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GOING UNDER REVIEW: DENTAL ANESTHESIOLOGY
By John Nguyen (2015)
SUMMER SPECIAL
FEATURE STORIES
ASDA Presidential Address Going Under Review: Dental Anesthesiology Organizing all those Drawers and Lockers Remembering Dr. Susan Kinder Haake Overtreatment in Dentistry Teen Oral Health Committee Health Tips for the Summer Budget Bites
In June 2011, the American Society of Dentist Anesthesiologists (the other ASDA) submitted an application to American Dental Association (ADA) for Dental Anesthesiology to be recognized as an official dental specialty. Authored primarily by Dr. Steven Ganzberg, Clinical Professor and Section Chair of Anesthesiology at UCLA School of Dentistry, this application is ASDAs fourth attempt to achieve official recognition by ADA. The last attempt was in 1999. The practice of dental anesthesiology can be traced far back to the beginning of dentistry. Pain and anxiety have always plagued dental treatment. The need for adequate pain control drove Horace Wells to develop nitrous oxide and William T. G. Morton to develop ether for anesthetic uses. These discoveries sparked the frenzy of research and development in anesthesia that advanced both the fields of dentistry and medicine. The significant involvement and effect of anesthesia in dentistry cannot be denied. The need for advanced anesthesia services is still prevalent in the practice of dentistry today. Unlike when Wells and Morgan experimented with anesthetics during procedures, the administration of sedatives and general anesthetics today requires extensive education and research. Both are provided by dental anesthesiologists. Despite the long-standing relationship between dentistry and anesthesiology, as well as the numerous CODA (Commission on Dental Accreditation) accredited dental anesthesiology residency programs and hundreds of practicing dental anesthesiologists, Dental Anesthesiology has yet to be recognized as an official specialty by ADA. For any field to be recognized as a specialty, a sponsoring organization must submit an application to ADAs Council on Dental Education and Licensure (CDEL). This council then
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Table of Contents
ASDA Welcome Address.............................................................................................................................................................................................2 Cover Story: Going Under Reivew: Dental Anesthesiology.......................................................................................................................3 Organizing All Those Drawers and Lockers.........................................................................................................................................................4 Remembering Dr. Susan Kinder Haake.................................................................................................................................................................6 SB 694 aka Mid-Level Provider Bill........................................................................................................................................................................6 Orofacial Pain Study Club........................................................................................................................................................................................6 Overtreatment in Dentistry.......................................................................................................................................................................................7 Teen Oral Health Committee....................................................................................................................................................................................8 Six for Success! Health & Fitness Tips ....................................................................................................................................................................9 Budget Bites: Pulled Pork Recipe...........................................................................................................................................................................10
Continued from Page 1 anesthesiology specialty. On the other hand, another group, led by the American Association of Oral and Maxillofacial Surgeons (AAOMS), argues that the establishment of a dental anesthesiol- Dr. Steven Ganzberg ogy specialty is unnecessary and detrimental. Below are a few points from each side.
Again this year, the application received the councils recommendation and will be considered by ADA 2012 House of Delegates in San Francisco. ASDA is hoping that its continued efforts to edu-
cate the dental community and to dispel certain misconceptions will be enough for it to be officially recognized this year. Look out for the result of the voting this October!
The Diastema
Summer 2012
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Drawing by Jessica Zhu (2015) In the bottom, larger section, I maintained two stacks of shoe boxes on top of one another. I had boxes for operative amalgam, operative composite, fixed, impressions, dentures, and waxing. In the operative amalgam box, I was easily able to fit: -Rubber dam materials -Extra burs -Jar of amalgam capsules In the operative composite box, I placed: -Composite curing light -Flowable composite -Composite gun -Etchant -Primer and adhesive -Mylar strips -#12 scalpel blades In the fixed box, I kept: -Extra burs -Fuji and heavy/ light body guns -Sprues -Yeti lube, thinner, and die spacer -Jet acrylic supplies (including mixing cups and brushes)
In the impressions box, I fit: -Alginate bowl -Some trays -Adhesive -Emulsion spray -Spatulas and lab knives -Alginate packets that came in our kit In the dentures box, I put: -Various rulers -Sets of denture teeth -Bottles of acrylic and pink base plate material -Denture polishing supplies -Denture polishing supplies
Finally, in the waxing box, I had: -Different kinds of waxes -Wax master and tips I was also able to stack my pindex saw, restorative cassette, gold and porcelain polishing kits, and box of different shades of composite on top of these boxes. In addition, on the side, I kept one box of light body, one box of heavy body, one box of blue mousse, and my Hanau torch. So, if for fixed, we were prepping a PFM and making a jet acrylic temporary, I would grab my loupes box and my fixed box from my locker; everything else I needed (hand pieces, burs, and the like) were already in my fourth floor drawer. For dentures, I would grab my dentures box, waxing box, and Hanau torch; all my smaller instruments (like the cleioid discoid) were in my fourth floor drawer as well. Finally, in my A floor locker, I primarily stored equipment that I we had not yet used in class or that I only used once or twice a week. In the top, smaller section, I stored: -Surveyor -Blue and yellow lab containers -Box of extra mounting rings -Past denture projects (for future reference) In the bottom, larger section, I was able to consolidate all the equipment that we had not opened yet in one white box. I kept another white box for endodontics, where I stored: -Rotary instruments -Files -Gutta percha -Sealant material -Apex locator -Radiography armamentarium -Stapler and hairdryer (which, I learned quickly, are useful when you have five minutes left to turn in your project) I also kept my organized box of extracted teeth here. Finally, I kept all the extra heavy and light body lined against the side of the locker, next to the two white boxes. I even have room to store my backpack here, on top of the two white boxes, so it does not clutter my cubicle, especially during blocks. Although I do not encourage keeping any equipment at home (since this could be problematic if you suddenly need something that you realize is under your couch), I do keep my (empty) tackle box and extra gowns at home, but these should be able to fit in your A floor locker as well. Lastly, as I venture into clinic, I realize that my organizational scheme must change. However, for my fellow third years, I recommend keeping your patient mirror, chairside instructor, blood pressure cuff, stethoscope, patient safety glasses, gloves, and loupes all together, since these items are needed for almost every appointment. I also recommend sterilizing all your instruments (including burs, handpieces, hand instruments, and polishing supplies) and keeping them in a readily accessible shoe box, since you never know what you may need during an appointment. But of course, keep in mind that this is only one way of many to organize your equipment!
The Diastema
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On May 1st of this year, UCLA School of Dentistry lost one of its premier researchers and educators, Dr. Susan Kinder Haake, to pancreatic cancer. Dr. Kinder Haake was a professor in the Sections of Periodontics and Oral Biology. She studied periodontal microbes extensively, earning two NIH grants for her research. The first, part of the NIHs Human Microbiome Project, was to characterize the microbiome of the periodontium, including all species and genetic variants. The second aimed to identify unique characteristics of the periodontal flora in patients with type II diabetes, who are twice as likely to have periodontal disease. Her passion for research was second only to her passion for teaching. Teaching is a pleasure because it provides me with the rewarding opportunity to help others who want to learn, she once said. While Dr. Haakes presence will be missed, she lives on through her contributions to research and in the minds of those who benefitted from her mentorship.
in 1993, with UCLA having one of the first postdoctoral programs, the standard of care and treatment of patients with acute and chronic orofacial pain have dramatically improved, especially with the strong rise in funding for research and training of dentists in the field. The mission of UCLA Orofacial Pain Study Club is to advance the art and science of orofacial pain by increasing dental students awareness of the various non-odontogenic pain conditions experienced by patients. Dental students will have the opportunity to enhance their learning experience and competency with information that will be beneficial in patient treatment. The study club aims to increase awareness of the Graduate Orofacial Pain Residency Program and hopes to expose students to its vast opportunities.
Overtreatment in Dentistry
By Jared Kenney (2014)
From behind a door comes the whine of a high-speed drill. When my name is called, I am ushered into an examining room and welcomed with a nutcracker handshake by the dentist, a graying-atthe-temples man. Soon I am staring toward the white cork ceiling while my teeth are probed, poked, tapped, and tugged. The numbers of my teeth are called out to an assistant, who jots the information on a chart: No. 11, crown; No. 13, M-O-D; No. 14, M-O A few minutes later comes the verdict: I need 11 crowns, plus other work. It will cost $8347. Do this and you will have no worries about your teeth for the next 30 years, the dentist purrs. Somehow I doubt that. Then he adds, You and I are going to become great friends. So begins a startling Readers Digest article by William Ecenbarger in which he reports his experiment visiting fifty random dental offices across the country with his introduction to each that he just moved into the area, and his dental expenses were covered through a direct reimbursement program with [his] employer. Before embarking on this study, he was examined by a panel of dentists, with no financial interest in his teeth, who concluded that he only needed one, arguably two crowns. As he traveled the country visiting dentists, proposed treatment plans ranged from a single crown to 21 crowns and six veneers for a cost of $29,850. His experiment ended at a dental school where, after a painstakingly long exam, the dental student concluded that he needed two crownson the same teeth that the original panelists agreed on. What happens after dental school that causes so many dentists to overdiagnose the dental needs of their patients? Some genuinely advocate that treating aggressively is the best course of action; others are heavily influenced by ideals of photoshopped beauty and sincerely feel this is an ideal to strive for. The most common reason, however, is simply financial gain (Fear of Unnecessary; Hartshorne). Economic self-interest and emphasis in training alike favor restoring teeth, not preventing disease. Traditionally, dentists have been highly regarded and trusted professionals. In a Gallup poll for Honesty/Ethics in Professions, dentists were ranked the third most trusted profession in 1994, slipped to ninth in 2001, and most recently, placed sixth in 2009 with 57% of Americans (Christensen, Elective). Commonly, patients presented with huge treatment plans without elective procedures properly explained as such, will visit another dentist for a second opinion. Upon finding out from the second dentist that many of the procedures in the first plan are elective, they commonly develop ill feelings for their previous dentist and it generally demeans the profession. Most importantly, we can decide now to be perfectly honest. As dental students, we are developing the skills, habits, and style in which we will practice dentistry the rest of our lives. Ethical dilemmas will arise, and the stress of these situations clouds ones judgment. Now is the time to decide to be completely honest and ethical in all that you do, because this decision is much easier to make before a difficult situation presents itself. A great philosophy is to treat your patient the same way you would a family member or close friend. Being ethical in your practice will help develop your patients trust in you. This increase in trust translates to more accepted treatment plans and more referrals to your office. Lastly, having integrity will bring you peace of mind and a greater satisfaction in the work you are doing.
placing high trust in dentists. (Honesty/ Ethics). As discussed in the most recent ADA Annual Session, scandalsmore frequently reported from dentists than any other healthcare professionlawsuits, overtreatment, and dentists excessive self-promotion and commercialization are tainting the professions image. What can we do? One important idea is to improve patient communication. Dr. Gordon Christensen suggests that we should always have all possible treatment options explained to our patients and clearly delineate between mandatory treatment and elective treatment
[References] Christensen, GJ. The Credibility of Dentists. JADA 2001;132;1163-1165 J. Christensen, GJ. Elective Vs. Mandatory Dentistry. JADA, Vol. 131, October 2000. Domino, Donna. Is Dentistry Facing an Ethical Dilemma? Oct. 2011. http://www.drbicuspid.com/index.aspx?sec=sup &sub=pmt&pag=dis&ItemID=308952 (7/2012). Fear of Unnecessary or Wrong Dental Treatment. http:// www.dentalfearcentral.org/fears/unnecessary-dental-work/ (7/2012). Hartshorne, J. Hasegawa TK Jr. Overservicing in dental practiceethrical perspectives. SADJ. 2003 Oct;58(9):364-9. Honesty/Ethics in Professions. Gallup. 1995, 2002, 2011. http://www.gallup.com/Search/Default.aspx?q=most+truste d+professions&s=date&i=&t=&p=2&a=0 (7/2012). Schoen, MH. Does dentistry as we know it have a future? J Public Health Dent. 1985 Summer; 45(3): 130-2.
The Diastema
Summer 2012
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REAL CLOTHES
By Jessica Zhu (2015)
agers are at an age when they are developing habits and becoming more independent, it is an opportune time to instruct them on healthy eating habits and nutrition. Our objective is to provide education and supplies to these students in order to help them establish a lifelong pattern of healthy habits that will prevent oral health problems. This committee will provide UCLAs dental students the opportunity to work with people of this particular age range. As future dentists, it is important for us to handle the young, the old and adolescents alike. Teenagers are especially unique in that they can present a different set of challenges to the den-
tist with regards to behavior and compliance. It is important for us as future professionals to develop the skills to effectively work with patients of all ages. As a brand new committee within the UCLA ASDA chapter, the Teen Oral Health Committees success depends on the support of our student body through active participation. Were confident this committee will not only shape the lives of numerous Los Angeles youth for the better, but also enrich its participating dental students with new experiences and strategies to connect with their patients.
1. Lift heavy (girls too!) Lifting helps build lean muscle mass that will help you burn calories long after you have left the gym. Your body uses more calories to maintain muscle, so lifting is important whether you are trying to bulk up or slim down! Girls, we dont consume enough calories to get big from liftingrather, lifting will help you achieve a more toned physique. So 4. Eat 5-6 meals per day. Eating every 2.5take a break from the endless cardio, and 3 hours helps keep your metabolism high try picking up a pair of dumbbells! throughout the day. Additionally, our bodies can only absorb around 25g of protein in 2. Eat within the first hour of waking up. one sitting, so it is best to consume smaller With an 8 a.m. class, it is easy to sacrifice meals, each with a good amount of protein, eating breakfast to get those extra 15 min- several times a day. Of course, we know that utes of sleep. However, eating soon after eating more frequently can make you more waking up helps kick-start your metabo- susceptible to cariesso be sure to stay on lism. Keep things at home that are easy to top of your oral hygiene routine and use a grab-and-go, like individually packaged yo- fluoride rinse! 5. Drink water! There are so many benefits to drinking plenty of waterincluding losing weight and getting the most out of your workout. When you exercise, you lose fluid as you
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BUDGET BITES
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my personal favorite, served in a pulled pork and pear coleslaw sandwich smothered in BBQ sauce mixed with Tapatio hot sauce. RecipeDry Rub: 1.5 Tbls 1 Tbls 1 tsp 1 tsp .5 Tbls 1 tsp 1.25 tsp .25 tsp 1 tsp
Salt Granulated Garlic Cumin Crushed Red Pepper Dried Oregano Chili Powder Brown Sugar Cayenne Pepper Black Pepper
Mix all ingredients thoroughly with a fork or whisk in a small bowl. Heavily coat a 5 8 lb pork shoulder, massaging the rub to cover each surface. Cook at 325 F for 4 5 hours. Shred meat and enjoy!
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The Diastema 2012-2013 Staff E D I TO RS - I N - C H I E F Catherine Kim l 2015 Kavita Sainanee l 2015 L AYO U T E D I TO R Vickie Lai l 2014 S EC T I O N E D I TO RS Lindsay Graves l 2014 Jennifer Sun | 2015
W R I T E RS & C O N T R I B U T I N G W R I T E RS Khushbu Aggrawal l 2014 Rishal Ambaram l 2015 Lindsay Graves | 2014 Adrien Hamedi-Sangsari l 2015 Jared Kenney | 2014 Lawrence Lin l 2015 David Lindsey | 2015 John Nguyen l 2015 Barrett Nordstrom l 2014 Kavita Sainanee l 2015 Jennifer Sun l 2015
SUBMISSIONS If you would like to submit an article and/or photos for The Diastema or have suggestions, please email the editors at catherine.kim@ucla.edu or kavitasainanee@gmail.com. EDITORIAL DISCLAIMER The opinions contained herein do not necessarily reflect those of UCLA or of the UCLA School of Dentistry in particular. SPECIAL THANK YOU We would like to thank the following faculty for their support and mentorship in this issue of The Diastema: Dr. Carol Bibb, Dr. Steven Ganzberg.
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