Friday, May 14, 2010

The D-3 Experience V

HUGE post been working on for a few weeks…get something to eat.

I’ve done it. Three years in the books. One more to go and you can legally be treated by me without supervision. Scary right? So to get back in touch with my blog roots of over-analyzing and nitpicking every little thing about the curriculum, I’m going to do a D-3 breakdown by semester with clever little names: The Summer of Firsts, The Fall of Rollercoasters, and the Spring of Bliss. Creative right?

The Summer of Firsts:

Ok, so you just wrapped up an insane final semester as a D-2. You have studied until your eyes bled; you have crammed and stayed up late for weeks on end knowing that at some point, it all has to end. Well ladies and gentlemen, welcome to the Promised Land. School is still school, but the third year of dental school blows the first two away in terms of pure awesome. The stress is there, but it is more in waves this time around and of a completely different nature. For example, as a D-2, I was horribly stressed about finding extracted teeth to get through my endo class. Entering the clinics full-time, the stress is now about finding a LIVE person to actually come in, pay for, and sit through the entire root canal procedure which takes FOREVER at the school. That is merely one example however. Yea it’s stressful, but oh so sweet when everything falls into place and that first final case turns out perfectly.

So my clever little title explains it all. The Summer of Firsts is pretty much all your firsts. Your first class II, your first denture, your first partial, your first crown, etc. This semester was probably the most stressful of the entire D-3 year. Not due to curriculum requirements, but just getting acclimated to the clinic lifestyle. Learning how to deal with patients and learning how to deal with instructors and so forth. Sure we had been in the clinics a little bit at this point, but nothing prepares you for five days a week until you get thrown in.

But you want to know what the best part of this summer is? You actually get to enjoy your summer for once. You aren’t studying for a bunch of bullshit courses with pointless minutia to cram for – which you will promptly forget of course. Sure you get home exhausted because you suck in general at doing anything efficiently yet, but there is nothing to stop you from sitting on the porch/deck/alcove/whatever you have, and having a drink of your choice. Grabbing dinner with friends, watching the white sox lose, or just listening to tunes. Your evenings are actually evenings for once, not just peripheral extensions of lecture classes. And believe me, it is a sweeeeet feeling.

So don’t let me get too carried away, there still is class. And unfortunately, the lecture classes during the D-3 year in general were not so good. They just sort of existed. Some of them had uses, and I’d be lying if I said I didn’t learn anything. But the time was managed so poorly and the coursework in general was just inefficiently taught. On top of that, thank god I have no desire to specialize – because these classes are actually harder to get A’s in for the most part. Not because the material was difficult, but because you would get ONE exam for your entire grade. How about having a 20 question final worth 100% of your grade right? Get three wrong, good bye oral surgery/ortho/whatever. That has GOT to be stressful.

But again, that isn’t my goal – so this post really doesn’t apply to the gunners out there…sorry guys. I still haven’t gotten any C’s (don’t know about spring grades yet), but I really don’t mind seeing a few more B’s here and there – ESPECIALLY in these classes.

So what kind of class did I have in the Summer of Firsts?

Comprehensive Care IIIa – Good old comp care. The requirements are simply all busy-work oriented. BS paper writing and making stuff up so that it is 4 pages long font size 12 with single spaces feels way to college-like for a professional school. I know schools have to do so much for accreditation…but really? This is the class that also spurs all the paranoid comparisons and child-like competitions regarding production in the clinics. Good god people, you do realize that means jack shit overall? Unless you are like 5k behind average (hence not showing up to school enough), then your production is based either on luck, or being underhanded - neither of which is really brag-worthy.

Dental Ethics – easy class, some interesting discussions, overall unnecessary. You can’t teach ethics, because I see plenty of people who got A’s in the class do some preeeety questionable things.

Dental Public Health – easy class, some bullshit papers, more crying about underserved areas. Again, this is stuff I would be more receptive to if I wasn’t being bled dry for this education. Sorry guys, I won’t be going to Alaska to work for free when I have 300k debt to pay off. I feel bad for the state of healthcare in general, but my hands are literally bound by financial commitments that are absurd. Quite frankly, I kind of want to live life for ME a little bit too once I graduate. Selfish? Maybe. Necessary? Yes. I have my whole life to give back (and I intend to once I am capable).

Basic OMFS – Don’t even remember this class anymore. I do believe that things were a bit more than ‘basic’ though. Like plastic surgery and botox for example. Not really interested in that guys.

Pain Control II – Should have been combined with OMFS and filled the lectures spaces about stuff most oral surgeons don’t even dabble in (plastics). These classes stressed things I simply cannot remember without repetition and real experience. Some of it was a bit too hospital oriented which is way too overwhelming and confusing at this point. I think the main problem was that we are all just so focused on the clinics now. Lecture classes simply are obstacles in the way of REAL experience. Having 9am classes also is a TERRIBLE idea as the lecturers get all pissy when people start leaving at 9:30 to set-up for 10am patients. Sorry guys, but if I didn’t have to set everything up myself for that 10am root canal, I could maybe sit through another 30 minutes of IV-drip brand names and compositions. I know I’m coming off as a little bastard, but I’m just pointing out how MANY students feel in this situation. We are still so fresh in the clinic that it is near IMPOSSIBLE to focus on anything as obscure as botox injections or MRSA infections. In my defense, I never did leave lecture early (well maybe once or twice), but even if I stayed – I just couldn’t focus. I would be too concerned with what I may possible screw up in the next hour and how this class is now forcing me to rush. Ok, rambling over.

Restorative Clinic I – Two performance exams (treatment planning, initial exam) and faculty assessment make up your grade.

Perio Clinic I – Two performance exams (oral hygiene instructions, initial exam) and faculty assessment make up your grade.

Endo Clinic – This class goes all the way until our D-4 Fall semester. You get experience points per canal of endo and need a certain number to pass/get a good grade. We also have to take one performance exam which is an anterior RCT.


Scary overall, but you start to get used to everything by the end. You aren’t a total dental wiz yet, but clinic life is starting to become normal. You are experiencing more real life pleasures as free-time is suddenly far more abundant, but the stress still exists. Now instead of cramming for tests, you are freaking out about getting performance exams done.

Quick note on exams – DO THEM ASAP. We had Four to get done in the summer. One treatment planing case, and one initial exam for restorative, as well as one initial perio and one oral hygiene instructions (seriously) for perio reqs. Twelve weeks goes by REALLY fast. I will leave it at that.

The Fall of Rollercoasters:

Aptly named, this is when things get interesting. As mentioned over and over in old posts, dental school is bipolar. You have moments of intense euphoria and triumph only to be completely shattered the next day by a horrible mishap or four patient failures in a row. The fall semester really put an exclamation point on this sentiment. At this point we have been in the clinics long enough to feel less uncomfortable, but still too little to be supremely confident. It is that awkward phase, like when you are growing out your hair and there is about a two month span between awesome long hair and awkward shortish/long mullet. That is poor analogy since most guys have the same short cut (where everyone looks the same) in dental school anyways. To the few that understand, you know who you are.

Back to the point, you will find yourself learning at an accelerated pace. You will have a nice routine down in terms of setting up your chair and getting your instruments in just the right spot. However, this is also when a lot of phase three stuff starts showing up (like partials, crowns, posts, etc) and you may find yourself doing a few more firsts while you’re at it. Delivering final products kicks ass. The very first week of the fall semester I delivered three arches of dentures. I had been fuddling my way through the entire process all summer long and it was awesome to get some great results. Unfortunately some not-so-great moments are likely to occur as well. My particular example was simply a partial denture that refused to get finished. Every time the framework came in, it wouldn’t fit right and I would have to start over. Redoing lab stuff is a real bitch at the school too because you have to get three different forms signed by the faculty working with you. This is so frustrating the first time because nobody tells you about it, so you get one form, fill it out, come back – and what do ya know, you forgot the other two. Oh my, the gopher running involved.

Again, the biggest problem with D-3 year is the classes. Some were useful, but most were drawn out far too long.

Comprehensive care IIIb – refer to my last talk about comp care several paragraphs up – same stance.

Restorative Clinic II – same as above except they threw in a glorious EBD presentation to the mix. We also had to do an RPD treatment plan exam as well as caries management performance exam.

Perio Clinic II – same as last semester except with new exams: one SRP performance exam and one radiographic interpretation written exam.

Internal Medicine for Dentists – Far too much information crammed into 50 minute lectures. The course was very heavy on the science and biology behind the diseases rather than how to handle the patients. I felt like a first year medical student. Useful information, but again, the timing is awkward and the presentation was too dense and not focused enough on what I, as a dentist, should and should not be doing.

Practice Management – Total joke. The guy in charge of this class jumped ship for the new dental school opening in Downers Grove in 2011. So he left us high and dry with a class that nobody had time to teach and consequently was unorganized and haphazard. It was a free ‘A’ though, so I can’t complain. Unfortunately this is the one aspect of dentistry in general that I am clueless about which is not good.

TMJ Disorders – No reason this should have been an entire stand-alone course. Every lecture invariable had the same message. We don’t fully understand the TMJ, and we don’t really have any good methods of treatment. Warm compress, analgesics, and in rare cases – surgery. Could have been done in 1 or 2 lectures of another course.

Special Patient Care – Honestly don’t remember much from this course. It had some relevant information on cleft lips/palates but we had already had that in OS. Pediatric based.

Radiographic interpretation – Big review of radiology from D-1 year compressed into seven or so lectures. This class was actually kind of nice to have as an overall refresher.

Dental Therapeutics – Way better than pharmacology. Some lectures were a little weak, but a lot the material was taught well. I just have so much trouble learning drugs. Can’t blame the course, I blame the topic in general.

So again, the classes aren’t bad per say, there is just a ton of overlap. I also think the biggest problem is simply that we are all too focused on the clinical aspects of dentistry. I wish these courses had more clinical discussion involved and not so much biology/disease process. Yea that is important, but it is even harder to retain at this point and I may just be a grumpy student who is tired of hearing about renal failure.

Note: I am NOT turning my nose up at these topics. I know how important they are. I am just being honest from the perspective of a third year dental student. It is simply difficult to concentrate on most of these lectures at this point in my dental education.


The Fall of Rollercoasters is just as advertised. You have tons of victories, and plenty of failures, some big, some small. As I’ve said previously, the amount of clinical knowledge you attain during this year is insane – especially during this semester. You are learning to manage several patients in various stages of treatment, whereas in the summer, everyone was pretty much needing initial exams and treatment plans. You are also beginning to feel comfortable with the entire faculty because by now, you have worked with most (if not all) of them. You know who to go to for advice on partials, who to avoid when you want to do a conservative posterior composite (not a G.V. Black inspired overextension through healthy dentin), and so forth.

School still does wear on you though. I spent a few Saturdays doing lab work (but nothing compared to D-2 year). Mostly you just get tired of having to schedule all your own patients and work around everyone’s schedule. I can’t wait to have people do that for me. Only by not having something do you realize just how important it is. RESPECT THE SECRETARY!

Spring of Bliss:

Perhaps the sweetest semester of dental school. The D-3 year is variable for everyone, but by the time spring rolls along, most everyone has hit their proverbial stride. Everything just starts feeling easy. Chatting up with faculty members is easy and fun, you also notice the leash getting loosened up a bit. For example, if I do crown prep, the faculty member will look at it, make a suggestion if necessary, and that’s it. They don’t need to see your modifications; they don’t need to see your temp. It is awesome. Now some of them are still pretty anal about everything, but you know which ones are like that by now and this helps greatly with stretching your own bounds.

This spring semester is also the first spring semester that doesn’t horribly suck, which is a welcome change of pace. My only real complaint is that I seemed to have less time in the actual clinic due to rotations and random clinic closures. I think I only saw five of my own patients the entire month of February. This is not me having tons of blank spots; this is me being too busy to see more.

The only real scare of the semester is assisting the D-4s for mock boards. Knowing this shit is less than a year away is already making my right eye twitch.

Otherwise I greatly enjoyed the semester. It is a fitting end to the best year of dental school (so far). Again, it is still school – but it is so much different from the first two years and all for the better.


Comp care IIIc – same as same as above

Clinical Oral Pathology – Culmination of our rotations held throughout the entire year in the oral medicine clinic and a lecture class from last semester. This rotation was hit or miss. Some days were actually quite educational. There were plenty of duds though where I really really would rather have been elsewhere.

Intro to Geriatrics – A class that would be best suited as a lecture series in a different course. The director was easy on us though and made the class as enjoyable as it could have been.

Radiology Clinic I – Culmination of our rotations held throughout the entire year in the radiology clinic. This rotation was good for the first two semesters. I felt that my final 10-12 experiences were just an excuse for cheap labor to take FMXs as I really wasn’t learning anything.

Oral Surgery - Culmination of our rotations held throughout the entire year in the Oral Surgery clinic. This was by far and away my favorite in-house rotation of the year. We got about 9 weeks of OS rotation which is HUGE. I don’t know many schools that have you doing tori removal and alveoloplasty procedures. My confidence level in extracting teeth is fairly high at this point. I still know the limits of what I would do in general practice, but I’m definitely not sending everything off to the local OS.

Intro to Hospital Dentistry – This class was pretty much unhelpful. You could tell the course director didn’t really care about us or the course and was just filling out part of his job description. That aside, the lectures were all rehashes of random stuff we had seen before. There was also an inordinate amount of hospital privilege and function lectures. After seeing how crazy hospitals work – I can’t believe anyone is able to get anything done in those facilities. The class is clearly meant to engage your interest in hospital dentistry – but it does the opposite, and scares you the hell away.

Pediatric Dentistry Clinic I - Culmination of our rotations held throughout the entire year in the pediatric clinic. I enjoyed pedo far more than originally anticipated. However, I kind of got the shaft in terms of rotation schedule. I had every Friday PM session of the week scheduled for pediatrics. I would be fairly generous to even guess that HALF of those slots actually had me seeing patients. The patients would either not show up; or the clinic would randomly be closed for some reason or another. I would not have passed this class if I didn’t start coming in on Thursday mornings as well as Friday afternoons. This is rather unfair as it eats up another slot that I desperately require for my own patient pool, but alas, what’s done is done.

Surgical Periodontics – Best class of the entire D-3 year, hands down. Completely geared towards preparation for the NBDE part II. A great review course. The lectures were concise, well planned out, and even had practice questions at the end. Perio is rather unappealing to me, but this class was well worth it.

Restorative Dentistry II – This was a lecture class, not actual clinic. The course had a lot of potential, and I did learn a good deal. However, I feel as though a lot of it was just a bit too complex for me at this point. The prosthetic stuff seemed way outside the realm of this school and I was hoping for a little more practicality in terms of what can I do NOW as a dental student. The handouts required loupes to read as well which made for some gnarly eye strain. At least the director was completely chillaxed about grading and pretty much gave away ‘A’s for attendance.

Restorative Dentistry IV – I really don’t understand the titles of these lecture classes. This was a clever camouflage name for a dental materials course. They probably did this to make sure everyone still registered. Kidding aside, I actually found this to be a useful class. It reviewed a lot of basic dental materials knowledge that actually made sense the second time around. Not bad!

Perio Clinic II – same as last semester except NO performance exams. Only had to take a diagnosis/prognosis written exam.

Restorative Clinic VI – wait..what happened to III, IV, and V? Hmmm maybe a schedule typo, well this was similar to the other restorative clinics except the performance exams sucked. We had to do either a class II or III direct restoration (not so bad) as well as crown. The only reason this sucked is that we had to deliver the crown as well. This can sometimes take awhile (especially if you want to trim you own dye). I just squeaked by and delivered the last Monday of the semester. We also had to deliver a case presentation which went well for me.


The spring is great semester overall. Your confidence is brimming by now and you get to revel in it quite a bit. I imagine the D-4 year will be similar with the giant exception of all the terrifying licensing exams and getting graduation reqs in.

Final thoughts:

What more can I say? This is already dangerously close to surpassing my orientation post way back when…maybe it even has. The D-3 year kicks ass overall. My only real experience shortcomings = lack of limited ortho case and implant cases. I don’t really care about the ortho (aside from doing enough to graduate), but I definitely am a bit disappointed with the implant situation. I do have one of my own patients on the horizon that will hopefully get going this summer…but everything still seems a ways away.

I have learned so much dentistry at this point that it is impossible to quantify. I can’t even begin to imagine how much more there is to learn throughout the rest of my life. While I feel confident in doing most basic procedures, I still feel quite crappy at the more complex stuff – or even treatment planning some of the crazy mouths I see coming in. I know another year will greatly reduce this deficiency, but I am realistic in knowing that there will always be ways to improve, regardless of how long I have been practicing.

So now I have turned the final corner. I am log-rolling my way down that huge mountain of dental school. The impossible and the improbable all coming to a front this year. I am going to be a graduate with a doctorate in dental surgery in twelve months. Just typing that out seems unreal. I can’t even imagine what it will feel like.

All I know is that I can’t wait.