I can still vividly recall that fateful day in August of 2010, when my childhood dream of becoming a dentist finally came to fruition, graduating from Islamic International Dental College, Pakistan with a Bachelor of Dental Surgery degree. Like every other dental school graduate, I had worn my white coat many a times during the course of my studies, but donning one as a professional truly filled me with a sense of mission and pride. I was truly excited to become part of a noble system that provided care for people who silently suffered in pain under the presumption that dental health is only secondary. My determination was not only patient care, but to treat them with a sense of compassion, dignity and otherwise bring change to society through education and service. First venture outside the boundaries of dental school brought me to Pakistan Institute of Medical Science (PIMS), thinking what better place to start a career than a hospital with the largest dental department in the city. I was shocked to witness the state of disarray and utter chaos, when I was first introduced to the emergency room. Often illiterate and with minimal financial resources, these patients were usually referred to other departments for lab work, without adequate directions. I could personally feel their sense of vulnerability further heightened by such insensitive however unintentional treatment, from the very individuals that had taken the hippocratic oath.

Bound by crippling poverty and illetracy, dental care for the poor enmass in Pakistan has primarily been relegated to streetside dentists. Albeit a cheaper alternative, these quacks have exacerbated the spread of hepatitis and other bloodborne infections. See the links below, which provides an overview of the services administered by these street side quacks and their impact on the health of those with limited financial means.

Youtube Video: https://www.youtube.com/watch?v=09XY0u0CQOM

BBC Article: http://www.bbc.com/news/world-asia-25370775

My first week of contact, I remember attending to a middle-aged patient complaining of severe discomfort. Further examination revealed a self-cure acrylic prosthesis installed by one of these quack dentists, where the monomer had caused a hypersensitivity reaction, requiring a healing period followed up with fabrication of partial dentures. How could a person be allowed to endure such pain, only because they were unaware or lacked the means (whether financial or accessibility) for proper treatment? Anger eventually gave way to acceptance and I made it my goal to help those in need. Over the course of the next three years serving at public institutions in Pakistan, I witnessed several other incidents of this nature but instead of being demoralized, it gave me the strength and determination to continue my passion of helping those less fortunate.

Living in Pakistan, a country deeply mired in the clutches of corruption and violence has sowed in me the desire to effect major change in the way we manage healthcare for the needy. It must become a priority for all dental professionals including recent graduates, practicing professionals and industry veterans to actively organize and participate in dental awareness campaigns and advocate access to affordable healthcare and medication for the poor across all communities and nations alike.

Happy Summer to us! As we enter into the beginning of another year of dental school, I wanted to take some time to thank all of Colorado’s students for taking interest in the blog. This year I have goals to expand the audience of both our writers and readers. I envision CU to be a place of camaraderie and I believe we can start with the blog.

This year, the Blog’s mission displays, “The aim of the Colorado ASDA blog is to celebrate the diversity of the students and faculty here at CU. The hope of the blog is to inspire dental minds and attitudes in an enjoyable reading format.” Not only is the blog meant to collaborate on dental topics, but it is also aiming to shine on our accomplishments and stories outside of dentistry.

I hope you can all look forward to reading the Colorado ASDA blog in the coming months. We have so many exciting changes this year and we want you to be a part of them! You can expect an email in the coming weeks on how to apply to write for Colorado ASDA.

I also want to congratulate the incoming Class of 2021! I am excited to meet you all and I am sure my ASDA colleagues can say the same.

Best,

Sierra

Lobbying on Capitol Hill is one of the most unique activities that happens in Washington D.C. Each year, the House of Representatives and Senate write bills that are passed into law by the President. As the political climate in Washington regularly fluctuates, it is essential that constituents address issues with consistency. Two weekends ago, we saw this in action. Thousands participated in the Tibet National Lobby Day, AIDS Foundation Lobby Day and ADA Dental Lobby Day. All were welcomed and given the ears and time of their elected officials.

For the past two decades, the American Dental Association (ADA) along with the American Dental Political Action Committee (ADPAC) have advocated for the dental profession on Capitol Hill. They have ensured that core concerns that effect our profession, providers and patients are voiced to our legislators. This year, for the first time, the American Student Dental Association (ASDA) joined with the ADA and ADPAC to voice the current issues important to our profession together. We took the following issues to our legislators; The Competitive Insurance Reform Act, the Student Loan Programs under the Higher Education Act and Health Care Reform: Supporting Oral Health.  

This year, a week before our Lobby Day, we saw years of the ADA’s hard work pay off as the 115th House of Representatives voted a 428 to 6 majority on H.R. 372. This repealed the Mccarran-Fergussan antitrust laws for medical and dental insurance companies. Since 1945, insurance companies have been exempt from the McCarran-Fergussan antitrust laws which prohibits companies and business owners to discuss and set similar prices for their products and services. Greater federal involvement in antitrust enforcement should encourage more competition in the healthcare insurance marketplace. More competition will promote lower prices and greater consumer choices for all Americans purchasing medical and dental insurance. This week, we thanked members of Congress for supporting this bipartisan bill and urged our senators to support or even sponsor a sister bill so that it can be passed in the senate as well. 

Rising student debt for undergraduate and graduate students is a prevalent concern for many of us. This concern is being voiced on Capitol Hill.  In 2016, the average student debt for recent dental graduates was $262,119. That is a 5% increase of average dental student debt in 2014. The weight of student debt limits many graduates’ professional pursuits, especially those who want to serve in public service, teaching and research positions. As Congress reauthorizes the Higher Education Act this year, we continued to voice our concerns regarding student debt as we met with members of Congress. Currently, there is a sponsored bill, H.R. 1614, that would allow students to refinance their graduate student loans at anytime through out the life of their loan. This would make keeping our student loans with the federal government more appealing and could save graduates thousands on accruing interest. Currently, the interest rate is fixed for the life of the loan. This week we tried to gather more representatives support for H.R. 1614 so that it will pass when it reaches the House floor. 

Since the instatement of The Affordable Care Act (ACA) the uninsured rate for Coloradans has dropped from 14.7% to 6.7%. Additionally the recent medicaid expansion in Colorado, passed in May of 2013, expanded coverage to more than 200,000 Colorado residents. As a direct result we have seen the number of hospital dental visits go from $11 million dollars to $1 million dollars annually in Colorado. We want to continue this progress as the expanding coverage reaches many of our small towns in eastern Colorado and in the Western slope. This was emphasized to our representatives by our doctors who practice in these areas. As health care is a hot topic on Capitol Hill right now we also discussed the importance and need for dental insurance transparency. Our doctors from the CDA have seen many patients who sign up for dental insurance and find out they aren’t covered until they pay for 24 months of premiums. Overall, we advocated for more transparent dental insurance plans so that our patients know what they are purchasing and what to expect from us.   

During our Lobby Day we were able to visit all 6 of our district representatives and both senator’s offices to discuss the issues above. It was great to see the impact we could make on organized dentistry by voicing our concerns to our legislators! It made me proud that we are included in a profession that stands united in protecting and advocating for our patients and doctors!

I’m rushing, I know I’m rushing. I feel the beat of my heart beating throughout my entire body. Underneath my yellow gown, I can feel myself getting sweatier and sweatier. Good thing I remembered to put on deodorant today. My anxiety levels are shooting out of the roof. Why? I got out of class late, and I’m trying my darndest to set up for my medically complex patient in time. I’m under a particularly particular faculty, and I feel nowhere near prepared. I’m getting to the point where I’m so stressed; I’m forgetting the little things. Have I gathered all of the materials I need? Do I even know exactly what I’m doing today? Have I looked up all of my patient’s medications, so I can give that stellar start check? As dental students and young practitioners we’ve all been here. In the journey to become a dentist, it is almost impossible to not experience the stress and anxiety similar to above. For some of us, it may be every single clinical experience, and for others it may be during our competencies and testing situations. No matter what, it would be remiss to ignore the effects that stress has on our work.

It’s in moments like these that we need strategies to deal with this tension. Lucky for us, there is a myriad of methods to prevent stress, anxiety, and other debilitating emotions from taking hold of our lives and our dental careers. My personal favorite is Mindfulness Meditation. You’ve probably heard of it, as it’s a bit of a “hip” topic in the psychology world. This is for good reason, as there are plenty of scientific studies to back it up.                               Photo Credit: http://www.huffingtonpost.com/lisa-firestone/mindfulness-benefits_b_2965648.html

Often, when people think of meditation they think that it is the absence of thoughts and feelings—a spiritual experience that only monks who practice for lifetimes get to go through. They couldn’t be more wrong. Mindfulness is actually being very present in the current moment. It is accepting and not judging your current situation. The very key to mindfulness is not that your mind doesn’t think of things, but that when it does you bring yourself back to the task at hand.

Mindfulness is a skill that can be practiced and honed. You probably won’t be very good at it in the beginning, but being good at it is not the point. The point of mindfulness is to not let your emotions and thoughts control you. Having mindfulness meditation in your “tool box” can take the hectic situation from above and flip it on its head. Mindfulness is most definitely not a cure-all to all stresses in life. However, after practicing mindfulness, when you start to feel those familiar feelings of stress and anxiety creep up on you before a challenging clinic session, you will have a tactic to no longer succumb to those pressures. Rather than freaking out over the things you cannot change, you take on the procedure one step at a time. You will make less mistakes, and most importantly you will provide your patient with the best care possible.

There are four different ways of practicing of mindfulness: breathing meditation, body scan, loving-kindness meditation and observing-thought meditation. The key is finding which one works for you. You can find a myriad of different sources to learn about each type and to get resources to help you out. Those include apps with guided meditations (Headspace is my personal favorite), podcasts, and videos on YouTube. Whether you are a mindfulness expert or simply a beginner, I encourage you to continue down the path to a healthier, happier you and a less stressful, more enriching dental school career.

Treatment planning is an integral skill taught in dental school and a core foundation of dentistry as a healing profession. This planning can become an overwhelming onslaught of triaging problems, combining disciplines, all the while catering to the individual patient’s desires and limitations. A particularly careful and important concept within treatment planning is the process of phasing out the treatment. At the University of Colorado, we generally abide by the layout of Phase 0 for emergency procedures, Phase 1 commonly for perio procedures and routine restorative work, and Phase 2 tends to be the fixed and removable prosth. We are taught to not move onto a new phase until we have completed all treatment from a previous phase (with some faculty following this guideline with the fervor of a religious zealot). While this works in the majority of cases, there are times when phasing must be thrown to the wind in order to achieve the most ideal outcome for the patient. Recently I had a patient, Z, for whom I completed an oral diagnosis. Z’s treatment plan consisted of a perio visit, a few simple (non-urgent) restorations, and a full coverage crown. It was a straightforward plan; however, I knew I was going to run into an issue with the phasing. The tooth requiring the crown had been endo treated two months prior and still contained a temporary restoration. Yet due to the phasing guidelines, I was technically not allowed to begin the crown procedure until I finished the restorative work. I found this outside of the best interest for the patient’s oral health—especially since it is widely accepted that the success rate for an endo-treated posterior tooth is equally dependent on the quality of the root canal therapy and the quality of the full coverage restoration. I was curious to see if timing of the full coverage restoration was also a key player in the prognosis for the tooth. I knew that if I was to challenge the phasing procedure during this patient’s care, I was going to need some evidence to back me up.

That evidence came beautifully presented in the Journal of Endodontics. Isaac Prat et. al. completed a retrospective study on the timeframe between completion of root canal therapy and the placement of a crown—and the resulting survival rate of the tooth in question. (1) Two different groups were formed: teeth receiving crowns within four months of the root canal therapy and crowns being placed after the four months. After analyzing the data and making the appropriate exclusions, the conclusion was significant: the teeth that received their crowns past the four month point ended up being three times more likely to be extracted than the teeth that had crowns placed sooner. (1)

This study confirmed my suspicions. It was likely in my patient’s best interest to have this crown placed sooner rather than later. Armed with my new arsenal of evidence-based dentistry, I presented to my faculty. Much to my relief, I was met with very little resistance as I articulated my case and elaborated on my plan of action. The faculty was very pleased that I had thought critically over the phasing and had done some research to support my claim. I gained a valuable lesson from this experience—not every patient fits into the idealized mold of phasing out treatment. Modifications need to be made, and careful thought must be undertaken to construct the most appropriate timing of a treatment plan. And what better way to guide you through those thought processes than a little evidence-based dentistry!

(You're welcome, Dr. Astorga)

1. Pratt, Isaac et al. “Eight-Year Retrospective Study of the Critical Time Lapse between Root Canal Completion and the Crown Placement: Its Influence on the Survival of Endodontically Treated Teeth.” Journal of Endodontics. November 2016. 42(11): 1598-1603

On January 15th, 2009, US Airways Flight 1549 took off from New York City’s LaGuardia Airport at 3:25 pm. Less than six minutes later, the aircraft crash-landed in the middle of the Hudson River. Everyone onboard survived and few serious injuries resulted. The event known as “The Miracle on the Hudson” immortalized the commander of the plane, Captain Chesley Sullenburger. Somewhat less well known is Sullenburger’s copilot, First Officer Jeffrey Skiles. Flight 1549 was Skiles’ first time flying an Airbus A320 since passing the qualifications to do so. As the keynote speaker at the recent 2017 ASDA Annual Session in Orlando, First Officer Skiles described the systems and protocols that led to the successful crash-landing on the Hudson. When a flock of geese collided with Flight 1549 shortly after takeoff, the airline crew initiated a cascade of emergency procedures. As Captain Sullenburger communicated with the control tower at LaGuardia, First Officer Skiles reached for the Emergency Procedure Book readily found in every airplane cockpit. Although this was Skiles’ first commercial flight on an Airbus A320, he had been trained for this. To simplify training, cockpits are standardized across the airline industry. This minimizes the unfamiliarity of a new aircraft. Other industry standards include seat belts and life jackets for each passenger and crewmember. These environments reduce the possibilities for failure or confusion. The familiar cockpit allowed Skiles to act quickly and confidently with each step of the protocol. Seat belts and life jackets at each passenger’s seat minimized panic and injury. First Officer Skiles sited a large part of his success that day to the standards set in place that diminished the possibility of failure.

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The airline industry is not alone in manipulating an environment to encourage success and influence human behavior. Plants and vegetation in inner-city housing developments reduce crime rates. Parks and trails result in improved community health. Advertisers use color to conjure certain emotions. Thanks to Annual Session being held in Orlando, I was able to make a quick trip to Disney World where I noticed myself being manipulated by the psychological puppeteers of Disney.

Because of ASDA-related activities that took place in the afternoon, my group only had three hours of magic before the park closed at 10pm. Despite our limited timeframe, we decided it would be worth it to jump into a 60-minute line for Space Mountain. To our surprise, just 20 minutes later we could literally see a light at the end of the tunnel! We went from this long, dark tunnel to a large room where we could see people getting on the ride. It looked like we’d be on the ride in no time. This disillusioned sense of progress kept our spirits up until another 20 minutes later when we realized the line had yet to wrap behind a long wall before re-entering the room. We ended up waiting a full 65 minutes!

It turns out Disney spends loads of money on studying the psychology of waiting in a line. To keep thousands of park attendees in good spirits, they design the lines in such a way that repeatedly gives people false hope as they endure the long wait for popular rides. A simple Google search on “Disney World psychology” revealed other ways Disney uses the environment to manipulate emotions and behavior. The walkways throughout the parks are made of black pavement, which encourages park-goers to seek the cool shade provided by nearby shops and eateries. Taking it a step further, some of the shops pump out fragrances that smell like freshly baked goods. Other shops crank the air conditioning to encourage shoppers to buy a hoodie that they would otherwise neglect in the Florida heat. Sections of the park Disney wants to remain hidden are painted in a color referred to as “No-See Green,” a shade of green easily overlooked by the human brain. This is uncanny, as I don’t recall seeing any “No-See Green” in Magic Kingdom…

While shadowing in dental offices during undergrad, I noticed this same use of environmental manipulation. Operatories, countertops, and cabinets were labeled to encourage organization, efficiency and infection control. A printed schedule displayed a morning huddle at the start of the day to confirm plans and review goals. Even switching a patient’s manual toothbrush for an electric one had repeatedly demonstrated a successful outcome in improving oral hygiene. Changing the environment for patients and staff yields real results!

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It’s difficult to invoke change in people who aren’t motivated to change. Being quite stubborn and impulsive myself, I have obsessed over this idea that changing one’s environment will change one’s behavior. As students, we can mold and model our environments to ensure success! The following are some examples of environment adjustments that have worked for me.

During my undergrad, I began every day with my phone. Checking messages, news, and social media consumed precious time that would have been better allocated toward working out and making breakfast. To change this, I set up a charging station outside of my bedroom. Before bed, I put my electronics in a drawer where they are charged out of site. I am not allowed to open that drawer until after breakfast. Hiding the electronics has been a simple change to my environment that has drastically improved my morning routine—just like “No-See Green”.

Other habits can be easily manipulated by simple adjustments. I’m a natural night owl. My nocturnal habits quickly became a problem in dental school, so I committed to going to bed earlier. The commitment fell apart within two days. After repeatedly failing to change my habit of staying up late, I turned to my wife (my copilot, if you will) for help. I told her my plan to set an alarm to go off at 9:00 pm every night, signaling for me to begin getting ready for bed. I asked her to help me stick to that commitment. The nighttime alarm combined with reliance on a copilot has yielded great results. Don’t have a spouse? Find one. Just kidding. Ask a roommate, friend, classmate, significant other, or family member to help you out!

After a decade of trying to set meaningful New Year’s resolutions, I was tired of letting those resolutions slip away by mid-January. All my mentors and role models successfully set goals and resolutions. Why couldn’t I? Did I lack motivation? Did I lack discipline? Yes. And yes. My wife and I decided to write “Weekly Planning” into every Sunday night in our calendars. We don’t let anything get in the way of our weekly planning session. This time is used to review goals, discuss obstacles, adjust our routine, and plan the upcoming week. It was such a simple change! We even took it a step further and laminated a protocol that we follow every time we plan. Excessive? Perhaps. But here we are, mid-March, and I’m still plugging away at the same goals I set in January.

Whether it’s to avoid disaster, maximize efficiency, or encourage a certain behavior, customizing an environment is a powerful psychological tool. As students, we often have so much to worry about that we can’t spare the mental and emotional energy required to constantly motivate ourselves toward success. If you’re struggling to exercise, study effectively, eat healthy, manage relationships, keep track of goals, maintain your sanity, or land a plane, try changing something in your environment that will make it harder for you to fail!

Dental Conferences are like rushing for a sorority; endless small-talk and prattle of where you're from, what school you go to, what year you’re in, and what position you hold. It almost feels like a rapid-fire competition of who can ask the most questions and how quickly someone can fill those awkward silences (my favorite). At this point, I could probably say I’m a small-talk aficionado given that most of my extracurricular activities have involved this sort of interaction with people. However, I have slowly come to the realization that these kinds of conversations, although I do them mindlessly, leave me exhausted and apathetic. One of the beauties of student dental conferences is the myriad of networking opportunities. We have the ability to expand our little black book of contacts in the hopes of making connections with the people that will be in our future professional community.

Networking: “interact with other people to exchange information and develop contacts, especially to further one's career” - Google

That last line has never sat well with me and I doubt anyone would like to be described as an opportunist or a carpetbagger. This type of “you scratch my back I scratch yours” mentality limits ourselves to the facts and figures of conversations instead of digging deeper to who we are as people. It seems that having one insignificant conversation with somebody and handing out our business cards like they’re Halloween candy will automatically put us in a position to ask for favors in the future.

Why does Networking only have to be small talk? Why can’t it also be big talk?

I understand that some people are uncomfortable with getting straight to the big questions right off the bat. But I will argue that you can definitely turn insignificant pleasantries into meaningful dialogue and part of it is getting over our fears of looking too inquisitive or intrusive. We all know what open-ended questions are; we do it with our patients all the time. Why can’t we do the same when networking?

This mentality may be in due part to my ENFP personality and my will to find the deeper meaning in anything and everything (I strongly encourage everyone to know their own Myers Briggs letters). I don't mean I will always try to have existential conversations or discuss the nature of the cosmos with every stranger, but I will absolutely try my best to leave an exchange of dialogue knowing something enticing about a new person. Opening-up and having a moment of feeling listened to will make a person much more likely to “do you a favor,” if that's what you’re looking for in networking. I know it sounds like common sense, but I challenge you to make an effort and skip the small talk when meeting a new person.

I decided to try this out at this year’s ASDA Annual Session with the first person I met, a foreign student who came to the USA at age 12 and also identifies as gay. Right after our exchange of names and schools and right before I asked him what year he was in, I stopped myself and went straight for it: “Tell me about your experience being in the LGBTQ community while going to school in Kentucky”. BOOM! He looked a bit taken aback by the question and I started regretting my decision. He tilted his head to the side, looked at the floor and started rubbing his chin. Suddenly, 30 minutes passed as he was telling me about a horrible but character- defining incident, the people in his life who stuck up for him, and how lucky he is to live in a city where he is much more accepted than the rest of the state and his native country. It was beautiful.

In the days that followed, we would happily run into each other and exchanged our excitement for the day’s itinerary. By the end of our time in Orlando we said our goodbyes, and as he hugged me for the last time he smiled and said, “if you ever need anything or if you’re ever in town, you always have a place to stay.” And that, to me, is real networking.

Annual Session 2017 has come and gone. After five fervent days in Orlando of legislative meetings, resolution debate, emotional elections, and evening festivities, ASDA has launched itself into the year ahead. Here are some highlights from the week:

-Colorado took home the Gold Crown Award for Best Chapter Blog. 

-John Luke Andrew (Colorado '18) was elected District Nine Trustee. He'll oversee the dental schools from Colorado, Texas, and Oklahoma.

-Houston ASDA became the new top dog with their well-deserved win for Ideal ASDA Chapter. Their very own Tanya Sue Maestas also became the new ASDA National President. District Nine continues its prolific reign (Colorado was last year's Ideal ASDA). #D9sofine

-Becky Bye (Colorado '18 and current Colorado Chapter President) authored and defended a resolution to unify all dental schools with one degree (eliminating either the DDS or the DMD). This topic will likely become a major player at future meetings. #1profession1degree

-The continual battle to remodel the licensure exam continues. The new Executive Counsel intends to make great strides in coming up with a system that benefits both the students and is mindful of the patients.

-Dr. Christian Piers (Colorado '16) concluded his influential and devoted service to ASDA with his role as this year's Immediate Past President. I'm sure we haven't seen or heard the last from Dr. Piers (and we certainly hope not).

-Nothing keeps Colorado from going to the beach. Even if it's hurricane-like rain. Worth it? Absolutely.

-Some of our members had the (mis)fortune of being stuck on the Pirates of the Caribbean ride at Disney World. They were rewarded with an extended stay in the park and free rides. I don't think they were too upset...

Thank you to everyone who contributed to The Colorado Quickset over the past year. Colorado truly knows how to make the magic happen.

Cheers!