Friday, January 23, 2015

2015: uncertainties and maybe's are okay

I just spent the long weekend with my friend Jorgen who visited from UW. One night I made him come to dental school with me so I could make custom trays. But mostly we got to explore Philly together like finally going to the Philadelphia Museum of Art. 

Since Jorgen's life is the one I would have had, it was interesting to see how different our lives are now. J has a vegetable garden and goes hiking on weekends... life as a Ph.D student doesn't seem that bad. ;)

2015 feels good. It feels light and fizzy, just like the New York Egg Cream that Jorgen and I got to try together at Reading Terminal Market. The biggest thing is this: uncertainty doesn't bother me so much anymore. 

My life after dental school is a puzzle. Residency? Work? Specialize? Where? Random things I deem important for my dental career pop into my mind. For example, I want to learn four-handed dentistry so I can worry about the dentist stuff. Not the grabbing instruments, not moving the suction out of the way (or trying to hold suction and mirror in one hand). I also want to better estimate difficulty of each case: from estimating how much time this restoration would take, to whether I should call in the big girls (specialists). 

And there's finances. Some days I want to be rewarded (financially) for all the extra hours I put in. Other days I snobbily declare that I'm a selfless saint for putting in extra time and energy to clinic- since I don't get paid. I want to live in a bustling big city. Nope, I want to have a huge forest in my backyard and see all the stars at night.

I'm also at peace about relationships. The relationship I ended was such a learning experience. Because everything was great but we just weren't compatible at this specific point in time with our current values and beliefs. Time is a very important dimension.

I took this tooth selfie and I love my transparent incisors with a hint of mamelons. #toothobsessed

Everything's possible and everything is open! Knowing how I want to feel is much more important than the actual decisions themselves. And right now, I'm loving this in-between process. I feel open, expansive, full of possibilities.

Here's a moment from clinic this week. My faculty put his hands on my patients' forehead and declared "I've healed you!". And me, laughing with a mix of shock (blasphemy!!!) and disbelief. What's the point of doing anything if you're not having fun? He says that and I'm starting to believe it. At the end of each clinic day, my heart rate shoots up in a mix of frustration, gratitude, excitement, relief, and joy. It's the strangest emotion cocktail. But you know, I haven't ran away to Jersey just yet. I must be having fun.

Monday, January 19, 2015

dentists should have cavities

I love going to the dentist. It may be because I've never had a bad experience at the dentist. Dental visits in my childhood are unremarkable: a couple of fillings here and there, but nothing traumatic or special to make me fearful.

I had a dental appointment with my new student dentist before winter break and it was awesome. I love being pampered and to me, a dental appointment is time to sit back and relax while being taken care of! Sitting in the chair for the first time since starting clinic, I learned a couple of things.


- When putting the rubber dam on, flossing in between teeth hurts. Be gentle!
I have some tight contacts and when the floss snapped to my gums, it hurt a lot more than I expected. I had never had a rubber dam placed before so that was an entirely new experience.

- Light flashing in your eyes? Painful. 
Every time my dentist moved the light from shining in my face, I was so grateful. And I relaxed immediately. 

- Phosphotic acid etchant tastes really sour, like lemons.
I have never tasted the etchant so I was surprised by how sour it tasted. Patients always comment on how something tastes: the etchant, alginate impression material, fluoride varnish... It's now totally understandable how a strong taste can feel invasive and scary. 

I loved my student dentist explaining every step: "we're almost done with the prep", "I'm putting some razor cream on the rubber dam" (that's a new thing we don't do in my clinic), "you're gonna feel some heat with the light cure". 

But this is also something that's different for every patient. Maybe they prefer to relax and fall asleep. Many of my patients will fall asleep in the chair and jerk around. I've learned to have a strong hand rest, especially when holding a drill!


Sometimes we dental students get embarrassed about having cavities: we should know better! But I think having cavities every once in a while is good. Maybe better if you've had a root canal. For the same reason we practice anesthetic injections and nitrous oxide on each other, it's entirely different when we are the patient sitting (nervously) in the chair.

Chocolate and gummy bears for dinner? Definitely. It's really for professional development.

    Friday, January 16, 2015

    How to become a dental wizard

    Malcolm Gladwell says you must devote 10,000 hour to something to become an expert. If we assume dental school is 40 hours * 50 weeks * 4 years, I clock in at 8,000 hours. And realistically, we get summers off, my vacations are dedicatedly dentistry-free, and some weeks fall short of 40 hours. In conclusion, I won’t be a dental wizard come graduation day- not just yet.


    I had a discussion with a friend about what a residency is. (I made a list of potential residencies to this winter break! I want to stay in the northeast in a city with good public transportation- that much I know.) He said that a residency is essentially some time you devote to furthering your knowledge. Instead of going out and practicing, you pause and say, “let me delve into this one thing”. The specific cases (which you hope to master) are funneled to you and you practice, practice, practice.

    Early this week I completed some restorations (lingual class III’s for you dentists!), stepped back, and thought “dang it looks good". Then Wednesday happened: I have a patient in the chair, working on a Class II. It's ten minutes to lunchtime and after taking off the rubber dam, no contact on the mesial.

    "I don't know what happened."

    You know the feeling when your heart just drops? That was me, dangling the piece of floss in my hand like "What the frenectomy just happened?". My faculty offered to stay behind and help me out. We used a different matrix system and after he helped me set it up, I said I could do it this time.

    Same thing, guys. Took off the rubber dam and NO CONTACT. I almost cried at this point. It was 1PM, no lunch break, and another patient was in the waiting room. Deep breath in, deep breath out. I needed to remember this quote and let it go- for today. Thankfully the patient was really understanding. She reads this blog too! But I'm not sure if she wants everyone to know she's walking around with an open contact... ;)

    My DMD will stand for: dentistry magic dandy-bird. It's such a jumpy journey! Dentistry is such a personal thing for me: I take a ton of pride in every restoration I place. And if it doesn't go well, I am frustrated and disappointed.

    10,000 hours. I've got a long way to go.

    Monday, January 12, 2015

    braces: found a good before picture

    You guys this back-to-school thing is crazy! I signed up for a selective class about pain management. Because it's an interdisciplinary class taught by different healthcare schools across Penn campus, the class is on weekends- a time that could be accommodated by everyone. 

    So all day 9-5 Saturday and 10-4 Sunday we learned about pain: the biochemistry, physiology of pain, and the treatments. It's tiring.... but the professors bring us coffee every morning! And everyone is so motivated to learn- not a single Facebook page on sight. This ongoing schedule also has pushed me to adapt quickly to school again. 

    This is possibly my last braces post. I found a good photo of my teeth at the start of my treatment. During vacation all I did was shout teeth comments at the television ("peg laterals!" "class III!"  "needs crown lengthening!") because all I notice is teeth (says my parents). And mine are no exception.


    The final product isn't perfect either, and if you look carefully at the pictures you'll notice two main things. I am not going to tell you what they are because I've chosen to ignore them and live in ignorant bliss. Besides, what crazy person's going to stare close-up at my teeth for two minutes? :)

    Many of you are starting school this week (last semester of undergrad, right?!!!!). Whoo! Rock your first weeks and have a great start to 2015.

    Friday, January 2, 2015

    gum health & recession after braces

    One thing I learned on vacation (now that my eyes are attuned to teeth,gums, and all) is that periodontitis runs in my family. It was a scary realization because you can't change genetics. I already have a receded spot where my teeth are extremely sensitive! And like everyone, I dread the black triangle... this is what I mean (in the before picture below):


    I wondered if my having braces made my recession worse. I'd heard anecdotes of peoples' gums going haywire after braces so I looked into it this sunny afternoon.

    In a study by Dr. A. Polson (who I actually work with in my clinic- I didn't realize this was his work until I went to reference this paper), six measures of periodontal health were measured in subjects that had orthodontic treatment ten or more years ago. Although some numbers differed (increased connective tissue attachment, probing depths), the results were clinically insignificant. This study hinted that there were no lasting effects of orthodontic treatment on periodontal health. However, study notes that none of the subjects were more than 36 and that an effect may manifest years later.

    Certain types of malocclusions, when fixed, may be prone to recession. One is Class II (a weak chin) which gets fixed by tilting the front incisors forward

    In conclusion, orthodontic treatment has not been proven to cause periodontal disease. I conceded that having braces makes oral hygiene difficult and may lead to inflammation/plaque accumulation/gingivitis, but the long term effects are still up for debate. However, a patient who is prone to periodontal disease (treated or untreated) may see their disease state worsen during treatment.

    So... for me? I'm going to take progress pictures every month to monitor my teeth (like any other good dental student) and not miss my dentist appointments. It seems to me that everyone has some periodontal issues and I wasn't immune to it... 

    Click for the entire (gloomy and funny) infographic:

    Sources:
    2. Nature