Update!

Wow! It has been about a month since I last posted. This semester has been really really hectic plus I have been arduously preparing for the National board exams. I'll take them soon so as soon as that is over with I'll start posting again.

Thanks for your patience, and send up a word of prayer for me for the boards!

Enjoy your Spring Break!

2 Ways the “Paper Clip Dentist” Scandal Affects Dentist-Patient Relationships

A Guest Post from Robert Milton

Wow. If people weren’t already afraid of the dentist, they’re going to have a tough time now. Or rather, practicing and future dentists will have a harder time convincing patients they’re trustworthy thanks to the latest dental lawsuit making waves in the media.
On Monday, Dr. Michael Clair of Massachusetts was sentenced to one year in jail because he used paper clips instead of stainless-steel posts for root canals and then fraudulently billed Medicaid the full price. One of the patients involved in this particular case, Joshua Almeida, suffered toothaches and eventually lost his tooth from the botched root canal.
What can we take away from all this?
I think there are a number of lessons to be learned from the “Paper Clip Dentist” scandal, but two things in particular stuck out to me.
Safety Over Cutting Corners
The paper clip post and core method for root canals may be familiar to some dental students. It’s not unheard of for a root canal project in a third year Restoration course to use a paper clip for the temporary core of a provisional crown. Even one of the most frequently cited textbooks on the subject, Fundamentals of Fixed Prosthodontics by Herb Schillingburg, DDS, includes this less than optimal material where you would expect a stainless-steel post to be used. However, it’s important to note that it is considered only for temporary use.
Clair acknowledges he used the common office supply because it was cheaper than the $50 a piece stainless-steel posts. He might have gotten away with it for the temporaries, but he kept them in permanently leaving unaware patients with structurally unsound teeth and vulnerable to infection.
It’s no secret that running a dental practice is expensive. Of course you’ll want to look for a way to cut costs when you’re dealing with massive student loan debt from dental school, keeping equipment up-to-date, and the everyday business expenses of rent, utilities, and payroll. But safety should always trump cutting corners financially. Granted, Clair may be suffering from some sort of mental issue that impairs judgment, but I believe his extreme case serves as a reminder not to cross ethical boundaries when under financial stress.
Easing Dental Fear
An estimated 75% of Americans are fearful of the dentist with up to 10% of those avoiding dental appointments all together. Much of the anxiety associated with dental work is a result of previous bad experiences whether it was a painful procedure or a poor relationship with a dentist. However, news stories such as this most recent lawsuit can horrify patients indirectly.
There’s a good chance that you’ll be faced with even more challenging dental patients than before. After all, root canals are already one of the most feared procedures and now they’ll shutter every time they reach for a paper clip at work. It may be time to boost your chair side manner in regards to this heightened anxiety.
Communication is everything. Keep your ears open and the conversation going with each patient. Some may not want to know what’s happening at all, but many relax when a full explanation of the procedure is given. Perhaps now would be a good time to start showing them the materials you’ll be using so they know you don’t shop at Office Depot for dental supplies.

Providing quality care and squashing fears make for a successful dentist. If you win them over while they’re in your chair, they’ll return frequently and brag about you in between appointments. As a bonus, you’ll get to feel all warm and fuzzy inside.
Does anything else strike a chord with you about the Paper Clip Dentist case?

Robert Milton writes for Austin Dental Center, an Austin dentist that’s dedicated to making patients feel comfortable while providing a wide range of services from mercury-free fillings to dental implants. You can find them at 2304 Hancock Drive #1, Austin, TX 78756 or call (512) 454-0414.

10 FAFSA Tips for Health Students

A guest post from Casey Roberts

As any student can tell you, paying for school can be the most difficult part of all.  But luckily, there are literally millions of students each year who have the same problem.  No matter if you are studying dentistry, radiology, or becoming a brain surgeon, there are financial aid options for you.  To prove it, we have included just ten tips every health student should know.

1. FAFSA – The Free Application for Federal Student Aid should be the first item any student attending any college should take on.  A copy can easily be obtained online, at your high school, or at the college you are considering attending.

2. Correct FAFSA – The rules to financial aid are always changing and so are the FAFSA forms.  Before you fill yours out, make sure that it is for the current year, as last year's form may not apply.

3. Early is better – Because the FAFSA is such a lengthy form, be sure and get started as early as possible as it will ask for all your information, your income, your parent's income, and much more.

4. Do it online – If you have an internet enabled device at home, use www.fafsa.ed.gov to fill out the FAFSA.  It will take all the usual hassles away from filling out paper forms and even has tips as you fill it out.

5. Dependent or not – If you are still living with your parents, chances are you might be a dependent.  However, those who don't or who do live with their parents and pay for their own school might be classified as independents.  Know which you are and which you should be to ensure the best results.

6. It's all free – If you have questions about filling out the FAFSA or any financial aid form, don't pay someone to help you.  The counselors at your high school or future college are paid to know the answers and can help you at no charge.

7. Deadlines – As with most things, there are deadlines for the FAFSA.  There is an early, on-time, and late deadline.  Getting your FAFSA in by the early one has many advantages including the option to reapply if your first application is wrong and the option of seeing how much financial aid you qualify for, which can help you decide between colleges.

8. No blanks – Even though an item on the FAFSA may not apply to you, it is important not to leave any line blank.  If you are positive the item does not apply to you, put in a “0.”  If unsure, ask a counselor.

9. No lying – It may be tempting to lie about something like income to get better financial aid results, but FAFSA will use you and your parent's income tax information to confirm your answers, so be sure and do it right.

10. Repeat – Most students plan to attend school for at least two years, and the FAFSA and financial aid process should be repeated for every year of school.  This is doubly true for students whose financial circumstances change, as the amount of financial aid can change too.

Bonus! Beyond FAFSA – FAFSA is the standard for financial aid, but many schools have their own forms as well.  These are also to be filled out for every school you plan on applying to.  The best part is if you fill out and turn everything early enough, you will know how much the school will cost out of pocket.

Casey Roberts is a student and also writes for http://radiologyassistant.org Radiology Assistant which helps students find the right radiology degree.

Access Opening on Molar Teeth

You may have seen my post a couple days ago when I started access opening on anterior and premolar teeth. (if not, see here). I have continued this process with accessing molar teeth.

Real Human Teeth embedded in a plaster block

The tooth at the very right is actually a pre-molar

Molars accessed

If you look really closely, you may be able to see a couple canals

Filing and measuring

See access opening on anteriors and premolars here.

Here's a handy guideline on access cavity preps.

Fabrication of Removable Partial Dentures

You may recall my post some time ago about Removable Partial Denture Design. If not you can find it here. Now that the design is complete, it's time to fabricate the denture.

Here's the RPD Design

This, according to the Kennedy classification is a Class II modification II arch.

After an alginate impression is made of the arch from the dentoform, it is then poured up in plaster.
 Though not very visible, the design/outline of the RPD is made on the cast
Wax is placed to block out undercuts

A record base is then made of triad material following the outline that was made on the cast
It is then cured, which makes it hard

Wax is then added to the edentulous spaces until contact is made with the lower arch

Alu-wax is added to articulate the upper arch with the lower arch

upper cast with record base in place along with with alu-wax
to articulate the lower with the upper arch

Lower arch. You can see remnants of the alu-wax where articulation was made

Upper and Lower arches articulated

Front view

Lateral view

The saga continues next week. Stay tuned.

Endodontics: Access Opening

We start endodontics this semester. So far we've been learning how to open a tooth and access the root canal. We were also introduced to some of the basic instruments of the trade as well as the type of burs used to access the canal.

Our instrument cassette

All things sharp and pointy

Endo Access Kit

Burs used for accessing root canals

Here are some of the teeth that I've accessed so far. Some are missing since I turned them in for grading.

Open access on a canine

Open acess on pre-molar

Steps to follow for accessing the canal:

•  High speed hand piece with EAD4 bur to enter through enamel and dentin;
•  followed by the use of a slow speed hand piece with the EARC4 bur to access the root canal and plane the canal walls.
•  At this point a broach can be used to remove pulpal tissue. 
• Using high speed han piece again the EARC4 or even the XGATE can be used to shape the access opening with guidelines for the particular tooth you are working on, eg: triangular outline for a maxillary central incisor or Oval outline for a canine.

Sorry for the crappy photos.

Roller Coaster Ride

This week I started my second semester of my second year! Man, time is flying (though not fast enough). Of course, the further I matriculate into Dental School the more hectic my schedule gets. This semester I have a whopping 13, THIR-TEEN classes plus clinic rotations to keep me well occupied and on my toes. Classes this semester include:

• Oral Pathology
• Anesthesia & Minor Oral Surgery
• Pediatric Dentistry
• Removable Prosthodontics II
• Fixed Prosthodontics II
• Fixed Prosthodontics II Lab
• Periodontics
• Therapeutics
• Endodontics & Pulp Biology
• Endodontics Lab
• Oral & Maxillofacial Radiology
• Treatment Planning
• Dental Practice Readiness Course
• Clinic Rotations

Add studying and sitting the NBDE 1 to the mix as well as my campus organization leadership responsibilities, conferences, seminars and research and we've got ourselves one ca-raazy semester.

Join me on this journey. Buckle up!