If the concept of giving local anesthetic injections wasn’t already anxiety producing, the name of the practice lab is sure to create some butterflies in your stomach. At least that is what happened to me. I knew I had the knowledge of where the nerves and the arteries were, how to position the needle, and how far to insert the needle into the tissues, but the idea of performing this procedure on a live patient still seemed a daunting task. As the day of Stab Lab grew closer, I started obsessing over the Local Anesthetic book, asking professors for tips, going over and over oral landmarks to assist in making the injections, even watching YouTube videos. Nothing seemed to make me feel more comfortable with “stabbing” my partner until I got the fact through my head that I will be doing this every day of my professional life! I had better get used to and become efficient at doing injections now so that I can begin to focus on all the other aspects of dentistry that come after the local anesthetic injection.

With this profound realization in my head, I still went into Stab Lab nervous. I was at the brink of being confident that I would do a good job, which showed personal progress compared to where I started. Setting up the clinic chair and talking to my classmates helped diffuse the apparent tension on the fourth floor. Then came the time to perform the injections on my partner. All I can say is that it was AWESOME! After you do your first injection, you get a feel for the needle and how it moves in the soft tissue. You get feedback from your instructor who is by your side the entire time, telling you to do this and do that. The fear slowly melted away and I felt more confident doing my last two injections…finally.

I learned that the anxiety was helpful because it made me slow down and really focus on what I was doing. I was able to pick up on cues my partner was giving, which were subtle but useful in helping me learn how to respond when my future patients react the same way. This is a huge step in becoming a dentist, and I can say with pride that our whole class did a great job in administering local anesthetic for the first time. Overall, it was a great experience and there was no need to be fearful to begin with. By the second semester of your second year, you are ready to learn local anesthetic techniques.

This past weekend I went to California for a college friend’s reunion. After graduating, my four college roommates and I decided that we would get together every year. While this is no small feat, it is extremely high on my priority list. Just as a great romantic relationship requires equal effort, this idea would require equal priority and value amongst all members. The Plan: Back in November, I started a group message to see when the best time would be to meet up. Timing can always be difficult, whether as a student or out in the workforce, but some compromises can go a long way. When deciding on the location, let’s just say that graduates, two years out of college, were not in the financial situation to jet off to Hawaii. We decided we would settle with a weekend in the Sierra Nevada’s at a family member’s cabin.

The Commitment: The two students had to commit to the idea and arrange flights so that we landed in San Francisco at the same time and decided one vehicle would suffice. The next step was to figure out what I would miss in school. I personally have always had a difficult time skipping class, because I often felt that it took about twice as long to catch up. I knew, however, that the value of seeing old friends would be worth the hectic week that lurked upon my return. The final and most important step to having a reunion was the act of getting on the plane or in the car to travel to the meeting spot. This was where one of my friends struggled this year. I texted him at DIA and asked if his flight was on time. His response was, “What?” I reminded him, “Your flight to CA?” Unfortunately, I was a bit too late, as he replied, “I’m at school. I thought the reunion was next weekend!” Needless to say, we were all devastated that this year would be 4 of the 5, but I’m sure this would not be the last time that all five would be able to attend.

The Value: In the few weeks leading up to our trip, I began to struggle focusing on my schoolwork. This was partly because I was getting excited to see friends. One had been in Santiago, Chile for 8 months, and I would be seeing him the day after his return, but also because there was a lot going on in my life. College friends have a special insight to your life. They are the ones that meet you as that semi-awkward and mostly lost 18-year-old. They get to share in your growth as your frontal lobe continues to develop and you become the person that is closer to your 50-year-old self than you might want to imagine. I believe that there is way more to college than a degree. The person that walks away from that institution can be exponentially different than the one that walked into it. Having people in my life that know and have shared in my self-growth can always provide a level of comfort no matter how long it’s been since we’ve seen each other. On a macro level, dental school can be a hedge maze, and as the days go on, the walls grow taller and taller. What is crucial for my pursuit to navigate (and sometimes crawl) my way through the maze is to every now and then get a birds-eye view of what I’m up against. Catching up with old friends and giving my elevator speech as to what dental school is like puts everything back into perspective. When I’m surrounded by other problems independent of how difficult a test was I feel like I am an executive in Westworld watching from above, and I can finally see the small confines of my own hedge maze.

Whether it’s commiserating about dating apps, swapping exciting stories about South America, playing board games while having a beer or two, or simply being able to shred sledding hills, there is some part of my wellbeing that can only be filled with time spent with old friends. They remind me who I really am and why I’m even where I am today. For myself, at no cost, financial, time or otherwise, is dental school and the busyness of a day or month worth the friendship of those that truly understand me.

The dental profession is combination of a great many things—science, medicine, art, psychology, and business. The list goes on and on. But it is also the center of a paramount struggle between subjectivity and objectivity. And no place is this more abundantly clear than in dental school. From the very early wax labs of first year, it became clear to me that dental school would not be nearly as cut and dry as any previous learning experience. One wax-up or sim lab crown prep could be deemed perfectly acceptable by one faculty member yet found to be perfectly horrific by another. Anyone who has weathered the many labs of dental school knows the familiar sting of rejected projects and grades all because they may have fallen upon the wrong eyes on the wrong day. Evaluations attempt to become standardized with grading rubrics and faculty calibration, but that only goes so far. When it comes down to it, each faculty member (and dentist) has a slightly biased opinion on what they find favorable and what they think works. That’s a completely natural and understandable phenomenon—they have multiple years actually practicing dentistry and have witnessed what is and isn’t clinically favorable in their hands. Not to mention there are multiple studies and research literature to help back their clinical actions and thought processes.

And, to you underclassmen, unfortunately this trend continues well into the clinic chairs during third and fourth year. A treatment plan can be created under one faculty, changed by a different faculty three appointments later and turned inside out again until you’re ready to consider a career change to professional badminton. It can be immeasurably frustrating. Part of that frustration is that most of the time, no one is really wrong. You can restore a tooth one way or six. The prognosis can be good with any path you take; it just comes down to picking a path.

This proves to be both a blessing and curse for dentistry. On one hand, it is insanely awesome that we have multiple options for caring for a patient’s oral health. Patients nowadays can choose from a variety of treatment options (favorability for that individual pending). Take for example a necrotic tooth. That tooth could receive endodontic therapy, be extracted and replaced with an implant, extracted for fabrication of a fixed dental prosthesis, etc. Dentistry does not always operate on a strict binary. This is something strikingly different from more physician-led medicine where many times an ailment comes with a diagnosis, and that diagnosis comes with a black and white regiment of certain medications or a rigid treatment plan. Dentists, more times than not, have the luxury of being flexible in treatment plans to cater them individually to a patient’s needs, whether those are medical or financial.

This is a notion that seems strange to the healthcare setting. Shouldn’t a patient’s health issues call for an exact and standardized course of treatment? Yes and no. Sure, there are standards of care in dentistry, but in many cases there is more than one way to achieve that acceptable level of care. And this is not without its issues. It’s no great secret that dental professionals disagree on a variety of treatment mindsets. Centric relation, ceramic material science, and timing for orthodontic interventions come briefly to mind. These are just the tip of the iceberg.

Matters only become more intricate when each dental discipline attempts to outmuscle each other. Perio becomes annoyed with restorative. Prosth scoffs at perio. Endo argues with oral surgery. And ortho just smiles and ignores everyone else. Therein lies a problem related to subjectivity in dentistry. No longer are the disciplines as strictly divided by an objective dental role. With in-office technology, it is now possible for an oral surgeon to cement a crown or for a general practitioner to place implants. The lines have become blurred. Dentists and specialists have been given the opportunity to subjectively decide what kind of care they should perform as opposed to adhering to a more tightly bound scope of practice. While there still are standards of care that every dental professional must meet regardless of standing or specialty, it has become more difficult to make those designations. There is, of course, nothing wrong with a single provider offering a variety of treatments, but we must be cautious, as one insightful professor stated, that the dental realm does not “turn into Wal-Mart.” We are here to provide excellent patient care. We are not here to cherry-pick sub-standard procedures out of convenience.

There are days when practicing dentistry can feel like opening Pandora’s box. Treatment plans, patients, and faculty all snap and snarl around your head making an organized train of thought nearly impossible. But it is important to also embrace the unique subjectivity that dentistry has to offer. We have the ability to explore various avenues in treating patients and benefit from the eclectic mix of guidance and experience that our mentors—whether faculty members or other practicing dentists—have to offer. Accordingly, we must understand and appreciate each dental discipline in order to allow them to exist symbiotically so that refined and effective comprehensive care is created.

*Image credit to Karen Mooneyhan--Colorado's finest post-modern artist.

As someone who volunteers at the local DAWN Clinic, I wanted to sit down with two of the student leaders and really layout the facility, its mission, and what it's striving to do for the community. Emily Malihi and Kim Engols, both third year dental students and masters behind the magic of DAWN, were kind enough to oblige me and offered some considerable insight into the clinic:  

Can you give me an overview of DAWN? Who's involved? What services are provided?

Emily & Kim: "DAWN (Dedicated to Aurora’s Wellness Needs) is IPE [inter-professional education] in action! There are students from every graduate program at Anschutz. In addition, there are behavioral health and undergraduate students from DU and UCD who are also active volunteers within the clinic. DAWN provides primary care services (including phlebotomy!!!) for the underserved population of Aurora every Tuesday. Specialty care, such as optometry, dermatology, and pulmonary health is provided on the third Tuesday of every month. Dental screenings are provided every week except the third Tuesday of every month to allow space for the specialty clinics. Instead, dental services are provided on the third Wednesday of the month to provide definitive dental care for previously screened patients."

Tell me about your roles.

Emily & Kim: "As dental workgroup leaders, we are responsible for recruiting and training faculty and student volunteers. Each week we alternate attending clinic nights to ensure dental clinic flow is smooth and volunteers are prepared for clinic night. We serve as the liaison between DAWN and the dental school, and advocate for our profession within the clinic. Once a month we meet with DAWN workgroup leaders from all professions, and discuss ways to improve clinic flow."

What does a typical night at DAWN look like? 

Emily & Kim: "On a typical Tuesday evening, 8-10 patients are scheduled with room for another few walk-in patients. Once patients are checked in, they are taken to triage to discuss chief complaints and take vitals. From triage, patients are taken to their respective exam room to meet with a team of inter-professional students to discuss and address health care needs. At the end of the evening, all patients will finish with Care Coordination to discuss treatment plan needs and plan for follow up care. As you can imagine, this makes for a very busy clinic! Managing the patients to and from registration, triage, exam rooms, and care coordination are three managers and a clinic director."

In what direction is the DAWN Clinic headed and what is its personal mission in the dental world?

Emily and Kim: "The DAWN Clinic is continuously working on expanding the services they provide for patients. The clinic will be hosting a large fundraising Gala in January to raise funds for our patients. Within the dental clinic, we recently partnered with Dental Lifeline to provide free definitive dental care for our patients. This has been our greatest accomplishment to date! We are also working on updating our dental chair to a more comfortable and functional one. In addition to providing screenings, our mission is to improve our impact on inter-professional education by involving more dental students in all aspects of patient care to include helping with registration, translation services, care coordination, and supply procurement. Furthermore, we seek to improve inter-professional knowledge of oral health care and knowledge of when a dental referral is indicated."

Is there anything else you two would like to add?

Emily: "I participated in many student organizations during my time in undergraduate and graduate school, but my involvement within the DAWN Clinic has been the most rewarding, most meaningful experience. I hope that more students get that chance to become involved within the clinic at some point during their educational experience at Anschutz."

Kim: "A few weeks ago, I had a new patient, Ms. A., assigned to me within the dental school. It had been 12 years since her last visit and I was curious to know what prompted her to make an appointment with us after so many years. Ms. A., mentioned she has been seeing an endocrinologist, Dr. J., to manager her type 2 diabetes, and at her last appointment he asked to look inside her mouth. Dr. J. told Ms. A., she needs to make an appointment with her dentist ASAP, and he expects this to be completed before the next time he sees her! Prior to this, Ms. A., mentioned no other health professional had asked about her dental health. This is the perfect example of what we should strive for with inter-professional education. The DAWN clinic fosters this attitude and I am confident this experience will make us all better and more well-rounded practitioners."

It is no surprise that the DAWN Clinic is having quite the impact on healthcare in the Aurora community. Patients who may not be privy to their health deficits can now find themselves with a wealth of information that can help them make decisions about treatments and future referrals. I am proud to be a member of the dental team, and I look forward to continuing to integrate oral healthcare into the primary health plans for the patients of DAWN.

*Many thanks to Kim and Emily for their time and insightful words. If you have any questions about the DAWN Clinic, please feel free to leave a comment and we will be in touch.

On Tuesday, November 2^nd (or early the next day), millions of Americans retired to their beds. As they closed their eyes, some felt hopeful and excited; others felt angry, depressed, or even confused. Regardless of the divergent emotions that night, the sun still rose in the morning. Life continued, as it always does. Now that the election frenzy has subsided, we can begin to examine the impact our newly elected leaders, referenda, amendments, and miscellaneous ballot initiatives can have on our personal and professional lives. As a lawyer and self-proclaimed political junkie, I spend a substantial amount of my free time fixated on articles and news commentary about the candidates, the issues, and the future. After countless hours of examining the impact of our new president, the power dynamic within Congress, and my local elections, I must confess that I cannot make any concrete assessments at this point.

However, I can conjecture what the main issues confronting dentistry and health care will be based on my own perspective and that of the ADA. I will continue to examine how the new administration, nationally and locally, will shape the future of these issues.

According to the ADA website, the main issues its advocacy branch monitors include access to dental care (including health insurance coverage), health care reform vis-à-vis the Affordable Care Act, and continuing oral health science and research initiatives at the federal level. Additionally, the ADA routinely reviews regulatory issues that face dentists as employers and business owners—from taxes, workforce safety requirements (i.e. the regulation of amalgam), labor and employment laws, and Medicare coverage for patients.

In addition to the issues that the ADA has identified, I also hypothesize that the general cost of health care and drugs will affect dentistry either directly or indirectly. As many have noted, non-dental insurance premiums have risen significantly and will continue to do so. Many blame the Affordable Care Act as the culprit. Regardless, those who must pay heftier insurance fees may exhaust any allotted funds they had for healthcare in general. Thus, it is possible that those most stretched by increases in insurance will forego dental treatment.

Additionally, the shifting environment of drug regulation may impact dentistry. Over the past year, senators and political candidates have questioned why some life-changing, necessary drugs come with exorbitant price tags, precluding many patients from taking them. The drug companies have responded that the price reflects the cost of investment in research, development, and the countless clinical trials required by the FDA to bring that drug to market. Since dentistry strives for continuous improvements to its techniques and methods, this issue may have an impact on the rate of investment in private oral health-related R&D.

I remain cautiously optimistic that regardless of this year’s election outcome, the dental profession will continue to thrive, and patient care will continue to improve. Members of our profession are passionate about improving dentistry, and will do whatever it takes to make it better. We are also fortunate to have one of the most successful national lobbies in history, which continuously advocates for patient’s interests and our personal interests. With a high percentage of dentists being members of the American Dental Association, the collective voice of dentists is one that lawmakers hear loud and clear.

As members of the dental profession, a profession that has a large health and economic impact on our country, it is imperative for all dentists and dental students to stay apprised of the political landscape. We must proactively work to make oral health care better for our patients and our own livelihood. Otherwise, we might wake up to a political climate that contradicts our profession altogether.

The other day I went on a run for the first time in a long time. When my hands stopped tingling due to a lack of oxygen and I finally caught my breath, I stopped focusing on the simple act of running and, instead, on letting my mind clear. That is my goal with running. I’m not particularly good at it, which is evident by the scar on my knee from falling on dry pavement not once, not twice, but three times. And, unfortunately, I do not have steel-cut abs from it (I like ice cream and beer too much for that). However, in spite of those things I still love to run. It helps me to clear my mind and accomplish new perspectives by seeing past the tunnel vision of dental school. Once I let the thoughts go that were occupying my mind, I took notice of the environment around me. I ran past a house with about 15 feet of sidewalk in front of it, and thought, “What is the point of that?” The sidewalk was not continuous, which basically rendered it useless. The only purpose that sidewalk served was to be stood on when the house owners checked the mail or for a short game of hopscotch for the kids that lived in the house. While those things do serve a small, individualized purpose, they do not serve the purpose for the goal of a sidewalk—to make a continuous path for pedestrians.

The more I thought about it, the more I saw the reflection of my dental school education in that oddly configured sidewalk. My classmates and I establish squares of concrete and temporarily learn as much information as we can about a certain subject. The newfound knowledge is then promptly “brain dumped” after a final. We learn essential details to get us through our most recent assignment in lab, but we fail to understand the big picture. While these segments of sidewalk serve a great and noble purpose for the task at hand, they will not be very useful when it comes to walking around the block.

As we slowly (and I’d like to think gracefully) crawl towards the graduation finish line, we must keep this in mind. Our snippets of knowledge will only get us so far; it is the segments that connect those pieces of knowledge into a contiguous and fluid path that will allow us to smoothly navigate to our endgames. No matter where we are in our dental careers, we need to be sure to construct our sidewalks so the stroll around the block can be as seamless as possible. After all, you can have all the knowledge in the world, but if you can’t see the forest through the trees, then that knowledge simply becomes facts rolling around in your head.

My thought process wouldn't be complete without including this popular and all-too-relevant poem from Shel Silverstein(1.):

1. Silverstein, Shel. Where the Sidewalk Ends: The Poems & Drawings of Shel Silverstein. New York: Harper and Row, 1974.

A truly historic and special weekend in Chicago happened to fall on the same weekend of ASDA’s National Leadership Conference this year. With the Cubs winning it all and the Ireland v. New Zealand rugby matchup the next day, the city was alive and buzzing. The energy of the city undoubtedly seeped its way into the already hyped up leadership conference. Opening the conference was keynote speaker Adam Kreek, an Olympic gold medal rower who took us through his journey rowing across the Atlantic Ocean and his subsequent trials and tribulations. His message on achieving happiness was simple and consisted of the fantastic four: health, relationships, community involvement, and self-awareness. Happiness is not, however, achieved through money, fame, and beauty.

The carefully selected speakers and quality content are what make the NLC one of the best dental student conferences in the country. Every year, Colorado ASDA sends our members to build a network with 600 other dental students while growing and developing as leaders. Although there is nothing like being present at the conference, it is worth sharing some of the gems and takeaways from the breakout sessions. Here are some of my notes from a couple of sessions:

Building Your Personal Brand

By Dr. Ryan Dulde

• A personal brand is a true story about who you are and why you matter. If you don’t know, there is no way anyone else does.
• Brands are not invented. Find something real. Make it intentional.
• Brands set expectations, start relationships, and make you unique.
• Futuredontics conducted a survey to figure out why people go to the dentist. Here are some of the results: 70% go for ratings, 70% education background, 70% location and availability, 80% insurance, 86% scope of services.
• Would you go back to the dentist? Here’s what people are concerned about: 87% say it’s important that the dentists is cost sensitive, 91% want cleanliness, 91% want upfront costs, 93% want options well explained, and 95% want quality work.
• Without a brand you are just a commodity.
• A great brand does not leave its story to chance.

How Not to Fail Miserably in Private Practice

By Dr. Chris Salierno (Chief Editor for Dental Economics)

• It is important to take the pulse of your practice.
• Take a look at your practice daily, monthly, and quarterly to assess how you are doing.
• Daily: How much did you produce? How much did you collect?
• Monthly: Productions, collections, and new patients.
• Quarterly: Income statement, profit and loss statement.
• The overhead monster: the national average for dental office overhead is 75%.
• Goals for overhead by specialty:
• 59% for GP
• 42% for Endo
• 49% for Ortho
• 49% for Pedo
• 50% for OMFS
• 51% for Perio
• 64% for Prost
• Overhead breakdown for GP practice:
• Staff = 25%, Lab = 10%, Rent = 5%, Supplies = 5%, Misc. = 14%, this leaves you with a 41% Net Income.
• Patients don’t care about what you do in their mouth unless it hurts, turns black, or falls out.
• The patient experience starts before you meet them.

This is just a snapshot into the 20+ breakout sessions that were offered over the weekend. Other topics included were mindfulness, non-traditional post graduate options, and effective communication. CE credit was given for each session attended and can be used towards an Academy of General Dentistry Fellowship Award after graduation. The closing session was a story told by Doc Hendley, the founder of Wine to Water, and described his journey through Sudan in an attempt to bring clean water to those in need. Side note: A surefire way to make your dental school problems feel small is to do a little research on the water crisis.

The National Leadership Conference attracts students who are excited about dentistry, want to make a difference, and strive to be better leaders. Valuable breakout sessions, CE credit, and epic five star social events in the evenings are all part of the experience. If you are interested in attending a National Leadership Conference in the future, be sure to ask how you can get involved!

Various professions, trades, and groups of individuals with similar interests have so-called annual “conferences”. Many of these are similarly structured in that they have a “kick-off” session, an inspiring keynote speaker, and various breakout sessions with a myriad of topics. On the surface, the American Dental Association (ADA) annual meeting seems no different. However, any attendees can tell you that attending the ADA Annual Session results in a deeper, more meaningful connection to the dental profession than imaginable.

This year, as a student at the University of Colorado School of Dental Medicine, I was fortunate that the ADA chose Denver as the host for the annual meeting. As supporters of organized dentistry and continual learning, the school administration also chose to close our school to allow enthusiastic students and faculty to attend the conference.

While I knew that over 20,000 individuals with some connection to dentistry attended the conference, along with hundreds of exhibitors, I never anticipated the invigorating effect attending the conference would have on me indefinitely.

As President of Colorado ASDA, I was honored to have a small role in the Opening Session. During the rehearsal, I spoke with several presenters for the Opening Session---all dentists who had overcome adversity in some way to become successful dentists and role models. Their relentless pursuit of dentistry demonstrated to me that our profession is a special one—a profession that people pursue despite numerous financial and personal roadblocks.

After the Opening Session, admittedly, I was overwhelmed with my breakout session choices. The ADA had dozens of interesting breakout sessions, ranging from the use of dental photography and botox for cosmetic cases to the status of global oral healthcare and how to better market yourself. No matter your interest, the ADA had a breakout session with a distinguished speaker for you!

Additionally, throughout the conference, the Exhibit Hall was open where one could learn about the various dental-related products and services available. This too was an educational experience, since all dentists must be thoroughly knowledgeable about the products they are using, the professionals they use for other needs, and the organizations that can help them.

Often, other dental-related groups hold meetings or corollary events during the annual meeting, since so many dentists will be congregated in one place. Our Colorado ASDA chapter also took advantage of this by hosting a private session with Dr. Gordon Christensen (along with the University of Colorado School of Dental Medicine, the LDS Academy and the Metro Denver Dental Society). Dr. Christensen is a pioneer in dental education and world icon in dentistry. We were honored to have him speak to our students and local new dentists. As with other distinguished speakers, he was also in Denver for the ADA Annual Session.

Another highlight for me, as with many others, would be the keynote speaker, Nobel-laureate Malala Yousafzai. As you may know, Malala is a global icon for vocalizing the importance of seeking an education.

At first glance, it may not seem like her cause is directly related to dentistry. But it is. As dentists and future dentists, we are automatically leaders. We are leaders of dental teams. And as professionals who must abide by a code of ethics and seek to do what is in the best interests of the people whom we serve, we are leaders in society.

As leaders, it is our duty to stay engaged in discourse about the status quo and continuously use our influence and respected position to make positive change—not just regarding dentistry, but any other injustice we see fit. As educated, and therefore, privileged individuals, we should never hold back. Instead, we should continuously be proactive to challenge our communities and ourselves.

Attending the annual session is just one way for dental professionals to stay connected with each other, reaffirm their commitment to the profession, and continuously evolve as professionals and people.