THE NEXTDDS Blog

Dr. Patrice Smith

Dr. Patrice Smith is an Academic Advisory Board member of THE NEXTDDS and is presently an orthodontics resident at Howard University College of Dentistry in Washington, D.C.
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Mastering the Class I Cavity Preparation

Posted by Dr. Patrice Smith on Mon, Jul 17, 2017 @ 10:00 AM

Restoring teeth is a basic skill that all dental students must master, not only to matriculate through operative dentistry labs or pass the boards but also in order to become good clinicians. It is the bedrock of our careers. Learning how to properly remove decay and prepare teeth for restorations, all while maintaining tooth anatomy and structure to maximize strength and retention, withstand the potential of fracture, and minimize pulpal exposure is an expertise required by all dentists.

To this end, Greene Vardiman (G.V.) Black was one of many pioneers who paved the way for modern dentistry. He established the proper way to prepare teeth for fillings and, as such, developed a classification system for carious lesions. Originally consisting of five classifications, Black's system ultimately included a sixth classification that was added later. In this article we will discuss the Class I lesion and how to properly prepare it for a restoration.

The Class I Lesion

Based on the Black classification system, a Class I lesion involves the occlusal surface of premolars and molars, the occlusal two thirds of buccal and lingual surfaces of molars, and the palatal pits of anterior teeth. There are two stages in cavity preparation:

Stage 1: Initial Tooth Preparation

  • Obtain outline form
  • Obtain primary resistance form
  • Obtain convenience form

Stage 2: Final Tooth Preparation

  • Removal of remaining carious dentin
  • Pulpal protection (if indicated)
  • Obtain secondary resistance and retention form
  • Finishing of enamel walls and margins
  • Sealing

Premolar Reference

Stage 1: The Initial Tooth Preparation Phase requires the clinician to establish a proper outline form (Figure 1). This is achieved by extending the external walls to sound tooth structure while maintaining a specified, limited depth and by providing retention and resistance forms. The outline form for the Class I occlusal tooth preparation should include only defective occlusal pits and fissures. The primary resistance form is the shape and placement of walls that enable the tooth and restoration to withstand masticatory forces or stresses that are delivered along the long axis of the tooth. The convenience form is the shape that facilitates proper and adequate access and visibility during preparation and restoration of the tooth.

Preparation-01.jpgPreparation-02.jpg

Figure 1. Outline form includes pits and fissures.

Based on current standards,[1] the ideal dimensions of a Class I cavity preparation should be 1.5mm to 2mm deep, and 1.5mm wide faciolingually. This prep should not extend beyond 1.6mm proximally. That is, a width of 1.6mm from the marginal ridge should be maintained for structural support.

The ideal bur(s) to use for this type of prep are a #245 or a #330 carbide. The #245 bur is 3mm in length and 0.8mm diameter, while a #330 bur is a smaller version at 1.5 mm in length.

 Preparation-03.jpg  Preparation-04.jpg  Preparation-05.jpg

Figure 2. Punch cut and extension of the preparation mesiodistally with a #245 bur.

The Class I occlusal preparation is begun by entering the deepest or most carious pit with a punch cut, parallel to the long axis of the tooth using a #245 or #330 carbide bur in a high-speed handpiece (Figure 2). The target depth is 1.5mm to the pulpal floor (i.e., one half the length of a #245 bur or the entire length of a #330 bur). The preparation should be extended from mesial to distal, taking care to leave at least 1.6mm of the marginal ridge on either side (or the diameter of two #245 burs) (Figure 3). The occlusal isthmus should be just a bit larger than the diameter of the bur. Note that a preparation with a narrow occlusal isthmus prevents fracture.

 Preparation-06.jpgPreparation-07.jpgPreparation-08.jpg

Figure 3. A 1.6mm-marginal ridge on either side of the preparation, or the diameter of two #245 burs. 

Stage 2: The Final Tooth Preparation Phase includes the removal of any remaining restorative material or defective enamel or dentin on the pulpal floor (Figure 4). This is best accomplished using a discoid-type spoon excavator or a slow-revolving, round carbide bur until the remaining tooth structure feels hard or firm. Pulpal protection should also be done if indicated (i.e., if the preparation extends close to the pulp).

Preparation-09.jpg  Preparation-10.jpg 
 
Preparation-11.jpg Preparation-12.jpg
Figure 4. Removal of remaining defective enamel/dentin with discoid cleiod. 

In complex preparations where retention needs improvement, secondary resistance and retention form is employed. This is usually done by adding retention grooves and cuts in the walls of the preparation. After this is achieved, then finishing of the enamel walls and margins should be completed to ensure all internal lines and angles have been smoothed. This is followed by the final steps of the procedure--cleaning and sealing the preparation with the clinician's restorative material of choice.

 

Reference

[1] Heymann H, Swift E, Ritter A. Sturdevant's Art and Science of Operative Dentistry, 6th Edition. Mosby, 2013. VitalBook file.

 

Further Reading

A Comparison of Various Adhesive Composite Restorations in the Posterior Regions

New Perspectives on Dentin Adhesion

Dentin Adhesion Bonding Methods

Direct Resin Veneer Restorations (clinical images)

Tags: cavity,, class I cavity, tooth preparation, dental filling

D1 Year School Survival Toolkit: Note Taking

Posted by Dr. Patrice Smith on Tue, Aug 30, 2016 @ 01:00 PM

taking-notes-1.jpgCongratulations on being accepted into dental school! All your hard work has paid off. You made good grades as an undergrad, studied and did well on the DATs, and you had a killer application that earned you a spot in your dental school. Now the real fun begins! There will be several hurdles to jump over throughout the next four years, but don’t worry! We will be taking it one step at a time.

You are about to start classes and, for many of you, it will be a bit overwhelming at first. It will be very different from your undergrad experience in terms of the sheer volume of reading and work required. One of the first things you will want to get a hang of is proper note taking.

Everyone has a different way of doing things. People’s levels of efficiency and how they absorb and retain information vary greatly, and you will have to find the way that works best for you. However, there are some tried and true ways to get this done without stress.

“Old Fashioned” Notepad and Pen

Some people are just not tech savvy, and that’s okay. You might find that you are more efficient at simply writing notes in a notebook rather than fiddling with technology, trying to figure out apps or hearing the lecture over all the clicking keyboards. Pick up a notebook, notepad or perhaps a binder with re-fillable note pages from your bookstore. Grab some colored pens as well if you find that helps you keep things organized. Typed Notes >Type your notes using your computer’s notepad or note-taking tool. Apple Notes, while pretty basic, is a good tool as is Microsoft Word. If you are not into apps or any of that “fancy” stuff, keep it simple and get the job done using one of these tools.

PowerPoint

Most of your lectures will probably be in the form of PowerPoint and will most likely be made available to you ahead of class time. You may find it simpler to either 1) Print out these PowerPoint lectures and make notes on each slide as you go along, or 2) Make notes at the bottom of each slide or write on the slide itself if you’re using a touch screen computer or tablet. This will make following along seamless and all your notes and lecture material will be in one place.

Note Taking Apps

If you are somewhat tech savvy, you might find that using some note taking apps will help you be a lot more organized. Some very useful note taking apps include Evernote, Microsoft One Note, Simplenote, Google Keep, and Google Docs. I personally have experience with Microsoft One Note and Evernote. Both are unique and I like different things about each. The great feature with Evernote is that you can incorporate text, images, audio recordings, web links, and files, and then organize them into notebooks. Another cool feature is that even if you have hand written notes, you can scan them into Evernote using the Scannable app by simply taking a picture of them with your phone.   Microsoft One Note was a favorite among some of my classmates. An entire semester’s PowerPoint lectures can be placed in designated folders. On these PowerPoints, you can incorporate audio notes and keep them next to written notes. You can also mark up images and place diagrams and drawings anywhere within your notes. This is particularly great when studying for cumulative exams. All the information for the entire semester can be accessed in one place.

Digital Recorder

Some people don’t necessarily get all the information while in class. Between mid-lecture snoozes and other distractions, it might be easy to miss some things. In this case, you can invest in a digital recorder. You can record lectures and listen to them at a later time. Your school may have podcasts where the lectures are recorded and made available to you at your leisure. A cool app that integrates recording and note taking is Pearnote. It allows you to upload a PDF or PPT file and record as you take notes. Before you start recording lectures, however, be sure you are given permission by the professor.

Hire a Scribe or Note Taker

So maybe you are not good at this “listening while taking notes” thing. You find that there are a lot of gaps in your notes, but you faintly remember your professor mentioning something else that you can’t quite remember. Ugh, how frustrating! Your note taker in this instance can be a classmate that takes really good notes and can seemingly write everything that comes out of the professor’s mouth verbatim. Or, as a class, you can pool together and hire a scribe. This person will get a digital recording of the lectures and turn them into files that can be distributed to the entire class. All of your classmates will have their notes and someone just got a part time job. What a win-win!

 

The key to note taking in dental school is finding what best works for you. Try a few of the above methods and see what you’re comfortable with and go from there. Don’t take too much time figuring this part out—you’ll have bigger fish to fry soon enough!

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Tags: dental school, note taking

Understanding The ADAT and How to Prepare

Posted by Dr. Patrice Smith on Thu, Jul 14, 2016 @ 11:00 AM

Have you heard of the ADAT exam? ADAT stands for Advanced Dental Admission Test and is a new computer-based examination that is now being required for entry into many post-doctoral education programs. According to the American Dental Association (ADA), the exam is designed to provide advanced dental education providers with insight into applicant’s potential for success in their programs.

This exam was implemented due to a lack of scores from other standardized exams, namely the NBDE I and NBDE II. Some of us may recall that in January of 2012 the NBDE exams changed from having scores to a Pass/Fail system. Since then, a number of dental schools moved away from GPA and started reporting grades as Pass/Fail. Thus, advanced education programs have been faced with the difficult task of comparing and selecting program-seeking candidates. The exam will enable programs to quantitatively compare applicants using a nationally standardized and objective test.

The ADAT exam comprises multiple-choice questions and consists of two broad categories: Critical Thinking and Principles of Ethics & Patient Management. The Critical Thinking portion is then further broken down into: Biomedical Sciences, Clinical Sciences, Data, Research Interpretation, and Evidence-Based Dentistry.

flowchart_7.12.16.png

Concept adapted from ADAT Guide; © 2016 American Dental Association

The exam consists of 200 questions to be completed over a four-and-a-half-hour period. There are 80 items in the Biomedical Sciences section, 60 items in the Clinical Sciences section, 30 items in the Data, Research Interpretation, and Evidence-Based Dentistry section and 30 items in the Principles of Ethics and Patient Management section. The specifications of each section can be found below:

Bar_chart_7.12.16.png

Concept adapted from ADAT Guide; © 2016 American Dental Association

The ADAT exam is in its pilot year and will be offered from May 2016 through August 2016 and April through July of 2017. According to the ADA, scoring will be based on a scaled system in a range from 200 to 800 with a target mean of 500 and a standard deviation of 100. Scores will be reported in increments of 10. Scores will be reported for six scales:

  1. ADAT Score - an overall score that is computed based on performance on all ADAT items
  2. Critical Thinking
  3. Professional Ethics and Patient Management
  4. Biomedical Sciences
  5. Clinical Sciences
  6. Data and Research Interpretation

The number of correct responses will not be reported, and examinees will not be privy to immediate feedback of test results. However, scores will be reported to the advanced education program to which the applicant applied. Though test administrators will hold the exam this year, official scores will be available on September 15, 2016 on the ADAT website.

While the ADAT is still in its early form, it is anticipated that this test will become the standard for students applying to advanced dental education programs. Many changes will most likely occur as the ADAT continues to be developed. As previously stated, this test will enable programs to quantitatively compare applicants using a nationally standardized and objective test.

The ADA has done a good job of providing resources that will aid applicants in preparing for this test. You may find a list of schools that will be participating in the ADAT for the 2016-2017 cycle via this link. You may also find guidelines of the ADAT exam here; sample practice items here; an ADAT practice test here, and an interactive tutorial may be downloaded on the Pearson Vue website here.

Good luck and all the best in your future endeavors!

Tags: ADAT

Passing the NBDE Part II

Posted by Dr. Patrice Smith on Thu, Mar 24, 2016 @ 12:00 PM

example-test-scantron.jpgYou have gone through the rigors of dental school and are now on the home stretch to obtaining your dental degree! The end is near, but there are still a few hurdles to jump: You are now preparing to take the National Board Dental Examination (NBDE) Part II.

The National Board Dental Examination (Part II) is typically taken during the latter part of your third year, or later in your fourth year of dental school. It is taken over a seven (7) hour period over the course of two days and comprises 400 questions on day one, and 100 case-based questions on day two.

The areas covered on the NBDE Part II include:

  • Operative Dentistry
  • Pharmacology
  • Prosthodontics
  • Endodontics
  • Periodontics
  • Oral Pathology/Radiology
  • Oral Surgery/Pain Control
  • Orthodontics/Pediatric Dentistry
  • Patient Management

You have taken a myriad of exams in dental school and have already completed the NBDE Part I, so you should have a good idea of what to expect with the NBDE Part II. You may find the ADA’s 2016 NBDE Part II Guide here: http://www.ada.org/~/media/JCNDE/pdfs/nbde02_examinee_guide.pdf?la=en

Testing yourself and seeing where your strengths and weaknesses are, in my opinion, always a good idea and a good place to start. You can purchase reprinted copies of old exams from the ASDA website here: http://www.asdanet.org/store/nbde.aspx

The good news about testing for Part II is that it is a lot more fun than studying for Part I! Yes, studying can indeed be fun! Part II is more conceptual and the information covered is more clinically relevant. It is definitely not a drag since you now have points of reference from clinical experiences.

By now, you should know how to test and motivate yourself to study. I can tell you from experience, however, that remaining focused and motivated when you have so much going on (clinic requirements, school exams, leadership and organization responsibilities, upcoming graduation, etc.)—especially while senioritis kicks in—can be quite a challenge. The best advice I can give you is:

  • Outline your plan of action and stick to it!

Be steadfast in your plans about this. Just think, the sooner I get this out of the way, the sooner I can move on and focus on other things. This is just one more step towards the finish line.

  • Avoid distractions.

Seriously, remove all social media apps from your phone and scope out a space where you can really zone in and get some solid study time. More power to you if you can focus at a place like Starbucks, with all the music, foot traffic, and the array of different delicious aromas!

  • Break up the routine.

Give your brain a break. A change of scenery after a couple hours in one spot can be very helpful. You can even go for a walk, indulge in some online retail therapy, and, if you’re home, make a meal or bake a cake! Do something to break up the monotony. When you return to the books you will be refreshed for Round 2!

  • Take practice tests and go through questions.

After you’ve gone through your study materials, the only real way to know if you’ve been retaining any of the information is to test yourself. It’s also a great way for you to learn some things. Practice make perfect!

Some very good resources that can be used for preparing for the NBDE Part II are:

  1. Mosby’s Review for the NBD Part II

I would recommend starting with Mosby’s Review. It has a great deal of information and covers each area well. It is pretty dense, but you will have a pretty good foundation after going through it. Pay attention to the patient management section. Kaplan and First Aid for the NBDE Part II would be reference materials of similar value.

  1. Dental Decks

This is always a top recommendation! The Dental Decks are very thorough and they cover each section well. The great thing is you can stuff a few in your pocket and study on the go.

  1. Tufts Pharmacology

This document is a gold mine for the pharmacology section. I would say it’s an absolute must, so get your hands on it. Here’s a copy: http://www.scribd.com/doc/70119341/NBDE-II-Pharmacology-Review#scribd  A quick Google search can also help.

  1. THE NEXT DDS

THE NEXTDDS will very soon be launching its self-testing tool where you will have access to a bank of over 5,000 questions and answers. You will be able to take practice tests that are structured to align to the NBDE Parts I and II. The question formatting will be flexible to include MCQs, short answer, fill-in-the blank, and video/visual recognition and response, and you will have real-time feedback and coursework scoring. This is all very exciting! Stay tuned for the launch.

Any combination of the resources above will almost always guarantee success on the NBDE Part II. Remember, you must know yourself and your study habits. Create a study schedule and stick to it. Almost there guys!

Good luck!

Tags: studying, NBDE, Passing the NBDE, National Board Dental Examination, resources

Passing the NBDE Part I

Posted by Dr. Patrice Smith on Fri, Mar 11, 2016 @ 03:46 PM

Congratulations! You have survived your first year of dental school and are now ready to take on your first standardized examination in becoming a dentist.

example-test-scantron.jpgThe National Board Dental Examination (NBDE) Part 1 is a one-day exam that is composed of 400 questions from the basic sciences, taken over a seven-hour period.  About 20% of the test is grouped into testlets with interdisciplinary focus and clinical application.

The subject areas tested on Part 1 of the NBDE include:

  • Anatomic Science
  • Biochemistry/Physiology
  • Microbiology/Pathology
  • Dental Anatomy

The exam specifications, schedule, registration, fees, and the rescheduling and cancellation policy, etc. can all be obtained from the ADA’s 2016 NBDE Part 1 Guide.

How do you prepare and study efficiently for this exam, building up the stamina to test for seven hours and ensure passing? By now, you will have developed strong study habits that you will need to call upon during this time. You will also need great time-management and organizational skills to continue to manage your dental school course load; studying for those pesky pop quizzes, intra-sessional, mid-term and final exams all while preparing for the NBDE (assuming you are taking your test during the regular semester and not over a break, i.e., the summer).

The key to being successful in practically anything in life is to have a plan. Be mindful that a failure to plan is always a sure-fire plan to fail.

So, the NBDE Part 1 is on the horizon for you. The first thing to do is to go to the ADA’s Guide for the NBDE Part 1, which can be found at the following link: http://www.ada.org/~/media/JCNDE/pdfs/nbde01_examinee_guide.ashx. Go through the guide thoroughly and carefully so that you get a general overview of what the exam is all about.

The next thing you should do is apply and schedule your exam. By scheduling your exam, you have now locked in your deadline and have a timeframe to complete your preparation. This will be the motivation behind your studies! Follow this link to apply to take your exam: http://www.ada.org/en/jcnde/examinations/nbde-general-information.

I would recommend giving yourself one to three months to prepare and study for this exam, depending on your individual study habits. Some people may need three months while others can get it done in a much shorter time. In my opinion, it is better to study and learn some new things over a period of time rather than cram information in at the last minute. You do not want to be cramming for this exam!

Now that you have gone through the guide and have scheduled your exam, it is time to develop a game plan. You must now breakdown and designate time to dedicate towards studying. Get out your calendar and start scheduling!

Starting anything is usually the most difficult thing to do. Don’t know where to start? I would highly suggest starting with some old questions. A good source for old exams is the ASDA – NBDE Reprints.

Start at Day 1 and test yourself. This will not only give you an idea of the testing format and the types of questions that are asked, but you will also be able to see how much of the information you know. You will get a pretty good idea of your weak areas and where to place more focus during your studies. Be careful not to rely on these questions as the basis of your studies. The questions can be a bit outdated and concepts might have changed, but it is a good place to start. You can get ASDA NBDE Reprints at the following link: http://www.asdanet.org/store/nbde.aspx. You will have to create an account in order to purchase.

Now that you have a good understanding of the exam, the types of questions that are typically asked, the format, and your deadline, IT IS TIME to kick start your studying. Your lecture notes and textbooks have a world of information. Everything you need to know to pass the NBDE may very well be in there! However, there are many resources that have streamlined all that information in a way that makes it more efficient for you to study and pass this exam.

I will outline a few resources that have been very helpful in my success with the exam. I have also interviewed a few students from my alma mater who have recently took the exam.  Rest assured, you are receiving the most up-to-date information:

 1. First Aid for the NBDE Part 1

This resource offers a good foundation in all the subject areas and is perhaps one of the most concise. Thus, this is a good place to start your studies. Since it is an easy read, try to get through this book quickly and ensure you are paying attention to key concepts.

2. Mosby’s Review for NBDE

This is another resource that has proved very helpful to many. Some dental students I know have either used the Mosby’s resource or the First Aid book as their starting point. I personally used Mosby’s as a reference book.

3. Dental Decks

This is a must have! After getting the foundation from the resources above, the Dental Decks can be used to both study from and test yourself. Every dental student I know that has passed the exam has credited this resource to their success. Dental Decks are flash cards that are concise, yet packed with high-yield information.

4. Kaplan dentEssentials: High Yield NBDE Part 1 Review

While I did not personally use this resource, dental students have said that it is akin to the Mosby’s or First Aid and covers most of the subject areas well.

5. Dental Boards Mastery

This resource is also highly sought after. While I have also not used this, they have had very good reviews among dental students I interviewed. It was created by dental students in partnership with the University of Iowa, coming equipped with practice questions and quizzes accessible online or by download as an app to your iPhone or Android smartphone. You can use this to break up your studying, and since you can access it via smartphone you can take quizzes and exams anytime, anywhere.

6. BONUS: THE NEXTDDS

THE NEXTDDS will very soon be launching its self-testing tool where you will have access to a bank of over 5,000 questions and answers. You will be able to take practice tests that are structured to align to the NBDE Parts I and II. The question formatting will be flexible to include MCQs, short answer, fill-in-the blank, and video/visual recognition and response, and you will have real-time feedback and coursework scoring. This is all very exciting! Stay tuned for the launch.

 

Now that you have the resources, here’s some advice:

  1. Outline your plan of action. Schedule time to study, manage your time wisely, and stay organized.
  1. Start with the easy subjects and get those out of the way. Review them so that you can move on and spend more time on the more challenging subjects. This will boost your confidence and motivate you to delve into your studies.
  1. Don’t acquire too many resources. Unless you are super-organized, this will only confuse you and cause stress. Get a few resources and focus on getting through those. You can use your textbooks and school notes as a reference.
  1. Try to get the most updated study materials. Information gets updated all the time, and while there may not be drastic changes year to year, you want to ensure that you are reading the most updated information on any topic.
  1. Upperclassmen are your friends. Speak with other dental students who have taken the exam before. Ask them for advice, the resources they used, and what their study habits were.
  1. As it gets closer to test day, take practice exams. Remember that this exam is seven hours with a scheduled 30-minute break. Pretend as though it were the real exam and go for the full scheduled time. You will be glad you did this come test day.
  1. This is a serious time, so avoid distractions during studying. You have a deadline and you must stay on task. During your studies you may have to go online to do some research, but do not get side-tracked and end up on YouTube or social media!

I have taken many standardized exams and have always followed the above approaches. They work for me and can hopefully be a guide for you. Ultimately, you have to come up with an approach that works for you. However, any endeavor towards success includes having a plan, getting and staying organized, and managing your time well.

Good luck!

 

Tags: NBDE, Passing the NBDE, National Board Dental Examination

Preparing for The "Match" Process

Posted by Dr. Patrice Smith on Sat, Feb 06, 2016 @ 12:00 PM

i-want-you.jpg

By now many of you have heard about the “Match” and, if you’re like I was back in dental school, you may be thoroughly confused about it. Since the Match process can be a little daunting, I’m going to explain how it actually works. I will also include a general schedule of dates, based on some of my experiences with the Match, in order to clarify the process and provide you with a reference when it comes time for you to participate.

What is the Match, anyway? According to ADEA, the postdoctoral dental match program is the mechanism used by some postdoctoral dental education programs to determine the final placement of applicants into positions. Simply put, it helps applicants get into their choice programs and also helps programs obtain their choice applicants.

Think of a relationship: Boy meets girl. Boy likes girl, he flirts with girl; now girl likes boy. Boy and girl think they would be great together. Boy chooses girl to be his main girl but still keeps a few girls on standby just in case it turns out that girl doesn’t like him as much as he thinks she does, and vice versa. If it turns out the feelings are mutual, they choose each other and live in mutual happiness together. If not, then they must go down the list and choose the next best fit. Relationships aren’t complicated at all!

The Match should not be confused with PASS; they are separate entities. PASS is the centralized application service itself, which collects and distributes information to the different programs – this initiates the application process. Recall when you applied to dental school. The PASS would be akin to the AADSAS application system/process, whereas the Match is used by applicants and programs to determine final placement after the completion of application evaluation.

Let us assume you have chosen not to join the 48% of dental school graduates that go straight into private practice after school (according to a 2013 ADEA survey) and decided to take your education a step further. This means once again applying to different schools and programs, much like you did for dental school.

Ideally you would know early enough what you wanted to do after graduation or have figured it out at least by your third year. At the minimum, you would need to know that you wanted to continue your education after dental school and in which area of study.

The postdoctoral dental education programs that participate in the Match are Advanced Education in General Dentistry (AEGD), General Practice Residency (GPR), Oral and Maxillofacial Surgery (OMS), Orthodontics (ORTHO), Pediatric Dentistry (PED), and Dental Anesthesia (ANES).

The best way to approach this is with a little organization. Start by identifying your desired program(s), and find out if they participate in the Match process. If possible, visit these programs and ensure that the program directors, attendings, faculty, and residents know of your interests in their particular program. By doing this preparation, you will have a good idea of which program best fits you and your educational needs.

The PASS application typically opens in May of each year. The deadlines for submission of your application will depend on the type of program to which you are applying to the particular program’s deadline. In addition, there are two phases of the Match process:

  • Phase I: Orthodontics and Anesthesiology Programs. Rank order lists are submitted late November each year for Match results in early December.
  • Phase II: General Practice Residencies (GPR), Advanced Education in General Dentistry (AEGD), Oral & Maxillofacial Surgery (OMS), and Pediatric Dentistry (PED) programs. Rank order lists are submitted in early January of each year for match results in late January.

You must be organized in order to meet these deadlines and you need to ensure that you have all the required documentation loaded on time in the PASS application in order to submit on time.

Below I outline a general timeline that I used when applying to Orthodontics programs. Regardless of the program to which you’re applying, this timeline can be used to keep yourself organized and on task.

Applications open in May annually for acceptance into programs in July of the following year.

  • January – Happy New Year!! Identify and write out a list of potential programs that you would like to apply to. Re-visit this list often to update and make changes as necessary. Plan to visit these programs.
  • February – Write first draft of Personal statement. Identify individuals from whom you would like to get letters of recommendation and Personal Potential Index (PPIs) from and ask if they would be so kind as to write you one.
  • March – Edit Personal statement. Possibly request a meeting with the dean of your school and alert him of your post-graduate plans. Alert him that you will need a letter of recommendation from him soon. This personal touch may lead to him/her writing you a non-generic LOR.
  • April – Edit personal statement. Finalize your list of schools/programs.
  • May – Applications are open. Fill in all the areas of the PASS application that you can and request LORs and PPIs, board scores and transcripts.
  • June – Requested LORs, PPIs, board scores and transcripts should be in. There may be a waiting period as some professors can be slow in uploading LORs.
  • July – Submit application. Most of my deadlines for Orthodontics are in August.
  • August – Waiting period/correspondence from schools/programs.
  • September – Waiting period/correspondence from schools/programs/Interviews.
  • October – Interviews.
  • November – Interviews; submit rank order list for Match.
  • December – Match day this month for Orthodontics and Anesthesiology.
  • January – Submit rank order list for GPR, AEGD, OMS, PEDS.
  • May – Finish dental school requirements and graduate
  • July – Start program.

To download this timeline as a PDF for future reference, simply click here.

Also, for a similar perspective on the Match, you can listen to Dr. Matthew Ronconi’s podcast here or Student Ambassador Sukhmani Multani's blog post here.

 

Have more questions about the process or want to talk to others who have also experienced the process, like me? Enroll in THE NEXTDDS today to interact with dental students just like I was; enrollment is completely free.

Enroll Now!

Tags: Match Process, The Match, Match

Taking Accurate Impressions: The Classic Approach

Posted by Dr. Patrice Smith on Wed, Jan 20, 2016 @ 02:00 PM

dental-humor-impression.jpg

Image source: John Syrbu, Dental Art & Humor

The field of dentistry has experienced rapid growth and change throughout the years. There have been advances in technology, which has vastly improved our modes of operation. We have seen our equipment and materials get better, which in turn has made us more efficient and has simplified our lives.

One such area of growth is impression taking. Every so often a manufacturer will pose a claim regarding the superiority and accuracy of its equipment and impression materials, whether conventional or digital. Regardless of the equipment or material of choice, the bottom line in taking an impression is that it provides the likeness of the structures being captured, that it captures detail, and (most importantly) that it is accurate.

Taking an accurate impression can be very technique sensitive and has been proven to be one of the most difficult parts of a procedure for some dentists. An accurate impression is critical in ensuring an accurate diagnosis, the proper fit of appliances, prostheses, and restorations, and for minimizing chairside adjustments (Figure 1).

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Figure 1. Proper retraction is key to obtaining an accurate impression that captures all the details of the prepared tooth or teeth. (Courtesy: E. Lee)

There are several techniques and certainly several different types of impression materials that have been introduced to dentists over the years. We can place impression materials--at least conventional options--into elastic and non-elastic categories. The elastic materials include alginate (irreversible hydrocolloid), agar (reversible hydrocolloid), polysulfide, condensation silicone, addition silicone (polyvinyl siloxane/PVS), and polyether. The non-elastic materials include plaster, dental compound, and zinc oxide eugenol pastes. (The properties of which have all been discussed ad nauseam in your dental materials classes (smile)). When evaluating these impression materials, most dentists tend to be more concerned with hydrophilicity, setting time, and cost – and rightly so.

However, there are other characteristics that beg to be considered. Such characteristics include viscosity, dimensional stability, detail reproducibility, tear resistance, ease of removal, shelf life, acceptable taste/odor, gypsum compatibility, among others. Simple research into the properties and characteristics of different materials, with consideration given to the kind of impression you are taking, should be very beneficial. For example, taking an impression for a study model versus one of a tooth prepped to receive a crown with margins placed subgingivally will call for completely different impression materials. Needless to say, the latter requires material that is able to capture far greater detail than that of a study model.

There Is More Than One Right Option

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Figure 2. Illustration conveys the application of light-body and heavy-body materials for impression making.

The keys to successfully taking accurate impressions are one's impression-taking technique, material, and choice of impression trays. There is no "one size fits all" when it comes to technique, and most practitioners develop their own based on what works well for them through a series of trial and error. Some systems utilize a gun/cartridge, are automated, or are hand mixed. There are pros and cons to each system depending on the intended use of the material, and it is up to the practitioner to find what works best for him or her. Implementing a retraction technique that will allow for visualization of the preparation margins or for retraction to capture the vestibule and muscles in that area should also be a consideration when thinking about honing technique (Figure 2).

Choices of impression trays are also vital. They can be metal, plastic, or Styrofoam, and are sterilizable or disposable. Many come with retention grooves or perforations and/or can be painted with a coat of adhesive to retain the material inside of the tray. There exist full-arch trays, sectional trays, dual-arch trays; one can even make trays customized for each patient (i.e., custom trays). The proper size tray for the particular patient should also be selected keeping in mind that all structures should be covered (including the last molar(s) in the arch), it should not impinge on the soft tissues, and the tray should not interfere with the dentition.  

Regardless of the technique or material that is used, a good impression should ensure:

  • Visible muscle definition
  • Clear representation of the midline
  • Smooth anatomical contours
  • Proper depths showing all gingival tissue margins
  • Molars on distal segment are fully captured
  • Impression material rolled over the edge of the tray (for strength and retention)

Impression taking seems a mundane topic and a pretty simple concept to grasp, but it is surprisingly a source of frustration in some dental practices. To avoid this frustration, improve your knowledge of the different materials on the market, or consider solidifying and honing good technique. Not only will this make you an efficient, detailed-oriented dentist, but it will prove to be very cost effective as well.  

 

Need more help taking an accurate impression? THE NEXTDDS has many other resources and step-by-step technique guides available to support you. What are you waiting for? Enroll today!

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Tags: dental impressions, impression making, impressions

Tips for Taking Proper Digital Radiographs

Posted by Dr. Patrice Smith on Wed, Jan 06, 2016 @ 12:00 PM

digital-radiographpy.pngThere is no doubt that the introduction of digital radiography has proved to be one of the most important new advances in the dental profession. Not only is it less labor intensive, it allows for saved time, diagnostic proficiency, and reduced radiation exposure.

Radiographs are an integral part of any dental practice and care must be taken to ensure they are of good diagnostic quality. They are taken just as one would take conventional x-rays, with the difference being the incorporation of a digital sensor. The digital sensor allows images to be propagated almost instantaneously on a monitor or screen, but is more rigid than conventional film, thus patient comfort is a big concern.

Tips for Better Radiographs

Here are a few tips and videos (for the visually inclined) on how to properly and comfortably take digital radiographs:

  • For the maxillary anterior segment: Using a rolling scoop motion, place the sensor into the patient’s mouth with the distal portion against the palate. Center the bite block on the maxillary central incisor teeth and ensure the sensor is placed parallel to the long axis of the teeth. Move the cable of the sensor to one side and have the patient bite down unto the bite block. Once stability is achieved, you can go ahead and press the exposure button. THE NEXTDDS shows here a helpful video on placement of the digital sensor for maxillary anterior teeth.

  • For the mandibular anterior segment: This is where things get a bit uncomfortable for the patient. To make taking x-rays in this segment more bearable, ask the patient to place the tip of his or her tongue to the lingual of the mandibular incisor teeth. Using a rolling scoop motion, place the sensor atop the tongue and roll into an upright position. The tongue will act as a cushion for the sensitive soft tissue and/or any tori that may be present. Center the bite block on the mandibular central incisors and ensure the sensor is placed parallel to the long axis of the teeth. Move the cable out of the way and ask the patient to bite down. Once stability is achieved, and press the exposure button.

  • For the posterior maxillary segment: Retracting the cheek (with your finger or instrument), guide the sensor into the patient's mouth between the maxillary central incisors and along the midline of the palate. Guide the sensor back until it is level with the desired posterior teeth, whether premolars or molars. At this point, angle the sensor slightly past the midline of the mouth so that the apices of the roots can be captured. Move the cable out of the way and have the patient bite on the bite block. Once stability is achieved, go ahead and press the exposure button. See here and here for instructional videos depicting placement of the digital sensor for the maxillary posterior teeth.

  • For the posterior mandibular segment: Taking these x-rays can be uncomfortable for the patient. You may want to use gauze or foam cushion that's compatible with digital sensors to aid in patient comfort. Retracting the cheek (with your finger or instrument), guide the sensor into the patient’s mouth between the tongue and the teeth at a 45-degree angle. Slowly guide the sensor back until it is level with the desired posterior teeth, whether premolars or molars. Move the cable out of the way and have the patient bite on the bite block. Once stability is achieved, go ahead and press the exposure button. See here and here for short videos on placement of the digital sensor for the mandibular posterior teeth.

  • Horizontal Bitewings: Retracting the cheek (with your finger or instrument), guide the sensor into the patient’s mouth, and place it between the tongue and the teeth with the tab resting on the teeth. Once it is level with the desired teeth and the cable is moved out of the way, have the patient slowly bite down. As the patient is biting down, swing the apparatus toward the lateral incisor. Swinging the apparatus toward the lateral incisor and adjusting the angulation will allow for open contacts on the radiograph so that any interproximal caries or anomaly can be easily seen. Click here for THE NEXTDDS video demonstrating placement of the digital sensor for horizontal bitewings.

  • Vertical Bitewings: Taking vertical bitewings can be uncomfortable for the patient. Here too you may want to use gauze or cushion (i.e., one that's compatible with digital sensors) to aid in patient comfort. Retracting the cheek with your finger or instrument, place the sensor into the patient’s mouth horizontally. Once the sensor is past the central incisors, roll into a vertical position and place against the posterior teeth. Ensure the cone of the x-ray source is parallel with the holder and is directed at the center of the ring. Move the cable out of the way and have the patient bite on the bite block--as shown on this instructional vldeo. Once stability is achieved, go ahead and press the exposure button.   

Following these tips will help in taking radiographs of good diagnostic quality. Keep in mind that digital sensors come in different sizes to accommodate different size mouths, and you may have to adjust accordingly. Of course, every patient is different and you may have to make further adjustments or incorporate different things to get desired results. Either way, the bottom line is: Ensure patient comfort; take x-rays that are of good diagnostic quality.

Find more videos and information on digital radiography and diagnostic imaging within THE NEXTDDS educational platform for dental students. Enrollment is completely free to dental students!

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Tags: radiographs, x-rays, digital radiographs,

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