My first community rotation

I am on rotation this week at the St. Vincent Depaul Children’s Dental Clinic. Working with those children is such a humbling experience. They have very little and they are in such desperate need of our care. I am so glad that a place like this exists for them. The supervising dentist has to be one of the kindest men that I have ever had the pleasure of working with and the dental assistants are excellent. They work so hard, but they never forget that it needs to be a fun and friendly environment for the kids. The facility operated via grants and donations. If you have ever wanted to donate to a worthy charity, this is it!! Here is a link to their donations page: http://stvincentdepaul.net/donateMain.htm please donate if you can. There are so many children that need this care and the availability is only limited by the donations they receive!

Dentists Can Identify People With Undiagnosed Diabetes

I just read a really interesting article that I wanted to share. As dentists we know all about the connection between oral health and overall systemic health. With diabetes reaching near epidemic proportions it is important to get the word out! Once I am in practice this will definitely become part of my examination process. Most adults see their dentist much more frequently than they visit their general physician. With diseases like diabetes, it is important to catch it early, and if you can catch it in the pre-diabetes stage...even better!

"ScienceDaily (July 14, 2011) — In a study, Identification of unrecognized diabetes and pre-diabetes in a dental setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found that dental visits represented a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition. The study sought to develop and evaluate an identification protocol for high blood sugar levels in dental patients and was supported by a research grant from Colgate-Palmolive. The authors report no potential financial or other conflicts."

For the full article please visit this link:

http://www.sciencedaily.com/releases/2011/07/110714191537.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Feedfetcher

Questions My Patients Ask

I seem to be asked the same questions repeatedly by patients so I thought it may be helpful to answer some of them on my blog for anyone else who have the same questions but may not have anyone to ask.

1.    What is the best toothpaste or toothbrush to use?

Well, the short answer is, whatever kind you will actually use! As far as toothpaste goes, any toothpaste that is approved by the ADA is a good choice. I personally prefer Colgate Total. The important thing about toothpaste is not to use too much on your toothbrush. If you read the instructions they tell you to use a pea sized amount, however on advertisements and commercials they show a large swipe of toothpaste on the brush. This is to get you to use too much so that you will buy more. It is an advertisement gimmick that works quite well because humans are visual. Even if you read the instructions, you are going to use the product as pictured on the box.  

Overuse of toothpaste

 The reasons that you should only use the pea sized amount is twofold. First, toothpaste is abrasive. If too much is used you can actually cause damage to your teeth. Second, If you use too much the cleansing effect is actually reduced because the toothpaste acts as a barrier to the bristles of the brush.

Abrasion caused by aggressive brushing or overuse of toothpaste.



This chart shows the different abrasiveness of several popular toothpastes.
If you already have abrasion issues, choose a toothpaste that is not very abrasive.



Toothbrush selection can be daunting. There are so many types. The important things to consider are the size of the head and the type of bristles. For manual brushes, you should always use a compact head with the softest bristles you can find. So brushes marked soft or sensitive are the best choice. Hard brushes with large heads are great for cleaning your bathroom, but have no business in your mouth. The firmer the bristles the less flexible they are and therefore the less effective they are at getting between the teeth, below the gum and into the tiny crevices on the tops of your teeth.



This toothbrush adapts really well into the spaces between the teeth,
you can see that if they were too stiff they would not be able to do this.

Toothbrush replacement should be based on individual wear rather than time.

2.    I have had a root canal on that tooth, how can I have a cavity now? Or, I have a crown on that tooth, how can I have a cavity?

This is a tough one because it seems that many people who have undergone a root canal or endodontic therapy have very little understanding of what that actually means. I have included a photo series that explains the process of a root canal.



In this case they are showing the tooth being restored with a filling,
in general root canal treated teeth are restored with a crown for strength.

Just because the nerve has been removed does not mean the tooth can no longer decay. Even if the tooth has a crown on it, a cavity can still occur at the margin of the crown.

Patients frequently assume that a tooth that has been crowned can no longer get decay. While it is true that the crown or bridge itself will not decay, the crown or bridge will not guarantee that the tooth will never get decay.





This shows how a crown is placed over a prepared tooth.
You can see how the margin of the crown is the area where the edge of the crown meets
the part of the tooth that is shaped like a step.

There is always a segment of exposed tooth between the margin of the crown or bridge and the point where the gum attaches to the tooth. It is in this zone that the tooth is susceptible to decay. The white arrow identifies a half moon shaped dark spot just under the edge of this crown. Decay removes minerals from the tooth allowing x-rays to show a dark spot in the area of decay

A second way to get decay on a crowned tooth is through marginal leakage. If your crown or bridge does not fit well, the margins of the crown or bridge are not properly adapted to the tooth. When margins are poorly adapted, the cement which seals your crown or bridge in place will wash out over time. This allows saliva and bacteria to leak in under your crown or bridge and initiate decay.
If the tooth becomes decayed, the decay may progress up into the portion of the tooth which is covered by the crown or bridge. This will not be visible to your dentist on X-Ray because the metal in your crown or bridge blocks the view of the X-Ray. X-Rays are still important if you have crowns or bridges so that your dentist can see if any decay is present near the margin (edge) of your crown or bridge.

3. I seem to have a lot of issues with my teeth, maybe I should have them all pulled and get dentures.

Ok, I know that is not a question, but it is a statement that I hear a lot! If any of your teeth can be saved, by all means save them! Everyone has a story of their relative or friend that has had dentures since they were 20 and they are 80 now and they love their dentures. The trouble is, I have never met that elusive relative/friend. Most people with dentures if being completely truthful with you would tell you that if someone had a magic wand that could give them their teeth back they would jump at the chance. What most people do not understand about dentures is that they are nothing more than a crutch. They do not really function very well for chewing. They are mostly for esthetics. Sure you can eat with them, and a well made set can work wonderfully. The trouble is that you will never eat the same again. When you switch from natural dentition to dentures your bite force is reduced to 10-20% of what it used to be. That is right, you lose 80-90% of your bite force. You also have to be careful of the size of the bites you take and you have to keep the food even in your mouth otherwise the denture will unseat. Most people get used to this over time and can actually adapt quite well and learn to eat relatively normally. There is also another issue that most people won’t tell you…dentures affect your sense of taste, because they cover your palate (the roof of your mouth). Not to mention, no matter what, you have a hunk of plastic in your mouth.



4. I am missing a few teeth, how can I replace them?

Well there are three ways to replace missing teeth. Implants, fixed partial dentures also known bridges, and removal partial dentures.

What is the difference?? Implants are actually used to replace single or multiple teeth without relying on surrounding remaining teeth for support. They are placed right into the bone. The picture makes it look like you can see the implant thru the tissue, this is not the way it actually looks in the mouth, the artist just wanted to show how far the implant goes.

Implants can also be used to support a denture. There are many ways that implants can be used to improve your esthetics as well as chewing function.

Fixed partial dentures replace missing teeth by being anchored to the adjacent teeth. This requires the adjacent teeth to be strong enough to support the bridge and they have to be prepared just like they would be for a crown. The challenge with fixed bridges is cleaning under them since they cannot be taken out. It is very important to keep them clean so that you do not get recurrent decay at the margins of the abutments. If you get a cavity on one of the teeth, the entire bridge must be cut off and replaced in order to fix it.

Removable partial dentures are similar to dentures because they are removable and they are made out of similar materials. Although they usually have a metal framework that the acrylic is attached to there are some types that have no metal and are flexible.

The teeth are replaced but rely on surrounding teeth that are strong enough to place clasps to hold the partial in. The largest complaint that I hear about partials is that when eating food gets trapped under them easily.

As always, if you have any questions or comments please share them!! Happy chewing!

 

Quick Update

I was having a really difficult time fitting in one hour a day of studying until I found an awesome app for my iphone!! There is a NDBE II app that is 9.99 which I really have fallen in love with. It is a bunch of board questions and I can squeeze it in a few minutes at a time. I love it!!

On a separate note, my husband and I met with Steve Anderson, the owner of Denco. We have chosen his company as the contractors for building my practice… provided I can get financing! If you are looking into having an office built and you are in Arizona I would really recommend Denco. They are awesome. He was able to answer all of our questions. We have another meeting with Steve, the bank, the broker, and the architect in a couple of weeks. I will keep you all appraised of our progress. Keep your fingers crossed that we can qualify for financing. That is major hurdle number one! The second hurdle is location followed by my complete inability to determine what style of office I like. It seems like such a huge decision that I am having a really difficult time making any real choices at this point. I guess I should take it one step at a time.

Here We Go Again

In my head I can hear the theme music from Rocky. I am at the point where I must begin my frontal assault on the NBDE II. When I studied for the first part of the national boards I had an entire summer. I went to school every day for a month and a half and poured over review material and published past exams. I walked into the exam feeling prepared. I do not have the luxury of time off for National Board part II. We do not get time off from school to prepare for it because unlike part one it is not part of our curriculum/graduation requirement. I have gathered my armamentarium and although I am not sure which resource will prove to be the most useful on exam day, I plan on using each to its fullest. I will most likely sit for the exam either the end of November or the beginning of December. So I have 5-6 months to prepare for the most important exam of my life. My plan is to spend one hour every day, no exceptions, no excuses going through one book at a time. I will then take the last two weeks prior to the exam and review the text that I found the most helpful. I am going to start today! I figure that if I blog about this, I will have to stick with my plan. I also have the WREB to prepare for. We will be sitting for the WREB as a class in April or May of next year so I will cross that bridge when I am done with the NBDE II. As I go thru the materials I will try to give you an idea what I am finding the most helpful. Of course studying for boards is a very personal thing and what works for me will not work for all.  I would ask you all to wish me luck, but I really believe that if you take the time to prepare…luck has nothing to do with it!

Creating a New Standard For Senior Home Care in Arizona

We (my husband, his brother, his brother’s wife and myself) spent the past week with our consultants for our new in home senior care business. I learned so much. I have been caring for seniors for more than 12 years in my capacity as a dental assistant and as a dental student now. As well as helping with end of life care when my uncle had terminal brain cancer when I was in high school. I thought I knew a lot about the challenges our elders face but I found out this week that I have only touched the very tip of an extremely large iceberg. I think my most shocking revelation is that since Arizona has no licensure requirements for in home care, anyone can open one and there are no regulations making sure that they are doing things to any type of standard. As a group we found this to be unacceptable. We hired a consulting firm out of Georgia because as a state Georgia has the strictest licensure requirements in the country and we decided that we wanted to exceed those requirements in an effort to force our competition here in Arizona to do better! I hope that this entry finds its way to someone who is researching in home services for a loved one and that they will be more educated in choosing a company. There are approximately 500 companies in Arizona offering in home services for seniors and disabled individuals, some are wonderful and some are not. It is very important to do your homework! In our research we found that many of the more prominent companies do not train their staff at all, they rely on the prior experience of the staff member. We found this week as we held a mandatory 8 hour training session with our first bench of employees that although they were all experienced, many lacked basic training. One of our new hires actually thanked me for having a company that trained the employees. She said that she is used to being interviewed one day and sent out to someone’s home the next with no idea of what was expected of her. We also learned that most companies do not do thorough multistate background checks. This is not good enough. Although expensive, it is critical to do the most thorough background check possible because we are being trusted by some of the most vulnerable individuals in our society. I would not send anyone into the home of a client that I would not trust with my own children or my grandmother. We developed a list of questions to ask when considering an in home services company. I am going to post them here because I feel that it is really important that people are aware of them. This is a critical decision for a family to make, please take the extra time to be sure you are making the best decision you can. We are also offering free training seminars for family caregivers, because although you love the person you are caring for, you may not be equipped with all of the skills necessary to properly care for them. We would rather help you learn, than have someone not cared for properly.

Important questions to ask any agency you are considering:

1.Is the agency licensed by the State?

Although Arizona does not require a state license to own a home care agency, the company you choose should meet the most stringent licensing requirements across the country that help protect and provide for the clients.

2. Are the agency’s caregivers bonded    and insured?

 The company you choose should have professional and general liability, bonding and Worker’s Compensation coverage in case of a mishap.  Some firms have only minimal coverage and some none at all.

3. How extensive are the agency’s criminal and background checks?

You want only the most ethical, skilled and compassionate caregivers in your home.  It is important that the agency not only run a check on the last place a person worked, but complete a complex multi-state check on all the places they have lived, their driving records and reference checks from previous supervisors.

4.How qualified are the agency’s caregivers?

Often times, an agency will simply hire someone without much experience and even less credentials.  Reputable agencies have requirements for levels of experience, certification and annual training. Select a firm that requires companion caregivers to be thoroughly trained through a recognized program.  Although Certified Nursing Assistants are state certified, they need to be trained in the agency’s policies, procedures and standards along with the diseases of the aged.  Reputable agencies must have a licensed RN on staff for supervision to insure that proper protocol is being followed in the care of the client.

5.Will the same caregiver come to the client’s home on a regular basis?

It is difficult to receive good care if different caregivers show up every week.  A good home care provider will insist on continuity of care and carefully match each client with the proper caregiver.

6.How would a complaint or question about service be handled?

A reputable agency will provide you with a detailed process for dealing with complaints or service questions.  All clients should be given the agency contact person and phone number to resolve any concerns that may arise.   

7.What procedure is in place to handle emergencies?

Emergencies can happen and a quality agency will have policies, procedures and plans in place to deal with emergencies if they do occur.  Its employees will be thoroughly trained in how to respond to any serious situation.

8. Can the agency provide printed materials describing service rates and fees?

An agency that provides detailed, carefully considered materials for your review, more than likely, has gone the extra mile in other aspects of its business.  These should include rates, minimal hourly requirements, billing cycles and any required deposits.

9. Is the client’s course of care documented with specific tasks to be carried out by the caregiver and is the client’s family involved in the creation of this plan?

A reputable agency will create an individualized plan of care for each new client.  It should be carefully and professionally developed with the client and family members.  The care plan should be written and a copy left with the client.  The plan should list specific duties, work hours/days, and the name and phone number of the supervisor in charge.  The care plan should be evaluated, updated and revised as the client’s needs change.

Crazy, party of one

“Anyone knows that if you drink your coffee hot enough you don’t have to brush your teeth!” Direct quote from a patient explaining to me that he was on to me with my perio mumbo jumbo.

With that, it is an exciting time at MWU. The new D3s have started clinic and my class has become the D4s!! Each of the D4s have been paired with a D3 to show them the ropes so to speak. It is kind of fun to see things thru their eyes again. I remember how overwhelming those first few weeks in clinic were. It is really great to help someone else thru it. I am sure I am not the only D4 that has realized how far we have come in such a short time. I think I often take for granted the experience that I had prior to coming to dental school. These two weeks with the D3s has reminded me that I am very lucky to be one of the few with previous dental experience. It allows me to put everything into perspective.

On another note, I am really leaning towards opening my own practice after graduation. My husband and I are going to meet with the owner of Denco which is a dental construction business. I have met the owner a couple of times over the past year but we are going to have a formal meeting to discuss specifics for my office. I am not sure that we will go with a new build, we may try to find a built out space and just modify it. Either way this is both exciting and terrifying!!

My hubby is home! He has been home for a few weeks. We decided to take a leap of faith because after three years of living in separate states we just can’t take it anymore. He and his brother have been talking about starting a business together for a while and recently they decided to actually move forward with this plan. We are starting an at home wellness care business for elderly and disabled individuals. So far everything is going very well. It is of course in its infancy but we expect great things!!

Sorry this post is a bit disjointed but such is life!