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Interviewer: Severe, sudden, and sometimes debilitating face pain is a symptom of a disease called trigeminal neuralgia and some people suffer with the condition and don't even realize that's what they have. Or maybe it was misdiagnosed as something else so they can't get treatment.

Dr. Shervin Rahimpour is a neurosurgeon who specializes in the surgical treatment of trigeminal neuralgia, and he's going to help us understand how to come to that diagnosis. So first of all, you tell me it's a poorly diagnosed disease. What exactly do you mean by that?

Dr. Rahimpour: Often this pain is distributed around the cheek and jaw area. And so it's natural for patients to think that this is likely a result of their dental health. And so they often seek treatment through a dentist, usually, you know, undergo a tooth extraction or something like that, and that pain persists. So that's often why this is poorly diagnosed is because it overlaps with other common issues like having tooth pain.

Interviewer: Yeah. And I think a lot of us think well, the pain is here, this must be the source of the pain. It's in my mouth or my cheek, it must be the source. But that's not the case with this disease. Where does the pain originate from?

Dr. Rahimpour: The trigeminal nerve, which is one of the 12 cranial nerves that we have, supplies, amongst other things, the sensation that we feel over our face. So there are two nerves, one for each side. Each nerve supplies the sensation to that half of the face. And the nerve has three divisions associated with it. There's one that kind of overlays the forehead and around the eye. The other division is around the cheek area, and then a third division encompasses the jaw. And so most commonly, the pain is likely to affect those bottom two divisions, which is around the cheek and the jaw area, and that's where this overlap comes with potentially pain coming from your teeth.

Interviewer: And somebody goes to the dentist, they have an extraction done and that doesn't solve anything. Do they try to get a diagnosis beyond that, or do most people just give up or do you know?

Dr. Rahimpour: Yeah, I should add that sometimes it can be your teeth. So it is worth having that evaluation done by your dentist. But eventually, this pain syndrome is referred either to a pain specialist or even a neurologist. Those are the folks that typically end up diagnosing this as trigeminal neuralgia-type pain.

Interviewer: Explain some of the common symptoms that people might experience.

Dr. Rahimpour: Yeah, absolutely. So again, this pain used to be . . . this disease used to be known as suicide disease because it was such a horrible pain for patients to experience. And it's often a severe electric type jolt or stabbing pain involving one or more of the divisions of the trigeminal nerve of the face. It's often set off by very relatively innocuous stimuli. What I mean by that is anything as simple as just a gust of wind, or talking or brushing your teeth, or having water hit your face when you're taking a shower. These are kind of the very, very basic and innocuous things that can trigger that type of pain.

Interviewer: And what's going on with the nerves that is causing this pain?

Dr. Rahimpour: The vast majority of cases are thought to be caused by a vessel sitting on the nerve root as it enters into the brainstem. And so what this vessel causes is damage over a period of time that ends up injuring the insulation around the nerve known as myelin. And then this can result in sort of aberrant firing of the nerve.

Interviewer: So it's rubbing against there, damaging the insulation every time your heart beats.

Dr. Rahimpour: That's exactly right.

Interviewer: It's damaging the . . . Okay.

Dr. Rahimpour: So the thought is that if we can remove or transpose this vessel from the nerve root . . .

Interviewer: Yeah, get it away from there.

Dr. Rahimpour: Get it away from there, that could potentially allow the nerve to heal and prevent some of this aberrant firing.

Interviewer: And if a patient has this type of pain, they would go to their primary care physician first likely. What would that workup look like?

Dr. Rahimpour: Typically, the patient has these classic types of symptoms or the stabbing electric type pains of the facial region, again, involving either one or more divisions of the trigeminal nerve. And we often ask patients, you know, "How is this pain brought about?" If it's something, again, wind, chewing, talking, anything like that, that's pretty consistent with trigeminal neuralgia. The pain also again persists to seconds to potentially minutes, and so that's another signature or hallmark of the disease. And we often look for patients that, you know, typically we find that this disease occurs more often in the older population. So the incidence kind of climbs as age goes up. But this can also be a result of some other secondary processes. Certainly, it can range anything from facial trauma and include other secondary causes like multiple sclerosis.

Interviewer: At what point should a person consider consulting with a physician who specializes in trigeminal neuralgia?

Dr. Rahimpour: I think early on it's best to have the medical therapy be optimized. So a lot of the medications we use for this type of pain are actually anticonvulsants used in epilepsy. The reason why is because, similar to epilepsy, the nerve can act on its own and fire. And so the idea is can we stabilize this nerve so that it prevents it from firing, the same way that we try for epilepsy. Those types of medications are started, they're increased to a therapeutic level and then the patient is evaluated to see if this treats their pain. Again, the vast majority of patients respond to these medications, something upwards of 90%, but half of those patients end up having unwanted drug side effects. And then, of course, there's a 10% that did not respond to the medication at all.

Interviewer: Yeah. And this medication, is it kind of a dialing-in process, you've kind of got to figure out the sweet spot for everybody?

Dr. Rahimpour: Yeah, I would say that most anticonvulsants are started at a low dose and gradually titrated up.

Interviewer: And for the individual that is not responding to medication, or the side effects are just so terrible that it's really impacting the quality of life, and that's where the microvascular decompression procedure comes in. That's what you're doing there.

Dr. Rahimpour: That's exactly right. So for patients that aren't responding to the medication, if they've had an MRI scan that shows that potentially there might be a vessel there pushing on the nerve, that's where microvascular decompression can play a role.

Interviewer: What about for patients where they have the condition, and it's not pressing against that nerve? That's possible, right?

Dr. Rahimpour: Patients where we don't necessarily see a blood vessel pushing on the nerve, or they might not necessarily be a good operative candidate, we can offer other minimally invasive approaches. Those approaches include percutaneous rhizotomies. The premise there is that we with a needle go to the base of this nerve, known as the trigeminal ganglion, and we try to damage that nerve to sort of disrupt the pain signal. The other option is using radiation in the same way that folks use it for tumors to try to focus the radiation and try to damage the nerve again, to stop this pain signaling.

Interviewer: Are these other last two procedures, are they an alternative to somebody getting a microvascular decompression?

Dr. Rahimpour: They are alternatives, but I should add that they're not as efficacious. So when we do find patients are good candidates for microvascular decompression, we try to advocate for that as it gives us the best chance for pain freedom.

Interviewer: After somebody has the microvascular decompression, what is the success rate that that actually takes care of the pain?

Dr. Rahimpour: We expect that patients often have immediate pain relief after surgery, especially if we do find a blood vessel that's compressing the nerve. Historically, 70% to 80% of patients are still pain-free at five years.

Interviewer: And the other 20%?

Dr. Rahimpour: Pain can reoccur. And if that's the case, we can always revisit other possible interventions, including some of the percutaneous and radiosurgery techniques that I mentioned.

Interviewer: For the patients who get the microvascular decompression, what's the satisfaction rate among those patients? I hear this could be life-changing for some people.

Dr. Rahimpour: Absolutely. So again, this is a very debilitating disease. I mean, you can imagine if it's affecting the way you eat, and the way you conduct yourself throughout your day-to-day in anticipation of a sudden pain strike, being pain-free means everything. And so when patients are pain-free again, where we expect that to be the case in the vast, vast majority of times after microvascular decompression, this is absolutely life-changing.

Interviewer: Is it safe to go to the dentist? Dr. Rory Hume is the Dean of University of Utah School of Dentistry. What precautions are dentists taking against COVID-19?

Dr. Hume: The standard precautions that we've used in dentistry for quite a while appeared to be effective in preventing infection within the dental setting. In the few months after the pandemic began, the American Dental Association, the Center for Disease Control started to look at all of this carefully and put out guidelines, and there are now very good guidelines for safety within dental practice.

Interviewer: So going to the dentist, very low risk, but maybe I should still just put it off to be safe. What do you think?

Dr. Hume: We don't know how long this is going to go on for. So it's better for you to have your routine dental care and stay healthy than to get into trouble and to need something in a more major way.

updated: February 17, 2021
originally published: August 14, 2020

Dr. Chan: What happens when you're studying for the MCAT and you realize you don't actually want to be a doctor? How do you shift from pursuing medical school to dental school? What are the differences between the MCAT and the DAT? How is the process applying to dental school similar to that of applying to medical school?

Today, on "Talking Admissions and Med Student Life," I interview Will, future dentist and soon-to-be graduate of the University of Utah.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the dean of admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, we have a very special podcast today. We've got Will. Hello, Will. How are you doing?

Will: How's it going, Dr. Chan?

Dr. Chan: Good. So I'm going to call this podcast "The Road Less Traveled." You know, when I talk to a lot of people, they're in med school, they're physicians, kind of talk about their journey. But your journey is different, and there was like a fork in the road. Would you say that?

Will: Yeah, totally.

Dr. Chan: Or a spoon or a knife or . . .

Will: Yeah, some dividing line.

Dr. Chan: Okay. So let's go back to the beginning. When did you think first about going to med school or being involved in health care? When did that start?

Will: So, after high school, I got a job working as transportation for a skilled nursing facility in Holladay, Utah.

Dr. Chan: So you grew up in Salt Lake?

Will: Yeah. So I grew up in Salt Lake. And then I really enjoyed that. I always worked with a lot of nurses, lot of physical therapists, and stuff like that, and got to see a lot of the different hospital facilities around because it was my job, transport patients who had gotten new hips, new knees, around the Valley to their respective appointments.

Dr. Chan: Okay. So you enjoyed helping others, making a difference?

Will: Yeah, so I . . .

Dr. Chan: You said during high school?

Will: So this was just after I graduated.

Dr. Chan: Oh, after you graduated, okay.

Will: So I decided to not go straight into college. I decided to work, get some money. And during that time, I got to see what nurses did, what PTs did, I interacted with a lot of variety of doctors, and even PAs. And so, that was kind of cool and that's when I started to say, "You know what? Maybe it would be kind of a cool route to go, is maybe the doctors."

Dr. Chan: Okay, medicine. And where did you go to undergrad?

Will: So I attended here at the U. I did a semester at the Salt Lake Community College just to get a few credits under my belt and get on up here.

Dr. Chan: And then, while you were in undergrad, same thing? Were you like shadowing docs and doing community service? What kind of stuff were you doing outside of classes?

Will: So I had a friend that . . . I wasn't quite sure what I wanted to study, and so when I first got to the U, I started studying engineering because he was like, "Hey, you can do this for a few years. It's kind of cool and you can transfer it to anything else." And so I was like, "All right. That sounds like a good idea," and realized I really didn't like engineering and I couldn't handle doing my entire undergrad . . .

Dr. Chan: It's intense, yeah.

Will: Yeah, and it was interesting stuff, but it was really when I got to . . . it was like a material science class, and it was super science heavy and I was like . . .

Dr. Chan: Just blew you out of the water, yeah.

Will: Well, I was just like, "I miss this stuff. I don't really like the math. And you know what? If I'm going to be paying for this, I might as well enjoy some of it." So that's when I decided, "Okay, I'll find a new major and I'll focus on these pre-reqs and get these out of the way." Because with engineering, it was like you do all your pre-reqs at the end because you just don't have time, so . . .

Dr. Chan: So, when you say pre-reqs, you're talking about pre-reqs for engineering or medical school?

Will: Medical school. Just because there are so many required classes for the degree in engineering, they just say, "Just do your pre-reqs at the end because you don't have time."

Dr. Chan: Did you love the pre-reqs? I mean, did you love the biology, the chemistry?

Will: I really did. So, after that material science class, I had done some chemistry, and I hadn't done any biology yet, but once I got back into it, it was like, "Okay, this feels right. This is . . ."

Dr. Chan: This is your wheelhouse, yeah.

Will: Yeah. So I really enjoyed that and it was fun. I enjoyed the pre-reqs. I mean, there were some that, no matter how hard I tried, I just got a B.

Dr. Chan: Yeah. They're intense classes. They're very competitive.

Will: But it was good. I enjoyed it.

Dr. Chan: So this entire time, medical school, medical school, medical school, what kind of stuff were you doing in the community? I mean, what kind of activities?

Will: So I worked with a group that kind of focused on a lot of refugees that were coming from, like, Nepal and Congo and all over the place.

Dr. Chan: Is this is the [inaudible 00:04:49] clinic?

Will: Yeah, so . . .

Dr. Chan: Am I saying that right?

Will: Yeah. [Inaudible 00:04:53], I think it's . . .

Dr. Chan: You're probably closer than I am. I apologize to [inaudible 00:04:59] if she's listening to this out there.

Will: But I worked with the . . . it was called Get in the Hood, so it was kind of like the mirror to the academics, so we did a lot of the fun stuff, like teaching the kids about the American holidays, like 4th of July, Mother's Day. And so, one of my favorite ones was we'd go do Soap for Santa, and we'd have a yearly auction where people would come buy stuff and we'd use that money to buy presents for some of the families in need.

Dr. Chan: Cool.

Will: And then I also worked a lot with the HELP program up in the hospital, so . . .

Dr. Chan: That's Elder Life?

Will: Yeah, so the Hospital . . .

Together: . . . Elder Life Program.

Will: So they focus a lot on delirium prevention in the hospital because that's kind of a big factor in . . .

Dr. Chan: How do you prevent delirium in the hospital?

Will: So it's mostly . . .

Dr. Chan: What's the magic? What are the secret tricks?

Will: Just engaging people mentally. So, in the hospital, you're sitting around a lot of the time, and a lot of the geriatric population doesn't quite have as many people around to come visit them. And so we would go and do interventions with them, which a lot of it was body movement. So just get the blood flowing and there's a lot of good with that.

Dr. Chan: Cool. So, I mean, during this entire time, it sounds like . . . I mean, there would be sometimes probably physicians in the room. Were you shadowing doctors kind of during this time?

Will: Yeah. So I shadowed like the house doctor for that . . .

Dr. Chan: Like, "House M.D." and the TV show?

Will: Yeah, the . . . No, no. It was like the physician that was over the skilled nursing facility. I got in touch with him, shadowed him a few times, and I didn't love it. And so I was like, "Okay, maybe this isn't the right specialty," because he was more in geriatrics. So he got me in contact with a couple of surgeons. He's like, "Maybe you'll like this more," and he was all . . . whenever I shadowed him, he was always trying to convince me to do something else.

Dr. Chan: Oh, boy. One of those, huh?

Will: Yeah, so it was like . . .

Dr. Chan: What were the reasons? What would he tell you?

Will: He's like, "Oh, there's too much debt. There's no autonomy anymore as a physician. The insurance companies say, 'Jump,' and you have to say, 'How high?'"

Dr. Chan: There are definitely nuggets of truth to that.

Will: Yeah. And so, he was kind of a guy that just . . . I could kind of tell he wasn't happy with where he was, so I was like, "I don't think I can shadow you anymore."

Dr. Chan: It's too much of a negative experience, yeah.

Will: Yeah, and I was like . . .

Dr. Chan: "I'm trying to build my dreams, man. You're dragging me down."

Will: Yeah, I'm trying to find what I like and you're just pointing out all the negatives. So shadowed some surgeons up at the U, and I thought that was really neat, and it was kind of fun.

Dr. Chan: Like general surgeons or brain surgery? What kind of . . . Orthopedics or . . .

Will: I did plastics up at the Huntsman, so it was pretty interesting to see.

Dr. Chan: Okay. So we're talking reconstruction?

Will: Yeah, so they worked with a lot of the breast cancer, and some were hand specialists, so hand injuries, and that was . . . I really liked the hand stuff. That was interesting to me.

And their advice was shadow as many people as you can, so I was like, "Well, surgery is kind of cool. Not sure if plastics is what I really want to do." And so I looked to orthopedics and unfortunately, I didn't know any orthopedics, so I thought, "Well, I still need to get some research under my belt, and we have an orthopedic research lab." And so I contacted a few of the professors in there and see if they needed any help and . . .

Dr. Chan: So a lot of cold calling.

Will: Yeah, just shooting emails out and looking through research papers of what professors were doing, see if there was anything that would really interest me.

Dr. Chan: That's a good idea.

Will: I didn't want to do something that I just had zero interest in. And so I got into contact with one and unfortunately, he didn't have any need, but he knew another guy that needed somebody and . . .

Dr. Chan: Called the network. Networking, yeah.

Will: So ended up working for that guy for two years with one of his projects, and I think they're just wrapping it up.

Dr. Chan: Wow. So, okay, so this entire time, Will, medicine, medicine, medicine. And then what year did you graduate?

Will: So I graduate . . . I am not yet graduated.

Dr. Chan: You're not yet a graduate. Okay. All right.

Will: Yeah. So switching majors kind of like pulled . . .

Dr. Chan: Ate some credit, huh?

Will: Yeah, pulled the graduated . . .

Dr. Chan: I secretly think undergrads are really disappointed with that, but they love it too because you're going to be in school a little longer, but eventually, they want everyone will graduate. It's like, "Oh, yeah."

Will: So, yeah, it will be about, I think, five years when I graduate for my . . . the length.

Dr. Chan: Did you ever take MCAT?

Will: I didn't. I started studying for it.

Dr. Chan: Okay. So this comes up to the big decision. So there came a time when you decided to pivot. Walk us through that. How did you come to this decision?

Will: So I was studying for the MCAT and I had shadowed a bunch of doctors and something just . . . I was like, "Okay, well, I don't know what I quite want to do yet, but that's okay. I can kind of figure it out as I get more experience in med school." Started studying and I just kept coming to the fact of like, "Why am I doing this?" You know, the MCAT is very rigorous.

Dr. Chan: It's stressful.

Will: It's super stressful. My wife was hating me at the time because I was practically 24/7 head in the books, you know?

Dr. Chan: Yeah, all these review books.

Will: All these review books. I had a tutor, I was meeting with my tutor, just doing everything I could to get a good score because it's so . . .

Dr. Chan: It's important.

Will: It's so important and it's a hard test.

Dr. Chan: It's a long test. It's, like 8, 9, 10 hours?

Will: Yeah, I think it's now . . .

Dr. Chan: With little breaks.

Will: I think it's seven and a half to eight.

Dr. Chan: Seven and a half? But it feels like 10, yes.

Will: Yeah. But I was studying. I had taken a couple of practice tests and I was doing okay. I was improving. And then one day, I was trying to find somebody that I could shadow for pediatric experience because I liked working with kids, and a family friend of ours who's a pediatric dentist was like, "Well, just come shadow me. I'm a doctor of dental surgery, you know, and I work with kids. The medical schools won't care. It might help you out." So I was like, "All right. I'll go shadow you, you know, see how working with kids is," and I loved it.

I was so surprised. I usually would tell my wife about how the shadowing went. I was just taken away, like had no words, and she's like, "Did you like it?" and I was like, "It clicked for me." Before, all the other shadowing hadn't really clicked. And so I was like, "I think I need to re-evaluate what I'm doing."

Dr. Chan: So it was that one shadowing experience?

Will: It was the . . . yeah.

Dr. Chan: And is this like normal checkups, or are these kids that got their teeth knocked out and they needed more surgery? How would you describe it?

Will: So a lot of it was just like general dentistry, so your typical fillings, crowns, and some of it was emergency that I saw, and that was pretty interesting. And then, some of it was like putting expanders in for the kids, just like pretty simple orthodontic things that they could do to help the mouth stay healthy until they could go to an orthodontist. And I just loved it. I thought it was very interesting and . . .

Dr. Chan: So I take my kids to the dentist. We go to this pediatric dentist. It's literally, and this is going to show how old I am, it's like Chuck E. Cheese in there, because they've got like TVs on the ceiling, and it's like a circus theme and a jungle theme. And they've got these little tokens. If you're good, you get the little thing from the . . . I was just like, "Wow, I do not remember my dentist doing this as a child." I didn't like the dentist as a kid, and it just seems a lot more fun now. There's a lot more stuff. Would you agree with that?

Will: Yeah. So a lot of the pediatric dentists, they look at making the whole dental experience a lot easier for kids, because a lot of people say, "Oh, I hate the dentist," and it usually stems from having a bad experience when they were a kid.

Dr. Chan: How can you hate the dentist now when you can stare up at the ceiling and watch Disney movies while getting teeth worked on and get a little . . .

Will: Yeah, and then get like a little prize at the end.

Dr. Chan: Yeah, get a prize at the end, which everyone seems to get. Everyone seems to be good. Oh, wow. So that one experience?

Will: Yeah, it really kind of just shook my world a little bit and I was like, "You know what? I really need to re-evaluate this because I hate studying for the MCAT. I need to figure out if I really want this." I didn't want to end up two years into medical school and say, "I don't want to be a doctor." That was my biggest fear.

And so I got in contact, talked to that pediatric dentist, got some people in his network that would let me go shadow them. And the more I just shadowed general dentists, all these specialties, orthodontics, endodontics, I just was like, "This is very interesting. I really like this."

Dr. Chan: You found your people. It's like a culture. You like the work, but also the people you're with.

Will: Yeah. So I kind of fell in love with it because you get the opportunity to help patients, build long relationships with them. I'm a very hands-on kind of guy, and I love to draw. I love to do stuff with my hands, and just seeing how they can do so much with their hands . . . You know, if you want to do surgery, there's still the option to do surgery. If you want to work with kids, you can still work with kids. If you want to work with older population, special needs, whatever, the opportunities that you have in dentistry are very similar to medicine.

Dr. Chan: Yeah. How did your family take it when you kind of told them?

Will: They were very supportive. My wife was like, "Sure. If this is really what you want to do, I'm with you 100%."

Dr. Chan: That's nice.

Will: And so she's like, "Just make sure it's what you want." And that's why I did shadowing and, you know, looked at . . . Luckily, the pre-reqs are all pretty much the same.

Dr. Chan: Yeah, it's pretty similar.

Will: It's very much the same and I loved it. It was great, and it just kind of . . .

Dr. Chan: You just felt better about it?

Will: Yeah, I felt better about it, and I shadowed that pediatric dentist more and more, and one day, he was like, "What are you doing this summer?" And I was like, "My research is almost done, so I don't really have any plans." He's like, "Well, I need an extra pair of hands in my office. Do you want to come work with me in the . . ."

Dr. Chan: For free?

Will: Not for free. He was . . .

Dr. Chan: "I love you Dr. Chan, but not that much." Yeah.

Will: Yeah. No, he was generous enough to say, "I can employ you."

Dr. Chan: Cool.

Will: So that's what I do right now is I just clean kids' teeth.

Dr. Chan: Okay. Awesome. And then how . . . it's the DAP, right?

Will: The DAT.

Dr. Chan: DAT.

Will: Yeah, Dental Admissions.

Dr. Chan: I apologize to all my dental colleagues out there. So it's the DAT?

Will: Yes.

Dr. Chan: Let's talk about the DAT. How long is it? What are the sections? Was it similar to kind of pivot?

Will: It's very similar to the MCAT. You have a science section, and then you have a reading section. There's a dedicated math section that you don't have on the MCAT. And then there's a Perceptual Ability Test on the DAT.

Dr. Chan: Oh, interesting.

Will: Yeah, so that's pretty much . . . I liken it to a bunch of visual puzzles and stuff like that to where you really have to kind of understand a 3D space.

Dr. Chan: So they're already kind of screening or testing for surgical skills or visual-spatial skills like you said at the very beginning?

Will: Yeah.

Dr. Chan: That's very fascinating. Can you study for something like that? I guess there are review books.

Will: Yeah. I pretty much just got a bunch of practice problems and went through those because I feel like after you kind of figure out . . . For me, it was pretty easy. I think drawing and kind of the engineering background really helped me, so it wasn't a huge difficulty for me to get a high score on that test area, which I'm thankful for.

Dr. Chan: So it's just as long as MCAT?

Will: It's not. It's four and a half hours.

Dr. Chan: Oh, wow, sweet. So you got three hours back in your life?

Will: Yeah, so I took all the practice tests and I was like, "Well, I'm done. It's only noon. All right."

Dr. Chan: Yeah, when you go from like 95 miles to 65, it's like a big . . . Yeah.

Will: But no, it was great. The science section, it's not . . . The MCAT's a whole bunch of reading. There are a lot of passages and a lot of questions that come from the passage, and there aren't very many what are called standalone questions. The DAT itself is a lot of standalones. And then the reading section is more like the MCAT, where you read a passage and you answer questions based upon the passage.

But I felt like it was nice to have the background of the MCAT to help me with the DAT because there were a lot of aspects that I struggled with on the MCAT that I felt like were resolved when I started studying for the DAT.

Dr. Chan: You, in many ways, found your home.

Will: Yeah. So I felt like not having to worry about, "Am I going to hate this in two years?" That whole worry itself kind of released, I felt like, my mind, to actually study and do well.

Dr. Chan: You took the blue pill. You felt released. It's beautiful. All right. So, again, you're going to teach me, Will, because I know some things, but I don't know a lot of things. So dental school is four years long.

Will: Yep.

Dr. Chan: And you can do fellowships.

Will: Yeah, so there are residences.

Dr. Chan: Residencies, okay.

Will: And it's very similar to what you do for medical school. There's a Match Day.

Dr. Chan: Do you know the names of some of the different residency programs? I know orthodontics is big.

Will: Yeah, so there's orthodontics. You've got periodontics, endodontics. You have oral/maxillary surgery, so that's like your plastic surgeon. And a lot of those programs now require you to do . . . a lot of them are tied to a medical school and so you actually do part of . . . like, two years of the medical school and then four years of a surgical residency.

Dr. Chan: It's very interesting to me the way health care has evolved in our country. You know, M.D.s, the physicians, they take care of all of the body, except for this, the mouth.

And I remember as an intern . . . I was an intern at George Washington Hospital, downtown D.C., and there was a fair amount of people that would come in the ER with really bad tooth pain, and we couldn't do anything about it. I don't know, they may have changed over the years, but we didn't really have a dentist on call. So if you go in the . . . and I think it's pretty true today. I think there are some programs that are trying to build that within their program, but if you have . . .

It's like, "Oh, we'll take care of all the rest of the body, but you have an abscess behind your tooth? I'm sorry. That's a dental issue." And, you know, it's just weird to me how . . . Again, it's a kind of fork in the road. It's like these two programs have really evolved and grown with time.

Will: It's very interesting because we get emergency patients that come in that had gone to the emergency the room the night before, and if there was a on-call dentist, it's usually a resident or a dental student, and they pretty much put a Band-Aid on it and say, "Go see your dentist tomorrow. Here's a . . ."

Dr. Chan: It's like there's no true dental emergency.

Will: Yeah, it's like, "Here's a prescription for some antibiotics to help cool off your infection, but you've got to go get this fixed by somebody else in the community."

Dr. Chan: I must say, again, just to kind of . . . there are a lot of dentists in Salt Lake, I've noticed.

Will: Yes.

Dr. Chan: Just to kind of rave about this, I love my dentist. And I remember growing up . . . I remember in the 2000s, so I wasn't a kid back then, but in the 2000s, back in my 20s, when I'd go to the dentist, they'd have a TV in the corner of the room and that was like a huge deal. But now, they have like . . . you know, it's awesome. They can bring the screens three inches from your head. You have Netflix, and then when they take the X-rays, they can project it there, and, "Oh, you see you have a cavity here." You're like, "It just looks like a bunch of splotches, but sure, Doc, whatever." So it's weird how it's kind of evolved, and now you wear the glasses and put in the little . . .

Will: Headphones.

Dr. Chan: . . . headphones, and just watch whatever you want to watch on Netflix, and they just go to town on your teeth, and it's very interesting. It's very different.

Will: I feel like dentistry is more . . . it just seems kind of like a . . . it seems like a more positive environment for me. That's what kind of drew me to it where it's you're going up for a routine check-up to make sure you're not going to, one day, have an abscess and have a crazy toothache at 2:00 in the morning. And just being able to help patients in that way, that's what really kind of pulled me towards it after shadowing and being able to identify that and seeing how much different it is.

When you're working with a family practice physician, there's no TV hanging from the ceiling and no headphones while they're checking your temperature, you know, because you've got to communicate what's going on. So it's an interesting contrast, for sure. Dr. Chan: All right. So, if I asked you today . . . I'm not going to hold you to it. Will, what residency would you choose?

Will: Working with kids is super fun. I've really enjoyed that and . . .

Dr. Chan: So is that an extra year pediatric or . . .

Will: So it's a two-year program.

Dr. Chan: Two-year program, okay.

Will: Most of them are from what I've understood. And so I think working with kids is a lot of fun. I think it's a super awesome position to be in where you can help kind of build that foundation of lifelong oral health, and help the kids that really are nervous and have a hard time at the dental office. And even the special needs kids that really need help, I really enjoy that part of the pediatrics.

Dr. Chan: That's awesome. All right. So let's talk details. So you start applying to schools. How many dental schools did you apply to?

Will: So I applied to 17.

Dr. Chan: Is that considered a lot?

Will: From what I've heard, it's pretty average right now.

Dr. Chan: That's kind of like the sweet spot?

Will: Yeah.

Dr. Chan: Have you started getting interview offers?

Will: Yes. So it's very similar to the same track of medical school. You apply. The application opens up. You have about a month to work on it. That was back in May. And then in June, you can start submitting to schools. And then a lot of schools have secondary applications and you submit those, and then you just start hearing back from schools that like you and invite you to come out and interview with them.

Dr. Chan: So how many interview offers have you gotten?

Will: Gratefully, I've gotten five so far.

Dr. Chan: Okay. Cool. Even here at our own dental school?

Will: Yeah.

Dr. Chan: Okay, good, because I can send them an email, which won't mean anything to them because every admissions process is fully independent and autonomous.

Will: Yeah.

Dr. Chan: All right. So you go and interview. What's the interviewing experience like?

Will: So it just varies from school to school from what I found. It usually consists of a tour, give you an understanding of the financial aid process because graduate school is expensive.

Dr. Chan: It is very expensive.

Will: So being able to understand how the loans work is kind of important, and knowing what you're going to be paying for. Then they usually tour you around their facilities. So usually walking through the clinic, walk through some of the classrooms, get to talk to students, have lunch with them, have an interview.

Dr. Chan: Have you heard back from any school?

Will: No. So dental schools, they all agree that they won't start sending out acceptances until the first business day in December.

Dr. Chan: Oh, okay.

Will: And so I think it's December 3 this year.

Dr. Chan: So they like to keep that anxiety building throughout Thanksgiving dinner.

Will: Yeah.

Dr. Chan: And then they just release the information. Interesting. Do you want to stick around here or . . .

Will: I think it'd be great to stay in Utah for another four years. But, I mean, I'm willing to go and venture outside another state, so . . .

Dr. Chan: Do you feel . . . I just have a lot of crazy questions.

Will: No, go for it.

Dr. Chan: That's what I do. So do you feel, on an interview, are they kind of checking out your mouth going . . .

Will: I don't know. Not . . .

Dr. Chan: . . . "Are you a good brusher, Will? Here's some floss. We want to see your technique."

Will: Yeah, "Can you teach it?" No.

Dr. Chan: I guess that'll be kind of the kiss of death if you've got a big old lima bean just right there in your tooth.

Will: Actually, it's pretty interesting because I feel like Utah oral health is pretty good compared to some other states, which is really interesting because we're quite saturated with dentists, so it's like people are pretty healthy here.

Dr. Chan: Well, this is a hot topic, but that segues into fluoridation in the water, right?

Will: Yeah.

Dr. Chan: And it's very controversial. Well, is it still controversial? Teach me, Will. Is it controversial?

Will: So a lot of people, that concern still comes up, the fluoride. I haven't looked quite at the concerns, but I know it's been pretty debunked.

Dr. Chan: Yeah. Well, you're going into the profession, so you should be very pro-fluoride.

Will: Yeah. So fluoride's like the only thing that can re-strengthen your teeth, and it's very important because acid kind of takes away your enamel and you need fluoride can help rebuild that calcium.

Dr. Chan: I drink too much soda and my dentist knows it, so every time I go in there, he's like, "You're still drinking soda." Like, "Yeah, I'm sorry. I know. It's bad." It's like the worst thing you can do to your teeth, right?

Will: Just chase it with some water after you're done drinking.

Dr. Chan: It's so bad. It's so good. It's very addictive.

Will: I mean, especially if you've got like a little bit of caffeine to kind of help pick you up in the afternoon.

Dr. Chan: Will, this is great. All right. Last question. To all those listening out there who might be struggling . . . you know, maybe they were kind of in your camp. They don't love medicine or they're kind of maybe thinking about another health science or maybe even dental school. What advice would you give them? What would you say to them?

Will: I would say, for me, what really helped was I took a step back and really evaluated what I wanted. From what I had seen, if you haven't seen enough of the medical field, do that. Look at everything. Don't just look at the M.D.s. Look at the PAs, look at the nurses, look at the PTs, look at the pharmacists, you know, and really evaluate. Take an honest eye, you know?

I feel like a lot of prestige is carried with the M.D. "I've got to be a physician. Got to be number one." And I think at the end of the day, it's really what do you enjoy and what makes you happy? Having an M.D. at the end of your name might not make you happy when everything's said and done.

Dr. Chan: It's very true.

Will: So I would say shadow, take self-inventory, look at what you like, what you don't like, and apply that to what you think you want to do. Yeah, there's not going to be a perfect job out there, there's going to be things that you hate, things that you don't like, but if the pros outweigh the cons, you've got a good fit.

Dr. Chan: Awesome.

Will: So, I would say do that.

Dr. Chan: Awesome. Well, Will, I'm really excited for you because I just know that you're going to take care of either my teeth or my kids' teeth in a few years. And I think you'll probably have some awesome set up where you'll make it fun and exciting for kids.

Will: Maybe do some virtual reality stuff.

Dr. Chan: Oh, while I still have you. Oh, virtual . . . I love that. Halloween is around the corner. As a future dentist, is this the worst holiday because just of all the poor candy and people gnashing on it? What's your advice? Throw it away, parents? Eat it, parents?

Will: I'd say . . . I don't know. I think that's like more about the parents, but I would say if you're going to have some candy, have it with a meal so it's not stuck to the teeth for hours and hours on end.

Dr. Chan: Do you know what Boo at the Zoo is?

Will: Boo at the Zoo?

Dr. Chan: Yeah, Hogle Zoo. So they do this event, where it's like the Saturday before Halloween. It opens up early, like 8:00 or 9:00, and they have all these different booths, "boo"ths, however you say it. It's throughout the park where they give out little candy and the kids get to wear their costume, and they just run around and look at the animals.

I mean, it's great advertising for the zoo. It's really fun for the parents, because, you know, when you go trick or treating late at night, it's a little bit stressful as a parent and, you know, people are tripping here and there. And the past few years when I've gone, there's been this one enterprising pediatric dentist who sets up shop, you know, and he passes out his card and . . .

Will: And toothbrushes.

Dr. Chan: Yeah, toothbrushes. And it's like, "Oh, this is great. Great marketing. Great idea."

All right. I learned something.

Will: Well, I hope I helped out some people that are feeling like they're on the fence and give them a little bit of information of what my journey was like and . . .

Dr. Chan: Cool. We'll have to have you come back and kind of hear what dental school is like. I sort of know, but we used to have . . . the dental school used to be more part of the medical school where they would take anatomy together and some classes, but since they have their own building and now their own school or college, it's more separate. And they have that nice building in Research Park, which is very nice.

Will: Yeah, I'd love to come back, tell you about it.

Dr. Chan: Cool. Well, thanks, Will.

Will: Yeah, thank you.

Announcer: Thanks for listening to"Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Gellner: It's never too early to start taking care of your child's teeth. I'll tell you how today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the healthy kids' zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: The American Academy of Pediatrics reports that tooth decay is the most common chronic children's disease in the country. As a result, it is very important that parents work with their pediatrician to establish good oral health care starting around the time that first tooth pops out. Since pediatricians see little ones so frequently for preventive healthcare visits in the first few years of their lives, we are in an excellent position to figure out which children are at risk for dental health problems, educate parents on how to take care of their child's teeth and how parents find pediatric dentists in the area that take their insurance.

The Centers for Disease Control and Prevention has stated that tooth decay is five times more common than asthma and seven times more common than allergies in children. More than 40% of children have tooth decay by the time they reach kindergarten. Children with cavities in their baby teeth are at much greater risk for cavities in their adult teeth. We know that tooth decay is a problem that is largely preventable. So what can you do to help your child have their best smile?

First, make sure your child has fluoride. It's a naturally occurring mineral that is added to the drinking water in most cities. It strengthens the tooth enamel, making it more resistant to acid attacks that can cause tooth decay. It also reduces the ability of plaque bacteria to produce acid and cause those nasty cavities. If you use bottled water or your city does not have fluoride in the water, you can give your child vitamins with fluoride in them to help their teeth. You should check and clean your baby's teeth.

Healthy teeth should all be one color. If you see dark spots or stains on the teeth, take your baby to the dentist. White spots can sometimes appear as the enamel forms so don't worry so much about those. But as soon as your child has a tooth, begin to use fluoride toothpaste the size of a grain of rice on the bristles. Now this is a change from the training toothpastes that don't contain fluoride that pediatricians and dentists used to recommend until about 18 months ago. There was a concern that little kids could swallow too much fluoride, but studies show that the rice grain amount is just the right amount for tooth decay prevention without being poisonous.

Parents should clean the teeth at least twice a day. It's best to clean them right after breakfast and before bedtime. Once your child turns three and they are getting better at rinsing and spitting, you can begin to use a pea-sized amount of fluoride toothpaste. It's best if you, the parent, put the toothpaste on the toothbrush until your child is about six.

Be sure to feed your baby healthy foods. Choose drinks and foods that do not have a lot of sugar in them. Give your child fruits and vegetables instead of candy and cookies. And be careful with dried fruits such as raisins, since they easily stick to the grooves of the teeth and can cause cavities if not thoroughly brushed off the teeth.

Chances are you know someone who has had baby bottle tooth decay. Milk, formula, juices and other sweet drinks like soda all have sugar in them. Sucking on a bottle filled with liquids that have sugar in them can cause tooth decay. Do not put your baby to bed with a bottle at night or at nap time once they have a few teeth.

During the day, do not give your baby a bottle filled with sweet drinks to use like a pacifier, just walking around from room to room and taking a sip whenever they want. If your baby uses a pacifier, do not dip it in anything sweet like sugar or honey. Near your child's first birthday you should teach your child to drink from a cup instead of a bottle. When your child gets their first few teeth in, your pediatrician should be discussing with you whether or not to have a family or pediatric dentist. Usually, a pediatric dentist will want to see the child by their first birthday or within six months of the first tooth popping out.

Some family dentists start seeing children more around their second birthday. At this first visit, your dentist can easily check your child's teeth and determine the frequency of future dental checkups. Remember, early dental care is important for keeping kids pearly whites healthy and teaching them good oral hygiene.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Debra: If you've been to the dentist you may have heard of laughing gas. Did you also know that it's used for labor pains? Today we'll be talking about nitrous oxide on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Debra: I'm Debra Penney and I'm talking today with Michelle Collins, PhD. She's also a certified nurse midwife and the director at Vanderbilt University of the Nurse-Midwifery Program. First of all Michelle, what is nitrous oxide?

Michelle: A lot of people think of nitrous oxide as laughing gas because that's what they know it from the dentist. It is similar to what they use at the dentist, but it's a different concentration. A lower concentration when we use it in labor.

Debra: And tell me, how is it given to women in labor?

Michelle: They inhale it either through a mask or a mouthpiece. The mask goes over their mouth and nose, where the mouthpiece they purse their lips around.

Debra: And can she be up and mobile while she's taking this gas or does she have to be in bed? How does that work?

Michelle: It does allow for a woman to maintain her mobility. So she can be on her birth ball, on her hands and knees on her bed, doing slow dance with her partner, in the rocking chair, any position really.

Debra: What kind of affect does it have on her and does it have any side effects?

Michelle: Probably the largest side effect is about 10% of women will feel nauseous or need to vomit. But that's only 1 out of 10 women. That's probably the most prevalent. Some women get a little bit dizzy when they use it as well.

Debra: What about the baby? How much of this gets to the baby?

Michelle: So there has not been a great deal of research done on nitrous oxide, although we have a large body of what we call anecdotal evidence, meaning it's been used for almost a century in other countries. So we have lots of babies born over lots of years in lots of countries to look at and we've not seen it affect the baby at all after birth. In other words, we don't see sleepy babies or drug affected babies from mom using the Nitrous.

Debra: Well it sounds like a pretty good thing then. If it's that good why aren't we using more of it here in the US? I understand there are only about 100 hospitals that have it available to laboring women.

Michelle: It was actually used in the '50s, and then with the advent of the epidural anesthetic it kind of went out of favor as epidurals rose in popularity. Now in other countries the epidural rate is not what it is, not as high as it is in the United States, so they continue to use nitrous oxide widely. For instance some countries, like Great Britain, 60% of all women in labor use it. Some countries like Norway 80% of women use it in labor.

Debra: So does this nitrous oxide work for every woman?

Michelle: Not every woman is going to take the nitrous oxide just like not every woman likes an epidural or not every woman likes a narcotic. Some women will try it and not like it at all, feel it's not helpful, and move on to something else.

Debra: When hospitals use it, do they have some kind of guideline in place for how it's given, or who gives it?

Michelle: In most places in the US the midwife or obstetrician or family practitioner, or whoever is taking care of the mother, gives an order to the nurse, and the nurse initiates the nitrous oxide. In some hospitals only an anesthesia person initiates it. So it's dependent on the hospital. In birth centers there are only midwives and nurses so they would be the ones doing it at a birth center.

Debra: So it sounds like a pretty good option. What other kinds of affects, other than taking the pain away, does it have any other affects on the mom?

Michelle: It is really good for anxiolytic properties. What that means is it decreases one's anxiety. So for some women it's not the pain of labor that is intolerable, but the anxiety. They're so afraid of the birth process. So it can decrease their anxiety and help their labor along.

Debra: So apart from labor pain, say she's waiting for an epidural that's really her drug of choice, can she still use this nitrous oxide while she's waiting?

Michelle: Yes, that's a good use of it, is for the woman to inhale it while we're having her epidural placed. Helps with the pain, helps with her anxiety and generally gets her through that transition period until the epidural is working well.

Debra: Have you ever seen it abused in the hospital? Or heard of stories with it abused?

Michelle: That's a common misconception and it doesn't appear in the literature as any problem in the European hospitals and we've been using it at Vanderbilt for four years and have not had one instance of that happening.

Debra: So what if a woman tries it and finds out she doesn't really like it?

Michelle: If she inhales a few breaths, part of the advantage of using nitrous oxide is it's a very quick onset. Within about 30 seconds she'll feel an affect, and it also has a rapid offset. Meaning if she doesn't like it, she stops breathing it, takes a couple breaths, and the effect is gone. And that is really one of the advantages of using nitrous oxide.

Debra: What are some of the other advantages?

Michelle: Besides not affecting the baby at all, that we have seen in use, women can also control it themselves, so it's not strapped to their face where somebody else is controlling it. They are empowered to breathe it when they want and not breathe it when they don't want. This makes it a really attractive advantage, and hopefully it will be widely available to women in the US soon.

Announcer: The ScopeRadio.com is the University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: How do I know if my headache is caused by a mouth-jaw issue? That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Gary Lowder is a practicing dentist and a professor, both at the University of Utah School of Dentistry. He's got 30 years of TMJ experience and he's seen a lot of cases of people coming in with headaches asking, "Is this a mouth-jaw issue?" Headaches are so common nowadays and can be caused by so many different things, how do you know if it's caused by a mouth-jaw issue? Is there any kind of one-tell that you look for?

Dr. Lowder: Well first of all, in my practice I like to know if a patient has been to their physician or their ENT to find out if there's any underlying infection that might be contributing to the headaches. A lot of patients will say that they have migraines, but in fact they're really just severe muscle tension-type headaches.

So what we do is we will often use a technique called Spray and Stretch, where we use a vapocoolant spray on the muscle areas of the face to see if there is a diminishing of the pain. If we can get headache to respond to that kind of a test, then it usually indicates that it could be related more to muscle irritability, muscle tension, or another term is called Trismus, and that gives me encouragement that this is something that can be treated because it's more of a muscle tension-type headache than a true migraine-type headache.

Interviewer: And we're talking about tense muscles in the jaw and the mouth area?

Dr. Lowder: Yes.

Interviewer: Does that cover the neck area as well what you do, or is that different?

Dr. Lowder: It also covers the neck area. A simple test to know why is if you look up toward the ceiling and tap your teeth together, the bite will feel different that if you look down toward the floor and tap your teeth together. And the neck muscles actually determine head position.

If the head position is altered by tension in those muscles, it can alter your bite, which in term can trigger clenching and/or bruxism, and you can either get headaches toward the end of the day or when awakening in the morning. Often morning headaches are due to the fact that the individual is clenching their teeth throughout the night.

Another sign that could help you understand if you're clenching or grinding is look at your teeth in the mirror and see if you see any signs of wear. The canine teeth or the cuspids just to the sides of the incisors, should have nice points on them. If those points are missing and they're flattened, that means that you have been doing some grinding and abrading of your tooth structure and it can be a factor in headaches.

Again, not all headaches are related to teeth and occlusion, but if it's been ruled out that you have migraines or some other systemic reason for a headache, then we need to suspect that maybe the occlusion is a factor.

Interviewer: So what are some common issues that might be causing my headaches? So TMJ would be one of them, grinding your teeth sounds like another. Are there any other ones?

Dr. Lowder: Well, stress is probably the number one culprit. And stress happens for good reasons and negative reasons. For instance, Christmas can be very stressful to some people, and so can birthdays and weddings. And so a promotion at work, increased responsibilities, can cause us to start grinding or clenching our teeth, and that usually can create tension-type headaches over time.

Interviewer: What can I do about it if I have headaches that are being caused by my muscles and my jaws and my mouth?

Dr. Lowder: I'd like to say, "Just take a deep breath and relax," but that doesn't always work. I think it is good though to evaluate the stress in your life, both physical and emotional stress and determine if there's a more healthy way to deal with them. Stress management counseling is a good idea. Considering your daily activities, is there anything that you're doing that puts more strain on the muscles of your neck and shoulders than the body is able to tolerate?

The position you're in, if you're at a computer all day, can make a difference in how those muscles feel, which can in turn, create muscle tension-type headaches. Physical therapy is beneficial in those cases, ice packs, good quality exercises, routines that can help strengthen those muscles are also beneficial.

If you feel like you're clenching or grinding your teeth and doing it habitually or waking up having these symptoms, some form of protective mouth wear can be beneficial. And those are called dental splints or mouth guard that helps to take the stress off of the teeth and distribute it over the plastic, protecting the teeth and relaxing the muscles associated with your jaw.

Interviewer: That's interesting. So a lot of headaches can start from there but it sounds like there's some hope for people if that's where their headaches are starting.

Dr. Lowder: There definitely is. It's worth investigating because you don't have to suffer with a headache if it's coming from muscle tension in that area. It's also important to know that in some cases of temporal-mandibular disorder, there is clicking and popping that occurs inside the joints just in front of the ear. If it's non-painful we often do not treat that, it's very common. And if it's non-painful or if it doesn't limit your jaw function, then we don't usually treat it. When it becomes painful then the patient should seek help to try and alleviate the problem as soon as possible so that further breakdown in the form of osteoarthritic remodeling isn't occurring.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at the scoperadio.com.

updated: December 19, 2018
originally published: May 27, 2015

Interviewer: You've been told by your dentist that you have impacted wisdom teeth and they need to come out. Is that the case and is there a way that it could be a little easier? We'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: I think my guests would agree that nobody looks forward to having their wisdom teeth pulled. But there could be an easier way than what you're aware of. We're with Dr. Bryce Williams. He's an oral surgeon in the Ear, Nose and Throat department at the University of Utah Health Care. Boy that's a tough thing isn't it? Is there anything more painful than having your wisdom teeth pulled?

Dr. Williams: It's certainly not the most exciting thing to have to look forward to. But it is kind of a rite of passage into adulthood.

Interviewer: Yes, so let's talk about why somebody should and the importance of it. And then we're going to talk about what you can do to make the experience a little bit better. So first of all, wisdom teeth. Why would somebody want to have them pulled? And is it important?

Dr. Williams: Wisdom teeth in the majority of people cause a problem because there's not enough room in the mouth for them to come in. So removing them early on in life is important because taking them out as you're older is more difficult; the bone is harder, you may have other health problems as you get older, and the roots are longer.

Interviewer: So get them out while you're young and healthy. Is this a preventative thing? This is before you see any evidence of impacted teeth?

Dr. Williams: Right. There's a lot of evidence to show that having the wisdom teeth taken out before the age of 25, you get a better outcome and you avoid long term complications.

Interviewer: And is that something everybody should do?

Dr. Williams: It's not for everybody. But the vast majority of people should at least get a dental x-ray to check out and see where those teeth are and to see if they're going to cause a problem.

Interviewer: And the dentist could figure that out for them?

Dr. Williams: Absolutely.

Interviewer: Okay, and then at that point the dentist says okay, you probably should have these pulled out. What then?

Dr. Williams: Yes a general dentist is able to remove your wisdom teeth. The difference between a general dentist and an oral surgeon is the oral surgeon is trained to remove the wisdom teeth using IV sedation.

Interviewer: Okay. And a dentist can't?

Dr. Williams: Oral surgeons typically do a deeper level of sedation and know how to do it safely. That way you can go completely to sleep and not remember any of the procedure, wake up when it's all done, and go home and have a somewhat good memory of the event.

Interviewer: As opposed to being awake the whole time and watching the thing.

Dr. Williams: Right. Exactly.

Interviewer: So only oral surgeons can do IV sedation which sounds like a huge benefit. What are some of the other benefits of having perhaps an oral surgeon do it over a general dentist?

Dr. Williams: So the core of an oral surgeon's training is four to six years after dental school. And the core of that is in removal of wisdom teeth. So we see a lot more cases, we do a lot more difficult cases, we're trained to do them with IV sedation. As a general dentist's bread and butter is fillings and crowns, an oral surgeon's core is the removal of wisdom teeth. So we feel very comfortable with it.

Interviewer: Yes, so that's what you do. You see a lot of it. You do a lot of them.

Dr. Williams: Exactly. And I think that helps translate into a quicker recovery for the patient, kind of a smoother procedure, and all of that.

Interviewer: Yes, and plus you don't have to be awake for it.

Dr. Williams: Exactly.

Interviewer: If somebody has any questions what can they do?

Dr. Williams: You can search for me on the university website, Bryce Williams, DDS. You can find more information about wisdom tooth removal and IV sedation, and my contact information is on there as well.

Interviewer: Final thoughts?

Dr. Williams: You should go to your dentist every six months for routine checkups and cleanings. Your dentist can take x-rays and diagnose you with impacted wisdom teeth. If you do need to have your wisdom teeth removed keep in mind that there is a nicer way to do it with IV sedation.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: November 7, 2018
originally published: August 8, 2014

Interviewer: Do mouth guards really make a difference for your kids teeth? We'll find out next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: We're with Dr. Bryce Williams he's an oral surgeon in the Ear, Nose and Throat Department of the University Utah Hospital. Mouth guards and kids, let's talk about that for a second, do you recommend kids wear them, I think I know the answer it seems like an obvious one to me.

Dr. Bryce Williams: If you ask any dentist, oral surgeon they'll say yes. Not wearing a mouth guard you're at twice the risk for an injury to a tooth or to your jaw and then someone who's wearing a mouth guard.

Interviewer: Two times? And those types of injuries, give me how significant that is, what I mean is at the end of the day.

Dr. Bryce Williams: Well it could range all the way from breaking off a small part of usually it's a front tooth which for most people that's pretty significant, as far as cosmetically, to actually a fracture of the upper and lower jaws which can require some kind of major surgery.

Interviewer: Really, wow. So mouth guards what types of sports should the kids be wearing them in?

Dr. Bryce Williams: Really any sport, where any kind of contact sport are in any sport where there's a risk of falling. So football, hockey, certainly skiing, playing tackle football.

Interviewer: Skiing really? Interesting. Tackle football keep going with your list.

Dr. Bryce Williams: Tackle football

Interviewer: I'd imagine soccer

Dr. Bryce Williams: Soccer for sure.

Dr. Bryce Williams: A ball in the face, that's no fun.

Interviewer: Is there a sport in particular that's really notorious for injuries?

Dr. Bryce Williams: I think in football is pretty well guarded even in the full face mask on but I think that - and even baseball as well. I've seen several injuries from a ball or from a bat in people playing baseball.

Interviewer: So I understand how the mouth guard might protect my teeth but how's it is protecting my jaw?

Dr. Bryce Williams: It protects your jaw by allowing the teeth to come together when you get hit. And having the teeth together when you get hit, protects the jaw as well.

Interviewer: Alright. What about you see the helmets with the jaw guard on them?

Dr. Bryce Williams: Yeah I see more and more of those when I go up skiing and I don't think there's any literature as far as those are concerned at this point but I think it's probably good idea especially people that are skiing very fast and doing very tricky maneuvers. Certainly it can help to protect your lower jaw.

Interviewer: Do you ever find yourself in a situation where you just want to scream? You just want to say put a mouth guard in.

Dr. Bryce Williams: You always see a teen age kid with perfectly white teeth come in and they been playing tackle football in the park with their friends and they've broken two of their front teeth and they're very distressed and in those situations I just want to take them by the shoulders and say wear a mouth guard next time. Especially, after you get fixed.

Interviewer: What age should kids start wearing mouth guards?

Dr. Bryce Williams: Most dramatic event start to happen when kids are playing sports. So typically between ages 8 and 10 years old. Sometimes it's difficult for a general dentist to make a mouth guard fit a patient choose teeth are erupting and changing all the time. In those cases, it's fine to go to the store and buy a store-bought mouth guard to wearing and change every so often when the mouse grows or changes or a new tooth comes in.

Interviewer: So is one type of mouth guard better than another type of mouth guard?

Dr. Bryce Williams: I think with mouth guards there's several different types, you can buy the kind at the store that you can boiling water and adapt to your teeth. I think those are very good but the best kind of mouth guard you can get is one that's custom- made by your dentist and the reason those are better is they adapt to your teeth. They're fit to the relationships of your jaw and they're less likely come out while you're playing sports or other activities.

Interviewer: What's one of those cost, roughly?

Dr. Bryce Williams: It depends on the dentist but sometimes it's covered by insurance.

Interviewer: Oh really?

Dr. Bryce Williams: So sometimes you don't have to pay very much at all.

Interviewer: No excuses.

Dr. Bryce Williams: No excuses.

Interviewer: No excuses to mess up those teeth.

Dr. Bryce Williams: Absolutely.

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Scot: Go to the dentist and get diarrhea? It doesn't make a lot of sense, but it happened to my Mom. She went to the dentist, they needed to do a procedure, they gave her some antibiotics and then a couple of days later she started having terrible diarrhea that persisted for a long time. She went to her doctor; they gave her a couple of different medications. Nothing quite seemed to work, except for this really expensive last resort. Dr. Tom Miller, what did she have?

Dr. Tom Miller: Scot sounds like she had Clostridium difficile colitis or diarrhea. And this is caused, it's commonly known as C. diff.

Scot: Yeah, that sounds familiar.

Dr. Tom Miller: We just call it C. diff. It's an increasing cause of prolonged and difficult to treat diarrhea and it's caused or triggered by certain antibiotics that are used to treat common infections, like strep throat or urinary or bladder infections or skin infections.
And what happens is when you take common antibiotics, they not only tackle the infections they are intended to treat but they also kill some of this normal protective bacteria and it's not a bacteria that we normally see in what we call colon carpet bacteria, but once it sets up shop it starts to produce a toxin in certain people, especially those people who receive antibiotics, and that toxin causes diarrhea and left untreated it can be life threatening.

Scot: So, if I get antibiotics, is that something that I need to worry about or only if I'm a carrier of it currently?

Dr. Tom Miller: If you are a carrier, you are at higher risk to get it if you take antibiotics.

Scot: Is C. diff contagious? My Mom said that her physician said it was highly contagious.

Dr. Tom Miller: The problem with C. diff is that it continues to exist on surfaces as spores and so it's hard to kill and so that's why healthcare centers or health centers and hospitals have higher rates of C. diff because it's hard to kill so we have to be very careful about hand washing and hygiene and sterile cleaning of the rooms and all of the pieces of furniture in a place where a person who has this type of diarrhea.

Scot: So what can be done? Like I said, my Mom I think it was for a two week supply of pills spent $1,200.

Dr. Tom Miller: Well, the other part of this is it is hard to treat and it requires prolonged treatment and sometimes repeated courses and treatment of different antibiotics which can be very expensive. So, this is a problem that we're facing nationally and again there are some take home tips for people.
Don't request antibiotics indiscriminately, don't use prolonged courses of antibiotics unless it's clinically indicated and directed by your physician and make sure you let your physician or dentist or healthcare provider know if you've had Clostridium C. diff in the past because they need to take precautions that you don't develop it again or watch for it.
And seek attention if you develop diarrhea lasting several days after completing the course of antibiotics. There's a test that can show if you have C. difficile toxin and this will direct your provider to treat you for it.

Scot: So, if I was concerned and my provider said you should be on some antibiotics and I was really concerned could I ask for this test?

Dr. Tom Miller: Right, I think the key thing is to describe the symptoms and what's going on to the physician and work with them to decide what the best course of action is. Many times people that take antibiotics will have diarrhea that lasts just a few days and then goes away, just simply due to the antibiotic.

Scot: How do I know that it's not in my stomach and if I take the antibiotics that I have been told to take that I'm not going to come down it?

Dr. Tom Miller: Again you don't really know. I guess my point is if you need those antibiotics for say strep throat or a bladder infection, then you need them. It's up to the physician to choose wisely to select an antibiotic that has a lower incidence of causing C. difficile colitis or diarrhea.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.