Seven Gifted Assets of a Dental Professional

Feb 9, 2019
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Dentistry is not easy work; patients sometimes give dentists a roller-coaster ride and send them back into their preliminary learning. Therefore, dentistry is also defined as an art of artist, a doctor`s dilemma and thorough engineering of head and neck.

The whole context of diagnosis becomes a center reputation for a dentist when he or she encounters a peculiar case that is often latent in symptoms or is camouflaged by certain characteristics. Therefore, every dental professional is gifted with certain skills, which act as the most helpful aid in diagnosis, management and treatment plan of the patients. Following are the gifted assets of a dental professional.

Assessment

This is an important skill where the dentist starts assessing the patient from the moment, he or she enters the dental premises. This skill gives the dentist a brief idea in order to frame his case history and determine the economic background of any patient.

Often patients who have low nutritional diet suffer from hair colour loss and loose skin at a very young age. The prescription of medicines actually can be either synergistic or antagonist to this condition. Therefore, visual assessment of the patient becomes crucial.

A rough idea of patient body mass and features helps a dentist to take up any possible risks anticipated after or during the treatment. The second round of assessment is done based on the patient interaction and communication with the surrounding relatives.

Permutation and combination

Assessing the patient is followed by permutation and combination, in the background of details furnished by the patient. Patient’s best interest is taken into account, and an ideal treatment plan is suggested based on their expectations and affordability. In dental practice, for certain cases, there might be recent advancements and newer techniques.

Advanced dentistry often comes with high price but with the consent interest of the patient, a dentist is liable to produce a beautiful record of advanced dentistry for  lifetime. The gift of knowledge helps a dentist to go ahead with permutations and combinations. But this parameter is also subjected to how much the practitioners updates himself with continued dental education.

Eye of an eagle

A dentist is gifted abundantly with an eagle`s eye, a quality which helps provides him to analyses not only the chief complaint of a patient but also updates them with associated problems, which he is unaware of.

A dental practitioners has a vision which can integrate information, differentiate the diagnosis and provide patients with an advanced information about the status of his medical wealth. Often cases reported with recurring lesions, secondary cancers or malignancy from other body tumours need a catch immediately through instincts.

In special cases, respecting to children with developmental deformities, the syndromes may present itself a bit challenging, but figuring out the various causative phenomena and analysing the contribution of the same in the current status quo is what dentists are gifted with. This gift develops with time and promotes itself from time to time with experience.

Detective analysis

Quite often it is a common observation among various patients whom they believe in concealing information, which are required to be furnished. In such cases, a detective mind works to save the practitioners, most of the time issues like unwanted pregnancies, use of contraceptives, abortions, smoking, cancer therapies, veneral diseases, and use of forbidden drugs are quite common. In such conditions, a thorough interrogation in case of doubt is required to prevent major issues arising in the future.

Motivation

Dental practitioners do not only limit himself or herself in treatment of diseases but also play a key role in the motivation sector of the treatment plan. Explaining the patient and encouraging him plays a major positive step in maintenance of the treatment and by extension the reputation of a dentist.

The ethical principle of doing well is a quality which every dental practitioner is gifted with. It is also termed as “Beneficence,” in the book of ethics.

Chameleon Tongue

A chameleon tongue is referred to as a tongue which is adapted to every patient. The belief needs no evidence to prove that every patient in dental practice is different, hence their management cannot be the same.

Sometimes, as dental practitioners we encounter with different people with anguish, fear, depression, anxiety and misguidance, hence the consultation cannot be same for everyone but the assessment of the patient and adapting a manner of interaction is truly a gift which every dentist has.

Veracity

Veracity or truthfulness is an ethical gift which practitioners receives right a beginning of his practice. Acquainting the patient with the actuality and building a truthful and ethical relationship with him are a quality of every dental practitioner.

A dentist in evidently builds a true and confidential relationship with a patient about his or her understanding of the disease and imparts the correct knowledge towards the same.

Concluding the discussion, the list of gifts which a dentist has gone on towards infinity but the role of instincts in determining, assessment and analysis of a dentist cannot be over ruled. These gifts are not only beneficial to the patients but also help a practitioners to establish a good market value with developing strategies.

References:

Sober peter:essentials of preventive and community dentistry, 3rd edition

George M Gluck and Warren M Morganstein:Jong’s community dental health,5th edition

Textbook of paedontic practise by Nikhil Marwah, 3rd Edition

 

Autologous Blood Injection for Treatment of Recurrent TMJ Dislocation: A Case Report

Dr Shishir Mohan Devki 1, Dr Venkatesh Balaji Hange 2, Dr Hasti Kankariya 3, Dr Shrey Shrivastava 4
1 Head of the Department, Professor 3,2,4 Postgraduate Student
123 Department Of Oral and Maxillofacial Surgery
KD Dental College And Hospital

ABSTRACT: Temporomandibular joint (TMJ) dislocation is a distressing condition characterised by locking of the mandibular condyle anterior to the articular eminence and inability of the patient to close their mouth. Various non-surgical and surgical modalities have been described in the literature with variable success. There is no definite consensus regarding superiority of any treatment modality over the other.
(1) Recently autologus blood transfusion injection has been used to treat recurrent TMJ dislocation. Schulz first described autologous blood injection for treating recurrent TMJ dislocation in 1973. (2)

INTRODUCTION: Dislocation of the TMJ occurs, when the head of the condyle moves anteriorly over the articular eminence into such a position that it cannot be returned voluntarily to its normal position. Luxation of the joint refers to complete dislocation, while subluxation is a partial or incomplete dislocation, actually a form of hypermobility. (1) TMJ dislocation can occur during simple activities such as laughing and yawning; it may occur after excessive mouth opening during dental treatment, tracheal intubation or episodes of vomiting.

There is a higher frequency of TMJ dislocation in patients with Parkinsonʼs Disease or cerebrovascular disorders, which is attributed to masticatory muscle incoordination. A person with TMJ dislocation is unable to close their mouth, which remains locked open until a mechanical reduction is performed. Frequent dislocation episodes characterise a condition referred to as recurrent TMJ dislocation. Thus, patients with this problem risk TMJ dislocation simply by carrying out their daily activities; this disorder can be especially dangerous when self-reduction of the TMJ dislocation is difficult or impossible. (2) Acute mandibular dislocation is usually managed by manually pressing the mandible downwards and then pulling it back upwards in an attempt to try relocating the condyle in the glenoid fossa. If the condyle continues to dislocate several times, it is described as chronic recurrent TMJ dislocation.

Dislocation of TMJ is generally of unknown origin, while several theories have been put forward to explain its onset, it is commonly associated with poor development of the articular fossa, laxity of the temporomandibular ligament or joint capsule and excessive activity of the lateral pterygoid and infrahyoid muscles due to drug use or disease. Additionally some disorders of collagen metabolism such as ligamentous hyperlaxity and Ehler-Danlos syndrome might be related. (3)

Dislocation of TMJ is generally of unknown origin, while several theories have been put forward to explain its onset, it is commonly associated with poor development of the articular fossa, laxity of the temporomandibular ligament or joint capsule and excessive activity of the lateral pterygoid and infrahyoid muscles due to drug use or disease. Additionally some disorders of collagen metabolism such as ligamentous hyperlaxity and Ehler-Danlos syndrome might be related. (3)

The decision depends on predisposing factors and the TMJ morphology. The more complex and invasive methods of treatment might not necessarily offer the best treatment option and outcome; less invasive approaches should be utilised appropriately before adopting the more invasive surgical techniques. Chronic recurrent dislocation may be approached with conservative procedures, including injection of botulinum toxin to various muscles of mastication, injection of sclerosing agents and autologous blood injection into the pericapsular tissue and superior joint space. (4)

Schulz [9] first described autologous blood injection for treating recurrent TMJ dislocation in 1973. In Japan, Takahashi et al. first reported the efficacy of autologous blood injection in a compromised patient who was unable to receive surgery in 2003. The reported overall success rate of autologous blood injection is approximately 80 percent.

Blood injections into the TMJ follow the pathophysiology of bleeding in the joints elsewhere in the body, such as the knee and the elbow. During the first few hours or days, an inflammatory reaction takes place, resulting in the release of inflammatory mediators by platelets along with the accumulation of dead and injured cells, leading to oedema of the joint tissue. This inflammatory reaction diminishes joint mobility. Thereafter, a combination of organised blood clots and loose fibrous tissue forms, which further decreases joint mobility. These tissues mature, causing a permanent limitation of joint movement. This exposure of cartilage to blood results in a disturbance of the cartilage matrix turnover and a decrease in chondrocyte metabolism, causing localised contraction. (4,5)

SURGICAL TECHNIQUE: Patient’s face is prepared. Local anaesthesia (2% lidocaine with 1:100,000 epinephrine) is applied to the auriculotemporal nerve. The articular fossa point (AF) is located at a point 10 mm anterior to the tragus and 2 mm inferior to the tragal-canthal line. At this location, a 19-gauge needle was inserted into the superior joint space of the TMJ; the correct location of the needle is confirmed by movement of the mandible during the fluid injection. Blood is withdrawn (3 ml) from the patient’s anticubital fossa; 2 ml of blood is injected into the superior joint space and 1 ml onto the outer surface of the TMJ capsule. The same procedure is performed on the contralateral TMJ. An elastic bandage is applied around the patient’s head and left in place for the first 24 h.

FIG.1 TMJ View Open & Closed Showing Dislocation

CASE REPORT: A 24 year old male patient reported to Department of Oral and Maxillofacial surgery, KD Dental College and Hospital with the chief complaint of recurrent locking of lower jaw and inability to close their mouth. History dates back to approximately 2-3 years, when the patient first experienced this distressing condition. Patient remained stable for variable time followed by recurrence.

Fig.2 OPG Showing Right Recurrent TMJ Dislocation

The condition was managed by manual reduction by various local clinicians. There was

marked deterioration of the condition with multiple episodes of dislocation per day. The diagnosis of TMJ dislocation was based on case history and clinical presentation which later confirmed by radiographic findings. It was decided to perform minimally invasive treatment modality. Restrictions to mouth opening by intermaxillary fixation using Erich’s arch bar seemed appropriate. Patient was informed regarding the procedure and written consent was taken.

Patient was under intermaxillary fixation for 2 weeks and a liquid diet was advised. After 2 weeks IMF was released and patient was followed up with for 2 months

Fig.3. Showing transfusion of Autologus Blood to TMJ

Patient showed relief in the number of occurrence of dislocations but dislocations continued even after restricted mouth opening for 2 weeks.

It was decided to use autologous blood injection therapy as patient was against surgical intervention seems. Patient was informed regarding the procedure and written consent taken. Arthrocentesis followed by injection of autologous blood only in the right TMJ space and adjacent pericapsular tissue as the right TMJ had the most discomfort as compared to contralateral side. Local anaesthesia was administered to block the auriculotemporal nerve.

This was followed by injecting 2 ml of autologous blood into the upper joint space and 1 ml around pericapsular tissue. Injection of blood was followed by opening the mouth and manipulation of the mandible forward to open the joint space.

For the purpose of restriction in mouth opening intermaxillary fixation using ivy eyelet wiring was done for 2 weeks. During post-operative period

FIg.4. Showing Post Operative Mouth Opening

patient experienced significant tightening of right TMJ with reduction in mouth opening. The result of autologous blood injection was highly encouraging in this patient.

DISCUSSION: TMJ dislocation occurs because of variable factors which prevent the condyle from translating back to the condylar fossa. These factors are laxity of the TMJ ligaments,weakness of the TMJ capsule, an unusual eminence size or projection, muscle hyperactivity or spasm, trauma and abnormal chewing movements that do not allow the condyle to translate back. Recurrent TMJ dislocation may cause injury to the disc, the capsule and the ligaments, leading to the TMJ internal derangement. (1)

Methods of treating recurrent TMJ dislocation range from conservative treatment to surgical interventions. Conservative treatments such as restricting mandibular motion with a chin cap, an elastic facial bandage or maxillomandibular fixation often fail to manage the condition. Whereas surgical treatment through eminectomy is considered the gold standard in the treatment of recurrent TMJ dislocation with success rates greater than 85%. multiple surgical interventions were developed including ,capsular placation,temporalis tendon scarification, and lateral pterygoid myotomy may have a high success rate,but it is an invasive procedure requiring general anesthesia, a hospital stay and a skin incision, in addition to increased risk of facial nerve injury. (2)

Non surgical methods are usually first applied to the patients before decision of surgery. There were some successful nonsurgical treatment models described in the literatures such as injection of a sclerosing solution into the joint cavity (tincture of iodine, alcohol and sodium psylliate). However, many side effects and the possible risk of facial paralysis or traumatic arthritis have hindered its widespread usage.Another procedure with less side effects is the use of botox. The toxin temporarily causes denervation of the muscles that draw the chin down. The muscle of choice for injection is the lateral pterygoid muscle. In this way, the displacement of the condyle is prevented even when the mouth is opened excessively. (3)

Autologous blood injection as a treatment of recurrent TMJ dislocation was reported by Brachmann in 1964. He successfully treated 60 patients by autologous blood injections into their TMJ. The therapy is based on the principle to restrict mandibular movements by inducing fibrosis in upper joint space, pericapsular tissues or both. (6)

There are no universally accepted guidelines for this therapy. The protocol differs amongst various clinicians. So, the autohaemotherapy includes the injection of autologous blood only into pericapsular tissues, upper joint space or into both upper joint space and pericapsularly. The volume of blood to be used ranges from 2 ml – 4 ml in the upper joint space and 1.0 – 1.5 ml into pericapsular structures. (7) To further enhance the fibrosis in and around the TMJ a period of restricted mouth opening was advocated in the literature. The protocol for mandibular movement restriction ranges from 7 days – 1 month. (4) The method to restrict mandibular movement utilises conservative elastic bandage head dressing to an aggressive approach of maxillomandibular fixation. (8)

The protocol for repetition of autologous blood injection varies amongst clinicians. Machon et al. advocated that intraarticular injection should be repeated only if there is recurrence of dislocation. Based on their experience, they advocated surgical intervention in case of failure of two intraarticular injections. Few case reports reported successful outcomes even on single blood injections. (9)

Schulz et al repeated pericapsular injection therapy twice a week for 3 weeks. Repetition of injection was not based on the recurrence of attack. Similarly, Khan et al used 3 injections of autologous blood into bilateral TMJ pericapsular tissues spaced at an interval of 5 days each. (10) Critical evaluation of protocols followed by various authors revealed greater success rates in case of use of both intraarticular and pericapsular injections as compared to either intraarticular or pericapsular injections alone. The variable protocols for repetition of injections and mode of mandibular movement restriction, on critical evaluation revealed that the clinicians who used pericapsular injections, advocated frequent repetition irrespective of recurrence. Also, the same clinicians recommended more aggressive form of mandibular restriction in the form of intermaxillary fixation for greater time period of 2 – 4 weeks. (11)

The autologous blood therapy was challenged by some authors who believe that even a brief exposure of the intraarticular cartilage to the blood may lead to decrease chondrocyte metabolism, chondrocyte apoptosis, cartilage degeneration and permanent joint destruction. (12)

Alons et al after inducing haemarthrosis in the TMJ of the rats reported that there is no noticeable damage to the cartilage and interposing disc on histopathological examination. Safran et al in an animal rat model have found that cartilage changes after blood injections were only temporary without any permanent damage. The disadvantage of this technique is the potential for severe restriction in mandibular range of motion. There were some concerns about the procedure such as fibrous or bony ankylosis and articular cartilage degeneration. (1)

There are several advantages of the autohaemotherapy as a treatment modality. As there is no tissue dissection, postoperative complications such as facial nerve injuries, altered sensation, swelling, infection and pain are all decreased or nonexistent. The procedure can be performed in an office setting with or without sedation under local anaesthesia and do not require any sophisticated instrumentation. (4)

Conclusion: Autologous blood injection in the superior joint compartment and around the capsule has been shown to be a safe, simple and cost-effective method for the treatment of chronic recurrent TMJ dislocation. This conservative approach can be tried prior to performance of more invasive surgical intervention. We hope this procedure will prove to be a feasible alternative treatment for patients prior to any surgical intervention.

REFERENCES:

  1. Autologous blood injection for treatment of recurrent TMJ dislocation: A case report. Gaurav Varma, Sumit Chopra et al., Annals Of Dental Speciality vol.2, issue 27, Jan-Mar 2014, 27-30.
  2. Autologous blood injection for treatment of recurrent TMJ dislocation. Norie Yoshioka et al., Acta Med. Okayama, 2016, vol 70, no.4, 291-294.
  3. Autologous blood injection to TMJ: Magnetic resonance imaging findings. Celal Candrili et al., Imaging dentistry science 2012, 42:13-8.
  4. Arthocentesis followed by intrarticular autologus blood injection for the treatment of recurrent TMJ dislocation. AM Bayomi et al. Int. Journal oral and maxillfac. Surg 2014.
  5. Srivastava D, Rajadnya M, Chaulhary MK and Srivastava JL: The Dautrey procedure in recurrent dislocation: a review of 12 cases. Int J Oral Maxillofac Surg (1994) 23: 229-231.
  6. Martinez-Perez D, Garcia Ruiz-Espiga P. Recurrent TMJ dislocation treated with botulinum toxin: Report of 3 cases. J OralMaxillofacial Surg. 2004; 62(2):244-6
  7. Aquilina P, Vickers R, McKellar G. Reduction of a chronic bilateral TMJ dislocation with intermaxillary fixation and botulinum toxin A. Br J Oral Maxillofac Surg. 2004; 42(3):272-3.
  8. Qiu WL, Ha Q, Hu QG. Treatment of habitual dislocation of the TMJ with subsynovial injection of sclerosant through arthroscope. Proc Chin Acad Med Sci Peking Union Med Coll. 1989; 4(4):196-9.
  9. Myrhaug H. A new method of operation for habitual dislocation of the mandible: review of former methods of treatment. Acta Odontol. 1951; 9(3-4):247-60.
  10. Daif ET. Autologous blood injection as a new treatment modality for chronic recurrent TMJ dislocation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109(1):31-6.
  11. Schulz S evaluation of periarticular auto-transfusion for therapy of recurrent dislocations of the TMJ. Dtsch Stomatol 1973; 23:94–8.

12. Aurora JK, Singh G, Kumar D, Kumar R, Singh K. Autologous injection for the treatment of recurrent TMJ dislocation – a case report. J Indian Dent Assoc 2011; 5:846–8.

Continuing Dental Education Part I

We live in a time and age where new trends take shape every few months, dentistry is experiencing a rise in a novel curve of learning – Continuing Dental Education (CDE) programs. Just as abundant as Good Morning WhatsApp forwards, we are bombarded with ads of these courses all over our social media accounts. There’s a lot of confusion regarding them – whether these courses should be regularly done or they are just a wasteful expenditure of time and money. To clear this, we must first understand what exactly are these programs.

Continuing Dental Education or CDE programs as they are popularly known, are defined by the Indian Dental Association (IDA) as ‘designed to offer ongoing education which is intrinsic to deliver high quality dental and oral health care services. The primary objective of such CDE programs is not just to update the clinical knowledge of dental graduates and practitioners, but also to exercise the highest degree of care and improve treatment methods that will be beneficial to the citizens of India.’ Clearly the definition explains well, the importance of keeping oneself updated with the ever developing and expanding field of dentistry. But as students of science, who must question everything before accepting anything, let us explore this definition, part by part, objectively.

‘Designed to offer ongoing education which is intrinsic to deliver high quality dental and oral health care services’ –

An accomplished dental practice with a fixed base of patients may inadvertently push the oral physician in a comfort zone. The good part about this comfort zone is its comfortable cushioning effect; the bad part is lying in a pool of stagnation – which is lethal to the growth of any individual. Not keeping up with the changing concepts and upcoming treatment modalities hinders the quality of oral care provided – and in a competitive world like ours, with clinics mushrooming in every street, this may also cause us to lose that same loyal base of patients to another up-to-date professional.

As a role reversal, CDE programs can also be viewed as a different and lucrative career option for postgraduates who have a flair for teaching and can offer their services to ensure ongoing education of their fellow colleagues.

‘To update the clinical knowledge of dental graduates and practitioners’-
Keeping this in mind, the apex body of dental education in our country, the Dental Council of India (DCI) has recommended 100-150 CDE points over a period of 5 years to be collected by every dental graduate and practitioner, with a minimum of 20 points and a maximum of 50 points a year. These points are awarded to only those dental professionals who attend certain CDE lectures or conferences or workshops. They have been made mandatory for renewal of dental registration (although this part of the recommendation is not enforced in some of the states presently).

However, this proposal also adds on to the responsibility of DCI to ensure that there is no breeding of corruption, no substandard quality of courses and no undue or unethical promotion of brands during the conduction of such programs. Dental professionals also need to be careful in selecting the courses to be done, especially courses making high claims in less duration.

‘To exercise the highest degree of care and improve treatment methods’-
We must not forget that it is not only dentists, but the entire general population whose lives are constantly evolving due to advancements in technology. There are hardly any ‘clean-slate’ patients who visit us – most of them are on the go with Google. They are aware of the problems and available recent treatment options due to the plethora of information accessible on the internet. We are catering to a demanding generation of well-read individuals. The good part is ample literature like dental journals, research papers, articles and videos are obtainable on the same internet medium, and it can be argued that imbibing knowledge through these can be equivalent to upgradation of education. But can we be assured of its authenticity and applicability to Indian population and subpopulation?

When we attend CDE programs, the mentors handpick authentic knowledge and teach in a simplified, dignified manner, which saves our time from flipping through the abundant information and avoids confusion. Coupled with the knowledge is also the long term experience of these mentors which helps us to learn from their mistakes and gauge the applicability of the particular technique or skill taught in the program. Both these factors are essential to exercise the highest degree of care and improve treatment methods employed.

‘ Will be beneficial to the citizens of India’ –

There’s no doubt that a higher skill set benefits our patients, but do these courses really benefit the Indian community of dentists? Does it fit into our ‘Socioeconomics’, which in my opinion is where the CDE programs lack to some extent currently.

The main question that makes us think twice before enrolling for such programs are –

Which conference or course will benefit me and the section of patients I cater to and how do I select the right course? (A point-to- point guide to finding an answer to this is enlisted in Part II of this article).

After complete exploration of the definition, it is clear that this initiative is definitely pointing to a brighter future of dental education and learning, and with a wise selection will prove to be an absolute boon for your dental practice.

-Dr Nupur Shrirao
MDS, Prosthodontics & Implantology

References –
1. www.cde.ida.org.in
2. The gazette of India, New Delhi, Dental Council of India Notification; September 13, 2007 [cited 2015 Jul 10]

Removal of a Broken Instrument: An Endodontic Challenge

Feb 8, 2019
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Dentists love to flaunt the curves of treated root canals. With advancements in endodontics, it has become easier to reach normally inaccessible areas in a root canal, helping the clinician to achieve 3D cleaning and obturation.

After the development of new instruments and techniques, use of NiTi rotary instruments has gained popularity;  not everything is without its own pros and cons though.

One of the most dreaded nightmares of any clinician is broken instruments in the midst of treatment. NiTi rotary instruments show a high incidence of instrument fracture despite their favourable qualities. Broken instrument not only includes separated files but also applies to a sectioned silver point, a segment of a lentulo, a Gates Glidden drill, a portion of a carrier-based obturator or any other dental material left inside a canal.

Causes

Cinematic movements wrongly applied on instruments. Use of already deformed instruments that can be fractured due to cyclic fatigue.

Treatment

With the advent of newer visualisation techniques, clinicians get an enhanced magnification and illumination by using dental loupes and operating microscopes. It helps in visualising the most coronal aspect of broken instruments and allow them to remove it without perforating the root canal.

There are three options from which a clinician has to choose anxiety attack because of the realisation that the instrument has broken settles down. They are whether to:

  • Remove the fractured segment
  • Bypass and seal the fragment within root canal
  • Go for a true blockage
Factors

There are many factors for the treatment plan:

  • Status of pulp
  • Root canal infection
  • Root canal anatomy: Higher success rate in cases of anterior teeth with wide and straight canals and for posterior teeth with narrow and curved canals.
  • Position of the instrument: The removal of an instrument fragment located in the apical third is particularly complex as compared to middle and coronal thirds. In general, if one third of the overall length of instrument can be exposed, it can be removed.
  • Type of broken instrument: It is more difficult to remove NiTi rotary instruments as compared to stainless steel instruments because they generally fracture at a smaller length. They tend to straighten out when they break in a curved canal due to elastic memory. Stainless steel instruments do not break during removal process while NiTi instruments may fracture again and go deeper in the canal presumably due to heat generation.

Amount of damage that can be caused to the remaining tooth structure: Procedure and instruments used to gain access to the broken instrument may increase the risk of perforation of canals.

Along with good technology, a succe

Non surgical method of instrument removal

No attempt to remove the broken instrument should be made unless a proper straight line access to the head of instrument is achieved. It is done step by step by creating a coronal access followed by a radicular access.

Coronal and radicular access

High speed, friction grip, surgical length burs are used to gain straight line access to all canal orifices.Clinical experience suggests that most of the broken files separate towards their terminal extents between D3, D4 and D5.

A predictable way to create a safe radicular access is to initially use hand files, small to large to create sufficient space to use GG drills. The drills are then used to create a smooth flowing funnel which is largest at the orifice and narrowest at the obstruction.

Creating a staging platform

When an ultrasonic instrument introduced into the pre-enlarged canal does not have enough space lateral to the broken segment, to initiate the trephining process, staging platform is created.

This is made by using GG drills whose maximum cross-sectional diameter is slightly larger than the visualized instrument.

Techniques for removal
  • Ultrasonic techniques

Prior to performing any radicular removing techniques, cotton pellets should be placed over other open orifices to prevent the re-entry of fragment into another canal. The tip of ultrasonic instrument is placed in intimate contact against the obstruction and typically activated at the lowest power setting that will accomplish the task.

These techniques do not usually generate much heat so procedures can be performed dry to assist visualization. The ultrasonic vibrations help loosen the broken fragment which may sometimes jump out by itself by a slight wedging action.

In case where an instrument is deep inside, a larger length, smaller diameter tip can be used. If it is still deeper, titanium instruments which provide safety due to its smooth cutting action should be used.

  • Microtube removal methods

There are several microtube removal methods that are designed to mechanically remove an intracanal obstruction like a broken file. But it requires excessive removal of dentin which may dangerously weaken the tooth structure and predisposes to ledge, perforation and fracture.

Following are the examples of microtube removal techniques:

  • Lasso and Anchor use an appropriately sized microtube and a wire passed through the tube, looped at one end and passed back through the tube.
  • Tube and Glue uses an adhesive such as core paste to bond the obstruction to the microtube.
  • Tap and Thread contain five microtubular taps but its use is limited to radicular obstructions that extend coronally to the pulp chamber or to coronal one-third of the root canal.
  • Masserann Kit is an old yet very effective method for strong purchase of instrument and its removal but limited to use in large canals of anterior teeth.
  • Spinal Tap Needle is used along with its metal insert plunger or a hedstrom file to remove the broken instrument.
  • Endo Extractor is a newer recently released instrument system which is able to gain a strong mechanical purchase on a broken instrument but limited to coronal aspect of larger canals.
  • Instrument Removal System consists of three colour coded microtubes each with a different diameter.
Surgical method of instrument removal

In cases where non-surgical removal is not possible like an instrument beyond the apical foramen and intentional leaving of the broken instrument might prove to be risky, surgical approach is undertaken.

This procedure is performed under local anesthesia only after thorough history, proper clinical examination and good quality radiographs.

But as an age old proverb goes:

“ PREVENTION IS BETTER THAN CURE”

  • Root canal instruments should be examined before and after use to make certain blades are regularly aligned. Too much or too little space is an indication that the instrument has been under strain and may break.
  • The degree of torque applied should be in a controlled manner.
  • Instruments should be used according to the sequence without skipping any size.
  • Debris should be removed between the blades from time to time.
  • Instruments should be used with agents used to wet the canal like sodium hypochlorite and chemicals should be used to facilitate cutting where necessary.

References:

  1. Ruddle, CJ. Nonsurgical endodontic retreatment. J Calif Dent Assoc. 200432:4
  2. Friedman, S, Stabholz, A. Endodontic retreatment: case selection and technique. Part 1: criteria for case selection. J Endod. 1986;12:28–33.
  3. Stabholz, A, Friedman, S. Endodontic retreatment: case selection. Part 2: treatment planning for retreatment. J Endod. 1988;14:607–614.
  4. Ruddle, CJ. Microendodontic nonsurgical retreatment. in: Microscopes in Endodontics, Dent Clin North Am. 41. W.B. Saunders, Philadelphia; 1997:429– Johnson, WT, Leary, JM, Boyer, DB.
  5.  Smith, BJ. Removal of fractured posts using ultrasonic vibration: an in vivo study. J Endod. 2001;27:632–634.

Johnson, WT, Leary, JM, Boyer, DB. Effect of ultrasonic vibration on post removal in extracted human premolar teeth. J Endod. 1996;22:487–488

Does air pollution affect your teeth?

Feb 1, 2019
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We are all well aware of pollution that has been slaying us for years now. Pollution used to be an essay question in school and if I am not wrong it is still. So we human beings studying pollution for decades have not managed to raise a single finger to do something about it, is what we can conclude by released statistical reports. Recently on the festive evening of Diwali, New Delhi was proclaimed as the most polluted city on earth. Health issues are given code red during this scenario. But how many of us are aware of pollution having adverse effects on the development of teeth, on the beautiful pearls we brush and clean every day.

Pollution by definition is introduction of contaminants into the natural environment that causes adverse change. IARC* has classified air pollution has human carcinogen.  Poor air quality is linked to premature death, cancer and long-term damage to respiratory and cardiovascular systems. Air pollution influences the development of oral clefts in animals. There are few epidemiologic data on the relation of prenatal air pollution exposure and the risk of oral clefts. New evidence suggests that exposure to outdoor air O3 during the first and second month of pregnancy may increase the risk of cleft lip/cleft palate. Similar levels of O3 are encountered globally by large numbers of pregnant women.*(1)

Particulate Matter (PM) consists of breathable particles to which several compounds, such as heavy metals, polycyclic aromatic hydrocarbons (PAHs) and some volatile compounds may adhere. Epidemiological studies have found a consistent association between exposure to airborne PM and incidence and mortality for cardiovascular disease as well as lung cancer with natural cause mortality*(2–9). Recently, diabetes and other chronic diseases have been associated with PM exposure, possibly through oxidative stress and inflammation*(10). The finest fractions of PM (PM2.5 and less) play a major role in causing chronic diseases because they are retained in the alveolar regions of the lungs and diffuse into the bloodstream, inducing inflammation, oxidative stress and blood coagulation *(11,12). Children are a high-risk group in terms of the health effects of air pollution. Some studies suggest that early exposure during childhood can play an important role in the development of chronic diseases in adulthood. A study conducted in children living in a town with high levels of air pollutants in a Western country, the conclusion drawn was a high level of MN** in buccal mucosa cells, confirming previous findings of a mutagenic effect of urban air pollution on human beings. Thus DNA damage in buccal mucosa cells of Pre-School children exposed to high levels of urban air pollutants was confirmed.*(13)

All this scary evidence gives us a brief idea of how health and oral health are getting affected and interlinked. Exposure to solvents and pesticides, fertilisers, engine exhaust, textile dust and leather dust also increase the risk of oral cancer. Another contributing factor to oral cancer is indoor air pollution with other significant inflammatory respiratory diseases and infections. Around 50% of people in developing countries rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with incomplete combustion thereby exposing women and children to indoor air pollution on a daily basis.

In India, the increasing economic development and a rapidly growing population that has taken the country from 300 million people in 1947 to more than one billion people today is putting a strain on the environment, infrastructure and the country’s natural resources. The latest urban air quality database of 2014 released by WHO reconfirms that most Indian cities are becoming death traps because of very high air pollution levels. It’s estimated to be the cause of seven million premature deaths every year (4.3 million from ambient outdoor pollution, and 2.6 from households).*(14). In this scenario, we should be conscious of our health and try our best to lessen this pollution even if it is in a small way. Let’s observe this National Pollution Day coming on December 2nd by taking small steps in minimising pollution thereby taking better care of our health, our children and our future generations.

Air Quality Index on Nov 16, 2018 @ 4 PM

(Average of past 24 hours)

 

City Air Quality Index Value Prominent Pollutant Based on Number of Monitoring Stations
Delhi Poor 285 PM2.5 37
Mumbai Moderate 129 PM10 1
Chennai Satisfactory 54 CO 2
Kolkata Very Poor 308 PM2.5 2
Hyderabad Moderate 118 PM10, PM2.5 6
Thiruvananthapuram Satisfactory 78 PM10 1
Varanasi Very Poor 326 PM2.5 1

 

Possible Health Impacts

Good Minimal Impact
Satisfactory Minor breathing discomfort to sensitive people
Moderate Breathing discomfort to the people with lungs, asthma and heart diseases
Poor Breathing discomfort to most people on prolonged exposure
Very Poor Respiratory illness on prolonged exposure
Severe Affects healthy people and seriously impacts those with existing diseases

 

# cpcb.nic.in//upload/Downloads/AQI_Bulletin_20181116.pdf

Abbreviations

*IARC : International Agency for Research on Cancer

** MN : Micronuclei ( MN frequency used as a biomarker of DNA damage)

Reference

 

  1. Ozone and Other Air Pollutants and the Risk of Oral Clefts by Bing-Fang Hwang and Jouni J.K. Jaakkola, Environ Health Perspect. 2008 Oct; 116(10): 1411–1415.
  2. Particulate matter air pollution: how it harms health. World Health Organisation, 2005
  3. Anderson JO, Thundiyil JG, Stolbach A. Clearing the air: a review of the effects of particulate matter air pollution on human health. J Med Toxicol 2012;8:166–75.
  4. Raaschou-Nielsen O, Andersen ZJ, Beelen R, et al. Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol 2013;14:813–22.
  5. Shah ASV, Langrish JP, Nair H, et al. Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet 2013;382:1039–48.
  6. Silva RA, West JJ, Zhang Y, et al. Global premature mortality due to anthropogenic outdoor air pollution and the contribution of past climate change. Environ Res Lett 2013;8:034005.
  7. Review of evidence on health aspects of air pollution— REVIHAAP Project. First results. WHO Regional Office for Europe, World Health Organisation, 2013
  8. Beelen R, Raaschou-Nielsen O, Stafoggia M, et al. Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 2014;383:785–95
  9. Cesaroni G, Forastiere F, Stafoggia M, et al. Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ 2014;348:f7412.
  10. Puett RC, Hart JE, Schwartz J, et al. Are particulate matter exposures associated with risk of type 2 diabetes? Environ Health Perspect 2011;119:384–9.
  11. Sørensen M, Autrup H, Møller P, et al. Linking exposure to environmental pollutants with biological effects. Mutat Res 2003;544:255–71.
  12. Lewtas J. Air pollution combustion emissions: characterization of causative agents and mechanisms associated with cancer, reproductive, and cardiovascular effects. Mutat Res 2007;636:95–133.
  13. DNA damage in buccal mucosa cells of pre-school children exposed to high levels of urban air pollutant;Elisabetta Ceretti,Donatella Feretti;Published: May 2, 2014 org/10.1371/journal.pone.0096524.
  14. Institute for Health Metrics and Evaluation (2017). Global Burden of Disease (GBDx Results Tool). Available online.

Oral rehabilitation-Vertical dimension

Jan 16, 2019
0

This video will prepare you to plan and manage cases with severe attrition, develop skill sets to assess and record vertical dimension of the patient and create a step by step guide to execute a case with a collapsed bite and TMD with occlusal splint therapy and full arch restorations.

 

 “Eduhub is the place where you get proven expertise to hone your skills, under the mentorship of the best dental professionals of India. Come, be a part of today’s leading dental community.”
– Dr. Ratnadeep Patil, MD and CEO Eduhub

For more information: 

About the course:

What after BDS? Earn and Learn.

It was his last day of internship. All cases completed, and he finally felt accomplished after the long years of struggle to complete his Bachelor’s degree in dental surgery. But there was this ounce of doubt in his head. What next?

Indeed, it’s a privilege to be a dentist in today’s scenario. But just being a Bachelor may not suffice in some parts of our country. Especially in the metropolitan cities where patients proactively browse the internet looking for the highest form of degree a dentist can hold for a specific treatment. Whether you have the apt skills or the experience, it just does not matter. Indian millennials today want the best of the best practitioners with the highest qualification. So sooner or later the amateurs start preparing for NEET and then MDS for another 4 years. But despite all this, a bachelor’s degree in dentistry is more than sufficient to make a living.

It would be unrealistic if I say the road to success after bachelor’s degree is an easy one. One must be diligent and hardworking to get to a point where we have the finances flowing. But with a lot of planning one can achieve whatever he/she is willing.

But so much for our innate qualities, we still look for something more in our careers. Hence in this article, I shall take you through all the best options one can explore after BDS.

What after BDS?

  1. Start your own practice:

Starting a practice in India in the current scenario is beneficial as India is world’s fifth largest economy after the United Kingdom in 2018 as per the news reports. Infact, any small scale enterprises are doing well in India as the currency values are going up.

Advantages of owning one’s own practice after BDS:

  • Be your own boss: Having your own practice gives you the freedom to live the way you want. You can always delegate work to your team members in practice and visit your clinic as per your time.
  • Keep your money for yourself: The profits you make through some gigantic cases shall stay with you instead of just getting a fixed salary and lose out all the big money.
  • Getting established sooner: The sooner you put your own clinic the sooner you start having a name in the society and get the recognition for your good work.
  • Continuous Professional Development: You can have enough time to go for professional development courses alongside your practice. You have the luxury to decide things for yourself.
  • Applying new skills: It is understood that no one can question you while you try your hand in any new case when you have the license to do so. For instance, if you would like to try your hands on implants. You can always do it with confidence if you are a certified implantologist.
  • Learn the dental market: Private practitioners have a better understanding of what works and what does not.
  • Support your family at an early age: Can run other family business alongside your practice. Can support a family member who is a dentist like your spouse.
  • Sponsor your own post-graduation: After BDS, we all would like to go for a post-graduation. Instead of using financial support from your folks, we can support ourselves having an income from the clinic.

Hence, I would always recommend starting your own practice after BDS. It’s a win-win situation. But there are many factors you should also take into consideration, for instance, the kind of locality your planning to open a practice, the dental labs nearby and the convenience to commute to the clinic etc.

Calculated risks should be taken when it comes to opening one’s own clinic. Using some advice from your seniors will help you in case you’re naïve.

2. Pursuing your Master of Dental Surgery (MDS):

Course level: Postgraduate

Type: Full time

Course fees: Depends on your chosen branch (2 to 60 lakhs)

Admission process: Entrance based and direct admission if you pay more.

Average starting salary: 4- 10 lakhs per annum for a full-time job.

If you are sure you would like to specialize in any specific branch it’s always better to start preparing for your MDS entrance exams or NEET. Most dentists are likely to succeed undoubtedly in their careers after MDS. There are a galore of career opportunities available after MDS in private practices and hospitals across India.

Options after MDS:

  • Start your own speciality practice or a multi-speciality hospital.
  • Can work towards starting of multiple practices.
  • Working as a consultant and freelancer at your stipulated time.
  • Start your own business.
  • Get teaching in top dental colleges. Can aim to become a reader or a dean of a dental college. Getting into academics can create financial stability at an early age.

. 3. MBA in Hospital Administration or Healthcare Management:

Course level: Postgraduate

Type: Full Time or Part Time

Duration of course: 2 years

Course fees: 60,000 to 7.5 lakhs depending on the university.

Admission process: Based on performance in entrance test or direct admission.

Average starting salary: 3-12 lakhs per annum

A master’s in business administration in the healthcare sector is the most desirable course for the dentists since the past three decades. In fact, our Indian universities are having some of the best faculties and the training is fine enough to escalate one’s career after bachelor. With the expansion of healthcare industry in India, the scope of a career in this field is better. MBA opens a lot of career opportunities for youngsters at higher posts in hospitals.

With the growing number of group practices, rehabilitation centres, chain of hospitals there is a rise in demand for qualified and talented administrators in most places in India except in the rural areas.

Some of the roles one can take up in hospitals after completion of MBA are Administrators, Human resource manager and supervisor roles.

Some of the roles include:

  • Maintaining the standard image, policies and ethics of the hospital.
  • Catering to the needs of the patients and to make sure all the treatment protocols are followed by the staff.
  • To help doctors meet the standards by catering their demands rationally.
  • Recruiting the best staff. Hiring and firing people as per requirement.
  • Managing accounts in the hospital.
  • Dealing with lawsuits involving the hospital, making sure the hospital runs smoothly.
  • Looking for sponsorship and support for the hospital and its staff.

4. MS in Clinical Research (for pharmaceutical companies)

Course level: Postgraduate

Duration of course: 2 years

Course fees: 50,000 to 5 lakhs depending on the university.

Admission process: Based on performance in entrance test.

Average starting salary: 3-12 lakhs per annum

There are plenty of new openings in clinical research in pharma companies. It deals with the evaluation of how effective or useful a drug, vaccine, diagnostic test, new device; surgical technique can be in humans.

The number of trials approved by the Drugs Controller General of India is increasing due to the number of diseases prevailing in India. Various multinational companies and Indian companies are eager to conduct multicentre trials in India. The Clinical Research Organizations (CROs) are outsourcing pharmaceutical research services to India and hence creating employment.

India is the second largest pharmaceutical market in Asia grew by more than 9 % annually. In 2017-2018, 50,000 jobs were created for fresh professionals from various dental and medical colleges.

Some of the roles available for BDS candidates with a clinical research course in Pharmaceutical industries are:

  • Co-Investigator
  • Medical Advisor
  • Drug Developer
  • Regulatory Affairs Manager
  • Clinical Research Physician
  • Clinical Data Manager
  • Clinical Trial Documentation in charge

Top recruiters are all hospitals, CROs, Educational Institutes, Government drug and food regulatory /research organizations etc.

5. MA in Clinical Psychology (practice as Psychologists/ Psychotherapist)

Course level: Postgraduate

Duration of course: 2 years

Course fees: 50,000 to 2 lakhs depending on the university.

Average starting salary: 1- 4 lakhs per annum

This course is recommended for BDS candidates who are willing to switch their domain to some extent, and who are focused on earning at the earliest. The fact that these set of skills are highly lucrative and can help you grow immensely.

Some of the posts available after an MA in Psychology are:

  • Child support specialist
  • Self-reliance specialist
  • Drug and alcohol specialist
  • Career Counsellor
  • Human resource analyst
  • Daycare centre supervisor
  • Clinical psychologist
  • Forensic psychologist
  • Health educator
  • Parole officers
  • Community Relations Officer
  • Rehabilitation Specialist
  • Research Psychologist

6. Master in Public Health/Administration (MPH):

Course level: Postgraduate

Duration of course: 2 years

Course fees: 3 to 6 lakhs depending on the university.

Average starting salary: 3-10 lakhs per annum

This course is structured to build knowledge, develop skills and provide exposure to real-world situations in public health. The principal areas covered in the curriculum are Epidemiology, Environmental Health Science, Public Health Biology, Health Management and Functional Management, Social and Behavioural Science, Public Policy etc.

It also includes disciplines such as Medicine, Engineering, Information Technology, Social Science and Management.

Top recruiters for candidates with MPH degree are McKinsey and Company, Children’s fund, WHO, Clinton Health Access Initiative, Bill and Melinda Gates Foundation, etc.

7. Government Service Jobs

India is the best country to support your needs in the recruitment industry.

There are several government jobs in the following sectors:

  • Public Service Commission (PSC):

There are a galore of jobs available in this category of the state govt for dentists. However, the selection is based on exams. There are opening for lecturers and dental surgeons after BDS and MDS.

For any further information refer to GovtJob.com

  • Odisha Public service commission(OPSC):

This was constituted on 1st April, 1949 by three individuals and it was a single body. But later it got bifurcated from former Bihar and Odisha Joint Public Service commission. This has gone a long way and is source of recruitment for the mainstream jobs in the government sector of Odisha.

For further information refer to www.opsc.gov.in

  • Union Public Service Commission(UPSC):

This is one of the best government sectors which provide jobs in Ministry of Railways. It comes along with many other bonuses and perks for the railway employees. It’s another highly recommended platform for candidates after BDS.

Dental Council Jobs in India:

This is the best platform to launch you into the mainstream jobs for dentists at a national level. The various posts available from time to time are:

  • Medical Officer
  • Associate Professor

The recruitment is based on face to face interviews. One needs to apply in websites like Naukri.com.

  • Army dental corps

Candidates can opt for dental jobs in the Indian Army which are available in the various hospitals across India. It is prestigious SSC Officer’s post and the dentists are called Indian Army Dental Corps SSC Officer. Any desirous dental surgeon can apply for this post. It’s a very promising and challenging career. If luck is on your side, you can be selected directly as Captain/ major.

  • Territorial officer in Indian Navy/Air force:

There are several jobs available in this government sector as well. Like Dental officers, counselors etc. Armed Forces Medical Services is the finest options available in the country for dental professionals. The life of a dentist in the Indian Air force is filled with adventures and is full of self-esteem. It promises both professional and personal growth for dentists. The pay and perk are supposed to be the best and the lifestyle of the armed forces is of the highest standards.

Criteria to get selected:

  • Candidate should hold a BDS degree with 60% marks and have MDS from a recognized university.
  • Candidate should have completed one year of compulsory rotary internship recognized by the Dental Council of India.
  • Candidate should hold a permanent Dental registration certificate.

8. Teaching or Academics:

There are many opportunities in teaching for both graduates and postgraduates in India. Vacancies are available at various times of the year. Teaching is a safe way to balance life between work and family. As the working hours are limited and the salary is fixed.

Above all, one needs to focus on overall self-development to stand out in the job market. Do yourself a favour by improving the following skills:

  • Good communication skills.
  • Focus on overall development.
  • Improve your growth mindset.
  • Have a parallel profession.

Why go abroad?

Despite all the unravelled opportunities available for dentists in India we witness a lot of brain drain happening in our country. When asked to doctors about their career plans, they literally talk about going abroad and wishing to earn in dollars. They fancy the lifestyle in foreign countries. The word ‘abroad’ looks appealing to students who have a foreign background or whose relatives are living abroad. It must have been a promising idea few decades back to be in Europe, UK or gulf since our currency values were low at that point in time. But seeing the tremendous growth in the Indian economy, it doesn’t seem practical to move abroad.

India is the fifth largest economy and the most desirous destination for investors. India like China has opened its markets to the world. The Indian rupee has hit a 32-month high against the American dollar. More and more people are willing to settle down in India, there is freedom to practice. Dentists are indomitable and using independence effectively. You can ask a dentist who practices in any developed country. Are they allowed to prescribe any drug which seems appropriate for a case without a pre-written consent? Are antibiotics available to people freely over the counters like in India? Is any BDS doctor allowed to do specialty treatment without scrutiny from the patients?

Every developed country has its own restrictions. Whereas, in India general practitioners can do treatments from any specialization as far as they have the skill. This is next to impossible in abroad countries. Of course, the kind of payroll the dentists in US or UK receive is too higher. But the kind of practice we do in India is way too challenging and we give better results . Moreover, with the kind of population we have in every part of India, any dentist who owns a clinic is bound to do well with a bit of hard work and perseverance.

For the ones complaining of work pressure and lesser pay, I would suggest drawing a line in your work hours and getting the facts right. Seven out of every ten Indians are overworked and underpaid according to a source from IndiaToday as said by Mr Raghuram Rajan the Chicago based economist and former governor of Reserve bank of India. But unless we opt for a change, change isn’t going to come by easily. If you want to see your money double, invest in real estate, mutual funds and put your money into your own family business. Sound knowledge on how to handle money can bring about the kind of income you want. Just as much as you will earn abroad.

Starting your own practice abroad too is a painstaking task. Anywhere abroad, you need a sponsorer. In East Asian countries, the sponsorers even have names like Bhumiputras. The stakes held by you over there as a dentist will be just 35-40% of the total income you make in a day. If you’re opting for developed countries like UK or Australia, you have to clear their set of licentiate exams which costs nothing less than 5-9 lakhs. The exams are itself are so tough, only the smartest of the candidates may get through. The study material and training courses cost separate. After which you will have to go in for vocational training for another year. The entire process easily takes 3 years. Even after all this, you will have to work under restrictions.

The other point is in India, we citizens can open multiple businesses, or practices and still will not be questioned except for the various taxes that we must bear. In India, we can start earning just after our bachelor’s degree. Either one can work as a trainee in a clinic or can get jobs in academics and research field. Moreover, in today’s generation summer jobs are also quite popular to make some quick bucks.

If a country like India can be so relaxed in its rules and can still give us the kind of lifestyle we get in developed countries, then why to go abroad? We are standing at the brink of globalization and will emerge to be a superpower in a few more decades. I don’t see any reason why we should leave our country for any reason.

The only time we Indians should be going abroad is for ‘Holidaying’ and maybe a world tour whenever you are ready to backpack.

Financial advice for dentists

Jan 9, 2019
1

Long arduous training period compels young dentists to start their working life late. Long erratic working hours restrain dentists to devote sufficient time to plan their finances. Dentists are at great disadvantage and some may not get proper financial advice.

Dental schools only teach clinical aspects of dentistry, absence of financial classes or fiscal understanding are other disadvantages to dentists.

Many of us dream about a big home and luxurious car as soon as we graduate and start practicing, the reality is quite different. We may be able to cut a prep with a 400,000 rpm handpiece in a couple of minutes. Yet the full restoration takes time and patience to build longevity. Similarly, it requires lot of patience and management at the beginning of career to be successful apart from clinical expertise.

Dentists should take care of themselves first as it is the most important financial asset.

Health Insurance

The first thing to be done is to make sure to have health insurance. If we get ill, injured or cannot work, all our training becomes useless and the ability to earn a lucrative living is procrastinated. Yes, it is likely that we may be in a state of complete health, but as a part of our training, we know that unexpected accidents and unforeseen illness can happen to anyone at any time. Therefore it is prudent to first and foremost get ourselves insured. All our medical expenses are covered apart from having a small cash reserve to cover our emergency medical expenses.

Indemnity Cover

In a profession like ours, it is mandatory to have an indemnity cover. It protects us against any threats given by a patient in losing their close one due to negligence or ill advice. Human error cannot be eliminated and we are always at risk. Such claims can pose a significant threat to the financial security of a practitioner. This insurance protects us against claims arising out of bodily injuries caused by error, omission, negligence and covers defence cost incurred while investigations, cost of representation and compensation cost to a certain extent.

Debts and Loans

Be smart and start to pay off all your loans and be debt free before starting to spend all the newly earned fresh money on tempting luxuries. Pay all your debts including credit card,  student loan or anything else. It may seem to be an easy task but it is not simple in the present era of advertisements and the need to show off.

Advertisement allures us to the consumer brands that provide us with an identity. Our mind becomes captive to the appealing products and their features presented in a manipulated manner. The result increases in the amount of debt to buy every new product in the market in order to ‘upgrade our lifestyle or practice’ and failure to pay back and left with no savings.

One must remember that although it is very important to keep upgrading with advancements in the field of dentistry it is not necessary to buy every fancy instrument that our fellow dentists buy. All that glitters is not always gold.

Start Saving

Always pay yourself first at the end of every month. Use the remaining amount to pay bills. Excess incoming money creates an internal representation of an empty room which must be filled with purchases. By reducing this money for savings, we make this empty room smaller.

It is said that those who start saving their 20% income consistently at a young age have no problem retiring at an age of 60. This consistency is very difficult to achieve. There consistency which is mentioned in the following point.

Automate your Savings

Set up an automatic withdrawal of money from your earnings into your savings account. Make sure that this account is separate from your daily or monthly expense accounts. After all, out of sight is out of mind. Within a short span of time, you won’t think about reduction and will be comfortable with the available money.

Learn the rules

A little financial literacy can be a dangerous thing. All of the seminars that one attends on financial aspects teach us what to do without focusing on what not to do. This little learning gives us confidence to be more adventurous and take undue risks.

One must avoid falling victims to glossy investment policies. Be sure to take second opinion of a neutral third party before investing in any plan.

Learn where to find the best tax deductions, when investments can be made and how much can be invested and understand what kind of investment produce what kind of returns.

Be Patient

Being impatient and selling our old investments when not getting big profits in the first year and buying new ones will take us nowhere. Disappointments can happen with our investments as well. The market can crash, the company can get out of business. As in our field, we need to be ready to face investment casualties as well.

In the end, I want to conclude by saying that begin the planning before its too late and you might wish that you know who has a Time Machine for you to go back and change your mistakes.

 

Three things Dentist can learn from Politicians

Dentistry is one of the most competitive and rewarding sectors in the health fraternity. Financially, it is going through a blended patch worldwide. In some areas, it is blooming but in some areas, there is no growth. That said, dentistry ranks in the top 5 highest paying careers.

Our first concern in dentistry should be our patients and their well-being. You must always strive to do what is best for them. Over the years, you may have analysed countless dental practices and coached numerous dental clients. Dentists can learn three most common and important attributes (reliable predictors of uncommon success) from politicians:

Earn more and stress less (key to success)

Success in dentistry depends on the ability to manage both clinical and practical management skills. You have to hone your skills to balance both the skills. Enhancing helps in diagnosing and treating patients better. Here are few tips to success in dentistry:

  • Count the number of new patients every month.
  • Cost of acquiring a new patient.
  • Enhance your clinical as well as practice management skills

Dentists spend a significant amount of time and money enhancing and upgrading their clinical skills. But, they come back to their clinics with the same management complications, they left with. They are now able to offer incredible dentistry to patients, but there are no takers. Patients don’t respond only to clinical skills but see lot of aspects.

The most important aspect which you need to know is the number of new patients visit your clinic every month. This is critical because you always want to feed the funnel with new patients. Your patient base is one of your most precious assets and the key to your success. Building a relationship with your patients will increase the steady inflow of new complaints.

The third thing which you need to know is what it costs you to acquire a new patient. This is also called cost of acquisition. Obtaining a patient is usually viewed as an expense, but you need to modify your thinking to see each new patient as an asset. Many people look for the cheapest way to acquire new patients. This is not the profession to be cheap. You need to be happier, stress-free and efficient surrounding for the whole dental team and that is when you really attain success in dentistry. This synthesis is crucial to your success.

  • Establish goals with accountability

Dentists learn long-term vision from politicians, but interpreting their vision is important for their goals. Their behaviours are routinely tracked, analyzed and adjusted.

It is all about keeping the tension in the right areas, and keeping team members engaged and accountable. You must establish specific goals and chart the progress of things like:

  • Case acceptance rates
  • Hourly productivity
  • Invitations
  • Retention and new patient flow

It’s like having a “dashboard” of signs that ensures that every day is on purpose and that any slippage can be immediately identified and corrected.

  • Invest in yourself and your team

The most important revenue-generating asset in dentistry is you and the people around you. So, if you are not growing and educating in an organized way you will become a quickly depreciating asset. The most significant thing is to know from the beginning that equipment and technology upgrades are not the expenses to be endured when the money is there for it. These are the most valuable re-investments that protect and enhance the worth of your practice and keep you at the leading edge of the profession.

There are many paths to success in dentistry but there are few core principles (stated in this article) which are common to the best politicians and one can learn from them.

The First Time I Truly Helped A Patient

Jan 5, 2019
8

“Die when I may, I want it said of me by those who knew me more, and that I always plucked a thistle & planted a flower where I thought a flower would grow,” could be in Abraham Lincoln’s words the best way to describe and define “help.” However, in this era when we are entangled in our own cobwebs of knitting & sewing the true essence of help appears to have evaporated unless it promises a definite return. A hundred times every day I remind myself that my inner and outer life depends on the labours of others around me, and I must expect myself in order to give in the same measure that I have received; I thought of penning down today something I thought I did out of my regular business of life. To those who are raising an eyebrow in astonishment, it’s the bitter truth of life. Every profession talks to business and to our agony, even in the life sciences.

“Time is money,” is what keeps echoing in our ears since the time we initiate, the first day in our professional lives. Unfortunately, I am yet to understand that in this statement, has time lost its value or has money become quintessential! The person who tends to balance the equation between time and money well is the sole individual who knows the true meaning of “Help.”

The memory of one of my dental camps is still so fresh in my mind. On a bright sunny day with my fellow house surgeons, I set out for a screening and treatment camp at a Palliative Cancer Care Institute in Bangalore. The word “Palliative” was new to us and so we were excited a little more than usual to experience the sight of this place. Our bus stopped and the moment I got down to my surprise; my heart came in my mouth. Numerous cancer ailing patients whose life was juggling between life and death, crying out to God for their last breath as their pain and agony were irresistible. If I could put it in words, it was “Hell On Earth,” in every sense. We were then allotted one patient each for overall oral assessment and treatment to be imparted.

When I approached near my allotted patient’s bed, the patient was not there. After a few minutes, I felt a trembling warmth on my left shoulder and when I turned around I saw a face with a huge exclamation struck between the tortuous course of raised wrinkles on his face. The face that reflected not only the experience of various seasons and fluctuations of life but more than that, hardships of time and betrayal of family in a true sense. He had put his hands on my shoulder assuming me to be his son who had left him bereft in his last phase of life because cancer is not only the disease of an individual but that of the entire family, succumbing to it physically, mentally as well as socio-economically!

Make no mistake it is one of the most significant challenges in our history. I made him comfortably move towards our dental van, examined his oral cavity, conducted ultrasonic scaling and gave him a few lozenges for his reduced salivary flow. His entire mucosa was atrophic. He lost his appetite but more so, interest in his life. When I was about to leave him at the end of my service, he looked at me for a while with eyes wide open which after a few seconds narrowed down with tears rolling down his cheeks as in the past one month there had been nobody to sit by him and even listen to him! The drops of tears appeared really miserable to me who themselves seemed to beg me to say, ”Can you please call my family and make them realize how inconsiderate they are? ”.

I immediately took help of the Palliative Care Institute Director with the help of my faculty and summoned his son. After being reluctant for a while when he realised that his social status was at stake, he agreed to visit his father. At that moment he spoke to me very professionally about his father’s illness and why he could not take our time because he was striving hard to put two and two together in his own life! Fortunately, I could recollect my principles that my mother has installed in me and made him realise that life of a human is ‘humane’ just because we have feelings, emotions, respect, love, care and tendency to help.

When a dying father is longing to hold his son’s hand for a few seconds or minutes, the son should not forget that those are the same hands who clenched his fingers to stabilize his trembling legs in childhood. Fortunately, after that, his son sat beside him and the father who was a victim of prostate cancer held his hands with trembling fingers as if although in last stage but still wanted to shower all his love and warmth on his son. It was a tight and warm hold. Tears drooling from the corners of his eyes wetting the pillow and there was no stopping. As I held both their hands in acknowledgement, I could feel the grip loosening, father’s hands turning cold and to my horror, just after that, his old hands fell into despair! The man took his last breath!

In our daily practices, we treat a lot of patients and send them smiling because I am a dentist by profession. Though this episode will remain memorable to me because I ‘Helped’ or rather ‘Truly Helped’ a patient of mine in taking him through the last phase of his life and helping him reach out to his son whom he had been longing for the past few months. May his soul rest in peace!