IADS Experience ETHIOPIA The IADS Voluntary Committee kicked off their program of 2020 by launching the very first International Volunteer Program (IVP) in Ethiopia. It took place from the 16th to the 30th of January! As a two-week program, the Local Organising Committee(LOC) divided the volunteers into two groups to provide free dental treatment to the underprivileged in the capital, Addis Ababa. Apart from the hospitable LOC, we had a lot of passionate volunteers from around the world! They came from Czech Republic, Germany, Jor- dan, Slovakia and Taiwan. Since the program was in cooperation with AfroDSA, we also had two doctors from Somaliland volunteering with us. On the first day of the program, we visited the Yekatit Hospital, the place where the patients would receive dental treatment. During the vis- it, we greeted the local professionals to have a more in-depth look at their working procedures, as well as having an orientation tour. During the whole program, the LOC was trying very hard to give us all a pleasant stay in Ethiopia. After the orientation tour at the hospital, we went to have a sip of Ethiopian Spirit - coffee! During the talk, the volunteers learnt more about Ethiopia and its culture. To our surprise, the country was hav- ing a festival called Timket during our stay. As people were getting busy around the city to pre- pare for the festival, we decided to leave the city centre and visit another province nearby during that day. But before the holiday, it was time to get to work! 13 IVP2020
Our patients came from a local NGO, Mekedonia Humanitarian Association, which provides shel- ter for those who are homeless, handicapped, with mental illness or disabled elderly, including an orphanage for those in need. In the program, the volunteers firstly went to the site located in the outskirts of Addis, to proceed with screening of the residents in need and arrange them in a schedule for us to continue the treatment at the hospital. Due to time and equipment concerns, we were only able to provide scaling, fillings and extractions during the program. While we were screening the residents in the shelter home, the LOC was helping us with the translation. Thanks to their effort which indeed sped up the screen- ing procedures; we were able to screen a total of 10 patients that morning. As future dentists, we have to know how to get a work-to-life balance, so on the day of Timkat, we went to Oromia to have a chill and relaxed free day. The view of nature in Ethiopia is stunning! The work continued and in the following days of the program, we focused on treating patients. We divided into groups for dif- ferent treatments and shift after a while. The vol- unteers came from a diverse background; some of them were experienced dentists while some were students. The grouping mechanism helped a lot, with every group having at least one doctor from the volunteers to guide the students. Most of the students’ feedback was that they learned a lot, and they even performed the treatments they’d never done before! At the end of the pro- gram, we had treated 100 patients in total. After the IVP, the volunteers gave very positive feedback and most of them are willing to rejoin this meaningful program in the fu- ture! We will keep you updated with the latest IVP information on the IADS Facebook page and the official website, so stay tuned for that! We look forward to meeting you in one of the future pro- grams! Written by: Yolanda Chan (Taiwan) Proofread by: Silvi Domnori, Živa Antolin Design by: Mohamed A. Abuzaid, Živa Antolin 14
MY EXCHANGE EXPERIENCE: Lebanon The clinical exchange was held at the beginning of April 2019 and it lasted for two weeks. It was organized by the International As- sociation of Dental Students (IADS) and the Lebanese Associa- tion of Dental Students (LADS) in collaboration with the Faculty of Dentistry of Beirut Arab University, Lebanon. I chose Lebanon be- cause I was interested to see how dental faculties are like outside Italy and the European community. Yet I was even more curious about Lebanon. I was immediately impressed by the hospitality of the LADS members and the professors as they always tried to make me feel comfortable. They truly know how to welcome a guest. As I was new there and a bit scared at the beginning of the exchange, I appreciated their attention towards me and the other students.Firstly, I would like to dedicate a few words to the LADS members. Since my arrival at the airport and for the whole duration of the exchange, they cooperated well so I never had to spend time alone. In the beginning, they introduced me to the Dean and the Assistant Dean of the University who welcomed me and made me feel like a part of the university. They prepared all types of activities for me for the whole day; at the University and also for the evening so I could never get bored!). At the University, I was able to attend both lessons and clinical practice. Also, I had the opportunity to observe the post-graduate activities and I must say that all the specializations and masters are valid. Each day I visited a different department, so I was able to observe and assist at all dental practices. Students discussed the treatment plans with their tutors and then performed the treatments on the patients. Even if our day was full of activities, that didn’t stop us! After an intense day at the University, there was just enough time to rest for a little bit and then we went out to see Beirut and observe the Lebanese way of life. Despite the cultural differences, Lebanese people welcomed me with open arms. They are very proud of their culture and traditions and they introduced everything to me with enormous pleasure. The food I tried was very delicious and the places I visited were unique, all accompa- nied by people who made me feel at home. This was an important experience for my personal growth. Visiting a city that is very similar to Italy in certain aspects but deeply different in others, certainly sur- prised me in the beginning but enriched me at the end. After some time I can say I have found friends in Lebanon that I will always carry in my heart. Would I do it again? Of course! 19
Written by: Elena Cerisara, AISO Varese (Italy) Proofread by: Živa Antolin Design by: Živa Antolin 20
IADS in Romanian ZÂMBETE ÎN CARANTINĂ Written by: Mihaela Răileanu, Irina Bodnar Design by: Živa Antolin România, primăvara 2020... cu siguranță, când ne-am făcut rezoluțiile pe anul acesta nu ne-am imaginat că așa va arăta viața noas- tră pentru minim o lună și jumătate: fiecare în propria casă, fără ieșiri cu prietenii, fără mers la facultate și fără plimbări sau excursii. Pare dezolant, un scenariu neprevăzut și o incertitudine care ne neliniștește. O să mai dăm examenul de licență anul acesta? O să se prelungească semestrul deși facem cursuri online? O să ne mai vedem cu toții la toate festivalurile plănuite vara asta sau pe plajă în Vama Veche? Nimeni nu știe cu siguranță o dată la care ne vom relua viețile de dinainte, dar putem măcar să sperăm la ce e mai bun și să vorbim despre lucrurile care ne fac plăcere și ne aduc zâmbetul pe buze. Cum sunt fie toate congresele organizate în România de asociațiile locale, fie întâlnirile bianuale IADS unde ne reuneam cu prietenii de pretutindeni. De la prezentări ale lectorilor din întreaga lume, workshopuri unde puneam în practică tehnici despre care am citit și am auzit, până la excursii în locuri noi sau locuri deja vizitate și îndrăgite, petreceri memorabi- le cu prietenii în fiecare seară, room partyuri, râsete de dimineața până seara și nelipsitele plânsete de la final la gândul că vor trece alte câteva luni până la întâlnirea următoare. Toate amintirile frumoase ne pot fi folosi- toare acum dacă ne gândim că, la un moment dat, vom retrăi toate experiențele minunate cu oamenii dragi și le vom aprecia chiar mai mult. Pe mine, cel puțin, aceste lucruri mă fac să fiu optimistă zilele acestea și să aștept cu- minte acel viitor care va veni, chiar dacă va avea o oarecare întârziere. Putem privi toată această perioadă ca pe o oportunitate. O oportunitate de a învăța ceva nou, de a citi, de a lucra la un proiect person- al, de a ne mobiliza pentru a ne crea un viitor mai bun. E totuși dificil dacă nu știm de unde să începem sau punem prea multă presiune pe propria persoană pentru a fi productivi în fiecare zi și uităm că poate fi copleșitor con- textul actual. Este ok să nu fim la capacitate maximă zilnic. Este ok să avem timp în care ne gândim la momente frumoase de care ne este dor, ne uităm la seriale și facem ce ne bucură. Știm, cu siguranță, că dacă suntem viitori medici stomatologi, atunci și partea ști- ințifică este ceva care ne pasionează și poate această pauză de la viața noastră agitată este benefic să citim, să ne punem întrebări și să studiem ceva mai mult. O soluție de a ne menține neuronii în priză este să participăm la cursurile online pe care facultatea noastră ni le pune la dispoziție, ori la diferite sesiuni online ale lectorilor noștri sau lectori străini, sau pur și simplu să răsfoim noi articole apărute. Citind, lecturând practic cu plăcere articole din literatura de speciali- tate, ne pot inspira în așa fel încăt să dorim chiar noi înșine să începem o cercetare ști- ințifică. 28
Să prezinți o lucrare științifică în fața unui juriu și a unui public necesită curaj, încredere în sine și bineînțeles, pasiune pentru cercetare. Dar te-ai gândit vreodată să faci asta la un congres internațional? Aceasta este adevăra- ta provocare. Să ieși din zona ta de confort, prezentându-ți lucrarea științifică departe de granițele țării tale, unui public complet necu- noscut și totuși să reușești să transmiți același mesaj, stare și pasiune, indiferent de faptul că o faci în limba maternă sau în engleză. Practic, acesta este un level up în abilitățile tale de ,,public speaking”, și în plus, ai șansa de perspectivă, de a observa cum abordează studenții din întreaga lume o prezentare ști- ințifică și de ,,a fura” de la fiecare pentru a-ți îmbunătăți propriul stil, oferindu-i un car- acter internațional. Cine știe, poate chiar tu la rândul tău îi vei inspira pe alții să își abordeze cercetările științifice ,,in the Romanian way”. Dacă totuși vorbitul în fața zecilor de oameni, nu este chiar punctul tău forte, există soluții pentru a împărtăși cercetările tale cu lumea întreagă. Poți rezuma o lucrare științifică prin- tr-un poster. Acestea de obicei sunt afișate în cadrul unei sesiuni de postere, autorul fi- ind prin preajmă pentru a răspunde la even- tualele întrebări și nedumeriri asupra studi- ului efectuat. Haideți să vedem această perioadă ,,oprită în timp” ca o șansă pentru noi. Șansă pentru a deveni mai echilibrați, de a ne stabili cu ex- actitate prioritățile, de a învăța lucruri noi și bineînțeles, de a ne pregăti pentru următoar- ea experiență IADS. Cum faci ca urmator- ul congres IADS să nu te prindă nepregătit? Răsfoiește IADS Magazine, aruncă un ochi pe paginile oficiale Facebook/Instagram pentru a avea un preview al experienței IADS, bea un pahar de vin la tine în cameră pregătin- du-te pentru room-party-urile specifice IADS și citește, fă research, pentru a-ți reprezenta eventual țara susținând o lucrare științifică în cadrul unui congres IADS. IADS este un cumul de experiențe care oferă posibilitatea studenților din întreaga lume de a se dezvolta, nu numai pe plan profesion- al, dar și cultural și social. Oamenii pe care îi cunoști în cadrul acestei asociații sunt cei de la care vei avea cel mai mult de învățat și sunt cei cu care îți vei face amintiri de care te vei ,,agăța” în momentele dificile ale vieții tale de zi cu zi. Până când ne vom întâlni data viitoare, aveți grijă de voi. Iar dacă nu sunteți încă membrii IADS, faceți-vă temele despre cum asociația voastră se poate înscrie și haid- eți să ne bucurăm împreună la următorul meeting. See you soon! 29
Written by: Silvi Domnori, Shukri M. Jama Graphic Design by: Jawhar Maazoun Proofread by: Irina Bodnar #BeyondDentistry GETTING ON THE MAINSTREAM BOAT - IS MEWING REALLY THE SOLUTION YOU’RE LOOKING FOR TO YOUR JAW INSECURITIES ? People will go to great lengths to avoid going to the dentist and you’d guess even more so when the dentist will tell them that they need jaw surgery. After lemon and baking soda teeth-whitening recipes, apple cider vinegar mouthwash and garlic to stop toothache, comes face-shaping. A recent trend on social media sites is MEWING and it already has quite the number of fans. What is it and is it actually helpful? Let’s discuss it! What is it and how did it start? Mewing is a technique that is attributed to Dr Michael Mew and his father Dr. John Mew, both orthodontists. Different sources have different claims about whether they originally came up with it or just contributed to making it popular. Basically, Dr. John Mew and his son are both practitioners of an unconventional technique called ‘Orthotropics’ – claimed to alter face shape through oral exercises and facial muscle posture. In the past 2 years, videos of Mewing started trending all over the internet with more and more people trying it.1 Mewing involves placing the tongue against the roof of the mouth while closing the lips and setting the teeth together. It’s supposed to change your facial features over time, especially your jawline. The other supposed benefits include alignment of chin and nose, other claims have been that it could help resolve breathing and swallowing problems, speech disorder, alleviate jaw pain and even sinusitis. The concept of skeletal and dentoalveolar deformities being caused by the abnormal posture and/or function of the tongue and jaw muscles is much older. It was a hypothesis suggested by Melvin Moss. Moss considers the effect of functional demands on the development of maxillofacial bones – the functional matrix hypothesis. 2 Not able to explain all aspects of bone development and with embryologists showing that long bones can develop normally without the soft tissue, this hypothesis seems quite hard to be proved right. A study that shows the jaw development of a 10-year-old girl with parafunctional swallowing, goes on to give a more believable explanation that bones grow correspondingly to the positional information they receive from cells of neighboring structures. 5 There is no denying that Moss’s theory does fit some cases but it does not explain all aspects of malocclusion. A long reported fact is that incorrect placement of the tongue is a primary etiologic factor in the development of malocclusions and articulation problems, for example, an anterior open bite3,4, but could ‘pulling the reverse UNO card’ on this factor correct malocclusions? Conventional orthodontics does indeed use orofacial myofunctional therapy via different appliances to correct different types of malocclusions or deformities, however, this happens in a controlled and case-specific way. 39
“even a small increase in muscle activity for a prolonged period can lead to developing pain and dysfunction” it is important to encourage people to rest their tongue at the floor of their mouths not pressed against the palate – demonstrating lower EMG activity of the surrounding muscles whenever the tongue was in resting position. Not only did they deem this as beneficial for the joint but also for the physiological rest of the heart. Is it actually effective? There have been a few claims about the benefits of this technique although none scientifically proven yet, so proper research is wanted. Which begs the question, why are people doing it? Those who have tried it, claim that it has helped them improve their features and perhaps make their faces look thinner too, over time. However, a good literary approach to this would be researching what the actual dentists and orthodontists have to say about it. What we know so far is that like skeletal and dental features, muscle patterns are also inherited; however, this study conducted on identical twins6 claims that environmental stress could alter the way or the extent to which these inherited patterns are expressed. We also know that childhood habits such as mouth breathing and tongue thrusting, significantly alter the position of teeth, jaws and the tonus of maxillofacial muscles. At a young age, orthodontists encourage proper myofunctional therapy followed later on by orthodontic treatment to successfully intercept and achieve a functional and aesthetic occlusion. A study7 conducted on the hypothesis that “positioning the tongue with slight pressure on the palate would involve an increase in the temporal, masseter, and suprahyoid muscle activity, compared with measured muscle activity when resting the tongue on the floor of the mouth.”8,9 One of the conclusions they reached is that, coinciding with other evidence10 that 40 So one thing to keep in mind is that at the age most people are now using mewing to alter their jaw shape and teeth alignment, they are well past the phase such “therapy” if so we may call it, could give immediate results. Although there is no recent research at hand on positive or negative effects of mewing, based on what we know so far, it seems to cause more muscle stress and strain than alterations in the bony structure. We could go as far as to claim that, though not completely reliable, the changes we see in before-after pictures circulating around the internet on the benefits of mewing are merely due to the increased tonus of masticatory muscles of the face, rather than the hard tissue of the jaw itself.
To conclude, while there is not much evidence to prove that mewing itself is highly dangerous to people’s wellbeing, there is also no evidence to prove that there are significant results to it. As you might have deduced yourself so far, it would take a long time of mewing to actually see results and that means also a long time of unnecessarily increased muscular activity. Taking into consideration that orthodontists measure and analyse the forces they apply to maxillofacial structures down to the most minute detail, going at it with an uncontrolled activity could lead to more damage than good. It’s up to you to try it anyway, but it would be wiser to first consult a dentist and possibly wait for more reliable research Sources: 1 . h t t p s : / / w w w . j o m s . o r g / a r t i c l e / S 0 2 7 8 - 2391(19)30349-0/pdf 2. Moss, Melvin L., The functional matrix hypothesis revisited. 4. The epigenetic antithesis and the resolving synthesis. Am Journal of Orthodontics and Dentofacial Orthopedics, Volume 112, Issue 4, 410 – 417 3. Johnson NCL, Sandy JR. Tooth position and speech - is there a relationship? Angle Orthod 1999; 69: 306-10. doi: 10.1043/0003-3219(1999)069 < 0306:tpasit>2.3.co;2 4. Farronato G, Giannini L, Riva R, Galbiati G, Maspero C. Correlations between malocclusions and dyslalias. Eur J Paediatr Dent 2012; 13: 13-8. 5. Mew, J. R. C. (2004). The postural basis of malocclusion: A philosophical overview. American Journal of Orthodontics and Dentofacial Orthopedics, 126(6), 729–738. doi:10.1016/j.ajodo.2003.12.019 6. Sharma K, Corruccini R. Genetic basis of dental occlusal variations in northwest Indian twins. Eur J Orthod 1986;8:91-7. 7. John E. Schmidt, PhD,a Charles R. Carlson, PhD,b Andrew R. Usery, MD,c and Alexandre S. Quevedo, DDS, PhD,d Rochester, MN, Lexington, KY, and Winston-Salem, NC, Effects of tongue position on mandibular muscle activity and heart rate function, Mayo Clinic, University Of Kentucky and Wake Forest University 2009 Published by Mosby, Inc. doi:10.1016/j.tripleo.2009.06.029 8. Carlson CR, Sherman JJ, Studts J, Bertrand PM. The effects of tongue position on mandibular muscle activity. J Orofac Pain 1997;11:291-7. 9. Takahashi S, Kuribayashi G, Ono T, Ishiwata Y, Kuroda T. Modulation of masticatory muscle activity by tongue position. Angle Orthod 2005;75:35-9 10. Glaros AG, Burton E. Parafunctional clenching, pain, and effort in temporomandibular disorders. J Behav Med 2004;27:91-100. 41
Written by: Irina Bodnar Graphic Design by: Jawhar Maazoun Proofread by: Shukri M. Jama, Živa Antolin #BeyondDentistry ORAL MODIFICATIONS PATIENTS WITH BULIMIA Bulimia is an emotional disorder characterized by an unwanted body image and an obsessive desire to lose weight. This disease is defined by extreme overeating followed by fasting or self-induced vomiting. The etiology of this disorder can be treated by a psychologist, and its repercussions like – ulceration of the upper digestive tube - can be treated by a gastroenterologist. The hardest step of the bulimia treatment is to diagnose it. It is not easy for a bulimic person to accept and recognize their illness, so most of the patients tend to hide their vicious habits. Thus, it is quite difficult for them to voluntarily contact the doctors that they need to treat their illness. The important link between the diagnosis and treatment of bulimia is often made by the dentist. Due to acid regurgitations from the upper digestive tract, specific lesions occur in the oral cavity; such as dental erosion, characterized by an irreversible loss of tooth substance. Dental erosions, besides aesthetic issues, also cause dental hypersensitivity and pain, and potentially also tooth loss. To diagnose bulimia we as (future) dentists have to notice certain signs: • Oral erosion - especially on the palatinal side of the superior teeth. • Lesions of the oral mucosa, especially located on the soft palate and pharynx, caused by the introduction of various foreign objects in the oral cavity to provoke vomiting. • Infection with Candida Albicans (mucosal lesions, such as those produced by direct trauma with foreign objects, subsequently become infected with Candida, become atrophic and erythematous). • The patient lost weight in a very short time (can be noticed if the patient presents to regular dental appointments). • Saliva can be also influenced - by disturbing the salivary and/or qualitative flow due to its high acid composition (teeth are more vulnerable to acids). 42 includes treatment Bulimia comes with a lot of complications such as esophageal ulcer, painful deglutition, and burning stomach. The symptoms may vary from a person to another, but the specific sign for every bulimic is dental erosions. The psychological therapy sessions to resolve the cause and helps the patient accept their physical appearance, as well as consulting a nutritionist to adopt normal and healthy eating habits. An endoscopy might be needed, to search for possible ulcerations in the superior digestive tube, and if the lesions exist, a gastroenterology consult is a must, followed by the specific treatment. When it comes to oral health, dentists have an important role. Firstly, oral acidity needs to be under control. The acid pH makes dental structures to become more susceptible to demineralization. Patients should be educated about proper oral hygiene; such as brushing their teeth correctly, cleaning their tongue, using antiseptic mouthwash and maybe adopting medical treatment to stimulate the production of saliva (to adjust the oral pH).
Patients should avoid both medications that stimulate all exocrine glands and chewing gum because this stimulates the production of gastric acid, which is an aggressive factor. If bulimia is advanced, dental erosions have a drastic impact, both aesthetic and functional. Erosions make the teeth more sensitive to external factors like the mechanical stimulus, hot/cold food and also to the simple act of mastication. After getting bulimia under control, a treatment plan is required to regain dental and periodontal health. Pre-prosthetic treatment includes dental occlusion analysis, esthetic and functional evaluation and if needed, temporary prosthetics. The final restorations of the affected teeth should be made of both resistant and esthetic materials so using metal-ceramic crowns is the best choice. Sources: https://www.researchgate.net/figure/The-palatal- surface-of-the-maxillary-anterior-teeth-of-a- bulimic-patient-showing_fig2_6395973 https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3267322/ https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4125596/ http://www.scritub.com/medicina/ANOREXIA- NERVOASA-SI-BULIMIA-S54394.php https://pocketdentistry.com/esthetic-dentistry- and-eating-disorders/ https://www.nature.com/articles/bdjteam20159 Credit: A bizarre palatal haematoma in a 30-year-old female bulimic (from BDJ 1999; 186: 109–113) The clinical history of a patient is very important. It can be observed in their detailed history if they tend to be unsatisfied with their appearance. If a dentist suspects a bulimia disorder, it is important to keep a natural and friendly attitude with the patient. When it comes to questions related to bulimia, we should be very careful not to make them feel uncomfortable. We should kindly make them understand that they need help from other medical specialties. Dentists are often the first doctors who encounter the manifestations of this disease and should be the first to report it. Greater importance should be given to the manifestations of erosion and ulceration in the mucosa because they precede the general manifestations and would facilitate the detection of the disease at an earlier stage. 43