The Prevalence and Preventability of Tooth Decay

If I asked you to list the top 10 most prevalent diseases in the world, you would most likely begin listing diseases such as diabetes, asthma, acne, or perhaps even Alzheimer’s disease. However, much to the surprise of many, dental caries, more commonly known as tooth decay, really should make an appearance in that list. Although tooth decay is prevalent, particularly throughout the western world, it is also highly preventable and has been occurring more and more often in recent years. In fact, a paper by Dr. Robert Bagramian from the University of Michigan School of Dentistry labeled dental caries as a, "pending public health crisis."

Recently, a shift in diet of the western world has lead to the prevalence of tooth decay. Historically, people have eaten a diet consisting of proteins, carbohydrates, and fats. However, more recently there has been a trending shift where people shy away from fats and replace them with carbohydrates, namely, sugars; and this is part of why tooth decay is running rampant. Tooth decay occurs when bacteria in the mouth feed off of sugars, left over from eating, in the mouth. After processing the sugars, the bacteria then excrete an acid. According to webMD.com, these acids will persist in the mouth for about 20 minutes after you eat, causing tooth decay. Additionally, these acids can become trapped in food and other material in the mouth, persisting for much longer and forming a plaque. This makes most people highly susceptible to suffering from tooth decay. Below are some examples of what extreme tooth decay can look like.

Child Presenting with Severe Tooth Decay

Tooth decay is extremely prevalent, including richer countries. According to the Center for Disease Control, tooth decay, while largely preventable, is the most prevalent disease in children and adolescents aged from 6 to 19.  This is a particularly appalling statistic because, like the Center for Disease Control said, it’s largely preventable. They also cite that tooth decay is four times more common than asthma in adolescents and children. Finally, they cite that 9 out of 10 adults over the age of 20 have, or will have, some form of tooth root decay during their lifetimes. If these statistics alone are not saddening enough, perhaps worst of all is how preventable this disease really is. To illustrate this, below is a map of the world showing the prevalence of dental caries by the number of decayed, filled or missing teeth for 12 year old children for a given country.

Map Showing Average Number of Decayed, Missing and Filled Teeth in 12-year-olds

Although tooth decay is prevalent, it is very easily preventable. In fact, simplest way to prevent tooth decay is for one to brush their teeth twice a day using a sugar-free fluoridated tooth paste. The American Dental Association includes this along with the following as a comprehensive method to prevent tooth decay: cleaning in between your teeth with floss or an interdental cleaner, eating nutritionally balanced meals and limiting snacking, visiting a dentist regularly for cleaning and oral examination, and checking with your dentist whether or not supplemental fluoride and/or dental sealants may be appropriate for you to use. The adoption of these measures by people throughout the world would lead to a significant decline in the prevalence of tooth decay. There are some people, however, who will still suffer from tooth decay because they are predisposed to the disease. The Center for Disease Control cites one example of a condition which does not directly cause tooth decay but accelerates the process is xerostomia, commonly known as dry mouth.

In summary, although tooth decay is prevalent, it does not have to be. While tooth decay is currently one of the most prevalent diseases in western society, particularly among the young, simple oral hygene can be used to almost completely prevent the disease. Although there are some cases where people are predisposed to tooth decay, they remain as the very few, and failure to adhere to the simple guidelines of the Center for Disease Control and other professional sources are the true cause for the disease.

Photos courtesy of:
1) Imaging Systems

2) The Royal College of Surgeons 

Where Should I Apply to Dental School?

"Where should I apply to dental school?," seems to be a question on every pre-dental student's lips. If you've found this blog, maybe you're wondering it yourself. Unfortunately this is often a very difficult question to answer for a number of reasons, and the only person who really knows the answer is you. I know right now you're probably thinking, "now what kind of advice is that?," but it really is a question that no one but you can answer.

There are currently 65 accredited dental schools in 36 different states, the District of Colombia, and Puerto Rico, all of which American pre-dental students are welcome to apply to. In theory you could apply to all 65 schools, however this would be an incredibly wasteful process that is likely to jeopardize your chances of acceptance altogether. By applying to too many schools, not only will it be very expensive (over $6000 in application fees to apply to all of them, not to mention flying all around the country for interviews), but completing all of those secondary applications and interviews will likely demand more than a full time job. This will likely lead to sloppy work on your part; not a trait that dental schools are looking for. However, perhaps most importantly, you will likely be applying to a lot of schools which are just not the right fit for you.

"So where should you begin narrowing down the potential list?," I hear you asking. Well, the first place to start is by determining which schools are a good fit for you. This makes perfect sense because you want to make sure that you will be attending a school that will support you through your journey to become a dentist. As such, you want to determine which dental schools best fit your personality, beliefs, learning styles, and the like. Unfortunately, there is no objective way to do this. Setting aside some time to peruse dental school websites is likely the best approach. Is there anything that stands out to you about a particular school? Is there something that makes you feel that you wouldn't thrive in a particular dental school environment? Is this school clinically focused, or research driven? These are all the important kind of questions to ask and are all relevant. I suggest compiling a spreadsheet of all the dental schools in the country and assigning each with a rating from 1 to 5 of how well the school fits you personally. This alone will likely narrow down your list considerably.

Location is another important aspect to consider. Are you just leaving college and happy to live anywhere in the country? Or do you have a family and think it will be difficult to relocate? Either way, the location of a dental school should be a part of deciding where to apply, however it should not be the only factor. It would be foolish to apply only to schools in your state just because you can get in-state tuition, however, you might not be able to afford to attend dental school without it. These are all very personal questions to ponder.

Finally, one of the other big influencing factors for many people is the cost of tuition. It is generally thought that state schools are more affordable than private schools, however, at times this may be a sort of false economy. While state schools do generally have lower up-front tuition, there may be other benefits that will level the playing field. The University of the Pacific Arthur A. Dugoni School of Dentistry, for example, is a very expensive private school to attend in San Francisco, a very expensive town. However, its three year DDS program will mean that you will finish a year earlier, opening up an extra year for you to practice dentistry. According to U.S. News, the median salary for dentists in 2013 was $146,340. If you take this into account, the University of the Pacific is now actually a more cost effective option than most other American dental schools.

Cost of dental school pie chart courtesy of The Curious Dentist.

In summary, there are many different options for where to attend dental school and it is only up to you to determine where you should apply. There are also a myriad of other factors that might influence you decision and the American Dental Education Association's Official Guide to Dental Schools is a perfect place to get all of this information.

Title photo courtesy of NCAA Logos on Pinterest.

My Favorite Piece of Interview Preparation Advice

Interviewing; It's one of those things that we all need to be good at but we very infrequently do. Something I've also noticed that pre-dental students are very concerned about when they apply is their interviews. There are literally hundreds of pieces of online advice for how to succeed in your dental school interviews and even courses and classes you can take. However, I have a slightly different view on how you should best prepare. In addition, if you want to be an attractive candidate for any professional school, you're likely going to have to interview for other positions before hand while gaining experience. This makes interviewing well an incredibly important life skill to possess, especially as a professional.

My entire premise for how to best prepare for any important interview is to practice. If I asked you to bake a cake for the president and you had only done it once before, you're probably going to want to practice. Interviewing is no different. But unlike many other skills, interviewing is not something that is very easy to practice on a day to day basis because the opportunity to interview doesn't arise on many occasions. However, this is easy to change if you choose to look at interviews in the way I do. An interview doesn't need to be thought of as an interview. An interview is simply a conversation where two (or perhaps more) people are meeting each other for the first time and want to become acquainted. By and large, this is very true and makes perfect sense. Think of applying to dental school like online dating, you've already submitted your application (your dating profile) and the school wants to interview you (the first date) to see if you will be a good match for the school and the school will be a good match for you. Again, this makes sense. If you've already read through someone's information, you have a good idea what they are like as a person, however, meeting them is the only real way to see just who they are.

Now that we've turned a huge, daunting interview into a simple introduction and conversation, how should you best practice? Well, in my personal experience, the best way to practice introductions and conversations is to meet new people. I'm not saying that every pre-dental student should head out to a bar tonight and try and start up a conversation, but it is an important skill to have. Not only is it important for interviewing, as future dentists we will be meeting new people every day and interpersonal skills are tremendously important for a good dentist. Still, you can target your audience. A great place to start is at school. This is a place where people share similar interests and will be conducive to creating conversation. What would be even better is if you can find out where the other pre-dental students hang out and start meeting them. This way you can also be asked and ask questions you would expect to encounter in a dental school interview. After all, the big "why are you interested in dentistry?," question is bound to come up and what better way to prepare for your interview by having to answer it a few dozen times in casual conversation.

If you've done what I've been talking about then perfect! You're well on your way to having a great interview day at your top choice dental schools. By now you've reduced the nerve wracking interview to a casual getting-to-know-you type conversation. Don't get me wrong, there are still many other important aspects to an interview, such as dressing professionally and having considered some of the more important reasons you want to become a dentist, however if you've mastered telling your story to strangers you're most of the way there.

Another little tip: see if any colleges or dental schools nearby offer mock interviews. These can be done just prior to your interviews to help you hone your skills and are absolutely invaluable. And most of all, remember to be yourself and have fun! Good luck and please feel free to leave any pieces of advice you have in the comments section below.

Photos courtesy of:
1) snagajob.com
2) Derrick McCann

A Pre-Dental Necessity: 5 Essential Study Tips for Finals

It's almost that time of year again and it seems to be a pre-dental way of life. That's right, I'm not talking about a Thanksgiving feast big enough to leave you full for weeks, I'm talking about finals! Along with finals naturally comes one tell tale trait of the pre-dental student: their study habits. Maybe you're a freshman, new to the pre-dental stream, or maybe you're just trying to take your game to a whole new level. Either way, this list of tips and tricks may just be what can help you to achieve the level of academic performance you desire. These tips and tricks are both from my personal arsenal and those of others online. Most of them I've developed through years of study as an undergraduate, grad-student, my time in pilot training in the air force, and now as a post-bacc.

1. Develop a plan. A well considered plan is always key when you've got multiple different classes all competing for study time. I prefer to start early and generally and then increase the level of detail in my plan as finals week approaches. This adds more flexibility to my earlier study time and prevents me from being concerned about fine, unnecessary details.

2. Sleep well. This is personally my most important study and exam strategy. Although it may seem counter intuitive, by not studying late and sleeping instead, you will increase your productivity dramatically while also reducing stress. By being well rested, I find that my memory "opens up" and allows me to both recall and learn details more accurately and faster. This tip also ranks highly on almost any online source, including Time Magazine's 6 Tips for Surviving Finals Week. 

3. Eat well. Not only do you need to take care of your mind, you also need to take care of your body. Now that you've probably got a little more free time on your hands (which should be used for study), you're probably spending a lot more time at home. This often means that there is far more temptation to eat poorly and use your finals study as an excuse to justify it. We all begin to prioritize study over other things when finals come around, but you can't use it as an excuse to not be taking care of yourself. Take some time to go grocery shopping and prepare something reasonably nutritious for yourself: it will pay dividends when you actually sit down to study.

4. Stay active. I really should have roped the last few points into one big "take care of yourself" section, but it's really true. Taking care of your mind and body should be atop any studying plan. This is also one are which is backed by science and almost guaranteed to improve your memory functions. According to the Harvard Health Letter, researchers at the University of British Colombia found that regular exercise boosted the size of the brain responsible for verbal memory and learning. Not to mention, exercise is known for it's wide array of positive psychological effects.

5. Stop procrastinating. Although pre-dental students are usually among the most motivated of college undergraduates, we can still fall victim to this often taboo side of studying. Unfortunately, it comes with the territory and in today's world there are more procrastination inducing triggers than ever. However, I like to think of study in terms of the old adage, "an ounce of prevention is worth a pound of cure," except I like modify it to say, "an ounce of study not is worth a pound of study later." I find that by completing study earlier, it makes subsequent study more effective. Take for example the normal semester class in one of the most notorious pre-dental classes; organic chemistry. If I have completed the reading and example problems before the class, I find that I can absorb almost all of the material being presented to me in lectures and I leave feeling confident. However, if I have not I don't understand half of what is said and leave feeling as though I have a mammoth study task ahead of me. By doing that small amount of study early, I've significantly reduced the amount of effort required for later study and have overall learned and retained the information significantly better and faster.

Although certainly not exhaustive, this list is my top five essential study tips which I believe have helped me through the plethora of study I've done in the past. If you apply them well, hopefully you too can achieve your desired study outcomes. Please feel free to leave any feedback in the comments section below or even some of your own study tips. What have you found helpful?

(Title photo courtesy of Syracuse University)

The Digital Dentistry Revolution

If you're interested in dentistry as a career you've probably already heard the term, "digital dentistry." But what is digital dentistry? What does it do and why, as future dental practitioners, do we need it for our patients? Although this post won't be exhaustive, it will aim to point out some of the more prevalent areas where digital technology is being applied to modern dentistry.

Much as it does for the rest of society, the introduction of technology into the lives of dentists have made procedures faster, easier, more accurate, more comfortable for the patient and more productive for the operator. Although the term, "digital dentistry," is not well defined, it generally refers to anything which has traditionally been done by hand which can now be done with the assistance, in one form or another, of technology. Until recently this has proven difficult because dentistry, which is a delicate mix of art and science, is difficult to replicate with machines. However now there are many procedures and techniques which can be aided with the use of technology. Some of these technologies include, but certainly are not limited to; CAD/CAM restorations, cone beam CT, computer aided implant dentistry, digital x-rays, electric handpieces, lasers, intra-oral cameras, and patient and practice management systems. Although all of these technological developments have had a profound impact on the art and science of dentistry, below, I will elaborate on three areas which I believe have had the most profound impact; intra-oral cameras and CAD/CAM restorations, digital x-rays, and patient and practice management systems.

Intra-oral cameras and CAD/CAM restorations

Previously, if a patient needed a crown, a long and slow road was ahead of them. To deliver a crown to a patient typically took no less than three visits to the dentist over a period which usually spanned weeks. This was primary due to the fact that a dentist would have to first prepare the tooth for the crown, then take an impression to send to an external lab so the crown could be made, then finally fit the crown, each at a separate visit. This is obviously less than ideal for both patient and clinician. However, with the advent of intra-oral cameras and CAD/CAM systems (such as CEREC) a crown can be delivered in a matter of hours. This has lead to many dentists offering crowns in only one appointment. These systems work by the dentist preparing the tooth for the crown in a traditional sense, then using a intra-oral camera to scan the prepared tooth surface, finally a machine makes the crown from a block of ceramic; all while the patient waits. Check out this video below from Dr. Barbra Kane which explains the process from beginning to end.

Digital X-rays

Another new and exciting development in the world of digital dentistry is the introduction of digital x-ray technology. The best way to explain digital x-rays is that it is like taking a digital photo. No film is required, there is no wait time after the x-ray is taken so if the first x-ray needs to be redone it can happen immediately, the x-ray can automatically be kept on a digital database, the x-ray can be easily viewed on a computer, and perhaps most importantly digital x-rays require far less radiation than traditional dental x-rays. In fact, according to Dental Economics, a dental related publication, digital x-rays deliver only 10% of the radiation dose of traditional film x-rays. No matter how you look at it, just like digital photos, digital x-rays have everybody smiling!

An Example of a Digital X-ray system compliments of Atlantic Avenue Dental.

Patient and Practice Management Systems

Although it might not seem obvious, being able to keep patient records on computers has both saved time, energy, waste, and also made dental records more efficient. Everyone is familiar with the traditional manila folder full of a patients dental records. Here, a busy dentist scribbled down what little information that he or she could after an appointment just prior to seeing the next patient. This made managing both the practice and patient records unruly. However, with the digitization of such records, dentists are easily able to keep complete, neat, and up to date records with the press of a button. There are also great features integrated into software packages that allow x-rays and other patient information to be kept readily on hand. So long paper!

Above are just a few of the more modern and prevalent digital dentistry systems that are being adopted by dentists practicing across America and throughout the world. I'm very excited by what these and other new systems will mean for me and my patients in the future when I finally begin practicing dentistry.

Where'd All The Pre-Dental Students Go?: Your Local Pre-Dental Club

So right now some of you may be wondering; if there are so many pre-dental students online, where on earth are they hiding? Well, to start with, they really aren't hiding. The truth is, there just aren't all that many of us! While wherever you're going to school there is likely thousands of biology majors and maybe even some who identify as being pre-med, but there will generally be far few pre-dental students. Just to give you an idea, according to the American Dental Education Association in recent years there have been roughly 5000 students, nationally, entering dental school. On the other hand, according to data from the American Association of Medical Colleges over 20,000 medical students are entering school every year. I think it's a reasonable assumption to make that these numbers also reflect the number of pre-dental or pre-med students still in college. Therefore, this data means that you are four times more likely to come across a pre-med student than a pre-dental student. Although this might help explain why you are finding it so tough to find other like minded pre-dental students I still haven't answered the burning question: where can I find them?

Without a doubt, the best place to find other pre-dental students is at your local colleges pre-dental club. Although you might not be aware of them, most four-year colleges in America will have such a club. For quite some time I was blissfully unaware of my school's pre-dental club until a simple google search for, "SFSU pre-dental club," revealed that there was in fact an active club on campus. After talking to other pre-dental students in the club, I found that these clubs don't generally advertise well and as a result they are often difficult to find.

Now that you've found out that you college actually does have an active pre-dental club you're wondering why should you bother joining? I'm sure, like me, your schedule is already full of classes, pre-dental activities and probably even work commitments. Your time is definitely valuable, but investing some of this time into getting involved with your local pre-dental club will definitely not be wasted. Not only will you meet what will definitely become a new group of like-minded friends, just being around people with the same dreams, goals, and visions will almost certainly be both motivating and inspiring. Perhaps best of all though are some of the volunteering activities that are hosted by your local pre-dental club.

Although I'm sure you are already a fairly active member within your community, I'm sure it is difficult to find ways to support dental and other oral health related causes with the work that you are doing. However, pre-dental clubs often focus their community work on these areas. For example, the pre-dental club at SFSU is affiliated with America's ToothFairy: National Children's Oral Health Foundation.This foundation, which focuses its efforts on promoting the oral health of some of America's most vulnerable children, provides my pre-dental club with many opportunities to conduct public outreach and teach young children about oral hygiene and health. Not only do activities such as these allow me to actively participate in solving a national problem, but they also help prepare me for a career in dentistry by teaching me valuable skills in patient education which I will no doubt employ in the future.

Among other things, being a member of your local pre-dental club will afford you the opportunity to both meet driven, like-minded individuals such as yourself and conduct incredible community outreach activities. For these reasons alone I implore you to become involved in your local pre-dental club; not to mention knowing upperclassmen who matriculate to dental school can serve as a solid foundation for mentoring and navigating the future application process.

UC Davis Pre-Health Professions Conference

Being local to San Francisco, about a month ago I was fortunate enough to attend the 13th Annual Pre-Medical and Pre-Health Professions National Conference over the weekend of October 10th. "What's a Pre-Health Professions conference," I hear you ask? A pre-health professions conference is a gathering of like-minded pre-health students, including pre-dental students of course, to attend a variety of different keynote speeches, panels, workshops, exhibitions and more. All of these are aimed at giving the budding dentist information that will not only help them decide if the profession is a right fit for them, but also to give useful information about the application process, what to expect, and how to get the most out of pre-dental activities. The remainder of this post will give a brief synopsis of my experience at the conference will provide some other little tips along the way for those thinking about attending next year.

After registration and breakfast, which was provided, I attended the main conference speeches. These were delivered by many esteemed members of the health-professions and although heavily focused on speaking to pre-medical students, I felt that there points were still applicable to dentistry.

However, after the main conference speeches were over, the real pre-dental really fun began. The two keynote speeches, presented by Dr. Friedrichsen, Dean of Western University's dental school, and Dr. Featherstone, Dean of UCSF School of Dentistry, were both informative and inspirational. Both had the general overarching theme of describing how the role of dentists is changing as healthcare becomes more integrated. The primary focus of this is that as future dentists, we will not be working in isolation. Instead, we will be working as a part of a larger healthcare team, aimed at providing a holistic approach to both healthcare and dentistry simultaneously. I would definitely recommend attending the keynote speeches in the future.

Immediately following the keynote addresses were a series of panels. First was a panel of members from admissions committees from dental schools around the country. Attending this panel was great way to get the perspectives from many different schools on what makes a successful applicant and how to best go about applying. Although there is far too much information for me to mention here, a few of the biggest mistakes that they said that dental school applicants make when submitting their applications are in not completely proof reading their personal statements and applying late in the cycle. The consensus of the panel was that having grammatical and spelling errors in a personal statements say a lot about the applicant. It says that they either lack the attention to detail that dental schools are looking for in future dentists, or worse still, that the applicant simply does not care enough to compile a contentious and thoughtful submission. Either way, if you want to get accepted you can not fall into either of these two categories. Dental school applications also open for submission on June 1st. The panel made it clear that even if you submit on the first day admissions open, it will be some number of weeks before your application is complete, which are usually held up waiting for letters of recommendation. Therefore, if you submit your application even three months after applications open, say around the beginning of September, by the time your application has been processed and reviewed, it is probably already into December. With rolling admissions this places you at a great disadvantage because not only are you now competing against a larger pool of applicants, some schools have already accepted half of their class (UCSF admits half of their incoming class in December)!. Although it is long, below is a video of the 2013 dental admissions panel.

Following the panels I had lunch, which was also provided, and then spent the remainder of my day attending workshops and the exhibition. The workshops were a fantastic way to get information about more detailed topics within dentistry and applying to dental school. They are also an excellent time to have your questions answered by people who definitely know that they're talking about. In all, the workshops were engaging, useful, and interesting and I would definitely recommend that you attend them if you come to the conference next year. In addition, make sure you set aside some time to attend the exhibition. Here you have the opportunity to talk to multiple schools directly, one after the other, and have any questions you have answered. Often I was able to talk not only to admissions staff, but also to students from the schools. In my opinion these are very valuable opportunities.

In summary, I found that the conference was both engaging and interesting. I also was sure to take notes which I'm sure will serve as an invaluable resource on the long road to dental school. A word of advice though, make sure to plan your day in advance: there are so many great workshops to attend that fitting them all in without a plan would be impossible. To give you an idea of what the workshops entailed, check out page 142 - 149 of the 2015 program.