Back to school: year 3 of 4

Surprising news: traffic to this blog has kept coming in, despite the decline in posts during the past year.

A casual glance at Blogger's nifty Stats tab shows that I just had visitors via a Google search for "tooth ID quiz." Despite that I have 58 unmoderated spam comments, I believe that some of this traffic is from real humans and not Botnets. I hope that my links are not broken and my suggestions are helpful.

I also noticed that, since enabling Google AdSense to display sidebar ads here, I've generated enough to buy a Chipotle burrito:

15 clicks spread over two years and 17,500 advertisements displayed. I guess I've gotten my slice of the that precious internet money. But at what cost? I was personally responsible for 17,500 advertisements to be displayed, and I dislike the presence of advertisements in general.

The hassle of sending my tax information to Google so they actually give me that $8 is an adventure for another day.

Early Childhood Caries

Tooth decay is the single most common chronic disease among children in the United States. In Washington state, almost 60% of elementary school students have experienced tooth decay. Yet tooth decay is 100% preventable. Your child should visit a pediatric dentist when the first tooth comes in, usually between 6 and 12 months of age.

Resources:

http://www.aapd.org/publications/brochures/babycare.asp

Temporary Removable Partial Dentures

School has been busy, and I've struggled with how to describe what life is like for a second year dental student at UW. Because every day is different, it's easier to just give a snapshot of what I'm up to at the moment.

My day started with a lecture by Dr. Marashi.

The topic of the lecture: Fabrication of Temporary Removable Partial Dentures.

Here's a straightforward, lay-terms description of what we're making, from a dental lab website:

Affectionately known in dentistry as a "flipper", this is the least expensive of all the removable partial dentures. The one pictured on the right replaces 4 missing teeth, leaving spaces for 7 natural teeth. Two of the natural teeth are clasped with wrought wire clasps which are cured into the structure of the denture base.
The pink plastic of the denture base is brittle acrylic, the same material used to make standard full dentures. The largest single advantage to this type of RPD (aside from the cost) is that new teeth and new denture base can easily be added to an existing treatment RPD. These are frequently fabricated even if the remaining teeth have existing decay or periodontal disease and their prognosis is doubtful. If later in the course of treatment some of the existing natural teeth are extracted for any reason, new false teeth can be added quickly to the partial, maintaining the patient's appearance. In spite of the fact that they are considered a temporary solution, many people keep this type of appliance for many, many years, because as long as they are properly maintained, they look outwardly as good as the more expensive permanent appliances.


My notes which include paraphasing:

○ Temporary RPD
○ Usually when anterior teeth are to be extracted
○ Occasionally valuable for posterior teeth but not indicated
○ Indicated in anterior for esthetics. Not a functional appliance
○ Take alginate impressions and pour right away act as final impression
○ Choose teeth
○ Remove teeth from master cast
○ Add clasp
○ Set teeth
○ Wax up and process
○ Pt has extraction, appliance goes in immediately after surgery due to swelling
○ During first week it stays in all the time. Make sure to educate patient that this is a removable appliance that needs to be removed and cleaned each night after first week
○ Overuse of TRPD can result in tissue damage, RPD sinks gingivally - because the TRPD design doesn’t include the rests
○ Retention - rest seats, clasps are desirable but not always necessary
○ Definitive RPD - one clasp per side is adequate
○ Same over here
○ Ball clasps engage buccal gingival embrasure on posterior teeth. Ball on then end of a wire wrapping over teeth. This requires occlusal space available
○ Acts as a rest seat and a retentive feature.
○ Wrought wire clasp possible
○ Put very light occlusion on posterior teeth
○ IF the treatment plan is a definitive RPD, it makes sense to prepare rests. Otherwise, do not place rests to avoid touching the abutment teeth.
○ I bar clasps work very well for TRPDs
○ Transitional partials - transition from temporary to permanent appliance. Elderly pt who can't afford a definitive partial and will not benefit from extraction and implant placement

Lab project Patient #1
Treatment plan
Ext 23 24 25 26 31
TRPD/ITRPD
Surveyed crown 18 27 28
RPD/RPD

You'll be given models with upper RPD premade
1. Expose mesial surface of canines by cutting off distal half lateral incisors
2. Mark teeth to be extracted
3. Survey cast including canine
4. Draw design use design given by Dr.
5. Hand articulate evaluate space for clasps
6. Put ball clasp in for practice's sake and wrought wire on other side
7. Rest seat on molar (3 wires bent total)
8. Carve groove to indicate extension line for post processing trimming.
9. No need to make wax-up removable from the stone model since this appliance will not be 'tried in' at any point
10. Every undercut on proximal and lingual of remaining teeth is filled with acrylic up to 1mm away from the survey line. Use wax carver on surveyor to ensure block outs are parallel. Facial undercuts are desired however.
11. AFTER block out waxing, duplicate the cast so these block outs are now in stone.
12. Soak stone in warm soapy water before alginate impression, remove quickly.
13. Pour up duplicate in yellow. Mount duplicate cast, not the master cast.
14. Bend ball clasp wires. Bend wrought wire clasp. Make sure wires not touching the tooth on the distal guide plane
15. Bend wire for rest seat.
16. Remove teeth from cast
17. Set newhue teeth, secure with a little wax. Remove and set replacement one tooth at a time, every other one to have a frame of reference for alignment
18. Secure bend wires with sticky wax on facial of teeth. Put a little papertowel between wire loop and stone. Secure wire loop with Perm Resin.
19. To rephrase: paper towel on palatal. Secure facial with sticky wax. Remove paper, secure palatal with perm resin
20. Set posterior teeth in slight hyperocclusion - 1/4 mm
21. Adjust tooth so pin comes all the way down. This ensures good centric occlusion
22. 2 - 3mm wax


The rest of the day, from about 10:30 to 4:30, was spent going through these steps one by one. The work is challenging, and the project won't be done until the end of the day next Tuesday. It is the first time I have used many of these tools and materials; the work tests a group of lab skills some of which are used every day and others once every 6 months. Its impossible to remember all the technical details if you don't have them written down. We are given the information in textbook form, lectures, and in class by the faculty who often demonstrate hands-on skills at the student's work bench.

Winter quarter 2010 update

In the hopes of not letting my blog become a "digital graveyard" I'm going to try and start posting again. So far I've only posted once or twice since second year of dental school has started. Yes it has been busy but the lack of posts simply reflects my desire to spend time outside of school not writing about school.

School is going well. I am embracing that this is my time to really buckle down and make some sacrifices. I'm learning a lot and staying positive but it's clear that second year of dental school is an endurance game. Here is what today was like, it illustrates the time spent on my education on an average day as well as the very specific things we do that are different every day.

7:30: lecture on reading Panoramic radiographs. After the lecture, an interesting exercise where we were shown x rays of teeth which may or may not have interproximal caries - aka tooth decay in the areas between the teeth, which can sometimes be seen on the x ray. We were asked to rate 74 tooth surfaces based on the extent of caries they appeared to have, the results will be returned to us soon and it will be interesting to see how our x-ray reading skills are at this point where we have very little experience or training in that area.

8:30 2 hour lecture on an important aspect of fixed prosthodontics, making multiple unit temporary restorations.

10:30-5:00 was spent in the simulation lab where we worked on a huge number of projects. General chaos including taking impressions and making models (of simulation mouths), preparing simulation teeth with rotary instruments, fabricating a post and core pattern for a crown buildup and investing the pattern so it can be cast in a gold alloy.

10- midnight: Doing oral pathology homework which consists of looking at clinical pathology images and describing what disease they could possibly represent and why. Also studying for tomorrow's quiz on last week's periodontology lecture which covered ergonomics.

Image, because every blog post deserves at least one image:

A Provisional Fixed Partial Denture, aka the "temporary multiple unit restoration" I wrote about above. This slide illustrates the error of not using enough material to connect the multiple teeth of the restoration.

2nd Year: Week 2 Round-up

In this post Dental 2.0 will summarize the key events of the last 5 days of class, which made up week 2 of year 2 of dental school.

Oral radiology: Covered radiation physics and safety. Practiced identifying anatomical landmarks on xrays.

Oral Pathology: Identifying, describing, and Differential Diagnosis, using photos and histology of lesions.

Complete Dentures course: Fabricating custom impression trays, mounting master casts, making occlusal rims

Operative Dentistry: Placing rubber dams, preparing and placing class 1 amalgams on natural teeth (I took this picture in class with my phone)

Fixed Prosthodontics: Preparing complete gold crown veneers (CGCV) on teeth # 19 and 28, waxing the model for the gold crown

Lecture on the history and etiology of orthodontic treatment

Pharmacology: General principles of pharmacology

Drilling and Chilling

A big part of year 2 of dental school is drilling cavities. They are starting us out on a Class 1 amalgam cavity preparation.

The cavity prep must be drilled in a very specific way to avoid stresses that will lead to fracture of the enamel or amalgam. In addition, the walls of the cavity prep must converge slightly towards each other to prevent the hardened amaglam from slipping out of the prep. This slight convergence can be seen in the cross section (above right).

Out assignment for today, the first day of class, was to do this prep on one plastic tooth and one natural tooth mounted in a dentoform. Many of us have been practicing in the past weeks to prepare for the start of school. Here's one of my first preps ever, from last week:

Most students have opted to purchase magnifying loupes by this point due to the level of detail required in the preps.

I'm planning to go with 3.5X expanded field loupes from Designs For Vision.

Geriatric Dentistry Intro paper

Although tomorrow is considered orientation and the first day of instruction is scheduled for September 30th, some teachers have assigned homework. I believe this written content for my Geriatric Dentistry course is highly blog-worthy and have decided to share it with the blogoverse. Enjoy.

"As a way of introducing yourself to me, and helping me understand your experience with older adults, especially older patients, please prepare the following brief paper (TWO paragraphs, 10 points):

Paragraph 1: Describe briefly your experience with older adults age 65+, including relatives, neighbors, supervisors and colleagues in jobs. What are some challenges and benefits in knowing, working with, and communicating with the older persons you have known? Are these different or similar to your experiences with younger patients?
Paragraph 2: As you know, your first clinical patient will be a complete denture patient, most likely an older adult age 65+. Describe briefly any concerns you have as you anticipate this clinical introduction. To what extent are you concerned about the patient’s age, personality, reliability, etc. vs. your ability to perform clinical dentistry? "

My experience with elderly persons is probably average for someone of my age. I am currently 24 years old with both of my parents in their 50's. My maternal and paternal grandfathers are deceased and my grandmothers are living, one in her own house and the other in assisted care. I did not have much contact with my grandparents growing up due to them residing on the east coast of the US. Some of the other elderly people I have known in my life include neighbors. I would spend time with my neighbor, an American man of Italian descent who practiced carpentry and wood carving in his garage. In some ways he played a role similar to what my grandfather, also an Italian American, would have if he lived closer to me. I generally get along well with the elderly. I attribute this to my parents who taught me to treat all people with respect and common courtesy. I feel that traditional rules of courtesy are especially important when communicating with the elderly. The ways people communicate today are very different from what they were in previous generations. I value my experiences with the elderly because I believe their perspective of the world is unique from mine. An important experience for me was when my piano teacher held a recital in a nursing home. Piano recitals were usually attended by parents and siblings of the students but in this case the music was shared with many elderly people. I realized that many of the residents of the nursing home did not have much contact with younger people, especially children. It was rewarding to share the music I was playing with this audience; I could tell that the event was important to many of them.

My approach to communicating with an elderly denture patient will be slightly different that how I would speak to an adult or middle-aged person. I will be focusing on speaking clearly. After speaking I will try to gauge their level of understanding before moving on. I will give them time to process what I say and ask if they have questions. I have observed elderly patients react badly when the information given is presented in a way that is unclear to them. I feel that some elderly patients are distrustful of clinicians, due to past experiences where they might not have been treated with the respect and understanding they deserve. I will work to earn my patient’s trust through friendly yet professional conversation. At this point in my training I believe that I can learn something from each patient I treat and I hope to gain experience by working with my complete denture patient. At its heart I believe that clinician-patient interaction can be fun, and a positive experience for both parties. I hope to keep this attitude despite the challenges I will face in performing clinical dentistry.

[VIDEO] Grizzly Bear: “While You Wait for the Others” (Directed by Sean Pecknold)

Autumn 2009 Course Schedule

Just received the schedule for Autumn quarter of my second year of dental school. Each quarter at UW is 10 weeks of instruction plus a week for final exams. Autumn quarter has 10 different classes totaling 23 credits, and begins on September 30th 2009.

Fun facts about Taste Perception

• Taste receptor cells tuned to a particular tastant ARE NOT located solely in specific regions of the tongue.
  
• Evolution of the sense of taste was to detect nutritionally important compounds
• Saliva is necessary for the maintenance of taste bud function. This appears to be due to epidermal growth factors present in saliva.
  
• Innervation of taste buds is by the Glossopharyngeal (IX) nerve (posterior tongue), with cell bodies in petrosal ganglion; and the Chorda tympani branch of the facial nerve (VII) (anterior tongue), cell bodies in geniculate ganglion
  
• Injury of the jaw from mandibular fracture, intubation, or dental treatment can result in taste loss over the anterior 2/3 of the tongue on the ipsilateral side of the tongue.
  

Source: Oral Biology 510 Guest Lecturer Dr. Susan Coldwell, University of Washington