Principles for Thinking - Part 2/3 of Organizing a Military Dental Clinic

Principles for Thinking - Part 2/3 of Organizing a Military Dental Clinic

Below is a list of concepts, ideas, thinking principles, thought experiments, mental models, or whatever else you want to call them. I do not claim to be the originator of any of these concepts, but all of the following are some synthesis of the many ideas I've gleaned from the books I've read and the experiences I've had.

They are "how to think" about certain types of problems, without delving into any specific issues. Hopefully these can be useful ways for you to think about problems as you work to come up with solutions.




Would they choose to come here? (for military clinics)

If your patients had a choice, would they choose your clinic? In the military, they don't have a choice! This question is the best way to think about the entire patient experience, and will ultimately lead to a more streamlined and efficient clinic all around.

Build it for the new person

You should do your best to *never* build a system just to accommodate a person. You build it to accommodate a position and fulfill the purpose of that role. Now, having said that, you may have to tweak it for a certain person but the resulting outcome should not change.

Example: some people prefer digital lists of supplies while others prefer written lists. The resulting outcome should still be identical.

When creating a system, imagine yourself as a new person walking into the clinic for the first time and as yourself the following question.

How quickly could we train a new person to be proficient enough to run this system alone?

This question is the measuring stick for every system you create. The quicker the training to sufficient proficiency such that you trust them by themselves, the better the system.

The poisoned river problem

Imagine a village living on the edge of a river. One day, the water in the river starts making people sick. What is the best way to solve this problem?

1. Build a water filter
2. Remove the contamination upstream

Most people will answer #2 but actually do #1 in their life, because #1 simpler. Don't give in. Solve the real problem! Stop building filters. Filters are for emergencies, they are not solutions.


Ask "why?" several times

I can't remember specifically where I learned this, but "why" is the most powerful tool you have to get to the root of any problem. It should be asked several times before settling for the answer.

This is a summary of a real conversation I had a few months ago.

Me: "Why are we out of XYZ forms?"
Person A: "Well, Person B isn't here"
Me: "Why does B need to be here?"
A: "She prints them" // *(MOST PEOPLE STOP HERE!)*
Me: "Why can't you print them?"
A: "I don't have access to the forms"
Me: "Why not?"
A: "I don't know, they tried to give me access but it didn't work"
Me: "Why didn't you follow up?"
A: "Person C was working on it but I haven't heard anything"
Me (talking to C): "Why doesn't A have access to the forms?"
C: "Person D is in charge of that, and I tried for a while to get A access but they couldn't do it"
Me: "What is D's email address?"
...

In 2 hours, person A had access to the forms via an email and phone call I had with person D. Most people would stop at the first question and just accept the problem. No more!


Pay attention to your shoulders

Shrugging your shoulders is admitting defeat. I do this too, usually without thinking. But don't let the shrug be the final response. You know you're making things more efficient and simpler when the shoulders of people around you are being shrugged less and less.

A shoulder shrug says "I don't know, I don't want to put in the effort to find out, and I give up".

It's ok to not know, but it's not ok to not know who DOES know or how to find out. A shrug is an indication that people are too far removed from the solution to take any action at all. A shoulder shrug is an indication to make things easier or more accessible!

When someone shrugs their shoulders, this is a silent request for a better system.


Remove redundancies

If there's 3 versions of the same thing, but only 1 is the real version, hunt the other 2 down and get rid of them. Bonding agent, rubber dams, paper forms, whatever.

Having more than 1 version of something, especially if it's no longer used, adds confusion to the supply chain and your clinic at every level.


Organize relentlessly

This sort of plays off the previous comment, but be relentless in your pursuit of organization. Do not accept clutter. A cluttered work space (unless a project is in progress, obviously) means the mind is cluttered. Our mind is a powerful tool, don't waste its energy on clutter.


Don't let other people dictate your programs

Put your foot down, standardize the process, write down how to implement it, enforce the rules you set, and watch the chaos subside. This often takes lots of up front work (although sometimes it just takes making a decision to stop tolerating something), but the ultimate result is a better process for everyone, and a happier work-life for you.


Don't ever rely on verbal transfer of information alone, except in emergency situations

Every important verbal exchange should be followed by an email or a note, and every interaction you have with those you work with that involve one-way exchange of information should involve as little verbal communication as possible because this is where things get either confused or forgotten. Exceptions are very routine items that require very short instructions, like "please check XYZ before you leave today". An email would defeat the purpose here.

Sometimes conversations must be had in person, and they are more efficient that way, but summarize the conversation with a note or an email, especially if action will not be taken on that item immediately.

Example: If you're running logistics, don't let people come tell you an item is low. Have them mark the low item bin itself or write it down on an order form (more on that in part 3). Asking them to verbally tell you something is begging for trouble. Some day, you will forget or hear them wrong, or they will get used to telling you and filling up your brain instead of putting the information somewhere simple for you to access.


Think into the future

The clinic needs enough supplies to last through a shortage, and enough notice to get an item before it runs out. If you know that product X takes 30 days to come in from the day you order it, you better have some way to know when you are getting close to a 30 day supply. Stop waiting for the product to dwindle down and then panicking that it's low. This also touches on the previous point. If you run into this problem once, design a better way to communicate.

If the same problem happens again, that's on you. You're not thinking into the future. This is a key mistake I see people make very often.


Have projects ready for down time

Sometimes things break. Sometimes patients cancel. Have some projects ready that can be handed off and worked on during this down time. Stop just working "in" the clinic and start working "on" the clinic.

Everything can be simpler, better, or faster. Everything. Make it so.


Your clinic is a machine. Build a better machine.

Could you imagine the hilarity of watching a family push a Flintstones-style car down the highway? It would be absurd.

But we do this ALL THE TIME! How often have you watched a coworker (you and I aren't exempt here) complain about a process but fail to actually do anything about it? They keep pushing their Flintstones car down the highway, complaining about how slow it is, and never really thinking it might be time for a new car.

The car is a symbol of the system you've created. If you're not getting the result you want, build a better system!


Put instructions at the point of contact

If you want someone to do something when they encounter an particular object, make it obvious.

Example: If you want people to know where they can print new forms, post an address to the computer drive on the wall above the paper forms! Tada!


The good system you'll actually do is better than the perfect system you won't

I don't care how good a system is. If it's too complicated or burdensome to actually use, it's no good. Make something that's good enough but simple enough that people will actually follow it. Then you can gradually improve the system from there.


Start now, but make things editable

There's two problems that occur when you make a system too hard to modify:

1. You have your ego tied up into the time it took to make it perfect
2. You're more reluctant to change it because it will take a lot of effort

Example: At my first base, I typed labels for all our supplies. It looked nice, but it took forever and was a pain to change. At my new base, I made blank cards that we can just handwrite. It doesn't look as nice, but it's been much easier to make changes and it works functionally just as well as the typed versions. Besides, once we are stable for a while, I can always go back and type the labels.

Get started, but be prepared to change course. It doesn't have to be perfect before you begin. In fact, it shouldn't be.


Be thankful

Give people specific thanks and praise for what they do. Every. Single. Day.

People are far more motivated to continue doing good things than being constantly told to fix bad things.


Write it down, and take a picture

If you want something TO GET DONE a certain way, write it down. Checklists, how-to guides, easily accessible Powerpoint presentations... it doesn't matter. Don't rely on mouth-to-ear transfer of knowledge.

If you want something to LOOK a certain way (a standardized room, for example) then you MUST take photographs and make them easily accessible. Photos are the gold standard for standardizing anything visual.

Bonus: Add pictures or computer screenshots, where applicable, to whatever written process you want people to follow for added clarity.


If you want it to fail, fix it and walk away

This sort of piggybacks off of the previous point, but you must have a process for duplicating your solutions.

Here's the progression, applied to treatment rooms:

1. Create the standard (develop a standard treatment room) *(MOST PEOPLE STOP HERE)*
2. Make the standard reproducible (take photos of a perfect room setup)
3. Give people time to hold the standard, and then enforce the standard (the photographs, not a person's opinion, is the ultimate authority, so use them to enforce the standard)
4. Develop repercussions the failing the standard (what happens if the standard is not met?)


A car uses more energy than a spaceship (how to create a system)

Ok, sort of. A spaceship uses WAY more energy to get off the ground and into space. But once it's in space, it's aided around the Earth by the force of gravity and does very little work to propel itself in orbit. Eventually, it travels farther than a car could ever go.

A car is under the same gravitational influences, but it must have constant energy input because it deals with FRICTION. It takes way less work to move a car on a road than a spaceship from a launchpad, but the car takes the same amount of work every single day, and ultimately, the car can't go that far.

Look for friction in your clinic. Where are people complaining? Where are people bumping up against the same problem over an over? Where are things harder than they need to be? Where are things taking 5 steps when they could take 3? Where are efforts being duplicated for no reason?

Can you be a spaceship and put in a lot of energy up front right now to make the friction go away forever?

This is how you create a good system.

(Amazon's "One-click ordering" is an example of reducing friction)


A system is a 3-part answer to "how do we... ?"

The answer to this question must be:

1. Obvious ("here's an obvious location to find clear, documented directions on how to handle certain patients")
2. Clear ("here it is, documented in easy-to-understand and follow language")
3. Documented ("here it is, documented completely, so that you could do what I do if I'm not here")

If you don't have these three components, you don't have a complete system. People plug the holes of incomplete systems. An incomplete system is going to collapse when the person (or people) that is running it eventually leaves.

If you have someone just manhandling the Class 3 program, answering all the questions, doing all the work, but none of what they do is obvious, clear, and documented for someone else, you are asking for problems.

Tip: ask people to document their own jobs! Most are happy to do so.


Create decision ladders

For my Class 3 program, I have a file on the computer that is basically a "how-to" guide called "Class 3 Operations Manual".

Open that document and you'll find only 3 main points. What do do daily, what to do weekly, and what to do monthly.

Each section has references to other places on the network drive where there are directions on how to create certain forms, how to log our patients, and where the log is located.

In fact, once you navigate to the patient log, the log itself has instructions on how to use it!

Do you see what I've done? I hand over the starting point (the "Class 3 Operations Manual") and it points the reader--

Where go to
When to go there
What to do when they get there

Boom. All they have to do is open that first document and "climb the decision ladder" to each step. Every rung is built for them. There's only one way to do it.

Systems fail when there is a gap in the ladder so wide that the climber has to find another path to keep climbing. That's where mistakes are made.


Don't let old problems disguise themselves as new problems

Sometimes we fix a process, but something that was created under the old process pops up and causes discouragement.

If you created a new process on 1 October, 2018, then give it some time! If a problem pops up that was created before 1 October, 2018, no sweat. That problem says absolutely nothing about your new system!

Now, if the problem popped up in November, then you may need to do some tweaking. But old problems will bubble up, just have your head wrapped around when the problem started and don't nuke your new system or add a bunch of new steps just because old problems are still out there.

The goal of the new system is to prevent new problems from arising.

Side note: It might also be good, when creating a new process, to have a sister-process that can go try to hunt down old problems that might exist. The sister-process can be shut down when everything is corrected. (Example: you have a new chart color system, so new charts get the new colors as the patients come in for treatment, but for a while, someone needs to go through the old charts and proactively update their colors, too.)


Don't enforce a standard that doesn't exist

"Have your rooms cleaned and looking nice by the end of the day" is 100% unfair.

Your definition of that statement may be different than the person who has to clean the room.

Who is right? You both are. And by default, neither of you are.

Have a checklist or photographs of every standard you wish to enforce. If the standard is unclear, make it clear and then update the checklist/photos. You cannot rely on someone's opinion as a "standard". This allows the standard to change on the whim of the person enforcing it. Not good.


Ask "what's the most annoying thing you deal with?" and fix it ASAP

Learned helpless will drag someone down slowly over time, to the point that they may fail to realize that their situation is solvable or avoidable.

People typically either:

1. Fail to see the "real" underlying problem as something small and easily solvable
2. See the problem, but lack the experience or critical thinking skills to come up with a sustainable solution

Solving someones most annoying problem will accomplish and demonstrate a few things:

1. Helps them realize their problems are really not that big, usually just an accumulation of small issues
2. You're on their side, you are a team, and you want them to win
3. Being "busy" and "stressed out" does not have to be the default operating mode
4. Paying attention to the little things and fixing those can lead to a spiral of success, instead of a spiral of destruction
5. Most of the things they don't like about their job are the accumulation of small loses, not just a few big problems

Automate your brain

With calendar alarms, reminders, and digital to-do lists, you should never ever forget a task or an event.

If you are, you're relying on your brain to be a calendar or a to-do list. This is secretary work for your brain, something it's notoriously bad at doing.

Write it down, make a calendar alert, whatever you have to do. There is no excuse for "forgetting" these things, because they should never try to be "remembered" in the first place.


Big goals, little steps

You can't complete big audacious goals in 1 day. Many will take months or years to fully realize. This can be hard in the military, but you can do it if you focus on the smaller pieces!

Set an intention to accomplish big things, but break the individual steps into small and manageable pieces that you can accomplish.

I even like to have daily goals that are very small (example: research 1 new item each day).

Here's why:

On your "off" days, when you're just too busy to really get anything done, you can still find time to do your one small step.

On days when a patient cancels or you have a ton of unexpected free time or energy, you can slay a weeks worth of work!


Double the time, halve the results

Anticipate that any change you want to make will take twice the time and be only half as effective as you hope it will be.

This isn't to discourage you from trying to make changes, but to keep in mind that difficulties are often impossible to see, especially when the perfect end result is to clear in our minds.

Be prepared to work hard, long hours to get things done. Keep moving forward, and you will accomplish them.

Dental Tips from a Newbie

I've been at this dentist thing for a few years now, but I'm constantly running across different tips and tricks that make my life easier as a dentist.  I wanted to share them with you guys, because sometimes in the military, we have to be creative with the supplies we have at hand!

Hemorrhage control in restorative dentistry:

This is tough sometimes.  You've got a patient that has less than ideal hygiene and when you drop the box for your prep below the gingival margin, inevitably you get some bleeding right into where you're working.  Here are some tips to help you out.

1. Viscostat Clear on a cotton ball - Viscostat Clear is an excellent product that is comprised of 25% Aluminum Chloride to help control minor hemorrhage.  Emphasis on "minor".  It will not stop the gushers from gushing but it will keep minor hemorrhage at bay.  However... if you saturate a small cotton ball with it and use pressure against the hemorrhaging area for about 3 minutes, you will be able to push the tissue back and control bleeding at the same time.  Excellent for working that tissue distal to mandibular 2nd molars on crown preps or deep restorations.  This saved my bacon on a CAD/CAM crown 2 days ago!  You could use another hemostatic agent, but Viscostat Clear is what we use at Eielson.

2. Injecting surrounding gingiva with anesthetic - This was a trick I learned in my AEGD residency and it's saved me more than once.  Here's how it works.  Anesthetic has epinephrine in it to constrict the blood vessels so that the anesthesia stays in the areas we want it to stay.  But this effect of epinephrine can also be utilized to control localized hemorrhaging. Let's say you are prepping a crown on #14 and the mesial marginal area is sub gingival and none of your hemorrhage control methods have worked.  Take some anesthetic and insert the needle directly into the facial side of the papilla between #13 and #14 and inject 1/4 to 1/2 of the carpule with a fair amount of pressure.  This forces epinephrine into the tissue and can keep hemorrhage at bay long enough for you to refine the prep and get a good impression.  The best is to use a high concentration of epinephrine (1:50,000) but traditional anesthetic works well, too (1:100,000).

Note: Do NOT inject straight into the area that is hemorrhaging.  The fact that you're stabbing pissed off gingival tissue will sometimes make it worse.


Prepping crowns:

This is a very stressful procedure for dental students and new dentists.  You're taking away a lot of tooth in hopes that you can reduce a tooth enough for clearance of your material but not so much that compromise resistance and retention.  Here are some tips to help you out!

1. Pick a more aggressive bur - If you pick a moderately coarse or medium grit bur, you're going to notice quickly that you sometimes want to push the bur faster than it will cut.  I've found that using a very aggressive bur allows me to push at a constant rate and get into a "flow", if you will, of prepping instead of constantly feathering off the prep to let the bur speed up again.  If you have an electric handpiece, you may notice that this isn't as relevant, as you can maintain pressure and not worry about stalling out the bur.  However, I like to move quickly but smoothly. I never prep out of control.

2. Prep a wider margin - Another tip from my AEGD.  I don't think I've ever had a case that I said "crap, my margin is about 0.2mm too wide on this one".  A wider margin helps you out in several ways: 1) Easier for you to tell that you actually have adequate margin everywhere 2) easier for lab to discern between gingiva and margin and give you a good product 3) a wider margin gives you some "play" room in case the impression is less than perfect or there's some sort of issue in building the crown all the way out to the margin.  If for some reason you'd need to enameloplasty the margin back after crown cementation, a wide margin gives you room to do this.  Crowns don't fail from having adequate axial thickness. :)

3. Reduce occlusion a little more - In my opinion, you're better off reducing that extra 0.3mm than fighting for the wall height if you can avoid it.  Not to mention, the area we tend to under-reduce is right in the middle of the prep which has no bearing on how tall the surrounding axial walls are.  Get a #330 bur and carve depth grooves into the occlusal table and go down to them.  Then smooth everything up!  Now, this is not a blanket statement condoning negligent over-reduction, but if you're on the fence and are unsure, reduce a little more. This is especially true when prepping for CAD/CAM crowns that will be bonded into place.

4. Change burs only three times/don't prep the same area twice - This is how I prep, and it results in very fast and efficient crown preps without me having to waste my bur trimming tooth structure from two angles.  Here's what I mean.

If you do your occlusal reduction first, you are inevitably reducing the occlusion on areas that will eventually be prepped away when you go to do your axial reduction (example: you reduce the entire occlusion and then end up prepping off the circumferential areas for the axial prep that you just reduced the occlusion on!).  Don't do that!  The axial reduction is virtually independent of occlusal clearance so do your axial reduction first.  I always start "in the open", as I like to call it, on a nice wide area of the tooth that's easy to see. I prep the margin down to the most acceptably apical position depending on the material I'm using.

Let's take a #19 e.max for example (assuming it's ready to prep and doesn't need a core, etc.).  I would start with my aggressive flat ended tapered bur mid-facial ("in the open"... a nice wide area of the tooth) and work my way towards the mesial until I broke through all the way to the ML line angle, keeping the bur as deep into the tooth as necessary to make a complete axial reduction with 1 pass.  Notice how I never switched burs to pass through the inter proximal area?  This touches on two principals: 1) I'm going to prep the interproximal area away anyway so I don't step up with skinny burs, I just push through it with my regular bur 2) prep a wider margin.  So, I work through to the ML angle and then I come back to my starting point mid-facial.  Then I work the same pattern, this time towards the distal until I break through and get to the DL line angle. Then I connect the DL and ML line angles across the lingual.  Margin and axial reduction are done.

Occlusal reduction is next.  Switch burs (first change) to the #330, or a bur of your choice with reference points, and cut the depth groves I mentioned in tip #3.  Now switch back to the first bur again (second change) and level it all out to the depth of the grooves.  Now switch to a fine version of your first bur (third change) and smooth everything.  Done!

The problem with doing the occlusal reduction first is this: You are using false reference points on the outer edges of the occlusal table.  If you reduce the occlusion, you don't yet know exactly which areas you're going to end up prepping off when you do your axial reduction.  So do your axial reduction first so you have your smaller "true" occlusal table, and then reduce it.


Oral surgery:

Caveat: I am not an oral surgeon but I do routinely perform IV sedations and extract impacted wisdom teeth.  I don't do the crazy ones, but I've seen enough to help me become more proficient at taking out all kinds of teeth.

1. Remove more bone - Don't be scared to take some bone away!  Now, this is not a general rule, but it's true most of the time.  On anterior cases, patience is going to serve the patient better than reflecting a flap and buzzing away 4 mm of bone to get that root tip out.  But... for posterior teeth, you should recognize that if the tooth isn't moving now, it's not going to be moving much later.  Do yourself and the patient a favor and remove some more bone on the facial aspect of the tooth and try again.

2. Section the tooth - This can seem scary for a new doc, but sometimes it's what we have to do.  I was recently extracting a severely carious #30 and the tooth kept breaking into pieces while I was trying to get leverage from the mesial.  I had great visualization, so I took the handpiece and sectioned the tooth from F to L across the furcation, broke the tooth in half, and plucked both roots out in less than 20 seconds.

3. Use an endo file - Huh?  Ok, so I've seen this trick before and finally had a chance to try it a few months ago.  A patient had facial trauma and had fractured #7.  The problem is that there was a horizontal root fracture so the root tip was lying a good 3mm apical to the crestal bone.  I got a set of endo files and took the largest file that would engage the root tip at least 1 full clockwise rotation. I wrapped floss around the handle of the endo file and twisted the file to engage the canal of the root tip.  I pulled gently on the floss until, about 3 minutes later, the root tip popped right out. (Notice the clean and unused blade?)

Extracting #7 with an endo file

So that's it for today.  I'll try to catalog some more tips and do some more of these posts from time to time.  Are there any other topics you guys would like my to discuss or give input on?  Just another dentist trying to learn!

1 Year Later

I saw my first patient out of my AEGD on September 21, 2015.  So now that we are in October 2016, I've been an official "non-resident" dentist for a whole year.  Here are my thoughts so far:

Easier than I expected:

--- Getting faster - I expected to slowly get faster but my speed was much better very soon.  Having a good assistant goes a long way, and not having someone check every little thing really speeds things up!

--- Additional duties - In the Air Force, you have "additional duties" which are programs or tasks assigned to you to take care of.  I got assigned a few but since our base is small, they are easy to manage.  Our AEGD faculty kind of scared everyone into thinking that small bases were a big extra workload but I haven't found that to be true.

--- Work - This is broad, but I do like my job a lot.  I don't love it every day, but I'm learning and I do really enjoy doing what I do.  It's fun!  Finally!  Isn't dentistry supposed to be fun?  You get to manage your schedule without the stress of producing so it allows you to book harder cases out a little if you need to.

--- Working with co-workers - At my last base, we had a ton of staff because there were so many dentists.  Here there is really just a small group of people doing everything.  But everyone pulls their weight and we have a lot of fun together.

--- Winter in Alaska - It's not even windy!  Come on!  Easy :)

Harder than I expected:

--- Not much else - So... most things really are easier, smoother, and more fun than I anticipated.  There are hiccups now and then and I don't mean to sound like things are easy... but most things are not as hard as some of the people at my AEGD made it sound.  I guess it depends a lot on your expectations.


So that's an overview, and here's a glimpse into a very typical day in my actual-real-life-...life.

Monday, Tuesday, Thursday and Friday
-Get to work around 0700
-First patient at 0730
-Do some fillings, maybe endo or a crown prep
-1 hour for lunch!
-4 more hours of a seeing patients!
-1 hour of PT time on Monday
-Some days we have a doctor assigned to ONLY do exams, recently we have been just squeezing them into the schedule when we can because of staffing issues.

Wednesday
-Get to work around 0700
-Do a 3rd molar sedation/surgery case at 0730
-See a couple more patients
-1 hour for lunch!
-Training day in the afternoon or catch up on things (usually no patients)
-1 hour of PT time

Here's how I would breakdown how I spend my time when I'm actually seeing patients:

Operative (fillings): 55%
Endo: 5%
Pros: 10%
Evals/Exams/etc: 20%
Surgery: 5%
Other admin stuff: 5%

You get to work your own schedule a bit and put things were you like them.  I prefer to do "big" cases right after lunch or leading into the end of the day (endo and pros).

Each base is different, and if you're at a large base you may not do any endo or oral surgery and very little pros.  Depends on the specialists and the need at your base (AND your desire to do whatever it is).

Hope this was helpful!  A little "day in the life" for you guys.

Educating Patients

Here's the thing.  We go to school and learn to become dentists.  How does this work?  Well, we sit in classrooms for hundreds of hours, then we practice on some fake teeth, then we start doing the real thing.

So what happens when it comes to treating patients? Well, we think back on our education and we make decisions for treatment based on what we know.  However, I truly believe that it's easy to put blinders on and forget to educate the patient on one basic question:

What can I do to prevent all this?

A strange question to think about because for the dentist, we essentially rely on the work of bacteria in the oral cavity to keep us working!  But our ultimate goal is to put the patient's oral cavity in such a position, and to educate the patient properly, that they can go home and maintain their oral health optimally for... ever!  We are humans so this often doesn't happen, but I want to emphasize patient education today.

I spend a lot of time on patient education.  I tell them how carcinogens in cigarette smoke can alter a cell's ability to properly duplicate itself; I tell them how small areas of demineralization on their tooth are in a fragile balance between repair and destruction; I tell them that calculus is a structure that a village of bacteria built as a way to protect itself so that it can go out and invade our mouths.

It's always exciting when new and highly applicable patient education materials arrive and I had the privilege of finding out about one just a week ago.  It really is a wonderful balance of talking on a level the patient understands without using fluffy words and bogus language that doesn't hit on the severity of the issue.

Here's a little word from Southcommon Dental on the sweet infographic they've created that you're free to use with your patients!

---Most people know that if you don't take care of your teeth, you will eventually get cavities and have to pay an extra visit or two to the dentist.  But what is actually going on in your mouth?  Why do cavities form when you stop taking care of your teeth?  Southcommon Dental has put together a dental infographic that delve into this topic and teaches you why not brushing and flossing ultimately leads to this problem.  Check it out!

Reimbursements and the days ahead...

A lot has happened since my last blog post a few months ago, and a lot is about to come my way. I'll go one by one, starting with the Air Force stuff, and then narrow down to some odds and ends I've been doing. Then I'll close with what's to come... enjoy!

First off, the Air Force.

2 things I need to cover here. For those awarded a 4-year scholarship, Commissioned Officer Training (COT) is supposed to happen the summer before their first year. For 3-year scholarships, COT happens after the last year. For me being on a 4-year, mine was supposed to be this summer. However, the dental school I'm attending starts so early (I'll talk about that soon) that COT would have ended too close to the start of school so it was deferred to next summer, between my 1st and 2nd year. So you'll have to wait another year to hear all about that!

Now about reimbursements and dealing with AFIT (Air Force Institute of Technology, where the people you'll be in contact during your scholarship work, located at Wright-Patterson AFB in Ohio). Let me say that dealing with AFIT has been one of the easiest, quickest, and overall amazing experiences I've ever had. The people working there are extremely fast at responding to e-mails, accommodating my needs, and making things absolutely clear. It truly has been a joy to have my questions answered so quickly and to deal with such professional people. One of the best parts is about reimbursements. When I was awarded the scholarship, I was under the impression that I would need to mail my reimbursement packages to the Air Force base, which would be a big pain, and if anything was wrong, I'd have to mail it in again. Well all those worries went away when I was informed that reimbursement packages can be submitted by e-mail! It was such a relief, because they respond so quickly to my e-mails, I could get almost immediate confirmation that my package was accepted or what needed to be altered. Huge weight lifted off my shoulders. For those that are wondering what a 'reimbursement package' is, it's fairly simply. If I buy something the Air Force will pay for, lets use my textbooks as an example, then I go buy the books and then assemble what's known as a reimbursement package. A reimbursement package is simply 4 things, proof of requirement (I have to prove that my dental school makes me have what I'm asking to be paid for), proof of purchase (basically a receipt or a credit card statement), an AFIT form 31 (this is where you list everything you are buying and total it up for the AF), and an EFT form (a form where you verify who you are with SSN and signature and give the AF the bank account # where you want them to direct deposit your money). All in all, reimbursements are much easier and smoother than I could ever imagine, one of many reasons I am very happy with my choice so far! My first reimbursement was submitted by email around May 22, and my account had the reimbursement money in it on June 15. Only about 3 weeks! I was very impressed.

Secondly, about what I've been up to since my last post.

I went and paid for my scrubs! Cost me about $250 and the Air Force actually doesn't cover the whole cost of that, but it's enough! They cover basically everything else in full.

I got health insurance through the dental school which the Air Force will pay for too, awesome!

I finally got my military ID and have gone over to Tinker a few times. It's pretty weird still to think I'm in the military because I haven't really done any 'military' type stuff yet.

I think I've got all the teeth I need. I almost had 100 at least check and I've got a bit more than that so I'm sure I hit my mark. I hear we don't need them until spring anyway so I'm considering the possibility of continuing to collect them this fall.

Class starts for me on June 29, so I've got all my anatomy books ready to go. We take anatomy by itself from June 29 to about mid-August, so it's going to be pretty intense. Once it hits mid-August, anatomy ends and we start in on our normal 24-25 credit hour schedule... ahh!!!

For now, that's all I can remember. School starts for me next Tuesday... wish me luck!

waiting...

Well, not much has been going on this last month. I should be getting my military ID soon, so I'll be able to head over to the base and get some tax free shopping whenever I decide I need something big enough to justify getting it tax free! Which will probably be everything.

Anyway... I'm required to collect 100 intact human teeth for dental school and I believe I'm almost there. About 2 weeks ago I went out to all the offices (4 total) that I dropped jars off at and had the following count at each one: 4, 4, 20, 45. So I took the jar with 45 home with me (the solution was pretty murky), emptied it out, put them in my own little jar at my house, and ran it back over to them the next day. I left the other 3 at the offices because the solution was still clear and there was no reason to waste a trip home and back just to unload some teeth. I also have a jar at a local free clinic with about 12. So the tooth quest continues...

Other than that, I'm just waiting a few more days for that 60 day mark to hit so I can get some stuff taken care of so the Air Force will reimburse me. Oh, and I may need about $800 of work done on my car... luckily I have a pretty good job right now and I'm blessed to have a car as it is. So despite the big bill that is staring me down, I'm just smiling and plugging along.

Should be hearing from me again in a couple of weeks at the latest...