Using Technology in Dental School

[rcraven9]

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Hey guys, I'm starting dental school in the fall. Just wanted to hear from student doc how technology has helped you in dental school. I got an iPhone a couple months ago and I'm just wondering how i can use it to organize or whatever. I just downloaded Springpad which seems really useful.

Thanks!

 

[txaggie03]

Try a combination of flashcardexchange.com and Mental Case.

 

[Contach]

um. put your Class schedule/rotations/exams into iCal or google calendar, or maybe it would work with microsoft office calendar...

Then thru gmail, sync your calendar on your iphone to your calendar on your computer.

Then, because you want to help your classmates, allow them permissions to access to your calendar via gmail calendar so they can upload it onto their phones/computers.

 

[DentinBond]

There are many, many things; I will select the two that I believe are the very most important.

1- If there is access to a surgical operating microscope, use it. As much as you can. Most schools have them somewhere by now, I'd think. At the very least they'll be in grad endo; it's even worth assisting a grad student a few times just to see things this way. There is microscope dentistry, and there is other dentistry. It is that much of a dichotomy. And it's impossible to put the experience, and the rise in quality of your diagnosis and treatment, into words. Impossible.

2- Take two high-res digital images of each and every patient's teeth. One anterior shot of them occluding, one of the mandibular arch from an "aerial", occclusal view. Maybe add a shot of the maxillary arch from the same occclusal perspective. Now show your patient in the biggest, baddest way possible. We use a 2nd computer screen in front of the patient; in dental school, I'd think an iPad would be best. (Maybe with DDSGP, though it's expensive). (http://www.ddsgp.com/DDSGP/Home.html) Or a laptop if necessary. Now ask them this question, credit to Dr. Dick Barnes:

"Are you disatisfied with your teeth or their appearance?"

"Dissatisfied" not "satisfied"; you want them getting used to saying yes not no if there is an issue. Teeth, referring to health, and appearance, referring to esthetics. Let's not start down that slippery slope of breezing past health and trying to sell white chunks of porcelain to everybody. Even in dental school, under close faculty supervision, that aggressive selling process can start to take hold. Requirements loom... And yes you can vary the question according to what feels comfortable to each individual patient, but show them and ask it.

Oral health issues are best understood by patients when they can see what's happening in their mouths. Be creative. Caries, broken cusps and missing teeth are easy. For perio, get a shot of a Williams probe sinking in 7mm. Etcetera.

Esthetic issues are definitely best approached by asking, not telling.

We've done this for four years and it's the greatest practice growth mechanism we've ever found (and even in dental school you have to grow your practice; remember the word "requirements"?), and it's ethical and intellectually honest. I am appalled by the level of overtreatment for financial gain in our profession that currently exists. Equally appalling is the underdiagnosis and undertreatment of perio, esthetics because the patient wasn't asked, etc. Take these pics, ask these questions, and you will train yourself to avoid the Scylla and Charybdis of overtreatment and undertreatment- I'm not sure that every school coaches its students in this adequately.

You will also be astounded by what your patients tell you, and how emotional they get about it.

And: microscope. microscopemicroscopemicroscope.

 

[SoulPower]

There are many, many things; I will select the two that I believe are the very most important.

1- If there is access to a surgical operating microscope, use it. As much as you can. Most schools have them somewhere by now, I'd think. At the very least they'll be in grad endo; it's even worth assisting a grad student a few times just to see things this way. There is microscope dentistry, and there is other dentistry. It is that much of a dichotomy. And it's impossible to put the experience, and the rise in quality of your diagnosis and treatment, into words. Impossible.

2- Take two high-res digital images of each and every patient's teeth. One anterior shot of them occluding, one of the mandibualr arch from an "aerial", occclusal view. Maybe add a shot of the maxillary arch from the same occclusal perspective. Now show your patient in the biggest, baddest way possible. We use a 2nd computer screen in front of the patient; in dental school, I'd think an iPad would be best. (Maybe with DDSGP, though it's expensive). (http://www.ddsgp.com/DDSGP/Home.html) Or a laptop if necessary. Now ask them this question, credit to Dr. Dick Barnes:

"Are you disatisfied with your teeth or their appearance?"

"Dissatisfied" not "satisfied"; you want them getting used to saying yes not no if there is an issue. Teeth, referring to health, and appearance, referring to esthetics. Let's not start down that slippery slope of breezing past health and trying to sell white chunks of porcelain to everybody. Even in dental school, under close faculty supervision, that aggressive selling process can start to take hold. Requirements loom... And yes you can vary the question according to what feels comfortable to each individual patient, but show them and ask it.

Oral health issues are best understood by patients when they can see what's happening in their mouths. Be creative. Caries, broken cusps and missing teeth are easy. For perio, get a shot of a Williams probe sinking in 7mm. Etcetera.

Esthetic issues are definitely best approached by asking, not telling.

We've done this for four years and it's the greatest practice growth mechanism we've ever found (and even in dental school you have to grow your practice; remember the word "requirements"?), and it's ethical and intellectually honest. I am appalled by the level of overtreatment for financial gain in our profession that currently exists. Equally appalling is the underdiagnosis and undertreatment of perio, esthetics because the patient wasn't asked, etc. Take these pics, ask these questions, and you will train yourself to avoid the Scylla and Charybdis of overtreatment and undertreatment- I'm not sure that every school coaches its students in this adequately.

You will also be astounded by what your patients tell you, and how emotional they get about it.

And: microscope. microscopemicroscopemicroscope.

wow that is a really smart and clever way to use technology to educate and sell your services to patients through their own perspective. I applaud to that.

 

[DentinBond]

wow that is a really smart and clever way to use technology to educate and sell your services to patients through their own perspective. I applaud to that.

Thank you. And ethical, for the realm of the elective treatment. So ethical.

 

[SeattleRDH]

DentinBond knows what's up!

I am totally getting an intraoral camera prior to starting dental school. I use it every day at work.

 

[DentinBond]

DentinBond knows what's up!

I am totally getting an intraoral camera prior to starting dental school. I use it every day at work.

Thank you, RDH. And perhaps I should have been more precise in my wording- we use a digital camera with a macro lens for this, because of the extraoral nature of the shot, it's not one tooth at a time. It can be done either way, but digital SLR cameras would be far less costly and many intraoral cameras give lower resolution at whole-arch ranges than when used intraorally. I'm not talking upper-level Canons here, any digital camera with good resolution and a macro lens with a ring flash will do. Ring flash is much better than point flash for this.

Use cheek retractors too. You want the patient to see their entire buccal segments. And, for later, after dental school, if you do Invisalign, I cannot tell you how astounding this method is. Because, you see, virtually every human being on the planet is experiencing a slow but inexorable crowding of their teeth. And the largely ignored skeleton in the closet of orthodontics is that very few patients wear their retainers long-term. So even previous ortho patients are re-crowding. Some may want to correct it, many will not, at least until it gets severe. That's why asking is so much better than telling, though we do mention the health benefits in terms of better acccess for oral hygiene and better force distribution/less wear when teeth are properly aligned.

Everyone not wearing retainers is continually crowding though:
http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/06/orthodontic-relapse-and-invisalign.html

If you were going to get an intraoral camera, the cost is higher but the Soprolife has resolution so high it's off the scale and of course it has the 450nm caries-detection light as well as the white one. Not sure how this would be accepted in D-school- depends on if the faculty are actually listening to the new literature or not. Here's their site:

http://www.soprolife.com/

Mind if I say a word about faculty? Evaluate them in your mind at least partly in terms of how much they pay attention to new science, how mentally adaptable they are. When I was at Penn our Dean was Jan Lindhe, still one of the world's most prominent periodontal researchers. I saw him lecture again last year (he came over from Sweden)- I sat in rapt attention for 7 straight hours, lunch was a bothersome interruption, the man is so brilliant and such an excellent speaker. He and his group did tons of reproducible, statistically significant, elegant studies that carved out a new understanding of periodontitis back in the late 80's. (He's still at it.) We'd hear him lecture on it and I'd just be sitting there like: "wow!"

Then, old-guard faculty would lecture on their stuff which was in pretty much direct contradiction to the reproducible studies that Dr. Lindhe and his colleagues had presented. And the old ideas were just plain wrong. They had been proven so by new science.

This will happen to you in school too, I'm sure. All of you. Unfortunately, you have to learn both ways, the new and the wrong, so to speak, to pass both tests. But then learn the more important lesson from it, beyond any single dental school test-

Pay attention to the science. And keep up with it. Be ready to drop outdated ideas as soon as there is adequate evidence to render them obsolete.

Don't become a dinosaur at the age of 35. And this protects you from the aggressive product reps too.

Sorry to digress, but you can get a lot of flak for being creative in dental school, even for taking pictures, and I'd like y'all to be prepared to defend your creativity when the dinosaurs come down on you.

 

[rcraven9]

DentinBond,
Please keep talking. You're making me a better dentist and I haven't even started dental school yet!

 

[DentinBond]

DentinBond,
Please keep talking. You're making me a better dentist and I haven't even started dental school yet!

*Blushes*

OK I will, and thanks for your kind words, they mean a lot...

So, since this picture thing is generating interest, I'll mention one more point.

Again, we're using high-res pictures for:
-Better explaining our diagnoses and treatment plans. We live in a very visual society (TV etc.) and, almost regrettably, people are used to taking in information that they believe from TV and certainly the Internet. As long as we're being ethical and intellectually honest in our diagnoses, we might as well leverage that.
-Asking, not telling, patients what they desire in terms of esthetics, consistent with our ability to provide that within biologically and ethically sound principles. (Example- no veneers to resolve severe crowding...)

What we do is take close photos where the entire arch of teeth is visible, and not much else, with cheek retractors. This gives the most detail, and patients can really comment on what might be on their minds. They like their diastema, they despise their diastema... You get the idea.

However! Studies have shown that the best emotional reaction to a human smile is to show the lower third of the face, with a natural smile, no cheek retractors but no hair/makeup/eyeglasses etc. to distract from the dentistry. You know, you ask Mrs. Stepnik what she thinks of her smile, and the whole time she's staring at her hairdo, angry as a wet cat that Nino from the salon screwed up her highlights last Tuesday...

So- don't assume I'm right about the whole cheek retractor thing. Experiment. Go for detail on some, and show natural smiles from a greater distance on others, and see what works best.

By the way, in four years of doing this I've only had four patients say "Ewww, don't show me that!" And the most vociferous was a physician, a pediatric ER physician as a matter of fact.

You can never over-estimate human incongruity...

(And: microscope.)

 

[sweetdaises2000]

DentinBond,
Please keep talking. You're making me a better dentist and I haven't even started dental school yet!

Ditto! Actively following this thread. Keep it going Dentin Bond🙂

 

[HupHolland]

Keep talkin DentinBond..

I just graduated from dental school and starting my residency. Between residency, Pankey and you, I have learned more about dentistry than I did during 4 years of dental school.

Clap-clap.

Hup

 

[DentinBond]

Keep talkin DentinBond..

I just graduated from dental school and starting my residency. Between residency, Pankey and you, I have learned more about dentistry than I did during 4 years of dental school.

Good grief! You guys are going to lead me into hubris- you know, overarching pride, like that old joke about the dentist who gets to the Grand Canyon and wants to, you know... fill it.

Actually the first ten or so years of my practice were filled with good intentions and technical excellence but I really didn't understand human communication. And some other important things, but that was the big one. Communication skills in both writing and in person are in some ways the greatest asset you can develop.

So, while not strictly technology, I would strongly encourage y'all to read about the DISC system in none other than our JADA:

http://jada.ada.org/content/138/3/381.full?ck=nck

(I wish to go on record however that I would have chosen the words "Communicate With" rather than "Motivate")

Here is the main DISC website, and you can even purchase DISC evaluations for yourselves- and your spouse or significant other if you really want to create some fireworks:

http://www.discprofile.com/

I don't want to push my blog into here too much but I also don't want to write the same thing over again; and I don't mind people seeing who I am because I much prefer online interactions to be transparent. So, when it comes to dental school faculty, and even colleagues, and certainly how we ourselves adopt or choose not to adopt new ideas, here's my riff on it:

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/08/facts-versus-our-opinions.html

Finally, getting back to the DDSGP app, http://ddsgp.com/DDSGP/Home.html, it's expensive at $400 but in our sugar-laden society the interproximal caries simulation alone is worth the whole nut. Unlike the complex Hollywoodesque CAESY patient education system, this DDSGP vibe is all visual, you can talk as much or as little as you want. (In the DISC system view, only C's want lots of detail at the start; S's moderately so, and D's and I's want brief decisive info about their dental condition. If they want more details, they will ask for them. CAESY will drive them mad.)

Students- if you see your patients looking right and left a good deal, or eyes glazing over, you've just passed their information saturation point, you've gotten too technical. You probably hit a "D" with what a "C" would want to hear.

And: microscope. Don't forget to try to use your school's microscopes. I haven't talked more about them because the experience of microscope dentistry is so beyond amazing it's very difficult to capture in mere words...

 

[spearmint]

Fill that canyon, please! I get so much when experienced dentists come on SDN and share valuable bits of wisdom/information. Even the smallest detail sheds so much light. I share the sentiment of the other poster who feels like I'm becoming a better dentist just by reading your thread (and Hammer's) and I haven't started school yet either. We should make you and the other dentists who have taken the time to "teach" us the official SDN Dental Faculty.