Hi, welcome to Dentistry 101. Today we have the pleasure to have Dr. Elisabeta Karl with us here. Elisabeta Karl is a Clinical Assistant Professor from the University of Michigan, and she'll be talking about restorative dentistry. So Elisabeta, thank you so much for coming and being here with us today. Thank you, Rogerio. Thank you. So, what is really restorative dentistry? Well, restorative dentistry is the field in dentistry that restores, or places restorations-- what people in general call tooth fillings. We try to stay away from that terminology, "tooth fillings,” because a dental restoration is much more than filling up that area of the tooth that was lost by either decay or trauma. A dental restoration should replace form, structure, shapes, and function. Depending on the materials we use, a dental restoration can even match the color of the tooth. To place good restorations, it's very important that the dentist or dental students know the tooth anatomy that they're working on. For example, the front, upper tooth or teeth we have, have a very particular difference here. So, we have an angle that is always more round up than the other angle, so when we fail to place those angles correctly we can really change the way patients smile. Or if we fail to place this right nice contour here next to the gum line, we can cause gingiva inflammation for the patients, so it's really important to know the anatomy of the tooth. So, from a student perspective, how is the transition between the learning and the practice to the clinic itself? That's a good question. First, dental students extensively practice in plastic teeth like we see here, in a fake mouth and a fake head in a simulation laboratory. So in these laboratories, these laboratory sessions, they practice all kinds of tooth preparations, which the students call “preps.” So, knowing how to cut these tooth preparations is very important because it allows us to remove decay and to cut the teeth in such a way that they are ready to receive the dental materials. For example, in these preparations, we look at walls, we look at angulations. So, those features are very important, especially for silver fillings or the amalgam restorations. For the most modern materials, like the composites, those walls, those angulations can vary a little bit more. In the past, the dental preps we had were bigger, deeper, but now with more modern materials and smaller burrs, we can cut smaller and not-so-deep preps. It can be very tricky. Look at this tiny cavity here, tiny carious lesion. When we cut the prep to remove decay and receive the dental materials, it gets much bigger, so it's very important to cut preparations that we are actually saving sound tooth structure. It's even possible today, Rogerio, to place a restoration without using any burrs, without cutting teeth. It's very interesting. How does it work, this process, that you don't really need to drill the tooth? Well, it can only be possible in very tiny cavities or in very incipient lesions because in those areas we don't see a cavitation, because what people call caries, or a decay, is nothing more than when the tooth loses mineral, mineral loss. So, in cases that we don't have too much of that loss and there is no cavitation, dentists can insert devices like this to slightly separate the teeth. Then, we insert this other device here that allows us to insert the products or the solutions that we need to prep, chemically, the tooth to receive the restoration. This technique is called resin infiltration. So first, we apply an acidic solution, then we dry, and the last step is to infiltrate the resin. What the resin does is to refill those areas where the tooth lost minerals. It's a very interesting technique because it's not only preventive, but it's also restorative. It's been very well-used in Europe and South America, and more recently in the United States a lot of dentists are using this technique. There is an ADA code for that, which means some dental insurances cover it. Like I said, I like it. I think it's very cool because it's restorative and preventive at the same time. So, in your opinion, what's the most important aspect of restorative dentistry? Well, I think to me, not just in restorative dentistry but all dentistry, the most important part is prevention, because once we lose tooth structure or bone inside of our mouths, it's gone forever. Small changes in diet and oral hygiene habits can really improve the oral health of any patient. So, we try to encourage the students even in simulation lab to think about prevention and to talk about prevention to their future patients. That's very interesting. Can you talk a little bit more about the transition or the students in the simulation lab? Well, in general, students find quite challenging the simulation lab experience. I think the reasons are: one, because it's the first time that the students are being criticized for something that they did with their hands; and the second reason is because students are used to seeing things in inches, centimeters, not in millimeters, and that's how we measure the preps in a simulation lab. Sometimes half a millimeter makes a huge difference. So, it is challenging. There is a learning curve that happens, not just for the hand training but the eye training, and we understand that these challenges can be stressful. So, thinking about that, we tried over the years to incorporate integrative or holistic approaches to reduce anxiety, and our goal is not just to improve anxiety but improve the climate of the course and encourage and facilitate learning. For example, this year we tried two different things. We tried a kind of a meditation therapy with gratitude. So, we had this tree, and we encouraged the students to post things that are they are thankful for. For example, some students report, "I'm grateful for my friend.” “I’m grateful for the water I drink everyday." So, it seems to really help them focus on the positive sides of their lives. Another very interesting project that happened this year, in partnership with the University of Michigan Musical Society, was the music therapy. So, we asked the music students to come to our simulation lab and play for us. What happened is that the baseline of the course, we could see 25 percent of the students reporting feeling very much worried and only six percent feeling happy. After the music therapy we totally shifted, and the students felt very much happy and not too much worried. So, to me, this is a great thing we tried, with good results in the lab. One thing that we always worry about is the posture of the students in the simulation lab. So, we have a very interesting project with the occupational therapy students from Eastern Michigan University, and they are coming here to help us improve our posture, to improve our ergonomics, to improve the way we work in the simulation lab, with very simple things like carrying the backpack the way you should carry the backpack, or stretching exercises. So, this is another very interesting project. But this summer we have a very unique, very interesting project, again with the partnership of the art and design school from our university, that we are trying to improve the visualization skills of our students using art. So, the art students and art faculty bring us those kind of paintings, and with their guidance we look at form, content, context, and meaning in that piece of painting there. From there, we translate all this knowledge into our tooth scenario. From that, we hope that the students will see shape, edge, and contours more easily. So, this is a very interesting project. We had a small pilot study with the grad students, and the students really enjoyed it. It was a very, very positive experience, and we hope to see students being able to visualize details sooner, better, in our simulation lab. This is beautiful. It's a very nice technique that you guys are applying to the clinic, and I really, really enjoyed learning about that. Yes. We are very excited about this. It'll be a very fun, nice experience. For sure. So, Dr. Karl, thank you so much for coming here with us. Thank you. Thank you all for watching.