Bulletin of Dental Education Article

Dental students at the A.T. Still University Missouri School of Dentistry & Oral Health (ATSU-MOSDOH) receive training in dental education at the school’s Kirksville, MO, campus in addition to clinical education at the St. Louis Dental Center in St. Louis, MO. Depending on their year in school, learn more about what students learn at each location.

Kirksville Campus: Dental Education for First- and Second-year Dental Students

“Not too long ago, dental education focused on reading books, viewing slides, memorizing terms and practicing in basic simulation labs using artificial teeth,” recalls Ammar Musawi, B.D.S., M.D.S., M.P.H., Professor at ATSU-MOSDOH, who is the Assistant Dean of Preclinical Education and teaches first- and second-year dental students at ATSU’s Kirksville, MO, campus.

Today’s education begins with traditional basic science lectures that encompass reading and discussions to prepare students for pre-clinical experiences in simulation clinics. The most important learning resource in the simulation clinics is the dental patient simulators or manikins, which help students build confidence as they develop their skills and experience lifelike impressions of providing care for real patients.

“Our basic goal is learning hand skills without the fear factor of practicing on a real person,” emphasized Prof. Musawi.

ATSU’s Kirksville campus offers state-of-the-art classroom settings, including a dental simulation clinic filled with nearly 100 individual student stations, each including a dental patient simulator. Their “jet age” simulator has no tongue to get in the way and provides a perfect bite.

“We ease the students into the field with more straightforward, but important procedures, such as infection control, taking a patient’s dental and medical history and radiographs. Then, we crank up the curriculum, and add teeth cleanings, fillings, followed by crown preparation and restoration,” added Prof. Musawi.

The next stage involves complicated bridges, dentures, root canals, implants and pediatric dentistry. Today’s technology allows a dentist to utilize a camera in the mouth to digitally design a crown and the 3D image is then sent to a milling unit to ensure it looks exactly like the actual required crown. The use of “haptic technology” mimics real-life situations for practice sessions and allows students to reset procedures to start over, if needed, until they get it right.

As first- and second-year students learn and become more confident, they begin practicing on one another during peer-on-peer activities such as impressions, intraoral exams and images and charting. The human component of emotion—fear, excitement and empathy—are incorporated into traditional dentistry techniques. Their knowledge and experiences prepare them for clinical education as third- and fourth-year dental students, which consists of real-life experiences with actual dental patients at the St. Louis Dental Center, a partnership of ATSU-MOSDOH and Affinia Healthcare.

St. Louis Dental Center: Clinical Education for Third- and Fourth-year Dental Students’

Along with fellow ATSU-MOSDOH and St. Louis Dental Center faculty members, Prashanth K. Haribabu, D.D.S., M.D.S., M.S.D., FICD, Specialty Care Unit Director, Associate Professor of Oral and Maxillofacial Surgery and Director of the internship program, mentors and supervises third- and fourth-year dental students assigned to provide care for an underserved population.

In situations where a patient presents with a more complex oral health concern and a multidisciplinary approach is needed, digital dentistry faculty are often consulted, and digital resources are utilized to improve the dental team’s diagnostic and treatment planning capabilities.

Akshay Vij, B.D.S., ACT, FAGD, FICD, ATSU-MOSDOH Specialty Care Unit Director of Esthetic and Digital Dentistry, founded the digital dentistry program at ATSU-MOSDOH. Prof. Vij has also taught cutting edge technologies such as intraoral scanning, 3D printing, same-day fabrication and milling of dental crowns and 3D Cone Beam Computed Tomography (CBCT)-guided surgical planning since its inception. Patients at ATSU-MOSDOH’s St. Louis Dental Center receive the benefit of these technologies on a daily basis.

For instance, with intraoral digital impressions, ATSU-MOSDOH third- and fourth-year students are able to 3D scan a patient’s jaw and teeth without the need to use those conventional “goopy” impressions that may cause gagging. Often a dental crown, which usually takes two weeks to be fabricated at a dental laboratory, can be made in less than an hour onsite; reducing a two-week procedure to a single day. The costs and time savings dramatically increase patient satisfaction and acceptance of the needed treatment. Utilizing virtual planning, with a 3D CBCT radiograph, enables accurate simulation of dental implant surgery, reduces treatment time and increases accuracy substantially. The end result is a very predictable and accurate result with fewer post-operative complications. 

Another recent case at the St. Louis Dental Center utilized digital navigation as a tool for surgery. A patient with a history of osteoporosis was advised to take a medication containing bisphosphonates (anti-resorptive medication), known to prevent spontaneous fractures. The medication has also been known to have side effects, such as jawbone necrosis. 

“After examining the patient, we observed that she had eaten something with sharp edges, like a potato chip, resulting in gum damage that prevented healing. Chronic ulcers developed in her mouth, which led to infection within the bone and necrosis in the hard palate,” said Dr. Haribabu. The patient’s diagnosis was based upon clinical exam and a 3D CBCT scan.

David Ubanek, D.M.D., an oral and maxillofacial surgeon and ATSU-MOSDOH adjunct faculty member in the Specialty Care Unit of Oral & Maxillofacial Surgery, led the school’s team in planning and performing an operation to successfully remove the necrotic jawbone due to side effects of bisphosphonates. Upon removal, a unique procedure utilizing palate-rich plasma (PRP) effectively enhanced post-operative wound healing.

“The PRP involved drawing blood from the patient’s arm, then spinning the blood with a centrifuge at specific revolutions per minute. We used innate cells to accelerate bone healing and promote a faster recovery,” explained Dr. Haribabu. 

Because necrotic bone disease is extremely challenging, a patient can lose a significant amount of bone. A digitally fabricated surgical stent was inserted as protection and prevention of external injury for a period of time. Everything healed uneventfully and about three months later, the patient returned for examination. There was no physical disfigurement or problem inside the mouth.

“This case involved a unique problem, a unique solution and a unique way to involve a surgeon in an outpatient setting; therefore, reducing the cost of hospitalization and providing the best possible outcome,” explained Dr. Haribabu. “Importantly, this example demonstrates the value of cutting-edge technology paired with teamwork in health care so that medical professionals can effectively address complex and challenging cases. This patient example reflects the many experiences our ATSU-MOSDOH D3 and D4 students gain and prepares them to be excellent clinicians upon graduation.”

Courtesy of A.T. Still University Missouri School of Dentistry & Oral Health