Class I Cavity Preparation

No doubt dentists have to be proficient in cavity preparation, it is part of our basic training. But just how to we master the cavity prep? I have laid out the steps for the Class I cavity prep on the blog over at TheNEXTDDS, follow the link or click the image below to learn more.

Any questions, comments? Feel free to drop me a line here or on the blog at TheNEXTDDS

Momentum Motivation for The New Year, and Beyond

The beginning of a new year is a great time for goal setting, re-assessing and re-evaluating. It's a time for resolutions, a time to figure out the things you've done in the past that may not have worked or may need a little help/boost. You have a clean slate now and everything you do from here on out has to count!

If this is your first year of dental school, ask yourself the question: did I meet my GPA goals last semester? Do I have a firm foundation and a good understanding of the fundamental core coursework in which to move forward and build on? If your answers aren't a resounding Yes! then this is the semester to really hit the books hard and try to make a "come back," so to speak.
If you're in the clinic, are you on track with your requirements or fulfilled your yearly/quarterly requirement goals? and If this is your final semester of dental school (at long last!) are you on track for graduation? Have u taken/passed your boards and are you on track with the myriad requirements to graduate?

At whatever stage you are in dental school, this time of the year is crucial and is always met with high energy and a get sh*t done attitude. The goal is not solely about making a long to-do list of things you need to do but to keep momentum. How many times do we start the new year off with dieting and work out goals to only have them fall by the wayside by mid-january??

I've had my share of new year resolutions while going through dental school and I have curated a short list of the key principles to follow to make your year successful:

1. Stay Motivated - Remember why you chose to become a dentist. Dental School is not easy and there will be times when you feel like giving up. Don't! Dig deep and keep your eyes on the finish line. Perhaps you can schedule to shadow a local dentist just to remind you of the reason you chose this great profession. Stay focused on you juicy vision and that will increase your motivation and energy to take the necessary actions to see your vision through.

2. Stick-to-it-iveness - That to-do list that you have, get to it and keep going until all your tasks are complete. Develop the habit of following through. As you strike things off that to-do list you are building momentum which will be the motivational force that will sustain you to the end.

3. Time Management - If you struggle with any of the above, managing your time will be a problem as well. All these three points go hand-in-hand and one really does not go without the other. Here are some tips to help you with these:

• Keep you energy levels high!
• Make your goals exciting. Follow the SMART rule and make your goals Specific, Measurable, Attainable, Relevant and Time-bound.
• Stay Positive. Check yourself from time to time. What kind of self talk are you having? If you think you will fail, you probably will. If you think you can do it, you will be unstoppable. 
• Avoid procrastination and think of creative ways to reward yourself. Perhaps a mani/pedi if you get all your week's goals complete? 
• Don't put off for tomorrow what can be done today! Self explanatory. In other words, JUST DO IT!
• Get support. Don't be afraid to ask for help - closed mouths do not get fed.
• Balance your life. Dental School can be stressful, find ways to decompress. Do not ditch your hobbies; you still have a life outside of school!

I hope you will take these pointers to heart and really get motivated to smashing your goals this year. As usual, I'm here for you. Drop me a line in the inbox with questions and Comments!

A Guide to Success on NBDE Part 1

I have written a guide on how to pass the NBDE Part 1. This is an important time for you and I do hope that this guide is beneficial. Ihave attached a snippet below, please follow to think for the entire article on The NEXT DDS

Removable Prosthodontics: Complete Dentures

Earlier, I made several posts about complete dentures and setting teeth. Since then, I've done a couple more and of course, with practice everything gets better.

1st Set-Up:

This was my very first set-up. Of course at the time I thought this was great
but looking back...yikes! You can clearly see that the left side is slightly higher
than the right, and the wax job is nothing to call home about.

Upper Arch

Looks a bit like it's leaning to the left an the 2nd molars are sticking out
too far bucally.

 Lower Arch:

Lots of faults: Right canine is making the distal turn, lingual gingiva on
the right too thin, left 1st premolar sticking too far bucally, etc etc

2nd Set -Up

Looks much better than the first, neater, more polished...
However, left posteriors sticking too far bucally.

 Upper Arch

Some areas needed wax re-enforcement.  2nd molars might have
been placed too far bucally.

 Lower Arch

Looks okay to me

 3rd Set-Up

Good, better, best right? In terms of occlusion, presentation, etc this one
turned out best.

 Complete dentures!

before festooning

 You can see here a little festooning and gingival anatomy

The Saga continues next semester. Stay tuned!

Finals!

It is that time of the semester again.

This post is kind of delayed since Finals started on Monday. Nonetheless, it is still relevant. 

Good luck to all taking Finals!!

Removable Partial Denture Design

Removable Partial Denture - this is sometimes used for patients that are missing some, not all of their teeth (partial), where a fixed prostheses is contraindicated, where cost doesn't allow or just a preference of the patient.

There are different ways to classify an edentulous mouth. The basics are:

Class I (bilateral free ended partially edentulous)
Class II (unilateral free ended partially edentulous)
Class III (unilateral bounded partially edentulous)
Class IV (bilateral bounded anterior partially edentulous), etc 

My design:

Classification: Class II, modification II

I will be making the actual prostheses some time in the future. Stay tuned.

Fixed Prosthodonics: Crown Preps

Now that Operative Dentistry is over, It's time to start Fixed Prosthodontics. We started with crown preps and here is my first:

Proximal & Height of Contour Reduction

Buccal & Lingual Reduction - 0.8-1.5mm

- In the first plane I made the axial walls parallel

 then tapered in the second plane - approx. 3-6 degrees

-Ensured maxillary lingual cusps were tapered towards 

the central fossae of the opposing mandibular tooth

- Kept original form, outline and orientation of the tooth

Occlusal reduction- 1.5 - 2mm

- Reduced occlusal surface following the outline 

of the cusps and keeping the central groove

In Occlusion

In Occlusion: closer view

Occlusal View

Definitely not perfect but it is my first and will have to practice practice practice!

Setting Maxillary and Mandibular Posterior Teeth

Here goes the setting of the posterior teeth:

Maxillary Left Posteriors Set

Lateral View of Maxillary Left Posteriors

Ignore those gaping holes, I made them for adjusting the 2nd premolar and 1st molar.

Lateral View of Maxillary Right Posteriors

Mandibular Left Posteriors Set

Not complete because of constant adjustment

Mandibular Right Posteriors Set

Again, not complete because of constant adjustment

Complete Maxillary Teeth Set

Complete Mandibular Teeth Set

All done!!

except I have to reinforce and fix the wax around the teeth

Adjusting...

More Adjusting...

Stay tuned for the FINAL set up after all adjustments and reinforcements are made.

Oral Myiasis

Warning: Graphic Content

Oral myiasis is a rare disease in humans associated with poor oral hygiene, suppurative oral lesions, alcoholism and senility, etc. It's caused by fly larvae! Though sterilized fly larvae is sometimes used to treat stubborn non-healing ulcers (by eating the necrotizing tissue while leaving viable tissue behind), this is not the case here:

A psychiatric (schizophrenic) patient presented to The University of The West Indies Dental School with this problem:

Yes! those are maggots in his palate

Other cases:

Treatment includes surgical exposure of the affected area, physical removal of the maggots and cleansing with either topical or systemic medications and, wound debridement. 

Suture him up, give him some antibiotics and he's as good as new! or close.

See related article here

I had to share this. Unbelievable!

Setting Mandibular Anterior Teeth

Now that midterm exams are over I can resume the posting of my complete denture fabrication.

This is where we left off:

Maxillary Anterior teeth set

First Mandibular Central Incisor Set

All Mandibular Incisors Set

Lateral View

Maxillary and Mandibular Anterior Teeth Set

Front View: Might need to adjust the mandibular canines just a bit

Stay tuned for setting of maxillary Posterior teeth!

Setting Maxillary Anterior Teeth

I don't like to stay in school longer that I need to. I'm there from 8am to 5pm everyday, after which I've had enough! This is how the "Home Lab" was invented: 

Of course, I need all the tools of the trade:

I need the teeth for setting

Here we go! After midline has been established, start setting teeth on one side first

All maxillary anterior teeth Set:

PS: This is wrong on so many levels. I should have been setting teeth

in the articulator, NOT while it's in the dentoform.

This was before I knew better ;)

Something tells me I need to correct the position of the left canine 

lateral: Left View

Lateral: Right View

Finished Maxillary Anteriors (or so I thought...)

Front View

Turns out the above teeth were a bit lingually placed. After making the adjustments,

Finished Maxillary Anteriors:

Front View

Stay tuned for the setting of the Mandibular Anterior teeth!

Dentist License Revoked for Administering Botox

Helaine Smith, a well known Massachusetts cosmetic dentist, lecturer and author who has been practicing for ~ 20yrs, was disciplined and got her license revoked for unauthorized use and administration of Botox (Botulinum toxin).

Apparently, in an article written in The Boston Globe about the increased demand for Botox treatments, she told the paper she has been using them for quite some time. This piece of information caught the attention of the state's Board of Registration of Dentistry and they later launched an investigation. The investigation revealed the unauthorized administration of Botox to patients as well as other violations including; failure to conduct weekly  tests for sterilization, failure to correctly store dental instruments, administering sedation without a permit, etc.
According to the law, general dentists are not allowed to administer Botox to patients, this can only be done by a certified Oral and Maxillofacial Surgeon who has been trained in the use of Botox and dermal fillers and can only be used for the treatment of disease, disfigurement and dysfuntion.

The punishment is pretty harsh but it reminds us that we should keep abreast of state and federal law and regulatory changes as well good practice management.

See full article here and here.

Yikes!

Removable Prosthodontics: Mounting Casts

Last time I posted about Removable Prosthodontics I left off at Occlusal (wax) Rim:

Next step is to mount the maxillary cast.

After the articulator is put together and the condyles, incisal table etc is set at the right angle, the bite fork is wrapped in wax and seats the cast (with record base and wax rim). Mounting ring is screwed in place then it's time to mix, place and shape plaster, giving: 

Lateral View: Notice the notches in the wax, these are placed to hold the maxillary
and mandibular cast in occlusion while being mounted

Frontal View

For the mandibular portion, simply flip the articulator and repeat

Maxillary and mandibular casts mounted. Notches in the wax
 rim filled with aluwax to hold casts in occlusion. ~ Pretty messy

Cleaning up all the mess and making the plaster nice and neat.

Stay tuned setting of teeth! Don't you just love the suspense?