A Guide to the Problem-Solution Research Paper Senior Challenge Committee These recommendations on the mechanics and format of the research paper reflect the practices of the Modern Language Association of America (MLA). Updated by the Hodgson Senior Challenge Committee: August 2007 Specific Requirements for the Research Paper The final draft of the paper must be produced and saved by the student on an adequate word processing system. It should be double-spaced and typed in 12point Times New Roman font with 1” margins. Using a variety of reference materials is encouraged. Sources need to be reliable and current. Each career area instructor may have different requirements regarding the sources used in that area’s papers. Students are encouraged, and in some cases required, to utilize sources of information found outside of the school. The paper shall be five to eight pages in length. Papers surpassing eight pages in length will only be graded through the eighth page. The number of pages reflects the introduction, body, and conclusion of the paper only and does not include the outline, works cited page, and/or visuals. Successfully completing requires independent and efficient work as well as the ability to follow directions and meet deadlines. 1 The Problem-Solution Format Description Being able to identify and solve problems in the workplace and in everyday life are essential skills for all productive citizens. Problem-solution essays inform readers about problems and propose methods to address the problems. People draft and present problem-solution essays daily in business, government, education, and other professions. Problem-solution essays and presentations are an essential component of the world of work. In most disciplines and professions, problem solving is a basic way of thinking. For example, health professionals use problem-solving skills when diagnosing and addressing patient health concerns; mechanics maintain systems and use sophisticated tools and problem-solving techniques to perform 60,000 mile checkups on cars, and optimize performance in turbocharged engines; politicians and community leaders propose solutions to troubling political and social problems; attorneys find legal precedents to solve their clients’ problems; teachers make decisions everyday about how to help students with specific problems; carpenters, plumbers, masons, electricians, and HVAC technicians are in continuous demand to solve difficulties for home and business owners; and business owners or managers must themselves be problem-solvers as they work with the public and plow through bureaucratic red tape. Problem-solution essays are a form of persuasive writing. In addition to identifying a problem and exploring its ramifications, the writer proposes a solution or solutions, recommends a course of action, and explains the reasons the recommended course of action is the best to pursue. The writer is arguing in favor of following the recommended course of action. Therefore, the writer must be aware of the reader’s needs and expectations. Does the reader understand the problem and its seriousness? What other solutions might the reader think of, and what objections might they have to the writer’s solution? An awareness of the audience, including their concerns and possible objections, is a central element of all effective persuasive writing. 2 Basic Features Each career area will have different expectations regarding information required in the paper. One career area may require only one solution, but an extremely detailed discussion of causes and steps in solving the problem; while another may require an indepth discussion of the problem’s history and an explanation why two possible methods of solving the problem are unacceptable. Thus, no one outline format will suit every paper. However, the following elements should be in all papers to some extent. While English teachers and career area teachers are the primary resources for organization issues, mentors may also offer suggestions. Introduction: (order of items within paragraph may vary; introduction may be more than one paragraph in length) - Identify the problem - State thesis - Gain the reader’s interest, perhaps by explaining why he should be concerned or describing the seriousness of the problem Present Problem: (more than one paragraph in length) - Describe the problem thoroughly - Be sure to address the following questions as they apply to the assigned problem, giving examples and explanations of each and supporting answers with research: What caused the problem? Who is affected by the problem? What are the effects of the problem? Why is it important? Where did it begin, or where is it most problematic? When did it become a problem? What background information would a lay reader (not someone in your career area) need to know to understand the issue? - What factors need to be considered when you think about how to “solve” your problem? What do you need to consider and what are your priorities? Present Solution(s): (more than one paragraph in length) - Describe, examine, and evaluate the solution or solutions. - If you have more than one solution to discuss, place the least acceptable first, then progress in order to the best solution. - Each discussion of a solution should Identify the solution Go through the pro’s and con’s (which can include cost, time, labor, feasibility, as well as how it meets or surpasses current industry standards…) - Some career areas may require papers to include a description of the steps necessary to implement the solution . - If more than one solution is required by your career area teacher, your paper should include a clear explanation of why your chosen solution is the best way to 3 address the problem. Anticipate and address any objections or reservations your audience may have. Conclusion: - Remind the reader of key points, benefits to your solution, or of the problem’s significance. - Call to action: What do you want your reader to do now or to better understand? 4 Preparing a Working Bibliography Once the subject has been chosen and approved, the next step is to search for and collect a list of POSSIBLE source materials and references. This list is referred to as the Working Bibliography. Recommended sources of information include: The electronic card catalog of a library Books and other materials within school UDLib/SEARCH or other sources of current magazine articles Specialized reference books (dictionaries, encyclopedias, handbooks, manuals, almanacs) DELCAT – the computerized catalog of all materials available at the University of Delaware’s Morris Library EBSCO database search INTERNET and CD-ROM Interviews (inside and outside of the school) In preparing a Working Bibliography, the first task is to list as many sources as might be helpful in researching the paper. Even those sources that are questionable should be included. Later, if some sources seem to be of no help, they can be dropped from the final list of works cited. The Working Bibliography can be added to at any time as new materials become available. Entries in the Working Bibliography must be listed in alphabetical order, and each entry must follow the prescribed MLA format. Correctly formatting these entries is essential because they will be used not only in the Working Bibliography, but also on the note cards and the Works Cited page of the research paper. All sources listed must be current, authentic, and appropriate to the topic. If the instructor has any questions concerning the source materials, the student must produce the actual materials or evidence of their existence within forty-eight (48) hours. 5 Bibliography and Works Cited Page Rules Italicize (as opposed to underline) the titles of books, magazines, newspapers, and journals. When a print source does not indicate the publisher, the place or date of publication, or the pagination, the following abbreviations should be inserted: n.p. n.d. n. pag. No place of publication/no publisher given No date of publication given No pagination given When typing bibliography or Works Cited page entries, one space is used after each punctuation mark. In listing two or more sources by the same person, the name is given in the first entry only. Thereafter, three hyphens and a period (---.) are used in place of the name. Bibliographies and Works Cited pages are always double-spaced. There are no extra spaces between entries. Bibliographies and Works Cited pages are always organized in alphabetical order. Each entry starts at the margin. Any subsequent line within the entry is indented five spaces. Capitalize every important word in a title, regardless of the style used in the original article. Months are abbreviated to the first three letters, except May, June, July, and Sept. 6 Bibliography and Works Cited Page Format MLA Style Guide Note- All entries on the Bibliography and Works Cited pages must be double-spaced. The examples on the following pages are single-spaced to save room. Book with One Author Silverstein, Herma. Threads of Evidence; Using Forensic Science to Solve Crimes. New York: Holt, 1996. Book with Two or Three Authors Biggar, Bill and Joe Myers. Danger Zones; What Parents Should Know about the Internet. Kansas City: Andrews and McMeel, 1996. Book with Four or More Authors Bisaccio, Dan, et al. Biological Diversity in the El Eden Preserve. Boston: Thomas & Sons, 2004. Book with an Editor (ed.) or Compiler (comp.) Mandelbaum, Paul, ed. First Words: Earliest Writing from Favorite Contemporary Authors. Chapel Hill: Algonquin, 1993. Gordon, Ruth, comp. Pierced by a Ray of Sun; Poems about the Times We Feel Alone. New York: HarperCollins, 1995. Book or Pamphlet with Corporate Author Time-Life, Inc. This Fabulous Century: 1950-1960. New York: Time, 1970. Centers for Disease Control. Tobacco. Washington: GPO, 1999. Newspaper article – Knickerbocker, Brad. “Sorting Through a School Tragedy.” Christian Science Monitor 22 print format April 1999: 1+. Magazine or Journal article – print format Smith, Jane. “Computers: Where are the Real Bargains?” Consumer Reports Dec. 1999: 54-58. Ryan, Katy. “Revolutionary Suicide in Toni Morrison’s Fiction.” African American Review 34 (2000): 389-412. Article in Print Collection (e.g. Opposing Viewpoints, Current Controversies) White, Lawrence. “Campus Speech Codes Do Not Violate Free Speech.” Censorship. Opposing Viewpoints. San Diego: Greenhaven, 1997: 93-97. Hepburn, Mary A. “Television Violence May Cause Youth Violence.” Youth Violence. Current Controversies. San Diego: Greenhaven, 1998: 91-94. Reference Book — Conger, Clement Ellis. “White House.” The World Book Encyclopedia. 2004 ed. 7 familiar with frequent, new editions “National Park System.” World Almanac and Book of Facts. 2004 ed. Weis, Elizabeth, et al. “Motion Pictures.” The New Encyclopaedia Britannica. 15th ed. 1998. “Ozawa, Seiji.” Current Biography Yearbook. 1998 ed. Reference Book — specialized, with single or infrequent new editions “Anne Sexton.” Encyclopedia of World Biography. 2nd ed. Detroit: Gale, 2002. "Italians." American Immigrant Cultures: Builders of a Nation. Vol. 1. New York: Simon & Schuster, 1997: 475-483. Hammond Atlas of the World. 2nd ed. Maplewood, NJ: Hammond, 1999: 188-9. “A Bell for Adano.” Masterplots. Vol. 1. Englewood Cliffs: Salem, 1976. Literary Work in a Collection (essay, trans. story, play, poem) Chaucer, Geoffrey. “The Knight’s Tale.” The Portable Chaucer. Trans. and Ed. Theodore Morrison. New York: Viking, 1977: 76-123. Shakespeare, William. “Twelfth Night.” Shakespeare: The Complete Works. Ed. G.B. Harrison. New York: Harcourt, 1968: 850-879. Online Database EBSCOhost Knickerbocker, Brad. “Sorting Through a School Tragedy.” Christian Science Monitor 22 April 1999: 1+. EBSCOhost. Joseph Moore Library, Paul M. Hodgson Vocational-Technical High School Library, Newark, DE. 10 Nov. 2001 < http://search.epnet.com>. History Resource "Mexican Americans." History Resource Center: US. Joseph Moore Library, Paul M. Center Hodgson Vocational-Technical High School Library, Newark, DE. 23 Sept. 2002 <http://galenet.galegroup. com/servlet/HistRC/>. Newsbank Perrin, Marlene J. “Single Book Gets City Reading, Talking.” Cedar Rapids Gazette 25 Nov. 2001: 1B. NewsBank. Joseph Moore Library, Paul M. Hodgson VocationalTechnical High School Library, Newark, DE. 4 Dec. 2001 <http://infoweb.newsbank.com>. SIRS Wilson, Ted. “How to Feed the World.” Christian Science Monitor 22 Apr. 1999: 3-4. SIRS. Joseph Moore Library, Paul M. Hodgson Vocational-Technical High School Library, Newark, DE. 13 Sept. 2002 <http://sks.sirs. com>. Encyclopedia “Cisneros, Sandra.” Encyclopedia Britannica Online. Joseph Moore Library, Paul M. Britannica Online Hodgson Vocational-Technical High School Library, Newark, DE. 25 Oct. 2004 <http://school.eb.com>. AP Photo Archive “Atomic Bomb Nagasaki.” Photograph. 9 Aug. 1945. AccuNet/AP Multimedia Archive. Joseph Moore Library, Paul M. Hodgson Vocational-Technical High School Library, Newark, DE. 5 Dec. 2001 <http://ap.accuweather.com>. Opposing “A Clone Can Exist with Full Human Dignity.” Opposing Viewpoints. Joseph Moore Viewpoints Library, Paul M. Hodgson Vocational-Technical High School Library, Newark, DE. 9 October 2002 <http://www.galenet.com/servlet/OVRC/>. 8 Websites Peterson, Susan Lynn. The Life of Martin Luther. 1999. 9 Mar. 2001 <http://pweb.netcom.com/~supeters/luther.htm>. National Rifle Association. A Parent’s Guide to Gun Safety. 12 Sept. 2000. 6 May 2003 <http://www. nrahq.org/>. The North Atlantic Right Whale. 18 Oct. 2003. Biology Dept., University of New Hampshire. 3 Apr. 2005 < http://www.unh.edu/projects/right_whale.htm>. Boshart, Rod. “GOP Candidates Gear Up for Tonight’s Debate in New Hampshire.” The Union Leader Online. 13 Dec. 1999. 31 Dec. 1999 <http://www.theunionleader. com>. CD-ROM Resources “The Media and Vietnam.” American Decades. CD-ROM. Detroit: Gale, 1998. Melina, Lois Ruskai. “Adoption.” Encyclopedia Americana 1998. Danbury: Grolier, 1998. “Bronte, Emily.” DISCovering Authors. CD-ROM. Detroit: Gale, 1999. Letter to the Editor /Editorial Sharma, Ratnesh K. Letter. Discover Feb. 1999: 12. Love, Robert. “Praise for Clinton.” Editorial. Rolling Stone 5 Aug. 1999: 7. Interview Telephone Kennedy, Edward. Telephone interview. 23 Nov. 1999. Personal Houlihan, Ted. Personal interview. 15 Feb. 2004. Email Message Young, John. “Off-Campus Privileges.” E-mail to the author. 1 Sept. 2005. (Note: The author is you, the writer of the paper. In this example, John Young sent an email to you, and you’re using information from that email in your paper.) Letter or FAX Slocum, Lee. Letter to the author. 12 Nov. 2005. (Note: The author is you, the writer of the paper. In this example, Lee Slocum sent a letter to you, and you’re using information from that letter in your paper.) Television or Radio Program “Deep Jungle: Monsters of the Forest.” Nature. Prod. Gene Gordon. Narr. Paul Christie. PBS. WGBH, Boston. 19 Sept. 2005. Lecture, Speech, or Address Brockhurst, John. “Slavery and Astronomy.” Hayden Planetarium, Boston. 19 May 2004. 9 Film or Video Napoleon Dynamite. Dir. Jared Hess. Perf. Jon Heder, Efren Ramirez, Jon Gries, Haylie Duff, Tina Majorino, and Diedrich Bader. Fox, 2004. To Kill a Mockingbird. Dir. Robert Mulligan. Perf. Gregory Peck and Robert Duvall. Twentieth Century Fox, 1962. Recording (CD, Audiocassette, LP) Chapman, Tracy. “Paper and Ink.” Telling Stories. Elektra, 2000. Dylan, Bob. “Blowin’ in the Wind.” Forrest Gump: The Soundtrack. Perf. Joan Baez. Sony, 1994. Musical Composition Chopin, Frederic. Waltz in A-flat Major, op. 42. Work of Art Cropsey, Jasper Francis. An Indian Summer Morning in the White Mountains. Currier Museum of Art, Manchester, NH. Online Images “Black Bear in Tree.” Bears and You in the North Cascades. National Park Service. 11 Sept. 2002. 28 Sept. 2005 <http://www.nps.gov/noca/bear.htm >. Online Audio Clips “Neil Armstrong’s Reactions to 1969 Moon Walk.” NASA Spacelink. NASA. 1 Mar. 1999. 12 Jan. 2003 <http://town.hall.org/radio/IMS/NASA/ 00394_ nasa_01_ITR.au>. Online Video Clips “Hurricane Victims on Rooftop.” CNN.com. Cable News Network. 30 Aug. 2005. 15 Sept. 2005 <http://www.cnn.com/video_archives/Katrina_2005/new _orleans/clip1.html>. 10 Copyright Guidelines Unless you ask permission of the copyright holder, the following guidelines must be followed when using other’s material in your multimedia presentation: Text Material Up to 10%, or 1000 words of copyrighted text, whichever is less, may be reproduced or otherwise used as part of a project or multimedia program created by a student for educational purposes. When copying a poem, you may use up to 250 words, but you are further limited to: three poems or portions of poems by one poet; or five poems or portions of poems by different poets from an anthology. Illustrations and Photographs A photograph or illustration may be used in its entirety, but no more than five (5) images of an artist or photographer may be incorporated into a student project. When using photographs and illustrations from a published collective work, not more than 10%, or 15 images, whichever is less, may be used. Video Up to 10% of a motion video, or three (3) minutes, whichever is less, may be used as part of a project created by a student for educational purposes. Music Up to 10% of a musical sound track, or 30 seconds, whichever is less, may be used as part of a project created by a student for educational purposes. Data Up to 10% of the cells in a database, or a total of 2500 cells, may be used. Important: Even if you follow the guidelines above, you must always cite each source you use. Please refer to your MLA Style Guide for help. Include on the opening screen of a multimedia program and any accompanying print material a notice, i.e., “Certain materials are included under Fair Use Exemption of the U.S. Copyright Law and have been prepared in accordance with Multimedia Fair Use Guidelines and are restricted from further use.” 11 Preparing a Preliminary Question Series Once the subject for research has been selected and a Working Bibliography has been constructed, it is time to begin a step-by-step plan to complete the paper. The nature of the problem-solution paper will help the student prepare a series of questions to guide research and analysis. At this stage the questions may be rough, but often the major topics will suggest themselves. The questions that the paper will answer become the basis for the Preliminary Question Series (PQS). The PQS functions as a general guideline to reading and research. Instead of wondering where to begin, the student simply finds the answers to questions The PQS is never carved in stone. As reading progresses and more information is gained, the questions can be revised and/or extended accordingly. Questions can be discarded if insufficient research materials exist, and questions can be added as additional sources become available. The questions should be listed in an order that makes sense to the continuity and focus of the paper. A Controlling Purpose or Thesis Statement should emerge as the list of questions is completed. The length and/or scope of the paper will determine the number of questions. (A general rule is one question per page, but if the questions are very broad or require in-depth research, this can vary.) PQS questions should be “fat.” In other words, because they serve as guides for the note cards, these questions should generate large amounts of information. It should be impossible to answer a PQS question in one word or phrase. On the following page is a sample of an appropriate Preliminary Question Series. 12 Sample Preliminary Question Series Topic: Impact of Terrorist Attacks on U.S. Immigrants Controlling Purpose or Thesis Statement: The calamitous attacks against the United States on September 11 have left immigrants with not only a less accepting mainstream American society, but also with dramatic changes to the economic and political aspects of their lives, perhaps for years to come, due to the government’s stringent changes to immigration policies. Questions: 1. Why do immigrants come to the United States? 2. What must immigrants do to fit into American society? 3. What impact have the 9-11 terrorist attacks had on American’s perception of immigrants? 4. What economic impact has 9-11 had on immigrant workers? 5. What solutions have been proposed to address post 9-11 immigration concerns? 6. What impact might implementing proposed solutions have on the nation? 13 How to Take Notes There are both SOURCE cards and NOTE cards in the research process. Follow the steps below to create a well-organized note-taking system. Start with any source of information. Source Card Take an index card for the first source. Write in the center of the card all the bibliography information for that source. (Use underlining to replace italics.) Label that source card “A” in the upper left-hand corner of the card. The second source will be labeled “B”, the third source “C”, and so on. DO NOT automatically write up a source card for every source in the Working Bibliography. Wait until you actually take notes from that source before you write a source card for it. Note Card 1. Take an index card for the first note card. In the upper left-hand corner of the card write the letter of the source you are using. 2. In the upper right-hand corner of the card write the number of the PQS question that this note will attempt to answer. 3. In the middle of the card write the FACT, IDEA, QUOTE, or VISUAL that you are using as a note. If it is a direct quote, it must be put in quotation marks. If it is paraphrased (in your own words), do not use quotation marks. 4. In the bottom right-hand corner, write the page number from which you got the note or visual (if appropriate). Information obtained from interviews, videotapes, other non-print sources, and most Internet material is written in the exact same way. The only difference will be the presence or absence of a page number in the bottom right-hand corner. On the following page is an example of a source card and a note card. 14 Source written in correct bibliography format Source Letter A Mowar, George. The Ancient Norse in Greenland and America. New York: Little, Brown and Co., 1995. Source Letter PQS Question Number A 5 The ancient Norse used the names of their gods and goddesses to name their ships. 54 One fact that answers the question Page Number 15 Your Responsibility as a Researcher If you are submitting a paper as your own research, then you have a responsibility to present your own findings. Too often, student researchers piece together the ideas of other people without adding their own insights, support, and color. How do you make your research your own? Gain control over the information. Do not take notes if you do not understand the information you are writing. If you do not understand it, then either get help understanding it or do not use it! Use sound judgment when using direct quotations. Quotations are used to liven up writing or to prove a point. Choose them carefully. Do not use them as a thesis statement, to provide background material, or to end the paper. It is your paper; therefore, your thoughts and commentary must be used to bridge the facts and opinions supplied by expert sources. Avoid back-to-back quotations. A string of quotations is not considered your work. Properly paraphrase a source’s information. Paraphrasing is putting into your own words something another person has said or written. It is not merely changing a word or two from the original. Even if you paraphrase, you must still tell your readers where you got the idea. If you fail to cite your sources or use words someone else has written as if they were your own, either deliberately or accidentally, you are guilty of plagiarism, an offense that will damage your credibility as a researcher and your grade on this paper. “Plagiarism” comes from the Latin word for “kidnapper”! Effectively interviewing persons who are knowledgeable about a topic can make your paper more interesting. Talking with these people can also help keep you on track and save you valuable time. When you interview someone, do it in a systematic manner using your PQS questions. Transcribe the answers onto note cards, following the guidelines. Be courteous, take careful notes, and be organized when interviewing people inside or outside of the building. 16 General Directions for Taking Notes Regardless of the short cuts you may think you have devised for taking notes, following these directions will be the shortest short cut of all! 1. Use ink. It is easier to read than pencil and will not smudge as easily. 2. If it is difficult to decide when to take notes, stop trying. Read a few of your sources of information and look over your PQS. Revise these preliminary questions whenever you feel the need. Then return to your sources with a clearer idea of the facts that you need to find. 3. Write only one item of information, as a complete thought, on a note card. Write only on one side. 4. Keep your labeling straight. Keep all corners of the cards labeled correctly, especially page numbers. 5. If you copy information directly from a source, use quotation marks on your note card. Although you may ultimately paraphrase the material in your paper, these quotation marks will be a constant reminder to you throughout your study that the information is a direct quote. Organizing Notes and Writing the Final Outline The research paper is longer and more complex than a short paper, and the outline will be longer, too. Remember, however, much of the work is already done. The PQS numbers on your note cards and your PQS will provide the divisions and subdivisions of the outline. Put each note card into separate piles according to the PQS numbers. Look through the cards that correspond to each PQS number and see what smaller divisions exist within the pile. In your outline, the PQS or subheadings will be assigned Roman numerals and the smaller divisions will be assigned capital letters. This is the point at which you must decide exactly what you are going to include in the paper and what you are going to throw away. Make sure that the entire outline is in a logical order. Look at the sample outline on the following page. 17 Drafting the Paper Begin with an introduction that establishes the purpose of your research. One or more of the following elements can be worked into the introduction: information the reader needs to understand the research definitions of complex terms or concepts an opening quotation an interesting story or anecdote DO NOT START THE INTRODUCTION WITH THE FOLLOWING: “My research paper is going to be about…” FOLLOW THE FORMAT FOR FORMAL COMPOSITIONS! Do not use contractions. Write out numbers less than one hundred, other than fractions or percentages. Pay close attention to homonyms and frequently confused words. Present your ideas honestly and clearly. Support the topic sentence of each and every paragraph with sufficient and documented facts, reasons, statistics, and commentary. As you incorporate your note cards into the paragraphs, you must connect them cohesively with your own thoughts. Use a variety of sentence structures and clear, concise vocabulary. Vary the ways in which direct quotes are introduced. 18 Plan for your visuals. If you are using pictures, diagrams, charts, or photographs, they must be referred to in the body of the paper, but placed at the end and appropriately labeled. Visuals do not count towards your minimum number of pages. Visuals work best when they are easily understood and provide information that would be unclear if only presented textually. All figures or tables must be labeled (Fig. 1, Fig. 2, Table 1, Table 2, etc.), titled, and cited. Everything that is not a table (a visual using columns and rows to organize information) is considered a figure. This includes illustrations and photographs. Here are two examples. Figure 1. Dental Implant (“Implant Reconstruction”) Table 1. Delaware State Test Scores (Baily and Besso A4). Reading Grade 3 5 8 10 2002 Score 441 478 519 513 Below Std. 21% 22% 29% 34% 2001 Score 436 471 514 511 19 2000 Score 437 470 513 512 1999 Score 428 463 509 504 1998 Score 421 460 508 509 The final paragraph(s) of the paper should leave the reader with a clear understanding of the analysis of the solution. This is usually done by reviewing the important points that have been made and by drawing a final conclusion. Read the paper out loud to help you find obvious mistakes and problems. MAKE SURE THAT ALL PARENTHETICAL DOCUMENTATION AND A WORKS CITED PAGE ARE INCLUDED IN THE DRAFT AND THAT THEY ARE RECONCILED. Reconciling involves checking to make sure that every source cited parenthetically in the paper is listed on the Works Cited page and making sure that every source listed on the Works Cited page is actually parenthetically cited in the paper. 20 Transitional Words and Phrases To add or show sequence: again, also, and, then, besides, equally important, finally, first, further, furthermore, in addition, in the first place, last, moreover, next, second, still, too, to begin with, initially To compare: also, in the same way, likewise, similarly, in a similar fashion, in a like manner, as, as though, in the same manner To contrast: although, and yet, but, but at the same time, despite, even so, even though, for all that, however, in contrast, in spite of, nevertheless, notwithstanding, on the contrary, on the other hand, regardless, still, though, yet, either, instead, neither, unless, whereas To give examples or intensify: after all, an illustration of, even, for example, for instance, indeed, in fact, it is true, of course, specifically, that is, to illustrate, truly, basically, essentially, in essence, certainly, no doubt, doubtless To indicate place: above, adjacent to, below, elsewhere, farther, here, near, nearby, on the other side, opposite, there, to the east, to the left, under, beneath, among, amid, behind To indicate time: after a while, afterward, as long as, as soon as, at last, at length, at that time, before, earlier, formerly, immediately, in the meanwhile, in the past, lately, later, meanwhile, now, presently, shortly, simultaneously, since, so far, soon, subsequently, then, thereafter, until, until now, when To repeat, summarize, or conclude: all in all, altogether, as has been said, in brief, in conclusion, in other words, in particular, in short, in simpler terms, in summary, on the whole, that is, therefore, to put it differently, to summarize, to conclude, having considered all of the above To show cause or effect: accordingly, as a result, because, consequently, for this purpose, hence, otherwise, since, then, therefore, thereupon, thus, to this end, with this object, for this reason, obviously To introduce counterargument: others might believe alternatives to others -some, people believing…., it, the author or a name, my opponents alternatives to might - may, could, do, have alternatives to believe – contend, assert, argue, maintain, claim, say, aver, allege To introduce rebuttal: However,… But I believe the evidence shows…. While that might seem convincing,…. I think you will agree, however, that… Nevertheless, I still contend… 21 Quoting/Paraphrasing Sources Sample Sentence Starters According to source … A recent report in source states… Source reports that … An important fact from source is… According to a recent study by source… Source has determined that… Research from source reveals that… In order to solve the problem, source claims that… Based on a recent study, source believes that… Source has concluded that… According to source and source… 22 Parenthetical Citations Since 1988, the Modern Language Association (MLA) has recommended citing sources in the text with parentheses rather than in footnotes or endnotes. Parenthetical citations are there to give credit when the writer directly quotes someone, uses a visual from a source, or paraphrases information that is not common knowledge from a source. The following information must be cited: Direct quotes Statistics Visuals Opinions of experts/authors Specific facts that are not common knowledge Parenthetical citations should be kept as brief as possible. They should only provide enough information for the reader to be able to locate them easily on the Works Cited page at the end of the paper. The basic elements of parenthetical citations are: 1. The author’s last name 2. A shortened form of the title (when the author’s name is not given or when there are multiple works by the same author) 3. The page number (if there is one) Whenever possible, place the citation BEFORE the punctuation mark at the end of the sentence containing the borrowed information. In extended quotations, such as lines of poetry, the citation is placed after the final punctuation mark. Works on the Internet are cited just like printed works. Web documents generally do not have fixed page numbers, so these numbers are often omitted from parenthetical citations. To avoid confusion when citing more than one Web page by a single author or Web pages with the same title, include the final element of the URL. For example (Hansen, michalos.html). If the author’s name is mentioned in the text when quoted, only a page number is necessary in the parentheses. If you add a word or words in a quotation, you should put brackets around the words to indicate that they are not part of the original text. Jan Harold Brunvand, in an essay on urban legends, states: "some individuals [who retell urban legends] make a point of learning every rumor or tale" (78). 23 If you omit a word or words from a quotation, you should indicate the deleted word or word by using ellipsis marks, which are three periods (...) preceded and followed by a space. For example: In an essay on urban legends, Jan Harold Brunvand notes that "some individuals make a point of learning every recent rumor or tale ... and in a short time a lively exchange of details occurs" (78). Place quotations longer than four typed lines in a free-standing block of text, and omit quotation marks. Start the quotation on a new line, with the entire quote indented one inch from the left margin; maintain double-spacing. Only indent the first line of the quotation by a half inch if you are citing multiple paragraphs. Your parenthetical citation should come after the closing punctuation mark. When quoting verse, maintain original line breaks. (You should maintain double-spacing throughout your essay.) For example: Nelly Dean treats Heathcliff poorly and dehumanizes him throughout her narration: They entirely refused to have it in bed with them, or even in their room, and I had no more sense, so, I put it on the landing of the stairs, hoping it would be gone on the morrow. By chance, or else attracted by hearing his voice, it crept to Mr. Earnshaw's door, and there he found it on quitting his chamber. Inquiries were made as to how it got there; I was obliged to confess, and in recompense for my cowardice and inhumanity was sent out of the house. (Bronte 78) The following page shows examples of the most commonly used parenthetical citations. Pay close attention to the use or absence of punctuation. The easiest way to determine what goes in a citation is to look at the source card you wrote for that source and use whatever the first element on that source card may be. In most cases it is the author’s last name. If not, then use what you have. The page number you wrote on the note card will complete the citation. NOTE: EVERY CITATION MUST HAVE A MATCHING SOURCE LISTED ON THE WORKS CITED PAGE, AND EVERY SOURCE LISTED ON THE WORKS CITED PAGE MUST HAVE A CITATION SOMEWHERE IN THE PAPER. 24 Parenthetical Citation Examples (Cohen 76) one author (76) author’s name mentioned in the text (Smith and Jones 103) two authors (Johnson et al. 149) more than two authors (Scott) no page numbers available; interview (Woolf 2: 115) source has multiple volumes; this is volume 2 (Berstein 101; Strubb 8) two sources cited at once (Jones, The History… 31) author has more than one work cited (Sound and Poetry 44) book/pamphlet cited; no author or author’s name mentioned in the text (“Hunger” 14) short work/article cited; no author or author’s name mentioned in text (“Nordstrom,”npta.com) web page cited; end of URL supplied for clarity (“Solar…”) web page cited (no page numbers used) (qtd. in Lester 2) indirect quotation; original speaker identified in text 25 Preparing a Works Cited Page The final page of a research paper is a Works Cited page. This is a list of all the WORKS that were CITED in the paper. If there is no corresponding citation in the paper, the source cannot be listed on the Works Cited page. As shown in the sample on the following page, the Works Cited page is written according to the rules of the Working Bibliography. It must be in alphabetical order according to the first letter of the first element of the work. In the case of “A”, “An”, or “The”, the next word is used to determine alphabetical placement on the Works Cited page. If more than one work begins with the same word, the second word is used to determine alphabetical placement (and so on). If an author has more than one work on the list, three hyphens are used to replace the author’s name in the second and/or subsequent works. Reverse indentation is used. The source begins at the left-hand margin, and subsequent lines are indented five spaces. The page is double-spaced as is consistent with the entire research paper. Numbering is never used to list the works. There are no extra spaces between entries. If an entry begins with a number, treat the number as a word for the purpose of alphabetizing. For example, “12 Ways to Floss” should be alphabetized as if it began “Twelve Ways….” 26 Last name # Works Cited “Acrylic Adventure.” Nails. Nov. 1997: 104-106. “Acrylic Nails.” 12 Sept. 1997. 23 Oct. 1998 <http://www.pamcoacrylic.nails.com/ ntmessg/2645.html>. Ahern, Jerry. West’s Textbook of Cosmetology. New York: Wadsworth, 1995. Berne, Betty. “Nine-inch Nails.” Vogue June 1997: 173-176. Resource/One. CD-ROM. UMI-PROQUEST. Aug. 1997. Cosmetology. New York: Sheridan House, 1999. “Dirty Nails.” The Edell Health Journal (Jan. 1990): 6 pgs. Search Bank. 8 Oct. 1998 <http://sbweb2.med.iacnet.com/infotrac/session/794>. Furjanic, Sheila, and Jacqueline Flynn, eds. Milady’s Art and Science of Nail Technology. Philadelphia: Milady’s Pub. Co., 1991. Hamaker, Amy. “Clients Speak Out!” Nailpro. Aug. 1996:121-127. ---. “Norwegian Nails.” Nailpro. Aug. 1997: 158-161. Kurt, Thomas L. Telephone interview. 12 June 1999. Oleksey, Bette. Personal interview. 2 Oct. 1999. Owens, Barbara (owensb@aol.com). “Acrylic Nails.” E-mail to Nikeeya Parsons (niki@ravenet.com). 13 Aug. 2000. “A Perfect Ten.” Seventeen Dec. 1998: 78. “Primer for Nails.” Acrylicnails.com 8 Oct. 1997<http://www.acrylicnails.com/ vi03000.html>. 27 Research Paper – General Appearance The paper must be typed on a computer-generated word processing program. The paper should be double-spaced throughout. The paper should have 1” margins all around. The paper should be in 12-point Times New Roman font A research paper does not need a title page. Instead, the following information should be listed at the left-hand margin: the student’s name, the instructors’ names, English 12 and period, and the date (each on individual lines.) The next line contains the title centered. The first word, last word, and all principle words in the title should be capitalized. No other emphasis is needed. A running header should be set up which includes the student’s last name and page number. This header should appear at the upper right-hand corner, ½” from the top of the page. The paper should be fastened with a single staple in the upper left-hand corner. The following pages contain a sample Senior Challenge paper from Action Plan through final draft. 28 To: Mrs. Wolhar, Ms. K Smith, and Mrs. Christina Smith From: Ima Student Date: September 12, 2006 Subject: My Action Plan for Senior Challenge For my problem “What do you do for a patient who is in the need of dentures?” I plan on taking these steps in finding my information. My source and paper requirements include having two books or periodicals, two Internet sites, and one interview. To locate my sources of information, I will look online and use the key terms such as dentures, custom trays, denture materials, skills, impression material, and skills. Sites that will be helpful in finding this information would be search engines such as google.com and ask.com which will assist me in locating web sites that have helpful information. Books will also be a component I use. My shop books, as well as books I will check out in the library, will be useful. Pamphlets found in dental offices will also hold information I could use. Interviews will give me additional information from people in the dental field. I have three people in mind that I could contact. They are Dr. Karen Carter, my dentist; Dr. Hazuda, a past employer; and Barbara McKane, a past co-worker. These three people are good candidates because they work with materials used in taking impressions and have exposure to making and working with dentures. To contact them, I plan on calling and making an appointment for an interview at a time that works best for them. In addition to my paper, I am expected to construct a hands-on component or demonstrate a skill related to my problem. I feel a demonstration of making a custom tray or taking an impression would be best. Either of these would help me demonstrate I have an understanding of the process it takes to construct dentures. Assisting me during the Senior Challenge process will be my mentor, Mrs. K. Smith. I know I need to meet with Mrs. K. Smith at least four times this semester. I will talk to her after school so we can set a date and time to meet. If anyone has questions or concerns, please feel free to contact me in school (my schedule is below), by e-mail, or on my cell phone. My e-mail address is Imastudent@AOL.com. My cell phone number is (302) 555-1234. Period 1/2 Period 3/4 English 12 Math IV Mrs. C. Smith Mrs. M. Smith Period 5/6 Co-op Period 7/8 Co-op 29 Ima Student September 25, 2006 Topic: Replacing a full set of teeth Controlling Purpose or Thesis Statement: Having to depend on Social Security does limit her options; however, Mrs. Elwood can still receive a set of teeth. Her options include receiving either denture-supported implants or dentures to replace the missing teeth. PQS Questions: 1. What can cause a person to lose her teeth? 2. Why is it important for an edentulous person to replace her teeth? 3. What options are available for the edentulous person who desires to replace her teeth? 4. What are dentures? 5. What is the procedure for making and fitting dentures? 6. What expenses can a patient who chooses to get dentures expect? 7. How does a person care for her dentures? 8. What are the advantages and disadvantages of dentures? 9. What are implant-supported dentures? 10. What is the procedure for making and placing implants? 11. What expenses can a patient who chooses to get implant-supported dentures expect? 12. How does a person care for implant-supported dentures? 13. What are the advantages and disadvantages of implant-supported dentures? 14. How does a person choose between dentures and implant-supported dentures? 15. What is the dental assistant’s role in the care and treatment of an edentulous patient? 30 Interview Questions Name of interviewee: Place of interview: Date of interview: Estimated time: ______________________ ______________________ _______________________ ________________________ 1. What do you have to consider when determining the type of replacement for permanent teeth? 2. How long would you say it takes for the oral cavity to shift enough to need to adjust the dentures? 3. How often do you have denture patients return for adjustments? 4. How long does it take for the implants to be finished? 5. How many parts are there in an implant, and what are the parts? 6. What are some of the problems that can occur due to implants? 7. How much do implants cost, and what is a breakdown of the cost? 8. What are the most frequently asked questions from your patients? 9. What are the steps of the procedure? 10. Who gives the procedure, and what type of schooling do they have? 31 Ima Student September 28, 2006 Interview Questions With Dr. Karen Carter (family dentistry) Q. What do you have to consider when determining the type of replacement for permanent teeth? Successful previous wear of dentures Bone height and width Desires and what they are looking for: improvement or intentions. Q. How long would you say it takes for the oral cavity to shift enough to need to adjust the dentures? Every person’s mouth has a different pace. Implants maintain the bone. Q. How often do you have denture patients return for adjustments? If it is successful, not often Usually if the denture is broken lose or they are having trouble. Q. How long does it take for the implants to be finished? It depends on the person and what type they are receiving. The average implant insert takes 3 months to heal the gums Then you train the gum with a (cover) that takes a month Abutment about 4-8 months. Q. How many parts are there to the implant? 3 different parts Q. How often do you see implant patients after they had their procedure? Once a year Q. What problems can occur with implants? They could not be anchored in securely Some medical conditions can be, but they aren’t a limiting factor Implants can be lost but not often; because of how it was anchored (usually). Q. How much do the implants cost? Average &1,500- $2,000 The abutment is about $100 Crown $900-$1,200 Denture implant: Implant + denture- $1,000-1,500 32 Q. With the denture implants would you only add 2 implants to anchor the denture? The more implants in the harder it is to remove. It all depends on the person and their needs Q. What are the most frequently asked questions? It is going to hurt? Cost Q. What is used to drill in the implant? A torqued drill with adjustable widths and lengths Q. Who does the procedure? To place the implant - a periodontist or an oral surgeon Some dentists can specialize in implants and can do it in the office. Name of interviewee: Dr. Karen Carter Place of interview: Family Dentistry Date of interview: September 28, 2006 Estimated time: 30 minutes 33 Ima Student October 11, 2006 Senior Challenge Detailed Paper Outline I. Introduction: A. “A patient, Mrs. Elwood, comes into the dental office without teeth and is on Social Security; what can be done to address her needs?” B. More and more Americans are in need of false teeth because of unfortunate accidents, periodontal disease, or other occurrences. How does a person know what is the best way to go about replacing their teeth? Two possible options are implant-supported dentures and dentures. Determining which solution is best requires a consultation with the dentist. C. The best solution for my patient would be dentures since cost is a limiting factor. II. Problem: A patient without any teeth comes to the dentist. The dental team will work with the patient to determine which type of false teeth appliance would best meet the patient’s needs and/or budget. Replacing the missing teeth will allow the patient to eat and speak more normally and feel more self-confident. The appliance will also help maintain the patient’s facial structure. A. Causes of the Problem: There are several reasons a person might lose their teeth. Some of the most common are: 1. One cause of tooth loss is as the result of an accident such as a car crash or a fight. 2. A second cause of tooth loss is poor oral hygiene. a. Poor oral hygiene results from decreased brushing and flossing. b. When a patient visits the dentist, as she should do every six months, the hygienist will clean and check her teeth for plaque/calculus buildup and decay. c. The dentist will intervene and attempt to correct any problems resulting from ineffective homecare. d. Neglecting the dentist’s instructions for homecare can make any problem worse. 3. A third cause of tooth loss is periodontal disease. B. Consequences of the Problem: The patient is directly affected by this problem. They will be the primary “victim” throughout the whole process. 1. Being edentulous could lead to difficulty eating. 2. The loss of one’s teeth can lead to a loss of self-confidence. 3. Also the muscles around the mouth will soon deteriorate if not properly supported by the teeth. III. Potential Solutions A. First Option – Implant-Supported Dentures 1. Implants are a type of false tooth that is embedded into the gum 34 and bone. 2. The implants are stable because they are placed into the bone and gum. 3. Implants have four different parts: the screw/cylinder, the abutment, the bar attachment system, and the denture. 4. Placing the implants requires several steps. a. An incision is made in the gum and a hole drilled in the jawbone to hold the fixture. b. The gums are sutured over the implant. c. The gums are allowed to heal for two-six months during which time a temporary denture is worn. d. The implants are uncovered and a healing abutment collar is worn for ten to fourteen days. e. After two weeks, the permanent abutment is placed and an impression is taken of the gums and implants. f. The impression is used to create the bar attachment system and teeth. g. The final denture is created and fitted. 5. Implants are esthetically pleasing and relatively easy to maintain. 6. The cost of the implant-supported denture is based on the costs of several different procedures. B. Second Option - Dentures 1. A denture is devise of false teeth that is placed over the patient’s gums. 2. Each pair of dentures includes a maxillary (top teeth) and a mandible (bottom teeth). 3. Fitting a patient with dentures requires several appointments. a. At the very first appointment, the dentist will determines if the oral cavity will allow proper support to hold and maintain a denture. b. At the second appointment impressions are taken. This will be the bite registration. c. Appointment three is the wax try in. d. The fourth appointment will be the anterior try in. e. The last appointment is scheduled when the dentures are finished. The dentures are placed into the patient’s mouth to make sure all is fitted correctly. If adjustments need to be made, then another appointment will be scheduled. If not, the dentist will send the patient home with a satisfied smile and homecare instructions. 4. Taking care of the denture is important. 5. The cost of dentures depends on the complexity and quality of the fixture. 35 IV. Preferred Solution A. Ms. Elwood could be a candidate for either option. B. Because of her financial limitations, dentures are the better choice. 36 Ima Student October 20, 2006 Outline I. Introduction A. Briefly State Problem B. Background Material/Bridge C. Thesis/Solution II. Problem A. Fully State Problem B. Causes of the Problem C. Consequences of the Problem III. Potential Solutions A. First Option – Implant-Supported Dentures 1. Description 2. Procedure 3. Maintenance 4. Cost B. Second Option - Dentures 1. Description 2. Procedure 3. Maintenance 4. Cost IV. Preferred Solution - Dentures A. Option Chosen B. Reason for Choice 37 Ima Student Mrs. Wolhar Mrs. Smith English 12, Period 1-2 1 November 2006 Replacing a Full Set of Teeth Mrs. Kristine Elwood enters the dental office; she warmly greets the receptionist with a toothless smile. It quickly becomes apparent that she will need to replace her permanent teeth with an appliance containing a full set of artificial teeth. After Mrs. Elwood is seated in the dental chair, the dental assistant kindly asks her if she has ever considered replacing her missing teeth. Mrs. Elwood’s response is, “Yes, having teeth would make life much easier; however, living on Social Security restricts my budget.” Having to depend on Social Security for financial assistance does limit her options; however, Mrs. Elwood can still receive a set of teeth. Her options include receiving either denture-supported implants or dentures to replace the missing teeth. Tooth loss can occur for several reasons. One cause is loss due to an accident or physical injury. “Teeth may be injured during a fall or a sport activity. A tooth may be knocked out” (“Mouth and Dental”). This occurrence is not as infrequent as many might think. People who are engaged in sports are most likely to have this problem. A second cause of tooth loss is poor oral hygiene. Poor oral hygiene begins as soon as a person decreases their brushing and flossing activity. “Good oral hygiene is the back bone of preventing dental disease” (Taintor and Taintor 17). “When we do not properly care for our teeth, plaque, a sticky substance, loaded with bacteria, clings to our teeth” (Balshi 6). When plaque is not removed after 24 hours, it begins to harden. The microorganisms in the plaque start to produce acid that will erode the tooth structure. This acid eventually affects the gums if the plaque is not properly removed. When a person has their regular dental check-up, the hygienist Student 2 checks for plaque and will remove any buildup. If a dentist notices evidence of weak points in homecare, the dentist will intervene and correct the situation as best she can (Taintor and Taintor 16). Should the patient neglect the dentist’s instructions, more calculus (tartar or calcified deposits on the teeth) will develop. Soon the gums will begin to recede exposing the root of the tooth (Balshi 6). “The roots are coated with cementum, a substance softer than enamel, which is the hard thin coating covering the outer layer of the tooth, making them susceptible to decay” (Balshi 6). Once the roots are exposed, the tooth is not firmly secured in the mouth and will fall out. Associated with poor oral hygiene is periodontal disease, which is a third cause of tooth loss. Periodontal disease can be caused by either smoking or an increase in bacteria in the mouth due to poor oral hygiene. The disease affects the tooth root, gums, supporting tissues, and bone of the tooth. “The disease takes a rather predictable course, starting with bleeding gums and advancing to swollen, inflamed and painful gums, ending with loosening teeth and then tooth loss” (Schissel and Dodes 6). To detect the presence of periodontal disease, the dentist and hygienist will use a periodontal probe to measure the pocket depth of the gums. Using this method, the dentist can measure the degree of periodontal disease by the height of the gum. When the probe reaches one-three millimeters, the gum is considered healthy. When the probe reaches four, the gum is considered to be in the beginning stages of periodontal disease. A measurement of five or higher would necessitate immediate treatment if the teeth and gums can be saved. This treatment may include gum surgery. If the gum recedes too far from the teeth, the pocket between the gum and the tooth becomes infected, gum tissue and bone are destroyed, and the teeth may loosen and fall out or require extraction (“Periodontal …”). 1 Student 3 Once a patient begins to experience tooth loss, they face several challenges. One significant challenge is difficulty eating. Teeth assist in chewing and breaking up food into smaller particles for the body to digest. When teeth are no longer present, there is an absence of hard surfaces to grind and shred food. This limits the variety of food choices a patient can eat. Many patients who need to limit their choices do not enjoy the food choices available to them (Davis). Soft foods will be most comfortable for the patient; however, they are not always the most tasty to eat. Leaving the house to go out in public requires confidence for anyone; when teeth are missing, a person’s level of confidence is diminished. The patient feels embarrassed, so she avoids eating, laughing, and going out in public, and she avoids forming close relationships (Davis). This lack of self-confidence is a challenge to the patient because it affects her daily activities. She is not able to enjoy the lifestyle to which she is accustomed. A further challenge is dealing with the changes in facial appearance that occur with tooth loss. “If teeth are lost due to caries or periodontal disease, the jawbone which held the missing teeth will begin to deteriorate. In extreme circumstances, all of the alveolar process is lost, with only the basal bone of the maxilla and mandible remaining” (Serio 10). When the alveolar process is lost, the support structure for the teeth is gone, and the bones in the mouth begin to resorb. This changes the base that the facial muscles rest on; the realigning of the facial muscles changes the structure of the facial features. It is important to resolve the problem of missing teeth so the muscles around the jawbone do not shrink or realign. Once the structure of the oral cavity changes, it can be readjusted, but requires support to remain stable and functional. Artificial teeth can be used to support the jaw and facial structure. 2 Student 4 Determining and discussing what type of appliance is appropriate will be the first step in addressing the edentulous patient’s problem. One possible solution for a patient needing a full set of artificial teeth would be implant-supported dentures. “The implants themselves are tiny titanium posts which are inserted into the jawbone where teeth are missing” (Ettinger). “It acts as an anchor for a false tooth or a set of false teeth” (Davidoff). Using implants to replace a full set of teeth requires using a screw/cylinder inserted into the gum and bone, an abutment attached to each screw/cylinder, and a bar attachment system designed to hold the denture in place attached to the abutments. This is considered to be an implant-supported denture. The implants securely hold the denture in the oral cavity. Implants supporting the denture can eliminate problems such as dentures shifting and sores that are created from movement. “Dental implants integrate with your jawbone, helping to keep the bone healthy and intact” (“Dental…”). When a periodontist or oral surgeon places implants in the oral cavity, she makes an incision in the gum and uses a torquing drill to cut a hole through the bone in order to place the fixture. Different drill widths and lengths are used to create the proper-sized hole (Carter). Once placed, the fixtures are covered by the gums, which are then sutured together. The gums will take from two to six months to heal. A denture can be worn after approximately four weeks following the procedure. If a denture is not already in use, a temporary denture will be made before the surgery. Once the temporary denture is finished, a copy of it will be used as a guide to help the surgeon place the implants in the proper positions for the bar attachment system (“ImplantSupported…”). Holes are drilled in the copy of the denture, so the surgeon can see where the implants should be placed (“Implant-Supported…”). Once healed, the implants will be uncovered by making an incision in the gums. A healing abutment collar, a round piece of metal, 3 Student 5 will be placed on the head of each implant for ten to fourteen days (“Implant-Supported…”). After the two weeks, the permanent abutment will replace the healing collar. Once the gums are healed enough, an impression will be taken of the gums and implants. This allows a model to be used to construct the framework and teeth (“Implant-Supported…”). The framework consists of a bar attachment system. This system attaches to the abutments, and the denture clips to it. After the metal bar is adjusted and properly secured, the teeth are set in wax and will be tried in the patient’s mouth. Following necessary adjustments, the dental lab will create the final denture. Once the denture is constructed and set in acrylic, it will be clipped into the bar attachment system, so it is secured in the oral cavity. For all practical purposes, the patient now has her full set of teeth. “After a short time, you will experience a restored confidence in your smile and your ability to chew and speak” (“Dental …”). The denture must be removed and cleaned at least twice a day. The patient must go to the dentist to have the dentures cleaned once every three months. At cleaning visits, the dentist will check the fit and bite of the dentures. Any movement of the dentures can create sores, so regular checking is necessary to avoid the development of irritation. The dentist will also check the plastic clips, which usually need to be replaced every six to twelve months (“Implant-Supported …”). The patient must be aware that the cost for implant-supported dentures is based on several procedures, not one. The surgical fee for the placement of the implant can range from $900-$2,100. Many oral surgeons charge by the implant, with costs ranging from $1,500-$2,000 per fixture. The abutments cost around $395 each. The bar attachment and denture are an 4 Student 6 additional charge. The general dentist’s fees, which include the manufacturer’s price and a maintenance fee, will add to the total cost. Mrs. Elwood may also consider dentures to solve her problem. “Generally made of plastic or cast metal, dentures are custom-fitted to match and adhere to the upper or lower jaw”(Doundoulakis 40). Dentures fit over the gums and are held in place by suction. They are used to retain the oral cavity’s shape when they are in place inside the mouth. A full set of dentures includes a maxillary (top teeth) and a mandible (bottom teeth). Dentures range in cost from $500-$2,500. With dentures suction can be a problem, more so with the mandible because of its horseshoe shape. This suction problem leaves the patient uncomfortable and prone to sores since the dentures are shifting and sliding around. Fitting a patient with dentures requires several appointments. Each appointment accomplishes a task needed to create the final product. First, a consultation will be scheduled. The consultation includes a discussion with the dentist concerning what is to be expected during this procedure and an examination of the oral cavity to determine if it will provide proper support to hold and maintain the denture. During the appointment, X-rays will be taken to assure the dentist that the oral cavity is free of disease and any jaw conditions that would rule out the use of dentures (Schissel and Dodes 113). Impressions will also be taken with an edentulous tray at this appointment. Beading wax or a similar material will be used to cover the edges of the tray to create a muscle mold to achieve closer adaptation of the impression tissues in the mucobuccle fold (Bird and Robinson 838). The alginate impression will be used to fabricate a custom tray for the next appointment. At the second appointment, elastometric impression material will be used to fill the custom tray inserted into the patient’s mouth; this assures accuracy when the lab 5 Student 7 creates the base plate and occulsal rims. The dental lab builds the base plate onto the master casts, and then the occlusal rims are built of wax and attached to the base plate. During the third appointment the base plate, which has been returned to the dental office, is checked for fit. The occlusal rims are removed from the master cast, and the dentist records the vertical dimensions, occlusal relationship, smile line, and canine eminence. This is necessary to ensure accurate bite and comfortable fit. This appointment also includes finding the correct mold, shade, and material that will be used for the artificial teeth. An occlusal registration, which includes the centric relation, protrusion, retrusion, and lateral excursion, is required. These terms are all movements of the patient’s jaw; the exaggerated motions simulate the actual movements of the mandible as it functions in the acts of mastication, biting, yawning, and speaking (Bird and Robinson 839). All of the information gained from this appointment will be sent to the dental laboratory and used to create a wax try-in. Once the wax try-in is created, it returns to dental office, and the tryin appointment will be scheduled. The wax try-in consists of the base plate with the artificial teeth that are set in wax. The patient will reenact the exaggerated movements that were done during the third appointment. When the try-in fits and feels comfortable, it will be sent back to the dental lab for the proper adjustments to be made and will be set in acrylic. Lastly, the insertion appointment will include the patient trying on the final product - the denture. The patient will get a feel for the denture by speaking and biting. If any part of the denture creates sore spots, the dentist will make the necessary adjustments. After the patient feels comfortable in the dentures, the dentist will send the patient home with a satisfied smile and homecare instructions. In the beginning, the denture may feel awkward or bulky; however, the patient will eventually become accustomed to wearing them (“Removable …”). 6 Student 8 Taking care of the denture is important. Rinsing off food particles and brushing the denture is suggested. Hand soap or mild dishwashing detergent is fine to use as long as the denture is not exposed to harsh abrasives. When the patient is sleeping, the denture can be either worn or removed. If the denture is removed, it must be kept moist. “At night, the denture should be placed in a soaking solution or water”. “Over time, adjustments may be necessary” (“Removable …”). The oral cavity could shift if the dentures are not fitting properly. Returning to the dentist is important if the dentures become uncomfortable or break. Dentures can fall out if they are not inserted properly, so being cautious is important. Dentures will improve a patient’s outlook and daily activities by giving the patient confidence while eating, speaking, and smiling. Like implant-supported dentures, the cost of dentures includes several appointments and materials. The dentures range in price from a few hundred to a few thousand dollars, depending on the complexity and quality of the workmanship and materials (“Dentures …”). Generally, they are less expensive than implant-supported dentures. Discussing the desires of what the patient is looking for whether it is improvement or intentions determines the route the patient will decide to take (Carter). Mrs. Elwood’s initial consultation revealed that she was on a restricted budget. Therefore, even though she is physically a candidate for either option, due to her strict budget she must stay with the least expensive appliance - dentures. While implants would keep the denture more stable in the oral cavity, Mrs. Elwood cannot afford the cost of the implants. Dentures will supply enough stability of the oral cavity for her to perform daily tasks such as speaking and eating. By wearing dentures, Mrs. Elwood will solve her problem of being edentulous and still stay within her budget. 7 Student 9 Works Cited Balshi, Thomas, et al. A Patient’s Guide to Dental Implants. Omaha, Nebraska: Addicus, 2003. Bird, Doni L., and Debbie S. Robinson, eds. Modern Dental Assisting. Seventh ed. Philadelphia: Saunders, 2002. Carter, Karen. Personal interview. 28 Sept. 2006. Davidoff, Robert. “Frequently Asked Questions about Dental Implants.” The Dental Implant Source. 1996-2006. 25 Sept. 2006 <http://www.dental-implants.com/index.html>. Davis, D. M. et al. “The Emotional Effects of Tooth Loss: A Preliminary Quantitative Study.” British Dental Journal 188.9 (May 2000). Rpt. in BDJ. Nature. 1 Nov. 2001. 13 Oct. 2006 <http://www.nature.com/bdj/journal/v188/n9/full/4800522a.html>. “Dental Implant Treatment Options.” American Academy of Periodontology. 11 June 2004. 26 Oct. 2006 <http://www.perio.org/consumer/2mb.htm>. “Dentures Cost and Dentures Prices (sic).” Dental Find Dentist Directory. 26 Oct. 2006 <http://www.dentalfind.com/Denture_Cost/>. Doundoulakis, James. “Tooth Replacement.” The Perfect Smile. New York: Healthy Living, 2004. 40-41. Ettinger, David B. “Dental Implants.” Delaware Center for Oral Surgery and Dental Implants. 24 Oct. 2006 <http://www.deoms.com/den_index.html>. “Implant-Supported Denture.” Colgate World of Care. 22 Feb. 2005. 23 Oct. 2006 <http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthAtAnyAge/ Seniors/DenturesAndDentalImplants/ImplantSupportedDenture.cvsp>. 8 Student 10 “Mouth and Dental Injuries.” WebMD. 17 Nov. 2004. 18 Oct. 2006 <http://www.webmd.com/hw/dental/hw240709.asp>. “Removable Partial Dentures.” American Dental Association. 14 Mar. 2005. 26 Oct. 2006 <http://www.ada.org/public/topics/dentures_partial_faq.asp>. “Periodontal (Gum) Diseases.” American Academy of Periodontology. 10 Mar. 2006. 26 Oct. 2006 <http://www.perio.org/consumer/2a.html>. Schissel, Marvin J.and John E. Dodes. “For the Dental Consumer.” Afterword. The Whole Tooth. By Schissel and Dodes. New York: St. Marvins, 1997. 49 86 112-117 133. Serio, Francis G. Dental Health. Jackson: UP of Mississippi, 1998. 10-12 44-46. Tainor, Mary Jane, and Jerry F. Taintor. The Complete Guide to Better Dental Care. New York: Facts on File, 1997 9 Student, Ima. “Replacing a Full Set of Teeth.” Paul M. Hodgson VocationalTechnical High School. 7 November 2006. Problem Statement – A patient, Mrs. Elwood, comes into the dental office without teeth and is on Social Security; what can be done to address her needs? Once Mrs. Elwood entered the dental office, it became apparent that she would be in need of a full set of artificial teeth. Since her income comes primarily from Social Security, Mrs. Elwood felt purchasing an appliance would be out of the question. Even with her limited income, Mrs. Elwood can still receive a set of teeth. Replacing her teeth is important due to the effects missing teeth can have on the oral cavity. Without teeth, patients experience difficulties eating, a decrease in self-confidence, and changes in facial features. These problems can be diminished once a patient is fitted with a full set of artificial teeth. Two solutions are available for Mrs. Elwood, either implant-supported dentures or dentures. Implants are integrated into the jawbone to act as an anchor for a set of teeth. Implants eliminate the problem of shifting and sliding that dentures tend to cause and keep the oral bones healthy and intact. Due to the surgery involved, the cost of implants is high. Dentures fit right over the gum, using suction to stay in place. Dentures tend to slide around in the oral cavity, causing sores. The average cost of dentures is usually lower than that of implants. Although implant-supported dentures are more secure in the oral cavity than dentures, this solution is too expensive for Mrs. Elwood’s budget. Dentures will be less expensive and will also help maintain the structure of the oral cavity well enough for her to eat what she desires and feel self-confident. Ima Student March 9, 2007 Panel Presentation Outline I. Introduction A. Greeting B. Overview II. Problem A. Fully State Problem B. Causes of the Problem C. Consequences of the Problem III. Potential Solutions A. First Option – Implant-Supported Dentures 1. Description 2. Procedure a. Describe steps involved b. Demonstrate dental assistant’s role 3. Maintenance 4. Cost B. Second Option - Dentures 1. Description 2. Procedure a. Describe steps involved b. Demonstrate dental assistant’s role 3. Maintenance 4. Cost IV. Preferred Solution - Dentures A. Option Chosen B. Reason for Choice V. Conclusion A. Thank Panel B. Invite Questions 1