‘Through instrumental contacts that the Alpha Omega (AO) society has built and guided me towards, I have been able to arrange a summer placement at the Hadassah Hospital Dental Faculty in Israel. This is an invaluable opportunity to deepen my understanding of clinical dentistry in the first dental school, established by the AO International Fraternity, in Israel. Hadassah’s values resonate with me, and I would be honoured to learn from their clinicians. For example, they sent a team to assist with oral hygiene during the Ukraine crisis, which evidences their core values of respect, teamwork and holistic dental care.
I am excited to build my critical thinking skills by learning from a diverse team of clinicians who have studied and practised dentistry across the globe. They bring different experiences and opinions, which will widen my clinical knowledge and skills upon returning to the UK. Through observing unique cases in the speciality clinics, I hope to learn how I can apply my knowledge and tailor my treatment to my future patients. This experience will enhance my history taking, diagnostic and treatment planning abilities.
My passion for dentistry and my desire to further my clinical knowledge have driven me to seek this opportunity. I am incredibly excited to visit Hadassah and extremely grateful for all the support that AO has provided for me so far.
Here is the report following the trip:
Alpha Omega Report
Hadassah Hospital Dental Faculty 2022
By Talia Harris
‘I arrived at Hadassah Dental Faculty early Tuesday morning where I was warmly welcomed by the dental team and was given my busy timetable observing a range of dental specialties.
For the first three days I was placed on paediatrics. From the moment I entered the department I saw the holistic anxiety reducing techniques used by the dentists from the brightly coloured walls to the televisions on the ceiling together with the communication techniques implemented allowing the children to see, touch and feel the dental probes. As well as this, children requiring conscious sedation were provided a strawberry flavoured drink, the same colour and consistency as the premedication required for midazolam. On the first day I shadowed the diagnostic units where I saw an interesting case of pre-eruptive intra-coronal resorption, diagnosed post x-ray after a child presented with pain. I learnt of the aetiology of this condition related to the invasion of resorptive cells during crown formation as well as local factors such as ectopic teeth. This was only the first of many rare conditions I saw, diagnosed and managed under the supervision of expertise at the dental faculty. Throughout the rest of my time on the paediatrics department my clinical understanding of dental techniques and materials was widened when observing a pulpotomy due to a deep carious lesion. The use of a pre-formed stainless-steel crown was used to restore deciduous molars due to the durable nature and limited chair side time. Calcium hydroxide was contraindicated as a pulp capping material due to the predisposition to sclerosis of deciduous root canals. Metapex was used to fill deciduous canals during a pulpectomy due to the resorbable nature of this material as during tooth exfoliation.
I was given the opportunity to scrub up and observe paediatric dental surgery for a child who had admitted the previous night due to hyperinsulinaemia. I saw the strong teamwork and holistic pre-operative care delivered as the child was treated in the surgical theatre, where a vast amount of dental treatment was completed within the hour, including four extractions and eight pulpectomies.
At the start of my second week at Hadassah I was placed in oral medicine. On this department I saw a fascinating array of oral mucosal conditions including a lupus case, erythematous leukoplakia in a cannabis smoker, geographic tongue in a diabetic patient presenting with burning mouth syndrome and most commonly lichen planus. I observed the use of prescription oral corticosteroids to manage painful and recurrent lesions. I also observed cases of benign mesenchymal fibromata and melanomas. My clinical diagnostic knowledge was widened and the importance of thorough history taking to make an accurate diagnosis and the key clinical features of these conditions were made apparent. Pemphigus vulgaris was one of the more serious mucosal conditions presenting on this clinic, the patient requiring frequent check-ups to monitor the extent of the lesions. I also learnt about the effective pain reducing capacity of photobiomodulation therapy used in the dental faculty to manage mucositis disorders.
I saw a SUNCT case, on the pain clinic, a rare facial pain condition diagnosed after a patient presented with a blood shot eye, shooting pain around the temple area with a 15 second duration which had occurred for around 6 months. I saw the importance of taking a thorough dental history and the complex variety and diagnostic overlap of different headache/facial pain disorders.
On the salivary gland clinic, I saw a case of a squamous cell parotid carcinoma, initially diagnosed as salivary stones; however, despite the initial symptom presentation overlap, the tumour continued to grow. This patient had had the tumour removed and had come for a post operative visit having experienced some pain in the salivary gland due to the radiological changes occurring within the parotid tissue. On this clinic I saw an interesting case of a patient with a hypertrophied masseter requiring mepivacaine trigger point injections to relieve pain. I observed the use of salivary infiltrations, which have been found to be largely successful for stimulating saliva flow in those with Sjogren's by dilating the fibrotic duct with a probe and infiltrating with saline.
During my experience shadowing on the prosthodontics department, I learnt how, using the intraoral scanner, a replica of the patient’s pre-existing denture was fabricated without a flange and scanned intraorally to visualise the potential implant outcome. I saw the combined use of superimposing the CERC intraoral scanner images with CT images to increase clinical knowledge of where to place implant screws in bone as well as visualisation and processing of an anterior implant.
In the orthodontics department I attended seminars on the use of head gear, 3D computer modelling and a clinical case presentation. In the morning, the clinic specialised in surgical cases requiring mandibular advancement surgery whereby the aim was to establish a class I occlusion prior to surgery. In the afternoon the clinic specialised in cleft palate cases requiring orthodontics post-surgery due to absent incisors. I learnt about the importance of the balance of forces and anchorage when needing to move or rotate a tooth. On the second day the clinic specialised in impaction cases. I saw a patient with a supernumerary tooth, who had the tooth extracted via a flap procedure and a wire string was used assist the eruption of the buccally located tooth. Elastic bands were tied to the wire and attached to the patient’s braces to encourage eruption. I also saw a case whereby a young patient had an auto transplant of an upper premolar into the position a lateral so that the bone level could be preserved for a future implant. This clinic also offered Invisalign treatment which I learnt is better for sequential distalisation compared to fixed braces since the plate holds the whole tooth compared to the brackets on fixed braces which hold one surface.
On the endodontics clinic I saw a trauma case. Using a microscope, tactile feedback and radiographs a radix entomolaris was identified in the lower right first molar requiring endodontic treatment. I was given the opportunity to look down the microscope and locate this extra canal due to its dark black corridor nature. I saw the use of the RACE EVO rotary system, which was chosen due to its flexible nature for the curved roots. I learnt of the 7 other rotary systems available at Hadassah hospital. Furthermore, I saw a case of an avulsed tooth requiring intraoral bleaching post endodontic treatment with sodium perborate. The cardinal signs used to establish the prognosis of a tooth and the need for it to be root filled were made clear to me including tooth colour, gingival pain, deep pocketing, sensibility testing and TTP.
I thoroughly enjoyed this invaluable time at Hadassah where I learnt so much and met so many experienced dental professionals. I feel so honoured to have been able to have had this opportunity to shadow so many different dental specialities in such a renowned advanced hospital in research and education. I look forward to applying some of the techniques and clinical knowledge I have gained during this placement in my clinical practice on returning to England.
Thank you very much to the Alpha Omega London Chapter. ‘
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