Doing It Yourself

Let's be honest. In Dental School, you end up doing a lot of ticky tack tasks that no practicing dentist would ever do. For example, setting up the operatory is a time consuming task, and let's not even get into cleaning up afterwards. I probably spend a good hour out of ever day setting-up and cleaning up, and this is only for TWO patients.

The obvious aside, what about lab work? Most general dentists aren't mounting every case on the articulator or waxing up crowns. I don't know many that even set the denture teeth either - yet we do it as students. I'm glad we do, because you need to know what good is.

Now the point I'm getting at is that it becomes quite easy to get lazy and complacent. Simply assume the lab can do everything. This is ok sometimes, but every now and again we get a situation that requires some improvisation.

So here is my case. I get a patient on public aid that simply can't afford the partial she desperately needs (missing 7-10). She eventually plans on getting the partial but needs more time to save up.




Clearly that is a space that most people would like to have filled up ASAP. So at the college, we require that the patient's balance be UNDER 100$ before we send anything out to the lab. As soon as I prep rest seats, the partial will be charged (and it costs 600$). She needs other work as well that is not covered so we are looking at a couple months before I even start the partial.

So our options:
1) Do nothing, let this lady walk around like this trying to get a job
2) Send to the lab for an interim partial
3) Make the temp myself (flipper)

I had attempted to make a flipper last summer and while I thought it went pretty terribly, the patient never came back (which is actually a complement in this case).

So the flipper is generally made to replace ONE, count em' ONE tooth. If I send to the lab, it will cost her about 300. If I make it, it costs 160. Given financial limitations and my desire to learn - I decided to get a little crazy and attempt to replace the 4 most esthetically important teeth in the entire mouth.






Here it is after about an hour of work and one helluva a time getting it off the cast. She has all of her posterior teeth, so I decided to go without wires.




Now I will be the first to admit that the gingival shade sucks. In my defense, that is really the only color we have to work with in the lab. This is also supposed to be TEMPORARY. I needed to bring the acrylic buccally for a little extra retention. I would not have been comfortable attempting to have those teeth blend into the natural gum line. Again though, considering I couldn't even fix a toilet prior to dental school, I was pretty damn happy with this result. It looks even better far away.




Her voice didn't change at all after a few adjustments but she does use just a touch of denture adhesive. I probably could have used some wires but I used them last time and wanted to try one without.

This post is not to toot my own horn but rather to emphasize how much you can change someone's life by taking the route less traveled. I will never become a prosthodontist, but I would like to think I can help when the easy lab option is not possible. I delivered this thing in september and it is still holding out great. She is interviewing for jobs now and we will hopefully get her partial going early next semester.

With all that said, making your own temps is pretty time consuming. We were never taught this in the pre-clinic so you end up with a little trial and error. With that said, this result completely trumps my first attempt (which I wish I had pictures of) and was quite honestly, a far more difficult case.

Will I be making my own interim partials all the time? Of course not, but it feels good to know I can should the need the arise.

Happy thanksgiving all!

Experience?

I obviously can’t really compare UIC versus other dental schools because I can only go to one. I have received numerous questions from randoms and friends/family about how much experience I am getting in the clinics.

So I decided - what the hell, why not just run a production report and find out. I could care less about HOW much production I have made in dollar values but I do care about WHAT I have done or how many procedures.

So I am fairly deep into my time as a D-3, why not see just how much experience I have gotten thus far. I will probably do a follow-up towards the end.

Quick note: I am not including EVERYTHING – pretty much just procedural dentistry. I am also leaving out radiographs because I don’t get credit for the ones I do on rotation and I get credit for simply ordering them but not actually doing it. Needless to say, I feel fine with radiographs for the most part.

I am also including things I haven’t finished or will be (hopefully) starting shortly.

RUN DOWN:

7 – Periodic Oral Evaluation (6 month exam)

34 – Urgent Cares (about to become 35 this afternoon)

12 – Comprehensive Oral Evaluations (new patient work-up)

9 – prophylaxis (mostly on kids)

5 – fluoride application (all kiddos)

5 – class II amalgams

1 – MOD amalgam

15 – class V composites

1 – class III composite

2 – three-surface posterior composites

1 – PFM crown (still in process, 4 more in the near future)

1 – FGC (planned, starting sometime next month)

1 – SS crown

1 – 3-unit FPD PFM (not guaranteed yet..but keeping fingers crossed it doesn’t fall through)

1 – Direct pulp-cap

4 – core build-ups

1 – cast-post/core (still need to cement it)

1 – pulpotomy on a screaming child

1 – RCT pre-molar

8 – Quads of SRP

3 – Arches of Full Dentures

1 – RPD (currently at framework try-in phase)

22 – Extractions

1 – Surgical Extraction (which was awesome)

2 – occlusal guard (one done, one planned)

1 – unilateral space maintainer (planned and on the horizon)

So there you have it. This is what I have accomplished so far. While the list isn’t that massive, I am feeling quite content with my current level of experience. While I am definly lacking in Endo and Fixed, I have done a ton of directs and feel pretty good about them. I also have plenty of fixed on the horizon. The only trouble-area is endo. Hopefully I can pick up another one sometime soon.

My experience obviously is going to be quite different from anyone else in my class. I know someone that has done a ridiculous number of endos already and someone else that has been really dealing out the crowns. However, I also know people that haven’t done an amalgam yet, or a denture. It is completely unique and based almost entirely on your patient pool.

Being a D-3 can be frustrating at times. You go through good streaks and bad, but all in all – especially once you start to feel at home in the clinic, it just kicks ass. I see all those silly D-1s running around to with their bone boxes or skulls and just shudder. Thank god I am done with that. 19 months and I’ll be graduating.

Wow.

Performance Exams

I have made mention of these types of exams on several occasions but I felt compelled to give them a post of their own. Anyone that took science classes in high school or college probably had tests known as ‘practicals.’ For example, in high school we had an anatomy practical on the frogs we dissected. Up until dental school, the dreaded lab practical was probably the most stressful type of exam I had ever taken.

In dental school, we still have the standard lecture exams (which are almost exclusively multiple choice). I remember getting really stressed out during the first wave of these back in the D-1 year. However at this point, they are more of a nuisance than anything else. We also got a good dose of practical exams during the first two years. While these were definitely more of a pain on the nerves than the written exams, they still weren’t much different from the crap I did in college.

Now though we get to the granddaddy of all of them – the performance exam. Essentially these are the exams that actually test your physical ability to perform dentistry. In other words, if you can’t do these, you picked the wrong career and now must pay off 200,000 in student loans working in retail. What makes these things the worst type of exam in the history of my educational career is how morale-crushing they can be. There is nothing worse than failing a performance exam. An essence, the instructor is telling you that you fail at being a dentist, which is a tough aspect to shake. Granted, we are still learning, and failure is part of the curve – but it is easy to forget that when you are stuck in remediation.

Now in fairness, they break us in to this new testing format pretty slowly. The performance exams in the D-1 year were all quite easy. We had to cut class I prep on #19 the first semester (and our grade was 100% self-evaluation). In other words if you made the shittiest prep in the world, you still could get a perfect grade if you pointed out why it was shitty. The second semester was a bit rougher, introducing the good old class II prep and amalgam fill (which of course is the same thing we have to do to get licensed). Still, the grading was lenient enough (my amalgam carving was average at best and I still got good grades).

The D-2 year was when things really got crazy. While the summer wasn’t too bad, once we hit the fall – the remediation waves starting hitting the class. I know very few people that didn’t have to redo something during that semester. Whether it was an endo, or a crown prep – pretty much everybody failed something. While I did well on all my endo exams, I remember the absolute terror of those exams. After you do the access, you have to get it graded before you cleanse/shape and fill. So you are standing in this grading line hoping you made it. If you fail the access, you STILL have to finish the exam AND remediate later. I can’t imagine how crappy that would feel knowing you already failed but still have to keep your shit together and continue.

I have plenty of posts on that crap so you can look them up if you want to read about my tortured soul last year. However, what brought about this post is the new breed of performance exam I just experienced yesterday. This semester we have three patient-based performance exams. One is a tx planning exam which is annoying only because it involves a lot of busy work. The other is an SRP exam which I have yet to attempt, and the last is a ‘caries management’ exam which I finished yesterday. The difference obviously is working on real people, but you must also find a good patient to perform the exam on. If you have no patients that have the specified issue, you need to mooch off of your peers.

Ok so what makes this the mother of all stress? The pure fact that you have very little control over another living human being. If they decide they aren’t going to show up on time (or at all), you pretty much got all pumped up for nothing and have to attempt to reschedule. This is particularly nerve wracking towards the end of the semester when you just don’t have enough openings. Another stressor is the fact that some of these exams must be completed in a different clinic. This is the first year they are implementing this and it is an attempt to eliminate bias and favoritism which I can understand. If I was doing an exam with an instructor that likes me because we have worked a ton of cases successfully already, then he most likely will give me the benefit on border line stuff. Still..would have been nice to have the advantage every other class has had up until I got to the clinics…sigh.

So I here I am setting up a chair in another clinic, not knowing any of the faculty, trying to find where they keep all their shit, and praying my patient shows up and the lesion gets approved.

Fortunately for me, the patient showed up spot on time. I got him seated, took BP/P and so forth. Then I had to find TWO instructors and have them sign off that I could do the exam. For this particular exam, we are allowed to pick ANY tooth that has caries on it. Doesn’t need to be a specific class, just has to have decay. I have done nearly 20 class V composite restorations, so I figured go with something I have done a lot of. So I tracked down two faculty I had never met before and had them look at the tooth. Thankfully, they both approved and gave me the green light to start.

Quite honestly, that was the most stressful part of the exam – knowing whether or not I could start and figuring out who would be evaluating me. I had to remove a GIANT restoration and was getting a little freaked out about hitting the pulp, thankfully that did not occur. The prep itself went really well and both instructors gave me the go-ahead to fill. I was feeling confident at this point, filled with composite, and started cleaning up the margins. The only real problem I had during the exam was getting the gingival margins smooth. This usually equates to slashing the crap out of the gingival tissue with the finishing burs. I did notice on the grade sheet however that there is NO category for soft tissue trauma. This was good because this guy’s gums were looking pretty roughed up by the time I finished. Despite having cord placed, there is not much you can do to avoid some tissue damage. I mentioned it to both instructors as they came by to grade, and they both essentially told me: “don’t worry, you can’t avoid it on these restorations and it will heal quickly.” So feeling pretty confident, I gave myself a perfect score on the self-evaluation. Only because both the instructors gave me positive impressions each time they dropped in.

If I had failed, I would have been informed instantly – so things went well. Thankfully it is over.

Another hurdle cleared. Now I need to find a perio patient for that other performance exam. It never ends.

So this rambling went on for a while, but I noticed many of my family/friends asking me about how we are tested, and I find myself constantly explaining the performance exam – so there it is.

Can’t wait till I’m a D-4, where the year is essentially one GIANT performance exam.

Hospital Dentistry

Back after another long sabbatical I know, but typing these things eats up a lot of time as one might imagine. Excuses aside, I did have an experience that inspired me enough to cement it for all time in the annals of the internet. As I have explained in prior posts, as D-3 students, we go on a variety of rotations (most of them in-house). For example, we rotate through radiology, urgent care, screening, and oral surgery to name a few. Now as D-4 students, we still go on rotations; however these are OFF-campus and should be interesting to say the least. I will go into those more as my time draws closer. Yesterday I went on a very unique rotation which sent me off to Masonic – a hospital found a ways north of the school. We had an entire day for this rotation so it felt in essence like an old-school field-trip. This, along with a geriatric rotation are the only outside experiences we get as D-3s.

The day did start at the college as I had to plow through a 15 question radiology final which was thankfully easy. Afterwards, one of my peers also on rotation offered me a ride and we decided to skip the now defunct practice management course – which has been quite useless up to this point. The director of the course took a job at the up-and-coming Midwestern College of dentistry and consequently left us high and dry for this course since it is pretty hard to manage a class when the guy who was in charge of everything jumps ship the same week the class starts. Honestly though, I doubt it would have been useful even if he was still here – the material is geared at stuff I need to know after graduation. Unfortunately, I am so fresh in the clinics and so far from graduating that I honestly cannot process this information at all right now – nor do I really want to. Let me figure out how to do some dentistry before I start learning office politics. Is it important? Of course. Am I learning anything? No.

But I digress; we left around 9:15, ate some disgusting McDonald’s breakfast, and arrived at the dentistry building affiliated with Masonic around 10:30. After taking care of a bunch of hospital paper work and getting I.D. badges, we finally get to see some dentistry. Now I have mentioned being interested in a GPR several times, and I still am. This was my first actual experience SEEING a GPR in action and getting to talk to the residents. Let’s just say I am even more set on doing a post-grad residency at this point. Granted, Masonic is probably one of the better GPRs in Chicago, but it just seemed quite beneficial. They do IV sedation for special needs patients every Thursday, so we got to see some cool cases and really learn what this particular GPR is all about. The bottom line is that you get to experience a TON of different things all the while improving your technique and skill. It isn’t like another year of dental school because you don’t have instructors breathing down your back. HOWEVER, if you need that extra bit of help or advice – you have experienced attendings to fall back on as necessary. To put things bluntly, you also get another year to screw up and not lose your license or get sued. Not to mention you can defer your loans and get paid for a change. So I would make 30-50k which is peanuts compared to an associate position, but you also must consider that getting a job straight out of school isn’t all that easy – especially getting a good one. Having a year of residency on the ol’ resume really beefs things up and puts you ahead of anyone that just graduated.

Now unfortunately we only spent about an hour and a half in the actual dental clinic. After lunch we spent our time in the main hospital. Three of us go to radiology and one goes to the E.R. I ended up in radiology which I was actually interested in. However, once we sat down in this dark room with one of the radiologists, I quickly realized how boring this was going to be. The guy didn’t really talk to us that much, we just sat around him as he dictated a few cases, took some phone calls, and bull-shitted with the other radiologists. We saw ZERO maxillo-facial cases. It was just one brain CT/MRI after another. That was the LONGEST hour and a half of my life.

We returned to the dental clinic and discussed how to analyze blood reports which was pretty useful as I don’t know what I’m looking at when I see these things. At this point it was 4:30 and we were done for the day. I really wish we could have hung out in the dental clinic the whole day instead of wasting time in the main hospital. I know that GPRs send you on hospital rotations as well, but you will never be reading brain scans in a radiology room…EVER.

So my resolve to keep the grades afloat has been refilled. GPRs in general are not super-competitive in comparison to other post-grad residencies, but if you want to have choice and go to a specific location, you can’t be a total schmuck. I figure I’m probably in the top 30-40% or so which is reasonable and my board scores are ‘ok.’ So I just need to keep doing my best and see how things land.

I definitely see myself in a GPR though; it just feels like the right move for me.

In other news, the clinic life is going smoothly. I finally got an endo case and the patient has paid for half of it and showed up for both appointments so far. Single canal on a pre-molar, hope to finish next appointment but I am really struggling with the x-rays. I had the instructor take WL pics for me last time because I missed them on my first try. HE even missed the apex so I felt better despite having to retake them AGAIN.

I am chugging along with most things. I feel like I have gotten a good deal of operative work in – but am definitely lacking in the fixed department. However, I have THREE crown preps coming up in the next two weeks so things are progressing.

Basically I love the D-3 year in comparison to the first two. It still is dental school and it still has its ridiculous moments – but all in all, I can safely state that this is the best year of dental school BY FAR. The fourth year will just be too stressful with all the licensure crap so I can already rule it out.

And with that, I’m off to enjoy the rainy weekend.

Getting Adjusted And Pulling Teeth

I am slowly becoming fairly acclimated to the clinic lifestyle here at UIC. I feel pretty confident with basic restorative work (amalgams/composites) and full dentures. I still have had ZERO endo experience which absolutely blows because we have to do a case presentation this semester. As you might imagine, doing a case presentation when you have no case to present sort of makes things impossible. Hopefully I will get something soon..but I have been thinking that for the past 18 weeks now, and I still have seen nothing. I also have done zero fixed work..but I do have several patients on the horizon so that experience is on the way.

So this semester started out with a bang. I am currently on an Oral surgery/medicine rotation that lasts for an entire month. So half my days are spent extracting teeth now which is actually pretty damn fun. The rotation is great because not only do you learn the basics on extraction, but you also get a hefty dose of simple patient management skills, a crash course in pharmacology, and a great place to improve your local anesthetic techniques. I have no desire to be an oral surgeon, but I love this rotation. Outside of third molars, I plan on doing most of my own extractions in practice anyways.

You would be surprised just how much force you actually have to apply to get the tougher teeth out. It is pretty exhausting actually – especially for a tall fellow like myself because the chairs refuse to raise high enough for me not to hunch horribly. The oral medicine rotation is hit or miss. Sometimes I learn something, other times I don’t. The OM faculty do love to talk though – which is good in certain instances, but bad in others. I have seen a potential carcinoma (waiting for biopsy), a salivary stone, and about a million TMD patients (which usually have some form of myopathy rather than TMD). We meet in this clinic on Wednesdays and we meet in OS on the other days.

Now outside of the rotation things are going fine. We have way more classes than I thought we would which sucks, but at least we always finish by 10AM. The actual clinic itself is becoming almost like a second home. The faculty is getting used to us and I honestly feel pretty confident doing basic stuff at this point. I really don’t even feel like I need faculty supervision anymore for certain procedures which is great. Each composite I do looks better than the last, each prep is smoother, and everything is clicking.

Obviously there is MUCH to learn, but I love the feeling of progress – knowing I am inching ever closer the realm of competent dentistry and graduation….ahh graduation.

Sorry for the lack of posts, I just find myself consumed in other activities when I’m not at school.

Feel free to continue emailing questions and I shall reply as promptly as I can.

Transmission End.

The D-3 Experience II

While I am somewhat disappointed that I haven’t kept up to date on all the happenings this summer, I realize that there are so many ‘firsts’ to talk about that I could never find the time to make separate posts about them all. Regardless, now is as good a time as any to lay down another experience post on the third year of dental school.

The semester wrapped up on the 7^th of August, which also coincided with an annual festival right on Taylor Street which happens to be the way I walk home. I like to imagine that they are celebrating another semester taken down by this weary dental student. I also enjoy walking down the middle of a street without fear of getting run over.

So where do I begin? Grade-wise, I’m not sure about most of the classes yet – regardless of the outcome though, I am completely satisfied with my progression and could really care less about the arbitrary letter. I feel like I got along with all of the instructors and I did manage to work with everyone in my clinic at least once. I didn’t make any drastic mistakes and I would say I did a decent job for a first semester in terms of speed and efficiency – clearly there is plenty of room to improve of course. The grades seem so out of your control at this point that I just don’t care. A lot of it comes down to luck – who you worked with, the types of cases you got, type of patient, ect. Plain and simple, some instructors give out A’s for free while others are tough as hell. I really don’t know how our ‘clinic’ grade is determined either, but I do know this one score counts for a TON of the percentage value in more than one class. Again, I got a decent score, but it was about 0.5% shy of what I needed. In other words, much like last semester I got hosed on the wrong side of the A/B border. Frustrating yes, but as each semester passes; I realize more and more that I am leaning towards general practice. I’m just getting antsy to ‘begin’ my life – as in, do things that involve me not being in school. Work hard and actually make money, get a house, start a family, all that good stuff. Obviously I don’t know if my passions will change, but I currently see myself possibly doing a GPR and then hitting the private sector.

Enough on the technical stuff, how does it feel? Knowing that I officially passed the half-way point of dental school back in July? Knowing that yet another batch of incoming D-1’s are on the way next tomorrow? Knowing that I can actually accomplish dentistry on real people without horribly butchering them? Everything is great. Six semesters down, five to go. Seeing new D-1s roaming about made me feel older LAST year, this time around I will likely feel like an ancient relic.

There is a lot changing in the clinics right now, the construction should be finished by October (of course they were supposed to be done by the end of august so this obviously might change again), so we are still all squished together and disjointed. Pre-clinic chairs will still eat up eight of our live patient chairs on Wednesdays, but the big news is that all the clinics are officially merging. There are three pairs of clinics that are adjacent to one another in the school. They are numbered 1- 6. 1 and 2 merged last fall as the pilot group. Apparently, things ran smoothly enough and they are merging 3 with 4 and 5 with 6. I don’t really mind as we have essentially been merged already this summer. My GP manager is taking over group 5 along with my group (6) so I won’t have to adjust to any change in command. I also think my classmates in GP 5 kick ass overall so we will all get along fine. Yea, it doesn’t really matter at this point. Even with change, you still find a way to manage and learn at the same time.

So what do you DO as a D-3? This summer we had several courses to roll through. Allow me to elaborate:

Dental Ethics – Pretty dull overall, most of the scenarios applied to a realm that we have zero experience with – the real world. I was hoping for a few more dental school based scenarios but I suppose dealing with the real world stuff is important. However, it is sort of pointless to expect a bunch of dental students to have anything really valuable to contribute to discussions that are clearly out of our realm of experience. You simply can’t teach ethics, it is something you must inherently possess or had ingrained as a child. I will encounter plenty of tough situations in my professional career, however, reading a book about it won’t help me solve the problem – I will have to sort through them as they arise and hope that my own morals keep things in check. The course ended with a 5-10 page written final due in early July. Afterwards I got to sleep in on Tuesday mornings. Cha-Ching.

Dental Public Health – Nothing to say really. Free ‘A’ if you showed up and turned in the assignments (super easy I might add) on time. Ended in July, slept in on Mondays thereafter.

Pain Control II – You standard OS-style lecture course. Straight-forward overall. The final tripped me up a little, but it was by no means unfair.

Advanced Oral Surgery –Pretty much everything discussed was way over our heads (as in the specific surgical technique to repair a cleft or nerve or something along those lines). We had an entire lecture devoted to facial cosmetic surgery. Like face-lifts and botox and all that crap. I DON’T CARE. The course director also happens to be the head of the residency program here. He is brilliant no doubt and a top flight surgeon. However, he seemed to consistently talk down to us and make us feel like the insignificant worms that we are. He also tended to lecture past 10:00 which is when our patients expect to be seated. Bear in mind that it takes a good 10-15 minutes to set up your chair and get all your equipment ready. Not to mention the exams were insanely difficult. When the high score on an exam is 43/50 (86%) in a class with several geniuses – you might have to revise your educational strategy.

However, I am being a bit whiny, some of the stuff was interesting and I did learn a lot (particularly about the TMJ).

Comprehensive Care IIIa – Not nearly as bad as IIc. We had a few pointless lectures, but we also a few GOOD lectures. Not to mention they CANCELLED the final exam three days prior which was AWESOME. We had to write a random patient portfolio, business report, and complete a clinical photo project. Otherwise this course was laid back. Of course the grade scale is unforgiving as hell and getting an ‘A’ seems based more on luck than aptitude. I feel bad for the classmates I know that want to specialize. They seem overly-stressed out and I don’t blame them. You really can’t control your grades as easily at this point. There is still plenty you can do, but it is not nearly as clear cut as get 90% of the bubbles filled in correctly.

OK, that ends the classes that had lectures. Now here are the clinical courses.

Endo clinic I – This is my only real big gripe. I cannot get an ‘A’ in this class. You know why? Because I simply didn’t get to do ANY endo this summer. I can’t force someone to need a root canal; and when they do need it, I can’t force them to not opt for the extraction because they can’t afford endo. What is even more annoying is that several of my classmates have done MULTIPLE RCTs. I really feel like the school should do a better job spreading the wealth, because it is bullshit and not an even playing field to be graded in this manner. We have to do a case presentation next semester as well. That will be mighty hard to do if I don’t actually get any patients that need endo.

Restorative Clinic I – Pretty much your entire grade is based on the faculty eval. I have no idea how they determine this grade, but I feel like I’ve done a pretty good job so far. We had two performance exams that were fairly basic. One was on the initial exam appointment and the other was on treatment planning. Nothing where you are under the gun.

Perio Clinic I – No idea how they grade, the performance exams were pass/fail. We had two – initial perio evaluation and oral hygiene instructions. That’s right; we had to take a performance exam on telling the patient to brush their teeth. Ok, it was a little more in depth, but not much. My only real complaint about perio is that several faculty members enjoy grilling the crap out of you with very detailed questions. I’m sorry that I don’t remember the exact name of the bacteria involved in chronic periodontitis, that was 2 years ago and I won’t remember it after I graduate (unless I go into perio). When in doubt – remember that calcium channel blockers have the potential to cause gingival hyperplasia!

So there is the class run down. Really though, this summer was a semester of ‘firsts.’ My first MOD, my first DO, my first F/F denture, my first partial (not really close to done yet), my first class III composite, my first pulp exposure and direct cap, my first palatal injection, I could go on and on. Everything is a first, and it is actually surprising how well things can go. It is also not a shock when you have a rough outing. You still learn from both and that is what really counts.

I still have a long way to go. The next semester won’t be as laid back as the summer, we have a couple of presentations and more class to attend – but it still will feel sweet to just continue treating patients. I get to deliver three arches of dentures in the first week! Hope they fit.

I still have another glorious week of vacation on the horizon as well. Two weeks truly is a HUGE difference from the single we got back in May. I would have posted this earlier, but I truly am enjoying the brief respite from dentistry.

I’ll be back at it full time next week…five semesters left till I finally grab that hard-fought DDS.

Extension For Prevention

I have found a MAJOR flaw in dental education. Actually, there are plenty - but this one is particularly bad. During the pre-clinical years at this school (and I'm sure everywhere else) we are really hammered on the idea of prevention. Not necessarily cutting the shit out of a tooth with a tiny speck of caries interproximally. Attempting remineralization, PRRs, ect. Back in the day, a gent by the name of G.V. Black came up with an old-school concept called "extension for prevention." The idea is that you extend your preparations well beyond the caries with the idea that you guarantee it won't recur. This thought process was caried out for a LONG time, only recently it seems in education they are teaching the reverse concept "Prevention of extension."

This is what we were taught, conserve structure when you can. Today I finally got my hands dirty with my first DO amalgam (#5). Radiographically, this tooth was a good example of the kind of case I will have to do for my board exam as a D-4. So I start the prep, all is going pretty well. I finally get a real time example of what cutting through tooth and caries feels like. The box was a bit overextended but workable. So how far mesially should I go with the occlusal portion? About half-way is what we are taught unless there is occlusal decay - which there was not. Assuming your walls are convergent, that should be enough retention.

I finish up the prep, and grab my instructor. He proceeds to tell me that I need to, and I quote, "G.V. Black this thing up, extension for prevention." So now I need to cut this healthy tooth all the way to the mesial marginal ridge because I can't exactly argue with the instructor who could easily make my life a living hell for the next two years.

Do you see the problem? What good is the pre-clinical teaching if it is instantly contradicted on live patients? OK, granted there are instructors who are conservative, but nobody seems to realize what we have or have not been taught. It's as if the pre-clinical years are taught at a completely different school.

This sort of confirms my original idea of the clinic - which isn't necessarily all that bad. You will get exposed to many different points of view. It won't take very long to find out whose opinion you actually value and whose you find outdated or downright wrong. This is actually a good thing because it defines you as a professional, you obviously can't agree with everyone on everything.

So the actual fill was quite the bleh, I didn't adapt the matrix band very well and totally stabbed the guy with the wedge which resulted in some unecessary bleeding (good thing he was numb). I put way to much amalgam in initially which took away a lot of carving time. I didn't have my instruments organized very well so I wasted time hunting for various tools and I had to keep grabing the highspeed suction to grab the huge chunks of overfill that were getting dangerously close to aspiration/swallowing territory. I pulled off the matrix and the contact was WAY to tight. I seriously spent about 30 minutes cleaning up the interproximal and reducing the occlusion. My margins were pretty decent, no open margins or excessive excess. Basically I was just too slow and REALLY rusty using all the carvers (I mean it has been about a year since my last amalgam).

The important part is that I didn't have any major errors. I could get the floss through by the end with fairly normal pressure and I got the occlusion down enough so it wasn't bugging him or showing up with the articulating paper. I was actually pretty damn satisfied considering this was my first amalgam on a real person. I need to get faster and remind myself how to use the carvers and burnishers effectively but otherwise, not too shabby.

Now back to dentures tomorrow...sigh.