UCLA School of Dentistry

SPRING 2012 | VOLUME 9 | ISSUE 1

The Diastema

FEATURE STORIES
ASDA Welcome Address ASDA Special Needs Committee What Lies Behind Clinic Doors? Faculty Interview: Dr. Fisher Dental Education: New Oral Surgery Requirements Research: Mouthwash Eliminates Caries

By Kent Lau hen Dr. John Yagiela passed away on February 21, 2012, the UCLA School of Dentistry community lost one of its most endeared members. Dr. Yagiela was a Distinguished Professor in the field of Dental Anesthesiology until his retirement last year. A revered lecturer and passionate mentor, he also served on the American Dental Board of Anesthesiology and was President of the American Society of Dentist Anesthesiologists. He was recognized for his immense contributions to the field by receiving a myriad of awards, and his textbook, Pharmacology and Therapeutics for Dentistry, was considered the standard reference for dental students alike across the country. When asked about Dr. Yagielas contributions to the school, Dr. Barrie Kenney, a colleague of his for over thirty years, said that: Dr. Yagiela was integral in developing the reputation of this school and making it one of the best in the world. He also played a central role in developing the renowned dental anesthesiology program here at UCLA and worked to make dental anesthesiology an ADA recognized specialty. As those in the Dental Anesthesiology community will mourn the loss of a great mind, his students will also miss his passionate lectures and mentorship. What made him a great educator, however, was not only intellectual prowess and his unique ability to communicate complex subjects to students, but it was also his upbeat personality, sense of humor, and passion for teaching. Dr. Yagiela was one of the biggest names walking around UCLA. At the same time, he was still one of the most approachable, recalls Sarah Koyama, a second-year dental student. Dr. Yagiela is survived by his son, daughter, and five grandchildren. A memorial service was held on Saturday, April 7th at the UCLA Neuroscience Research Building Auditorium.

UCLA ASDA Members,

ASDA Welcome Address

n behalf of the executive cabinet of UCLA ASDA, it is my great pleasure to welcome all students, faculty and staff to another great year at the UCLA School of Dentistry. UCLA ASDA has been working diligently to launch an extensive slate of events this year designed to help students navigate dental school and to advocate on behalf of dental students at the local, state and national level. From health fairs and school visits to the newly created special needs outreach events, UCLA ASDA is committed to providing plentiful opportunities for students to reach out and support the community, both locally and abroad. In the last year alone, our ASDA chapter has increased the schedule of Lunch-and-Learn seminars and informational sessions solely to make sure you are receiving information about the important issues affecting the dental profession beyond dental school. ASDA is also commited to easing the burden of dental school by increasing the number of tutorials, student panels and stress-relieving morale events. All members are encouraged to get involved and to bring new ideas or suggestions to the Executive Cabinet so ASDA can continue to improve. It is with great pride that I am able to report that the UCLA ASDA chapter was honored with the prestigious Ideal ASDA Award in 2011, receiving this recognition for the second consecutive year. This award recognizes UCLA as the overall strongest chapter of all 61 dental schools across the country. This year, we were awarded for our achievements with the prestigious Gold Crown in Fundraising and also received 1st Place in the ASDA/Crest Oral-B Community Dentistry Category. The Executive Cabinet would like to congratulate all UCLA ASDA members, as their dedication to becoming leaders in the community and advocates of organized dentistry enables UCLA to be an example for other dental schools and a continued source of optimism for the future of the profession. Thank you again for your dedication and involvement in ASDA and we look forward to another outstanding year! Best Regards, Matt Sandretti UCLA ASDA President UCLA SOD Class of 2013

ASDA Welcome Address.............................................................................................................................................................................................2 Health: Piercings of the Oral Cavity and Oral Health........................................................................................................................................3 Opposing Cusps: Anti-Mid-Level Provider...........................................................................................................................................................4 Opposing Cusps: Pro Mid-level Provider..............................................................................................................................................................4 ASDA: Big-sib ASDA program...................................................................................................................................................................................6 Main Story: ASDA Special Needs Committee.....................................................................................................................................................7 What Lies Beneath Clinic Doors...............................................................................................................................................................................8 Events: American Association of Women in Dentistry.....................................................................................................................................9 Faculty Interview: Dr. Fisher....................................................................................................................................................................................10 Games Factual Faculty Factoids.........................................................................................................................................................................12 Research: Mouthwash eliminates caries.............................................................................................................................................................13 Dental Education: New Oral Surgery Requirements......................................................................................................................................14 Taking Off the Loupes: Seeing the bigger picture of ASDA........................................................................................................................15
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Table of Contents

ORAL HEALTH

Piercings of the Oral Cavity and Oral Health

By Khushbu Aggarwal
Whether through the lower lip, tongue, or cheek, oral and perioral piercings have undoubtedly become increasingly popular among the adolescent and young adult population. These rings, studs, and loops have not escaped the attention of oral healthcare professionals who question the short-term and long-term effects of this jewelry on dental and systemic health. As a result, dentists should be informed of these sequelae because patients may present either before acquiring a piercing to inquire about the risks or in need of urgent care immediately afterwards. While most patients are well aware of the lingering pain of a newly inserted piercing, few are familiar with some of the potential shortterm consequences of even a correctly placed piercing into such a highly vascularized and innervated part of the body. In addition to the potential to develop major hemorrhage, lasting paresthesia, or permanent hypogeusia, 50% of patients will experience painful ulceration and inflammation that last 3-5 weeks and that may affect deglutition, mastication, and respiration. Furthermore, the continued presence of jewelry in the oral cavity (especially that made of stainless steel) facilitates the entry of pathogens such as Staphylococcus aureus, A group and beta-hemolytic Streptococcus, Pseudomonas aeruginosa, and Erysipelas. These infections can easily spread through nearby lymph nodes and subsequently to vital organs, for instance in the case of endocardititis. In addition to experiencing mild to serious allergic reactions (such as contact dermatitis) to the jewelry itself, patients also risk contamination by infectious diseases as a result of improperly sterilized equipment. Such diseases include hepatitis B and C, HIV, tetanus, syphilis, and tuberculosis, as well as a variety of conditions caused by herpes simplex virus, Epstein-Barr virus, and Candida albicans. Moreover, the constant presence of a foreign object in the mouth may cause lasting consequences on both the dentition and surrounding soft tissues. One study found enamel loss in 80% of patients with tongue piercings, due to constantly playing with the jewelry. Unintentional orthodontic movement has also been reported to occur. In one interesting case, a woman with a barbell-shaped piercing presented with a midline diastema between the maxillary central incisors (see image). Patients should be aware of these long-term risks prior to acquiring a piercing, if possible, as removal of the piercing if so desired may become difficult if epithelial tissue (for instance, in the form of hypertrophic or cheloid scars) grows over the insertion wound. Furthermore, the metal piercing provides a greater surface area for food particles, plaque, and calculus to collect, resulting in halitosis and gingivitis, especially in the region of the piercing. Constant irritation of tissues by jewelry may also lead to localized gingival recession, horizontal bone loss, and increased periodontal pocket depth, depending on the location of the piercing. Finally, dentists must consider how oral and perioral piercings may impact dental work. First and foremost, dentists should remember to remove all metal objects above the neck, including piercings, prior to x-ray examinations to avoid inclusion of interfering artifacts. Second, when considering large restorations (especially those of porcelain) in patients with piercings, clinicians should remember that piercings increase the risk of cusp fractures. Thirdly, when selecting a material for a direct restoration, dentists should opt for composite instead of amalgam since the discrepancy in reduction potential between certain metals and amalgam may lead to corrosion of the restoration and pulpal sensitivity. Finally, even though patients may not always wear their piercings to dental appointments, piercings should be considered in differential diagnoses for both soft and hard tissue alterations. Though the effects of perioral and oral piercings may not have been covered extensively in Periodontics or Oral Pathology, bearing these considerations in mind will allow dental students (and future dentists) to provide their patients with the comprehensive care that UCLA emphasizes.

The Diastema

Winter 2012

Vol. 9

Issue 1

Mid-level Providers Novel Solution or Unethical Short Cut? By Stephanie Cappiello

The discussion surrounding the implementation of dental mid-level providers in states such as Alaska, Minnesota, and even California, has been one of the most hotly debated controversial topics to affect dentistry in years. There is no doubt that there are significant barriers to care for almost 35% of the population in the United States. Geographic isolation, financial barriers and disabilities are among the most common reasons people cannot access adequate dental care. In response, the idea of mid-level dental providers has flourished as an alternative workforce model to combat the barriers to care and offer acceptable dental

OPPOSING
this problem. One of the biggest barriers to care is the lack of an adequately sized workforce in the midst of an exponentially growing population. The demographic group representing people aged 65 and older in the United States is growing at a rate three times that of the general population, and increasingly more of the elderly are maintaining their dentition. This increasing demand for dental care reminds us of the situation our country faced 65 years ago when the medical field realized that physicians needed to delegate a particular scope of their practice so that they could focus on higher-level care, making the whole system more efficient. Their solution of mid-level providersphysicians assistants and nurse practitioners

servicesweeee its gonna rain tonite!! i to the underserved populations. hate sunshine!! Unfortunately, many of the proposed models create environments where undertrained dental surgeons perform irreversible procedures without direct dentist supervision. The term mid-level providers has been tossed around the dental community like a hot potato for the past few years. However, this term is actually a misnomer. Some states allow people who are being trained as these so-called mid-level providers to have less training than Registered Dental Hygienists. For example, the Alaskan Dental Health Aid Therapist, or DHAT, is a two year program providing one year of medical training and a second year of clinical training. Therapists will provide oral exams, preventive dental services, restora-

tions, stainless steel crowns, extractions and take x-rays without direct dentist supervision. However, some of these are irreversible procedures being performed by undertrained providers. This short-term educational program does not qualify them as a mid-level provider, but a subpar provider with little educational and clinical experience. Ultimately, they may become a liability to the dental community. The DHAT is not the only example of a mid-level provider program. A more promising model is Minnesotas Authorized Dental Therapist. These providers are required to obtain a four year bachelors degree or two year masters degree in Dental Therapy. Direct dental supervision is required for the first 2000 hours until they are allowed to work offsite. These therapists can diagnosis oral

The Case for Mid-Level Oral Healthcare Providers By Jared Kenney

The former U.S. Surgeon General, David Satcher famously named oral disease the silent epidemic; it has now become a universally accepted access-to-care conundrum. Poverty, geography, lack of oral health education, language and cultural barriers, fear of dental care, and the misguided belief that only pain necessitates dental care are the main barriers to oral health care for tens of millions of Americans. Though the problem has been thoroughly analyzed and universally agreed upon, sharp divisions exist among oral health care providers regarding the solution to
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has worked extremely well as long as these mid-level providers stay within their designated scope of practice. The situation in dentistry is largely the same. Jack Dillenberg, dean of Arizona School of Dentistry and Oral Health, believes that the dentist-supervised mid-level providers can be successful doing simple restorations, and will allow dentists to perform more sophisticated restorative dentistry, which many prefer to do anyway. The important difference between the medical and dental models is that in dentistry, mid-level dental providers would be performing many more irreversible operations than medical mid-level providers. Indeed, this issue of quality of care is the principle argument of those that oppose current measures

UCLA School of Dentistry | ASDA

provide limited restorative procedures. In addition, the Advanced Dental Hygiene Practitioner in Minnesota and Washington State expands the scope of practice for dental hygienists that complete further training and clinical experience. Both the ADA and ASDA have firm policies against the implementation of dental mid-level providers. The ASDA C-1 policy states that only a dentist should perform the following functions: examination, diagnosis and treatment planning, prescribing work authorizations, performing irreversible dental procedures and prescribing drugs and/or other medications. Furthermore, ASDA is strongly opposed to independent dental hygiene or mid-level provider practice and believes that it is incumbent on the profession to assure that expanded functions for dental auxiliaries

TWO OPPOSING OPINIONS ON MID-LEVEL PROVIDERS

In 2003, Alaska created the Dental Health Aide Therapist (DHAT) position, a community driven workforce system to improve access to care in rural Alaska. A DHAT works in conjunction with a dentist through real-time teledentistry to perform preventive care, restorations, pulpotomies, and simple extractions. These mid-level providers practice within their boundaries, and provide a high quality of care within those limits. In a 2011 study of several DHATs and their supervising dentists, Williard and Fauteux found that quality assurance is integral to the DHAT model. The system requires a DHAT to have a lengthy preceptorship with their supervising dentist, so that dentist is fully aware of the capabilities of the DHAT and adjusts his or her standing orders accordingly. Daily two-way communication facilitated by teledentistry promotes continual guidance and trust in the DHAT/dentist relationship. Also, all of the interviews in this study indicated that DHATs know their scope of practice and err on the side of caution. A study by Bader et al. evaluated the clinical technical performances of DHATs and found that they are performing at an acceptable level, with short-term restorative outcomes comparable with those of dentists treating the same populations. Bolin et al. found similar results. With strict adherence to DHATs limited practice and continual communication with their supervising dentists, the system is largely seen as a success. Other similar models of limited-care mid-level providers are at beginning stages, so no data is available yet on the quality
The Diastema

CUSPS

will not adversely affect the health and well-being of the public. These strongly worded policies reflect the voice of the dental profession. It is unfair to compare dental mid-level providers to their medical community counterparts: Physicians Assistants and Nurse Practitioners. Dentists must diagnose disease and perform surgical, irreversible procedures on a daily basis. Allowing undertrained people to decide the treatment plan and perform these procedures without dentist supervision does not live up to the Dentists Pledge that all dentists take and the dental community assumes as their responsibility to do no harm to patients while providing the best care possible. It is reasonable to believe that the current dental model is not providing enough care for our coun-

try. Therefore, in the near future, it may be necessary for dentists to delegate a certain scope of their practice to these so-called mid-level providers. However, the current models and legislation surrounding this issue are not the answer. The dental community must go back to the drawing board and establish a dental teammate that knows their boundaries, will practice within their boundaries and will provide a high level of care within these boundaries to their patients while being supervised by a dentist.

of their work or their effectiveness. Despite the uncertainty that surrounds the dilemma of mid-level oral healthcare providers, a few things are certain. Additional studies are needed to evaluate the quality and longevity of the work of these mid-level providers as well as their effectiveness in improving access to care. Also, as desires for mid-level provider programs become more popular across the country, efforts should be made to standardize these programs to prevent the creation of too many different types of programs. Meanwhile, the dental community should guide the creation and implementation of these programs to ensure access to the quality of care that all Americans deserve.
Winter 2012

Vol. 9

Issue 1

ASDA
A

Pre-Dental Committee helps UCLA Pre-Dental students through the Big Sib/Little Sib Program
ris Castro, fourth year undergraduate student. Following the one-on-one sessions, first year dental students David LindInouye stated, I thought it was really helpful for students to know what admissions committees were looking for in an applicant. This presentation is part of the ASDA Pre-Dental Committee Lecture Series (headed by second year students Allie Inouye and Ryann Walker). Future events planned include: mock interviews, shadow days, application and personal statement workshops, and Q&A panels with dental students. Second year co-chair Ryann Walker strongly believes that upon graduation these students will be extremely competitive candidates with strong applications because they are so well-informed and prepared by their mentors.

By Mona Derentz and Rebecca Paddack

pplying to dental school can be a daunting task. Undergraduate students can feel lost or unsure about the process. In an effort to remedy the situation, the ASDA Pre-Dental Committee held a Big Sib/ Little Sib Dinner on November 22, 2011. At this event, first year dental students met one-on-one with pre-dental students to share their experiences and to answer any questions that the undergraduates may have had. The event drew over 120 pre-dental students from the UCLA Pre-Dental Student Outreach Program (PDSOP). Each pre-dental student met with a mentor to discuss and tailor a specific plan of attack for his or her application. Before meeting with my mentor, my application was all over the place I really didnt know how to strategize my ideas. My mentor helped me streamline some of my ideas so that I really highlight my strengths, says Clo-

sey, Alex McMahon, and Rebecca Paddack presented a statistical breakdown of the Class of 2015, highlighting the diversity of the UCLA School of Dentistry and its students. In regards to its purpose, second year student Allie

UCLA School of Dentistry | ASDA

Breaking Down the Barriers to Care: UCLA ASDA Introduces Committee to Address Patients with Special Needs
By Katy Rosen and Matt Sandretti
s the gap between need and ac- remarking: when I was a student, newly learned skills. Sanda Yen, seccess to care widens, it becomes special needs patients were very in- ond year co-chair, explains, Students increasingly more essential to bridge timidating to me. I didnt even know get to interact with patients with spethis discrepancy. Barriers to care are where to start. Now that I have been cial needs, give instruction and begin traditionally regarded as products of exposed to so many I wanted to be to understand those factors that ingeographical hindrances, financial re- a mentor to help others gain the con- fluence compliance. They also have a strictions, and cultural differences. A fidence that I have obtained so that chance to remind care givers of the barrier often ignored in these discus- [students] will be able to provide care importance of oral health. In the past quarter, the committee has already sions, however, is the accomodations to these patients. Since its formation in Septem- hosted a number of events aimed required for patients with special needs. These patients may be blind, ber 2011, Kohanbash has expanded to accomplish their mission. These events include a hard of hearing, physically or men- I volunteered for a therapeutic center for the blind during session on how to tally disabled; unmy undergrad and felt compelled by the hardships of their give oral hygiene instructions to fortunately, they face many obsta- lives to return to them and to reassure them that dental blind patients, a visit to the Theracles that prevent students do care. peutic Living Centhem from seeking and receiving adFarnaz Kohanbash, 2013 ter for the Blind in Reseda, CA, a visit equate care. Disheartened by the plight of the scope of the Special Needs and to Vista Del Mar Elementary School, these patients, Farnaz Kohanbash, a Access to Care Committee to pa- which is a school for orphans, an inthird year dental student at UCLA, ap- tients with developmental disabilities, structional session about autism, and proached the ASDA Executive Cabinet stroke, spinal cord injuries, Alzheim- a visit to Summit View West School, last May with a vision to reach out to ers, arthritis and other congenital which is dedicated to serving special this community in need: While in un- diseases. Its mission statement has needs children. Since its inception, the Special dergrad, I volunteered at a therapeutic become to encourage dental students center for the blind. I felt compelled to practice effective communication Needs and Access to Care Committee by the hardships of their lives to pro- with and treat individuals who have has been met with unique excitement. vide them with service and to reassure intellectual disabilities or are affected The student response in particular by other medical, physical, and emo- has touched Kohanbash who was imthem that dental students do care. pressed by an overwhelming turnThe Executive Cabinet re- tional issues. In order to achieve its goal, out during its first Lunch-and-Learn sponded to Kohanbashs passionate plea by founding the Special Needs the committee has created a dual- in which even the professors and facand Access to Care Committee, with faceted program directed at arming ulty were eager to learn about how to Kohanbash as its Inaugural Chair. We students with the knowledge and skills work with these patients. Though only in its infancy, the were moved by Farnazs fierce dedica- to interact with patients with special tion and by her insight into the oral needs. The first component focuses on efforts of Kohanbash and the Special health problems of this population, teaching students how to interact and Needs and Access to Care Committee says UCLA ASDA President Matt San- treat these patients. Lunch-and-learn have not gone unnoticed. In fact, it dretti. Sandretti added: with their seminars with engaging lecturers aim was recently recognized with a presphysical considerations aside, we must to increase awareness, guide proper tigious award from Proctor and Gameven consider the strain of transporta- communication, and tailor more ap- ble. The response in the community tion and finances for these individuals propriate treatment planning. One and amongst students has been overwhen theyre seeing their healthcare such lecture was given by Drs. Pierson whelmingly positive, and the greater and Chung who discussed the appro- LA community can look forward to providers. The Committee works closely with priate way to treat and manage autis- many more amazing outreach opportunities in the coming weeks. its founding faculty mentors: Dr. Kel- tic and visually-impaired patients. The second facet of the comly Pierson and Dr. Evelyn Chung. Dr. Chung welcomed her new responsi- mittee builds on the first by giving stubility as mentor for the committee dents the opportunity to practice their
The Diastema
Winter 2012

Vol. 9

Issue 1

tips on how to survive in clinic

by Jessica Woo

Every first and second year student must be wondering what lies behind those clinic doors Armed with an arsenal of questions, second year student Jessica Woo probes upperclassman about some of their experiences in clinic. Their responses reveal what to expect in clinic, and how to best prepare for upcoming years at UCLA Dental School: Q. What would you have done differently or the same, if you had a chance to start your clinic experiences from the beginning? A: I would have definitely finished all the ODs [Oral Diagnosis] and PEs [Periodic Exams] that were due in summer [of my third year] because those take anywhere from 1-3 appointments where you dont get any credit. They also take up time during the rest of the year when you could be doing an actual procedure or working up new patients given to you by your Group Practice Director or fourth year. In short, jump on clinic as soon as you can! I know its pretty scary at first, because clinic is something completely different from anything youve done before. The sooner you get your hands in it, the quicker you will become comfortable, and the quicker you can start knocking off requirements. (2013)
8 UCLA School of Dentistry | ASDA

Q: Whats the most common problem you run into in the clinic and how do you manage it? A: In the beginning, its really tough coordinating appointment openings when you still are in class and lab during your second year and beginning of third year. Just make it very clear to the patients when you are available. I know its tempting to miss lab and class, but in the end, you will have more than enough time to see them. Its not something to stress overEvery time I try to accomplish two things, I always warn my patients ahead of time that we will try to get everything done but might not be able to. That way if you dont accomplish everything, they will not get mad and if you do, you seem really efficient in their eyes! (2013)

Q: Whats your personal secret to success in pre-doctoral clinic? A: Im an obsessive list-maker. You might not need it but lists keep me sane. I make lists of everything I need from Central [Services] because getting back in that line ages you dont be afraid to ask questions! I could not have survived some days without asking third and fourth years who were around me. Ask upperclassmen and ask the floor faculty; you will be surprised at how willing people are to help you. (2013)

have a really good system going and I would feel comfortable treating any of her patients if she were in a bind, and she mine. As the year continues, we will begin to incorporate our second year, so that the transition at the end of this school year will go as smoothly as possible. (2012)

Q: Is there a better way to manage your graduation requirements so that you dont have to rush to finish them at the end of your fourth year? A: If you get moving right away and communicate your needs clearly to your Group Practice Director, you will be Q: How closely do you work with your Comprehensive Pa- well on your way to accomplishing most of your requiretient Care (CPC) team? And what are the benefits of hav- ments. . When you start third year, make sure you have ing a close relationship with your team members? (Com- some good active patients to see. When I started, I had prehensive Patient Care (CPC) team is a team comprised five active patients. Two of them never called me back or of second, third and fourth year students who work to- wanted to come in, one needed just a prophylaxis, and one gether closely with same group of patients) needed only a single filling. That left me with essentially A: When I was a third year, I did not work that closely with one active patient to see, which is not a great place to start. my fourth year and, in turn, I met with a lot of surprises be- Dont be afraid to ask for simple restorative patients right cause I was unaware of his patients and their needs. In my away, so you actually can get some regular work done in fourth year now, to prevent that as much as possible, I have addition to seeing recall patients. (2012) been working very closely with my third year. We meet and talk on a regular basis and she keeps me updated on her patients and I keep her in the know about mine. I think we

American Association of Women Dentists

by Misoo Cho

hile some have mistakenly labeled it a feminist club, the American Association for Women Dentists (AAWD) is in actuality one the most resourceful and active student groups at the UCLA School of Dentistry. After a long hiatus, the UCLA chapter of the American Association of AAWD was recently reinstated two years ago, under the mentorship of Dr. Fariba Younai. Since its reintroduction, AAWD has quickly established its young roots as a community-centered organization that enriches the professional and personal lives of its members and the community they serve. The organization commenced the 201112 school year with its annual visit to the Downtown Womens Center (DWC), a nationally recognized program supporting homeless women. The Center supports over 2000 women per year who become homeless as a result of the

old age, mental illness, physical disability, domestic violence, poverty, and dismissal from foster care. This year, the AAWD fulfilled its yearly commitment to serve the DWC by providing Oral Hygiene Instruction (OHI) and establishing the UCLA SOD as a dental resource for the community.

nai. Along with its current co-presidents, Dr. Younai has been instrumental in the revival of the UCLA SOD chapter of AAWD a feat AAWD never fails to appreciate. Of Dr. Younai, the co-presidents Melissa Ota and Michelle Okamoto say, Dr. Younai is wonderful and we are very fortunate to have her as a mentor. Our club could not be what it is today if it were not for the guidance of our mentor.

Though most events are attended by female students, all events and club membership are open to all students regardless of gender. The club has many more upcoming events including HIV/ AIDS clinic visits, pre-natal presentations where the UCLA SOD will team up with the David In addition to outreach programs, AAWD Geffen School of Medicine, finance semialso entertains its members with special nars for dentists, and more faculty talks. dinners hosted by influential women in the dental community. At the end of fall quarter, members were invited to dine at the residence of UCLAs very own, Dr. Fariba YouThe Diastema
Winter 2012

Vol. 9

Issue 1

FACULTY INTERVIEW
By Vickie Lai

Dr. Donald Fisher is one of the most dedicated and experienced faculty members at the UCLA School of Dentistry. After
graduating from Northwestern University Dental School in 1962 and serving three years in the U.S. Army Dental Corps near Washington D.C., he began teaching at UCLA in 1965. During his time at UCLA, he headed Fixed Prosthodontics as the Chair for 20 years and was the Director of the Faculty Group Practice for eight years. He is the only faculty member to have taught every student at the dental school! He continues to mentor students in the preclinical laboratory and general student clinic since retiring from his full-time teaching position in 2000. Dr. Fishers notable contributions to the UCLA School of Dentistry include conceiving the Advanced Treatment Planning protocol and clinic, as well as writing (with Dr. Grenfell) the Policy for the Student Performance Committee. He was the first chair of that committee for 10 years. Dr. Fishers notable achievements extend far beyond the campus. He is the co-author of two dental textbooks, one on fixed prosthodontics preparations with Dr. Shillingburg and Dr. Hobo, and another on preservation and correction of existing restorations with Dr. Morgan. Dr. Fisher has also contributed his insights to another book, written by Dr. Caputo. He has helped shape UCLA into one of the best dental educational institutions in the world, and his legacy will last for years to come.
Youve taught at UCLA since the beginning when the school started. Were you involved in establishment of the school? How did you get involved in teaching? Why are you so attached to this school?
The establishment of the school began in 1960 and took 4 years to plan and get the building started. The first students came in 1964, and I started in 65, so Ive taught every student starting with the first second year class. In terms of planning, I was not included in the initial planning, but I helped developed the fixed prosthodontics program as it evolved over the years. When I first came, I started with oral biology and fixed prosthodontics. Most of the student contact was in fixed prosthodontics. For about the first 3 years I worked full time, then I went part time, started a private practice with another faculty member for 7 years. After Dean Caldwell died, I was asked to come back full time as I have been ever since. I stayed at the school because I really enjoy teaching.

How has dental education changed over

the years?
Patient population has changed. Over the years whats changed is the third party payment plans and made it possible for many of our patients to pay for their treatments. We get more complex cases, which often approach full mouth reconstructions. These cases many times push the limits of what can be accomplished in the school environment. But new technologies have also emerged, such as implants, ceramics, bonded restorations, CAD/CAM, and which are constantly improving, making it easier to care for patients better.

in periodontic cases. You still need metallic restorations, but I see the trend going more and more toward stronger aesthetic restorations as the systems improve.

Any advice for new graduates without dental relatives to start career with?
If you are going into general practice, find a rapidly growing area of the country, one where you would like to live in, and practice there. Once the office gets busier, and the economy becomes more stable, you can basically have a successful practice there. Or, you can try military services. Today is a very different situation than we were in. In my time, most graduates in the United States joined the services. Only a few people in my class did not join the military. I found it to be the best possible way that I could have to start off as a dentist. It gives you confidence, you work with your own patients, and there is mentoring to help you with any problems, and you develop some speed. You dont have to worry about the management problems in the office, but just concentrate on learning how to do treatments correctly and providing care for your patients. Also today, the uniformed services provide many opportunities for advanced education.

Whats the future of dentistry?

Well I think that the future is going to involve much more technology such as CAD/CAM and improved tooth colored restorative materials. The technology is advancing...so fast that some of what we are teaching this year will be different next year. You have some restorations that you guys have been doing up until now, I think in time will replaced by better ceramic technology. Also, I think a lot more emphasis will be placed on implants for replacing individual teeth, and also for replacing teeth

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UCLA School of Dentistry | ASDA

What was the most complicated or exciting case you ever worked on?
There was this interesting case where I was able to make a difference in the patients life, which does not happen too often in dentistry as opposed to medicine. This was a young person who had been out of work for years due to anxiety problems. He could not keep his job because he was troubled with eating, sleeping, headaches and other systemic problems because he had no teeth to function on. And he had amelogenesis imperfecta , with no coronal tooth structure. I spent about 6 months determining centric and VDO using repositioning appliances, then did a full mouth reconstruction using all pin retained crowns as there were not enough coronal tooth structure for normal preparations. And every year after his treatments he would come to visit me, and he really felt that I had given his life back. I had a similar case of a lady who was the principal of a continuation school program in Reseda High School, where students were sent if they were too disruptive in normal classrooms. It was a very high tension and high stress job. She had been out of work as well. She had a lot of work and crowns done when she was a teenager, but the occlusion

was very poor. She ould not work because she was in too much pain and discomfort. We did extensive reconstruction, and eventually had to do some implants to replace the teeth that were lost permanently. So these were a few interesting cases that I will never forget. One of the more challenging and rewarding case was a man who had been a prisoner in one of Hitlers death camps at age 15. It was another full mouth reconstruction, but I think I learned more about history than he did about dentistry. Finally, I always had something of a sub-specialty practice treating musicians, since being a musician myself, I was able to relate to and understand their dental needs with respect to their ability to play their instrument. It was very gratifying to be able to help well known professional players to continue playing long after they would otherwise have had to retire.

Any hobbies you would like to share with us?

AUTOMOBILE RESTORATION: I have completely restored 8 cars and working now on a 1948 Lincoln Continental. Oldest car in collection is a 1916 Detroit Electric. Cars I have restored have won car shows as far away as Washington DC and have been featured in some books. I do all the mechanical, body, paint, interior work myself. MUSIC: I was soloist on the Weber Bassoon Concerto with the Pasadena Community Orchestra which is a 75 member full symphony orchestra. The performance was videotaped and posted online at: https://www.facebook.com/pages/PasadenaCommunity-Orchestra/125809577468516

Dr. Fishers Shop, photo courtesy of Dr. Donald Fisher.

The Diastema
Winter 2012

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FACTUAL FACULTY FACTS

By Sandra Yen
The impressive faculty members at UCLA School of Dentistry boast more than just formidable resumes: can you match the correct faculty member with his or her factoid? Match correctly to answer the question: What does the Dentist of the Year win?

Descriptions1. Growing up in the hometown of Martinellis apple cider, I raced street cars as a teenager, and am one of 10 US dentists to be inducted without examination into the Royal College of Surgeons, Edinburgh. 2. I wake up at 4:15 am to go the gym five days a week. 3. I own a miniature zoo in my house consisting of 4 dogs, 5 cats, 1 rat, and 1 bird. 4. My ideal vacation includes cross country skiing and also visiting remote destinations in Alaska accessible only by small boat or bush plane. 5. I am an accredited gourmet chef with a culinary degree and I also have studied Chi Kung with an O-Dan Master. 6. I am an ambidextrous inventor, swimmer in college and a former commander in the Navy. 7. I went to junior high and part of high school in Puerto Rico and the rest of high school years in Switzerland. 8. I rock the bass guitar and am married to a stuntman that has been in Spiderman and Indiana Jones. 9. Im an avid theater lover who enjoys flying my airplane during free time. 10. I play in a comedy improv troupe and am avid fan of Luna Lovegood from Harry Potter. 11. I once had a teaching award check stolen and cashed in to buy a car. 12. I swam for my high school swim team and played the oboe and piccolo. 13. I was a foreign exchange student at the University of Copenhagen School of Dentistry in Denmark, and was the Clinic Director for ten years at UCLA.

Faculty membersDr. Richard G. Stevenson III Dr. Alan Felsenfeld Dr. Christine Quinn Dr. Jeffrey Goldstein Dr. Carol Bibb Dr. Craig Woods Dr. Ronald Mito Dr. Evelyn Chung Dr. Fariba Younai Dr. Paulo Camargo Dr. Andy Wong Dr. Earl Freymiller Dr. Clarice Law L L E L T A A U T Q E I P

10

11

12

13 Answers:

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1Dr. Ronald Mito. 2) Dr. Jeff Goldstein. 3) Dr. Earl Freymiller. 4) Dr. Carol Bibb. 5) Dr. Fariba Younai. 6) Dr. Richard G Stevenson III. 7) Dr. Christine Quinn. 8) Dr. Carice Law. 9) Dr. Alan Felsenfeld. 10) Dr. Craig Woods. 11) Dr. Paulo Camargo. 12) Dr. Evelyn Chung. 13) Dr. Angy Wong.
UCLA School of Dentistry | ASDA

UCLA RESEARCH
UCLA Mouthwash to Eradicate Caries

By Camron Fakhar
ove over fluoride A new mouthwash developed at UCLA School of Dentistry promises to eliminate microgranisms responsible for dental caries, raising hopes that tooth decay may soon meet the same fate as small pox and polio. Though some may overlook the importance of this discovery, few can deny the implications of eradicating the worlds most prevalent infectious disease. It is with overwhelming pride, therefore, that researchers at UCLA SOD are eager to submit their names behind arguably the most groundbreaking contribution to modern dentistry. This project, spearheaded by UCLA SOD microbiologist Dr. Wenyuan Shi, culminates nearly a decades worth of work and research into targeted antimicrobial therapy. Unlike modern antiseptic mouthwashes which indiscriminately kill both harmful and benign microbiota, Dr. Shis alternative works by singling-out the bacteria S. mutans, thereby eliminating the primary culprit in caries without unnecessarily eliminating harmless organisms. Dr. Shi was able to isolate the specific antibiotic compound by utilizing a newly developed technology called STAMP or Specifically Targeted Anti-microbial Peptides. The peptide discovered by Dr. Shi, C16G2, acts as a smart bomb that specifically binds and neutralizes S. mutans. According to Dr. Shi, the smart bomb works in a manner analogous to modern weed removal: If you want to kill the weeds but you still have your lawn there as well [i.e., natural flora], the general herbicide [e.g., antiseptic] that you use will not only kill the weeds, but will destroy the lawn in the process. The moment the herbicide is stopped, the weeds tend to come back first. The smart bomb therefore will amend a glaring shortfall of popular (and widely advocated) mouthwashes. Dr. Shi supports the success of this new mouthwash by citing a recent clinical trial in which 12 subjects who rinsed with the mouthwash containing the antimicrobial peptide over a four day period had essentially no trace of S. mutans remaining in their oral cavities. With such promising results, Dr. Shi and the U.S. Food and Drug Administration are currently working together to introduce more clinical trials expected early this year. Dr. Shi also reassures clinicians who may worry about how this new discovery might effectively eliminate the need for dental treatment (and therefore the dental profession altogether). To these needlessly concerned few, Dr. Shi emphasizes that dentistry will not end as we know it. In fact, he relates his discovery to the blood lipid tests introduced to the medical market, whose introduction had sent a panic amongst heart surgeons about the future of their profession as well. Although these new tests dramatically decreased the incidence of heart surgeries, they also spurred a multi-billion dollar industry of prevention in the medical field. In addition, Dr Shi adds to the matter, if the smart bomb is successful, it will add another resource that will change the way dentistry is practiced rather than render it obsolete. Dentistry will take much more of a medical approach. Right now too much time is spent on mechanical repair and surgical procedures. Now we will be able to run diagnostics, treat infections and take preventive measures in the same fashion that medicine works today. Therefore, it will not be eliminating dentistry, but rather changing our approach. Perhaps most reassuring of all, the drug will not be accessible from any store as an over the counter, rather it will be exclusively administered by dentists only, making the new resource profitable for dentists.

The Diastema

Winter 2012

Vol. 9

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New Requirements for future Oral Surgery Applicants

I
By Josh Elyahouzadeh
n response to the recent conversion of the National Board Dental Examination (NBDE) to pass/fail score reporting, the American Association of Oral and Maxillofacial Surgeons (AAOMS) has announced that all future applicants to OMFS residency programs must also take the Comprehensive Basic Science Examination (CBSE) of the National Board of Medical Examiners (NBME). The new pass/fail scoring system was intended to dilute the over-emphasis placed on a single numerical value and allow for other important factors such as interpersonal skills, extra-curricular achievement, leadership responsibilities, and letters of evaluation, to be taken into account. Despite the benefits of the new scoring system, the AAOMS has expressed some concern with the challenge of fairly assessing candidates without any means of standardized scores. Dr. Earl Freymiller, Chair of the Oral Surgery explains, OMS programs tend to put a lot of weight on scores because a strong basic science knowledge is required. Now that there is no measurable resource, one of the major factors that we look at is gone, and we felt hard-pressed to try to determine the quality of someones educational background. In its search for a replacement testing system, the AAOMS consulted with the NBME, an organization designed to create national board exams for medical students. After much collaboration, the two organizations selected the CBSE as a valid means to assess and standardize an applicants basic science education. The exam which, according to the NBME website, places emphasis on second year medical school courses, was originally designed for medical students to evaluate their strengths 14 and weaknesses before taking the official USMLE part 1 by giving test takers diagnostic feedback following completion, as well as a self-assessment score to estimate a score on the USMLE scale. The CBSE, is in a sense, analogous to the PSAT taken by high school students used to gauge their achievement on the SAT. The exam is divided into two sections: General Principles and Individual Organ Systems. In the General Principles sections, students will be tested on behavioral sciences, biochemistry, immunology, microbiology and general pharmacology. The Individual Organ Systems section will evaluate knowledge of embryology, anatomy, physiology and pathology of the cardiovascular, endocrine, gastrointestinal, hematological, neurological, renal, reproductive, and respiratory systems. With the exception of psychiatry, the UCLA School of Dentistry curriculum addresses the content of the CBSE and students should be well prepared. As expected, there is no section dedicated to dental anatomy or an emphasis on head and neck anatomy. As Dr. Freymiller contends, we are concerned about a candidates knowledge of head and neck anatomy; however not having that on the new exam is not crucial, as that is one area where residents will certainly reinforce their knowledge during residency. The CBSE will be a benefit not only to OMFS residency admissions committees, but also to applicants themselves. Residents will find themselves more adequately prepared for Step 1 of the USMLE, a major obstacle of most surgery residencies. Applicants to both 6-year and 4-year OS programs will benefit, though Dr. Tara Aghaloo, part of the faculty at UCLAs OMFS program, posits the exam may be more beneficial for 4-year residents who are so busy in the beginning of residency that they do not have enough time to study individually. She adds this will definitely give them that opportunity to study medicine, and go through rotations without having gone to medical school. Both Drs. Aghaloo and Freymiller believe the NBME CBSE will receive the same emphasis as the previous NBDE Part 1 scored exam. They caution, however, that students should not find comfort in the score alone. In response to how the new exam will change assessment criteria, Dr. Freymiller states, I dont even believe this exam or the NBDE scored Part 1 could adequately predict how a student will perform during residency there are so many other factors, in particular, personality factors, that are important that will show how someone performs in residency. Instead, he indicates that the ideal applicants are those who are self-starters who take it upon to themselves to do outside studying take on more work than what just assigned to do. go the extra yard [sic] and are really willing to give 110%. In regards to this matter, both Dr. Aghaloo and Dr. Freymiller agree that these applicants will more likely perform better regardless of their board score. Prometric centers will be offering the CBSE for dental students only once a year, at various locations. Though the exam will be offered only once a year, students will be allowed to take the exam as many times as they please and only the highest score will be considered. The CBCE consists of 200 multiple choice questions. Twelve versions of the exam are available on the NBME website.

UCLA School of Dentistry | ASDA

ASDA EDITORIAL

Taking Off the Loupes

By Lindsay Graves

Seeing the Bigger Picture of ASDA

A
t UCLA, ASDA (American Student Dental Association) is ubiquitous. Our school enrollment rate is close to 100%. A huge percentage of school activities are sponsored by our ASDA chapter everything from Dental Olympics, local health fairs and school visits, predental mentoring, to our tri-annual Honduras mission. However, in spite of all of this, I believe that few really recognize or appreciate all that is ASDA. In the past months, I have been fortunate enough to attend both the ASDA District 11 Meeting at Western University of Health Sciences and the ASDA Western Regional Meeting in San Antonio. These meetings have given me insight into what ASDA is beyond our chapter According to the mission statement, The American Student Dental Association is a national student-run organization that protects and advances the rights, interests and welfare of dental students. It introduces students to lifelong involvement in organized dentistry and provides services, information, education, representation and advocacy. ASDA works to fight for dental students and dentists interests in the political sphere. As one student speaker at the Regional meeting put it, ASDA is insurance for the profession we invest in it to protect our future as dental practitioners. Much of the power of ASDA is in numbers. A whopping 87% of dental students nationwide are enrolled, giving the organization clout within the ADA and ADEA. ASDA serves to inform dental students about the political issues that affect our education and profession. For example, the mid-level provider debate: many law-makers cite access to care issues for certain populations as the reason that there needs to be a new category of dental professionals trained to go to these populations and perform simple preventive and restorative procedures. While ASDA recognizes the care discrepancies, they work towards alternate solutions for the mutual benefit of the patients and dentists. They argue that we have enough, or more than enough, dentists to go around - there just need to be more incentives for them to practice in lessthan-desirable areas for potentially less money. Inadequate training by the mid-level providers is their other major concern. Another hotly discussed issue at the recent meetings was licensure: portfolio, vs. traditional patientbased examination, vs. postgraduate residency. As emerging dentists, we also will be faced with many non-political issues, for which we have no training in dental school. ASDA recognizes that in order to be successful, we must know more than just treatment of oral maladies. Both meetings included talks by business professionals, providing insight into leadership, debt management, associateship/partnership contracts, starting your own practice, and large-group practices. Perhaps the greatest, if not, the most enjoyable, benefit of ASDA is the connections it fosters among dental students from schools across the nation. Ideas are exchanged and friendships are formed at the meetings. ASDA creates unity among us as American studentdentists, in both identity and purpose, to speak as a whole on issues that concern us.

As emerging dentists, we also will be faced with many non-political issues, for which we have no training in dental school. ASDA recognizes that in order to be successful, we must know more than just treatment of oral maladies.
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UCLA ASDA The Diastema Staff

SPRING 2012 | VOLUME 9 | ISSUE 1

The Diastema 2011-2012 Staff

E D I TO RS - I N - C H I E F

Samir Farhoumand | 2014 Lindsay Graves l 2014 Sapna Lohiya l 2013

L AYO U T- E D I TO R - I N - C H I E F Vickie Lai | 2014

Khushbu Aggarwal | 2014 Sandra Yen | 2014 Jennifer Sun | 2015

E D I TO RS

L AYO U T E D I TO RS Kent Lau | 2014 Jessica Woo | 2014 Catherine Kim | 2015

Robert Banh

P H OTO G R A P H E R |2013

W R I T E RS & C O N T R I B U T I N G W R I T E RS

Stephanie Cappielo | Misoo Cho | 2014 Mona Derentz | 2015

2013

Josh Elyahouzadeh | 2014 Camron Fakhar | 2014 Lindsay Graves | 2014

Jared Kenney | 2014 Rebecca Paddack | 2015 Katy Rosen | 2013

Matt Sandretti

| 2013

CONGRATS UCLA SOD c/o 2012 and best of luck for the future!

Platinum Sponsors for ASDA Vendor Fair

SUBMISSIONS If you would like to submit an article for The Diastema or have suggestions for us, please email the editor at lindsay.l.graves@gmail.com. EDITORIAL DISCLAIMER The opinions contained herein do not necessarily reflect those of UCLA or of the UCLA School of Dentistry in particular. SPECIAL THANK YOU We would like to thank the following faculty for their support and mentorship: Dr. Carol Bibb, Dr. Karen Lefever, Dr. Tara Aghaloo, Dr. Donald Fisher, Dr. Earl Freymiller, Dr. Wen Yuan Shi.

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