winter 2018

Off the

Cusp

Come Cool Off with RU ASDA Winter 2018 NEWSLETTER

Table of Contents Community Spotlight 01

Perseverance Pays

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Effects of Marijuana Smoke in the Oral Cavity

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Class of 2022 at their class holiday party

Challenging Yourself With A Foreign Language

“If Your Back’s Not Erect, You Won’t Get Respect!”: Being Mindful of Ergonomics In the Dental Practice On Midlevel Providers and Proposed Solutions to the Access to Care Issue

Dear Readers Welcome once again to another edition of Roseman University’s Off the Cusp. I’m honored to present to you several articles from your Lifelong Colleagues, on a variety of topics about which they are passionate about. Before we start the new year let’s take a look at some of the issues that are relevant to our field.

Vegas Conference 2018

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Shealin Easton Editor-in-Chief

Roseman ASDA Board 2018-2019 ASDA Executive Council

Tammy Pham President

Danny Huynh Vice-President

Madison Kurz Secretary

Joell Chen Treasurer

Leigh-Ann Wahl Legislative Liason

2018-2019 ASDA Board Members

Jordan Geiler Communications Social Media

Stephanie Stevens Cultural

Hilary Mazzone Ethics & Wellness

Jasmeen Pabla Community Outreach Co-Chair

Kimberly Veltman Golf Tournament

Asbley Czechner Oral Cancer Foundation

Julie Hanna Community Outreach Co-Chair

Caitlin Parker Vendor Relations

Gatlin Marks Pre-Dental

Parth Kansagra Social Chair

Alyssa Neelley Historian

Aditi Desai Vendor Relations

Marivic De Leon Fundraising Chair

Jonathan Wong Pre-Dental

Gagandeep Gill D1 Rep.

Off the Cusp

Perseverance Pays Parth Kansagra, BS, MS Social Chair Class of 2021 Starting my undergraduate career right out of high school, I was excited to leave my parents nest and expand my horizons at this wild dream we know as college. The freedom to wake up as I please, the ability to sleep when I wanted, and the liberty to live my daily life at my pleasure was emancipating in the moment but came with many consequences. Although I was an exceptional student in high school, I found myself struggling in my first semester of college. My newfound autonomy was starting to create a void in my academic goals.

My senior year of college, I decided to apply to dental school for the first time, not even receiving one interview for that application cycle. Once I became more aware that my academic shortcomings were a hindrance to my life goal of becoming a dentist, I had a decision to make: would I continue down this path or reassess my career, and make a drastic change to my goal? After careful consideration, a lot of research, and some sleepless nights, I decided that dentistry was truly the career for me. To achieve this route, I would have to persevere the grueling process of remediating this mess I had found myself deep inside.

Immediately, I started to evaluate my dental school application, and honestly gauge the weakest aspects of my application. It was apparent that I needed to strengthen my lackluster application. I enrolled in upper division Biology classes, got a job tutoring Biology and Chemistry to high school students, and worked on developing dental offices for a dental corporation. Later, I went on to obtain my Master’s in Biomedical Sciences, which was one of the best decisions I made. This program allowed me to take graduate level biomedical courses, similar to those I would have to take in dental school. This program was demanding and fast-paced, which turned out to be helpful when adjusting to the intensity of dental school.

While I was completing my Master's degree, I received some dental school interviews, eventually choosing to attend Roseman University, College of Dental Medicine. I still remember the day I received my first acceptance into dental school. I was sitting in the conference room of the Biology department in graduate school, when Dr. Harman called me personally, to tell me that I had been accepted into their program at Roseman University. I was overcome with emotion; this was the moment that I had imagined for years and was brought about by my perseverance and hard work. It was an emotion of relief, gratitude, excitement, and confusion - but nonetheless empowering. This feeling finally solidified every doubt I ever had and made my dream very real.

Now that I am in dental school, I have been able to look back and reflect on those years leading up to this point. I realized that, although I was frustrated that I was not getting admitted into dental school, the perseverance I exhibited and the struggle I dealt with allowed me to grow into a much more focused, passionate, and mature individual. This maturity has given me the confidence in my ability to conquer dental school. It has also allowed me to concentrate on future endeavors and not stress about immediate success. It has allowed me to get through my first semester of dental school with minimal stress, and still have time to continue my hobbies. I was able to learn all of these vital lessons because of my own experiences, and learning from them. We all are going to have testing moments along whatever road we chose to take, but it is important to “just keep swimming.�

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Off the Cusp

Effects of Marijuana Smoke in the Oral Cavity By: Jordy Geiler

Communications Chair, Class of 2021

With Utah constituents voting in favor of Proposition 2: Utah Medical Cannabis Act, it is important for dentists and oral health care providers to know the effects cannabis can have on oral health. Marijuana can be consumed in three ways: smoking, ingestion, or topical administration. Proposition 2 will allow patients with HIV, Alzheimer’s, cancer, Crohn’s disease, epilepsy, post-traumatic stress disorder, multiple sclerosis, autism, and chronic or debilitating pain in opioid addiction cases to be prescribed medical-grade marijuana on a case-by-case basis. Under Proposition 2, medical marijuana may only be consumed via ingestion or topical administration. Current research does not suggest ingestion or topical administration of cannabis leads to changes in the oral cavity, but such administration methods may cause adverse reactions with anesthetics (1). Dentists should recommend patients cease all forms cannabis use at least one week prior to treatment.

Unlike ingestion or topical application, inhalation of cannabis has been linked to an increase in oral health concerns, ranging from smoker’s palate to hyperkeratosis.

The most common side effect in the oral cavity of patients who smoke marijuana is xerostomia, which increases the risk of developing caries, fungal infections, and burning mouth syndrome. Additionally, those who smoke cannabis are prone to developing cannabis stomatitis and gingival enlargement (2). More concerning oral health issues caused by marijuana smoke include earlier onset of periodontal disease (3) and increased bone loss in patients already affected with periodontal disease. Current research does not show an increased risk of head and neck cancer in patients who smoke pure cannabis (4).

As student dentists, it is important that we are able to recognize lesions and educate patients on the effects marijuana smoke has in the oral cavity.

Citataions (Rosenblatt KA, Daling JR, Chen C, Sherman KJ, Schwartz SM. Marijuana use and risk of oral squamous cell carcinoma. Cancer Research 2004 June 1: 64, 4049-4054).

Rawal, S Y, et al. “Periodontal and Oral Manifestations of Marijuana Use.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2012, www.ncbi.nlm.nih.gov/ pubmed/23420976.

Thomson, Murray W, et al. “Cannabis Smoking and Periodontal Disease Among Young Adults.” National Library of Medicine, Journal of the American Medical Association, 17 Feb. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2823391/.

Berthiller, Julien, et al. “Marijuana Smoking and the Risk of Head and Neck Cancer: Pooled Analysis in the INHANCE Consortium.” Marijuana Smoking and the Risk of Head and Neck Cancer: Pooled Analysis in the INHANCE Consortium, Cancer Epidemiology, Biomarkers & Prevention, 1 Mar. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3046921/.

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Off the Cusp

Challenging Yourself With A Foreign Language

By: Stephanie Stevens Cultural Chair Imagine waking up one morning with an excruciating toothache. You need to get help, but you are currently in a different country where you do not speak the language. How will you explain to the doctor what your symptoms are? How will you understand the diagnosis and treatment options? For many in the US, this scary scenario is a reality every time they need to seek medical care. As future healthcare providers, we will all most likely encounter a language barrier in our careers, if we haven’t already. How you prepare for it and handle the situation is what will set you apart.

First, it is important to place ourselves in our patient’s shoes and imagine what it would be like to need dental care and not be able to communicate effectively or understand what our provider is trying to explain. Patience is key, and while it can be an extremely frustrating situation, openly showing frustration will only heighten stress and anxiety in your patient and make matters worse.

If no one is available to translate, keep calm and maintain a friendly demeanor while you search for other options. The internet is a vast pool of information, and as dental students there are several helpful resources available to us. For example, through the Colgate Professional website under the education tab, we have access to dental translation guides available in several languages. These can be printed out and used to help determine chief complaints, medical history, treatment plan explanations and more. It also includes some common greetings and phrases to be able to make light conversation with your patient and put them more at ease.

Also, don’t be embarrassed or worried about not saying something perfectly. If a patient laughs or smiles, generally it is not that they are laughing at you, but they are so happy and appreciative that you are making an effort. Sometimes even a small gesture like this can go a long way in establishing a good relationship with your patient, and they will be so thankful to you for trying to help. You might not be able to fluently speak to your patient, but you will be able to communicate enough to be able to treat them, and they will trust you and be comfortable having you as a provider.

Recently, I was challenged with a language barrier myself in the urgent care clinic. My patient only spoke Portuguese, and even though I am fluent in Spanish, it is different enough to be problematic since it was difficult for her to express exactly what was bothering her and for me to explain exactly what we were going to do. Somewhere between the hand gestures and internet searches, we were able to locate someone to translate the more detailed explanations. For the next appointment, I used the translation guides and picked up a few Portuguese phrases. Even though I could only master the basics, it made a vast difference in our clinical interactions and we both look forward to our appointments.

Demographics in the U.S. are changing rapidly. It is important for us as future healthcare providers to recognize and adapt to these changes. Not only should we be empathetic to cultural barriers our patients face, we must make an effort to connect. Over time, you patients will forget the procedures you’ve completed but they will always remember how you made them feel.

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Off the Cusp

“If Your Back’s Not Erect, You Won’t Get Respect!”: Being Mindful of Ergonomics In the Dental Practice Before I dive into discussion, I would just like to make it clear that in selecting to write on this topic, I am VERY MUCH epitomizing “right message, wrong messenger”; in other words, I am quite guilty of precisely what I will be cautioning against. Maybe this article will be precisely what both you and I need to hear in order to improve our ergonomics, to ensure longevity in our respective dental careers.

As a second year dental student, I am still very much in the process of perfecting my craft in the simulation clinic. And as a novice, it has proven challenging to simultaneously produce clinically acceptable work while also maintaining ideal ergonomics. I have lost count of how many times Dr. McCraley has stopped me during a maxillary restoration, prompting me to use my mirror instead of breaking my back trying to use direct vision.

I am grateful each time for the reminder, because across the span of a dental career, quite a lot of strain is put on a dentist’s musculoskeletal system. In fact, development of a musculoskeletal disorder, or MSD, is the #1 most common reason dentists retire early (Murphy DC et al)! And if that fact alone does not scare you into paying closer attention to your ergonomics, I urge you to read on.

There are several risk factors that make dentists particularly susceptible to disorders such as upper and lower back pain, tendinitis, and Carpal tunnel syndrome. These risk factors include but are not limited to awkward postures, forceful exertions, repetitive motions, duration, contact stresses, vibration, and, believe it or not, psychosocial factors (Gupta A et al).

Yes, seriously. Poor ergonomics have the potential to yield psychological repercussions. Work-related MSDs are directly correlated with increased anxiety, decreased confidence, and poor psychosomatic health (Murphy DC et al). By improving ergonomics during dental procedures, we are protecting our physical bodies as well as our mental health! And when we take care of ourselves, we optimize our abilities as dentists and in turn provide our patients with paramount patient care.

A dentist can spend up to 60,000 hours in his or her career working in distorted and tense positions that can consequently yield MSDs (Murphy DC et al). Some ways in which YOU as a dentist or dental student can protect yourself are as follows: consult with a physical therapist to resolve major trigger points, strengthen stabilizing muscles like the shoulder and back, and make chairside stretching part of your everyday routine in the dental practice.

Sources: Murphy DC (NYU College of Dentistry, USA). Ergonomics and dentistry. NY State Dent J. 1997 Aug-Sep;63(7):30–34.

Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in Dentistry. Int J Clin Pediatr Dent 2014;7(1):30-34.

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Off the Cusp

On Midlevel Providers and Proposed Solutions to the Access to Care Issue Michael Rosales, J.D., Class of 2022 Introduction Midlevel providers (MPS) are non-dentist dental practitioners with four years of undergraduate education that, depending on state laws, may perform irreversible procedures on a patient. The two main MPS are the Advanced Dental Hygiene Practitioner and the Dental Therapist. Both are intended to amplify the ability of dentists to see patients and, in doing so, address the access to care issue that is affecting the United States. The American Student Dental Association (ASDA) promulgated a presentation regarding MPS which addresses barriers to care issues, the intent behind allowing MPS to practice, and Organized Dentistry’s view on MPS. MPS are currently permitted in seven states. Arizona, the most recent to allow midlevel providers to practice, did so in 2018. MPS are intended to address the access to care issue by 1) reducing dental treatment costs, 2) quickly increasing the number of providers of irreversible dental treatment, 3) addressing the lacking education of certain US populations regarding oral health.

While these goals are laudable, organized dentistry is split on whether or not to support MPS. As of the time of the presentation - the American Dental Association (ADA), Academy of General Dentistry (AGD, and ASDA has chosen to take a stance against MPS performing irreversible procedures on the basis of patient safety. The American Academy of Pediatric Dentistry (AAPD) has shown tentative support of MPS in a role limited to “specified reversible procedures and certain surgical procedures under the general supervision of a dentist.” The AAPD went on to narrow the scope of MPS by stating that the treatments rendered by the MPS must be “thoroughly evaluated and demonstrated to be safe, effective, and efficient and to not compromise quality of care in similar settings.” Ultimately, it can be inferred that the AAPD has chosen to support MPS in a narrow scope where the MPS must be held to the same standards as a dentist so as “not compromise quality of care.”

Opposing ADA, ASDA, and AAPD is the National Dental Association (NDA). The 2015 NDA President Carrie Brown stated that “[t]he current dental delivery system is outdated and no longer works for a third of the nation . . . It is time to create a system that embraces team-based care, and where a range of providers can work together efficiently to provide cost-effective, high quality dental care to all.”

The bottom line is that an access to care issue exists in the US and organized dentistry is currently at odds as to how to address that issue.

The Health Policy Institute (HPI) currently projects that that “the supply of dentists will increase faster than the US population through 2037”. However, even though the supply of dentists is projected to outpace population, the access to care issue will not abate. This is because there is a maldistribution of dentists across the US. In 2001 a study titled “Identifying Communities with Low Dentist Supply in California” stated: Approximately 20 percent of California communities may have a shortage of dentists. Two-thirds of dental shortage communities are rural. Communities with a lower supply of dentists have higher percentages of minorities, children, and low-income persons. Minority dentists were more likely to practice in minority communities. Geographic maldistribution of dentists may contribute to poor access to dental care in many communities, especially in rural, low-income, and minority communities. Minority dentists are more likely to practice in minority communities, but are a small portion of the dental workforce.

Here it is seen that the maldistribution of dentists in California caused rural areas to suffer from lack of supply. The researches noted that minorities were more likely to work in rural and minority communities. This means that non-minorities were more likely to choose to work in higher income areas at major metropolitan areas. If this holds true for graduating dentists, the distribution of dental therapists may follow the same trend where its graduates are more likely to practice in metropolitan areas. Therefore, the distribution of dental therapists may also become an issue and the access to care issue will not be addressed. In order to address the distribution issues, it would be appropriate to incentivize individuals to seek out rural underserved communities. Ultimately, three options for alleviating this issue involve 1) student loan reform incentivizing individuals to work in rural areas in exchange for loan forgiveness; 2) increased Medicare and Medicaid fees to make treating rural communities attractive; and 3) legislation restricting midlevel providers to economically disadvantaged rural locations that demonstrate immediate need of oral health providers.

Addressing the maldistribution of dental care providers.

Student Loan Reform -for-facility-leaders/, Accessed on October 28, 2018.

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Off the Cusp As student loan costs continue to rocket, most graduating students are concerned with the ability to pay off their loans. In order to do so, new dentists will need to be able to make enough income to service their loan and still survive economically. At this point in time, “Medicare and Medicaid reimbursement in rural areas isn’t enough to make practicing there financially viable.” Therefore, where rural dentists predominantly rely on Medicare and Medicaid fees and those fees are low, graduating dentists will not be able to practice in that area. In order to address this issue – student loan reform incentivizing working in a rural community in exchange for student loan forgiveness would be an option. It will draw graduates to areas of need and, if they live there long enough, may result in them staying.

Increased Medicare and Medicaid fees will draw more people to rural communities.

Where state insurance pilot programs have been enacted that increased the dental fee schedule, Dental Service Organizations (DSO) inevitably flocked to the area to avail themselves of the increased schedule. In doing so, DSOs recruit heavily from new graduates to fill their new practice locations at those underserved areas. The result is a drastically increased number of dental offices accepting state insurance and patients in that rural area receiving treatment.

Ultimately, if Medicare and Medicaid fees increased to make practices in rural communities viable – dentists will have the financial ability to service their loans, or have an otherwise successful financial future, while treating community’s oral health needs.

Legislation Restricting Midlevel Providers.

If MPS are deemed required to address the access to care issue in the US, then legislation should be enacted to restrict them to areas of need. This will obviate the potential issue of MPS congregating in metropolitan areas and not addressing the issue for which they intended. At this point, the maldistribution of dentists is the result of economic forces. MPS graduating from their respective schools will be doing so with less time investment and financial investment than their dental school counterparts. Therefore, their financial needs will be much lower in order to service their loans.

If their financial needs are low, then legislation forcing MPS to underserved areas will ensure that the access to care issue is actually addressed without making the MPS an undesirable profession.

Conclusion Ultimately, MPS may not be necessary as there are avenues to address the particular need they are created to address utilizing the current and graduating dental workforce. However, Midlevel providers will have an impact on dentistry’s future. How much of an impact and how remains to be seen, as it will be determined by lobbying efforts of both pro-MPS and anti-MPS parties. States will obtain information as to the benefits and downsides of MPS and will make decisions as to whether the benefits outweigh the risks associated with the relatively new profession. Therefore, choosing a side and being willing to generate an opinion, voice that opinion, and being willing to create new material will help you promote your chosen side.

Citations: American Student Dental Association, Midlevel Provider Timeline. Available at https://www.asdanet.org/images/ infographics/midlevelproviders_june2018-01.png?sfvrsn=0, Accessed October 28, 2018.

American Student Dental Association, A Guide to Midlevel Providers. Available at https://www.asdanet.org/index/getinvolved/advocate/issues-and-legislative-priorities/Midlevel-Providers, Accessed October 28, 2018 Id. Id. at 8 Id. DentistryiQ, National Dental Association releases statement supporting emerging workforce models to improve access to care. Available at https://www.dentistryiq.com/articles/2015/07/national-dental-association-releases-statementsupporting-emerging-workforce-models-to-improve-access-to-care.html, Accessed October 28, 2018.

American Dental Association. Health Policy Institute, Dentist Retirement Patterns. Available at https://www.ada.org/ ~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0818_1.pdf?la=en, Accessed October 28, 2018.

Mertz, Elizabeth & Grumbach, Kevin. (2001). Identifying Communities with Low Dentist Supply in California. Journal of public health dentistry. 61. 172-7. 10.1111/j.1752-7325.2001.tb03386.x. Available at https://www.researchgate.net/ publication/11747797_Identifying_Communities_with_Low_Dentist_Supply_in_California, Accessed October 28, 2018.

Algrim, Zach. (2017) Barriers to Dental Care Access in Rural America: Next Steps for Dentists and Facility Leaders. Barton Blog Available at https://www.bartonassociates.com/blog/barriers-to-dental-care-access-in-rural-america-next-steps

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Vegas Conference 2018 Aditi Desai Class of 2021

Attending the Leadership Boot Camp in Las Vegas, despite it being one of the hottest days, was one of the coolest experiences I had this year! Seeing all the District 10 members within the glamorous Vegas setting brought back the nostalgia of the District 10 conference I had the opportunity of attending last year in Arizona. It was also great meeting new members and reconnecting with old friends from other schools within District 10. The day started off with all of us visiting the Pacific Dental Services (PDS) headquarters. Dr. Cari Callaway was one of our main speakers from PDS. She is a multi-practice owner in partnership with PDS and she gave us her expertise on how to be one of the most successful practice owners. Her inspiring lecture incorporated many personal examples that showcased how she came to this point in her life.

Dr. Callaway taught us about the “three hats of leadership” which are the boss, the teacher and the friend and the pros and cons of each. The “boss” leadership style can be very strenuous as it could lead to burnout and limited growth of the team. A “teacher” type of leader fulfills the expert role of an educator, but this leads to lack of initiative within the team and the team becomes very dependent on the leader. The “friend” leadership role portrays the leader as merely another member of the team thus he or she is perceived as a weak authority figure. An ideal leader must be able to juggle between the three leadership styles depending on the situation and task at hand.

In addition to learning about leadership, we were also taught the tools to write an effective vision statement. We learned that vision statements can actually be longer than a single statement; they can be as long as we need, to get our goals and thoughts across to the rest of the team. Dr. Callaway told us the importance of hanging up our vision statement for staff members to see it daily. This serves as a constant reminder for each team member to implement this vision and to work towards our common goal in the office. Your success is dependent on your team's success so if each staff member succeeds, then you will succeed.

The one thing that stood out the most to me from the leadership bootcamp is that Dr. Callaway is a successful and inspiring woman in dentistry, who managed to have few kids all while operating multiple practices. How do women in dentistry that own their own practices manage to take maternity leave? What happens if the pregnancy doesn’t go as planned and you are bedridden for few months?

What happens when you are a solo practice owner and have an emergency? These are some questions that I am sure all women in the dental field are curious about yet find difficulty finding answers to. Dr. Callaway was kind enough to answer all my questions and she let me in on a little secret. She has been able to form a female support group that consists of successful women in dentistry. They are a very close -knit group that she found online, and they are all there for each other when things turn sour. They even take yearly vacations together!

She gave us an example of how one of the women in the group was bedridden due to pregnancy complications, but other members of the group picked up and helped her out by taking shifts at her dental practice. This friendship and support group helped ensure that the patient numbers did not fall, as long-term absence could really hurt the success of her practice. She also let us know that many women after giving birth end up hiring a nanny or family member for childcare or building a nursery in the office where staff members can check periodically on the baby. Also, being part of a corporate company such as PDS also helps being a mother because if you take few months off or have an emergency then other doctors from other states could fly in to ensure your practice is running smoothly while you are gone. Dr. Callaway agreed that as much as women like to think we can do everything a man can, we definitely have the short end of the stick. Thus, preparing for all different possibilities during family planning is vital for a successful practice.

Last but not least, there were also some entertaining lectures by Craig McKenzie (District 3 trustee), Kai Huang (District 5 trustee), Brandon Rensch (District 8 trustee) and our very own Paul Lamoreau (District 10 trustee) who all made us laugh till our stomachs hurt!

I am grateful that I was able to attend the Leadership Boot Camp because I took away so much valuable information from it! I don’t know where else I would have been able to get insight on starting a family while being a practice owner. Let’s just say that in the case of the Leadership Boot Camp, what stays in Vegas will definitely not stay in Vegas… this time!

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Off the Cusp

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