It is well worth taking a year or two off before you start dental school to work with Dr. Dorfman. After working in the office for over a year, I cannot begin to explain just how much I have learned. Aside from learning a wealth of dental information (terminology, anatomy, instruments, steps and instruments used for procedures, clinical tips, how to interact with patients, etc.) that will help immensely when I start dental school, I have also learned the ins and outs of running a successful dental practice. You will get out of it what you put into it. If you show Dr. Dorfman that you are eager to learn and willing to work hard than he and the other dentists in the office will take the time to teach you all aspects of dentistry, many of which you will never learn in dental school. It is also a great opportunity to see if any specialties interest you.

I could go on and on about all that I have learned from this program and how much it will help me in dental school and as a practicing dentist. Simply put, this is an invaluable experience for any pre-dental student. I strongly recommend any pre-dental student to apply for this program.

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!

There is a HUGE opportunity for Apple in dentistry. Most major Dental Practice Management and Imaging Software Platforms are pc-based, closed source, bulky and require huge capital expense for in-office hardware, software and ongoing maintenance. Two Henry Schein (NYSE) subsidaries, Dentrix and EZDental, are examples.

We are developing 1dentist Software to offer lean, Open Source Cloud Computing and SaaS. Our early data shows significant interest from dentists within our 500 dentistry urls worldwide at 1dentist.com.

And even Kodak should refocus on open source digital medical and dental imaging, e.g. CT, MRI, x-ray and photography. Dexis (Danaher) currently has significant market share of dental imaging and is closed source.

Read The Wall Street Journal article.

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

Today’s patient came in to have new zirconium crowns placed on #8 and #9.  Here is a summary of the patient’s previous relevant visits:

First visit – #6,7,8,9,10,11 prepped based upon lab models

Second visit – zirconium crowns placed for #6-11 with Nexus base clear. Patient requested darker shade – changed to A2.5 and canines to A3.0 with lab on same day

Third visit - patient feels #8,9 are too thick palatally. Pt informed that space at mesio-gingival margin can be closed

Fourth visit – crowns on #8,9 removed, slightly reprepped and new temp placed

The patient had signed a consent form before cementation, stating that the patient is happy with the try in and understands the consequences of changing their mind once the crowns have been cemented. However Dr. Dorfman was went out of his way to accommodate her and agreed to place new crowns on #8,9.

Today the new zirconium crowns for #8,9 were placed so the patient could see the new look. However she was still unhappy after the try in. She felt that it was still a bit thick palatally and also didn’t like the convergence of the teeth mesio gingivally. At another office, the crowns would have to be sent back to the lab and the patient recalled. However Dr. Dorfman called up his lab tech who showed up in minutes. He noted the changes the patient wanted and advised it would take a few hours.

The impression was taken with Impregum polyether impression material, using both light and heavy body. An anterior tray was filled with the polyether regular body and the light body was placed around crown preps. The lab technician said it was a good idea to blow air over the light body to prevent bubbles from forming. Once air had been blown all over the light body, another layer of light body was injected. Then the anterior tray was placed. The lab tech took his impression back to the lab to make the necessary adjustments.

The adjusted crowns had outstanding contours in the mesio-gingival area. The patient did still feel a slight thickness palatally so this was adjusted down. The crowns were then cemented on with Nexus Base Clear.

This experience really showed me the importance of always giving the highest standard of care, regardless of the circumstances. The patient clearly signed the waiver and knew once the crowns were cemented in, it would be difficult to make any changes. However, it’s clear from all my visits so far that Dr. Dorfman takes tremendous pride in the work he delivers to his patients. It is this reputation that he has build, which draws patients from all over the world to his office.

R.A., Columbia University School of Dental Medicine

Our New York City dental practice has considered the whole body relationship of dental disease for 24 years. We obtain periodontal cultures of patients with advanced gum disease, based upon the early work of Dr. Max Listgarten. The recent discovery of diabetes in a patient based initially on periodontal (gum) diagnosis is a case in point. The Center for Special Dentistry (www.NYCdentist.com) is proud to work with Dr. Keith Berkowitz at the Center for Balanced Health (www.CenterForBalancedHealth.com) in mid-town NYC. The fasting glucose tolerance test they performed to diagnose the patient’s diabetes will contribute to the overall health of this 42 year young woman. This should be considered the standard of care in dentistry particularly with the present Administration’s push to expand healthcare for all. It will improve health, save lives and is cost-effective. For microbiology results from Temple University’s Oral Microbiologic Testing Lab visit:
http://www.nycdentist.com/?fuseaction=atlas.displayImage&im_id=2249&at_id=243&at_parent_id=242

Read the Wall Street Journal article.

Reply:

Please re-read my comments:  I said our dental practice screened the patient for diabetes but worked with Dr. Keith Berkowitz (M.D.) at The Center for Balanced Health for diagnosis and treatment.  Dentists should not diagnose and treat diabetes but they can be invaluable in screening patients.

Separately, most physicians do not have any understanding of dentistry nor how it relates to systemic health.  It should be part of medical school.  Just 15 minutes ago we had to reschedule a patient who underwent AV Nodal Reentrant Tachycardia (AVNRT) in March at a prominent Long Island heart hospital but was not given instructions to premedicate for dental procedures for the first six months post-op.