This summer, I was fortunate to shadow Dr. Noxon and Dr. Bruno at Noxon Orthodontics in Wellesley, MA. I was their first non-dental school intern so I was unsure of what to expect, but I was ready to make the most out of this incredible opportunity. From listening to advice from current dental students to learning the expectations upheld by the dental assistants, I felt extremely welcomed and engaged in the work they allowed me to be a part of.
Orthodontics is one of the many dental specialties that is offered as an option when going into dental medicine. Orthodontists' task is to align and train the configuration of a patient’s jaw and teeth typically using braces, invisible aligners, or other corrective appliances such as palate expanders or lingual arches.
Within my first hour at the practice, I was exposed to creating 3D scans that are often used for Invisalign models. Using an iTero machine, the dental assistant would create a digital impression by scanning the inside, outside, and top of the teeth and examining the patient’s bite to manipulate a virtual mold. Being able to move this mold on the screen lets dentists see all parts of the teeth at any point in time by navigating the scan by either zooming in closer or shifting the viewer's perspective. On my first day, I was able to watch and understand how to use this machine on at least five different patients, and later that day, I saw how the orthodontist used the scans from the morning to diagnose a treatment plan for the patient going forward.
Each morning, I would go in and check the schedule to see how many people were slotted
for the morning and if there were any familiar names on the list to look forward to. Some appointments like “adjustment” (ADJ) and “Invisalign check” (INVSCK) were slotted for 15 minutes, and longer treatments such as “bonding” (BOND) and “braces off” (BOFF) ranged from 45-90 minutes. I started learning the abbreviations for different procedures as they would pop up on the patient tracker, and when I felt like I had the definition down, I began to know which type of tray to grab for the given appointment.
Throughout my experience, my main role was to make sure everything in the practice was sanitized. Whether this entailed spraying and wiping down the chairs and desks between appointments, placing instruments into the autoclave sterilizer after sitting in a cold sterile basin, or washing the impression bowls and replacing the powder used for 3D teeth molds, there was rarely a dull moment. When things got busy, I was able to help by greeting and seating patients and looking back, these little interactions were definitely one of my favorite tasks.
Each chair has its own set of archwires. While many of these skinny, curved pieces of metal looked the same to me initially, I learned the difference between the strength, width, and flexibility of the wire and what that meant for the patient’s treatment. There are two materials these wires can be made out of: Stainless Steel (SS) and Nitinol/Nickel-Titanium (NiTi). With the stainless steel being denser and less pliable, they are more prone to cause soreness after application and will force the teeth to align tighter, quicker. NiTi wires on the other hand are more flimsy and feel lighter. On top of these two material options, there is a number printed on the package that tells dentists how thick the wire is. For example, a dentist might prefer that a patient use a NiTi 0.020 as opposed to a NiTi 0.016 so that they will have a stronger wire that pulls the teeth together in a certain manner. Finally, when organizing the wires in their perspective holders, separating the upper and lower wires is detrimental. Upper and lower wires sit and operate differently, so it is very important that the correct wire is placed in the right holder for the orthodontic assistant to grab quickly during the appointment. Although this task can seem tedious, it exposed me to information and terms that I now understand the meaning and intention behind.
I was super fortunate to have a strong support system that encouraged a positive learning environment. With this said, each day brought a new group of patients that were very different from one another. From one patient who didn’t want to give an open-mouthed smile during her final pictures after getting her braces off to a patient that needed his dad to repeat the phrase “calm body” in order for him to sit still when there were sharp instruments in his mouth, unexpected moments like these were plentiful. This challenged my ability to adapt on my toes, and by working through unexpected difficulties, I developed an altered approach to the given situation.
Huge thank you again to Mr. Schlenker and the entire team at Noxon Orthodontics for letting me have this incredible experience that I will never forget. I gained so much exposure and feel even more excited to keep learning about this field and what it may bring for me in my professional career!