December 22, 2023 • 40 mins
Smiling is a universal symbol of happiness. However, there are instances when the ability to smile is taken away from a person, outside of mere saddening and heartbreaking life occurrences. There are situations when one chooses not to smile because of how it looks on them. In a 2019 survey of 2,000 Americans by Snow Teeth Whitening, 57% of people said they cover their mouths when they laugh because they were ashamed of their teeth' appearance, with 7 in 10 people admitting self-consciousness about their teeth due to lack of whiteness, crookedness, and gaps between teeth. However, beyond the sphere of dental aesthetics, there lies an array of dental issues that seep deeper than color and shade. The dental specialty of orthodontics focuses on the skeletal issues of the teeth, such as crookedness of teeth, malposition of the jaw, and misalignment of bite patterns, that are usually corrected by traditional braces, clear aligners like Invisalign®, and retainers that seek to correct these issues and restore one's confidence to smile.
We are joined by Orthodontic resident dentist Dr. Vivian Chen. She received her BA in Biological Sciences from Columbia University, DDS from the University of California San Francisco School of Dentistry, and is currently completing her Orthodontics residency at the University of Pennsylvania School of Dental Medicine. Previously, she was a Fulbright Research Fellow in Chengdu, China, where she was a research assistant to Dean Xue-Dong Zhou, the Director of State Key Laboratory of Oral Diseases at Sichuan University for dental public health. She was also a research assistant at UCSF School of Dentistry's Department of Orofacial Sciences. Through her social media platform, she promotes oral hygiene and oral health, as well as academic guidance for prospective Orthodontics trainees.
Livestream Air Date: March 5, 2023
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Thankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi friends, happy December 22nd.
(00:07):
I cannot believe it.
Christmas is around the corner.
But honestly though, this year, I'm not really feeling the holiday season.
Is it just me or what?
But that doesn't matter because I'm actually flying out today to LA to be with my family
next week for Christmas time.
And I hope you all have a great rest and a joyous time during this holiday weekend as
(00:28):
well.
This episode is such a personal topic to me because it is one that is closely related
to one of my most unforgettable moments as a child.
And I would like to thank many of you too.
The dentist.
You have no idea how many times I had to go to the dentist as a kid.
For some reason, I always had cavities.
Despite not even eating too much sweets.
(00:49):
I cannot remember how many root canals I've had on my molars, ultimately leading to it
being extracted.
Whenever I think of the dentist, all I can think of is pain and trauma.
I can still hear and feel the drilling, the visceral feeling of my tooth pulp being picked
on by the sharp dental instruments, the blood I spat on the continuous water running sink,
(01:12):
and just the numbing and throbbing pain down in my jaw that I couldn't ward off by any
well wishes.
It was only in the past few years since college that I actually looked forward going to the
dentist as all of my cavity and infection issues have been resolved.
Now, I can enjoy and get excited about my teeth cleaning every 6 months, try new teeth
cleaning devices at home, and even splurge in luxurious activities like teeth whitening.
(01:36):
But this brings out an important topic when it comes to teeth.
Why we do all of these things outside of just general oral health is because we want to
have a shame-free smile.
Smiling is such an important part of life.
I mean, it is the universal symbol of happiness.
There definitely are life moments when we don't want to and can't smile.
Heartbreaks, I'm going through one recently, grief, and even just a stress-filled day.
(02:02):
But there are also reasons why there are those who choose not to smile, simply because of
how it looks on them.
According to a 2019 survey of 2000 Americans by the company Snow Teeth Whitening, 57% of
people said they covered their mouths when they laugh because they are ashamed of their
teeth's appearance.
With 7 in 10 people admitting self-consciousness about their teeth due to lack of whiteness,
(02:24):
crookedness, and even gaps between them.
This reminds me of a time when I was seeing a patient in the clinic years ago trying to
get their health and medication history.
The whole encounter, she was turning her face away from me and covering her mouth.
I realized it was because she was trying to hide her mouth, which had multiple missing
teeth.
Truly, the way our teeth look has a huge impact not only in our self-perception, but also
(02:48):
in how we believe the world perceives us, thereby affecting our confidence and self-esteem.
But beyond just the dental aesthetics of teeth shade and color, there definitely exists an
array of skeletal issues of the mouth, teeth, and jaw that can affect not only our psychosocial
aspect but also our general health and quality of life.
Teeth and jaw malformations and misalignments may affect our breathing, our sleep, what
(03:12):
and how we eat, and the daily activities we may all partake in life.
The field of orthodontics is a specialty of dentistry that deals exactly with these, malpositioned
teeth and jaws, misaligned bite patterns, and even malocclusion of the teeth itself.
This opens up the conversation to treatment modalities that are usually commonly known,
such as traditional braces, clear aligners like Invisalign, and retainers.
(03:37):
Today, I have the honor of being joined by my friend, Dr. Vivian Chen, a dentist and
current orthodontics resident at the University of Pennsylvania School of Dental Medicine.
She was a Fulbright Research Fellow in Chengdu, China, where she was a research assistant
at Sichuan University's Laboratory of Oral Diseases, with a focus on dental public health.
(03:57):
She was also a research assistant at the University of California San Francisco School of Dentistry's
Department of Oral Facial Sciences.
This was recorded back in March for National Dentist Day, and we talked just about that.
Dentistry, her passion behind it, what is orthodontics, and why is restoring smiles
so important?
(04:18):
I hope you enjoy today's episode, and I hope that we all smile more as each day passes.
(04:48):
We have a day I didn't know actually.
Chris approached me and was like, let's do it for National Dentist Day.
And I was like, wait, when is that?
Hi, everyone.
I am Dr. Vivian.
I am a first year orthodontics resident at Penn.
I did my undergrad at Columbia, New York.
(05:08):
I did my dental education in San Francisco, and I just moved to Philly last summer.
And I actually started this account to inspire people to want to do dentistry, people who
are interested in orthodontics, or if you just care about your oral health.
Yeah, I have some friends in the dental space.
I'm not a, you know, for someone not in dentistry, I love having dentists on on the pod.
(05:33):
We had Dr. Joyce come on.
We had a duo come on for the first season.
I had cavities growing up and had like two extractions and root canals.
So even though I'm so traumatized by the dentist, I love hearing their stories and I love hearing
about their field.
So again, thank you for being with me today.
Again, you graduated from UCSF for your UBS degree, right?
(05:59):
Which I heard is such a great school.
And then now you're at U Penn for your residence and for your orthodontics residency.
And you were talking about how you created this account to inspire other people.
I wanted to know what's your inspiration for entering the field.
So I actually came to the realization that I wanted to be a dentist maybe halfway through
(06:20):
my college experience.
My mom is in the healthcare field.
She's a physician.
And so growing up, she was always like, you should consider being a doctor.
It's a state profession, all that.
And I was always motivated by her, but I didn't know if that's exactly what I wanted to do.
And so in college, I actually majored in biology and I had a visual arts minor.
(06:44):
I kind of had an existential crisis halfway through college.
I was like, I don't know if I want to be pre-med.
It's so cutthroat.
I don't know if I vibe with the people.
And so during a painting class, one of my professors was like, have you ever thought
about doing dentistry?
And I was like, wait, what?
I didn't know that was like the field that we went into.
And so I shadowed a dentist.
(07:04):
I went on a mission trip actually to Panama and Honduras halfway through college just
to see what it was like to kind of get my feet wet in that field.
And I came back loving it.
And I didn't know I wanted to be an orthodontist either when I first started out, you know,
being creedental, but it's been a really good journey since then.
And I think dentistry is great because it combines science, patient care, and art as
(07:29):
well.
And I just think that it was a really good blessing that I landed on this in college.
Yeah.
I mean, the field is definitely an art, especially when I'm in the dentist.
Yeah, they're like thin fillings.
You really have to be so precise because we're working in millimeters.
When we're getting graded on our crown preps or fillings, they grade by the millimeters.
(07:50):
So you have to be so precise with your hand skills too.
That's something that I joined with Dennis.
Yeah.
I can't imagine.
Your journey to dentistry is like something, I guess, like you said, you didn't really
expect or that it's not one of those, oh, ever since I was a kid, I wanted to be a dentist.
And yet the whole journey to get where you are now is such a long road, right?
(08:14):
Four years of undergrad, which is so hard, especially biology, and then four years of
dental school and all of your rotations, and then now you're in residency.
Do you have any regrets pursuing the field, being where you are now, given that there's
so much time involved and for the most part, so much money involved, right?
It is a lot of time commitment, a lot of money commitment.
(08:38):
So I would say to anyone who is thinking about dentistry, I personally think that four years
of college, four years of dental school, and on top of that, I'm doing two years of residency,
I was prepared to go into it just because I knew about how long the schooling would
(08:58):
take from, you know, my mom talked about a lot.
And she actually had kids when she was in residency.
And so that's something I had to think about too, when I was considering this field, definitely
something that you have to buckle down on and work hard at.
But at the same time, I do think it's such a rewarding career because dentistry is a
(09:19):
lifetime career, and people will always need someone to take care of their teeth.
So that's kind of what keeps me going.
At the same time, you're getting to help people every day.
So that's kind of my big motivator as well.
I really like helping patients and seeing them smile at the end of the day.
That makes me really happy and keeps me going.
We know that like doctorate degrees, especially within clinical and dentistry or medicine,
(09:43):
are so expensive, right?
And the six figures, but I remember like reading a statistic on Instagram, I think last year,
right before I had my other episode with another dentist, and it was showing how the top six
careers in the United States and the most student loans, the top five or six dentistry,
(10:05):
orthodontist, yeah.
So this mountain of finances is a very big topic, right, and it's something for students
to think about, pre-dental or dental students.
Given that mountain, and you probably answered this already, what would be your advice to
a student who is hopeful to become a dentist and take care of people with dental health,
(10:30):
but are faced with this daunting statistic of just amount of student loans?
That's a really great question.
I touched on this already, but dentistry is a lifetime career.
And so if you are passionate about dentistry, I do believe that we can get out of this field,
even though we have to take a lot of, you know, I personally have a lot of student loans,
(10:50):
I don't know about other people, but I do believe that through helping people and, you
know, starting my career as a dentist, I will be able to make it back because it is a simple
career.
People always need a dentist.
At the same time, there are other opportunities out there that you can apply for a scholarship.
I know there's scholarship through the Navy, through the military that you can apply for.
(11:11):
And I personally didn't apply for this, so you might have to do a little bit of research
yourself, but you can apply going into it with four years of dental school tuition covered.
You'll just for every year that they cover your tuition, you'll have to make it back
by working for the military.
But I heard that you have a lot of great benefits that come with it, and you are also employed
(11:33):
straight out of school.
And also if you want to do residency, they let you do that too.
And I think there's also a chance they might be able to cover that for you as well.
So there are definitely financial opportunities out there for you to apply for to handle the
financial loans.
And I guess it also will come to a point where you mentioned the REBEE, where I guess the
(11:56):
benefits outweigh all of the costs and all of the costs that you may have in mind.
Like you were talking about being with patients.
And I always call Ventus the restorer of smiles.
And I said this story before in the episode, but I work in a cardiac clinic.
And I will never forget how there was this one day when an other patient came and we
(12:20):
were getting her medical history.
And the whole time that she was talking, she was just covering her mouth with her hands.
And so I couldn't see her mouth the whole interview.
And then I was looking more into the history and then her family member came in.
We found she had crooked teeth and she had missing teeth all over her mouth.
And that made me realize that, well, the teeth is really like a source of a lot of consciousness
(12:45):
for a lot of people.
And it really places a lot of hold on someone's demeanor and someone's confidence.
And especially that patient, they didn't want to smile.
They didn't want to show her teeth because she had no teeth or the teeth are misaligned.
And it just shows that for dentists, those who can fix the teeth and put an implant or
(13:07):
fix any misalignment that we'll talk more about, you truly do God's work.
Restoring people's confidence and people's quality of life.
That being said, as a dentist yourself, I was just a bystander.
I was a third person in the story.
What do you think are the best thoughts about your time?
(13:28):
That's such a compliment to hear.
But honestly, I think that everyone in the healthcare field plays an important role in
restoring someone's overall health and confidence.
I think that I personally have seen that firsthand though, when I was in dental school.
The first time I delivered my first set of dentures to a patient, they really had no
teeth and they had trouble speaking and chewing.
(13:50):
I think that is one of the best feelings in the world when you can truly see firsthand
the way that you are impacting someone's life through dentistry.
To some people, it might have just been a graduation requirement to deliver a set of
dentures.
But the feelings that come with it, there's really nothing that can compare to it.
And I'm sure that a lot of healthcare workers can say the same in every area that is patient
(14:14):
or consumer facing.
We have experienced some of these same feelings.
So I think that's the best part of dentistry for me.
And now maybe some more transparent side.
What do you think are the least parts about the job that you may not like?
I will say that being on the side of being a resident is a little bit better than being
(14:40):
a dental student.
I think dentistry, going back to my previous point, you definitely have to think about
how long you're in school for.
And when you're learning things for the first time, it takes a little bit to get to a place
of confidence.
So I think there is a little bit of imposter syndrome that goes with it.
(15:03):
That's one of my least favorite parts because when you're learning something for the first
time, there's always this feeling where your patient is wondering, am I your first patient?
Dealing with that, you don't want to tell them, oh, you're my first patient.
And so you do have to do a little bit of more preparation going into it.
(15:28):
Definitely giving a facade that you are the most confident provider out there, even though
internally you might not feel that way.
But I just want everyone to know if you're thinking about going into healthcare or dentistry,
everyone goes through this feeling.
You wouldn't be alone if you felt this way.
(15:50):
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(20:45):
about it.
I didn't know how expansive the actual field is.
I didn't know there were different types of dentists years ago.
I remember, I think I had to go to a doctor and they were like, yeah you have to go to
an oral surgeon or you have to go to a periodontist and an endodontist.
There's more than one dentist.
I can kind of explain different types of dentists in dentistry but I get this question from
(21:10):
I get this question from a lot of people too when I say I want to be an orthodontist people
are like what is that and how does it differ from being a general dentist?
And so in dentistry you can go to dental school usually it's four years there's some programs
that are three but usually it's four years of dental school and then when you graduate
from that you can go straight into being a general dentist.
So general dentist takes care of I call them kind of the quarterback of the field of dentistry
(21:35):
they coordinate your overall dental health and your overall treatment plan what it takes
for you to have a healthy smile and healthy gums all of that.
So they do a lot of things they do an exam for you they can do cleanings they can do
fillings you know general dentists they are so amazing they cover everything in dentistry
but if there are some procedures that they think I want you to go see a specialist for
(21:58):
they can also refer you to see someone who's more specialized.
So for example an oral surgeon if they want to take wisdom teeth out or if you have pathology
that maybe needs an extra set of eyes or an extra set of x-rays that are more specialized
or you can go see a gum surgeon or if you need a root canal done they can refer you
(22:20):
to go see an endodontist or you have crooked teeth and you want a better smile you can
come see people like us who are trained to be an orthodontist.
So there's definitely different specialties out there and your general dentist can kind
of coordinate seeing other specialists if you need that kind of care done.
Yeah and so for orthodontics which is you're in residency for how does that look like after
(22:43):
dental school I know you mentioned it already but where are the specifics with it like how
many years is it one year that takes more?
For orthodontics it depends on the program and I can tell you about my personal journey
to applying for and becoming an orthodontist.
I knew my second year or maybe halfway between my second and third year I wanted to be an
(23:06):
orthodontist I actually didn't know anything about the application process.
It was me meeting another resident and talking to them that I figured out you know that there's
different programs and different structures to the programs.
To apply for orthodontics you first need to consider if you want to do a two-year or three-year
program at Penn it's a two-year program.
A lot of programs are three years that's something you can consider.
(23:29):
Another thing you want to consider is maybe the cost of the program.
I'm at a private program so tuition is definitely higher.
There are public programs out there where you can save a lot of money by applying for
and going to those programs.
You have to take what's called a GRE so that is a standardized test with critical reading
and math section.
It's scored out of I think 700 points per second and so I tried to aim around at least
(23:58):
600 points per section to apply.
The other thing that I wanted to consider for orthodontics was the location.
So as an orthodontist you have the flexibility when you start practicing you can apply for
anywhere across the country to work in but you do need to get a specialized license for
it but depending on which program you go to you can probably work anywhere you wish to
(24:22):
apply for work in.
It's really just a couple years of your life where you're deciding where would I like to
train in my residence.
Got it and why orthodontics are supposed to take an endodontist or a periodontist?
I guess one of the reasons of going to dental school is that you spend four years to decide
(24:43):
if you want to be a general dentist or if you resonate more with a specific field.
So for ortho specifically I fell in love with it because of the lifestyle and the type of
work that we do as an orthodontist and so it's a little bit different from general dentistry
(25:05):
and other careers in that it's a lot of thinking.
When we look at the cases in orthodontics we have to treatment plan by looking at x-rays,
looking inside the mouth, all of this but we have to think about an overall picture
of how we want someone's smile to look like and so you have to think about ways to treat
crowding, misaligned teeth, all of this in relation to the skeletal structure of a patient
(25:32):
and that's not simply going in and just treating one tooth at a time.
Sometimes it is but it really is about coordinating an overall smile for someone and I kind of
like doing that.
When I shadowed orthodontists and figured out that's what they're doing every day,
that's how I decided on that field.
But I did consider being oral surgery and oral scan for a hot second but first you'll
(25:58):
learn in dental school after you shadow which ones you like more and maybe which one you
think.
Okay I definitely appreciate and respect that field but I couldn't see myself doing that.
And so orthodontics as we look more into it you were talking about things like misalignment,
malocclusion, can you explain what those are for people who may be listening or watching
(26:22):
this who may not know?
Yeah okay there's actually a lot of things in orthodontics that we have to consider.
It's not just about crooked teeth at the end of the day and that's something I didn't actually
realize until I got to residency myself.
But when we are looking at someone's teeth we're actually looking at the teeth in relation
to the entire skeletal structure.
(26:43):
And so there's actually I'll give you a little bit of an overview but there's actually three
dimensions that we look at as an orthodontist.
So the first is the sagittal dimension, the second is the transverse and the third is
the vertical.
So we look at how your teeth are oriented to your entire face and skeletal structure
in these three dimensions.
(27:04):
So when we treat people orthodontically speaking we not only have to look at your teeth but
we have to take all these x-rays to get measurements as well and see exactly how we can move the
teeth so that you still have healthy bone structure at the very end.
And so things like having an overbite that would be a vertical dimension.
(27:26):
So that's like if you look at my teeth it's like how much overlap do I have between my
top and my bottom teeth.
And then sometimes we also look at how narrow your palatal structure is and that can also
relate to other things in your overall health like if you have sleep apnea, you have difficulty
(27:48):
sleeping or if you're a mouth breather that's all related to orthodontics as well.
And then so I covered the transverse, I covered the sagittal and verticals up and down.
So it's not just crowding but it's also how your teeth are related to the smile.
So if patients come in and they're like oh I'm not happy about how my smile is looking
(28:10):
because I have a big overjet and my teeth are very proclined which means they're outward
facing.
We can also do things in orthodontics to kind of help bring those teeth in a little bit
and maybe tuck them in and then also level them upwards, things like that.
Those misalignments are kind of based on what we see is it mostly like people are born with
(28:32):
it or is it a byproduct?
That is a really great question.
I think there's a lot of research that's being done on that still.
So not only is there a genetic component to it but we also talked about habits that can
lead to crooked, crowded misaligned teeth.
So some common habits that we look at as an orthodontist might be nail biting, tongue
(28:57):
threading, does your tongue sit against your teeth and when you swallow does it push forward?
So some things that we study are in some cases people have what's called an open bite and
when they try to swallow and their teeth don't touch in the front, their tongue might push
forward between your teeth.
And so that's something that we've actually been discussing with our faculty and our lectures.
(29:20):
Did the open bite come first or did the tongue thrust come first?
Either way it's our job to kind of get it together and then retrain some of these habits
that the patients come in with.
There's both a genetic and a ritual component to it.
Got it.
And you know when it comes to the concept and the reality of straight teeth, right,
I think nowadays we see a lot online that it's more of like an ideal, right?
(29:44):
Like it's a physical ideal that oh they have perfect teeth, they have beautiful teeth,
they have straight teeth, right?
So there's definitely a societal view of what's seen as ideal and it's perfect when it comes
to straightness of teeth, right?
But when it comes to actual physical health, is there a benefit when one has a straighter
(30:04):
teeth as opposed to let's say someone with a lot of crowding or?
I think the biggest one for me is that everyone out there should be flossing.
But if you have a watered teeth, it's really hard to not only floss but also sometimes
it can affect your speaking, your confidence, eating.
(30:25):
A lot of different things can be affected by the way that your teeth might come together.
And so it's definitely you can improve your oral hygiene by straightening your teeth with
orthodontics in addition to some of the other things that people might see like, oh, I just
want a straighter smile and I want to feel more confident when I go outside.
(30:49):
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But still, it's like people do want to fix these crookedness of teeth, right?
Or over-crowding, or misalignment, overbites, underbites, and stuff.
And when it comes to fixing these things, we usually, at least from what I know, we hear
of three different things, right?
(34:04):
They also know what my dentist have told me or what I overhear them say is braces, clear
liners, or like invisible line, right?
And retainers.
I guess this would be more in your expertise.
When would one need braces over invisible line or overreach it?
Yeah.
(34:25):
So actually in our program, we offer a wide variety of treatment modalities.
So we can give people braces, just the traditional ones that are metal, but we also offer invisible
line, which are clear retainer trays with attachments that go on your teeth.
The force of the attachments actually push your teeth using the clear liners.
We also have ceramic braces.
(34:46):
Part of it is up to patient preference.
So if someone comes in and they're like, I definitely want metal braces.
I don't want invisible line.
We can do that.
But in some cases, if we are offering invisible line, we need to make sure that patients can
qualify for invisible line because research has shown that invisible line is better at
some movements over others.
(35:07):
And so it's our job to kind of guide the patient to the right treatment modality for their
case.
So that's kind of what we're learning in residency right now as well is which one should we recommend
over the other and why is it more beneficial to do one versus the other?
Yeah, I got it.
And you know, again, such beautiful work to be able to restore teeth or to fix one's alignment,
(35:32):
right?
Like we didn't just talk about the self-confidence that teeth has connections with, but also
possible physical problems or health problems that can arise, right?
Like you said, with the crowding of teeth, it can be more susceptible to other problems
within the teeth, right?
What do you think would be your message as a dentist to someone who may be burdened down
(35:58):
by their teeth, whether it's crooked or overcrowded?
What would be your message to them as someone who's gone through years of education and
training to potentially give them hope to get the teeth as well?
I would say so the first thing I want people to understand about orthodontics is that it's
(36:21):
not simply something that can happen overnight.
And also, it's never too late to go into an orthodontist.
So some people think I miss the train at 12 or 13 years old, I never had braces, I miss
the train is too late and I can't go in right now.
I've seen patients who are encompassing a wide range of ages and it's really never too
(36:45):
late to come in and at least get a consultation.
If you are thinking about it, just go into your nearest orthodontist today.
The other thing is the change that I see in someone before getting braces and after starting
braces, I really do think that it's worth it to go in and at least get a consultation
(37:09):
because your orthodontist, even if you think, oh, it's just something small, your orthodontist
can also point out things that maybe you haven't realized yourself before.
And so I really think there is a great benefit to doing that.
And then at the same time, if you are thinking about going into this field yourself, don't
be intimidated or think that you can't do it.
(37:32):
I really do think that it is hard work, but I really do think it's such a rewarding career
path.
And so if you are thinking about it, please reach out to me.
There's a lot of other people who are doing this as well.
And so I would like to help anyone who is thinking about this.
I love that.
And just as a final thought, again, we're here for National Dentist Day tomorrow.
(37:55):
Yes, you have your own day and you deserve it.
You deserve a week, you deserve a month.
You know, being a dentist, whatever specialty you make or general dentist, you really do
make the executive decisions on people's oral health and dental health, which again, not
only has physical health and physical benefits, but there's a lot of psychosocial aspects
(38:20):
involved to this field.
And I can't imagine also the stress that you feel hearing people's stories about their
teeth, stories of disappointment, stories of fear.
And as a dentist, you try to give hope and you try to fix what can be fixed.
How do you decompress from all of this at the end of the day?
(38:43):
I'm blessed in that right now I live in the East Coast, but my sister is also out here
in the East Coast.
So even though I live in Philly, my sister is in DC.
So I'm actually in DC this weekend hanging out with her.
I think I like taking time on the weekends.
Dentistry is great because you can work as much as you want or you can take weekends
off as well.
But this weekend, I'm here in DC eating some good food, just relaxing.
(39:08):
And so I think it's important to take care of your mental health too.
Dentistry as a career is stressful.
It's very high intensity and high pace.
If that's something you like, this is a great field for you.
But at the same time, it's okay to just relax and chill and spend time with family, spend
time with your friends and enjoy life while you're doing all of this.
(39:31):
Dr. Vivian, thank you so much for spending your Sunday with me.
I am always just so inspired by all of the work that you do.
And I love following your orthodontics journey.
I'm living vicariously per se because I am nowhere close to dentistry or within the dental
(39:52):
field, but I love following your journey and all of the great things.
I have a lot of things to say, but I propose that we just call it March, National Dentistry
Month.
That's it.
If you haven't seen your dentist, please go see your dentist.
Give them a shout out.
Give them some love.
I'm sure they'd love to see you.
Thank you for having me.
Hi friends, happy December 22nd.
(00:07):
I cannot believe it.
Christmas is around the corner.
But honestly though, this year, I'm not really feeling the holiday season.
Is it just me or what?
But that doesn't matter because I'm actually flying out today to LA to be with my family
next week for Christmas time.
And I hope you all have a great rest and a joyous time during this holiday weekend as
(00:28):
well.
This episode is such a personal topic to me because it is one that is closely related
to one of my most unforgettable moments as a child.
And I would like to thank many of you too.
The dentist.
You have no idea how many times I had to go to the dentist as a kid.
For some reason, I always had cavities.
Despite not even eating too much sweets.
(00:49):
I cannot remember how many root canals I've had on my molars, ultimately leading to it
being extracted.
Whenever I think of the dentist, all I can think of is pain and trauma.
I can still hear and feel the drilling, the visceral feeling of my tooth pulp being picked
on by the sharp dental instruments, the blood I spat on the continuous water running sink,
(01:12):
and just the numbing and throbbing pain down in my jaw that I couldn't ward off by any
well wishes.
It was only in the past few years since college that I actually looked forward going to the
dentist as all of my cavity and infection issues have been resolved.
Now, I can enjoy and get excited about my teeth cleaning every 6 months, try new teeth
cleaning devices at home, and even splurge in luxurious activities like teeth whitening.
(01:36):
But this brings out an important topic when it comes to teeth.
Why we do all of these things outside of just general oral health is because we want to
have a shame-free smile.
Smiling is such an important part of life.
I mean, it is the universal symbol of happiness.
There definitely are life moments when we don't want to and can't smile.
Heartbreaks, I'm going through one recently, grief, and even just a stress-filled day.
(02:02):
But there are also reasons why there are those who choose not to smile, simply because of
how it looks on them.
According to a 2019 survey of 2000 Americans by the company Snow Teeth Whitening, 57% of
people said they covered their mouths when they laugh because they are ashamed of their
teeth's appearance.
With 7 in 10 people admitting self-consciousness about their teeth due to lack of whiteness,
(02:24):
crookedness, and even gaps between them.
This reminds me of a time when I was seeing a patient in the clinic years ago trying to
get their health and medication history.
The whole encounter, she was turning her face away from me and covering her mouth.
I realized it was because she was trying to hide her mouth, which had multiple missing
teeth.
Truly, the way our teeth look has a huge impact not only in our self-perception, but also
(02:48):
in how we believe the world perceives us, thereby affecting our confidence and self-esteem.
But beyond just the dental aesthetics of teeth shade and color, there definitely exists an
array of skeletal issues of the mouth, teeth, and jaw that can affect not only our psychosocial
aspect but also our general health and quality of life.
Teeth and jaw malformations and misalignments may affect our breathing, our sleep, what
(03:12):
and how we eat, and the daily activities we may all partake in life.
The field of orthodontics is a specialty of dentistry that deals exactly with these, malpositioned
teeth and jaws, misaligned bite patterns, and even malocclusion of the teeth itself.
This opens up the conversation to treatment modalities that are usually commonly known,
such as traditional braces, clear aligners like Invisalign, and retainers.
(03:37):
Today, I have the honor of being joined by my friend, Dr. Vivian Chen, a dentist and
current orthodontics resident at the University of Pennsylvania School of Dental Medicine.
She was a Fulbright Research Fellow in Chengdu, China, where she was a research assistant
at Sichuan University's Laboratory of Oral Diseases, with a focus on dental public health.
(03:57):
She was also a research assistant at the University of California San Francisco School of Dentistry's
Department of Oral Facial Sciences.
This was recorded back in March for National Dentist Day, and we talked just about that.
Dentistry, her passion behind it, what is orthodontics, and why is restoring smiles
so important?
(04:18):
I hope you enjoy today's episode, and I hope that we all smile more as each day passes.
(04:48):
We have a day I didn't know actually.
Chris approached me and was like, let's do it for National Dentist Day.
And I was like, wait, when is that?
Hi, everyone.
I am Dr. Vivian.
I am a first year orthodontics resident at Penn.
I did my undergrad at Columbia, New York.
(05:08):
I did my dental education in San Francisco, and I just moved to Philly last summer.
And I actually started this account to inspire people to want to do dentistry, people who
are interested in orthodontics, or if you just care about your oral health.
Yeah, I have some friends in the dental space.
I'm not a, you know, for someone not in dentistry, I love having dentists on on the pod.
(05:33):
We had Dr. Joyce come on.
We had a duo come on for the first season.
I had cavities growing up and had like two extractions and root canals.
So even though I'm so traumatized by the dentist, I love hearing their stories and I love hearing
about their field.
So again, thank you for being with me today.
Again, you graduated from UCSF for your UBS degree, right?
(05:59):
Which I heard is such a great school.
And then now you're at U Penn for your residence and for your orthodontics residency.
And you were talking about how you created this account to inspire other people.
I wanted to know what's your inspiration for entering the field.
So I actually came to the realization that I wanted to be a dentist maybe halfway through
(06:20):
my college experience.
My mom is in the healthcare field.
She's a physician.
And so growing up, she was always like, you should consider being a doctor.
It's a state profession, all that.
And I was always motivated by her, but I didn't know if that's exactly what I wanted to do.
And so in college, I actually majored in biology and I had a visual arts minor.
(06:44):
I kind of had an existential crisis halfway through college.
I was like, I don't know if I want to be pre-med.
It's so cutthroat.
I don't know if I vibe with the people.
And so during a painting class, one of my professors was like, have you ever thought
about doing dentistry?
And I was like, wait, what?
I didn't know that was like the field that we went into.
And so I shadowed a dentist.
(07:04):
I went on a mission trip actually to Panama and Honduras halfway through college just
to see what it was like to kind of get my feet wet in that field.
And I came back loving it.
And I didn't know I wanted to be an orthodontist either when I first started out, you know,
being creedental, but it's been a really good journey since then.
And I think dentistry is great because it combines science, patient care, and art as
(07:29):
well.
And I just think that it was a really good blessing that I landed on this in college.
Yeah.
I mean, the field is definitely an art, especially when I'm in the dentist.
Yeah, they're like thin fillings.
You really have to be so precise because we're working in millimeters.
When we're getting graded on our crown preps or fillings, they grade by the millimeters.
(07:50):
So you have to be so precise with your hand skills too.
That's something that I joined with Dennis.
Yeah.
I can't imagine.
Your journey to dentistry is like something, I guess, like you said, you didn't really
expect or that it's not one of those, oh, ever since I was a kid, I wanted to be a dentist.
And yet the whole journey to get where you are now is such a long road, right?
(08:14):
Four years of undergrad, which is so hard, especially biology, and then four years of
dental school and all of your rotations, and then now you're in residency.
Do you have any regrets pursuing the field, being where you are now, given that there's
so much time involved and for the most part, so much money involved, right?
It is a lot of time commitment, a lot of money commitment.
(08:38):
So I would say to anyone who is thinking about dentistry, I personally think that four years
of college, four years of dental school, and on top of that, I'm doing two years of residency,
I was prepared to go into it just because I knew about how long the schooling would
(08:58):
take from, you know, my mom talked about a lot.
And she actually had kids when she was in residency.
And so that's something I had to think about too, when I was considering this field, definitely
something that you have to buckle down on and work hard at.
But at the same time, I do think it's such a rewarding career because dentistry is a
(09:19):
lifetime career, and people will always need someone to take care of their teeth.
So that's kind of what keeps me going.
At the same time, you're getting to help people every day.
So that's kind of my big motivator as well.
I really like helping patients and seeing them smile at the end of the day.
That makes me really happy and keeps me going.
We know that like doctorate degrees, especially within clinical and dentistry or medicine,
(09:43):
are so expensive, right?
And the six figures, but I remember like reading a statistic on Instagram, I think last year,
right before I had my other episode with another dentist, and it was showing how the top six
careers in the United States and the most student loans, the top five or six dentistry,
(10:05):
orthodontist, yeah.
So this mountain of finances is a very big topic, right, and it's something for students
to think about, pre-dental or dental students.
Given that mountain, and you probably answered this already, what would be your advice to
a student who is hopeful to become a dentist and take care of people with dental health,
(10:30):
but are faced with this daunting statistic of just amount of student loans?
That's a really great question.
I touched on this already, but dentistry is a lifetime career.
And so if you are passionate about dentistry, I do believe that we can get out of this field,
even though we have to take a lot of, you know, I personally have a lot of student loans,
(10:50):
I don't know about other people, but I do believe that through helping people and, you
know, starting my career as a dentist, I will be able to make it back because it is a simple
career.
People always need a dentist.
At the same time, there are other opportunities out there that you can apply for a scholarship.
I know there's scholarship through the Navy, through the military that you can apply for.
(11:11):
And I personally didn't apply for this, so you might have to do a little bit of research
yourself, but you can apply going into it with four years of dental school tuition covered.
You'll just for every year that they cover your tuition, you'll have to make it back
by working for the military.
But I heard that you have a lot of great benefits that come with it, and you are also employed
(11:33):
straight out of school.
And also if you want to do residency, they let you do that too.
And I think there's also a chance they might be able to cover that for you as well.
So there are definitely financial opportunities out there for you to apply for to handle the
financial loans.
And I guess it also will come to a point where you mentioned the REBEE, where I guess the
(11:56):
benefits outweigh all of the costs and all of the costs that you may have in mind.
Like you were talking about being with patients.
And I always call Ventus the restorer of smiles.
And I said this story before in the episode, but I work in a cardiac clinic.
And I will never forget how there was this one day when an other patient came and we
(12:20):
were getting her medical history.
And the whole time that she was talking, she was just covering her mouth with her hands.
And so I couldn't see her mouth the whole interview.
And then I was looking more into the history and then her family member came in.
We found she had crooked teeth and she had missing teeth all over her mouth.
And that made me realize that, well, the teeth is really like a source of a lot of consciousness
(12:45):
for a lot of people.
And it really places a lot of hold on someone's demeanor and someone's confidence.
And especially that patient, they didn't want to smile.
They didn't want to show her teeth because she had no teeth or the teeth are misaligned.
And it just shows that for dentists, those who can fix the teeth and put an implant or
(13:07):
fix any misalignment that we'll talk more about, you truly do God's work.
Restoring people's confidence and people's quality of life.
That being said, as a dentist yourself, I was just a bystander.
I was a third person in the story.
What do you think are the best thoughts about your time?
(13:28):
That's such a compliment to hear.
But honestly, I think that everyone in the healthcare field plays an important role in
restoring someone's overall health and confidence.
I think that I personally have seen that firsthand though, when I was in dental school.
The first time I delivered my first set of dentures to a patient, they really had no
teeth and they had trouble speaking and chewing.
(13:50):
I think that is one of the best feelings in the world when you can truly see firsthand
the way that you are impacting someone's life through dentistry.
To some people, it might have just been a graduation requirement to deliver a set of
dentures.
But the feelings that come with it, there's really nothing that can compare to it.
And I'm sure that a lot of healthcare workers can say the same in every area that is patient
(14:14):
or consumer facing.
We have experienced some of these same feelings.
So I think that's the best part of dentistry for me.
And now maybe some more transparent side.
What do you think are the least parts about the job that you may not like?
I will say that being on the side of being a resident is a little bit better than being
(14:40):
a dental student.
I think dentistry, going back to my previous point, you definitely have to think about
how long you're in school for.
And when you're learning things for the first time, it takes a little bit to get to a place
of confidence.
So I think there is a little bit of imposter syndrome that goes with it.
(15:03):
That's one of my least favorite parts because when you're learning something for the first
time, there's always this feeling where your patient is wondering, am I your first patient?
Dealing with that, you don't want to tell them, oh, you're my first patient.
And so you do have to do a little bit of more preparation going into it.
(15:28):
Definitely giving a facade that you are the most confident provider out there, even though
internally you might not feel that way.
But I just want everyone to know if you're thinking about going into healthcare or dentistry,
everyone goes through this feeling.
You wouldn't be alone if you felt this way.
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(20:45):
about it.
I didn't know how expansive the actual field is.
I didn't know there were different types of dentists years ago.
I remember, I think I had to go to a doctor and they were like, yeah you have to go to
an oral surgeon or you have to go to a periodontist and an endodontist.
There's more than one dentist.
I can kind of explain different types of dentists in dentistry but I get this question from
(21:10):
I get this question from a lot of people too when I say I want to be an orthodontist people
are like what is that and how does it differ from being a general dentist?
And so in dentistry you can go to dental school usually it's four years there's some programs
that are three but usually it's four years of dental school and then when you graduate
from that you can go straight into being a general dentist.
So general dentist takes care of I call them kind of the quarterback of the field of dentistry
(21:35):
they coordinate your overall dental health and your overall treatment plan what it takes
for you to have a healthy smile and healthy gums all of that.
So they do a lot of things they do an exam for you they can do cleanings they can do
fillings you know general dentists they are so amazing they cover everything in dentistry
but if there are some procedures that they think I want you to go see a specialist for
(21:58):
they can also refer you to see someone who's more specialized.
So for example an oral surgeon if they want to take wisdom teeth out or if you have pathology
that maybe needs an extra set of eyes or an extra set of x-rays that are more specialized
or you can go see a gum surgeon or if you need a root canal done they can refer you
(22:20):
to go see an endodontist or you have crooked teeth and you want a better smile you can
come see people like us who are trained to be an orthodontist.
So there's definitely different specialties out there and your general dentist can kind
of coordinate seeing other specialists if you need that kind of care done.
Yeah and so for orthodontics which is you're in residency for how does that look like after
(22:43):
dental school I know you mentioned it already but where are the specifics with it like how
many years is it one year that takes more?
For orthodontics it depends on the program and I can tell you about my personal journey
to applying for and becoming an orthodontist.
I knew my second year or maybe halfway between my second and third year I wanted to be an
(23:06):
orthodontist I actually didn't know anything about the application process.
It was me meeting another resident and talking to them that I figured out you know that there's
different programs and different structures to the programs.
To apply for orthodontics you first need to consider if you want to do a two-year or three-year
program at Penn it's a two-year program.
A lot of programs are three years that's something you can consider.
(23:29):
Another thing you want to consider is maybe the cost of the program.
I'm at a private program so tuition is definitely higher.
There are public programs out there where you can save a lot of money by applying for
and going to those programs.
You have to take what's called a GRE so that is a standardized test with critical reading
and math section.
It's scored out of I think 700 points per second and so I tried to aim around at least
(23:58):
600 points per section to apply.
The other thing that I wanted to consider for orthodontics was the location.
So as an orthodontist you have the flexibility when you start practicing you can apply for
anywhere across the country to work in but you do need to get a specialized license for
it but depending on which program you go to you can probably work anywhere you wish to
(24:22):
apply for work in.
It's really just a couple years of your life where you're deciding where would I like to
train in my residence.
Got it and why orthodontics are supposed to take an endodontist or a periodontist?
I guess one of the reasons of going to dental school is that you spend four years to decide
(24:43):
if you want to be a general dentist or if you resonate more with a specific field.
So for ortho specifically I fell in love with it because of the lifestyle and the type of
work that we do as an orthodontist and so it's a little bit different from general dentistry
(25:05):
and other careers in that it's a lot of thinking.
When we look at the cases in orthodontics we have to treatment plan by looking at x-rays,
looking inside the mouth, all of this but we have to think about an overall picture
of how we want someone's smile to look like and so you have to think about ways to treat
crowding, misaligned teeth, all of this in relation to the skeletal structure of a patient
(25:32):
and that's not simply going in and just treating one tooth at a time.
Sometimes it is but it really is about coordinating an overall smile for someone and I kind of
like doing that.
When I shadowed orthodontists and figured out that's what they're doing every day,
that's how I decided on that field.
But I did consider being oral surgery and oral scan for a hot second but first you'll
(25:58):
learn in dental school after you shadow which ones you like more and maybe which one you
think.
Okay I definitely appreciate and respect that field but I couldn't see myself doing that.
And so orthodontics as we look more into it you were talking about things like misalignment,
malocclusion, can you explain what those are for people who may be listening or watching
(26:22):
this who may not know?
Yeah okay there's actually a lot of things in orthodontics that we have to consider.
It's not just about crooked teeth at the end of the day and that's something I didn't actually
realize until I got to residency myself.
But when we are looking at someone's teeth we're actually looking at the teeth in relation
to the entire skeletal structure.
(26:43):
And so there's actually I'll give you a little bit of an overview but there's actually three
dimensions that we look at as an orthodontist.
So the first is the sagittal dimension, the second is the transverse and the third is
the vertical.
So we look at how your teeth are oriented to your entire face and skeletal structure
in these three dimensions.
(27:04):
So when we treat people orthodontically speaking we not only have to look at your teeth but
we have to take all these x-rays to get measurements as well and see exactly how we can move the
teeth so that you still have healthy bone structure at the very end.
And so things like having an overbite that would be a vertical dimension.
(27:26):
So that's like if you look at my teeth it's like how much overlap do I have between my
top and my bottom teeth.
And then sometimes we also look at how narrow your palatal structure is and that can also
relate to other things in your overall health like if you have sleep apnea, you have difficulty
(27:48):
sleeping or if you're a mouth breather that's all related to orthodontics as well.
And then so I covered the transverse, I covered the sagittal and verticals up and down.
So it's not just crowding but it's also how your teeth are related to the smile.
So if patients come in and they're like oh I'm not happy about how my smile is looking
(28:10):
because I have a big overjet and my teeth are very proclined which means they're outward
facing.
We can also do things in orthodontics to kind of help bring those teeth in a little bit
and maybe tuck them in and then also level them upwards, things like that.
Those misalignments are kind of based on what we see is it mostly like people are born with
(28:32):
it or is it a byproduct?
That is a really great question.
I think there's a lot of research that's being done on that still.
So not only is there a genetic component to it but we also talked about habits that can
lead to crooked, crowded misaligned teeth.
So some common habits that we look at as an orthodontist might be nail biting, tongue
(28:57):
threading, does your tongue sit against your teeth and when you swallow does it push forward?
So some things that we study are in some cases people have what's called an open bite and
when they try to swallow and their teeth don't touch in the front, their tongue might push
forward between your teeth.
And so that's something that we've actually been discussing with our faculty and our lectures.
(29:20):
Did the open bite come first or did the tongue thrust come first?
Either way it's our job to kind of get it together and then retrain some of these habits
that the patients come in with.
There's both a genetic and a ritual component to it.
Got it.
And you know when it comes to the concept and the reality of straight teeth, right,
I think nowadays we see a lot online that it's more of like an ideal, right?
(29:44):
Like it's a physical ideal that oh they have perfect teeth, they have beautiful teeth,
they have straight teeth, right?
So there's definitely a societal view of what's seen as ideal and it's perfect when it comes
to straightness of teeth, right?
But when it comes to actual physical health, is there a benefit when one has a straighter
(30:04):
teeth as opposed to let's say someone with a lot of crowding or?
I think the biggest one for me is that everyone out there should be flossing.
But if you have a watered teeth, it's really hard to not only floss but also sometimes
it can affect your speaking, your confidence, eating.
(30:25):
A lot of different things can be affected by the way that your teeth might come together.
And so it's definitely you can improve your oral hygiene by straightening your teeth with
orthodontics in addition to some of the other things that people might see like, oh, I just
want a straighter smile and I want to feel more confident when I go outside.
(30:49):
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But still, it's like people do want to fix these crookedness of teeth, right?
Or over-crowding, or misalignment, overbites, underbites, and stuff.
And when it comes to fixing these things, we usually, at least from what I know, we hear
of three different things, right?
(34:04):
They also know what my dentist have told me or what I overhear them say is braces, clear
liners, or like invisible line, right?
And retainers.
I guess this would be more in your expertise.
When would one need braces over invisible line or overreach it?
Yeah.
(34:25):
So actually in our program, we offer a wide variety of treatment modalities.
So we can give people braces, just the traditional ones that are metal, but we also offer invisible
line, which are clear retainer trays with attachments that go on your teeth.
The force of the attachments actually push your teeth using the clear liners.
We also have ceramic braces.
(34:46):
Part of it is up to patient preference.
So if someone comes in and they're like, I definitely want metal braces.
I don't want invisible line.
We can do that.
But in some cases, if we are offering invisible line, we need to make sure that patients can
qualify for invisible line because research has shown that invisible line is better at
some movements over others.
(35:07):
And so it's our job to kind of guide the patient to the right treatment modality for their
case.
So that's kind of what we're learning in residency right now as well is which one should we recommend
over the other and why is it more beneficial to do one versus the other?
Yeah, I got it.
And you know, again, such beautiful work to be able to restore teeth or to fix one's alignment,
(35:32):
right?
Like we didn't just talk about the self-confidence that teeth has connections with, but also
possible physical problems or health problems that can arise, right?
Like you said, with the crowding of teeth, it can be more susceptible to other problems
within the teeth, right?
What do you think would be your message as a dentist to someone who may be burdened down
(35:58):
by their teeth, whether it's crooked or overcrowded?
What would be your message to them as someone who's gone through years of education and
training to potentially give them hope to get the teeth as well?
I would say so the first thing I want people to understand about orthodontics is that it's
(36:21):
not simply something that can happen overnight.
And also, it's never too late to go into an orthodontist.
So some people think I miss the train at 12 or 13 years old, I never had braces, I miss
the train is too late and I can't go in right now.
I've seen patients who are encompassing a wide range of ages and it's really never too
(36:45):
late to come in and at least get a consultation.
If you are thinking about it, just go into your nearest orthodontist today.
The other thing is the change that I see in someone before getting braces and after starting
braces, I really do think that it's worth it to go in and at least get a consultation
(37:09):
because your orthodontist, even if you think, oh, it's just something small, your orthodontist
can also point out things that maybe you haven't realized yourself before.
And so I really think there is a great benefit to doing that.
And then at the same time, if you are thinking about going into this field yourself, don't
be intimidated or think that you can't do it.
(37:32):
I really do think that it is hard work, but I really do think it's such a rewarding career
path.
And so if you are thinking about it, please reach out to me.
There's a lot of other people who are doing this as well.
And so I would like to help anyone who is thinking about this.
I love that.
And just as a final thought, again, we're here for National Dentist Day tomorrow.
(37:55):
Yes, you have your own day and you deserve it.
You deserve a week, you deserve a month.
You know, being a dentist, whatever specialty you make or general dentist, you really do
make the executive decisions on people's oral health and dental health, which again, not
only has physical health and physical benefits, but there's a lot of psychosocial aspects
(38:20):
involved to this field.
And I can't imagine also the stress that you feel hearing people's stories about their
teeth, stories of disappointment, stories of fear.
And as a dentist, you try to give hope and you try to fix what can be fixed.
How do you decompress from all of this at the end of the day?
(38:43):
I'm blessed in that right now I live in the East Coast, but my sister is also out here
in the East Coast.
So even though I live in Philly, my sister is in DC.
So I'm actually in DC this weekend hanging out with her.
I think I like taking time on the weekends.
Dentistry is great because you can work as much as you want or you can take weekends
off as well.
But this weekend, I'm here in DC eating some good food, just relaxing.
(39:08):
And so I think it's important to take care of your mental health too.
Dentistry as a career is stressful.
It's very high intensity and high pace.
If that's something you like, this is a great field for you.
But at the same time, it's okay to just relax and chill and spend time with family, spend
time with your friends and enjoy life while you're doing all of this.
(39:31):
Dr. Vivian, thank you so much for spending your Sunday with me.
I am always just so inspired by all of the work that you do.
And I love following your orthodontics journey.
I'm living vicariously per se because I am nowhere close to dentistry or within the dental
(39:52):
field, but I love following your journey and all of the great things.
I have a lot of things to say, but I propose that we just call it March, National Dentistry
Month.
That's it.
If you haven't seen your dentist, please go see your dentist.
Give them a shout out.
Give them some love.
I'm sure they'd love to see you.
Thank you for having me.
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