I study Dentistry - Ask me anything (AMA)

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Reply 120

swwet aish

can yu suggest me the name?

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Reply 121

Jitesh

Original post by Kartace

So, I volunteered in a care home on every other weekend. I attended a dental practice every Monday, I played in a band twice a week, I composed music, did DofE and helped out at a special needs gym club. :smile:

Oh nice! JW how long for and how long per week ie 4 hours at the care home a forth night? etc...

Reply 122

Howard

I've quit smoking cigarettes in favour of vaping. I've noticed that my teeth have become several shades whiter since I quit the cigarettes and the hard tartar buildup has completely gone. What is the medical view on vaping as compared to cigarettes in terms of oral hygiene?

Reply 123

Kartace

Original post by Howard

Hey there, firstly congratulations for giving up smoking, great decision and I know it can't have been easy! The positive dental effects you report are also encouraging.

What i can tell you about vaping is somewhat limited due to the fact that it's relatively new and we haven't had the benefit of long term research. However, i can tell you what we do know.

The levels of toxic smoke products are significantly less in E cigarettes than normal cigs, but the level is certainly not 0 and it needs time for us to say with any certainty whether this is significant or not.

The quality of the production of e cig fluid is quite variable - some cartridges have been shown to contain highly variable concentrations of Nicotine and other carcinogenic preservatives.

The nicotine in e cigs does not help with kicking the addiction to nicotine unless you phase down you dosage of nicotine over time and often people smoking e cigs end up becoming more severely addicted to nicotine as the levels in e cigs are much higher than normal cigs. (They're designed to be used when you have a craving, not smoked like a normal cigarette). In this instance they actually cause more trouble.

They still contain nicotine - this may sound obvious but despite the lack of tar and benzene etc. that are found in normal cigs, e cigs do still contain nicotine and we know from research that nicotine itself is carcinogenic and can potentially have a number of long term effects on neurological health and kidney/liver function.

In terms of oral hygiene specifically, nicotine is bad for periodontal health due to it's ability to cause vasoconstriction. This is also a problem for patients undergo minor oral surgery and extractions. There is also evidence that the heat produced in vaping can increase risk for oral cancer by activating heat shock proteins (HSPs) that play a role in carcinogenesis. Not to mention the fact that nicotine itself is implicated in oral cancer.

So I will close by say this - it's likely that e cigs are probably not as bad for you as normal cigs but we cannot at this stage say by how much.

It's also likely that e cigs are damaging to the health of the user and those who passively inhale the exhaled vapor but at this stage we cannot say how damaging.

E cigs are being shown to be an effective way of kicking addiction to smoking and nicotine but only when part of a structured program of weaning in which the nicotine dosage is systematically reduced.

E cigs have been shown to worsen addiction and dependence when used irresponsibly. (with high doses of nicotine multiple times in a day)

Hope that's helped a bit - my sources are listen below:

D. J. Worsley, K. Jones & Z. Marshman. Patients are asking about e-cigarettes. What do we tell them? British Dental Journal 217, 91 - 95 (2014)
Published online: 25 July 2014 | doi:10.1038/sj.bdj.2014.596

(edited 8 years ago)

Reply 124

Kartace

Original post by Jitesh

Oh nice! JW how long for and how long per week ie 4 hours at the care home a forth night? etc...

So i would usually spend about 6 hours at the care home. 2 hours at the gym club, 4 hours a week in band, all day in dental practice, a couple of hours doing DofE.

Reply 125

Kartace

Original post by swwet aish

can yu suggest me the name?

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Reply 126

Kartace

Original post by NainaK98

You must have great time management ahaha, this is a skill I am yet to master :tongue:

It comes with time and practice...I didn't used to be like this, but needs must. London is expensive, my thirst is great and I am so very poor!

Reply 127

Kartace

Original post by T.Stroodle

I understand with max fax you would have to go back to uni to get a degree in medicine, but if you wanted to specialise in anything other would you still have to go back to uni?

So, you're right in saying that for maxfax you need a medical degree but you don't need one for any of the other dental specialities - in some cases you may need medicine for an oral medicine position but there are now training pathways that do not require you to undertake another degree for this.

Having said that, a lot of specialists do choose to go back and study for a PhD etc.

The actual act of specialising itself for most dental specialties such as Endo, Pros, Perio etc. is a form of postgraduate university education - it usually takes the form of an Mclindent which is a masters degree in clinical dentistry. This can be done part time or full time,

Reply 128

swwet aish

Thanks alot ! But um just 19 can i have ?

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Reply 129

Howard

Original post by Kartace

Thanks for the reply. I have to confess that I am not vaping as a transition towards eventually stopping - it's not an exit strategy. I am vaping as a replacement for cigarettes.

I'm going for low levels of nicotine in my e liquids (4MG in a 30ML bottle) which lasts me three weeks.

I understand that a regular pack of cigarettes contains between 8 to 20 milligrams of nicotine. If I just take the lower level and say that I used to smoke a pack a day (about right) then over a three week period I'd have gone through 168MG so on this basis I am exposing myself to just 2.38% of the nicotine by vaping as I was when smoking regular cigarettes. So vaping might not be healthy but a significant reduction in nicotine to this extent can't be a bad thing!

(edited 8 years ago)

Reply 130

Howard

Original post by Kartace

That Nicorette gum has 4 mg of nicotine per stick. Let's say you have 4 sticks a day and your at 16mg a day (112mg a week) My e liquid is 4mg's a bottle - and a bottle lasts 3 weeks - 0.19MG/day. So using Nicorette will expose you to 84 times as much Nicotine in a day as vaping. I don't know how the medical profession is oblivious to this simple equation and continues to prescribe Nicorette - it's a wonder anybody could ever give up smoking on the stuff!

Reply 131

NainaK98

Original post by Kartace

It comes with time and practice...I didn't used to be like this, but needs must. London is expensive, my thirst is great and I am so very poor!

Fingers crossed London will get tne opportunity to do that for me too!

Reply 132

Kartace

Original post by Kaeden

Does it bother you at all that at least 90% of the people who will come to visit you at your workplace will be absolutely terrified of you?

especially someone like me. :blushing:

Hey there, firstly I'm sorry to hear that you suffer from dental anxiety, I'd advice trying to find a dentist who specialises in anxious patient, the best way to get over it is by going regularly and have routine check-ups and small desinsitisation visits when you have cleanings etc. But in extreme cases, there is always the option for sedation. My best advice would be to try and practice impeccable oral hygiene, the better you look after your teeth, the less likely you are to need to come and see us. If you come for your check ups we can spot any problems earlier on when they can be treated with a minimally invasive approach rather than if you just attend when you have pain. At that stage you've put the dentist and yourself in a really difficult position - often there is very little the dentist can do and most of the treatment options are on the more invasive end of the spectrum, so the patient has a bad experience and the whole thing perpetuates itself in a vicious cycle!

tl;dr - get a good, caring dentist and go every 6 months.

In answer to your question about how it affects me. I would start by saying that low level dental anxiety is fairly prevalent but the sort of extreme dental anxiety that we see portrayed in the media and that was so characteristic of dentistry 20-40 years ago is not so common these days. It certainly still occurs and the Adult Dental Health Survey shows us the trends in dental anxiety and it has fallen in recent years.

Dental anxiety is still the number 1 cause of non-attendance in a dentist, followed by cost. This is surprising and really quite saddening for me to be honest, it makes me feel like my profession is failing the public and in particular those people who are most vulnerable and need our help the most.

In my experience most of my restorative patients have been pretty chilled and quite happy to receive free treatment. However, I do tend to see a selective sample of patient given that i work in the hospital and in order to get to me, patient are usually referred and this means that they already attend a dentist and so probably aren't THAT anxious. In contrast to that a lot of the oral surgery patient i see and those on dental emergency clinic are exactly those sort of people that i mentioned before who only attend when they're in pain. The levels of dental anxiety in these patients is often much much higher and the levels of cooperation much lower.

This is challenging but it's where our training comes in. We have trained and practiced endless scenarios for dealing with nervous patients and after a while it just comes naturally, each patient is individual and not every technique works for everyone but i have found that being pleasant, explaining things, giving the patient as much control of the situation as possible and working quickly and efficiently is often a winning formula.

Now of course, we also see children as patients and this presents a very different challenge. Quite often i will see a child who has a mouth full of decay and needs a fair few teeth out, occasionally up to 20. These patient can be very difficult to work with as they are in pain and in a scary environment. There's a lot you can try and do but reasoning with children who are upset is difficult. A lot of it comes down to tone of voice, body language and engaging the parents and child, if at all possible i try and avoid performing invasive treatment at the earlier appointment in favour of desensitising with simple things like check-ups and cleaning. (this isn't always possible if the child is in pain though)

Having said that, some children are absolutely fine and are perfectly willing to sit and let you do almost anything to their teeth. Generally the older the child the more you can do...very often the parents are the source of anxiety or lack thereof. (it can sometimes be easier to have them out of the room). Unfortunately in very uncooperative patients, very young patients or those requiring multiple extractions it's sometimes necessary to use a general anesthetic (this is a last resort).

So in conclusion, nervous patients are an unfortunate part of the job but are equally something that every healthcare professional (not just dentists) have to learn to deal with. The ideal solution in my eyes is to change attitudes towards dentistry in general. It's not like a GP where you go when your sick, you should go to the dentist for check-ups so that we can catch things early and prevent them! Combining this with the superior teaching in patient management that we have in uni these days and a better appreciation of how to deal with patient anxiety. Hopefully we can reduce dental anxiety even further and improve the oral hygiene of the general public at the same time!

(Sorry for marathon post - i had a lot to say on this topic, and i could say a lot more. It means a lot to me)

Reply 133

Kartace

Original post by Howard

At least you're being honest about your use of E cigs which is good!

As i said e cigs are likely to being better for you than normal cigarettes and it's definitely good that you're going for a lower nicotine level in your liquid (not everyone does). There are however a number of other chemicals present in some liquids that are equally as carcinogenic as those in normal cigarettes. These are the worries that are troubling the medical profession at the moment. In order to recommend something as a viable alternative or solution to smoking we first need to have good evidence that it doesn't cause problems in other areas as well as establishing that it actually works etc.

Secondly I'm afraid that this comes down to pharmacology and the differential absorption of nicotine. I'm by no means an expert on smoking cessation and i would only recommend the gum to this patient on the basis that he is using chewing tobacco in particular. It's just as important to fulfill the physical habit as well as the physiological addiction when trying to quit. I also believe that nicotine in the chewing gum is likley to be absorbed at a much less efficient and slower rate than through inhalation. Nicotine is also broken down in the GIT and is conjugated by bile salts etc. and this lowers the amount of neuroactive nicotine. I believe this is the pharmacological reason for the disparity in the dosage. However, it could just be that this is for particularly heavy smoker and is a poorly designed product. Who knows. I would recommend therapy and medication via an NHS stop smoking service as the gold standard for tobacco cessation but the patient posting in this thread doesn't appear to have access to that kind of support so i just supplied the name of an alternative that he could chew which is less likely to lead to oral cancer.

I accept that your e cigs are probably less damaging than cigarettes i think that fairly well established but compared to the gum i'm not so sure. There is a lower level of nicotine in the vapour but there are a number of other chemicals too. The lining of the lungs is also much much more sensitive than the mouth. There's a reason that lung cancer is the most common in the world. My best advice would be to just stop the whole thing, then you've no need to worry which is potentially better or worse in the long term. I do understand that it's not as easy as it seems though.

(edited 8 years ago)

Reply 134

Blonde1

Wow thank you very much for the reply on the bruxism post. I get headaches, I developed a twitch but this went away before the clenching started. Trying my best to stay conscious of it and chew gum when driving. Never had a sore jaw in the morning. I seem to be a habit sort of person in general.

Reply 135

Kartace

Original post by Blonde1

Sounds to me like a tension problem. Chewing gum might not be the best solution as it can lead to increased muscle tension and clenching while you sleep, but if it's stopping you clenching then that's good. Some people recommend wearing a mouthguard in the day, some recommend keeping your mouth wide open. The truth is that we don't really know enough to give definitive advice unfortunately :frown:

Reply 136

Kartace

Original post by Jitesh

Oh I didn't realise it had changed formal name, I've only heard it referred to as VT! I'm in year 12 at the moment; sorry :smile:

What were the main extra curricular activities you did at sixth form?

http://www.copdend.org/content.aspx?Group=press%20releases&Page=press%20release%20april%202013

This explains what i was on about!

Reply 137

FluffyCherry

Original post by Kartace

As the title says - ask anything you like!

Do you get to study "organic chemistry" ?
And what sort of chemistry and biology are covered in dentistry that has been already taken in A levels?

Reply 138

KAWK

Might sound a bit stupid but what's the best way of using Mouthwash?

Reply 139

Kartace

Original post by FluffyCherry

Do you get to study "organic chemistry" ?
And what sort of chemistry and biology are covered in dentistry that has been already taken in A levels?

I wonder why you are asking specifically about organic chemistry?

There are definitely element of organic chemistry in the course. For example in first year there is a fair emphasis on Biochemical processes etc. which involve organic chemistry and of course anything involving sugars is in effect organic chemistry, there is also a small amount of organic chemistry in dental materials although the vast majority is inorganic chemistry.

Also the way in which you experience chemistry will be very different from A level, for example it's much more about appreciating the overall concepts and reactions than being able to recall and demonstrate the mechanisms and reagents/products etc. of any given organic/inorganic chemical reaction. I've only had to use skeletal formula about twice in my entire degree, dentistry just isn't about that aspect of science.

As for other things that are covered in Dentistry from A level i suppose it depends largely upon what subjects you've studied. There are certainly elements of both chemistry and definitely biology but there are also relevant concepts that are from physics etc. They are built on during the first year mainly when you cover the basic clinical sciences, pharmacology, anatomy, physiology and biochemistry etc. Although the workload is much higher and the detail much greater and more focused on the human body. Things like glycolysis and the krebs cycles etc. are possible examples of things that you might have covered at A level which are also covered in a BDS.

Doe that answer your question?