how funny and awesome our new tech and sim lab coordinator is.

 

Kimberly: So where are you from originally?

Sybil: I was born in Albuquerque, NM and moved to Colorado when I was one. I basically grew up in Thornton.

 

K: So, does that mean you’re a big skier?

S: Oh no. I’ve tried but I get going and going too fast, get freaked out, and end up on the ground every time.

 

K: Are you married or have any kids?

S: I am married and have one daughter and two grandsons. They all live with me and my husband. One is 9 and one is 3. They call me Gram Hammy!

 

K: What are some of your hobbies?

S: I like reading scary, mystery type books. Not horror. And I like Stephen King. I also love to camp. We have some property on the western slope that we usually go to during the summer. It’s at about 8,500 feet, so you never know what you’re going to get in the winter. We have a house on the property, but we usually stay outside and sleep in the camper whenever we go up there.

 

K: Any pets?

S: I have a mini-Jack. That’s a miniature pincher mixed with a jack Russel. His name is Opie. Like Opie Taylor.

K: Who’s Opie Taylor?

S: Oh geeeeeeeez. He was on the old show Maybeurry RFD. The continuation of the Andy Griffith Show....

K: Oh….

 

K: What’s your ideal way to spend the weekend?

S:  Because of the fact that my grandchildren live with me but go to their Dad’s on the weekend, I do a lot of holding down of the couch. Someone’s got to hold down the couch! It may float away.

K: What do you do while you’re holding down that couch?

S: Usually watching live PD. I love that show.

 

K: What is your go-to kind of music?

S: Oh, I like all kinds of music. I think I was either a singer or DJ in my other life. I’d be lost without music.

 

We proceeded to watch a 10-minute video of a competition of “elders” trying not to sing along, dance, head-bob or lip sync to iconic songs of the 60s, 70s, and 80s. It had us laughing out loud and embarrassing ourselves in the tech lab. Both of us totally lost the competition once Simon and Garfunkel and Aretha Franklin came on.

 

K: Is there anything you wish you knew more about?

S: I just love learning in general. I’m full of a bunch of trivial knowledge that no one cares about.

[Should we add her to our trivia teams?] Do you know why someone gives you a cold shoulder? It was a British thing way back in the 1700s or 1800s. Apparently, they partied for days on end, and when the party was over, the host would come and put a piece of cold meat on your shoulder, and that meant it was time for you to leave. Isn’t that the creepiest thing you’ve ever heard? I learn a lot of my trivia watching CBS Sunday Morning with Jane Pauley.

 

K: What are you addicted to? What life luxury could you not live without?

S: Live PD and coffee. My email address is “queenacafina!”

 

K: And most importantly… do you have a celebrity crush?

S: YES, I DO. Richard Rawlings. That’s it.

 

When I asked Sybil if there is anything else she wants students to know about her, she said it would be her depth of dental knowledge. Sybil has worked in the dental industry for over 30 years as an Expanded Duties Skills for Dental Assistants (EDDA) and lab tech. Most students do not realize that she is a great resource to go to when issues in lab arise. If you haven’t already, introduce yourself to this awesome woman dressed in vibrant scrubs breaking up our monotony of navy blue. You won’t regret it!

 

Kimberly is a second-year dental student at the University of Colorado School of Dental Medicine. She grew up on the east coast and graduated with a degree in biology from James Madison University. Kim enjoys exploring the mountains, running, and reading.
STREET SIDE DENTISTRY: A PAKISTANI DENTAL STUDENT’S PRESPECTIVE

I can still vividly recall that fateful day in August of 2010, when my childhood dream of becoming a dentist finally came to fruition, graduating from Islamic International Dental College, Pakistan with a Bachelor of Dental Surgery degree. Like every other dental school graduate, I had worn my white coat many a times during the course of my studies, but donning one as a professional truly filled me with a sense of mission and pride. I was truly excited to become part of a noble system that provided care for people who silently suffered in pain under the presumption that dental health is only secondary. My determination was not only patient care, but to treat them with a sense of compassion, dignity and otherwise bring change to society through education and service. First venture outside the boundaries of dental school brought me to Pakistan Institute of Medical Science (PIMS), thinking what better place to start a career than a hospital with the largest dental department in the city. I was shocked to witness the state of disarray and utter chaos, when I was first introduced to the emergency room. Often illiterate and with minimal financial resources, these patients were usually referred to other departments for lab work, without adequate directions. I could personally feel their sense of vulnerability further heightened by such insensitive however unintentional treatment, from the very individuals that had taken the hippocratic oath.

Bound by crippling poverty and illetracy, dental care for the poor enmass in Pakistan has primarily been relegated to streetside dentists. Albeit a cheaper alternative, these quacks have exacerbated the spread of hepatitis and other bloodborne infections. See the links below, which provides an overview of the services administered by these street side quacks and their impact on the health of those with limited financial means.

Youtube Video: https://www.youtube.com/watch?v=09XY0u0CQOM

BBC Article: http://www.bbc.com/news/world-asia-25370775

My first week of contact, I remember attending to a middle-aged patient complaining of severe discomfort. Further examination revealed a self-cure acrylic prosthesis installed by one of these quack dentists, where the monomer had caused a hypersensitivity reaction, requiring a healing period followed up with fabrication of partial dentures. How could a person be allowed to endure such pain, only because they were unaware or lacked the means (whether financial or accessibility) for proper treatment? Anger eventually gave way to acceptance and I made it my goal to help those in need. Over the course of the next three years serving at public institutions in Pakistan, I witnessed several other incidents of this nature but instead of being demoralized, it gave me the strength and determination to continue my passion of helping those less fortunate.

Living in Pakistan, a country deeply mired in the clutches of corruption and violence has sowed in me the desire to effect major change in the way we manage healthcare for the needy. It must become a priority for all dental professionals including recent graduates, practicing professionals and industry veterans to actively organize and participate in dental awareness campaigns and advocate access to affordable healthcare and medication for the poor across all communities and nations alike.

What it's like to Lobby on the Hill with the ADA

Lobbying on Capitol Hill is one of the most unique activities that happens in Washington D.C. Each year, the House of Representatives and Senate write bills that are passed into law by the President. As the political climate in Washington regularly fluctuates, it is essential that constituents address issues with consistency. Two weekends ago, we saw this in action. Thousands participated in the Tibet National Lobby Day, AIDS Foundation Lobby Day and ADA Dental Lobby Day. All were welcomed and given the ears and time of their elected officials.

For the past two decades, the American Dental Association (ADA) along with the American Dental Political Action Committee (ADPAC) have advocated for the dental profession on Capitol Hill. They have ensured that core concerns that effect our profession, providers and patients are voiced to our legislators. This year, for the first time, the American Student Dental Association (ASDA) joined with the ADA and ADPAC to voice the current issues important to our profession together. We took the following issues to our legislators; The Competitive Insurance Reform Act, the Student Loan Programs under the Higher Education Act and Health Care Reform: Supporting Oral Health.  

This year, a week before our Lobby Day, we saw years of the ADA’s hard work pay off as the 115th House of Representatives voted a 428 to 6 majority on H.R. 372. This repealed the Mccarran-Fergussan antitrust laws for medical and dental insurance companies. Since 1945, insurance companies have been exempt from the McCarran-Fergussan antitrust laws which prohibits companies and business owners to discuss and set similar prices for their products and services. Greater federal involvement in antitrust enforcement should encourage more competition in the healthcare insurance marketplace. More competition will promote lower prices and greater consumer choices for all Americans purchasing medical and dental insurance. This week, we thanked members of Congress for supporting this bipartisan bill and urged our senators to support or even sponsor a sister bill so that it can be passed in the senate as well. 

Rising student debt for undergraduate and graduate students is a prevalent concern for many of us. This concern is being voiced on Capitol Hill.  In 2016, the average student debt for recent dental graduates was $262,119. That is a 5% increase of average dental student debt in 2014. The weight of student debt limits many graduates’ professional pursuits, especially those who want to serve in public service, teaching and research positions. As Congress reauthorizes the Higher Education Act this year, we continued to voice our concerns regarding student debt as we met with members of Congress. Currently, there is a sponsored bill, H.R. 1614, that would allow students to refinance their graduate student loans at anytime through out the life of their loan. This would make keeping our student loans with the federal government more appealing and could save graduates thousands on accruing interest. Currently, the interest rate is fixed for the life of the loan. This week we tried to gather more representatives support for H.R. 1614 so that it will pass when it reaches the House floor. 

Since the instatement of The Affordable Care Act (ACA) the uninsured rate for Coloradans has dropped from 14.7% to 6.7%. Additionally the recent medicaid expansion in Colorado, passed in May of 2013, expanded coverage to more than 200,000 Colorado residents. As a direct result we have seen the number of hospital dental visits go from $11 million dollars to $1 million dollars annually in Colorado. We want to continue this progress as the expanding coverage reaches many of our small towns in eastern Colorado and in the Western slope. This was emphasized to our representatives by our doctors who practice in these areas. As health care is a hot topic on Capitol Hill right now we also discussed the importance and need for dental insurance transparency. Our doctors from the CDA have seen many patients who sign up for dental insurance and find out they aren’t covered until they pay for 24 months of premiums. Overall, we advocated for more transparent dental insurance plans so that our patients know what they are purchasing and what to expect from us.   

During our Lobby Day we were able to visit all 6 of our district representatives and both senator’s offices to discuss the issues above. It was great to see the impact we could make on organized dentistry by voicing our concerns to our legislators! It made me proud that we are included in a profession that stands united in protecting and advocating for our patients and doctors!

Evidence-Based Dentistry: Yes, it Actually Matters
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Treatment planning is an integral skill taught in dental school and a core foundation of dentistry as a healing profession. This planning can become an overwhelming onslaught of triaging problems, combining disciplines, all the while catering to the individual patient’s desires and limitations. A particularly careful and important concept within treatment planning is the process of phasing out the treatment. At the University of Colorado, we generally abide by the layout of Phase 0 for emergency procedures, Phase 1 commonly for perio procedures and routine restorative work, and Phase 2 tends to be the fixed and removable prosth. We are taught to not move onto a new phase until we have completed all treatment from a previous phase (with some faculty following this guideline with the fervor of a religious zealot). While this works in the majority of cases, there are times when phasing must be thrown to the wind in order to achieve the most ideal outcome for the patient. Recently I had a patient, Z, for whom I completed an oral diagnosis. Z’s treatment plan consisted of a perio visit, a few simple (non-urgent) restorations, and a full coverage crown. It was a straightforward plan; however, I knew I was going to run into an issue with the phasing. The tooth requiring the crown had been endo treated two months prior and still contained a temporary restoration. Yet due to the phasing guidelines, I was technically not allowed to begin the crown procedure until I finished the restorative work. I found this outside of the best interest for the patient’s oral health—especially since it is widely accepted that the success rate for an endo-treated posterior tooth is equally dependent on the quality of the root canal therapy and the quality of the full coverage restoration. I was curious to see if timing of the full coverage restoration was also a key player in the prognosis for the tooth. I knew that if I was to challenge the phasing procedure during this patient’s care, I was going to need some evidence to back me up.

That evidence came beautifully presented in the Journal of Endodontics. Isaac Prat et. al. completed a retrospective study on the timeframe between completion of root canal therapy and the placement of a crown—and the resulting survival rate of the tooth in question. (1) Two different groups were formed: teeth receiving crowns within four months of the root canal therapy and crowns being placed after the four months. After analyzing the data and making the appropriate exclusions, the conclusion was significant: the teeth that received their crowns past the four month point ended up being three times more likely to be extracted than the teeth that had crowns placed sooner. (1)

This study confirmed my suspicions. It was likely in my patient’s best interest to have this crown placed sooner rather than later. Armed with my new arsenal of evidence-based dentistry, I presented to my faculty. Much to my relief, I was met with very little resistance as I articulated my case and elaborated on my plan of action. The faculty was very pleased that I had thought critically over the phasing and had done some research to support my claim. I gained a valuable lesson from this experience—not every patient fits into the idealized mold of phasing out treatment. Modifications need to be made, and careful thought must be undertaken to construct the most appropriate timing of a treatment plan. And what better way to guide you through those thought processes than a little evidence-based dentistry!

(You're welcome, Dr. Astorga)

 

  1. Pratt, Isaac et al. “Eight-Year Retrospective Study of the Critical Time Lapse between Root Canal Completion and the Crown Placement: Its Influence on the Survival of Endodontically Treated Teeth.” Journal of Endodontics. November 2016. 42(11): 1598-1603

 

Annual Session 2017: A Brief Recap
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Annual Session 2017 has come and gone. After five fervent days in Orlando of legislative meetings, resolution debate, emotional elections, and evening festivities, ASDA has launched itself into the year ahead. Here are some highlights from the week:

-Colorado took home the Gold Crown Award for Best Chapter Blog. 

-John Luke Andrew (Colorado '18) was elected District Nine Trustee. He'll oversee the dental schools from Colorado, Texas, and Oklahoma.

-Houston ASDA became the new top dog with their well-deserved win for Ideal ASDA Chapter. Their very own Tanya Sue Maestas also became the new ASDA National President. District Nine continues its prolific reign (Colorado was last year's Ideal ASDA). #D9sofine

-Becky Bye (Colorado '18 and current Colorado Chapter President) authored and defended a resolution to unify all dental schools with one degree (eliminating either the DDS or the DMD). This topic will likely become a major player at future meetings. #1profession1degree

-The continual battle to remodel the licensure exam continues. The new Executive Counsel intends to make great strides in coming up with a system that benefits both the students and is mindful of the patients.

-Dr. Christian Piers (Colorado '16) concluded his influential and devoted service to ASDA with his role as this year's Immediate Past President. I'm sure we haven't seen or heard the last from Dr. Piers (and we certainly hope not).

-Nothing keeps Colorado from going to the beach. Even if it's hurricane-like rain. Worth it? Absolutely.

-Some of our members had the (mis)fortune of being stuck on the Pirates of the Caribbean ride at Disney World. They were rewarded with an extended stay in the park and free rides. I don't think they were too upset...

Thank you to everyone who contributed to The Colorado Quickset over the past year. Colorado truly knows how to make the magic happen.

Cheers!

 

 

Local Anesthetic Lab? No... "Stab Lab"

If the concept of giving local anesthetic injections wasn’t already anxiety producing, the name of the practice lab is sure to create some butterflies in your stomach. At least that is what happened to me. I knew I had the knowledge of where the nerves and the arteries were, how to position the needle, and how far to insert the needle into the tissues, but the idea of performing this procedure on a live patient still seemed a daunting task. As the day of Stab Lab grew closer, I started obsessing over the Local Anesthetic book, asking professors for tips, going over and over oral landmarks to assist in making the injections, even watching YouTube videos. Nothing seemed to make me feel more comfortable with “stabbing” my partner until I got the fact through my head that I will be doing this every day of my professional life! I had better get used to and become efficient at doing injections now so that I can begin to focus on all the other aspects of dentistry that come after the local anesthetic injection.

With this profound realization in my head, I still went into Stab Lab nervous. I was at the brink of being confident that I would do a good job, which showed personal progress compared to where I started. Setting up the clinic chair and talking to my classmates helped diffuse the apparent tension on the fourth floor. Then came the time to perform the injections on my partner. All I can say is that it was AWESOME! After you do your first injection, you get a feel for the needle and how it moves in the soft tissue. You get feedback from your instructor who is by your side the entire time, telling you to do this and do that. The fear slowly melted away and I felt more confident doing my last two injections…finally.

I learned that the anxiety was helpful because it made me slow down and really focus on what I was doing. I was able to pick up on cues my partner was giving, which were subtle but useful in helping me learn how to respond when my future patients react the same way. This is a huge step in becoming a dentist, and I can say with pride that our whole class did a great job in administering local anesthetic for the first time. Overall, it was a great experience and there was no need to be fearful to begin with. By the second semester of your second year, you are ready to learn local anesthetic techniques.

A New DAWN for Aurora Health
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As someone who volunteers at the local DAWN Clinic, I wanted to sit down with two of the student leaders and really layout the facility, its mission, and what it's striving to do for the community. Emily Malihi and Kim Engols, both third year dental students and masters behind the magic of DAWN, were kind enough to oblige me and offered some considerable insight into the clinic:  

Can you give me an overview of DAWN? Who's involved? What services are provided?

Emily & Kim: "DAWN (Dedicated to Aurora’s Wellness Needs) is IPE [inter-professional education] in action! There are students from every graduate program at Anschutz. In addition, there are behavioral health and undergraduate students from DU and UCD who are also active volunteers within the clinic. DAWN provides primary care services (including phlebotomy!!!) for the underserved population of Aurora every Tuesday. Specialty care, such as optometry, dermatology, and pulmonary health is provided on the third Tuesday of every month. Dental screenings are provided every week except the third Tuesday of every month to allow space for the specialty clinics. Instead, dental services are provided on the third Wednesday of the month to provide definitive dental care for previously screened patients."

Tell me about your roles.

Emily & Kim: "As dental workgroup leaders, we are responsible for recruiting and training faculty and student volunteers. Each week we alternate attending clinic nights to ensure dental clinic flow is smooth and volunteers are prepared for clinic night. We serve as the liaison between DAWN and the dental school, and advocate for our profession within the clinic. Once a month we meet with DAWN workgroup leaders from all professions, and discuss ways to improve clinic flow."

What does a typical night at DAWN look like? 

Emily & Kim: "On a typical Tuesday evening, 8-10 patients are scheduled with room for another few walk-in patients. Once patients are checked in, they are taken to triage to discuss chief complaints and take vitals. From triage, patients are taken to their respective exam room to meet with a team of inter-professional students to discuss and address health care needs. At the end of the evening, all patients will finish with Care Coordination to discuss treatment plan needs and plan for follow up care. As you can imagine, this makes for a very busy clinic! Managing the patients to and from registration, triage, exam rooms, and care coordination are three managers and a clinic director."

In what direction is the DAWN Clinic headed and what is its personal mission in the dental world?

Emily and Kim: "The DAWN Clinic is continuously working on expanding the services they provide for patients. The clinic will be hosting a large fundraising Gala in January to raise funds for our patients. Within the dental clinic, we recently partnered with Dental Lifeline to provide free definitive dental care for our patients. This has been our greatest accomplishment to date! We are also working on updating our dental chair to a more comfortable and functional one. In addition to providing screenings, our mission is to improve our impact on inter-professional education by involving more dental students in all aspects of patient care to include helping with registration, translation services, care coordination, and supply procurement. Furthermore, we seek to improve inter-professional knowledge of oral health care and knowledge of when a dental referral is indicated."

Is there anything else you two would like to add?

Emily: "I participated in many student organizations during my time in undergraduate and graduate school, but my involvement within the DAWN Clinic has been the most rewarding, most meaningful experience. I hope that more students get that chance to become involved within the clinic at some point during their educational experience at Anschutz."

Kim: "A few weeks ago, I had a new patient, Ms. A., assigned to me within the dental school. It had been 12 years since her last visit and I was curious to know what prompted her to make an appointment with us after so many years. Ms. A., mentioned she has been seeing an endocrinologist, Dr. J., to manager her type 2 diabetes, and at her last appointment he asked to look inside her mouth. Dr. J. told Ms. A., she needs to make an appointment with her dentist ASAP, and he expects this to be completed before the next time he sees her! Prior to this, Ms. A., mentioned no other health professional had asked about her dental health. This is the perfect example of what we should strive for with inter-professional education. The DAWN clinic fosters this attitude and I am confident this experience will make us all better and more well-rounded practitioners."

 

It is no surprise that the DAWN Clinic is having quite the impact on healthcare in the Aurora community. Patients who may not be privy to their health deficits can now find themselves with a wealth of information that can help them make decisions about treatments and future referrals. I am proud to be a member of the dental team, and I look forward to continuing to integrate oral healthcare into the primary health plans for the patients of DAWN.

 

*Many thanks to Kim and Emily for their time and insightful words. If you have any questions about the DAWN Clinic, please feel free to leave a comment and we will be in touch.