Tips for Passing the All-Important Exam

June is here, and for hundreds of dental school graduates this means it’s time for that major commitment. It’s time to set a date and say I do to the California Dental Licensure Exam.

For those facing the exam this month, there is good news and good advice. The good news comes from the Department of Consumer Affairs. The good advice comes from dentists who have been there.

First, the good news. The Department of Consumer Affairs reports a 76 percent success rate among last year’s examinees. For those who happen to be taking the exam this month, the success rate is even higher. June appears to be the magic month for dental examinees. Those who take the test during the summer traditionally have a higher passing percentage than those who take the test in March or in September/October.

Of the five clinical exams given each year, three are in June; and the majority of prospective dentists take the exam at this time. Last year, of 1,555 examinees, 765 took the exam; and only 152 failed, according to statistics from the Department of Consumer Affairs. That’s an 80 percent success rate for June examinees. Of those taking the exam in September/October, a 75 percent pass rate is reported while March examinees had a 66 percent success rate. Statistics for 1998 and 1999 show the same pattern.

Now for the good advice: Have faith in your dental education, visualize that every thing will go well on the exam, be organized and avoid a brand new bur. Oh, and a little Kentucky Fried Chicken may help.

"There were three of us studying together for the exam," explains Cynthia Brattesani, DDS, who took the dental licensure exam in 1989. " The night before the exam, we had Kentucky Fried Chicken, something we didn’t eat very often, but thought it would provide us with extra energy for the next day. After the exam, we all agreed that the fried chicken helped pull us through."

Fried chicken aside, Brattesani says she received some very good advice in a casual conversation with one of her professors at the University of California at San Francisco.

"The keys are to be organized and to envision what you will do step by step. And visualize everything going right."

Brattesani notes that advance planning helps organization on exam day.

"Take a cast of the arch you will work on during the exam, and then you can put the rubber dam on and punch it in advance. Do several in advance in case one rips.

"And remember details like wiping the dam after it’s prepped," she adds. "Remember, ‘what glows goes.’ Show that you are clean, organized and care about dentistry."

Another helpful suggestion Brattesani received was to avoid using a brand-new bur.

"You will have more control with a slightly used bur," she says. "This is especially useful since hands may be on the tense side during the exam."

Several dentists note that anxiety and mental stress are really the biggest hurdles. In retrospect, dentists say they were well-prepared in dental school and that having confidence in this training will help on exam day.

"Just depend on your education and try to be calm and cool," says Chick Wolf, DDS. Having taken board exams in six different states, Wolf says he may hold the record for taking dental licensure exams.

As a dental school graduate, he traveled around and took exams in Maryland, Florida, Colorado, Nevada, Arizona and California as he and his wife were trying to decide where to settle. Even though he had taken three other state exams by the time he reached California, it was still "traumatic."

"I took the exam at Loma Linda and it was a hot, smoggy day. You couldn’t even see the sun," he recalled. "At that time (1972), the pass/fail rate was 50 percent. At the exam, all of the students were wearing white clinic jackets and I was wearing a blue one from when I worked in the Coast Guard. Then the examiners arrived, and they were wearing blue jackets. Then during the denture set up, the lab was so hot that the wax was melting and teeth were floating all over the place.

"I think they just wanted us to sweat," he said with a laugh.

For graduates planning on taking exams out of state, Wolf suggests meeting and talking to local students about the exam.

"The level of education in schools around the country is very comparable, and students have been given the best possible background to practice dentistry in any state," he said.

"When all was said and done with the state board exam, it was not as difficult as I thought it would be," said Debra Finney, DDS, who took the exam in 1986.

"The biggest hurdle is getting over the anxiety and fear of the unknown. Just remember that you are well-prepared and that a majority of people have no problems.

"And in case something does go wrong, remember that it’s a one-point-in-time assessment and may not be an accurate reflection of your ability."

Results of the 2000 California Dental Licensure Exam

March 2000

Total participants: 289
Passed: 192 - 66 percent
Failed: 97 - 34 percent

June 2000
Total participants: 765
Passed: 613 - 80 percent
Failed: 152 - 20 percent

September 2000
Total participants: 501
Passed: 376 - 75 percent
Failed: 125 - 25 percent

Cumulative Statistics
Total participants: 1555
Passed: 1181 - 76 percent
Failed: 374 - 24 percent

Perio Disease May Lead to Diabetes

Chronic periodontal disease may contribute to diabetes, according to a review of recent research. While it has been established that people with diabetes are more prone to developing periodontal disease, new research is suggesting that periodontal disease may, in turn, be a risk factor for diabetes.

The research review was presented at an American Academy of Periodontology/National Institute of Dental and Craniofacial Research symposium on perodontal systemic connections held in April.

Periodontal disease can cause bacteria to enter the bloodstream and activate immune cells. These activated cells produce inflammatory biological signals (cytokines) that have a destructive effect throughout the entire body.

"In the pancreas, the cells responsible for insulin production can be damaged or destroyed by the chronic high levels of cytokines. Once this happens, it may induce Type 2 diabetes, even in otherwise healthy individuals with no other risk factors for diabetes," explains presenter Anthony Iacopino, DMD, PhD.

According to Iacopino, hyperlipidemia or high serum cholesterol, not impaired glucose tolerance, seems to be a significant risk factor for periodontal disease in diabetics.

"Therefore, lipid-lowering therapies -- such as low-fat diets, lipid-lowering drugs and exercise -- are vitally important for diabetics who want to improve their quality of life, as well as their oral health," he says. "The same approaches may also prove beneficial in nondiabetic patients with high cholesterol."

The next step to determine for sure whether periodontal disease can cause diabetes is to perform clinical studies and intervention trials.

Studies Needed To Advance Dental Caries Strategies

The development of new diagnostic techniques to detect early stages of dental caries may give dentists more options than ever before to stop or reverse decay using noninvasive techniques. This and other findings emerged from a Consensus Development Conference on the Diagnosis and Management of Dental Caries Throughout Life, convened by the National Institutes of Health in March.

The conference examined the current state of dental caries research to help dental care providers and the general public make informed decisions.

Conference panel members reviewed an extensive collection of literature related to dental caries, including a systematic review of the dental research literature provided by the Agency for Healthcare Research and Quality. The panel also heard presentations by experts in the field, as well as public comment.

Although optimistic about the future of dental practice, the panel was disappointed in the overall quality of the clinical data that it reviewed. According to the panel, far too many studies were small, poorly described, or otherwise methodologically flawed.

"This is not to say that the diagnostic, preventive, and restorative techniques currently used do not work," said the panel, "but rather that earlier studies to support their efficacy do not meet current scientific standards."

The panel noted that effective dentistry requires early identification of children at high risk for extensive caries so that they may receive early and intense preventive intervention. Children at low risk also need to be identified to reduce unnecessary care and expenditures. According to the evidence presented, the most consistent predictor of caries risk in children is past caries experience. Low socioeconomic status is also associated with higher caries rates. While some risk factors may be applicable across all ages, others are distinctive for adult and elderly populations, such as the inability to maintain good oral hygiene, lack of adequate salivary flow, and gum recession.

The panel called for a major investment of research and training funds.

Panel chair Michael C. Alfano, DMD, PhD, dean of the New York University College of Medicine, notes that "for the American people to benefit from these findings, insurance companies will need to change the way they compensate dental providers so that the next generation of conservative therapy can be enjoyed by everyone."

Breakout

The Consensus Development Conference on the Diagnosis and Management of Dental Caries Throughout Life called for:

* Studies of dental caries in the population that collect information on natural history, treatment, and outcomes in all age groups

* Clinical trials of established and new treatment methods that conform to contemporary standards of design, implementation, and analysis

* Systematic research on caries risk assessment

* Studies of clinical practice including effectiveness, quality of care, outcomes, health-related quality of life, and appropriateness of care

Fred Flintstone Went to the Dentist

Researchers looking at teeth found in Mehrgarh in pre-historic Pakistan have found what they believe to be one of the earliest examples of dentistry -- perfectly round holes in teeth that may have been created by early stone-tipped drills.

Electron microscopy showed the holes’ sides to be too perfectly rounded to be the result of caries. Also visible were concentric grooves that were probably left by a drill using a tiny stone bur.

Andrea Cucina, the scientist who discovered the holes, suspects they were a treatment for caries and that plants may have been inserted into them to prevent bacterial growth.

The holes were the same diameter as those found in necklace beads in the same area, so it appears that the people of Mehrgarh had the skill and tools necessary to perform the delecate dental work.

Cake Cravings Are in the Genes

Our appreciation of sweet foods begins with an interaction between sugars and specific receptors on taste cells of the tongue. However, despite progress in identifying receptors for other tastes (sour, bitter, salty and umami or glutamate), the sweet taste receptor in mammals has remained elusive.

Now, a group led by Linda Buck at Harvard University has identified a candidate gene that may encode a sweet receptor. The group studied two strains of mice: so-called "tasters," which prefer water containing sugar or saccharin, and "nontasters," which show far less preference for sweet water.

Based on previous evidence that the sweet taste receptor gene might resemble the bitter and umami receptors (which are G-protein-coupled receptors), the researchers searched for G-protein-coupled receptor genes within the region of the mouse genome known to control the "taster" or "nontaster" phenotype. They found several such genes, but one in particular (T1R3) was expressed in taste cells. Furthermore, they found specific changes in T1R3 (and not the other genes) in the "nontaster" mice, thus providing further evidence that this gene may function as a sweet taste receptor.

Despite the strong circumstantial evidence that T1R3 encodes a sweet taste receptor, definitive proof awaits a functional test. For example, it should be possible to insert T1R3 into a cell that normally does not respond to sweet stimuli. If T1R3 indeed codes for a sweet taste receptor, such a cell should become responsive.

Experiments of this sort have proven particularly difficult in the taste receptor field. Nevertheless, the work will certainly spark more research in this area, as there is substantial commercial interest in designing new sweeteners. At a more basic level, the work should also help to answer long-standing mysteries such as how responses at single neurons give rise to the complex perception of taste.

Unfortunately, You Have Come A Long Way, Baby

Women now account for 39 percent of all smoking-related deaths each year in the United States, a proportion that has more than doubled since 1965, according to a report on women and smoking released by Surgeon General David Satcher.

The report concludes that the increased likelihood of lung cancer, cardiovascular disease, and reproductive health problems among female smokers makes tobacco use a serious women’s health issue.

Meanwhile, increased marketing by tobacco companies has stalled progress in smoking cessation by women, and recent increases in smoking among teenage girls threaten to wipe out any progress that has been made in the past few decades, the surgeon general notes.

"In the early decades, smoking prevalence was more prominent among men, and it took nearly 25 years before the gap narrowed and smoking became commonplace among women," Satcher says. "Women not only share the same health risk as men, but are also faced with health consequences that are unique to women, including pregnancy complications, problems with menstrual function, and cervical cancer."

Women and Smoking: A Report of the Surgeon General summarizes patterns of tobacco use among women, factors associated with starting and continuing to smoke, the health consequences of smoking, tobacco marketing targeted at women, and cessation and prevention interventions.

"Smoking is a critical women’s health issue that must be addressed on all fronts," Health and Human Services Secretary Tommy G. Thompson says. "We must begin this battle in schools before girls even begin to smoke, and we must share with teenage girls that smoking is not only harmful, but it is not glamorous. Society must not glorify smoking."

The report calls for increasing public awareness of the devastating impact of smoking on women’s health; exposing and countering the tobacco industry’s targeting of women; encouraging public health policymakers, educators, health professionals, and women’s organizations to work for policies and programs that deglamorize and discourage tobacco use; reducing disparities related to tobacco use and its health effects among different ethnic/racial populations; decreasing nonsmokers’ exposure to environmental tobacco smoke; and mounting comprehensive statewide tobacco control programs proven to be effective in reducing and preventing tobacco use.

Breakout

* Cigarette smoking was rare among women in the early 20th century. However, the gender-specific difference in smoking prevalence narrowed between 1965 and 1985. Since 1985, the decline in prevalence among men and women has been comparable.
* Smoking prevalence decreased among women from 33.9 percent in 1965 to 22.0 percent in 1998. Most of this decline occurred from 1974 through 1990; prevalence declined very little from 1992 through 1998.
* The prevalence of current smoking is three times higher among women with nine through 11 years of education (32.9 percent) than among women with 16 or more years of education (11.2 percent).
* Smoking prevalence is higher among women living below the poverty level (29.6 percent) than among those living at or above the poverty level (21.6 percent).

Physicians Not Fleeing State, UCSF Says

Contrary to conventional wisdom, physicians are not leaving California for greener pastures elsewhere, according to a new study from the Center for Health Professions at the University of California in San Francisco.

But others maintain that the study is flawed and physicians are indeed leaving the state, leaving practice, or retiring, resulting in a medical "brain drain" out of the Golden State.

The study found that the number of physicians per 100,000 patients actually increased from 177 in 1994 to 190 in 2000.

Among the data studied were an American Medical Association medical licensure database and a survey of nearly 2,000 state physicians.

While many in the medical community believe that physician earnings in California are lagging due to the influence of HMOs and medical groups say they have trouble recruiting new physicians, 1998 incomes ranged from $120,000 to $250,000, which is comparable to that in other states.

But the Santa Clara County and California medical associations say that the study’s data are outdated.

Honors

The American Academy of Cosmetic Dentistry has presented Jeff Morley, DDS, of San Franciso, with its 2001 Award for Outstanding Contribtion to Cosmetic Dentistry. The award recognizes his 25 years of dedication to advancing the field of cosmetic dentistry in both practice and communications.

Deon M. Carrico, DDS, of Dana Point, Calif., has been awarded the Western Pedodontic Odontic Society Mentor Award for 2001. He was an innovator of the society in 1956 and served as the first treasurer.

Henry H. Takei, DDS, of Los Angeles, has been named the Marquette University School of Dentistry 2001 Distinguished Alumnus in Dentistry. Takei is a professor of periodontics at the University of California at Los Angeles.

John Green, DDS, of San Rafael, Calif., has been honored with the Distinguished Service Award by the American Dental Education Association. He is dean emeritus of the University of California at San Francisco School of Dentistry.

Mahmoud Torabinejad, DMD, of Loma Linda, Calif., has been elected vice president of the American Association of Endodontists. He is the director of graduate endodontics and a professor of endodontics at Loma Linda University School of Dentistry.

Web Watch: Women’s Smoking

Resources on tobacco statistics and cessation strategies are available on the following Web sites:

http://www.cdc.gov/tobacco/sgr_forwomen_yahoo.htm

This page from the Centers for Disease Control and Prevention contains abbreviated and full versions of the surgeon general's recent report on the increases in women's death rates due to smoking.

http://www.4woman.gov/quitsmoking/

This Web page of the National Women's Health Information Center provides information on tobacco cessation, including information especially for teens and in Spanish.

http://www.surgeongeneral.gov/tobacco/

This page contains the latest findings about drugs and counseling techniques for treating tobacco use and dependence.

http://www.cdc.gov/tobacco/statehi/pdf_2001/CA_sh2000.pdf

This page from the State Tobacco Activities Tracking and Evaluation System contains data on tobacco usage in California.

Upcoming Meetings

2001

July 19-21 Forensic Dentistry 2001: A Symposium With Workshops, Chicago, (312) 440-2895

Sept. 6-9 American Academy of Pain Managements 12th Annual Clinical Meeting, Pain Management: A Challenge for the New Millennium, Arlington, Va., (209) 533-9744, www.aapainmanage.org

Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

Sept. 27-Oct. 1 FDI World Dental Congress, + 44 207 935 7852, www.fdi.org.uk

Sept. 30-Oct. 3 Pacific Coast Society of Orthodontists Annual Session, Honolulu, (800) 445-8667

Oct. 13-17 ADA Annual Session, Kansas City, (312) 440-2500.

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.