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Periodontal Inflammations

by Simone Verardi, DDS, MSD and Sandra Bordin, PhD

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Welcome from the Publisher

the world just got smaller by Richard M. Groves

5 things you should know about To Hit the Ground Running Range and Mean Distribution Frequency of Individual Tooth Width of the Maxillary Anterior Dentition by Stephen J. Chu, DMD, MSD, CDT

Avoiding The Freshman Fifteen how to stay fit while in school by Sherry L. Granader

dental school? ya there’s an app for that by Kathleen A. Tracy

The NEXT DDS By You and For You The NEXT DDS Feature interview — dr.TIM MORIARTY by John Papa

Selecting the Ideal Associateship Defining OBJECTIVES and Setting Goals by Dr. Gene Heller

© 2011 Next Media Group, Inc. All rights reserved. THE NEXT DDS is published and copyrighted by Next Media Group, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form—print, electronic, or otherwise— without the expressed written permission of the Publisher. Opinions expressed in the articles and communications contained in this publication are those of the authors and not necessarily the editor(s) or the Publisher. The editor(s) and Publisher disclaim any responsibility or liability for such material and do not guarantee, warrant, or endorse any product presented in this publication, nor do they guarantee any claim made by the manufacturer of such product or service.

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f r o m

t h e

From Student. To Professional.

p u b l i s h e r

It’s A Journey

early two years ago, Next Media Group embarked on a journey to more fully understand the dental school experience and to develop a plan that would support your ability to think critically, to become a lifelong learner, and to help you enter the dental profession more empowered to care for your patients.

THE NEXT DDS was introduced in response to this challenge, availing to you the scientifically sound educational content and the social media tools that you depend on daily. Its development is possible thanks to a consortium of industry manufacturers who have similarly embraced our goal of expanding your access to credible educational resources. Based on their support, we are able to deliver THE NEXT DDS web portal and this publication to you for FREE. Three important driving principles regarding THE NEXT DDS: 1.

Its educational content (eg, videos, articles, blogs, podcasts) are aligned to your university curriculum, and our Academic Advisory Board ensures that each presentation shared via THE NEXT DDS is peer reviewed and meets academic standards.

The enrollment process ensures that you have an exclusive environment for professional exchanges with your classmates and others around the country.

Its profile and activity settings enable you to determine how best to stay informed about new contents posted in THE NEXT DDS and how to control the personal information you share with the student community.

And finally, thanks to all who contributed ideas, feedback, and requests through our focus groups and ongoing discussions, THE NEXT DDS includes social media tools that enable you to provide feedback on every article, forum, or podcast on the site. You can share images and videos—either your own uploads or from THE NEXT DDS—easily with other students. THE NEXT DDS is intended to support not only your classroom, clinical, and licensing requirements, but also to work in conjunction with the way you use the internet every day.

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Most importantly, we know THE NEXT DDS is not a final destination but a journey. To this end, Fall of mobile and Clinical Images are each 2011 will be important to THE NEXT DDS as our launched to you and your fellow students. With your guidance and feedback, we’ll continue to add elements most relevant to your educational requisites and incorporate functionality that makes THE NEXT DDS a more valuable educational resource. We encourage you to enroll or revisit the site today and look forward to learning how we can continue to shape this environment to best prepare you for your future in dentistry. www.TheNEXTDDS.

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Richard M. Groves Vice President of Editorial Services, Next Media Group Follow Rich On Twitter : http://twitter.com/#!/thenextdds 8

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The NEXT DDS provides you the support you need where you need it.

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the world just got smaller by Richard M. Groves

magine being able to examine and diagnose clients scattered throughout rural Appalachia —all from a room in your dental clinic. Or the advantages of consulting with remote specialists on a particularly difficult reconstruction—during the actual procedure. Or the convenience of an online portal such as The NEXT DDS—filled with searchable scientific articles and videos that help dental students learn and hone their clinical craft while in their dorm rooms. All these advances are already available because digital technology has made “telemedicine” and “digital dentistry” a reality.

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technology

500 million

subscriptions

for “smart” devices such as iPhones & iPads

In the same way the telephone transformed 20th century society, today’s mobile and wireless technologies are redefining how we work, play, communicate, collaborate, and learn. Whether one’s preference is the iPhone or the iPad, whether you are Team Android or Team Windows Phone 7, smartphones, wireless devices and emerging technologies such as telepresence have become the primary means of sharing information at the office, at home, and at school. Smart devices are currently leading this paradigm shift. According to handset manufacturer Ericsson, the five billionth global mobile subscription was sold in July 2010. Of that, more than 500 million are 3G subscriptions, meaning they are for smart devices such as iPhones and iPads. The worldwide embrace of mobile technology has been meteoric, with an estimated two million subscriptions being added daily. In 2000, approximately 720 million people in the world had mobile subscriptions; in 2010, there are more mobile subscribers in China alone. In December 2009, the amount of data traffic carried over mobile networks exceeded the amount of traffic generated from voice calls for the first time in history. In other words, smart devices have become a primary means of information exchange as well as personal communication.

Impact on Dental Education The implications for education, for dental students, and for instructors are enormous. In the same way that broadband has created a real-time, global economy The for businesses worldwide, mobile 5 billionth broadband—as represented by global mobile smart devices—expands learning beyond the walls of the classroom subscription and offers a rich well of resources was sold in that is no longer confined to the camJuly 2010 pus dental library. Dental students of today have unprecedented access to materials and research the world over—all, like THE NEXT DDS, in the palm of their hand. While social networking has become ubiquitous, the underlying technology can be used for much more than just Tweeting or updating

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one’s Facebook status. Individual courses now provide dedicated social networking sites where class notes can be kept or pertinent educational videos can be streamed. Study groups can also gather without having to travel to one localized spot, and professors can arrange class discussion groups or professional conferences online to save time and save money. Smart devices can also be used by both students and instructors to collect, manage, analyze, and share data. Digital dentistry provides secure, real-time services that improve healthcare and better manages resources. Dental records can now be kept “in the cloud” so they can be accessed from secure remote locations. Need a second opinion on a dental radiograph? Instead of having to hand-deliver the film, a colleague can simply download the digital image or scan. Remote monitoring through devices that transmit patient information (such as medication levels) allows dental providers to keep tabs on a patient’s health or recovery without the time and expense of an office visit. Dental students can observe an ongoing procedure up close and personal, practically through the oral surgeon’s eyes, via a minicam transmitting video to their laptops. Telepresence, a technology that brings people at a remote site virtually into the room with you via high-tech video imaging, enables real-time interactions and can be used as both a teaching aid and diagnostic tool. Traditionally, most new dental and medical technologies are first adopted by teaching universities or large private health institutions because they have the resources to afford it. But these new IT advances are more democratic because they don’t require expensive equipment, large facilities, or extensive training. They improve the efficiency, distribution, and application of existing clinical and educational resources through affordable mobile, wireless, and IT hardware and software that are readily available to dental student, instructor, and university alike. Richard M. Groves is Vice President of Editorial Services at NEXT Media Group Inc.

o r i e n t a t i o n

Loup Up. In order to increase your level of preparedness and level of confidence, be sure to invest in binocular loupes. These will prove to be helpful in both the pre-clinical and clinical settings, and it will be better if you learn how to use them in your first year. Though your stress levels and workloads increase, you should learn how to relax whenever you have spare time. Hang out with friends, go out for a date, dance the night away, or simply listen to music and you will be better prepared to face life again.

things

youknow should about to hit the ground running

Once you enter dental school, you feel lost at sea. Well, just keep reading and you’ll get the hang of it and feel better equipped to face life on campus.

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Every dental student has to go through the grind. Dental school involves four years of intensive training. Your work load increases. You have two to three times more work than you had as an undergrad. The pace is hectic, and many students find it challenging. As a D1, one of the first things to keep in mind is do not allow yourself to lag behind. Exams are often conducted every week, and this can increase your stress levels. Avoid skipping classes, and submit your assignments on time. Take an opportunity to find out what your professors expect from you and prepare accordingly. You can get valuable advice from senior students in this field. You can also join a study group, which may help you to be more prepared for examinations. Get hold of previous or sample question papers and prepare accordingly.

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The first two years in dental school involve classroom coursework and pre-clinical labs; the next two years are more devoted to clinical experiences. In the first year of dental school, D1 students are exposed to basic science courses including gross anatomy, medical physiology, microbiology & immunology, cell biology, along with introductory dental courses like introduction to operative dentistry with some pre-clinical work, oral microbiology, dental anatomy, intro to oral radiology, and periodontology. In pre-clinical work, students are usually taught waxing teeth and basic cavity preparations and fillings on typodonts.

Pair Up! In your first year, you will often be paired with a “big brother” or “big sister” —a D2 who will guide you and provide answers to your questions. They can also help you to manage stress and anxiety, sharing valuable tips on do’s and don’ts with you. D1 students begin dental school with an orientation program wherein they typically receive information on their schedules for the year. You are also introduced to the faculty members and are taken on a tour of the faculties. Some schools believe in making D1 students begin school by a lighter workload and then slowly increase it; other universities start off immediately with a tough schedule to give the students a taste of things to come. Take things in stride, excel in your work, and remember to celebrate the journey!

clinical study

see dr.chu explain more WWW.THENEXTDDS.COM/ videos/inside-individual-tooth-width

Range and Mean

Distribution Frequency of Individual Tooth Width of the Maxillary Anterior Dentition by Stephen J. Chu, DMD, MSD, CDT*

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Abstract: Proper diagnosis of tooth size for each patient is critical in treatment planning for aesthetic restorative dentistry. The goal of this study was to determine the clinically relevant range and mean distribution frequency of individual tooth width of the maxillary anterior dentition within a given population of patients. Mean values for restoration of tooth size were not interchangeable for the different group size of patients or respective tooth groups. The results of this study suggest that there exists a range value of maxillary anterior tooth width for both males and females. Learning Objectives: This article will discuss the clinical significance of tooth biometry and distribution frequency, in which size for tooth restoration may vary among patients of different age, race, or sex. Upon reading this article, the reader should: â&#x20AC;˘ Become more familiar with the range of individual tooth width of the maxillary anterior dentition, and the mean distribution frequencies within a given population of patients. â&#x20AC;˘ Understand whether gender differences exist for the maxillary anterior teeth, and if age and racial background affect tooth size. Key Words: individual tooth width, proportion, maxillary, biometry, distribution

ooth size is the primary building block within the framework of a smile. Correct tooth size allows successful arrangement of teeth in the anterior maxilla and enables aesthetic treatment outcomes to be achieved.1,2 Aesthetic restorative dentistry frequently entails correction of tooth size discrepancies associated with length and/or width. Consequently, tooth biometry may be an important aspect of aesthetic reconstruction, where identification of individual tooth size variations is critical to smile analysis, and correction of tooth size discrepancies are tantamount to smile design.3,4 There are several clinical situations that can result in dissimilar diagnoses and etiologies affecting tooth sizes.5 First, hereditary factors can lead to smaller dimensions, as well as malformation (Figure 1). In addition, partial anodontia with or without transposition of teeth can occur, which can contribute to an unaesthetic smile due to a lack of tooth proportion and visual harmony. Further, insufficient incisal tooth structure with excessive gingival display due to acid erosion (eg, gastric erosive reflux disease) is now a more common disease requiring aesthetic restorative treatment (Figure 2). Lastly, with the aging process, incisal attrition with compensation eruption can lead to excessively short teeth and gingival recession can result in excessively long teeth (Figure 3).

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The interdisciplinary restorative team can predictably address these aesthetic deformities associated with long or short teeth. Tooth length is frequently the variable that must be restored, as previously exemplified with the aforementioned conditions. Correction and restoration of proper tooth size and proportion are paramount to a successful aesthetic outcome. Individual tooth proportion of the maxillary anterior dentition, defined by the anatomic width/length dimensions as a percentage ratio, falls within a range of 72% to 80%, with an average of 76%.6 Sterett et al reported a higher average proportion ratio (ie, 81%) in a population of male and female patients in reference to clinical crown dimensions where the free gingival margin is incisal to the cementoenamel junction.7 In an effort to restore proper tooth size, proportion, and individual tooth aesthetics within the arch and smile framework, published width and length dimensions are often referenced.7 The questions are: What percentage of the time are these anatomic dimensions valid within a given population of patients? Is there a range and distribution frequency associated with individual tooth width of the maxillary anterior teeth, that is representative of patient width variations in size, that would be clinically relevant and applicable? From the tooth width, clinicians can derive the desired tooth length by using the anatomic width/length percentage ratio. Thus, an additional question is: Do these data vary based on race, sex, or age?

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clinical study

Figure 1. Genetic factors can lead to tooth malformation where corrections are required to restore aesthetics and a stable, functional occlusal scheme.

Figure 2. Accelerated loss of coronal tooth structure due to gastroesophageal reflux disease; compensatory eruption of the affected teeth and opposing dentition can occur.

Figure 3. Frequently, teeth can become short due to incisal attrition, which can result from bruxism; teeth can become long due to gingival recession.

table 1. Descriptive Statistics for Maxilla Width: Combined Gender Data

Tooth Number

N Statistic

Range Statistic

Minimum Statistic

Maximum Statistic

Mean Statistic

Mean Standard Error

Standard Deviation Statistic

2.41

6.50

8.91

7.66

.072

.524

2.00

6.00

7.00

6.63

.069

.497

2.52

7.10

9.62

8.47

.075

.544

2.74

7.32

10.06

8.49

.080

.590

2.00

6.00

8.00

6.69

.076

.545

2.55

6.34

8.89

7.61

.067

.489

The clinical significance of tooth biometry and distribution frequency is that size for tooth restoration may vary among patients of different age, race, or sex. Therefore, it is imperative that the proper tooth size for each individual patient be diagnosed and identified before any irreversible restorative procedures are performed. The purpose of this tooth biometry study was to find: • The range of individual tooth width of the maxillary anterior dentition; • The mean distribution frequencies within a given population of patients; • Whether there were gender differences for the maxillary anterior teeth; and • Whether age and racial background were factors in regards to tooth size.

Materials and Methods Fifty-four gypsum model stone diagnostic casts, consisting of 36 female and 18 male patients, were evaluated. The maxillary anterior dentition encompassing the central incisors (CI),

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lateral incisors (LI), and canines (CA) was measured. The casts were fabricated from irreversible hydrocolloid impression material that was poured immediately. The gypsum stone material was mixed with vacuum pressure. Six-inch digital calipers with LED display SAE/ Metric were used to measure individual tooth width at the widest mesial-distal aspect on each cast. The digital calipers were calibrated and set to ‘zero’ prior to each measurement. One operator performed all cast measurements under 2.5X magnification via surgical loupes. The criteria of the sample population consisted of nonrestored maxillary anterior teeth, nonorthodontic patients, anterior crowding of the dentition, and no visible signs of excessive incisal attrition and/or gingival recession. Cases exhibiting diastemata due to visible signs of tooth malformation were excluded. Maxillary tooth width was the only parameter measured in this study.8 The patients ranged in age from 16 to 72 years, with the mean age of 42 years. Fortyone of 54 patients (ie, 76%) were Caucasian.

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table 3. Total Maxilla Distribution Percentages: Combined Gender Data

Tooth Number Total Maxilla Width

Figure 4. Combined gender width distribution for the maxillary central incisors. A 36% width distribution is noted for the mean value of 8.5 mm. The majority of patients (ie, 80%) fall within ±0.5 mm of the mean.

Figure 5. Combined gender width distribution for the maxillary canine teeth. A 40% mean width distribution at 7.5 mm for maxillary canines exists. Of the patients, 84% fall within ±0.5 mm of the mean with 70% at +0.5 mm of the mean.

Figure 6. Combined gender width distribution is plotted for the maxillary lateral incisors. There exists a 26% mean width distribution of 6.5 mm for maxillary lateral incisors. Of the patients, 82% fall within ±0.5 mm of the mean.

Range

table 2. Clinical Data Accumulated for Analysis

Tooth Number Total Maxilla Width

Range

Mean = 7.50 [N = 52]

Mean = 6.50 [N = 52]

Mean = 8.50 [N = 53]

Mean = 8.50 [N = 54]

Mean = 6.50 [N = 51]

Mean = 7.50 [N = 53]

Median = 7.50 Mode = 7.50 StDev = 0.52

Median = 6.50 Mode = 7.00 StDev = 0.49

Median = 8.50 Mode = 8.00 StDev = 0.54

Median = 8.50 Mode = 8.50 StDev = 0.59

Median = 6.50 Mode = 7.50 StDev = 0.54

Median = 7.50 Mode = 8.00 StDev = 0.49

6.5 - 8.91

5.55 - 7.48

7.1 - 9.62

7.32 -10.06

5.65 - 7.88

6.34 - 8.89

6/11

7/10

8/9

6/11 5.0% (6.5) 14.0% (7.0) 40.0% (7.5) 30.0% (8.0) 8.0% (8.5) 3.0% (9.0)

7/10 3.0% (5.5) 24.0% (6.0) 26.0% (6.5) 32.0% (7.0) 14.0% (7.5) 1.0% (8.0)

Mean = 7.50 [N = 105] Median = 7.70 Mode = 7.50 StDev = 0.52

Mean = 6.50 [N = 103] Median = 6.50 Mode = 7.00 StDev = 0.55

8/9 1.0% (7.0) 10.0% (7.5) 22.0% (8.0) 36.0% (8.5) 22.0% (9.0) 7.0% (9.5) 2.0% (10.0)

6.5 - 9.0

5.5 - 8.8

Mean = 8.50 [N = 107] Median = 8.50 Mode = 8.50 StDev = 0.58 7.0 - 10.0

**Central incisor, lateral incisor, and canine data were grouped together because mean values were equivalent for contralateral teeth. Mean, median, mode, and range values are provided as a total aggregate. Distribution percentages were calculated for each individual width within each group as a ratio of the total number of teeth. Approximately 35% of the patients were at the mean values in regards to tooth width.

*Numeric data were rounded to the nearest 0.5 mm to make the information clinically applicable. For example, the absolute mean value for central incisor #9 equals 8.4857 mm, which equals 8.5 mm when converted to the nearest 0.5 mm. Note that mode values differ by +0.5 mm, implying asymmetry of tooth side width between right and left sides of the dentition (ie, left>right).

Range, mean, median, and mode values were calculated (Table 1). Distribution frequency of individual tooth width for the maxillary central, lateral, and canine teeth was calculated as well as comparative distribution frequencies according to gender. Numeric data were rounded to the nearest 0.5 mm to make the information clinically applicable (Table 2).

Results Individual tooth width in millimeters among the 54 patients ranged in size from a minimum of 2.5 mm to a maximum of 3 mm, with the central incisors exhibiting the greatest range at 3 mm. The central incisors, lateral incisors, and canines varied in range from 7 mm to 10 mm, 5.5 mm to 8 mm, and 6.5 mm to 9 mm, respectively. Mode norms, the value with the greatest frequency within a statistical range, showed an asymmetry in the left and right dentition. Mode values (ie, rounding off to the nearest 0.5 mm) differed by 0.5 mm, implying asymmetry of

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tooth width between the right and left sides of the dentition—with the left side being 0.5 mm greater in width than the right side (Table 2). This is consistent with concepts of asymmetry related to parts of the human body (ie, face, hands, feet). Only 36% and 40% of the total population exhibited the mean tooth width of 8.5 mm for central incisors and 7.5 mm for canines (Table 3; Figures 4 and 5), respectively. For the lateral incisors, 26% of the population exhibited a mean tooth width of 6.5 mm (Figure 6). As a group, a central incisor with a width of 8.5 mm, a lateral incisor with a width of 6.5 mm, and a canine with a width of 7.5 mm occur only in 34% of the population (Figure 7). Some 82% of the patients, however, fell within ±0.5 mm of the mean values (Table 3; Figures 4 through 6). The range, mean, median, and mode values were tabulated for males and females. Results of nonparametric Wilcoxon 2-sample test and parametric t-test revealed evidence for significant

Figure 9. Comparative gender width distribution for the maxillary central incisors. Mean values are identical in both gender groups at 49% (males) and 31% (females) width distribution. The higher distribution frequency implies greater consistency of tooth size for males in regard to maxillary central incisors.

Figure 7. Total mean distribution frequencies for each tooth group (ie, CI, LI, CA), and total distribution of the maxillary anterior teeth— which is only at a 34% confidence level.

Figure 8. Blot plots for the maxillary anterior teeth. Significant gender differences exist for all tooth groups with males being larger in tooth width than females.

Figure 10. Comparative gender width distribution for the lateral incisors. Mean values differ by gender with males +0.5 mm wider than females. Female mean values are consistent with the total mean (ie, 6.5 mm) for lateral incisors. A 37% mean (ie, 7 mm) width distribution was exhibited in males and a 27% mean (ie, 6.5 mm) width distribution in females.

Figure 11. Comparative gender width distribution for the maxillary canines. Mean values are identical for canines in both gender groups at 40% (female) and 41% (male) width distribution. Seventy-nine percent of the males were +0.5 mm above the mean while 60% of the females were -0.5 mm of the mean.

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Figure 12. Combined gender mean distribution

frequencies for each tooth group (ie, CI, LI, CA) and the distribution of the teeth at Âą0.5 mm of the mean, which increased the confidence level to ~80%.

gender effects for the maxillary anterior teeth (Figure 8). The findings of the two tests were consistent. Male patients ranged from 0.5 mm to 1 mm greater in tooth width than female patients. The majority of males were +0.5 mm and females -0.5 mm of the mean, respectively, for all three tooth groups (Table 3). The mean distribution frequency for central incisors (Figure 9) revealed 49% for males and 31% for females, indicating greater variation of size for females. There was a significant difference in the mean lateral incisor values between males (ie, 7 mm) and females (ie, 6.5 mm) with similar distribution frequencies at 37% and 27%, respectively (Figure 10). The canine mean distribution frequencies (Figure 11) showed dissimilar mean values for males (ie, 8 mm) and females (ie, 7.5 mm), with distribution frequencies at 38% and 40%, respectively. The consistency in distribution frequencies indicates equal variability between gender groups.

Conclusions Figure 13. Distribution frequencies of male patients for each tooth group (ie, CI, LI, CA) and total distribution of the teeth. Male patients were consistently +0.5 mm of the mean.

Figure 14. Distribution frequencies of female patients for each tooth group (ie, CI, LI, CA) and total distribution of the teeth. Female patients were consistently -0.5 mm of the mean.

In summary, a normal distribution of individual tooth width size exists for a given population of male and female patients. Only ~35% of the population is clustered around the mean. Expanding the range of the mean by +0.5 mm, however, will increase the occurrence within the population to about 60%. Including both +0.5 mm and -0.5 mm in the range will further increase the occurrence rate to approximately 80%. Mean values and normal distribution differed significantly between genders, with females consistently 0.5 mm to 1 mm smaller than males. Further research, however, is needed with larger population sizes to determine if race or age also affects this outcome of gender with respect to the width of the anterior teeth. These findings have significant clinical relevance in that proper tooth biometry exists for each patient; individual tooth size must therefore be identified prior to any attempt to create an aesthetic smile via dental restorations.

NOTE: An unabridged edition of this article as well as a video with the author are both available on www.thenextdds.com and readers are encouraged to visit for a full understanding of the topic.

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References 1. Bolton WA. Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. Angle Orthod 1958;28(3):113-130. 2. Bolton WA. The clinical application of tooth-size analysis. Am J Orthodont 1962;48:504-529. 3. Fattahi HR, Pakshir HR, Hedayati Z. Comparison of tooth size discrepancies among different malocclusion group. Euro J Orthodont 2006;28(5):491-495. 4. Araujo E, Souki M. Bolton anterior tooth size discrepancies among different malocclusion groups. Angle Orthodont 2003;73(3):307-313. 5. Chu SJ, Karabin S, Mistry S. Short tooth syndrome: Diagnosis, etiology, and treatment management. CDA J 2004;32(2):143-152. 6. Black GV. Descriptive anatomy of the human teeth. 4th ed. Philadelphia, PA: S.S. White Dental Manufacturing Co; 1897. 7. Sterrett JD, Oliver T, Robinson F, et al. Width/ length ratios of normal clinical crowns of the maxillary anterior dentition in man. J Clin Periodontol 1999;26(3):153-157. 8. Kraus BS. Dental Anatomy and Occlusion. St. Louis, MO: Mosby-Year Book, Inc; 1991. 9. Magne P, Gallucci GO, Belser UC. Anatomic crown width/length ratios of unworn and worn maxillary teeth in white subjects. J Prosthet Dent 2003;89(5):453-461.

*Associate Clinical Professor in the Department of Periodontics and Implant Dentistry and the former Director of the Continuing Education Program in Advanced Aesthetic Dentistry at NYUCD; Associate Clinical Professor in the Department of Prosthodontics and Director of Aesthetic Education at the Columbia University College of Dental Medicine. Stephen J. Chu, DMD, MSD, CDT of New York Specialized Dentistry 150 East 58th Street, Ste. 3200 New York, NY 10155 212-752-7937 â&#x20AC;˘ schudmd@aol.com

h e a l t h

f i t n e s s

by Sherry L. Granader

1 Freshman 5

It is up to us to prepare for battle against endless fatigue, brain fog, hard work performed with precision, and to face daunting expectations from ourselves and our patients. It is up to us to cope with illness on a daily basis and help every individual lead a life of good oral health. Taking these steps can be uncertain at times due to the immense knowledge required to care for an intraoral environment that has varying demands and is affected by diverse biological processes. We are expected to act fast in a consistent manner, often dealing with dozens of related professionals who range from dental hygienists to lab technicians to the maintenance person who keeps the digital radiography machine working in the examination room. All of this care is performed for one person and must be handled with humane technique, concern, and gentleness—which can be extremely interesting but unsettling at the same time. Practicing dental medicine can seem, at times, like “organized chaos” but since we ourselves are human, weak every now and then, plus concerned about our own health and life, it is still up to us to live a life of endless responsibility and prepare our bodies for the rigors of the dental practice.

Avoiding The

ost of us want to perform well in whatever task we face in life, but nowhere is this drive more important than in the field of dentistry where patients’ oral health is impacted by decisions made every single day. After the intense process of getting accepted to dental school, students finally face the rigors of clinical training and extensive study that lasts all hours of the day and often into the night. Even when we manage to stop for a moment and fall into a delicious sleep for a couple of hours, the phone can startle us awake to answer the simplest of questions.

Here are significant ways 1. Take a good quality multivitamin daily. Contrary to popular belief, you will not get all the vitamins and minerals you need every single day from food. The quality of our food today is not what it once was and a good multi-vitamin is inexpensive insurance. Look for one without additives, preservatives or fillers and choose one where the vitamins are actually derived from food sources. A pharmaceuticalgrade multi-vitamin can often be an excellent choice. 2. Supplement with Vitamin D3 —which is especially important since the majority of our time is spent indoors. Many become deficient in this very important vitamin that builds the immune system and keeps it strong. Dosage should be at least 2,000IU daily

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d1 students

the road to staying fit while in school to help win the battle against the rigors of your dental training: 3. B-complex A large number of studies have linked B-Vitamin deficiencies to heart disease but these important vitamins can lower homocysteine levels and improve the function of coronary arteries. Make a point of eating dark leafy greens, beans, oatmeal, and wild salmon whenever possible. As far as a supplement goes, look for a B-Complex Stress Formula, which will also help support the adrenal glands and aiding in de-stressing the body. 4.

Odorless garlic is another supplement to consider; it has a long history as a healing herb throughout the world from being used by the Egyptians to keep their slaves healthy to World War II, where it was utilized to disinfect battlefield wounds. Today it is used to treat colds, allergies, diarrhea, and arthritis as well as to fight bacteria and viruses by stimulating the immune system. It has a protective effect against coronary artery disease by lowering blood pressure and cholesterol, blood fats and

guards against damage to the arteries and veins due to age, hence reducing the risk of dangerous blood clots.

Omega 3s are one of the most important supplements to consider on a daily basis as they will help reduce inflammation throughout the body and reduce the risk of developing Alzheimer’s disease, asthma, coronary heart disease, depression, rheumatoid arthritis, and can lower both blood pressure and cholesterol naturally.

6. Eating nutrient-dense, mini-meals every 3 to 4 hours may sound like an impossible task with long, hectic schedules. They will, however, make all the difference in maintaining your optimal blood sugar levels—which should be 85 to 95 mg/dl. As you may already know, the symptoms of low blood sugar levels include fatigue, inability to concentrate, depression, irritability, lack of motivation, low energy, and food cravings especially for sugar or carbohydrates.

7. Lowering blood pressure naturally can be done by taking a good quality calcium/ magnesium supplement in the morning and again at night. It should be in a 2:1 ratio of calcium to magnesium, which can be accomplished by taking 500 mg of calcium with 250 mg of magnesium morning and night. 8.

“An apple a day keeps the doctor away” – this saying came about because one of the best ways to lower cholesterol naturally is through apple pectin found in the skin of an apple. Choose organic apples whenever possible and take one with you to dental school every day. Enjoy a satisfying snack by dipping apple sections in some almond butter, which will give you some good fats in the process as well.

By maintaining optimum blood sugar levels throughout each classroom or clinic day, you will have increased energy, motivation, better ability to focus, increased mental clarity and memory, no sugar cravings or mood swings, and increased self-confidence.

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m o b i l e

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d1 students

Dental School? ya, thereâ&#x20AC;&#x2122;s an app for that

by Kathleen A. Tracy

or as valuable as texting, tweeting and social networking are culturally, these functions represent only a fraction of mobile technology functionality. iPhones, iPads, Android phones, and other smart devices offer unprecedented value as educational and professional development tools that enhance traditional classroom instruction, complement clinical training, and expand research beyond the library walls. Online and remote activities in programs such as The NEXT DDS, platforms like Blackboard, and downloadable apps are all aspects of digital age remote learning.

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There are currently more than 700 apps available for general medical education, such as Medscape, which offers physician and pharmacy directories specialty-specific medical news, or Taber’s Medical Dictionary, which contains 60,000 definitions, 1,000 images, and more than 30,000 audio pronunciations. There are also apps designed specifically for dental students, from first year basics to final year hands-on clinic work. While the iPhone may be the best known smartphone, there is an array of smartphones on the market that offer advanced functionality that can make it easy to use educational apps, online resources, and other remote learning tools. Android phones are becoming increasingly popular. The HTC EVO, billed as the first 4G phone in America, offers the fastest speeds available for downloading material and overall functionality. The EVO and the Motorola Droid X turn into roaming hotspots for other devices, such as a student’s laptop. The Droid X also offers up to 40GB of storage The new Windows Phone 7 smartphones, which include the HTC HD 7, Samsung Focus, and the LG Quantum are individualized communication devices that accommodate a student’s particular educational needs. User-friendly slate devices such as the iPad, HP Slate, and ExoPC Windows 7 are becoming increasing popular among students. These devices are perfect for reading, browsing the web and organizing materials. With smart phones becoming ubiquitous, college programs are incorporating more remote education tools into their curricula. For dental students, resources such as THE NEXT DDS offer access to articles, procedures, reports, study aids, and information on traditional, new and/or experimental clinical procedures. And, of course, smart devices also allow students to communicate with each other and with their instructors. While academic class and clinical instruction will always be an aspect of dental school, utilizing digital technology to expand student learning opportunities will produced the most knowledgeable and highest-quality dentists possible.

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see dr.chu explain more WWW.THENEXTDDS.COM/ videos/inside-individual-tooth-width 3Dteeth provides general information about teeth—caries, disease, and dental implants—illustrated by 3D images of each tooth.

DAT AudioLearn is an audio study guide for the high yield science portion of the Dental Admission Test.

The Mobile Practice lets both dental students and practicing dentists keep their daily schedule at hand on their iPhones. More than just a scheduler, this app also shows the name of the patient waiting for treatment, what treatment they are getting, and how long they have been waiting. There is also storage for individual prescriptions and a place for notes.

The Little Dental Drug Book has everything you want to know and more the medicines commonly used in dentistry. Features include prescription and dosage guides and information on writing prescriptions.

The Lexi Dental-Complete app provides access to information archives along with quick links to resources and clinical information. Other features include images, resources, links, charts, radiographs and diagnostic tools.

The Cosmetic Dentistry Calculator is a diagnostic tool that analyzes a patient’s existing tooth width-to-length ratio. The app calculates the most appropriate dimensions of the maxillary anterior teeth based on accepted cosmetic dentistry principles. The app can also be used chair side when consulting patients on the treatment they are about to receive.

Orasphere is another iPhone app designed to help dentists consult with patients. Orasphere features animated videos that describe routine dental procedures. The app offers free drug reference with data on over 3000 drugs, including pictures, dosing, and drug interactions.

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t h e n e x t d d s

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students

The NEXT DDS By You and For You see more

WWW.THENEXTDDS.COM

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he NEXT DDS is poised to become the leading online community website for dental students and aspiring professionals in the various fields of dentistry. The NEXT DDS offers access to a large and varied database of peer-reviewed clinical articles, case studies, podcasts, and videos designed to help dental students gain information on procedures and materials, as well as practice management and general dentistry knowledge. This easy-tonavigate web portal will be constantly updated, giving the prospective dentist something new to see or read each time he or she visits the site; students can even choose to sign up for mobile/ email alerts when new content is posted, so as not to miss anything. The portal will also allow students and new dentists to design, create, and modify their own personal profile—complete with connections, contact lists, groups, and favorites. Blogs and forums allow the community to communicate in an easy, open, and ongoing fashion, and give dental students the opportunity to share their unique ideas, experiences, questions, and problems with a large audience of their peers. If you prefer more a more personal sort of communication, the site also features its own messaging system and real-time chat similar to that of Facebook. A constantly maintained and updated calendar of events ensures that dental students are aware of any large or small scale meetings or conferences going on in the near future, and an RSS feed feature on the site provides students with a one-stop location to quickly and easily access the latest news in the dental world from many of the field’s most recognizable sources. Access to the website is completely free! There is no fee to become a member, nor is there any ongoing charge for membership. The only requirement to join this helpful and expansive community is to be a registered dental student, and enrollement in The NEXT DDS is fast and easy. Become a member in this up-and-coming online community by signing up today at www. thenextdds.com!

An Expanding Educational Resource pEer-reviewed articles: The NEXT DDS is loaded with scientific articles on the most relevant topics in dentistry. The NEXT DDS articles are grouped and indexed so that you can easily sort by your D1 - D4 status to parallel your university curriculum. It’s simple to view, comment, forward, and bookmark articles for future reference.

instructional videos: The NEXT DDS provides access to hundreds of educational videos that help prepare you for a career in dentistry. Each video, with a professional voiceover, fosters your comprehension in areas such as risk management, occlusion, periodontal health, endodontics, prosthodontics, and many other subjects that support your university training. Videos can be rated by each member of The NEXT DDS community!

animation tutorials: The NEXT DDS brings important clinical concepts to life in anatomically accurate animations that reinforce topics relevant to your clinical training. The most commented and viewed animation tutorials are automatically displayed so you can remain on top of “what’s hot” on The NEXT DDS.

news: The NEXT DDS consolidates important dental news and industry events into a single location that you can easily browse by date or topic. This RSS-style feed keeps you “in the know” of the latest developments beyond the four walls of the university.

podcasts: These episodic audio narrations allow convenient access to contents of The NEXT DDS. The podcasts feature educators from around the world presenting clinical information, debating research issues, and exploring practice management topics related to your ongoing career development. All The NEXT DDS podcasts are indexed by posting date and topic to ensure the most timely content is availed to you and your fellow dental students.

case images: The NEXT DDS encompasses more than 1,000 before and after photos, as well as instructional diagrams to aid in your comprehension of diverse subjects such as margin design, radiography sensor placement, subgingival anatomy, and others where illustrations are the most effective resource. You can provide comments to these images, bookmark for future reference, and even share favorites with other dental students.

forums & blogs: The NEXT DDS enables enrolled users to follow leading educators in real time as they explore relevant topics in implant dentistry, emerging technologies, and every therapeutic category in between. The NEXT DDS Forum and Blog pages are where educators challenge you with important concepts and empower you to comment, share, and interact on each.

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Next DDS

I strongly urge students to take their education by the reins by signing up and taking an active role within The NEXT DDS

Tim Moriarty

American Dental Association Delegate former American Student Dental Association president interviewed by Rich Groves edited by John Papa

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About Tim:

ow do you make a real impact on the lives of your fellow students and your patients? Your dental school training affords you with numerous opportunities and diverse resources to develop your diagnostic and clinical skills as well as to build your confidence. With this in mind, The NEXT DDS recently interviewed Dr. Tim Moriarty, past president of ASDA and 2010 graduate of UConn School of Dental Medicine, about contemporary patient care and the rapidly changing face of dental education.

Education Monmouth Medical Center General Practice Residency General Practice Resident (PGY1) July 2010 - June 2010 UCONN School of Dental Medicine Farmington, CT Doctorate of Dental Medicine May 2010

How is dentistry in today’s era different from that of even 10 or 20 years ago?

Union College Schenectady, New York Bachelor of Science, Biology with Chemistry Minor, June 2005

We’ve seen so many advances in evidence-based practice models for improving patient care, patient comfort, and the patient’s ownership of their oral health. Dentistry remains a service-oriented industry, but it’s also embracing clinical science and technologies that enable us to really improve the way we communicate with our patients. Dentistry is making leaps and bounds at such a rapid rate that when you talk to professionals who have been in practice for 10 or 20 years, most seem hard pressed to say that more than 10% of what they’re doing now came from their dental school curriculum. Dental school professors often say what they’re teaching came from eight to 10 years ago, because they need to give students a basic fundamental education and background in some dated techniques or materials. This way, when a patient comes in to their practice with work that’s 10 years old the dentist has seen it, they know why it was done, and they know the best ways to use today’s technology to respond. Yesterday’s dental educators were teaching what they were taught in school, and it was in line with what was needed in the field. In today’s university training, there isn’t enough time, money, or logistics to have dental students master both the fundamentals of yesterday and the advancements of tomorrow.

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Professional Affiliations American Dental Association (2005-present) Delegate: (2010) Served as delegate at The ADA House of Delegates. American Student Dental Association (2009-2010) President, Represented 17,000 ASDA members as a liaison to the ADA, AGD, NDA, ADEA, AADB, ADEX,CDA, ADPAC, Specialty Organizations, and Student Dental Organizations.

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I think that’s the biggest change in dentistry; the burden is really on the student to be ready for the future when he or she graduates. New graduates will have to overcome the obstacle of experience, where they’ve learned all the basics but don’t have the experience to implement them with confidence. Dental graduates also have to overcome a complete lack of business education in a world where debt is so much higher than it ever was before. They have to master an entirely new generation of restorative materials. Without some educational adjunct to what dental students are learning in school, it’s not going to be a financially practical thing to go into dentistry, because students are going to graduate without the knowledge of what they need to make money to pay for what they learned. Right now, I think there is a real gap between what you’ll be doing every day in private practice and what you learn in dental school.

What role do you think technology plays in the education of the contemporary dental student? Without some sort of technological or informational resource as a supplement to their education, dental students are not going to be able to achieve the level of knowledge they need to function as practicing dentists. There needs to be a resource beyond the education available at the predoctoral level, and it needs to come in a package that students can digest quickly and easily. It’s easy for a new graduate to tackle one or two obstacles at a time. I chose to enter a residency because of this philosophy. I knew I could tackle the lack of experience and gain the confidence needed for private practice through a residency, because I would be working in a setting where I could

address both—but without financial consequences or pressures. If dental students are put in environments where they have to learn new materials or techniques instead of building confidence and practicing the fundamentals of good dentistry, their professional development will be impeded. Without some sort of resource like The NEXT DDS to give students the information they will need when practicing outside of the dental school environment, they won’t be able to better themselves in the first few years after graduation. A resource like this will shorten the learning curve dramatically because the students will have that information before they need it. I think technology plays a huge role in this because many dental students won’t be exposed to technological advances, digital advancements, new lab systems, new study models, surgical guides, which are out of budget for the average dental school—things that are very good for dentistry and patient care—but not practical for dental schools with limited resources.

What digital resources were available to you during your university training? While I know several dental schools provided textbooks on DVD, at UConn we had Blackboard. Professors would upload their entire curriculum to Blackboard and you could go and see all the notes they wanted you to have. We also used the “student’s symposium”, which was essentially a compilation of previous class’s notes on the same topic. You could pull up the PowerPoint from your course and go to the student symposium, pull up last year’s notes for that same lecture, and compare them to your own and make any adjustments necessary.

Wikipedia is interesting, even though a lot of its entries aren’t scientifically accurate or appropriate to study from. Occasionally you’d come across an entry that didn’t exist; something that you wanted to research and create an entry on that topic. You would refer back to your original entry and it would be edited and made more elaborate as the year went on. If you checked on it frequently, you’d be able to see not only your original post, but what other people needed to know about the topic, and that was a really interesting and useful thing. While these resources were pretty good, they were obviously limited in their scope. The “eBooks” contained only what the professor wanted you to see from his or her particular class, and Wikipedia is in no way focused on just dentistry. Or validated by experts, for that matter. The NEXT DDS gives students a resource that is not limited by their curriculum to help expand their knowledge database. I think that seeing these procedures and reading about relevant information will help instill confidence in the students because they will be better prepared when they get to clinic and ultimately into practice, and that is really one of the most important parts about dental student education.

What features of The NEXTDDS do you think will have the most value for today’s dental students? The first thing I thought of when I heard about The NEXT DDS was that it had amazing potential to expose students to evidence-based instruction on materials and techniques common to private practice that aren’t common in dental school. When I was in school, vendors were permitted to visit and demo technologies like YAG lasers or conduct hands-on sessions with CAD/CAM systems. By the time I

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2005

2005 - present

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2006, 2007

2008

2009

Special Olympics Winter Games Helped athletes in speed skating

American Cancer Society Organized a walk-a-thon to raise funding and awareness

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Schedectady Hospice Volunteered with hospice running a program for children that have lost a loved one, and doing office and administrative tasks.

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American Dental Association Member of the profession’s most recognized national organization

Issue:1

Student Activities Academic Advisory Committee Meet to discuss and implement extracurricular activities to integrate the Medical, Dental, and Graduate schools for the promotion collaboration

Crest, Give Kids a Smile Attended schools in Hartford and New Britain k-4th

Hartford Boys and Girls Club Worked with others to raise over 800 dollars for the healthy habits fund by running the Hartford Marathon.

Paraguay Service Trip Traveled to Tobati, Paraguay with Dr Michael Goupil and Dr. Robert Hall. The Population was without access to care.

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2009 - 2010

President, ASDA Represented 17,000 members of the nation’s largest dental student-run organization

The first thing I thought of when I heard about The NEXT DDS was that it had amazing potential to expose students to evidencebased instruction common to private practice that aren’t common in dental school

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May 16, 2010

July 2010 - June 2010

July 30, 2010

April 2011

UCONN School of Dental Medicine Farmington, CT Doctorate of Dental Medicine

Monmouth Medical Center General Practice Residency General Practice Resident (PGY1)

Fall 2011

Got Married! Ceremony at Wychmere, Cape Cod, and honeymoon in Hawaii.

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UCONN Huskies Win NCAA Basketball Championship Proud alumnus.

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June 2011

The Next DDS Enrolled within the dental student portal

the next dds

profile: tim moriarty

I think The Next DDS will go a long way towards preparing students for “real-world” dentistry

was graduating, though, they couldn’t do that anymore. Unfortunately, today’s technologies are only available to some schools for logistical and expense reasons. I think The NEXT DDS has a great potential to replace what was available when I was in my first or second year. Secondly, I think it can provide an avenue for students to showcase their work. Not only in states where portfolio models can be used for licensure, but also when recent graduates wish to demonstrate their experience to potential employers. It’s easy for employers to say “I’m 10 years out and I don’t use anything I learned in dental school, why should I hire you as a new graduate?” And you can say, “My portfolio on The NEXT DDS shows all the great things I did in school, look how good my work is.” And they might feel much better and want to hire you, so I think it’s a great tool for networking and job seeking. I think using this resource, students can gain a competitive edge in today’s demanding marketplace, and having this background knowledge and body of work might be the difference between getting accepted to a residency or not. Third, I think the fundamental everyday use of The NEXT DDS should be for professors to identify videos or instructional tutorials that will support upcoming instruction so students can spend less time in a classroom or a handson environment trying to learn what is really didactic material. They can get that information beforehand through an engaging atmosphere. Rather than a professor telling students to read 200 pages in some textbook that they never bought, the professor can now tell them to go on The NEXT DDS and watch a tutorial he or she flagged for them. I think that’s much more engaging than the way things have been done in the past.

In what areas did you wish your university training offered more coursework or information? This is a question we constantly ask from ASDA’s perspective: what content do you want to see in meetings? Probably 99% of students answer they need more practice management, but now that I’m out of school what I need is not practice management, but career management. Most

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students have so much debt that buying a practice is off the table for at least the first three or four years that you’re out. You just want to find yourself in an environment where you can make your loan payments and live the lifestyle you expected to. It would be valuable to have answers to questions in career management, like how can you be a good associate. What should you look for in your contract if you’re planning on buying in? If you’re planning on opening your own practice after you’ve worked for this person for a while, when is it appropriate for you to make that clear your employer? How much should you get paid? How do you pay quarterly taxes? What’s more important for an associate, getting the right results or getting faster results? What matters most to dentists when they’re hiring someone new? Little things that you just don’t know as a dental student that are important for being a good associate. The average dental student is not going to go out and borrow seven figures from a lender and open a building. I’m at a point where I know exactly how to value the practice in which I’m going to go to work; I know exactly how much I want to pay for it when I buy it, but how do I get to the point where the owner wants to offer the practice to me? There’s a huge sense of ownership in a practice that somebody’s spent 25 years building. It’s this thing that they go to every working day, that supported their family’s growth, that supported a staff of 10 that has been there for 15 years. It’s a lot more than just buying a company from somebody, it’s buying their second family, it’s buying their life’s work. There’s a huge personal investment that requires the development of trust and leadership that needs to take place before you can even think about buying or starting a practice. Through THE NEXT DDS dental students can discuss these topics and experiences with each other, as well as with some dental professionals who have gone through this process before.

How valuable do you think is the ability of The NEXT DDS to facilitate interaction and communication among dental students? While I’m not a Twitter user, if I saw a content post that was really interesting and professionally rel-

profile: tim moriarty

The NEXT DDS seems poised to provide engaging content that students might otherwise never be exposed to during training

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evant on a Facebook I would definitely click on it. Now when a new article or instructional video is uploaded, far more dental students are instantly aware of its availability. They’ll know, for example, that Captek crowns exist, and at some point curiosity is going to make them want to learn more about this material, how much it costs the lab to make, and what the preparation looks when it’s done correctly. I think it’s hugely important to keep people engaged and make the content fully immersed in student life. I think it’s really cool to see these up-to-the-minute updates. I know on Facebook it would show up on my newsfeed and all the ways we stay connected these days. I think it would be cool, I think all that stuff adds to the enjoyment of using The NEXT DDS.

You had some very interesting points that we embraced about finding a way to use The NEXT DDS for the educators as well. If you could convince half of the dental school graduates to take a 60% pay cut and devote their lives to educating dental students, then charge the students a million dollars a year, you could in just five or six years give them absolutely all the information that would fully inform them about everything in dentistry. I don’t think anyone is going to take offense to saying that dental students aren’t learning everything about the field. If you learned everything you needed in dental school, you would never have to go to a CE course. I think it’s great that The NEXT DDS has tutorials and information and evidence-based articles on really innovative and advanced technologies that the average dental school can’t afford to put in the hands of its students. It’s got to be challenging to put a CAD/CAM system in a state dental school, it would be so costly. There’s only so much money to go around and there’s only so much you can charge for dental school. I think the ability of The NEXT DDS to provide information in a peer-reviewed, responsible way to students—where information is not logistically or financially viable for that predoctoral environment—is not a bad thing. I think it’s a great thing, I think it’s something every dean should embrace. That way when their students go to the Prosth Program in San Antonio next year, they’re going to understand why they do things the way they do, they’re going to have a

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better understanding of the materials and techniques that they’re going to be using for the rest of their lives. I think schools are going to say that their curriculum and the level of education they can provide students is enhanced because of this adjunctive content. There are amazing university professors who are very visual in the way they present their information, and they’re very strong and very engaging. There are also professors who are just as amazing in their command and knowledge of their specialty, but they simply don’t have the background to be engaging. It’s not to say that the latter isn’t a great professor. I’m simply saying that dynamic tools such as The NEXT DDS can be highly valuable when used by such individuals in conjunction with a chalkboard and the traditional classroom experience. Whereas the lecture hall environment may not be super engaging to students in generations who follow me, The NEXT DDS is the type of resource that’s going to help address their professional development.

What is your overall impression of The NEXT DDS? As I mentioned previously, I feel that students really need a credible resource that will help bridge their curriculum to the demands of today’s dental practice. The NEXT DDS seems poised to provide engaging content that students might otherwise never be exposed to during their university training. I think it will go a long way towards preparing them for “real-world” dentistry, help broaden their thinking, and help give them confidence to practice good dentistry each day. It gives dental students the chance to take a more active role in their education. Using The NEXT DDS, they can now communicate and discuss their ideas with a huge community of their peers. The fact that it can be accessed through really any form of technology, you know, from desktop to laptop to smartphone, makes it an invaluable resource for the students, because no matter where they are or what they are doing, they can always remain connected and “in the loop”. As we heard at the ASDA conference, the more students that use this portal, the better it will become. I strongly urge students to take their education by the reins by signing up and taking an active role within The NEXT DDS.

associateship

see more about this article WWW.THENEXTDDS.COM/ articles/selecting-the-ideal-associateship-part-1

Selecting the Ideal Associateship Defining OBJECTIVES and Setting Goals by Dr. Gene Heller*

he intent of this discussion is to lead the reader through the associateship opportunity evaluation process. The goal is to present dental students with a list of identifiable questions and issues whose answers

and solutions will result in the highest probability of establishing and completing a mutually beneficial and rewarding associateship.

Fact: Fact: Fact: Fact:

An associateship after dental school is a great way to begin practice. There are more associateship opportunities available today than ever before. The chances of a successful associateship can be greatly enhanced. Many associateship failures can be easily avoided.

Adapted with permission from “Dental Entrepreneur”

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Defining the Successful Associateship Before beginning the evaluation process, it is important to define the intended end point, i.e., what is a “successful associateship.” In the simplest sense, an associateship is successful if it meets the following criteria: 1. The associateship has met the goals and expectations of the associate AND 2. The associateship has met the goals and expectations of the employer. Therefore, the associate’s starting point in setting up a successful associateship requires a determination of what the associate’s intended goals and expectations are. The associate must then locate a practice opportunity whose goals are consistent with his or her own goals.

associateship

An important “non-dental” question is... Will this community meet my personal, social, recreational, career and professional needs?

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Determining Your Goals and Expectations Setting your goals and expectations need not be a major task, but failing to do so prior to evaluating an associateship is an invitation to failure. You will need two sets of goals, one professional and one personal. Each set should be split into short, intermediate, and long-term goals. Typically, such goals cover two-year, five-year, and ten-year periods. For the purposes of this discussion, the personal goal discussion will be limited to where you want to live. You (and your significant other) must be happy. Your short-term location goal can be compromised if it is temporary. But if you are considering an associateship leading to a buy-in/buy-out, this will automatically limit your opportunity choices to where you are willing to live over the long term. The question requiring an answer when setting this goal is, “Will this community meet my personal, social, recreational, career and professional needs as well as those of my spouse and family?” This most important “non-dental” goal is typically the first consideration in evaluating an associateship opportunity.

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Answering a few questions for yourself regarding your reason for seeking an associateship will aid your determination of your shortterm professional goals. There is no right or wrong answer to these questions. However, the answers will help you evaluate opportunities offered and your answers should be clearly conveyed to your prospective employer as an aid in determining compatibility. Is your desired associateship intended to be short term because a change in your currently available desired location is imminent and/or you are uncertain about the long-term desirability of this location? Is your desire for an associateship based purely upon immediate financial needs, i.e., to earn money for school-related debt, personal living expenses, etc.? Do you desire an associateship to gain/ enhance your clinical experience only, but future ownership is not a concern? This is best classified as an on-the-job private general practice residency. This type of position requires potential employers who have no desire or intent to sell an equity position in their practice, but have far more patients than they can handle, so they hire associates every couple of years. Many larger clinics and the new dental practice management companies are always looking for associates, but equity positions are not available. Is one of the purposes of your associateship to gain experience “managing and operating” a dental business? While this type of associateship position is closely related to the “clinical only” type position, it will be very important to discuss this goal with your prospective employer to see how he/she intends to convey management and operations information to you. If the employer is a “control freak,” there is a good chance they will be unwilling to share in this area. The reverse is true in a practice where the employer delegates everything legally possible.

Nationally recognized expert in practice transitions and Vice President of Practice Transitions, Henry Schein Dental.

t r a n s i s t i o n

d4 students

Looking

Ahead

nce they have graduated from dental school, many students wonder what steps they should take next. There are a variety of career options available to a dental school graduate. Obviously, an important precursor for the D4 dental student is satisfaction of licensing requirements before he or she can start private practice. Each US state maintains a licensing board that mandates successful completion of your degree from an accredited institute and the satisfaction of written and practical examinations. In most states, US candidates complete this process via the National Board Dental Examination II. Many dental graduates opt then to pursue a career in the private practice of general dentistry. They take up positions with dentists who already have a flourishing practice on a salary or associateship and, after gaining a few years experience and confidence in managing their

by Sharmistha Bhattacharayya

a variety of career options are available to a dental graduate

see more about this article WWW.THENEXTDDS.COM/

patient’s oral health needs, open up a private practice of their own. A host of factors influence the ideal associateship, so it is important for the pending graduate to identify a practice that addresses his or her future plans on career development. There are other options to pursue too, such as dental research after specialization. Those who conduct research are essentially dental “scientists” whose objective is to bring about an improvement in dental health both national-

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ly and internationally. Some research personnel work in various universities; others pursue research from within government institutions or dental manufacturers. Dental graduates can also take up a job with the federal government or the military. The Federal government offers many opportunities to dental graduates at renowned hospital settings. After gaining valuable experience in such an environment, the graduate can then pursue his or her own ends. The military too hires dental professionals to look after the dental health needs of military personnel and their families. Every year, approximately 20 percent of dental graduates opt for specialization through advanced general dentistry, dental specialty, master’s, or PhD programs. They can also enter the academic environment and assuming a teaching position in dental school. They may be associated with teaching in didactic, clinical, and laboratory areas; patient care in dental clinics or in faculty practice; designing and conducting research; writing for journals; exploring new technologies, etc. Many dental schools allow their faculty to conduct private practice along with their obligations to the university—making this an interesting combination of career options. Whether you opt to pursue specialization in oral surgery, endodontics, or any of the related specialties, to strive for excellence in the research lab, or to join an existing practice, there a numerous paths to your future as a successful dental professional. Providing care and serving your fellow man as a dental professional can take on many forms. At this critical period, it is important to seek guidance from your instructors, your family, and others who have tread on the path before you, and then to make an educated decision on this path. All here at The NEXT DDS wish you a bright future!

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d1-D4 students

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Business

Malpractice Insurance 101

by Richard M. Groves

s dental students embark on training for their professional careers, they face numerous decisions that affect their daily lives. Which university should they attend? Which patient is ideally suited for licensure exams? What specialty or type of practice setting follows their graduation? One of the most important decisions faced by the student, however, is selecting the appropriate dental malpractice insurance at the start of his or her dental career. Consequently, dental students have to understand how coverage applies to them not only while in the university environment but also as they transition into the university clinic and thereafter. Typically, the university provides coverage for dental students engaged in any patient interactions conducted as a school-based activity. This coverage generally extends until each D4 student readies for their

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board examinations. At this time, the dental student is required to obtain malpractice insurance to address the related patient care component of the process. While some boards have already established malpractice coverage for their exams, students can opt to identify their own provider just like a dental student who is not afforded this arrangement by the board. After graduation? Well, a dental student obviously needs coverage at this stage— whether entering practice or ‘moonlighting’ during his or her residency. According to the National Practitioners’ Data Bank, each year approximately 8,500 dentists are named as defendants in malpractice cases. Regardless of the outcome of the case, any malpractice claim can be exhausting emotionally, time-consuming, and expensive—all red flags for the young dental professional. Fortunately, a malpractice insurance policy protects the dental student or practitioner in liability claims that result from alleged negligence, professional misconduct, or lack of skill arising from treatment of patients.

Taking the Decision Seriously

Each dental professional should select his or her own malpractice insurance rather than to defer this important decision to others. After all, this decision can protect one’s career, practice, and reputation in the event of an unexpected event that causes a suit. Following are several factors each dental student should carefully consider when researching malpractice insurance for him or herself: 1. Do not assume that your employer, if you ultimately join a group practice, will identify the appropriate company for you. It is your responsibility to select a malpractice insurance policy that will best fit you and your personal circumstances. 2. Not every malpractice insurance company will be there for the long term. Several malpractice insurers have left the industry in the past decade, leaving their dentists in search of new insurance and possibly at financial risk for inadequate coverage and claims defense. 3. Malpractice insurance companies provide different types of coverage. Some require your full consent before a malpractice claim can be paid, while other companies can settle without your consent.

4. Not all malpractice insurance companies will be equally effective in defending your lawsuit. Some providers have years of experience; others have just started insuring dentists. Some utilize an in-house experienced team of malpractice experts while others have less experience or outsource the process entirely. It is important too to know if the provider specializes in malpractice or offers many types of insurance.

Malpractice insurance—When?

There are several points in one’s career development when malpractice insurance becomes a key consideration:

• During dental school: As mentioned previously, dental students are typically covered under the university’s policy while working in the school’s clinic or under faculty supervision. • During an externship: During dental school, externships may or may not be covered by the university so each student should investigate the university’s policy and secure coverage as necessary. • During board exams: Universities do not typically cover dental students during patient interactions for board exams. Depending on one’s testing agency, malpractice coverage may or may not be included in an applicant testing fee. • During residency: As a resident who is moonlighting (ie, practicing outside of one’s residency), a practitioner will need an individual malpractice insurance policy. • In private practice: Private practitioners need an individual malpractice insurance policy. Dentists who own all or part of the practice may benefit from a policy that will cover the business entity too. • In the military: Those serving in the military are typically covered for activity conducted as part of this obligation. Other activities (eg, moonlighting) performed while one is in the military do require the practitioner to obtain individual coverage. • In public health: This can vary on a case by case basis, and those in the public health field should seek guidance from the public health organization for which they are working. Some dentists in public health have malpractice insurance coverage through the Federal Government, while others should seek their own individual malpractice insurance policy. Most dental students enter the profession with an eye on patient care rather than malpractice insurance coverage. Selecting the appropriate provider, however, is a decision that can have long-ranging impact to one’s career, and resources supporting this important consideration are under development today for THE NEXT DDS. Be sure to visit the portal and browse our growing library! Richard M. Groves is Vice President of Editorial Services at NEXT Media Group Inc.

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periodontal Inflammation

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Management of Periodontal Inflammations by Simone Verardi, DDS, MSD* and Sandra Bordin, PhDâ&#x20AC;

Key words: peridontitis, biofilm, disease, antibiotics, scaling, SRP, ultrasonic

n recent years, significant progress has been achieved in dental professionalsâ&#x20AC;&#x2122; understanding of periodontal disease. By intervening with the appro-

priate therapy at the appropriate disease stage, practitioners have a means of restoring affected patients to a state of oral health and wellness. This article provides context for the development of gingivitis and periodontitis and highlights nonsurgical, surgical, and pharmacological approaches to the management of disease.

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periodontal Inflammation

KaVo Group

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COUNTLESS SOLUTIONS Figure 1 Illustration demonstrating the effectiveness of a periodontal endoscope in visualizing residual subgingival calculus.

Figure 2 Flap debridement yields superior access in the treatment of severe periodontal pockets.

Historical medical records and studies in paleopathology reveal that gingivitis and periodontitis have long been an affliction in the history of mankind. These diseases remain among the most frequent ailments encountered, and they are often aggravated by host susceptibility, tobacco use, calculus, defective restorations, stress, and malnutrition. Associations between periodontal inflammations and systemic disorders underscore the importance of restoring periodontal health. The presence of bacteria is essential the initial development of gingivitis and periodontitis. Tissue destruction and tooth-attachment loss, however, result from factors produced by the host during the inflammatory response to biofilms and their products. Relevant host factors include matrix-metalloproteinases (MMPs)— which break down peri-cellular and basementmembrane components of soft connective tissues—and prostaglandins, particularly prostaglandin E2, which facilitate bone destruction by activating bone-resorbing osteoclasts. The primary objective of current therapeutic and preventive strategies is to eliminate plaque, calculus, and endotoxins from root surfaces using both nonsurgical and surgical approaches.

Nonsurgical Approach The use of a nonsurgical protocol (eg, oral hygiene instruction, removal of local factors)

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usually eliminates the symptoms of gingivitis. If the resulting improvements are inadequate, scaling and root planing (SRP) or ‘periodontal debridement’ (ie, phase-1 therapy) can be introduced to assist in the elimination of plaque and calculus, reducing bacterial populations below the threshold-levels critical for inflammation. Hand and ultrasonic instruments are equally effective in calculus removal. Combining these two methods provides shorter treatment time (ie, via ultrasonic instrumentation) and superior tactile sensation (ie, via hand instruments). Use of a low-power, CO2 laser after hand instrumentation can significantly improve root-surface debridment,1 while diamond-coated scalers and ultrasonic inserts have shown promising results in calculus removal.2 The effectiveness of SRP decreases as pocket depth increases; nevertheless, the procedure significantly ameliorates deeper pockets, especially when residual subgingival calculus can be visualized with a fiberoptic periodontal endoscope (Figure 1).3

Surgical Approach Surgical therapy treats the deep periodontal pockets that remain inflamed after SRP. Advantages of flap debridement (Figure 2) include superior access in the removal of etiologic factors, and possibilities for remodeling bone contours and/or regenerating intrabony defects. Longitudinal evaluations indicate that surgery

periodontal Inflammation

Figure 3 Illustration demonstrating the distribution of local antimicrobials via syringe-based delivery.

Figure 4 Antimicrobials may also be delivered through the application of synthetic fibers to the periodontal pocket.

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is more effective than SRP alone in reducing the probing depths of deeper pockets and furcations.

including gastro-intestinal injury and cardiovascular disorders.6

Pharmacological Approach

Conclusion

Pharmacological therapy for periodontal inflammations advocates the use of oral medications as an adjunct to SRP and/or surgery. Local antibiotics (eg, tetracycline, doxycycline, monocycline, metronidazole, chlorhexidine) are placed directly in periodontal pockets, either via syringe or synthetic fibers (Figures 3 and 4). The natural flushing of crevicular fluid and difficulty in reaching the deepest parts of pockets endanger the efficacy of this method. Prior to initiating this treatment, a periodontist’s evaluation is recommended to determine its efficacy in a given case.4 Systemic antibiotics (eg, amoxicillin, azithromycin, ciprofloxacin, clindamycin, gentamycin, metronidazole) are introduced to a site remote from the diseased tissue and treat the patient by targeting the bacteria indirectly. These antibiotics are commonly used in the treatment of aggressive periodontitis. Determining the appropriate drug for a given patient should be assessed only after bacterial tests and clinical evaluation have taken place. Clinical improvements are reported when drugs are administered orally. The possibility of creating bacterial resistance, the risk of gastric, hematological, neurological, and allergic side effects, and the lack of consensus on long-term planning, however, limit their routine use.5 Treatment with a submicrobial dose of doxycycline hyclate (ie, 20-mg tablets) inhibits the endogenous collagenases MMP-8 and MMP-9; thus, in conjunction with SRP, this therapy can improve significantly the clinical outcome. Antibiotics are commonly used in dental practices also as a prophylaxis for endocarditis. Nonsteroidal anti-inflammatory drugs show promise in their ability to slow periodontitis, although further evaluations are needed for their application because of possible side effects

The combined use of patient education, SRP, antibacterial treatment, and surgery has great therapeutic potential. The onset of possible complications with recent protocols, however, emphasizes the need to unravel further the complex microbiological and immunological etiology of periodontal inflammations before novel clinical approaches can be successfully and routinely applied.

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References 1. Crespi R, Barone A, Covani U. Histologic evaluation of three methods of periodontal root surface treatment in humans. J Periodontol 2005;76(3):476-481. 2. Yukna RA, Vastardis S, Mayer ET. Calculus removal with diamond-coated ultrasonic inserts in vitro. J Periodontol 2007;78(1):122-126. 3. Geisinger ML, Mealey BL, Schoolfield J, Mellonig JT. The effectiveness of subgingival scaling and root planing: An evaluation of therapy with and without the use of the periodontal endoscope. J Periodontol 2007;78(1):22-28. 4. Hanes PJ, Purvis JP. Local anti-infective therapy: Pharmacological agents. A systematic review. Ann Periodontol 2003;8(1):79-98. 5. Hafajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol 8(1):115-181. 6. Sims PJ, Sims KM. Drug interactions important for periodontal therapy. Periodont 2000 2007;44(1):15-28. * Department of Periodontics, University of Washington, Seattle, Washington; Department of Prosthodontics, School of Dentistry, Universitá La Sapienza, Rome, Italy. † Department of Periodontics, University of Washington, Seattle, Washington.

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