I worked and studied at The Center for Special Dentistry for three years full time and learned more than I ever could have imagined when I applied to the program.

You get out of the program, what you put in it. Dr. Dorfman has been teaching a long time and carefully observes the learning curve of each of the students and pays attention to their willingness and effort in the office. When he can, he will share with you what he is working on and will introduce diagnosis and treatment planning and educate you on different cases. He practices intelligently and teaches you about the business side of dentistry as well. Before this program I did not realize all that it took to run a practice and am extremely grateful for everything that I have learned. I will use all the skills that Dr. Dorfman has taught me for the rest of my life and implement many of them in my career!

Students who made the greatest effort were able to learn the most in the program. Dr. Dorfman is EXTREMELY giving and wants his students to succeed. I HIGHLY recommend this program and encourage everyone to apply!

The reason why I decided to apply to the Center for Special Dentistry or “The Private Practice Elective” as it is referred to at NYUCD was not because I needed more clinical time, I believe that NYU gives plenty of opportunity to improve one’s clinical skills. The main reason was to get a real life experience working in a low volume, high fee dental practice and to observe all aspects of patient and office management.

Unlike the majority of the dental students I have significant real life experience working in the dental office. Before I started NYU I was managing dental office for approximately four years and I am familiar with a lot of the aspects of the practice and patient management. However, the office that I worked for was in a completely opposite side of the spectrum of dental practices. It was a high volume low fee office located in Harlem, mainly catering to Medicaid and union plans. After working in that type of environment I was very comfortable dealing with most of the patients that would come to NYU. I felt that my clinical skills were fine, but I wanted to get exposed to all aspects of treatment of patients that can afford elective work. That is why when I read the description of the elective and visited the Center for Special Dentistry I thought that this was a perfect opportunity to acquire the knowledge and skills that in was missing.

The Center for Special Dentistry is a state of the art dental facility that focuses on providing exceptional personalized care to each and every one of the patients. When I first came to the center I immediately noticed the size and layout of the facility. The place is big with large reception area and open desk layout where receptionist sits in the same room with the patients and not behind the bulletproof glass window and the door with the buzzer that can be opened only from the inside. This kind of open room or open desk environment makes patients feel more relaxed and it is very important considering the fact that a lot of dental patients are phobic.

The second thing that I noticed that corridors were not 36 inches as a minimal width required by law, they looked almost double of that width allowing for easy passage of several people at the same time without them bumping into each other. Corridor walls have large black and white photographs of New York giving the place this upscale atmosphere.

The operatory rooms are also mach larger than 7×8 that I was used to. They are large airy and all have nice view of Madison Avenue.

As I mentioned before the facility is state of the art. It is completely paperless, you will not see a file cabinet with charts and you will never run into a problem where a chart is misplaced. Charts were replaced with Dentrix practice management software. It is the most advanced dental practice management system on the market at this time. It allows for patient’s chart to be seen from any operatory and if necessary remotely from outside of the office. The software has a built in chair-side charting capabilities and incorporates digital imaging. Every operatory has built in digital extraoral and intraoral cameras and images go directly into Dentrix and get incorporated into patient’s chart. In addition to the extraoral and intraoral cameras every operatory has digital x-ray unit and in the similar manner as the images X-Rays also get incorporated into the software. Digital practice management has several advantages over the regular paper based. Perhaps one of the main once is the fact that one can back up the data including the images and in case if something happens to the office, data can be restored with no loss of patient’s information. Second recall and patient tracking system can be automated. Also with addition of the optional module billing can be done paperless through Dentrix. One can also track account aging.

As I mentioned above one of the things that I wanted to get out of this elective is the ability to effectively deal with patients who have no problem paying for elective treatment like implants and veneers. In my opinion that was one of the main things that I got out of the program. Dr. Dorfman has a very unique approach to all of his patients. Because the practice is strictly fee for service and is not booked 1 month in advance Dr. Dorfman and his staff can spend a lot of time with each and every patients listening to their fears, concerns and expectations. In my eyes the only way for the doctor to provide good quality care is to approach each patient the way it is done at The Center for Special Dentistry. The main reason why many people avoid seeing a dentist is not finances. It is a fear of a dentist or dentistry. Usually it has to do with past dental experiences where the patient was treated in the insurance clinic where the doctor does not even have time to properly anesthetize the patient. Where it is not the doctor and patient who decide what kind of treatment the patient will get. The decision is made by the insurance company. A person, who never went to dental school, never saw the patient gets to decide what the right choice of treatment is. As incongruous as it sounds this is the kind of dental experience most of the patients who go into insurance practices get. The experience that most of the patients in the insurance practice get starts in the waiting area along side with ten to fifteen other patients. Once you got an appointment that some time you have to wait for months you get into the waiting area where receptionist is sitting behind a bullet proof glass. There you spend up to three hours. After that you being sent into the chair, doctor walks in gives you anesthetic and leaves. When after a few minutes he comes back he starts to drill without any explanation of what is going to be done or verification if the anesthetic is working. Usually the actual chair time is less than thirty minutes and patient gets very little if any feedback in terms of what is being done and what is next. The Doctor physically does not have time to spend with the patient because the fee that the insurance company is paying is too low. In addition a lot of the doctors that work in this kind of setups ether never had or lost the ability to provide quality care that all patients deserve.

Sometimes the fear of dentist and dentistry comes from parents. The parents’ fear of dentist transfers to the kids and now kids are afraid if the dentist.

Dr. Dorfman has different approach to patients. Each patient gets as much of undivided attention as needed. Every question is being answered and every concern is being addressed. The big portions of the patients that come to the practice are phobic patients with previously failed dentistry. This kind of patients takes up a lot of time. And that is one of the reasons why these patients can’t be successfully treated in the insurance practices. I have seen many patients come in with fear and leaving with a smile.

There are other things that I learned during the time I spend in practice. One of them was the amount of time that Dr. Dorfman spends on the informed consent. The informed consent is a very important part of treatment. Before beginning of any treatment Dr. Dorfman compiles personalized informed consent. This is much different from the standard consent that most of the offices use where there is one very general page written in the very legal language that most of the people do not understand and no one really bothers to read and just sign exactly the same consent regardless of the procedure being performed. The consent that Dr. Dorfman writes are formulated to reflect only the procedures and complications related to the treatment that will be performed. The language of the document is very plain that anyone can understand. It also encompasses the period after the treatment and patient’s responsibility to maintain the restorations because no matter how good the dentist is if the patient will fail to properly maintain the restorations they will fail regardless of the quality of work. Unlike other practices where patients just given the consent to sign. In the Center for Special Dentistry patients are being explained every paragraph before they sign.

One of the biggest parts of the treatment is treatment planning. It is very important when you do complex multidiscipline treatment plans that all of the specialists will have a common idea of what is the final result should be. Every case gets careful review and if the services of the specialists needed patient sees the specialist before treatment plan is complete. In the regular office where there is no specialist available onsite patients being sent to different locations and specialists usually don’t know why are they taking out a particular tooth or doing a bone graft they do not see the big picture. In contrast in the Center for Special Dentistry every specialist before they do anything has a conference with Dr. Dorfman and discusses that “big picture”. They also have access to patient’s electronic chart view the x-rays, images and previous clinical notes. This collaboration of restorative dentists and specialists brings better final results and greater patient’s satisfaction. Not only patient does not have to travel to another unfamiliar office they get the best possible treatment in the environment that they came to trust.

This collaboration of the specialists and restorative dentists in addition to the stress-free environment for the patient assures accurate treatment planning. It also provides better, controlled environment where patient feels that everyone in the office has their best interest in mind. This environment facilitates accurate and seamless execution of the treatment and makes patient active and interested participants in all steps of the process.

I saw people’s smiles transformed and people’s attitudes toward dentistry and life change. Patients would come in uncomfortable to smile, shaking from anxiety and would leave relaxed, self confident, with a big smile on their faces. I saw the satisfaction that the doctors and staff gets from being able and having time to help each and every patient that comes through the door. This environment is unachievable in the insurance practice, they simply don’t have the time.

In the past year I learned a lot. I experienced many interesting and rewarding parts of my profession that I have never seen before and saw many aspects of dentistry for the first time. I saw the venues of achieving my coals and proof that it is possible. None of this would be possible if I did not spent time at The Center for Special Dentistry

Thank you, Dr.Dorfman, for a wonderful, life-changing educational experience that goes beyond dentistry.

Igor Elperin

NYUCD Class of 2010

Recipient of the 2010 Academy of Osseointegration’s Outstanding Student in Implant Dentistry Award

Recipient of the 2010 NYUCD Award for Outstanding DDS Excellence

Member of

AACD, AGD, AO, ADA, ASDA, ADEA

Today a 31 year old female presented for an external bleaching. The case was interesting in that a maxillary central incisor presented with much darker staining due to a previous root canal therapy treatment completed at a different office. The goal of the external bleaching performed today was to not only to lighten all of the teeth, but to attempt to gain a few shades of whitening for this darkened tooth in particular. The teeth were properly isolated with liquid dam material. At the beginning of each cycle of bleaching, the darker central incisor was bleached for 4 minutes. Then bleach was added to the remaining teeth and the teeth were bleached for 12 minutes. Two cycles were completed. Upon completion the central incisor had lightened several shades. The patient had little post-op sensitivity. She was happy with the esthetic results.

N.D., New York University College of Dentistry

Patient presented for emergency visit at Dr. Dorfman’s office with a broken filling on tooth #20.  Patient did not complain of any pain or swelling.  Tooth #20 was badly decayed and the only option other than extraction was to perform Root Canal Therapy, crown lengthening, gold post and core, and a porcelain crown. The patient decided to save his tooth and we began work immediately.

Root canal therapy was performed by the endodontist. Right after RCT the patient saw the periodontist for a crown lengthening procedure. After the procedure, healing dressing was placed and patient was scheduled for a recall. After 1 week the dressing was removed and I began preparing the tooth for a post and core. I took a final impression with Impergum in a triple-tray for fabrication of a gold post and core to fit the tooth.Three weeks after healing, and after making sure that the crown margins would not be exposed, preparation margins were defined for a porcelain-fused-metal (PFM) crown with a chamfer finish and the final impression for a crown was taken. Together, we chose a color shade and  I wrote a lab prescription.

In the final appointment the crown was cemented with the glass ionomer cement. The patient was extremely happy with the outcome of this treatment. The patient was also made aware of other dental needs and decided to take care of his other teeth to avoid emergency visits in the future.

P.B., New York University College of Dentistry

Today I observed an orthodontic braces consult with a teenage tv celebrity. He had orthodontic treatment previously but #10 had relapsed to its original position because of failure to wear his retainer. The patient had also developed a crossbite in both canine areas.

Normally, for a patient who has not complied with previous treatment an orthodontist would opt for fixed braces, however this patient presented a unique case. Being a singer and celebrity, the patient needed something that would be esthetic for performances and television time. In dental school we are taught about creating an “ideal” treatment plan, and then alternatives if the patient cannot choose the ideal plan for whatever reason (cost, esthetic issues, etc). The ideal treatment plan is generally created on scientific foundations. However this case shows us that this plan cannot be created just on science alone.

If we don’t have compliance, science can be thrown out the window. Fixed appliances are definitely the best scientifically, and best for the orthodontist because they can be assured of usage. But it would not allow this patient to continue his life normally, since he is a celebrity. The dentist has to treat the person, not just the teeth! In this case, the challenge was not moving #10 back, but doing so without affecting the patient’s career activities.

Clearly with this patient it would not be possible to put anything fixed onto the buccal surfaces of his maxillary teeth. That really left two options, a spring aligner or Triple Star trays. Once the treatment objective was attained, a bonded lingual retainer would be placed from #7-10.

How to treat the mandibular teeth, in particular the anterior crowding, became a topic of debate. When on stage, the patient’s mandibular teeth would not really be seen, usually only the incisal thirds of the teeth, so a wire could be placed without being seen during singing or other activities. The patient was apprehensive, but made the decision with his father to go through with it, because he understood realistically he would need a fixed appliance for the mandible. He was informed that it was better to do it now, rather than when he would be older, and the teeth could have move even further from ideal positioning.

Also Dr. Dorfman explained to him that at any point in his treatment he could opt for one of the alternative treatments. Nothing was irreversible, appliances could be taken off, and this went a long way to reassuring him that his singing and acting activities would be able to go ahead as planned. Also Dr. Dorfman examined his bite once again and found that the lower anteriors would need to be sculpted in order to place the lingual retainer from #7-10.

So the final treatment planned that both father and son agreed to was:

Maxillary arch- a spring aligner or Triple Star trays to align #10 followed by fixed bonded lingual retainer (#7-10)

Mandibular arch- fixed appliance to align lower anteriors with sculpting followed by bonded retainer

It is important to note that the treatment plan was signed by the father today. The patient often comes here without his father, and usually with someone else, such as an assistant. So it was very important to get the father’s consent before starting any of the work. Finally at the end of the visit, alginate impressions were taken, and the patient was told he would need to return to have some sealants placed and begin the orthodontic treatment.

Interestingly at the end of the appointment, when the patient was about to leave, he mentioned that he had problems with his jaw locking on opening. There are many possible causes to his locking. Being young and still growing can contribute to jaw locking by abnormal growth patterns. Chewing gum can definitely cause TMJ issues, and of course being a singer extra care must be taken with his TMJ health. So on his next visit, he will get an oral surgery consult in addition to having sealants placed and a PAN taken.

R.A., Columbia University School of Dental Medicine

This afternoon I observed an orthognathic surgery consult in a high end practice. I was familiar with orthognathic surgery from Columbia’s emphasis on medicine and high reputation in oral and maxillofacial surgery. However this was the first time I had really witnessed a consultation for orthognathic surgery in a very practical setting.

A 28 year old female patient presented to the clinic because she was unhappy with her facial proportions. She had orthodontic treatment for 2 years prior, but was unhappy with her prominent upper lip, retruded lower lip, and also mentioned that she was unhappy with her nose being too wide (despite having a previous rhinoplasty).

Seeing this patient reinforced how important it is to take a good history of the patient. This patient in particular had a history of plastic surgery, included the rhinoplasty, so right away one has to be aware that she is going to be very particular about the results. Often patients like these change their minds, so even if the surgery gives her what she wants, she may be unhappy with it at a later point in time. It is important for the surgeon not to make guarantees, and to thoroughly advise the patient on their options.

The consulting surgeon was simply brilliant in the manner he conducted his consult. This oral surgeon is an attending at Columbia and I have met him before. However this was the first time I got to see the wealth of his knowledge in full action. He is a very powerful presence but he listened to the patient and all her needs and concerns. He then advised her on the possible options, however the patient was still adamant that she wanted to have her maxilla retruded. The oral surgeon was very honest with her and explained that women pay thousands of dollars to have her full look. He pointed out that if you retract the maxilla, the soft tissues will fall back as well, and she would lose that youthful look that she naturally has.

One of the most impressive parts of his consultation was that he was still very knowledgeable about general dentistry. He took two sets of impressions and was very proficient at taking them for an oral surgeon!

He found two issues from his exam and consult:

1. Deficient mandible/class II skeletal discrepancy

2. Wide alar base

His best treatment plan at this point was mandibular advancement via BSSO (bilateral saggital split osteotomy) along with an alar cinch to address the patient’s issue with the width of her nose. The alar cinch procedure was an intriguing option and gave the patient an alternative to getting another rhinoplasty. He  explained to the patient that an oral surgeon can go intra-orally with the alar cinch procedure which is more effective and does not produce the scarring that is possible from a rhinoplasty performed by a plastic surgeon. He explained that plastic surgeons are limited in what they can do because they cannot work intra-orally.

The patient finally became convinced that it was not a good idea to touch the maxilla, and mandibular advancement was the best solution. The oral surgeon didn’t shoot her down right away, and he advised her to choose between the given choices. However he took it step by step, until the patient saw the benefits of a less invasive approach.

The patient would also have a consult with the orthodontist because she would probably need brief orthodontic treatment after the surgery to adjust the bite so it is properly aligned.

R.A., Columbia University School of Dental Medicine

Periodontal disease is a multifactoral problem, and cannot always be answered by the traditional methods of mechanical debridement (scaling and root planing) and periodontal surgery. Although in most cases,  debridement and improvement of oral hygiene can do wonders, unique cases always arise which leave periodontists baffled.  What happens when you have a 30 year old patient, with no radiographic calculus or significant plaque buildup but has severe bone loss and 8mm pockets? Clearly debridement of the pockets isn’t going to work. Understanding the microbiology of periodontal disease is of increasing importance to the general dentist and working with specialized labs is vital to the successful treatment of the disease.

The Oral Microbiology Testing Service (OMTS) at Temple University School of Dentistry was designed specifically to assist dentists with identifying and treating difficult cases of periodontal disease. It is one of only 4 state and federally-licensed clinical periodontal microbiology reference laboratories in the United States.

The process:

How do you get the culture?
The dentist should first use college pliers and a cotton pellet to wipe away supragingival plaque. Then a medium cotton point should be placed into about six different sites with the deepest periodontal probing depths. The cotton point should be left in for 5 to 10 seconds and then quickly placed in the culture medium, which is then sent to the lab.

Once the lab has the culture, they incubate and culture it. This is done in a one to two week period in a special chamber that replicates the conditions of the area of the mouth in which the bacteria grows.

After the culture is grown , it is examined by microbiologists and  the types of bacteria are identified. Then an antibiotic sensitivity test is performed on all the species of bacteria that were found. The pathogens were divided into groups depending on their known associations with periodontal disease. An acceptable critical % threshold level was given for each species of bacteria. The % of cultivable microbiota for each species from the sample was then compared against the given markers. For example if the acceptable threshold level for a certain species was 2.5% but the level found in this sample was 5.6% then the conclusion would be that there were elevated proportions of that species.

Antibiotic sensitivity tests were performed for 4 major antibiotics commonly used to treat periodontal pathogens. This bodes well for the patient because specific antibiotic therapy can be given to the patient in addition to dental treatment.

Clinical Scenario:
A patient presented to Dr. Dorfman’s office recently with severe periodontal disease and acute necrotizing ulcerative gingivitis (ANUG) on the lingual aspect of #27,28. The patient was treatment planned for 4 quadrant scaling and root planning,

The patient was previously treated with amoxicillin and metrodiazanole, two commonly prescribed antibiotics for periodontal pathogens. However, the lab results showed that many of the periodontal pathogens found were resistant to both antibiotics. The head of the lab at the OMTS suggested the use of Cipro to target the gram-negative bacteria that were found to be in significantly higher levels than expected.

R.A., Columbia University School of Dental Medicine

This afternoon I viewed a patient who was in for an implant placement on #9. The 25 year old female had the tooth extracted over 10 years ago because the tooth would not erupt and was not able to be orthodontically erupted. Prior to the implant surgery a bacterial culture was taken because of a few severe localized pockets on select molars and premolars, which may be indicative of post-juvenile periodontitis. (See Image #1) The bacterial culture was taken by placing paper points into the facial and lingual sites of each deep pocket location for a few seconds, and then placed into the culture solution. The culture will be sent to an oral microbiology lab for testing and further treatment will be decided on then.

The patient received profound anesthesia prior to the implant placement. The size and location of the edentulous area indicated the use of a 3.5mm x 12mm implant in the area of #9. (See Image #2 and #3) Radiographs were taken to verify the placement and seating of the implant and healing abutment and sutures were placed to reapproximate the tissues for successful healing. The patient has been wearing a flipper for approximately 8 years and therefore the seating of the flipper post-surgery was confirmed and no adjustments were necessary.

N.S., New York University College of Dentistry

This afternoon I continued the treatment of a patient’s #3 PFM crown. The crown came back from the lab with a Kaitlyn Loop on the lingual side of it for floss to keep a better hold of the crown. The crown was tried in, margins and contacts were checked, and occlusion was adjusted. The patient was satisfied with the esthetics and fit of the crown and signed a consent form for final cementation. The crown was cemented in with RelyX cement and the Kaitlyn Loop was removed.

The patient then complained of a chipped filling on the lower left. The patient is not currently in any pain. Tooth #19 was examined and the restoration was chipped on the buccal portion of the occlusal surface. A periapical and bitewing radiograph was taken of tooth #19. A periapical pathology was seen on the mesial root as well as a widening of the periodontal ligament on the distal root. Caries was found on the distal portion of the tooth. There is a possible fracture on the mesial root. The patient was given the information and treatment options and will return at the next visit to further explore the treatment options for this tooth.

N.S., New York University College of Dentistry

43 year old male a broken upper right tooth. The patient was initially seen two days prior as an emergency. Intraoral revealed tooth #3 was fractured lingually. Previously the patient had had root canal therapy on #3 and had a composite MOD restoration.

Nitrous oxide delivered – 1:3 (liter nitrous:liter oxygen) for 1 hr. Local anesthesia ½ carpule lido 2% Hcl Epi 1:100,000 locally. Lingual portion of tooth #3 extracted without complications.

 

The remainder of #3 was prepared for a crown and temporized. The patient will return for root canal re-treatment at the next visit.  Subsequent visits will include conservative crown lengthening, a cast gold post and core and fabrication of a crown. 

N.D., New York University College of Dentistry