There and Back Again, A Dentist's Tale - Or the misadventures of me, that guy with glasses

One Week At County

2011-09-11T20:39:00.003-05:00

A musical interpretation.

Currently, this is my personal soundtrack whilst jumping from room to room during the morning sessions at Cook County.

By the end, I hope it sounds more like this

We shall see.....

The GPR Experience I

2011-09-02T17:17:00.000-05:00

OK. So I’ve been slowly scrapping this post together over the last few weeks..but now I find myself with a four day weekend, so I really have no excuses.

Two months in and things are going well. I will briefly outline the program here at Masonic with an obvious disclaimer: NO TWO PROGRAMS ARE ALIKE – especially in regards to GPRs. Masonic is probably the best option in Chicago if for no other reason than pure stability. It has been around for a long time and most of the attendings were residents themselves. It also boasts the largest number of resident positions. Some may be turned off by this, but you’d be surprised how much you learn from your co-residents either through their own experiences. Collectively it ends up being quite positive.

So a GPR generally lasts one year, at Masonic, there is an optional second year. The squad we have this year consists of eight first years and one second. Most of the year is spent in our dental clinic which is literally across the street from the hospital.

However, we are sent on various rotations:

Anesthesia – One month: in the hospital, the goal is to get adept at placing IVs and learning as much about anesthesia as possible. I’m on this rotation in January.

Oral Surgery – One Month: at Cook County, working the OS clinic with all of the OMFS residents. I literally just started here, will be spending September shucking teeth.

Emergency Room – 2 weeks: Literally hang out in the ER

Dental Van – 7 weeks total (whenever I’m on second call, I spend that week doing dentistry in a van)

There used to be a 2 week block for the oral medicine clinic at UIC, but that is currently defunct as that department is seemingly being dismantled. We may actually end up in the OS clinic at UIC as well, but that is still up in the air.

OK, so those are the big block rotations, we do take call and this can be light or insane depending on the week. The crappy part is that when we are on call it is for an entire week, so if you get slammed one night, there is no recovery period. However, the calls we take generally are fairly basic and if it isn’t, we punt the case to OS or ENT. By basic I mean simple dental traumas and intraoral drainage.

I take first call 6 weeks the entire year, second call is 7 weeks. The first few weeks of call we would go in as pairs, but after the initial fear of stepping into an ER and making decisions on your own subsided, we generally go in alone.

Now aside from actual clinic, we attend various lectures ranging in all kinds of dental topics. One of the best is anesthesia which is taught by a dental anesthesiologist who generally is around on Thursdays for all of our SPC IV cases. He will also come in on the occasional Tuesday for normal patient IV cases. I have yet to do an IV case yet but have been assured, my time will come. Two residents see two cases (sometimes three) apiece on Thursdays.

Now bear in mind, the majority of our IV cases are on special needs patients. IV placement can be pretty damn hard if the appendage is flailing about, but it gets done. Sometimes, just getting the patient into the chair is challenging which makes me appreciate the effectiveness of ketamine. Generally use midazolam and propofol once the IV is set, and it is pretty dramatic how well this stuff works. I will talk more about this when I start working through some cases.

Here is the basic schedule:

M: 9-6

T: 8-4

W: 9-6

TH: 9-4

F: 9-4

I listed our clinic hours, we generally show up anwhere from 1-2 hours early depending on what the lecture schedule is like. We may also stay 1-3 hours after, again variant on the lecture schedule.

Thursdays is special needs day, elsewise we are seeing standard patients. However, a few AM/PM sessions out of every month we will have a specialist in as an attending. This is when we do procedures most dentists stay away from (Impacted thirds, Implants, Crown Lengthening, Osseous surg/bone graft, etc.) We end up with a pretty nice amount of variety.

So what have I done so far? The biggest exposure for me 2 months in is definitely endo. I have done more RCTs in 8 weeks here then I did in four years of dental school (including pre-clinical extracted teeth practice). I also never did any molars in DS, and have already completed four here. I still don’t see myself jumping into molar endo in private practice, but I’m no longer really scared to try either. Regardless, every general dentist should feel comfortable accessing any tooth in the mouth, if for no other reason than to perform an emergency pulpotomy.

Perhaps the next most significant gain for me is in my OS skills. I felt UIC prepared me pretty well for basic exodontias, but I definitely love to get more efficient. I’ve also gotten to try my hand and full bony impacted thirds (well at least #32 and #17 were). It may have taken me 2.5 hours and I may have sweated like a pig because I’ve never extracted a tooth that I could not SEE prior to the procedure. But hey, it worked out and the patient did fine, no lingering parathesia (woohoo!)

The coolest part is that I did exactly what the textbook said to do, and it WORKED. The key is ACCESS. If you think your flap is big enough, it probably isn’t.

Speaking of OS, I began my month rotation at Cook County for the month of September. Pretty much a revolving door tooth extracting machine is what I must become. I felt like I did ok on my first day, the hardest part is actually just figuring out how documentation is handled because I’m already used to the system in my home clinic. We have to ‘dictate’ all of our notes here as well which is new for me.

But as an aside, there is an amazing blog crossover going down here that I just have to mention. It seems I will be a henchmen/minion/lackey to Ben from DMDstudent.com for the next month. He’s a second year at cook and is the chief resident of the general clinic this month.

So I will shamelessly plug his site again because it actually has tons of good info, where as my site is really more for the cheap thrills..it’s ok to admit it. DMDSTUDENT.COM. Pre-dents, dental students, aspiring oral surgeons – Go there. Hell, there’s even a link over to the right if you are too lazy to type it in.

So I expect my dental extraction prowess to increase dramatically over the next four weeks.

I think I have sufficiently outlined the deal here.

I am starting to put my resume together for the dreaded job hunt. Planning to work in a few offices, but need to feel it out first.

Sigh. At least I’m not going into more debt at the moment.

Cheerio!

Let Me Count The Ways

2011-07-21T20:53:00.000-05:00

Three full weeks into a GPR and I can already definitively say that this was a great idea. The amount of pure learning going on at this place is absolutely staggering. I probably learn more in one day here than I was doing in a month during my final year of d-school.

Unfortunately, the scheduled is pretty damn intense so I get home exhausted on a daily basis.

Real quick:

On call: got called in on a trauma case, replanted/splinted #9 and sutured facial lacerations. Scarring turned out pretty damn nice considering I'm not in plastics and had never sutured skin before.

OR case: Oral Squamous cell carcinoma , full mouth EXT prior to radiation therapy. Surreal experience to say the least.

Special Needs Thursdays: A brand of dentistry that many dentists never experience or are simply to frightened to try (with good reason). Exhausting and satisfying all at once.

IV sedations: Coming soon! One resident per week at the moment, eventually more. 20+ cases by the time I'm done (not including my month in anesthesia).

Implant dentistry: Free CE all year from nobel biocare once a month, new system at the office, will definitely be placing some soon.

Plenty of stuff I forgot. The attendings and co-residents are all great.

Sorry for the brevity, but time is not my friend anymore.

OFF!

End of The Trilogy

2011-05-07T15:23:00.002-05:00

It was bound to happen eventually. I have graduated for the last time. This was my ‘Return of the Jedi,’ my ‘Last Crusade,’ my ‘Die Hard: with a Vengeance,’ my…well I think you get the point.

Now in this brief window of opportunity prior to continued graduation festivities, I can take a second to capture the moment within this dusty old blog that I have managed to stay at least somewhat active with over the last 4+ years. I don’t know what is more amazing to me, the fact that I am finally done with school or the fact that I have had a ‘blog’ for this long.

Yes indeed, I have graduated. The big fat DDS can now be plastered at the end of my name. Much like all graduations, the experience is surreal. However, this one is particularly strange to me. It has not sunk in yet, but I will probably not see many of these people ever again. These people who I have endured with, stressed with, laughed with, shook my fists in the air with, I could go on forever. I spent four years with the same 60some faces. We all went through the same experiences, the same classes, the same everything. This is what defers Dental School from college, or from high school. A small group of people are in it together for four straight years.

It really is a bittersweet moment. The faces I never really was friends or talked with much, I will miss them all. Even the people that would annoy the ever living crap out of me nine times out of then, I will miss them as well. We all go down different paths now. I hope to keep in touch with my closest friends but am realistic that even those relationships will no longer be the same.

Life goes on, as it always does. And I’m sure some of you may be wondering - where does this blog go from here? I have done my best to maintain it and I know my initial intentions got muddled along the way. However, I hope that I have provided inspiration, insight, along with an edge of light-heartedness that we all need every once and while. I know I haven’t always kept up with email queries, but I have tried!

So does this blog end? I really haven’t decided yet. I can’t imagine myself throwing in the towel yet, but I can’t make promises of regular posts either (not like I do that now anyways).

I’m off to a one year general practice residency that starts July 1^st, but before that, I plan to take some vacation, relax and just appreciate life for what it is.

I would like to do one final post on dental school in the near future, a final D-4 experience of course, but with a kind of summary of everything.

I’m sure it won’t end, but it will be different. I mean, I can no longer be the whiney bitching student I have been for the last three years can I?

As an aside, I have to say, despite all that bitching, I am genuinely satisfied with the education I received here at UIC, ESPECIALLY from a clinical standpoint. I feel extremely competent with meat and potatoes dentistry and hope one more year of essentially free CE, will push me into a great realm of practical confidence regarding what kind of general practioner I plan to be.

I appreciate all the positive feedback (and even some of the negative) I have gotten over the years. It has really kept this blog alive.

Good luck to everyone applying to school, in school, graduating, or just living life in a world unrelated to dentistry.

Adieu

21 Days Left, Again

2011-04-16T16:10:00.003-05:00

What are the odds. I just randomly was thinking about this post I did approximately four years ago when I had 21 days left prior to graduation. As the blog gods would have it, I am in exactly the same position today. This was NOT pre-planned which is what makes it awesome. Twenty-one days stand between me and doctor-hood. So in the spirit of that original post, here are 21 things I will absolutely NOT miss about dental school. In no particular order:

1. Only learning dentistry for about 1 hour a day, the rest is spent cleaning up chairs, gopher running lab scripts, calling patients and checking out instruments.

2. Going into debt more and more each and every month

3. The pre-clinic

4. Studying power point presentations for hours on end

5. Cockroaches

6. Dental students, good lord we are an annoying bunch

7. Being treated like a 12 year old despite being 26

8. Calling my own patients and setting up appointments

9. Setting up my chair

10. Breaking down my chair and returning instruments

11. Having 1 out of every 3 units present with some malfunction (leaky water spray, broken hose, etc.)

12. Having 1 out of every 3 hand pieces not work, requiring me to go back to the window for seconds

13. Having to suck-up to pretty much everyone from the janitor on up

14. Being constantly hounded about collections as if I can actually get any of these patients to actually pay. What do you want me to do? Break their thumbs?

15. pre-clinic students leaving rotten smelly endo teeth in open jars all over the school. Pick that crap up please.

16. Having to coordinate with program directors that have NO cooridination in terms of what I have and have not done or when I'm on and when I'm not on rotation.

17. Having to mount every case as if the world would explode should I not

18. Having a crappy lab do all the work

19. Having to get everything swiped or signed (approved)...and I do mean everything

20. Attendance taking (again, I'm 26 years old here)

21. Being a student!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I AM DONE!! and just like that original post... GO BULLS!

Exit Interview - Loans

2011-04-11T15:35:00.001-05:00

Hilarious and disturbing at the same time!

"You are generally obligated to repay your student loan(s), even if you do not complete your program of study, do not complete the program within the normal timeframe for completing it, are unable to obtain employment after you complete your program, or are otherwise dissatisfied with or do not receive the educational or other services that you purchased from the school. However, there are a few situations in which your loan may be discharged and your repayment obligation canceled or forgiven.

- You die

...

...

...

Well at least they aren't beating around the bush.

CRDTS?

2011-03-24T13:38:00.002-05:00

Perio: 100.00
Restorative: 96.21

I'm going to be a dentist.

Get Me Outta Here!

2011-03-22T15:14:00.005-05:00

Great email this morning:

"Mandatory Phone-Triage sign up for D-4 Students."

So basically I have to come in at 8:30am and be an amazing dentist...and by dentist I mean secretary. Yes folks you heard correctly, I will be 215,000 dollars in debt for this education and what do they have me doing?

Answering phones. Not diagnosing, just setting up appointments. I'll just leave it at that.

In other news. My girlfiend (who is also about to become a dentist) just had her first job interview. A word of advice to dentists looking to hire associates. Look at their resume before you invite them for an interview. Or better yet, actually read the email/letter of interest that they send you.

Basically she got invited to an interview and the potential employer didn't seem to realize she was a dental student until she got there. I mean, it isn't like that sort of thing isn't advertised on her resume and job-inquiry email. The dentist was looking for someone to start next week and take over for another associate going on maternity leave.

Poor form, really poor form. Seeing as I drove, that was a wasted 2 hours of my life. That is definitely a practice I won't be looking at in the future. But hey, we all learned a valuable lesson. Actually look at someone's resume before you consider interviewing them. Not that I already didn't know that...but I guess a real life reminder doesn't hurt.

Bleh.

CRDTS!

2011-03-21T15:03:00.002-05:00

It's over...hopefully.

Barring some unforseen miscalculation or hidden blunder, I believe I have officially passed the final test required to legally practice dentistry in the state of Illinois. Rumor has it, the grades should be posted sometime this week, so we shall see.

So how did it go?

Started rough, but honestly, I think the day in general went VERY smoothly. EVERY one of my patients showed up 15 minutes early. I cannot emphasize enough how important this is. Find the perfect patient, not the perfect case. If they show up late or are unruly or just a PIA to work on, you will be stressing terribly. Secondly, get an assistant you are familiar with. Their importance goes far beyond just suctioning and gopher running. They need to keep you calm and focused, treat it it like a normal day....even though we all know the day isn't normal at all.

So let me break it down:
Wake up a 6am. At the school by 7am. Gather all my crap from the locker (forms, loupes, goggles, etc) and begin wrapping my unit. I walk out to check out my instruments for the first procedure around 7:30 and see my first patient already sitting in the waiting area...big sigh of relief.

My first procedure of the day was my class II amalgam, also the most technically demanding procedure of the day due to the less-than-ideal case selection. Basically you want a class II with caries just barely tapping the dentin (that perfect little triangle from all the D-1 lectures). You want good occlusion, and you don't want their to be an adjacent filling.

Well, my class II was a good millimeter past the DEJ with caries which already scares me because radiographs tend to underestimate the extent of decay. There was also a big bulky adjacent amaglam restoration to contend with. So while not ideal, this still is not a difficult procedure. What makes these procedures difficult for the day is the ENORMOUS amount of pressure you have to, putting it mildly, not fuck up.

My assistant showed up at 7:30 as well. I actually hired a real dental assistant from one of my rotation sites. More expensive than a D-2, but I felt comfortable working with him and knew that he would keep me focused while maintaing a sense of levity that helps SO MUCH when you are stressing.

So we seat my patient and get all the forms ready to go by 8:00. All the examiners come in and it is a mad house of students rushing to get the start check. By about 8:15 I'm set, the case gets approved, and I'm off to races...or am I?

It is now 8:45 and I still have not gotten the rubber dam on. I'm doing #3 MO, so I'm trying to clamp #2. This tooth is bulbous and I try about 12 different clamps. None will stay on long enough to withstand any sort of dam stretching. I can feel my face flushing, the sweat beading, thinking oh crap, I'm never going to get this damn thing on (pun intended).

Eventually, the practical voice inside of me says "Hey, remember you don't actually need the dam on for your prepration, just put it on #3 for the prep-check." Good job practical me.

I quickly cast my clamps and dams aside and just started preparing the tooth. Now here comes the next debatable topic. Modifications. I am of the thought group that if you aren't going to pulp-out, don't ask for a mod. You waste about 20-30 minutes per request. And believe you me, this exam may seem like you have lots of time...but you most certainly don't. With a minimum of 6 examiner checks a good 3-4 out of your 9 hours are spent waiting around. Add another 1-2 hours seating patients/eating something/administering anesthetic/breaking down/setting up/etc. You can run out of time fast.

So my thought, don't get the mods. Yea you will lose points for overextending, you may even get a substandard or two in there. WHO CARES, you fail if you run out of time. Case in point, my class II preparation was bigger than ideal. I chased stain and caries further than is ideal. But I got it all out and the prep didn't look bad at all from a realistic standpoint. Was I in failing range for overextension (2.5mm beyond DEJ)? Don't think so. Again, I haven't gotten the scores so maybe this choice to not mod will backfire, but I still feel like it was the right choice.

The dam is applied easily by clamping #3 and I send him off for a preparation check around 9:30. Now here is by far the worst part of this exam. Waiting for something to get graded. Oh my. It takes a good 30 minutes each trip and I felt my pulse just skyrocket each and every time. I literally couldn't just sit, I had to pace around, constantly doing laps around the clinic.

My assitant brings him back and gives me the thumbs up from far away, good news. I remove the rubber dam, place my matrix/wedge and fill 'er up with amalgam. The contour was awesome, the anatomy mehish but not terrible, but my contact was too damn tight. The adjacent restoration just had a HUGE broad contact area to work with so it was tough to get perfect. Floss was passing, but not as easily as I would have liked. This may be a sub or simply an acceptable..depends on the mood of the evaluator. The occlusion was mondo high, but I brought it down with round burs to an acceptable level. I sent it off around 10:30 and let my second patient know we'd be ready in 45 minutes (he also showed up early). So again, waiting is the worst part. Patient comes back with no instructions. I thank him profusely and send him on his way.

Class II thoughts:
Wasted a lot of time with the damn dam
Overextended pretty much everywhere without requesting a mod (hoping the point deduction doesn't ruin me)
Prep didn't look half-bad
Fill was nice overall with a slightly too heavy contact.
As you will shortly see, if I fail anything, I think it will be this.

My second patient is for the deep-cleaning. By the time he is seated with all forms completed it is about 11:15. So I send him off to get my treatment selection approved. The difference between perio and restorative on this exam is that you need to physically send your patient to the examiner station before you start perio. For restorative you only need a floor examiner to sign your sheet.

So believe it or not, it takes about 45 minutes for them to see and approve my treatment selection. Thankfully, I truly lucked out and got a PERFECT patient in terms of case simplicity. He had lots of calculus, but it was fairly light and not too difficult to remove. I was finished around 12:45. Now I may have missed the distal of #2 a little, but overall, I think this was one of the best SRPs I have ever completed in terms of results and speed. Now watch me somehow fail perio. Hopefully not!

Perio thoughts:
Great case selection helped
Compliant patient who could keep his mouth open HUGE for long periods of time
Feel like I smoothed pretty much all of the surfaces (maybe missed 1-2 sites)
Feeling pretty confident...but again..until those grades come up...

It is now 1:30, I go talk to my third patient (who has also arrived early!) and let him know we will be ready around 2:00. Could have gone around 1:45 but decided to wolf down a few power bars/drinks with my assistant. I had been too nervous to eat in the morning and hadn't had anything since 8:00pm the previous night...ugh.

After the quick breather we get my third and final patient (class III ML #8) seated and all paperwork cranked out. Now when we talk ideal case, this is about as good as it gets. Radiographically you can't see anything, but there is definitely a small shadow viewed clinically. I get the case approved and finish the prep around 2:30. Comes back with no instructions..I'm on the home stretch. Here is when the final terror ensues. I placed the composite and contour is great, but there it no/extremely light contact. How is this even possible? I didn't have to break the incisal contact during my preparation and didn't wedge the teeth either (for fear of displacement). The problem was that he has some serious perio (which is currently being treated). So his incisors exhibit a bit more mobility than most. So I tried wedging the distals of #8 and #9. Definitely got contact...but it would immediately vanish as I removed the wedges.

After some brainstorming, I finally end up removing some of the composite, rebond, and place new composite WITHOUT a mylar strip. This seemed to do the trick as I got that perfect little click when flossing the contact. I removed the flash/excess, polished quickly and send him off at 3:45 for the FINAL CHECK. As fate would have it, this final check was also the LONGEST.

The patient came back with no instructions around 4:25. DONE! DONE! DONE!

I immediately got all my stuff turned in and fled the scene.

Needless to say, the day lived up to my expectations in terms of sheer stress. And this was with things going relatively well, I feel terribly for my classmates that got screwed over in any way, shape, or form during this outdated and restrictive exam. The only final note I will add because I'm getting tired of typing is that all of the floor examiners were extremely nice. I was so worried they were going to be a bunch of hard-asses constantly nitpicking and docking us infection control points. Not at all. They would chat with us during waits and in general, were just unbelievably friendly. So that definitely helped relieve some of the stress.

Now back to enjoying spring break and praying that they post these scores ASAP so I can let out one final sigh of relief.

Rotation Vs Clinic

2011-02-16T18:13:00.001-06:00

Another post? Hot damn. So as I’ve just started my fourth (and final) block of rotation, I have decided to follow up on old promises and discuss rotations in general. I participated in what is known in these parts as the ‘2x2’ rotation. Basically I spend about the same amount of time offsite as I do in the school during my final year. This has been an overall wonderful experience. My only major gripe is that I truly don’t want to be gone anymore at this point. Three blocks was enough. Now my presence at the school is pretty important because I have requirements to finish and boards patients to find.

However, the topic here is what’s the point of rotation? Now all the muckiddy mucks up top will say that the primary goal of extramural rotation is to help you develop a sense of how crappy health care is in this country and how many people are lacking dental care. I understand that is important. But let’s be realistic. As a student, all you care about is experience. You want to get as much dentistry under your belt before you get booted out into the real world. Your paying out the ass for it, why wouldn’t you? And honestly, while I have seen a lot of great people on these rotations that truly appreciate what they are receiving, I have definitely seen plenty of the ungrateful dregs of society that are abusing the system for all it is worth. Eye-opening either way.

So have I gotten a lot of experience? Of course. Has it all been as technically complex as some of the things I get to do at school? Hell no. So you still need both. At school, I am pretty much doing all my fixed and removable work at this point (crown, bridge, partials, etc). On rotation is almost exclusively directs, EXTs, exams, emergency. Now I have done the odd endo and crown off-site, but these are exceptions, not the standard.

My stance is that my overall experience is pretty damn well-rounded. I wouldn’t mind some more crown/bridge, but honestly, at the rate things get done at the school, I’d rather just continue to learn with my own materials and getting to choose my own lab.

So here is what I have completed on rotation to date (not everything, but most)

Total patients treated: 330

POE: 101

Emergency: 31

Prophy: 71

Sealants: 62

Amalgam 1 surf: 19

Amalgam 2 surf: 33

Amalgam 3 surf: 2

Resin 1 surf: 120

Resin 2 surf: 41

Resin 3 surf: 13

Resin 4 surf: 5

SS crown: 11

Pulpotomy: 12

Anterior Endo: 2

PFM crown: 1

EXT: 75

Surgical EXT: 5

Ok so that is most of it. This is over approximately 14 weeks of rotation (with a few short weeks in there due to holidays or school business). Now as a DENTAL STUDENT, this is a pretty meaty chunk of experience. I don’t know many dental students at other schools that have pulled 80 teeth by the time they graduate (I am around 150 by now including all my in school rotations). And I’m not saying this to brag or pat myself on the back. I’m saying this to put it in perspective. I am a practitioner that will want to do most of my own extractions without spending 6 years in an OMFS program. Getting as much experience before I graduate will only enhance this plan. More importantly, it allows me to see which types of EXTs I should refer. Same applies to working on kids. I plan to do a lot of my own pedo work, but I know the signs/symptoms of the cases that NEED to be referred. This knowledge is just as valuable as any of the technical skill I have amassed offsite.

Another extremely valuable asset to rotation is working with different people (assistants, hygienists, dentists). You begin to figure out what makes an assistant good, and conversely, what makes them absolutely worthless. You will find dentists that were not trained at UIC who will teach you techniques you never knew, or how to use some instrument that makes your amalgam carving look like a DaVinci. Again, you will also disagree with some of them, and while you can’t be some cocky-ass student, you make a mental note of what and why. While frustrating at times, it is intellectually stimulating as hell and ultimately makes you better because you can further define what you are as a dentist. When is staining no longer staining? When is all the caries truly gone? Does this need a crown? Would I want to even attempt this RCT? Again, the cognitive developments I have gained throughout these rotations have been equally important to any technical accomplishment.

Now rotation isn’t all sunshine and roses. Some days are truly unhelpful. Like the day you get stuck doing 6-9 prophys and zero restorative. But these are not as often as people claim (at least in my experience). The other issue again is managing what little time you have at the school. You find yourself giving your patient’s shorter leashes in terms of leniency. If they fail an appointment during one of my precious days left at the college, I pretty much instantly dismiss them at this point. You also get frustrated during boards time. I really need to be at the college to look for patients either via screening new or my own, all while squeezing my own patient pool in for their own appointments.

So like most everything in life, there are pros and cons. Overall, I feel these rotations have helped shape me quite a bit into what I hope will be a great general dentist.

MOCK?

2011-02-14T16:26:00.003-06:00

As you may recall, or may find out by simply scrolling down a bit, you will see that I recently completed the MOCK CRDTS patient-based exam last tuesday. Well, in stark contrast to the mannikin exam, our grades were provided today.

Good news to all, I passed all three procedures. While perio was a bit of close call, I still survived. Most of my mistakes were actually clerical and not clinical which is ok with me, that is why we did this exam, to learn the process. I am going to make a checklist for the real exam to make sure I don't miss any signatures or leave any information blank.

For all my loyal readers, you may note that this the first MOCK exam that I didn't fail. NICE! It would be a real pain in the ass to remediate portions of this test because we essentially would have to do another performance exam in our home clinic prior to graduation. Rumor has it that about 1/3 of the class failed something which is a better percentage than our mannikin exam (about 1/2 I believe), but it still is a high number. Usually a number of people do indeed fail CRDTS, but I don't think it ever comes close to 1/3.

I definitely don't agree with a few remarks on my gradesheet..most notably the gingival contact not being broken on my class II (when it indeed was broken and passable with an explorer), but hell, even with a substandard grade on one section, I still got a reasonable score on the procedure. I even pulled out a hundo on my posterior composite restoration, not to pat myself on the back or anything, just sayin'.

The bottom-line is that despite being extremely stressed and having several things go wrong, the day ended up panning out positively. It was a great experience to have and knowing I can survive a MOCK exam that is graded tough no doubt, all while using less-than-ideal cavities. I'm feeling pretty good assuming I get patients for the real deal.

Speaking of which, I actually won a patient in the lottery this last saturday. So now I only need perio for the real thing. Of course, this is assuming the guy calls me back. Otherwise all bets are off.

So today was allright, despite having an implant crown delivery require re-fab due to the occlusion being MONDO off....bleh.

Allright, that was a quickie but I gotta run.

The light at the end of tunnel is beginning to shimmer!

MOCK!

2011-02-09T21:15:00.001-06:00

A major post for a major day. As I D-2, I assisted a D-4 during her CRDTS exam. I remember the intensity, I remember punching holes in the rubber dam faster than I have ever punched before or will ever punch again, and I remember praying not to screw up the simple task of suctioning or mixing amalgam. More specifically, I remember seeing the absolute terror and anxiety amongst the collective soul of all the poor bastards taking the exam.

As a D-3 I was not allowed to assist for the real exam. Instead, we were forced to assist the current D-4s with the mock exam. Basically this exam is identical to the real deal and is sort of a dress rehearsal. That didn’t make it any less stressful. I remember the student I was assisting pacing about anxiously when her second patient was late and then didn’t even show. I remember watching instructors harshly critique preps and restorations. Again, I remember the collective tension of the entire day.

So here we go. I finally am not the assistant, but the unfortunate guy taking the damn thing. The Mock exam was held yesterday for me and I can say without hesitation that it was probably the most stressful day of my life in the category of ‘school.’ I was extremely calm and serene in the days leading up to the exam, consistently reminding myself that this was the Mock exam and not the real thing. However, the day before the exam I just felt crippled by anxiety and paralyzed with trepidation. I couldn’t function. I just sat around like a convict waiting for his last meal. I’m sure many people can relate with this feeling. A BIG event in your life has been approaching and the waiting just becomes unbearable towards the end. The night before you wedding, the night before a big presentation, and the night before whatever - it all ends up the same. You just want the waiting to end.

So let me preface with a quick summary of this exam for those not in the know. I have already done an overview of the CRDTS exam in a THIS post. However, I will outline this final portion now. As you may recall, I took and passed the National written exam (part II) back in august. I also took and passed the manikin portion of the CRDTS exam. What is left? The patient exam: this is what I took a ‘practice’ version of yesterday.

For the patient exam we are required to do three procedures:

Periodontal: Extra-oral, intra-oral exam, calculus detection/removal, probing depth/gingival recession accuracy. All-in-all, we must select a patient with at least 14 surfaces of calculus located within mostly one quadrant of the mouth (with the possibility of using 4 additional teeth from another quad). Three of those 14 surfaces MUST be interproximals of MOLAR teeth while only 5 can be on incisors. So simply finding a patient is a pain in the ass for this exam because you don’t want them to have rampant perio, but they need to have ‘just enough.’ Believe me; the patient pool at the college is mainly of the rampant variety.

Restorative: We must complete two procedures for the restorative portion. A class II amalgam or composite, and a class III composite. Less complicated than perio in terms of selection, but still a pain to find that perfect cavity. Again, you want it to be small, but large enough to warrant treatment.

The hardest part of this entire exam is the fact that we are responsible for finding all of our own patients for both the mock and real exam. As a class, we have held free public screenings on 4 Saturdays over the last few months. Afterwards, all procedures are raffled off. Guess who hasn’t won any raffles despite attending every one of these things? We still have two more, so keeping my fingers crossed.

So up until last Thursday which was the final day of class before the school pretty much shuts down to prepare for the mock exam, I still didn’t have a patient for the perio portion of the mock exam. No patient equates to immediate failure..joy. As fate would have it, I happened to be discussing my quandary with a classmate when another of my peers overheard and graciously allowed me to use one of his patients that he was no longer planning to use. Not an ideal case, but better something then nothing. So it may have been last minute, but I got all three procedures lined up for the mock exam JUST in time. As for the real one which is happening in mid-March, I still need to find two of the three procedures. Five weeks feels like it should be a lot of time, but it isn’t…

OKOK, enough unorganized blather, let’s get to the actual experience I had with this mock exam yesterday. As previously mentioned, I was nervous as I think most people are at this point. The culmination of your LIFE of education hinges on passing this exam. Yea this was just the mock, but it does a decent job emulating the real thing, so it serves as a decent gauge.

So I woke up at 5am, unable to fall back asleep I just got up, showered, and trudged to school at around 6am. 10 degrees, windy, still dark….great start. I arrive at the school around 6:30 and start setting up my assigned unit. At 7am, the sterilization window opens so I get all my instruments for my first procedure – perio. We are allowed to seat the first patient at 7:45am, I told mine to arrive at 7:30, and she arrived at 8:00. I’m not complaining, considering I got this patient a few days ago and had never seen her before, I should be thankful, and I was. So I sit her down and proceed to go through this enormous medical history which I had already reviewed but needed some clarification. What makes this exam even tougher is the volume of paperwork that must be processed and filled out correctly with signatures from varying parties at varying points during the exam. As you might imagine, it is VERY easy to forget to do some of these things in the heat of battle.

All patients require a consent form signed, a medical history form signed, and then there is a procedure progress form that you must get initialed at various points during each procedure. I’m not going to try to outline everything; this is just to give you a basic idea. In short, there is a lot of shit to keep track of all while maintaining your own nerves and not freaking out and projectile vomiting all over the place. So I quickly complete my extra/intra oral exam, and check her teeth for calculus. Remember, I haven’t seen this patient yet, and I need to fill out a big old treatment submission form with all the teeth I plan on cleaning. If there is no calc on the tooth, I had best not put it on the treatment submission form. So once this is all done, I get a start check from a central floor examiner or (CFE). He pretty much reviews the medical history and makes sure it is good to go. I forgot to put one of the meds down from her laundry list of conditions, oops, the first of many tiny mistakes. Next, my assistant takes her off to the evaluation room to see if my tx selection is approved. Here comes the first of many long waits. I can’t emphasize enough how stressful this portion of the exam is. And the funny part is that it is not when you are actually doing anything, it is when you are just sitting on your ass praying the powers that be don’t reject you patient or fail your prep/restoration.

Well she comes back in 15 or so minutes and everything is good to go. I complete the procedure fairly quickly (by dental student standards) with no real noticeable complications. I send her back to be evaluated at around 10:00. At this point my second patient had arrived. My assistant and first patient come back with the “feedback” form which is unique to the mock exam for perio only. Basically I missed a ton of calculus. Now I am not one to bitch (well, maybe just a little), but feeling around the sites they said I missed, I really wasn’t convinced on SEVERAL of their observations. I am now positive that periodontists think the CEJ qualifies as calculus. Basically if the surface isn’t as smooth as glass, it isn’t done. Now the only reason I am not upset really is that EVERYONE for the most part was getting similar feedback. So either the perio faculty is trying to scare the crap out of us, or we all just suck at SRP (probably a little of both). Either way, general dentists will be grading the perio on the real exam, so I’m hoping for more realistic SRP expectations for someone who will most likely never do an SRP again after this exam. So I missed 5 sites (I think) total. I assume this is failing but have heard from several classmates that you can miss 6 and still pass. I also understand the case I was doing was pretty difficult overall and not exactly ideal (really tough to clean 7mm pockets on #16). Whatever, it wasn’t how I wanted to start, but you need to really be able to move on during this exam…as it is a LONG day.

After re-wrapping the chair, I get my second patient seated (#4 DO). Again I will mention that I had a D-3 assisting me throughout the day which was extremely helpful.

So here is where things get interesting. This patient needs to make a phone call at a certain time and also needs to pee every hour. Why? I don’t know, but it annoyed the crap out of me. I get the class II lesion approved, numb him up and attempt to place the rubber dam. Problem! The dam won’t fit in the interproximal surface that I need to clean. Upon further examination, I realized that this was a TERRIBLE tx selection because the adjacent tooth had a huge composite on it with a flat long contact. CRAP! So I start prepping without the dam (only needs to be on during evaluations officially). I soon realize that I am gouging the shit out of the adjacent composite because its bulky ass is getting in the way of my gingival box prepping. Now in real life, I would recontour the composite without question simply to create a better contact when I place the restoration. But I’m not allowed to do this without requesting a modification on the exam. What is a modification? Another piece of paper that requires signatures! So at this point, I realize that I also will need to extend my preparation beyond ideal to get rid of the caries as well as recontour the tooth. Three walls need to be extended/deepened. So I have a total of FOUR mods filled out. I send him over. He comes back 20 mintues later with a piece paper that titles: Instructions to candidate. NOT a form you ever want to see on this exam. This form is the one that comes when you fail. It also comes for other reasons, and this was thankfully one of those. The rubber dam MUST be placed whenever the patient goes to the examiner station. I didn’t have it on and hence wasted 20 minutes. So after a 15 minute phone call and another pee break, I get the dam on and send him back.

At this point it is nearly 1:00 and my third patient has arrived. I am feeling extremely stressed and assume I will probably fail this procedure. Basically, if they don’t allow me to recontour the adjacent tooth I cannot complete the procedure acceptably. He comes back in about 10 minutes and like night a day, things get better instantly. ALL four of my modifications were approved! I instantly recontour the crap out of the adjacent tooth and remove all remaining caries. The prep looked very nice in the end and if rotations have taught me anything, it’s how to detect caries and do directs. So I send him back for the prep evaluation. Yet more anxious waiting ensues. Back he comes…with another instructions to candidate sheet. Crap? Apparently I didn’t break the gingival contact. But wait, when I hold the mirror and look, the contact is passable with an explorer…I’d say that means broken..but hell, I’m just some plebian dental student. So this is not a fail, but a big point deduction - very deflating after feeling very nice about the prep. So I must show the floor examiner the instructions, he looks and the confusingly asks, “It’s not broken?” HAH, at least somebody agrees with me. Bah, I don’t need to prep anymore, the CFE signs without additional prep that I ‘broke’ the already broken contact. So now I fill using composite. Nothing to report, easy fill, good contact, nice margins, no occlusal interference. Send him for the final eval. Comes back, no problems – nice. I forgot to complete my anesthetic record and forgot to have a CFE initial my modification completion…two more whoopsies. I am normally a pretty organized person..but in the chaos of this exam and this particularly difficult case, I just forgot to do some pretty simple things. And yea I’m bitching about the patient a bit when I should be thankful that he took the time to show up. And I AM! Despite the phone calls and hourly urination, I’m glad he was there.

Note to everyone – DO NOT do a restoration that will be touching a poorly contoured adjacent restoration…it sucks.

So this patient took me 3.5 hours. I get my third patient seated (#7 ML) and all paperwork filled out around 2:45 (deadline to start final patient is 3:30). I get him numb and run to the locker room to pound a power bar and bottle of water (5 minute breaks!). The patient was one my cousins and pretty chill and thankfully isn’t peeing every hour. Again, the rubber dam is giving us trouble and requires replacement after I finish the prep. The problem this time was that we made the holes too small and it was stretching and getting small tears. I start the prep, the patient is having difficulty getting numb and I am getting stressed because I don’t exactly have time to wait around for more anesthetic to settle (+ get the signed approval to use it). Luckily, the patient declines additional anesthetic and we press on! This prep ends up being large due to caries and I must send him over for mods. All of my requests were granted 6/6 on the day, not bad. Unfortunately time is becoming an issue, but I manage to remove the remaining decay and get him over to the evaluation station by 3:50 (deadline is 4:00 for preps). He comes back and all we have left to do is fill, easy right? I slide in the mylar matrix, wedge it and fill. Once I remove the wedge and mylar, I notice the contact is NOT closed. After using every profanity in the book as well as a few new improvised phrases (mentally of course), I start wedging the other teeth to push it back. I end up adding more composite and FINALLY get the contact back. After polishing, and smoothing the contours, I BARELY get him over to the evaluation station in time (4:50 with a 5:00 deadline). Christ. Now I don’t feel great about this filling simply because I didn’t have time to really look it over as I normally would. One of my favorite instructors was a floor examiner for the exam and sat down with me while I waited. He could tell I was pretty frustrated and really calmed me a down a bit with some jokes and practical advice. And wouldn’t you know it; my assistant comes back and gives me the big thumbs up, no problems. FINISHED! Forgot to complete my anesthetic record again…whoopsies x4.

So I get home around 6pm…about a 12 hour day no real breaks. I was so exhausted mentally and physically it is indescribable. Hell, I’m actually pretty sore today from doing dentistry..muscles I didn’t even know I had are screaming in agony. I’m just glad it’s over. Besides perio, I’m pretty sure I passed everything which is awesome considering how crappy my treatment selection was. But hey, you don’t want to waste the really perfect lesions on the mock exam anyways.

Grades will be provided next week I believe. Either way, it was a well-organized and beneficial, albeit stressful exam. I applaud the faculty on their organization in running everything so smoothly.

The bottom line is that I got through it. One more Big hurdle (real CRDTS exam) and few small ones (endo performance exam, papers) are all that stand between me and that big fat DDS. The road has been long and arduous, but as my dad told me way back amongst my first year griping - at least there’s an ending. There sure is dad, there sure is.

The D-4 Experience II

2010-12-07T16:37:00.000-06:00

Let’s face it; I’m due for another one of these. It is difficult to come up with a proper description of the fourth year at this point. It actually feels similar to the fourth year of high school, or the fourth year of college. Similar in that you just are ready to get the hell out. Your third year is full of so many learning experiences and adjustments and failures that you barely have time to take it all in. Now I feel like I have pretty much come as far as I can in the dental school setting.

Sure, there is still a lifetime of learning ahead of me, but it seems best suited that I do that learning in the real world at this point. Seeing two patients a day truly limits what you can do. Not ever having an assistant truly limits what you can do. Having to do your own lab work, wrap your own chair, become a collection agency, or get cases sent to PG because they are “too tough” truly limits what you can do.

Don’t get me wrong, I still do learn at school – but I feel like I’m trying to squeeze juice from a turnip rather than an orange at this point. For example, I started my first bridge maybe a month or so ago. The preps were great, the temp was ok, and the impression turned out awesome. So I tried to send the impression, bite reg, and opposing cast out to get a framework made. Wait, no that is not allowed. For some reason I am required to trim my own dies and mount the case myself first…to get the framework. I am no longer naïve enough to think that general dentists mount every single bridge case themselves. In fact, I KNOW they do not. ESPECIALLY in cases where you can get MI without bite reg. So why am I forced to waste another week sending out the impression to get poured up so I can trim the die and mount it myself while attempting to work around all my rotations…sigh. That is one example of why school just annoys me nowadays.

The framework try-in is tomorrow. Assuming it goes smoothly, this poor bastard may have his bridge by the second week of January. So this will take at least 3 months. Ouch.

But bitching aside, what do I like? Pretty much feeling like the big fish again. All the people that used to be scary or intimidating are truly pleasant to me at this point. I feel like the faculty is giving me more and more lee-way with cases. Discussing cases with classmates has become a regular occurrence with genuinely good debates and questions regarding what the appropriate treatment should be. You just are feeling close to becoming a dentist which I guess is how it should be given how close graduation is.

School feels like a home away from home now. I enjoy just sitting around the conference room, BSing with faculty, classmates or the one dental assistant in our clinic. I also like having NO class. I only have to be at school by 8am one day a week for urgent care/screening sessions.

Now the other huge difference between the third and fourth year is rotations. Third year you are on a bunch of in-house rotations. The only truly beneficial block was oral surgery (8-weeks of extractions is pretty sweet for any third year). The fourth year has REAL rotations though. And while my experience is a bit different from the majority (mainly in that I am gone 19 weeks as opposed to 10), it is still unique to the fourth year. In fact, accepting my invitation to the 2x2 rotation program was a great decision. Sure the overall complexities of the cases I get outside are not all that great, but the sheer volume of work is what makes up for it. I still do get the occasional crown or endo, but it is mostly directs, exams, and extractions. However, you generally see 6-10 patients per day (as opposed to 0-2) and you also get a glorious assistant. Yea there is a lot of pedo, but that has been GREAT for me. It has made me comfortable with a very large portion of dentistry.

My first stainless steel crown at the college took me 2.5 hours to complete and it still was opening the kid’s bite. The last SS crown I completed was last Thursday and it took me 15 minutes from start to finish (note the pulpotomy was already done at a prior visit). This would not have ever happened without the massive pediatric exposure that these rotations provide. I am planning a future post comparing rotations to the school so I will save my comments.

The final difference I am going to touch upon today is the licensure exams. Third year is stressful because you have a bunch of performance exams to get finished each semester. Fourth year is stressful because everything you have done so far won’t matter if you don’t get licensed. I can graduate, but if I don’t have my license, it sure will be hard to practice dentistry. That thought alone is terrifying. Now granted, I feel that once you hack up the 2k that this licensure exam costs, that pretty much gets you the license. Sure you may have to retake something, but I honestly have NEVER heard of anyone failing the retakes. I hope I’m not the first!

The exams are simply stressful, but each one you knock off just brings you that much closer to the light.

One more HUGE hurdle and about three smaller ones is all that stands in my way.

Closer and closer every day.

GPR Bound

2010-11-30T18:54:00.003-06:00

Officially got offered a contract today. Next year I will be busting out dentistry over at Illinois Masonic. Nothing officially signed yet, so I will get into more details about the program in future posts. Needless to say, I am in very high spirits tonight.

Much like passing manikin boards or part II of the written exam, there is just this rush of pure euphoria. The soaking-in period should last a good week or so. I am on rotation so I am busting my ass off seeing 10ish patients per day but this was a nice bit of news.

While the stress wasn't as intense as the week leading up to finding out that I passed the manikin exam, it got pretty bad the last few days. As mentioned, I only applied to two programs, and while I got interviews at both, you really can't account for the luck factor involved in any application process. I feel like I interviewd well at both, so luckily my top choice panned out. Everytime my phone would start vibrating, my heart would crank up the pace for a few minutes. And so many times it was a friend or patient or even wrong number. BUT NOT TODAY!

All I know for sure is that I gotta buy a christmas present for one of my letter or rec writers because several of the interviewers mentioned how impressed they were with it. I wish I didn't sign away my right to read it because I'm damn curious now.

Pass NBDE part II - check
Pass Manikin CRDTS - check
Get into GPR - check
Pass patient CRDTS - taking in march
Don't die before graduation - pending

So there you have it, really not much left. I still have an endo performance exam to complete on a posterior tooth and a few implant cases to finish (surgeries already done); but otherwise I'm pretty much graduated. Holy crap.

Posts on the way:
D-4 Experience
Rotation v School

2/3

2010-11-11T14:05:00.002-06:00

Done. I have one more major test to take before I can legally practice dentistry (assuming I also graduate).

Let me see if I can portray just exactly how stressful this crap is. So as explained, the mannikin exam is just as it sounds, we perform several dental procedures on a fake patient with plastic teeth. There are two sections: prosth and endo. Prosth involves prepping #9 all-ceramic, #5 PFM and #3 FGC. 3 and 5 are to be made as a bridge prep meaning the must draw together. Endo equates to a #14 access and #8 full RCT. If you fail ANY tooth from any section you must remediate the entire section. So if I have 100% on my bridge prep but leave an undercut on #9, I have to redo all the prosth section. This also costs 950 dollars...ghee.

OKOK, so now realize we have been practicing for this thing since the summer pretty much. I failed the summer mock mock exam. I also failed the mock exam we had this fall. The trend was not looking good. So imagine my utter jubilation when I finally found out my score this morning. PASS. And REALLLY passed too. No score was below 90 which washed away any and all dental self-confidence issues I had been experiencing over this exam.

But let me emphasize that this was a terrible process indeed. First off, the exam itself was extremely stressful. But that's not even the bad part. The bad part is waiting 26 days for them to actually grade it. TWENTY SIX DAYS. It wasn't so bad for the first two weeks because you know it will take awhile. But oh boy, this last week I was border line going insane with anticipation. To the point where I was having trouble sleeping, concentrating on school, doing ANYTHING. I'm sure I've lost a month off of my life simply do the accelerated aging all this stress has placed on my organs.

I though the joy of passing the written exam was going to be tough to beat. I was wrong, this definitely takes the cake. And I'm sure the only thing that will surpass this feeling shall be finishing that last portion come spring time. Knowing that it is finally over. Good lord I can't wait.

Now I can move on with my life and get out of the mire of simply not knowing. I have two GPR interviews coming up. Seeing as I only applied to two programs, I couldn't have asked for anything better. They both are in the next week so my focus must now shift off the academics and towards the future.

Just thought I'd throw this celebratory post up before I head off for the evening to continue taking in all the good vibes. The blue label is coming out tonight.

Off I go!

Out There

2010-11-01T21:55:00.002-05:00

This is my first lap top post. I am writing this as I lay on a tiny bed in Rockford IL in a dumpy little duplex out behind the Rockford Memorial Hospital. I hate typing on these things. It feels so unnatural and the keys don't have the same feel.

I wonder what most people think of when they hear the word dental student. Hard work? Stressed? Insane? An amalgamation of the aforementioned descriptors (get it?). Or do they picture some dude sitting in his boxers on a bed after pounding down some taco bell typing about dentistry and dental related experiences. Sexy.

These rotations have been great though. The sheer volume of learning is expanded beyond what the traditional school setting is capable of. I mean just this last week at school, I spent about 5 hours of in-school time busting my ass catching up on paperwork and doing lab work that practicing dentists never perform. Why can't I send my impression out with an opposing cast/bite reg and get the bridge framework back? Why do I have to trim my own die and mount the case. Do they realize that this adds approximately 10 business days to the patient's already long-ass wait. I was so excited that I hammered this bridge prep out (my first one actually) in two appointments. But I probably won't deliver it until mid-January because of all the red tape.

I've said it many times, there is a window of maybe 60 minutes each day at school where I am truly learning and perfecting my craft. The other 5+ hours is completely worthless. This is coming from a fourth year student mind you, I would be pretty brash to say the same one year ago.

Did I mention the tuition is insane. My girlfriend and I will be combined over 500K at graduation. That's HALF A MILLION...geeeeh. Granted our combined income will be nice, but not .5 million nice...

Speaking of future. I got my second GPR interview last week. That makes me 2 for 2, not too shabby. I am really looking forward to the interviews which are both in the same week of november. Both programs have their pros and cons, I shall elaborate in future posts.

Back to the rotation. Today I got a great refresher course on emergency dentistry. A patient I was working on started out normal, but just sort of drifted off mid-procedure. At first I attributed this to sleep. The pulse-ox was good and I could get her carotid pulse fine. Still something clearly seemed off. Once the doc came in to check on me, he had me sit her up and verbally snapped her out of it. Now this clinic caters exclusively to mentally disabled patients, so you get some really tough cases. As such, sedation is used as necessary. However, some parents decide to self-medicate and not tell the dentist. As per today, this patient was loaded up on valium without us knowing. Needless to say, the doc was pissed and the mom lied about it. Ugh. Thankfully nothing bad happened, but it got me thinking.

WHAT THE HELL DO I DO IN THESE SITUATIONS!? This is PERFECT example of why I want to do a GPR. I have no confidence in handling emergent situations. Why is it tough? Becuase they are so freaking rare in dentistry that being experienced is near impossible. Thankfully my preceptor is extremely good at walking me through the more medical aspects of dentistry and he really boiled it down to the essentials. Airway, breathing, circulation, drugs, BAM. It is all stuff I've learned, but in a real emergency, the dentist needs to keep it together and know what the hell to do. None of it is complicated, it is a matter of staying calm and acting correctly.

Today was a "slow" day at this clinic, yet I saw 9 patients (4 which required ops/exts). Again, rotations = mondo experience (by dental student standards). It also serves as a blunt reminder that you are indeed "not the shit." I mean, this clinic has handed me my head on a platter more than once. Trying to place 2 back to back MO/DOs on a screaming punching 250-pound autistic adult in 15 minutes is extremely difficult and quite frankly, scary as hell. It truly is great though, because you walk out of there with a new confidence everyday. Even if your work wasn't anything to brag about, the amount of experience and simle comfort level with tough patients earned is unbelievably useful.

Speaking of which, it is time for me to hit the head followed by the hay. Getting up at 6am and working until 6pm is hard.

Keeping my fingers crossed that I passed CRDTS. I know I overtapered the distal of my molar to get the bridge to draw...but was it enough to fail? Gulp? My endo felt meh overall, who knows. I'm mentally preparing myself to retake the whole exam because that way I won't be crushed if it actually happens. And on the flip side, if I passed 1/2 of it or the entire thing, I will be pretty damn sassified.

Here's to good luck!

One Small Step...

2010-10-16T18:53:00.003-05:00

Just finished up the official mannikin portion of the CRDTS test today. I am too exhausted for a full debriefing. Let's just say I didn't have any glaring mistakes, but my endo was definitely not my best work. You don't realize how exhausting this exam is.

I practiced a good six times including our mock exam. Each practice takes about 7 hours. Then you finally get to the real thing. By the time I was on my last procedure (full RCT #8) I was just out of gas. I think it's OK, but who knows. The good news is that I felt pretty similar walking out of this thing as I did walking out of the written exam that I took in August. Not super confident, but not down either. So hopefully the result will be the same. We won't know for about three weeks. I will brood over it for a day or so, then it will slowly leave the forefront of my mind until the grades show up...gulp.

I really hope I passed simply because I'd hate to spend another 900 bucks to retake it. Not to mention the arduous process of preparing and actually taking the exam.

We go from 7:30am until 4:00pm with really no true lunch break. That just tires you out. Especially when you are trying to make everything perfect.

Needless to say, I went out with some classmates for a few beers afterwards. So here I sit now, ready to just pop a movie in and relax with the lady.

I think I outlined this exam already so I won't even try to do it right now. I figured I'd post while in that hazy after-aura of just completing part of the most important exam in my life.

Whew. Now I have to recover tomorrow and get back in the trenches starting monday. I have to give a case presentation on thursday. Why the hell did I sign up for the first time slot? CURSE YOU PAST SELF!

Sorry for the lack of posts, just been all over the place with board prep and rotations and life experiences.

In other news, I got my first GPR interview coming up in november. 1 for 2 in interview offers so far. Haven't heard anything from the other yet. We will see.

I'll shoot for another D-4 experience post by the end of the month. No guarantees, just a goal!!

Sorry for slowness in response to emails, same excuse as above. I will get to them ASAP though.

And I'm done.

Celebration Amongst Impending Doom

2010-08-25T17:45:00.002-05:00

While I am begining to feel the full weight of the CRDTS licensure exam as I mailed out my 1,900 doller chasier's check, there was a nice ray of sunshine to brighten up the begining of this semester - I passed the written boards part 2.

I didn't knock it out of the park, but I didn't sneak by either, a satisfying "in-yo-face' moment to open the letter and see that magical word PASS.

What makes it more gratifying is that aparently my class is being subjugated to a mandatory 'mock' NBDE part II exam in three weeks. If we do not attain an acceptable percentage - we will not be certified to take the exam. This is bad form in general because three weeks notice is not enough time to prepare for anything, not to mention we have mock boards in 2 weeks as well as more rotations to deal with.

But I can't complain because I already passed and am excused from the test. What actually appears most interesting is that I think I am the only person that has taken it in my class. This roughly makes me a hollywood action star in the school as droves of my classmates congratulate me and ask for advice. Fun times.

It is the same as with part I. The summer semester is the best time to prepare for any big exam - get it done.

Studying for this test amongst licensure preparation would simply be too much for me.

For those wondering - I used the MOSBY text, the dental decks only for prosth, pharm, path, and radiology, and finally, all of the old released ADA exams. Studied lightly from May until August. Some days of heavy cramming but not much, usually averaged 1-2 hours a day.

Passing the test requires a much higher raw score compared with part I, so study accordingly.

Enough of the test though, on to more pressing matters.

Let me explain how the Central Region Testing Services (CRDTS) is handled during this final stretch of dental school.

The test is broken into 5 parts.

Part 1 = NBDE exams (both 1 and 2) - DONE
Part 2 = endodontic exam
Part 3 = prosthodontic exam
Part 4 = periodontal exam
Part 5 = operative exam

So Part 1 gets done on your own time. Everyone should be done with the first NBDE exam by now, it is simply a matter of knocking out part II.

Part 2 and Part 3 will be taken in october, with a mock exam in two weeks. This is known as the manikin portion of the test because we work with plastic teeth. This makes the endodontic portion seem a bit absurd to me..but hey whatever.

For the endo section we must access, cleanse/shape, and obturate #8. We must also access #14. We need to follow all sterile protocols and place a rubber dam. We actually get to measure #8 by hand prior to placing it in the dentech to determine working length (see why this is sorta dumb?)

Afterwards we have the prosthodontic exam which we already practiced once over the summer. This entails preparing #3 FGC and #5 PFM for a bridge and #9 ACC. We must make PVS occlusal indexes prior to preparing the teeth as these will be used to evaluate reduction.

Still with me?

The big daddy is Part 4 and Part 5 which we will be taking in March. There is also a mock test for these portions as well in February. The periodontal portion involves probing, detecting calculus as well as removing said calculus. The operative portion involves completing one class III and one class II prep/restoration. This will be the most stressful portion simply because the patients are real and not always predictable - both in terms of what the tooth will look like when you start working and if they actually show up on time.

I will go into this more later because the thought of it is stressing me out right now.

We got a big packet of info regarding the test that I have just begun to read through. Needless to say, this will be the most stressful/important exam of my entire existance. Fitting as it will be the last major exam I ever take.

Two semesters left.

I am also apparently one of the "top 30 dental blogs of 2010.'

Back pats for all!

Profiling the Pediatric Patient

2010-07-25T19:58:00.020-05:00

After spending four weeks (with one more to go) at a clinic devoted solely to pediatric dentistry, I have begun to notice that every patient falls into a specific pre-determined (by me of course) category. Allow me to elaborate:

KEY:

Tell-Show-Do = this is when you show the kid everything you are using (aside from the needle) and explain what it does. For example, I will let them see the mouth mirror before I use it. I will show them my “tooth fixing wand” (the highspeed) and show them the noise it makes and even spray their arm with the water a little so they see what it feels like. This goes on as necessary.

N2O = Nitrous Oxide, a commonly used anxiolytic in the medical setting. Easy to use, easy to remove the effects, and pretty much no chance of killing someone.

Manhandling = when all else fails, you just go medieval on the kid to get the job done. This includes papoose boards, head holding, mouth props, and half-assed dentistry. Really, there is no way to do a great job on a patient with zero compliance. You just need it to last long enough for the permanent teeth to get in. Manhandling is more commonly used for the 6 and under crowd but there are always exceptions.

Difficulty = a generic scale of how tough the kid is to work on. Scaled out of five. One being easier than an adult, and five being extremely tough (general anesthesia candidate).

And now for the profiling!

The Vomiter

This patient, like most kids, wants nothing to do with the dentist. Once you papoose their ass and headlock them with two assistants, they still find ways to defend themselves. Frankly, they try to puke all over you. And it isn’t friendly gurgling puke, it is projectile – get in your eyes puke. What’s worse is that they inadvertently could kill themselves by choking on said puke. So you need to brave it out to suction all that shit up (god bless the assistants). The only way to tackle this patient is to wait out the vomiting because they will eventually run out of ammo.

Tell-Show-Do - ineffective

N20 - ineffective

Manhandling - marginally effective

Difficulty = 4/5

The Old Man

This patient is actually pretty relaxed. Nitrous can work wonders sometimes. They may still get crotchety during the injection, but afterwards they will just sleep – THE ENTIRE APPOINTMENT. A real treat to work with. Only annoying when mom comes back and thinks I OD’d her kid on nitrous…bah.

TSD - unnecessary

N20 - extremely effective

Manhandling -unnecessary

Difficulty - 2/5

The Stoner

A close relative of “The Old Man,” this patient wants nitrous and wants it bad. It may be hard to associate a 9 year old with a 25 year old pot-head. But when one sees these kids craving the “magic nose,” one can’t help but make the comparison. These patients generally are pleasant to work on because they are riding the good waves of N2O. I’ve even had kids laughing while getting a block…crazy.

TSD - Pointless, they aren’t listening

N20 - EXTREMELY effective

Manhandling - unnecessary

Difficulty - 2/5

The Question Asker

This patient simply doesn’t shut-up. They constantly need to know what you are up to. N2O is only marginally effective because they never stop talking. TSD is only helpful to a certain extent because I still haven’t found a pleasant way to show them the 25gauge needle. I am good at hiding it like a magician though. These patients can be really easy or really tough – they are unpredictable.

TSD – Marginally effective

N2O – Marginally effective

Manhandling – Effective when necessary

Difficulty – ranges from 2-4

The Victim of Circumstance

Perhaps the most depressing patient to work on. This is the kid who shows up with cheetoes all over his teeth and a bag of skittles in his pocket. This is the patient with parent’s that are ignorant, negligent, or just suck at parenting. “I can’t get him to shut up at night without giving him a bag of Doritos and a pepsi” is the most ridiculous thing I have ever heard. Suck-it up and lay down the law. These kids are generally too young to know any better, so it is really the parent’s responsibility to take care of them. Unfortunately, I see a lot of neglect going on.

TSD – variable

N2O – variable

Manhandling – variable

Difficulty – variable

The Momma's Boy

This patient generally arrives clinging to mom and is too old to be exhibiting such behavior. They generally freak out once detached and go one of two ways: total meltdown or total calm. Again, a bipolar patient type. If they freak out, being extremely stern often solves the problem immediately. Parents are not allowed in the operatory if the kid is 5 or older so this type is always a wildcard. After the procedure they always run straight back to their leech like hold on mom’s leg.

TSD – Effective to Useless

N2O – Effective to Useless

Manhandling – always effective

Difficulty – 2 to 4

The Screamer

Name says it all. This patient screams the entire appointment with variable pitches. Surprisingly easy to deal with if you aren’t fazed by the noise. The papoose is usually all that is necessary, they rarely thrash their heads around.

TSD – ineffective

N20 – ineffective

Manhandling – very effective

Difficulty – 3/5

The Negotiator

This patient will do anything to get out of the chair. They will bargain with you. For example, "please don't put that in my mouth (bite block), I promise I'll keep my mouth open." You may fall for the negotiator at first, that is until they bite down on the running bur and change that small occlusal composite into a pulp/crown. I usually just re-negotiate. "Be good and you get a shiny toy." If this doesn't work - proceed to manhandling.

TSD - slightly effective
N20 - slightly effective
Manhandling - effective if necessary
Difficulty - 2-3/5

The Mongolian Warlord

Containing attributes of both “The Vomiter” and “The Screamer,” this breed is the absolute worst. They are combative, spit at you, vomit on you, scream at you, and essentially struggle the entire time. Unlike other difficult patients, they don’t get tired. These patients unfortunately seem to have the most neglect as well in terms of oral hygiene. If they require multiple pulps/crowns – they are best referred to a hospital for general anesthesia, there is no way you can get it done acceptably otherwise.

TSD – ineffective

N2O – ineffective

Manhandling – ineffective

Difficulty – 5/5

The Angel

This is the type of patient that makes you happy to be a dentist. They are cooperative, exhibit very little apprehension, and are just cute as the dickens. TSD and N2O are always effective but are often not necessary as the patient will be compliant regardless.

TSD – often unnecessary

N2O – often unnecessary

Manhandling – unnecessary

Difficulty – 1/5

I may add or edit this post as the year goes on. I haven’t covered all the types – just the most common run-ins for me so far.

PS. sorry for the lack of spacing after periods. I swear I didn't type it up like that... but the mystery makes it even more exciting right?

The D-4 Experience I

2010-06-29T22:00:00.001-05:00

A little over half-way through my first semester as a D-4, shall I elaborate? I summed up the major feeling of fourth yearness in my “lords of the idiots” post – so just go back three posts and poof.

The curriculum at this point is one giant garbled mess. We have the most useless course in the world still chomping at my toes (comprehensive care IVa). I seriously need to explain the evolution of the comprehensive care class. I have had it EVERY semester. So this is my 9^th go around. The class has progressively gotten more and more useless each and every semester. At the beginning it was great – it focused heavily on all of our pre-clinical perio and restorative, the kind of stuff we need to know. Now it has simply turned into a stereotypical college level class that revolves around regurgitating paper after paper that do not stimulate any sort of joy – but rather decreases your brain matter as your bullshit your way through one double-spaced, font twelve, times new roman page to the next.

Case in point – I am required to right a progress plan for June that discusses all of the things we have been doing reports on since last year. Things like production, unpaid treatment, unapproved notes, ect. OK. Fine. I can do that, not a big deal. But we have to do ANOTHER one that is due 4 weeks after the first. I am on rotation (and MANY others are as well). This means I will be in the clinic seeing patients a total of eight days (prosth exam and holidays account for weird number) before the next one is due. How much do you think will change in these 8 days? Will I somehow increase my production by 5k? Will I end up having tons of unapproved entries? Will the same dead patients that didn’t pay before, magically come in and pay now? I’ll probably see about 10 patients and six will fail/cancel. Not much to write about there.

We have some “delivering bad news” presentation later this week as well as some other portfolio assignment that I haven’t looked at yet.

Now in our restorative class – we have to write some silly paper that involves, you guessed it, EBD. Thankfully it is short and we simply fill out a template provided.

None of these assignments are bad on their own – they just snowball when you add it to the massive pile of crap I already have flooding into my summer free time. Gets really tough to keep everything straight.

Examples:

Getting my GPR application put together through PASS (letters of rec, personal statement, transcripts, etc)

Going on rotation for 2 weeks a month

Studying for NBDE II (failure rate about 30% last year due to random increase in difficulty)

Attempting to schedule all my requirements around my rotations (implant cases, limited ortho cases)

Doing TONS of lab work

Practicing for prostho exam

Scheduling performance exam patients and praying they don’t fail

The list goes on

Apparently, based off of what one of the head honchos told us today at our ‘town hall meeting,’ the comp care class will be obliterated in the new curriculum. So I guess this point will be irrelevant to the entering classes.

We also have a mock mock prosth exam next week. Why two mocks? Because the real mock exam is September. We have to prep #9 all ceramic, and a 3-5 bridge (3 as FGC and 5 as PFM). The catch? There aren’t enough manikin heads and equipment to go around so we can’t all practice at the same time. The problem? A lot dental students are assholes and will hang on to the equipment for way longer than necessary – screwing others over in the process. I am taking this test next week and I hope to practice this weekend…assuming I can actually check out the right stuff. I haven’t cut a plastic tooth in a LONG time, so I feel like at least one practice attempt is mandatory.

OK, enough bitching. What do I like about D-4 year? I like knowing the end is near. I like that the faculty in general treat you with a lot more respect. I like going on rotation and being treated like a full-fledged dentist. I like feeling extremely confident with tons of dentistry.

There isn’t much more to it. I’ve entered my 7^th week of studying for boards and I have increased my correct percentage from 50% to around 70% which should pass (yay me). I’m taking the test in early august so I still have plenty of time.

I just am tired overall. Obviously deciding to take boards has destroyed any semblance of “summer” very much like part I did oh so long ago. I don’t regret it though. Assuming I pass – my life in the last two semesters will be just a wee less stressful.

What else can I address? I have become a little more jaded on our society in general the last two years. I see so many people that want something for nothing. People that are single, have no job, have five kids from three different fathers, and get pissed at you when their free insurance doesn’t cover the cleaning and they have to pay a whopping thirty dollars. Then they get on their blackberry in their SUV and speed off blabbing to all their friends about how shitty this clinic is. Their free insurance that MY taxes pay for essentially rewards the socially and financially irresponsible sect of this country whilst punishing the responsible. Now granted this is an extremely generalized statement and abuse of the system goes both ways no doubt. I’m just getting wearied by it all, especially as I see my debt piling up. I won’t even pretend like I know anything about our current healthcare system or politics in general – but I have noticed my interest and knowledge base slowly increasing – which can’t be a bad thing when I am so close to graduation.

I do like to counter-balance negativity with positive stuff. There have been plenty of ‘feel-good’ moments. That one smiling kid, grateful parent, or patient that brings you a sponge cake are all great things. Experiences like these make me thankful for the opportunity to be a part of the profession. I only keep my fingers crossed that there will be more of these to come in the future and less of the ‘other.’

Life is just helter-skelter right now. I am bouncing from one thing to the next with little time to breathe. This post obviously reflects my current scatterbrained thought process (and it wouldn’t be the first time). That is why I sometimes like posting when I am completely exhausted or frustrated or exasperated. I capture that pure emotion in this little time capsule and can read back on it years from now and think…daaaamn was I strung out! Or wow, look how ignorant I was about THAT. I would also like to emphasize that my life is great and I really am a whiny bastard for complaining at all. I have been lucky with my life – great family, great relationship, great friends, great profession, great everything. Anything I manage to gripe about can’t really stack up to that at the end of the day. How’s that for inspirational? Did I mention I have to write tons of bullshit papers where you just make stuff up that sounds good? Lots of good practice.

Kidding, kidding, kidding!

And holy crap, the scary part about summer in Chicago is that I cannot tell the difference between fireworks and gunfire – but there is definitely something going on by my house!

Time to hit the MOSBY review again with my 12 year old glen Fiddich. Still got to have some luxuries right?

Right.

19 Weeks and Counting

2010-06-16T18:05:00.003-05:00

I started my 2x2 rotation on Monday. I have just finished my third day and am a just a wee bit less exhausted than the first two..maybe I'm adapting.

I am paired with a classmate, so for the most part, we will both be at the same site (rockford being the exception). However, my partner got trapped on the east coast due to flight cancellations over the weekend and I had to go solo on monday. He didn't know about the cancellation until Sunday..so monday was booked as if he would be there. Nothing like getting thrown into the deep end right? Everything went great though and I'm having a good time so far.

Did I mention this clinic is inhabited solely by women? The dentists are all women, and ALL other staff are as well. I probably need to get used to that though since most practices have a similar ratio. Not that I have anything against women - far from it. However, anyone knows how the dynamic of a lunch room changes when it is all ladies as opposed to guys - and if you are the sole member of the opposite sex surrounded by these swarms, it can be an interesting social experience to say the least.

So I have probably accomplished in three days on rotation what I did in maybe 4-5 months of pedo at the college. Remember that I only spent 1/2-1 day a week in the pedo clinic during my D-3 year. The work load is absolutely overwhelming at first. You bounce around doing the POE check-ups and then run back to the nitrous room to do 3 fillings on a screaming 3 year-old in a papoose.

I have plenty of learning and adapting to go - but wow, the experience curve is amazing. Perhaps even more importantly, is learning to work with assistants. Some of them are amazing, others not so much. I still am getting used to ordering them around because I honestly have never been in a position of such authority in my entire life - as in pretty much the boss. Granted, I am still a student, but the assistants are supposed to treat me like any of the other dentists in the clinic - and they do...and it takes some getting used to.

I have no interest in pediatrics as a specialty, but I feel like this sort of rotation really really ramps up my comfort level. I mean, if you are OK with nitrous and a papoose board, you can deal with a HUGE percentage of the child population.

Complaints? The unit set-up. You can't sit at 12:00..ever - which makes the maxillary teeth a living hell on my back because I'm trying to learn new mirror angles. Why can't you sit at 12? Because the nitrous stuff and all the handpiece motors are right there...bleh. I also don't like the bur selection. Pretty much a huge block of 330s and round burs is all you get. I need a longer guy for those damn boxes...and I really really am sad they don't have enamel hatchets. But it's ok - you adapt...and fast because there really is no choice. My final, and perhaps biggest gripe is the gloves..they are slippery as hell. I have dropped my handpiece TWICE (thankfully never while running) and I honestly don't feel like I ever have a good grip on it because of it's awkward position in the operatory.

It's been a long couple of days...I haven't been this exhausted in a LONG time. But it still feels great. I feel like I'm working a real job. Yea we still get prep and restoration checks (but not always) but POEs are free game. If I think we need to do an amalgam on #I, then it gets tx planned and the kid comes back.

So I have 19 weeks of rotation this year...I really feel like this will be great for my technical speed. My only big concern is going to be lack of fixed work which is already a HUGE weakness in my experience belt. We will see though...there is an 18 year old coming in tomorrow for a PFM on #19...mayhaps I get to do it!?

Well I plan to post about my various rotation experiences as the year goes on. I still have 22 more days at the Children's clinic - so we will see how things play out in the coming weeks.

Expect a D-4 Experience post in the coming weeks.

Out.

The Lords Of The Idiots

2010-06-01T19:31:00.003-05:00

The title sums up how I feel to be a newly minted D-4 here in good ol' dental school. You are a king amongst morons, and that is putting it politely. Dental students in general are neurotic, obssessive, over-achieving people. You don't realize how insane they are until you see the classes beneath you. Then you realize how you were pretty much exactly the same way.

I see the D-3s going through the exact same pitfalls that I was stumbling through right at the begining of full-time clinic. Getting upset about failures, freaking out about openings, freaking out about pretty much everything.

Ah, but now I get to sit back and take it all in. It was actually quite remarkable. The day we changed to fourth year students, it seemed like the faculty in general treat you a LOT differently - and in good ways.

Faculty members I was terrifed of 12 months ago are yucking it up with me about this, that, and the other. You truly feel like the big dog....of the idiots of course. We still are students, we still have bullshit assignments, we still get talked to like little kids (by the academic departments), and we still are paying out the nose for three more semesters.

The greatest thing is the no class aspect of D-4 year. We have a total of around seven times this entire semester where we have to be at the school at 8am for good old compcare + rotation paperwork business. Other then that, my alarm is set for 8:15 and I'm enjoying the shift for every ounce of greatness that it is.

Rotations have started for the "A" group. Being in the "B" group means I go out two weeks from now. Expect some sort of post on my rotation experience after I complete the first set. Children's Clinic ahoy!

So what are my requirements this semester?
Direct peformance exam (class II, III, or IV)
Perio Maintenance/Re-eval/SRP (three exams total that need to be finished by the end of Fall)
CaseCAT - Annoying research paper that they are piloting on my class. God I love it.
Assorted CompCare Crap (ACCC) - The usual stuff I presume..although they still haven't really told us
Scary Mock Prosth Exam - Prep 3-5 bridge (3 - FGC, 5 - PFM) and #8 All Ceramic.

The big change to note is that EVERYTHING is now pass/fail. This is good in that stress of performance exams is GREATLY reduced. However, it is sort of silly because your entire grade is going to be determined by the most biased and uneven portion of the gradebook - the faculty evaluation. I'm to far along to care at this point though. Case in point - I nearly got a 4.0 last semester and my GPA didn't move - so I guess I'm stuck with what I've got. Way to many credit hours in the books to move.

Still no C's in dental school though...hope to continue the streak.

So the schedule doesn't seem terrible right? Well, remember that I am on rotation for 5 out of the 12 weeks this summer - leaving me a grand total of 7 to get anything and everything accomplished. This doesn't include all the assorted graduation reqs I'm trying to coordinate (limited ortho case, Implant case, other). Did I mention that performance exam patients love to cancel/fail appointments?

I also seem to have a TON of lab work that has just really started piling up. Despite spending ample time in the lab due to a rash of patient failures/cancellations - I still seem to be falling behind. Damn dentures.

I'm also applying to GPR programs..and getting together my recommendations and applications is just another chore.

Let's also be reminded that like an idiot, or lord of the idiots if you prefer, I decided to register for the NBDE Part II and am taking it on August 10-11....oops?

So I'm pretty busy.

Right now my only strategy is to read the MOSBY review book and do all the released exams. Updates shall be forthcoming.

So while the glories of being a senior student are nice. I still feel this mounting pressure in the back of my head that probably won't be letting up until May next year.

The pressure is also going to keep getting worse

and worse

and worse

and worse

The D-3 Experience V

2010-05-14T15:43:00.000-05:00

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.

Summary:

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.

Summary:

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.

Classes:

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.

Summary:

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.

D-4 Official

2010-05-07T17:40:00.002-05:00

As of 1 hour and 15 minutes ago, I officially became a D-4. This is of course pending grade posting (although barring some huge mishap, I'm just fine and dandy).

I really did burn out a bit by the end of this semester. Just no real desire to go to school at all. Tried to get some lab stuff done, but just found myself too drained to even be proficient at menial tasks. That and I my right eye has been twitching a bit lately. These are the symptoms of a man that needs a vacation.

Thankfully, it is time for one. With one week off, I hope to mentally and physically recharge for the final year of dental school. That's right, the FINAL year.

The other major decision is that I intend to take the national board dental examination (NBDE) part II in august during our break. I originally was going to do it later...but decided to just power through and get it out of the way. One less thing to deal with during all the other licensure crap. This will hurt my summer relaxing plans a bit, but not nearly to the same extent as part I.

HUGE final D-3 experience post on the way for next week.

Until then....

Rotations x 2

2010-04-28T17:17:00.003-05:00

As promised, here is a little update on how my rotations are shaping up. I am a bit dissapointed that one of the sites I was told to be part of the 2x2 is not an option this year. Of course I was told this after they had already scheduled me...so now I can't exactly back out. I also was unaware that one of the sites requires me to live in rockford for five weeks until fairly recently. I feel a bit conned overall with the program directors. They lure you in with flattery and all this talk of opportunity, than you just get dumped in the places you didn't really want to go because the original places presented as options are no longer options? WHA?

I am of course exaggerating my complaining a bit. I still am glad to have the opportunity and I know I will learn a ton regardless of where I am. More importantly, I will learn how to interact in dental situations not regulated by the school.

So how does this work? Thirteen upcoming D-4 students will be partaking in this rotation block. We are divided into two groups (A and B). So going with the name of the rotation (2x2), while the A group is out on rotation, the B group is at the college and vice versa. I am in the B group. So I start the third week of June. It is usually a two week block, but occasionally it is only one.

We have four total blocks of rotation. Each block has approximately five weeks worth of time at a certain location.

This summer I will be at the Children's Clinic in Oak Park. Obviously this will be a healthy dose of pedo. In all honesty, I don't mind. One major objective I have going into this next year is to greatly enhance my technical speed. Doing so on pediatric patients is a great starting point because if you horribly butcher a primary tooth, it isn't the end of the world (unless you create an extraction scenario). Now that isn't to say that I'm going to do half-assed dentistry, but I'm not going to be crying if I overextend a wee bit on good ol' #I. Seeing as they will lose this tooth naturally, as long as the restoration holds, it doesn't have to be sparkling perfect.

Secondly, your pediatric patient will definitely appreciate faster appointments. So we will see...if I get an assistant..who knows how much I could actually get done.

So starting in September, I will be going out to Rockford IL to spend three weeks at the Crusader Clinic which treats a rural population. Not sure if it is mostly kids or not. My other two weeks will be spent at the Milestone clinic which caters to the developmentally disabled. This should be a great learning experience. This block ends in early Novemeber.

The final two blocks are not decided yet so I will update when the schedule is finalized.

Now it appears that we do get time off for boards related events. I will have a post dedicated to all the licensure crap I have to do in the future. Basically, I have to take the national board part 2 written exam, take the prostho/endo mannequin exam, and take the live patient exam over the course of the D-4 year. This does not include the 'mock' exams hosted by the school itself. This also does not include all the random clinical requirements I still am responsible for.

So there will be plenty to do...and I hope being away on rotation so much doesn't completely screw me over in terms of finding patients for the licensure exam next March. That is less than a year away. Crap.

But I will save that sort of complaining for another day.

1.5 weeks left until I wrap up D-3 year

...gulp.

Spring Update

2010-04-16T21:54:00.002-05:00

Not dead yet folks, just busy.

The last few weeks have been full but I'll be blatantly honest - I got into the starcraft 2 beta test. If you don't know what that is, good - you are not a gaming nerd. It is my curse to bear. I am enjoying the bearing of it though. As a side effect however, this blog has unfortunately been tossed onto the backburner once again because I only have so much time for solo hobbies.

School has been great overall. I continue to improve in both my technical ability, as well as my overall confidence/comfort level in dealing with patients, students and faculty. I officially am going on this '2x2' rotation set-up and it starts in June. Unfortunately, I still have no idea where I will be going. I know which sites I 'could' be going to, but they have not solidified the schedule yet. I paired up with a classmate in my clinic and we both have POS automobiles...so hopefully between the two of us, we will make it through the year. Keeping the fingers and toes crossed on that one.

So today I just hammered out two case presentations. The first one was a restorative case and the second was pedo. They both went really well and I am happy to be done. Like most people, I am not a big fan of delivering presentations, it is simply uncomfortable getting stared at for so long. However, there is no greater feeling in the world than walking out of the building on a beautiful sunny friday afternoon and being done.

Ah yes, the weather is finally staying nice. I promise two in depth posts prior to my D-4 year. Expect a final D-3 experience as well as some sort of breakdown of my rotation schedule (assuming they provide it soon).

I am going to be a D-4 in three weeks.

Crazy? Yes.

Never Give Out Your Cell Phone Number

2010-03-11T11:35:00.002-06:00

Simple enough title right? Yea, it makes sense as well. I know as a first year dental student, I never planned on giving my patients access to my personal phone number. You are just asking for trouble. Obviously though, it is easy to talk about this well before you enter the clinics and realize how difficult it can be to contact some people

I was desperate. A fresh naive D-3 with tons of open time slots, paranoid about experience and letting the faculty know I was doing something. The first semester of clinic life is a slow process. It takes time to weed out the good transfer cases from the worthless pieces of crap that should have been dismissed years ago. In the process, you end up having a lot empty timeslots because the transition of finding reliable patients takes a good two months.

However, when you first enter the clinics, you want to have EVERY time slot filled otherwise you feel like you aren't being a good student. Here in lies the problem. I gave my cell phone number to about five patients total (and they were all during the first month of my D-3 year). Why would I do this? Because it is impossible to contact some people otherwise. I would call, leave a message to call me back at the clinic. They would call back, leave a message with the secretary and I have to call back. You very rarely can answer a call while you are in the clinics because you are too freaking busy and half the time the secretaries just take the message down without asking (and I'm fine with this).

So you end up playing phone tag and trying to catch these people, it just becomes frustrating. After my first two weeks of the D-3 year, I maybe had filled 1/2 my openings. So in an act of utter desperation, I gave my cell number to several patients.

Yea it worked out for the time, but it has come back to bite me the ass hard. Take this spring break. I am on vacation from dentistry. I don't want to go the school, here about projects, or talk about dentistry period. I want to enjoy other hobbies, see old friends, and just relax.

But no, I have been called a total of eight times (EIGHT) in the last four days by TWO patients. They call, leave a voicemail, call again 30 minutes later, leave a voicemail and so forth. I don't know about you guys, but when I leave one voicemail, that's it. If they don't call me back, they clearly don't want to talk to me and that's the end of it. But these patients just keep calling. It isn't an emergency either, it's about scheduling or rescheduling appointments.

This altogether isn't that bad. I wouldn't have posted until this morning's events. I was woken up at 6:30 in the A god damn M by a guy who wants to reschedule an appointment that isn't until next week because he has a birthday party to celebrate...good lord. Could this not have waited until normal hours? He also is aware that I am on vacation because I already talked to him YESTERDAY about scheduling this appointment that he already wants to reschedule.

The other patient called me saturday at 7:45 am and then followed up with sunday at 7:30 am followed with an 8am and 9am until I finally answered the phone to stop the insanity. Again, no emergency, just wants to schedule an appointment (for a cleaning mind you).

Good fucking god. There is nothing that pisses me off more than being woken up abruptly on a day I can actually sleep a little.

Moral of the story? NEVER give out your phone number to patients. If you absolutely have to communicate via some other avenue than your school, then buy a separate phone. Trust me, it isn't worth it with the same head cases pestering you on a weekly basis.

As a practicing dentist, I will have an emergency contact number. Key word though, emergency. And it sure as hell won't be my personal cell phone.

I will definitely be dumping this phone once I graduate, because sure as the grass turns green, these same people will be calling me until the day I die.

OK, raging over. Back to the rest of break!

D-4 Rotations

2010-03-02T20:17:00.000-06:00

So as I may have mentioned in previous posts, we are required to do at least 60 days of extramural rotations during the D-4 year. Now I hadn’t thought much about this until the last month or so, mainly because I can’t see that far ahead. Another factor would probably be that I don’t really like any of the options at this point. Either way, it appears that I would be forced to live somewhere else for several weeks and that just cramps my style.

However, I recently received word that I have been selected to participate in the 2x2 program. What the hell is the 2x2 program you ask? Basically it is how the college eventually wants to handle rotations in the future. You spend 2 weeks in the college, and then you spend 2 weeks on rotation. Rinse, wash, repeat. This goes on your entire fourth year so you essentially spend half the year on rotation. All of the rotation sites are located in or near Chicago so there will be no up-rooting (at least that is what I’ve heard). It was started two years ago as a pilot program with maybe 8 students participating. This year I believe 12 participated. 21 students from my class were invited to participate – but I’m unsure how many will actually accept.

I have no clue how the faculty chooses who is eligible. It can’t be based on production, because I am probably slightly above-average if even that high. I’ve done a reasonable amount of phase III (crown, denture, etc), but not tons. So who know? Either way, it is satisfying to get the offer. It is sort of a validation knowing that the faculty place enough confidence in me to go off-site without their supervision for half my senior year. More importantly, this offer sort of makes my rotation decision for me. I already had no idea what I wanted to do, so I may as well do this right?

Speaking with a few others who have been invited, the pros seem blatant. It will be a TON of experience, period. It will get you out of the school, which at this point, can feel more like a hindrance to learning than an adjunct. I really have no idea though as I haven’t talked with current fourth years doing the 2x2…maybe I should get on that.

We have a meeting about the program at the end of March, so maybe that will answer some questions. However, I feel like it will be more of a sales pitch to get us to accept more than anything else. Again though, none of the other rotation options stand out to me, so I probably will accept regardless of what I hear.

Updates shall be forthcoming.

In other news, school is pretty calm right now. I have gotten most of my requirements finished or at least started. I am staying surprisingly on top of all the bullshit papers we have to produce, and I’m also starting to put together my two patient portfolio presentations that are coming up in April.

Spring break is literally three days away. Sweet.

The D-3 Experience IV

2010-02-22T21:34:00.001-06:00

As I edge closer and closer to completing my third year of dental school, I find myself sad to see it end. Yea, I want to graduate and actually have an income, but once you hit your stride in the clinics, it becomes pretty damn fun. The fourth year will be wrought with the stresses of licensure and rotations..so I don’t intend to be in such a ‘stride’ ever again during school.

The summer semester you are a bit squeamish, scared if you will, because there is pretty much a ‘first time’ happening every day. The fall semester is a lot better because you are starting to do things you have already done. The spring semester is when it all comes together and you literally feel like a badass. This is because the instructors know who you are now and you are simply comfortable. It also helps to see the psychotic D-2s running around freaked out about doing a prophy or printing out a treatment plan. We’ve all been there.

You eventually get used to the ebb and flow of the controlled chaos that is any dental school clinic.

Today we had a lecture during lunch about the two licensure exams our school is considering for the class of 2011. The current class is taking the NERB, but most classes prior have taken the CRDTS. Believe me, I will be posting plenty on this stuff in the future, but for now I will leave it at that.

In the morning I took a class II amalgam performance exam. I swear dentin never looks the same when I get down into it – especially if there was caries. I’ve determined that the only REAL way to tell if the tooth still has caries is by feel – not sight. Pretty much anything not healthy and yellow looks like caries, and believe you me – I can see why so many people pulp out all the time. If you try to remove anything that isn’t ‘normal’ you may as well just remove the entire tooth. Case in point: my patient this morning had a radiographically simple class II; replacing a composite with a small bit of recurrent decay. Before I knew it, I was damn close to the pulp with a huge brownish-red circle still hovering around the axio-gingival line angle. Now when you are taking an exam, this becomes stressful because if you leave any caries in the prep – you fail. Well, I really poked around with my explorer and the spot felt firm. So I just held my breath, asked if I could place a liner, and had them grade the prep. Whew – no caries.

I find amalgam fairly easy to work with – aside from carving sweet anatomy. But as a clinical instructor I know is fond of saying: “Anatomy? You know what I say about anatomy? Anatomy (pause for effect) is over-rated.” Pure gold.

Finishing a performance exam is like finding relief after a bad burrito – it’s a battle going in, but the feeling of ‘passing’ is unequaled. Good wordplay yea?

So things are going well overall. Aside from the ‘RPD from hell,’ I feel as though I am getting a good deal accomplished overall. What is the RPD from hell you ask? Well, I plan on devoting an entire post to this beast at some point. Here’s a sneak peak. I took the final impression for the framework last July, and we still aren’t done. Yea, it’s that bad.

Aside from a crown performance exam, a couple of presentations, papers/ reports, and finals, I am about ready to mosey on into the D-4 year.

On the horizon decisions:
D-4 Rotations
GPR applications
Pre-order GOW 3 or not

Actually that last one isn’t really a decision, I already pre-ordered.

Schawing!

Syncope - Finally

2010-02-20T15:31:00.004-06:00

As morbid and terrible at it sounds, I have secretly been hoping to see a patient go into syncope for the last few months. I realize the best chance of this would be in my OS rotation which finally wrapped up yesterday. I am glad to finally have more time in my normal clinic for my own patients but dissapointed at the same time because OS is fun.

So what is syncope? Simply put, it means to faint. Of all the 'emergent' situations in dentistry, syncope is by far and away the most common. It is also the easiest to treat if you follow a few easy steps.

Why does it happen? Most commonly, blood is not getting up to the brain which causes hypoxia (no oxygen) up there eventually leading to loss of consciousness. A great example is a young male patient who is super anxious about needles. He knows it is coming, so his body naturally goes into 'fight or flight' mode. This means the blood vessels dialate to get the blood pumping and moving (especially into the leg muscles). Most dental patients are in a sitting position which means that gravity is also kicking in so all that blood is just pooling up down in their feet.

So they pass out. And it finally happened to a patient I was working on. A classmate and myself were tag teaming this guy on an alveoloplasty and the attending surgeon was going over a few pointers just after I opened the flap . Suddenly, the patient's eyes just rolled into the top of his head and he sagged off to the right. The instructor had us grab the O2 tank while he brought the patient into a supine (or laid down flat) position. He technically brought him all the way into trendelenburg (head lower than feet) but either way, that is the first step. We hooked him up to the oxygen and the guy came back really quickly. His BP had dropped a bit, but it wasn't dangerously low (which ruled out cardiac issues). So we finished up and sent him on his way.

There really isn't much else to say. It was crazy to finally see it happen, and equally amazing at how simple it was to manage. Laying him back got the blood going towards his head and the oxygen just sealed the deal.

Obviously many things can cause someone to pass out, and many of them much worse. The surgeon recommended that we have an emergency protocol/practice day in our private practices once every six months to keep everyone up to date. I completely agree.

Quickie.

He's A Bleeder

2010-02-10T19:53:00.002-06:00

Well since I'm not really doing much dentisty this week I have time to reflect on a pretty cool OS experience. Why am I not doing dentistry? It is mock boards this week. That means I am forced to assist the D-4 students taking the mock boards. This entails assisting from 8am until 5pm with no lunch break for three days. Now luckily I was an examiner assistant one day so that at least allowed me to walk around and wrap about 50 chairs.

What have I learned? Assisting is HARD. It kills the back, you are getting ordered around constantly, and worst of all - it is the most boring job I have ever performed. Maybe it's because we are assisting students. Maybe it's because our chair set-up is NOT condusive to having an assistant.. maybe I just am bored of not seeing what I am suctioning, or maybe even more appalled that I would even care to see what I am suctioning because I don't enjoy suctioning in the first place. At least it served as a chilling foreshadow of things to look forward to next year.

But back to the topic at hand. I got a new patient early this semester with about 14 remaining teeth floating in the most gross batch of perio disease I have ever seen. Basically an immediate denture will not be possible so we are doing full mouth extraction, possible gingivectomy, followed by F/F. This guy is a doo-wop singer so he clearly needs teeth for all that smiling. Unfortunately this process is likely to take some time. I have finished a few arches of dentures (although not for awhile), but the main issue I am foreseeing is whether or not his soft tissue will heal up well enough after the extractions.

That will be a future though. So at this point, I am capable of doing most any extraction outside of impacted thirds. This is a huge perk here at UIC. You do a TON of OS. We get 8 weeks of rotation througout the third year and the faculty here let you do a LOT. As in, surgical extractions/biopsies/tori removal. Laying flaps and suturing is actually pretty damn easy if you have instructors that will let you do it enough to get proficient.

Now this gentleman has 14 teeth I need to get out. I have three left after three appointments. Two were horribly ankylosed which really took up a lot of time, but the other major issue I've had is blood. The most blood I have ever seen. I took three teeth out in about 3 minutes that were not really in bone anymore, but the gingiva was so diseased and inflammed that he literally started dumping blood out by the buckets. I was packing surgicel/gel foam, jamming gauze in, suctioning..and thinking I was going to kill someone the entire time.

The first time this happened I got an instructor to help me out. He showed me a few tips to really packing the gauze as well as getting those first few sutures in during the worst of the bleeding. Last time I did it all solo without any complications.

This was just an awesome experience overall. It helped me learn to manage a somewhat abnormal scenario. It also is pretty satisfying doing these extractions myself and not having to refer him to the 3 month waiting list in PG OS.

He comes in tomorrow to finish the last three, then I will wait about 2 weeks to assess the healing..and maybe take initial impressions for dentures.

ooo boy.

And yes, I remember I was supposed to keep a really accurate log of my first F/F last summer...but I mean, are you really surprised. You can file that in my 'failed mini-series category' along with the vocabulary building and teaching my cat how to use the toilet and anything else I may have forogotten about that is now buried in the 100 some posts I have amassed over the years.

Tomorrow I might actually get to start my second RCT....keeping my fingers crossed on that one!

January Schmanuary

2010-01-31T18:40:00.005-06:00

I haven't been posting as much as ye olde days. Several reasons: It's freaking cold - my fingers get locked up and cold, typing sucks. I also find myself somewhat bitter as a student currently and really don't want to turn this blog into one giant bitch fest, which it already borderline is. Lastly, I just have been lazy with no real excuse.

The third year is going by faster than I would like. Yea I want to graduate, but the stresses of fourth year just don't seem appealing at all after the proverbial xanadu of third year. Yea things still get stressful, but it comes in waves - where as the first two years felt like a constant barrage of studying power point presentations over and over throughout the semester.

The main problem now seems to be economic. The state is not supporting the college much at all it seems and we are losing faculty this coming August. Faculty is the last thing you should be cutting from this education I am paying out the nose for. There just seems to be too much going on for my liking. I just want to get out of here before the school completely implodes. And in all honesty, this is a state school, so I don't see it closing, but you can't help but get a little paranoid with the current state this country is in.

School-wise is going pretty well. I still lack sufficient endo experience, but one of my classmates has generously sent a patient my way that needs two RCTs. Otherwise I am still pretty happy with my slate of experiences. I am getting tired of all these forced in-house rotations though. How many weeks of radiology are really necessary? We have something like 5 during the third year. Overkill.

The month of february: With rotations, mock boards, clinic and research day, and the mid-winter meeting. I have a grand total of 5 (count em') five appointment blocks to actually schedule my own patients. Once fourth year hits, I will be doing at least 60 days of off-site rotations. It is simply getting tough to see patients. And they aren't too thrilled about it either.

Example of this up-coming week. I'm doing a class II performance exam tomorrow morning, then I'm in OS in the afternoon. Tuesday I have screening (which equates to getting a new patient which I have no openings to schedule for) in the morning and OS in the afternoon. Wednesday the clinics are closed for clinic/research day. Thursday I have a patient coming in with 'a toothache.' and in the afternoon..you guessed it, OS. Friday the clinics are closed for the OSCE examination. What is the OSCE exam you ask? I have no freaking idea. They give us zero imformation, tell us to show up with headphones and two number 2 pencils. We are allowed to bring 'any books' we want, just no personal notes. Seriously? Do you want me to lug like 10 different text books to the school? At least I get a free afternoon out of it.

I'm still improving as a dentist. Still slow as shit, but in reality, I realize that is only partly my inexperience. A lot more of it is just doing stuff no practicing dentist has to do. For example, trying to prepare a lingually tipped #31 for a PFM on a patient with a super-active tongue without an assistant. Not possible by the way although I wasted 40 minutes trying until I actually got an assitant to help - I was able to finish in 15 minutes.

I'm just growing tired of the grind that is 'higher' eduaction. There really isn't anything 'higher' about it. The only thing higher I guess is my age and total years spent learning without actually making any sort of income.

I have become a rather lazy student in terms of book work. We have lots of portfolios and presentations this semester along with a bunch of random BS assignments that seem pretty much mandatory at this point. Where I used to churn these things out..I find myself forgetting about them until the week/day before and scrambling to crank them out. I still get the same grade, so it doesn't seem to make any difference how it gets done.

A turn I don't like is the obsession some of my classmates have on 'production' which is the dollar value you have made in terms of procedures completed. Apparently we are graded on this to some degree although the extent I am not sure. But when all some of these people can utter is "oh man, I made 2 k this week." I just get bored real fast and it ends up making me self-aware of my own production and whether or not I'm getting enough done.

To quote my favorite histo teacher from D-1 year. "Who cares."

But gloom and doom aside, I am satisfied with how things are turning out. I have decided to apply to Chicago based GPRs this coming summer. If I don't get into one (or if I don't like the options I end up getting) I will simply become an associate and start chipping away at the massive load of debt.

And now february begins!

PS. I treated this post much like one of those random assignments. Just had to get one in before January 2010 vanished.

Still do check my email from time to time, and I do reply to pretty much anyone that isn't trying to sell me something so ask away!

DONE!

The D-3 Experience III

2009-12-23T11:15:00.001-06:00

A few days into another nice two week vacation and I unfortunately find my thoughts drifting towards school. While grades have become less important to me, I still have the competitive spirit as well as a personal desire to do well. My last two semesters were frustrating beyond words in terms of final grading. I was borderline in TONS of classes and ended up on the wrong end in pretty much every class. The culmination of those being my restorative clinic grade over the summer (89.7).

This last fall semester was probably my favorite of all dental school thus far. It would have won the honor hands down was it not for a host of TERRIBLE, and I repeat, TERRIBLE lecture classes. I can count on one hand how many valuable lectures we actually received. It was mostly PhD and researchers lecturing us with statistics and numbers. The part that frustrates me is that we would have the same lecture in a different class by a different person and the numbers would be different. I was involved in research in undergrad and my summer prior to school – it is definitely an imperfect system with so many problems that I don’t put much stock in new progress unless there are a TON of papers supporting any given theory/thesis.

But I digress, the other minor gripe I have is that yet again I find myself on the precipice of getting an ‘A’ in all of my classes, yet seem to be getting screwed in a few big ones. Granted, the final grade isn’t up, but my comp care IIIb percentage sits at 91.8 or something like that and of course, this is the one class where you need a 92…sigh. I know there has to be a cutoff at some point, but jeez, help a brother out.

However, in completely opposite fashion, I have cause to actually celebrate. My faculty evaluation this semester went up (albeit a small amount, but up nonetheless) and I consider that the most important grade of all – your own evaluation. I felt as though I had improved dramatically this semester. Not simply in terms of number of procedures – but in comfort level, patient interaction, plain and simple confidence. I have worked with the entire faculty in our clinic at this point (some a lot more than others) but I have gotten positive feedback from each and every one at some point. While my grade didn’t dramatically elevate, it still went up though – indicating that the faculty see improvement as well. Positive reinforcement is always nice.

The point is not about the letter or the percent (unless you find yourself failing or gunning I suppose), but about how you feel about your own dental skills. If you had asked me to extract a tooth last spring, I would have tried sure, but I would have been scared shitless. Now I am jacking them out left and right without a second thought. All the pharmacology crap that I just could never keep straight? It is starting to come around. Yea, I have a long way to go – but I am slowly but surely recognizing medications without having to look them all up. All those first times are gone and now it is experience and practice that I am worried about. How many direct restorations can I finish in one appointment? I started off with one per session regardless of how easy it was. My current record is three, and I realize that with an assistant, I will be blazing through cavities in the future.

At this point in the D-3 year, you need to feel like the clinic is your home at school. The faculty all know who you are, the D-2s are beginning to timidly bring in patients and wear loupes during a routine cleaning. It’s hilarious not because of the utter futility of wearing loupes (with a headlamp even) for a prophylaxis, but because we all have been there. It is part of growing as a dental student and a future dental provider. They will be laughing at the new D-2s next year while I am freaking out about boards.

The D-3 experience is a metamorphosis. You completely evolve into a new type of student. The books and studying still exist, but we don’t really talk about it anymore. Now we discuss whatever tough case we are working on, or help someone out with a denture set-up, or a tip on how to make that surgical guide, and so forth. You find yourself talking about dentistry all the time, for better or for worse. You are slowly changing into a dentist despite still being a student. It is quite remarkable actually. The amount of learning has increased ten-fold while spending less time at school overall. If you blaze through a restoration and finish at 3:30, you don’t have to sit in a lecture hall for another hour, you finish anything that needs to get done lab wise, or you go home.

The D-3 experience still has its frustrations, but it truly is the best year of school. I see why it was rumored to be so. Especially once you get accustomed to your clinic and faculty, it is just plain fun. Now that’s not to say I’m having the time of my life. It is still school, anyway you cut it. I was about ready to gouge my eyes out by the end of finals. The drag of 17 straight weeks with only three official off-days will bear down on anyone. Now I know all you 9-5 jockies are saying: “hey, I do that ALL YEAR, what are you bitching about.” To them I respond: “At least you’re getting paid.” I am paying for this privilege, and paying quite dearly. I don’t remember exactly how much it is, but I think one of my faculty members told me that it costs me 400ish bucks PER AM/PM session to be in this school. That adds up.

But my time is slowly winding down. I was half-way through school back in July, so now I am well on my way, marching downhill, occasionally stumbling, but marching nonetheless. Only four semesters of school stand between me and graduation.

That brings me to a brief topic that I will elaborate on in a future post. What the hell am I going to do when I graduate? Work in a big dental chain? Work as an associate for a dentist planning to retire in few years? Do a GPR? Specialize?

The only one I am 90% confident of skipping at this point is specializing. I honestly prefer general dentistry as a whole over one aspect of dentistry beaten to death.

I am torn though, a GPR seems like a strong move, but do I end up wasting a year of real profit? Is the experience gained worth missing out on getting a large pile of wampum?

You can argue for pretty much any scenario, but I need to have an idea by the summer because that is when you apply for all these things.

Ahh what am I doing? This is my vacation. And dentistry is NOT invited. Have a Merry Christmas/holiday/whatever.

Fin.

Doing It Yourself

2009-11-23T11:07:00.006-06:00

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?

2009-11-05T12:05:00.001-06:00

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

2009-10-30T12:21:00.001-05:00

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

2009-10-09T15:27:00.001-05:00

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

2009-09-09T16:34:00.000-05:00

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

2009-08-16T23:10:00.001-05:00

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

2009-07-08T17:12:00.004-05:00

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.

Warm Fuzzies

2009-07-06T18:24:00.002-05:00

Today marked my first truly inpsiring moment in school where I know the crap I do had a true impact on somebody's life. I have a patient in dire need of dental work. She essentially is going to have about 12 teeth extracted (due to extensive perio disease) followed up with partial dentures on both arches. She has no insurance, was laid off last spring, and we are trying our best to spread the extractions out enough so she can pay. We probably will only do the upper arch first. Well this patient has a HUGE gap in the front (#9 missing and #10 has shifted distally). While pretty much all her teeth up top will be yanked minus the canines and premolars, a MAJOR concern for this 40something female is getting that space fixed - especially considering that she is looking for employment and can't stand smiling and looking like Mike Tyson.

So while I know the other anteriors will be extracted eventually, I went ahead and made her what is known around here as a flipper - or interim partial. Basically a removable device that replaces a few teeth - usually used for emergency esthetics.

Now were we ever taught how to make a flipper? You can probably guess the answer to that. So here I am, getting tips from classmates and D-4s, and just really going for it. It took me about 3 hours, but I got the damn thing made. I spent this morning adjusting the wires and removing excess with the patient in the chair.

Was it perfect? No. The thing is not as tight as I would want it in terms of stability and her occlusion is already a bit edge to edge so it is difficult to get that perfect angulation. Her speech is slurred a little with 's' sounds but not too bad (after I trimmed the crap out of it). However, the one part that I knocked out of the ballpark was tooth shade and shape. I added a new #9 and #10 to fill the gap and the color was very close to perfect. The acrylic shade clearly wasn't meant to match african americans, but her smile line is low enough to display zero gum.

The part that makes me happy is knowing that she finally got a job interview for this thursday and I managed to fix the esthetic issue (albeit temporarily). She was happy with the appliance and didn't come back that afternoon which means it didn't break!

So was it the greatest flipper ever made? Hell no. Does it get the job done? Hell yes. Now that my first one is out of the way, I already know what I did wrong and what improvements I can do for the next time. When they say you get out of school what you put into it - this type of experience is exactly what they are talking about.

In other news, I am still chugging along this semester. These next two weeks will be rough. Endo exam (despite having no lecture class), public health final (took today), and OS midterm on friday. Ethics take home final (5-10 pages) and Caries patient portfolio both due next week. Not to mention all the extra lab work I have on the horizon. It kinda sucks having essentially removable cases exclusively. But I can make a custom tray in like 5 mintues now.

First DO amalgam on wednesday coming up. Hope I remember how to use all those carvers!

New D-3 experience post probably up by the end of this semester.

I miss summer vacations.

FAIL

2009-06-18T17:52:00.003-05:00

So far, I have been pretty lucky with patient’s actually showing up on time for appointments. Most of them have been making all payments as well, so yea – good fortune. I have had a few patients’ cancel their appointments but they have always done so at least a day in advance. True it isn’t always enough time for me to fill the spot, but at least I have a chance.

So today, of all days I had my first patient failure. This equates to the patient not showing up, not calling, and you simply can’t get a hold of them to find out why. I was going to do one of my performance exams on this patient so I am justifiably pissed. Not only did I waste my afternoon (which costs about 150 in tuition), but I have to find a new patient to do the PE on. School policy is that I can dismiss this patient because she failed the initial exam (normally we have a 2-strike policy after they have been coming for awhile).

I am at a crossroads. This patient cancelled the previous initial exam last week but called the day before. She also made her own FMX appointment and got the x-rays taken without me having to do anything. So I don’t quite understand how to take the situation.
If she doesn’t call back by tomorrow, I will most likely dismiss her as a patient. Just sucks that I was all ready to get some requirements out of the way and now am back at square one. On the plus side, I have scheduled a transfer patient for an appointment who is a veritable gold mine of directs and crowns. So I will finally get some consistent operative experience.

Funny side note:

We are required to call our pedo patients the day prior to our rotations. I have pedo on Friday..hence calling on Thursday. We don’t have to actually schedule them, we just verify that the scheduled patient still plans on coming. Well, it seems that 2 out of every three kids I get does not speak English. I don’t speak Spanish. So when I call and mom answers with: bueno, I naturally get a bit off guard. I totally half-assed my way through, and she seemed to understand. Needless to say, my classmates around the phone area were laughing their asses off. Get your jollies now people, it will happen to you to.

Cutting REAL teeth

2009-06-16T18:49:00.002-05:00

Today was my first foray into the operative component of dentistry. It was definitely a nice change of pace from the constant stream of perio problems, dentures, and RPDs. It was the perfect starter for any newbie like myself – a very conservative prep on the distal of the left second premolar. I didn’t even need to provide anesthetic. I rarely used round burs on the plastic teeth, but that was all I used this afternoon to make a nice little slot in the side of the tooth. Got my instructor to check, and he said “looks good.” Sweet. The hard part was placing the composite. You really don’t understand what working in a wet mouth is like when you practice this stuff on plastic teeth. Composite resin requires a DRY field to work in. Placing a rubber dam is not always practical (especially when the patient lacks any posterior teeth to clamp). So I just loaded her up with gauze and the suction tip.

The placement went ‘ok.’ I had a bit of excess that I didn’t notice until after I cured everything, but my instructor showed me a few good tips on how to really take advantage of the finishing burs. I finally had her bite down on some articulating paper to check if the restoration was too high. I hear this horrible crunching sound. SHIT! Thankfully she only fractured a tiny bit of the marginal ridge off, which was the high part anyways. I just smoothed it off, checked occlusion again and sent her on her merry way.

GO ME!

Uninformed

2009-06-14T20:39:00.002-05:00

Ok, here is my first post in a bit. I really haven’t had any reason not to post, outside of rediscovering what having a life is all about. I actually have time to do stuff…it is a crazy feeling.

That’s not to say that things can’t get stressful. In fact, I would say that school itself IS more stressful in the clinics, but you get used to it, and then you go home and drink a beer or scotch. I mean let’s consider: on the one hand, you are sitting in a lecture hall fighting to stay awake while you learn about kidney stones or something. Yea, not stressful. On the other other hand, you are running around the clinics like a chicken with its head chopped off trying to find the vitrebond, or locate a professor to help you use the facebow or do something else you vaguely remember being taught in a half-assed fashion eons ago. Yea, stressful.

In fairness though, things would be much smoother if all the damn construction wasn’t conveniently scheduled for my entrance into the clinics – again, something that would have been nice to know during interviews..cough cough. Would I have gone somewhere else? Probably not, but it still sucks.

So clinic craziness aside, things are still great. You learn a billion things a day and you feel the experience growing with each and every patient encounter. I no longer am timid when rooting around someone’s mouth. I am slowly improving my operator positioning as I learn how much easier it is when you can have the patient move their head to one side or the other (the mannequin head lacked this quality).

My major complaint as of now is that I STILL have not cut a tooth yet…seriously. I have classmates that have done tons of direct restorations, crowns, ect. I have been doing initial exams and dentures all day every day so far. All my initial patients seem to have zero caries and tons of perio issues which will require either more dentures or RPDs. However, good things are on the rise. A recent transfer patient needs about twelve, count em’, TWELVE directs. Not the crappy class V’s either. I’m talking class I’s, II’s, and III’s. The stuff we get tested on for boards. Hopefully he returns my friendly phone call for an appointment. Keeping my fingers crossed on that one.

OK, time for the gist of this post. How hard would it be to sit us down during one of our ‘comp care’ lectures and outline exactly WHAT we are expected to accomplish/turn in this semester? This course is run by so many different people that clearly don’t communicate with one another and it is impossible to get a straight answer. We have FOUR performance exams that MUST be completed before this quick 12 week semester ends. Yes they aren't part of the comp care course, but we also have no lectures for these courses..so when else are we supposed to find out? Two of these are for perio and two for restorative. Yes you can find all this information if you dig around on blackboard or ask an upperclassmen. But why can’t there be one big sheet of paper they hand out during one of numerous lectures that says: “THIS IS WHAT YOU HAVE TO DO BEFORE FALL.”
There is some random endo exam we must take in July also. What should we study? Who knows.

Ahhh but complaining feels stupid when I am still in such a good place. Yea I spent 6 hours at school this weekend doing assorted lab work and filling up my scheduler. But I even impressed myself at how easy making record bases and wax rims was this time around (first time in 6 months..must be like riding a bike). I can only pray that this technical carry-over applies to operative procedures as well.

I was going to whine more, but I see no point. This is how dental school goes, just suck it up and learn as much as you can. There are plenty of great teachers and opportunities to really develop. These last two years are what count the most towards getting off on the right foot in the real world. Real-time job training.

The D-3 Experience I

2009-05-22T16:26:00.001-05:00

Amazing. Exhausting. Terrifying. Fun. These four words spring to mind after completing one week as a D-3 student. I have gotten home exhausted pretty much every day, I am amazed at how much experience I have gained in five days, I am terrified by how little I actually know, and I am having fun amongst it all. I love it. I may be a bit blinded by how much hatred I had for the last semester of D-2 year, which finally got our grades up this week and I did pretty awful compared to previous semesters. What sucks is that I was border line in every class - but where I would usually end up on the better side of that border, I seemed to get hosed in nearly every course this time. Key difference though, I don’t give shit. A ‘B’ is not a bad grade, and it isn’t a damning grade either towards any future aspirations (at least for someone who isn’t planning on specializing IMMEDIATELY after graduating if at all).

I am totally digressing though, this is not a post to whine about last year, it is to discuss initial impressions of my new found status as an upperclassmen. I know I will have bad days, I will be humbled, humiliated, ect., but I hope to learn a LOT. I see no other alternatives when you are practicing dentistry on real people every day. So far, I have really enjoyed it.

I was nervous Monday morning, had that same uneasy feeling you get when you are about to step into a new world – very similar to orientation. Once I got going, things just blazed by and before I knew it I was sitting at home with a beer watching TV.

So what is my schedule you ask? Here goes:

Monday:
8-10: Dental Public Health (meets 6 times, done in July)
10 – 4:30 - Clinic (lunch is designated 12:30-1:30)

Tuesday:
8-10 - Dental Ethics (meets 8 times, done in July)
10 – 4:30 - Clinic

Wednesday:
10-4:30 Clinic

Thursday:
8-9 - Pain control II
9 – 10 - Comp care IIIa lectures
10-4:30 Clinic

Friday:
8-10 - Basic Oral Surgery (but less basic than last semester)
10-4:30 Clinic

OKOK, now some of these numbers vary. Clinic time can be spent in many ways. We generally have a morning block and afternoon block of time, so we usually can’t see more than two patients a day. HOWEVER, we also have several required rotations scheduled at various times that take precedence over general clinic. Now we won’t all go through the same rotations this summer, but by the time graduation rolls around, everyone will have spent an equal amount of time in each rotation.
Generally when we have a rotation, one session occupies half of any given day and lasts a week. So when on rotation, half your time slots will not be available to schedule patients for that week.

Here is a breakdown of what I go through this summer:
Urgent Care (12 sessions) – Basically we treat the walk-in emergencies of the day. Usually end up referring to post-grad endo or OS. If we get lucky, we can do something interesting like a pulpotomy. The best part of urgent care is that you can pick up new patients with interesting cases. Most of your endodontic experience will be gained through urgent care patients. I had my first rotation this week, and picked up a new comprehensive care patient (which is great as most of my current patients refuse to call me back).

Oral Medicine (2 sessions) – We will be in here checking out oral pathologies and working on our clinical exam skills. I need to remind myself to reschedule one of these rotations as it conveniently overlaps one of my OS finals.

Radiology (5 sessions) – become cheap labor in the radiology department and take FMX and pans all morning/afternoon. I have this in 2 weeks and am glad because I need more practice.

Invisalign Training (1 day) – Get certified in invisalign in 8 hours, sounds good.

Pediatric Rotation – EVERY FRIDAY AFTERNOON FOR THE ENTIRE D-3 YEAR. Holy crap..that is a lot of pedo experience. I really hope I can learn to manage little kids by the time this is all said and done.

My only gripe is that I am missing out on the oral surgery rotation that most of my classmates seem to have. It lasts three weeks and must be completed before you can start extracting teeth without heavy supervision. Seeing as MANY urgent care patients require simple extractions, it sucks that I won’t really be able to start until I get my OS rotation (hopefully early in the fall).

All other clinic hours are meant for our patients. If a patient cancels, or you just couldn’t book anyone, you are expected to help out in urgent care, assist classmates, call patients, do lab work. You can’t just take off (although it seems like nobody would notice in the chaos that is this summer due to all the clinic shuffling). I really don’t mind doing UC when I have nothing else going on; it provides extra experience and offers the slim possibility of picking up a new patient.

Quick breakdown of courses:

Comprehensive Care IIIa – I loathe comp care. Simple as that. This class seems like it will be very similar to last semester, with a constant stream of ticky tack assignments just to bug the hell out of you. I’m not sure of the grade breakdown yet.

Dental Public Health – Haven’t had the class yet, but I doubt it will be a problem..most likely to be annoying though. 8 am still sucks for any lecture.

Dental Ethics – While this class sounds terrible, I can actually find value in it. There are plenty of really tough situations that I wouldn’t mind talking through with my classmates and faculty.

Endo Clinic I – This class is carried over a bit from last semester (I’m not exactly sure what else we do to get graded). I know if I get at least one RCT done this summer, my ‘experience’ grade will be an ‘A.’ Other than that…not sure.

Basic OMFS – very similar to last semester, some of the intstructors write absolutely dreadful multiple choice questions which pretty much makes easy tests much harder.

Pain Control II – The bad lecturer from the other OS classes is not in this one, so thank god. Hopefully the tests will actually be manageable. We get to load up each other on nitrous again at the end of the semester.

Perio Clinic I – I honestly didn’t even know this was a class until I looked up my schedule while writing this post. I assume we will be evaluated by the perio faculty for this grade.

Restorative Clinic I – Not sure how we are evaluated (performance exams most likely), but I will update when I figure it out. Hope I actually get to do some direct restorations this semester…it sure feels like all of my patients only need RPDs, Dentures, or Perio.

So that wraps up the official schedule, here are some drawbacks that will become more apparent as I get further into the year:
1.) Not enough chairs – with all the construction going on this summer (not to mention over-matriculation of international students), we are really tight on space. I am lucky if I can book a patient within a week at this point which sucks.

2.) Lack of endo – several of my peers have completed root canals already (some have done more than one). This sucks because it is pure luck if you find one through urgent care which seems to be the main avenue for RCT cases. This is also the one specialty I am interested in, so I would like to get some experience to determine if my interest stays legitimate.

3.) Lack of patients – yes I still lack a good patient pool, I know I will be getting more and more as the summer progresses, but I still have a TON of blank spaces on my calendar.

4.) D-4’s still around – I was under the impression that MOST of the D-4 students would be on rotations this summer, but it seems like they are all still around. Of course having them around is also helpful, because they can quickly offer advice/help when you most need it.

5.) Performance exams – Finding enough patients to practice, and then finding a good one to get graded on for any procedure simply sucks. I still am unaware of our actual requirements this summer, but I know it will be stressful.

6.) Not knowing what the hell you are doing – yes, believe it or not, the two years of pre-clinical training really can’t prepare you for live patients. It is frightening to be responsible for someone’s well-being when you feel so naïve and overwhelmed. All of the upperclassmen claim that it takes some time, but we will eventually feel pretty confident doing many different procedures. I hope so!

7.) Unclear expectations/goals – I really don’t know how we are evaluated, or what we are expected to complete.
Enough bitching! Most of that is pre-emptive bitching anyways because I haven’t had enough experience yet. Bottom line is that I am quite happy with where I’m at right now. I look forward to getting the ball rolling with my patients and actually improving their quality of life. I haven’t even thought about that yet.

Now I’m off to enjoy a three-day weekend. The nice weather has finally arrived!

Period Of Adjustment

2009-05-19T21:35:00.002-05:00

Two days into life as a third year dental student and the differences can easily be identified. First off, we don't have that much class, simple as that. I had monday morning off and I have tomorrow morning off (this means I don't have to be at school until 9:30 or 10:00 depending on if I have a patient or am on rotation). That extra 1.5 hours of sleep already kicks sooo much ass. Two of my courses this semester also end in early July, meaning I will only have early class on Thursdays and Fridays. I will break down the schedule in a week or so.

So what am I doing then? Working my ass off in the clinic trying to adjust and get used to everything. While our early clinic exposure did help during the D-2 year, it is a completely different animal when you are in there all the time, expected to be doing something, and doing that something well. One major flaw I already see in myself is lack of speed. I am far to slow and cannot adjust to changes in appointment plan fast enough. For example, I planned on getting 1/2 my initial exam done on my patient this afternoon. Instead, he spent 1.5 hours getting full mouth radiographs taken, then I essentially spent the rest of the time trying to deal with all his health problems that were clearly not under control. Blood pressure of 180/110 is NOT good. Blood glucose of 241 mg/dL is also NOT good for a 'controlled' diabetic. Had to write up a medical consult, and then before I knew it, I was already 45 minutes past the time we are supposed to be DONE!! So all my chart entries are unapproved because our instructor pretty much jetted after he signed the med consult. So now I have to hunt him down tomorrow to get all my unapproved entries swiped through.

I got home around 6pm, tired and drained. But instead of studying pharm..or reading endo...or writing a bussiness report...I opened a beer, grilled a few hot dogs and watched tv.

Now THERE is the big difference.

I know things will change. For one, I won't be able to drink a beer and do nothing every night I get home. There will be projects and lab work to do, and the few courses I have will require a bit of out-o-class time, but I know it will pale in comparison to the first two years. On the plus side too, I doubt I will be stuck in the school an hour late doing simple procedures after a few months grinding it out in the clinics. I am bound to get better by sheer repitition. I am aware of my shortcomings, which is a great step in learning to resolve them.

Everyone says D-3 year is the best. I can see this being true - especially after I adjust and get better at things that I know are simple, improve my communication with patients, and improve my general knowledge of common clinical problems such as what to prescribe for so and so or how drug X may interfere with treatment option Y...and so forth.

My only gripe is in regards to the lack of chairs. This would not normally be a problem at this school, but they decided to refurbish the pediatric and ortho clinics this summer. So those two clinics have been crammed in with the undergrad clinics and we are all shuffled around right now. That in itself isn't horrible, but what really steams me is the fact that the admissions committee cannot do simple math. They over-accepted on international students in the last cycle and they don't have enough room in the pre-clinic for the newcomers. This means that 8 of our clinic chairs are getting sucked up for pre-clinical courses. Guess what clinic they are in? Mine of course. So there are only 10 restorative chairs on tue and wed for my clinic now. Hmmm..there are 11 D-3s, 3 IDDP-2s, and 11 D-4s. This is going to work out great right? Ok ok..several of the D-4s will be out on rotation and we never ALL need restorative chairs (often need perio and sometimes endo)...but still. This is how I feel.

Well I will save further ramblings for my formal D-3 experience post. Just wanted to let all know that things have started and I am learning to adjust. I hope to be fully assimilated by the end of this summer.

Back to total relaxing and sleeping in until 9am. SWEET.

The D-2 Experience VI

2009-05-07T11:53:00.000-05:00

It has happened, I never thought this day would get here but it finally has – I am a D-3. FINALLY. Time usually flies in dental school, but the tail end of this semester has just dragged on and on. This year was without question, more difficult than the D-1 year. Anyone that argues otherwise is probably above average with their hands and hates studying basic science. Yea every school is different, but the basic route is still about the same – first year is essentially all books, second year is essentially all pre-clinic, and 3-4 is all patient care. Granted, the curriculum at UIC is getting a face-lift – but I really feel that this will mainly affect the D-1 portion of the curriculum. You still have to learn all those pre-clinic skills and PBL or whatever the hell they are calling it will never replace the bulk of the pre-clinical requirements.

The year in general was a rollercoaster. Every semester had a different feel to it. There was the Summer Semester of Waste, the Fall Semester of Saturdays, and the Spring Semester of Bull. I will elaborate on these personalized names right about now:

Summer Semester of Waste:

Waste, truly the best descriptor I could concoct to describe how I felt about the Summer. It was a shorter semester (about 12 weeks as opposed to the fall/spring 17 week marathon), but it still felt pretty long. Overall, the course load was manageable. We had comp care IIa, Intro to pediatrics, Path II, Pain control, and Dentures (this class started in July). We spent a lot of time with the comp care course learning how to use composite as well as preparing class III/IV teeth. We also did inlays and onlays towards the end. I remember the restorative portion of this course being really frustrating because they never really teach you how to polish anything here; you just have to sort of figure it out. Yea, it isn’t that hard to do – but there are a few tricks that would have been beneficial to know AHEAD of time. Perio was mostly lecture based, with a few clinical sessions. EBD was blah as usual. I suppose the true interesting aspect of this course was that we began assisting in the clinics. This was beneficial a few times but was also boring and useless on other occasions. Basically if you got stuck perio charting, you didn’t learn much (except that the perio instructors are VERY anal about EVERYTHING.)

Pain control was a standard 1 credit course, but of course STAB LAB stole the show. It was not nearly as scary as people made it out to be. The only drawback is that I haven’t done an IAN since last August…watch out next patient that needs mandibular work. Path II was the same as path I, lectures simply way to long.

Pedo was an interesting course. The tests were made impossible because each lecture covered around 200-300 slides of material and we had 2 lectures a week. Try keeping up with 600 slides PER week. However, the director gave out extra credit like candy and if you did all the lab work – you most likely got an ‘A.’ However; I do remember some of those lab days dragging on forever. Learning how to bend wires into a lingual holding arch was bad, but it could have been worse. Soldering and polishing was actually pretty interesting although I probably won’t be doing it very often.

OKOK, so the course load during the Summer of Waste really wasn’t all too bad. The kicker is that I took the National Board Dental Examination Part I in August right after the Summer of Waste ended. You know what that meant of course, I spend pretty much all of my evenings and weekends deep in study.

I call this the Summer of Waste because it truly was a wasted summer. The weather never got insanely hot, perfect breeze, and there wasn’t an inordinate amount of rain. The biggest treat I had all summer long was getting to sit on my deck and study for the boards. OK, maybe I’m embellishing a little, but not by much. I am sad to think back on how little ‘fun’ I got to have, but it’s all part of the game. Plus, I have this next summer to look forward to (the schedule looks AWESOME..more on that later).

The Fall of Saturdays:

The name is self-explanatory. I am NOT exaggerating either; I was in the school at least 14 out of the 16 weekends. Most of my classmates did their extra work during our Tuesday afternoon board study time, but I found that day to be too crowded because the D-1s were always doing something in the pre-clinic or wet lab. So I started the unfortunate tradition of coming in on Saturdays…every Saturday. Time was variable, but I would say the average was 3-4 hours.

Course load:
Compcare IIb: restorative, perio, communications, and clinic components (actually got a few of our own recall patients).
Fixed Prosthodontics I: Hardest class of the semester
Removable partial dentures
Complete Dentures
Pre-clinical Endodontics
Oral Pathology

The list may not be that long, but each and every one of those classes was a monster in terms of time/work involved – particularly Complete Dentures, Endo, and Fixed.

I spent so many hours groping my way through disgusting jars of extracted teeth, finding maybe 1 in every 20 to have any potential use, x-raying them, finding only 1 in 3 of these to be useful, mounting them in stone, and x-raying them again. This was all just to prepare for the course. That doesn’t include actually performing endodontic therapy on these teeth – which takes a LOT of time in itself. This class was my Saturday class for the first half of the semester. Afterwards the shift was towards Fixed and Dentures. What made endo stressful was that I had no extra teeth for practice. It wasn’t like fixed where I could go to the window and buy 10 plastic teeth to prepare crowns on – I could only use what I had, or what I could get via the mooch/trade with classmates. Not only did I not have to remediate, but I averaged an ‘A’ on the performance exams which was a true lift to my dentistry morale considering how poorly I did in fixed.

As just mentioned, fixed was terrible during the Fall of Saturdays. I averaged a 71% on the two performance exams(had to remediate one of them) and generally felt like I sucked at everything. I just couldn’t find a good technique for making a provisional and many of the labs had us doing very important things that I already can’t remember how to do (cast/post and core with biscor build-up for example). If not for my absolute domination on the final exam, I would have gotten a ‘C,’ which is the bottom-line goal I had coming in grade-wise – no C’s, D’s, or F’s.

Complete Dentures was not too bad until we got to setting the denture teeth. We had to use mounting jigs to get these things set on our articulators (a facebow transfer would work in a real patient). The jigs were pieces of crap and essentially created an extra 5-6 hours of work for me. My original mounting was off; I simply had no inter-occlusal space to set the teeth. So instead of suggesting a remount, every instructor had me grinding the base plate and the teeth for HOURS trying to make room. I FINALLY decide to try remounting after measuring the space on a few classmates (we all use the same jig)…so I pry the thing off, remount and voila, I have another 5-6mms of space. Turns out, I used one of the ‘crappy’ jigs. Bullshit I say. There was so much theory involved and not enough hands on in the mouth experience. Some things were simply not taught like how to pour up your final impression using the plaster/pumice box technique – I still have no idea what a clinical re-mount is and in all honesty, have no clue how to properly do a facebow transfer. So I guess this will be trial by fire in the most literal sense of the phrase.

So while the Fall Semester of Saturdays was the toughest, labor-intensive semester of dental school at this point, I still probably enjoyed it the most out of all three during the D-2 year. You simply learn a TON of dentistry, and that is what I am in school for.

Now for some crap, the Spring Semester of Bull. This past semester was probably the worst out of them all (with the possible exception of D-1 Spring). Hmmm, maybe the spring semesters just suck? It wasn’t ‘difficult’ per-say…it was mostly just complete bull. I had to do so many random projects and other filler-material that made me realize UoP graduating dentists in 3 years probably IS more feasible than I once thought assuming you trim the fat – like having to sit through 18 EBD presentations (9 of them during finals week).

Comp care was more spastic and all-over the place than usual. We had a clinical component, a portfolio to write up, and the implant course. The aforementioned sections were how we got graded. However, there were a billion pass/fail sections. Radiology, Pediatrics, Perio, Endo, Urgent Care rotations all had to be completed (many of them requiring little write-ups to prove attendance). I don’t know how many root canals I could watch while coming up with an interesting “what did you learn today” response. Ummm, watching root canals is perhaps the most boring thing I have ever done in my life? I would love to actually DO the root canal…ahhh maybe next semester. We also had to tape-record ourselves during a patient interview and play the recordings during a communications rotation which was blah..then of course we had to write the obligatory reflection paper. There was a bunch of other random crap to do as well, but I’m not in the mood to sort it all out. The bottom line is that I felt completely stretched thin in this class, every time I thought I would get a little break in the action, some new and annoying project or paper would randomly appear. It was one thing after another.

The implant portion of Comp care was valuable in the sense that I actually did learn a TON. However, the quizzing and final exam were complete jokes. Case in point – we had three lectures given by three different specialists (prosth, OS, and perio). EACH one gave a different number for surivival rates of maxillary implants. So go figure, this exact question appeared on the exam. Guess what? ALL three numbers appeared as answer choices. Give me a break. The lectures were NOT organized and the teaching was often haphazard at best. However, the labs were beneficial and again, I learned a TON despite my previous bitching. I also give this course a little lee-way because I believe we are only the second class to have it..hopefully things improve for the future.

Pharmacology was the biggest waste of time/effort this semester. I will sum it up: “Here is a massive list of drugs. Memorize everything on this list even though you will maybe prescribe 1% of them and can easily look the others up as necessary because there is no way in hell you remember any of this.” I will not even dignify its presence with further comment.

Ortho also turned into a class I dreaded going to. The lectures were insanely long and ended up repeating themselves over and over towards the end and the tests covered things we weren’t exactly taught. I learned a lot, but have officially been turned off to ortho as a future career route. Far too much theory and guessing for me. Not a huge fan of working on kids either.

OS and Endo were standard lecture classes, not much else to say. Treatment planning was somewhat useful but as mentioned in previous posts, I probably could have used this class earlier in the curriculum.

Fixed II was easier than last semester, but that doesn’t make it EASY. I magically developed skills with acrylic during our winter break so that is something to be happy about.

The best part of this semester was that I finally started getting my own patients and have seen a few of them already. I look forward to seeing lots of patients in the VERY near future.

The Spring Semester of Bull, aptly named because there was so much random crap to do, felt as though we took a significant step back in our dental education when compared to the intensity of the fall semester. It was a lighter semester in terms of work, but motivation was definitely a struggle.

Conclusions:

I found the D-2 year to be one hell of a challenge – both mentally and physically. I truly did enjoy it more than the first year though because everything was FAR more relevant. My small taste of the clinic life has made me realize just how little I actually know about dentistry and just how different real people with not-so-ideal problems compare with plastic teeth.

I am nervous about treating live people, but I am definitely ready to get started. No amount of pre-clinical practice/study can compare to real experience – and that is something I hope to get a lot of in my final two years of dental school.

Wow, I am officially half-way through. I can only imagine how insane things will be two years from now when I am two days away from graduating…

Now it’s time to enjoy my week off!

12am And All’s Not Well

2009-04-30T00:31:00.000-05:00

I am so screwed for my pharm final tomorrow. I have never felt this unprepared for an exam in my life. Even coffee and staying up won’t help at this point so I am about to throw in the towel and get some sleep.

There is a list of about 200 drugs that we are responsible for on this exam. Note that this is not a cumulative exam either, we have had these drugs crammed down our throats in the last three weeks. I don’t see how it is possible to maintain all your other responsibilities to school and simple life-maintaining processes like eating and crapping while learning all this. It isn’t like I have been procrastinating either. Yea, I am un-motivated as hell, but I still have logged a TON of time on this shit. The end of the D-2 year is much like the grand finale at a 4th of July show….except you are strapped to one of the final fireworks.

I will proceed to forget everything I have crammed for within 24 hours. Times like these really make me despise school with a genuine passion.

After this test, I get to start studying for Implants, Tx planning, Endo, Fixed, and Ortho.

..god dammit

First F/F Case – 1

2009-04-28T19:38:00.001-05:00

While I have completed a few preliminary appointments and recalls with other patients, I finally seem to have roped in a committed and punctual patient that I will be treating from start to finish. It also happens to be a complete dentures case (full over full (F/F)). While I really didn’t enjoy the dentures course, I must have learned more than I thought, because reviewing the material didn’t seem so bad.

Obviously as I get into the more technical components, things might get interesting. The thing is, I am extremely motivated to make these things look awesome (much more motivated than I was for the fake patient in the pre-clinic course). I plan on getting a camera soon so that I can possibly upload photos of this entire process because those of you in school learning about dentures for the first time probably know how confusing things can seem.

So today was the first appointment I have had with Mrs. E. (HIPPA!!) The appointment was scheduled for 2 pm and she showed up at noon. She knew the appointment was at 2 also, she just didn’t want to be late…holy crap – talk about someone who actually wants treatment (unlike ½ my patients). I suppose if I had no teeth, I would be anxious to get that solved as well.

I set up my operatory, check out an exam kit from sterilization, grab my mixing bowl/spatula and BP cuff/stethoscope..time to go. I introduce myself to the patient and bring her back. She is EXTREMELY easy-going and well-mannered. Our initial conversation lasted about ten minutes. She told me how in January she had her remaining teeth extracted and palatal torus removed (all in preparation for the dentures). Many dentures patients already have a pair that simply are broken down or not working out. However, this patient has never experienced dentures before. So I try my best to make sure her expectations don’t get INSANELY high. Dentures will never be as good as real teeth, period. I also mentioned the option of converting the mandibular denture into an overdenture (implant-supported denture) once we finished the two arches. This is actually a GREAT deal at the school. An overdenture is created by placing two implants in the anterior region of the mandible and placing attachments on the parts that poke out of the gums which fit directly into the denture – greatly improving retention/stability. This will run you about 4k outside of the school. However, if you get them done at UIC, it will cost you 300 dollars – INSANE bargain. Mrs. E. is on a bit of a financial strain however, and she can only pay so much at a time. So in a rare way, the slow process of treatment at a dental school will actually work in her favor, she will be able to pay most of it off before I even finish.

OK, so I take her BP. I get a fairly high reading using the steth and cuff. However, I am still inexperienced and the clinic is loud so I take it again. Still around 160/90. She told me her BP is usually ‘good.’ I switch to the wrist BP cuff which reads 170/105. Pretty damn high. However, I really question the validity of those wrist readers as they are often all over the place. So I proceed with the med history/dental history/risk factor analysis. She has arthritis and takes a few meds for the pain, nothing else jumped out. It was nice that she was edentulous because I could skip the long process of odontogram charting and focus more on the clinical stuff. I took her BP again after all this talking (15 minutes or so) and it was 149/78 which is much better. However, if I continue to get high readings, I will probably get her a med consult.

So I proceed to the extra-oral and intra-oral exams. She has AWESOME ridges. As in huge, broad, tall, awesome - I really couldn’t have asked for a better patient in terms of success potential – not to mention we are required to do one overdenture case to graduate so it is a win-win (assuming she goes with the implants down the road).

I grab my instructor, he agrees that Mrs. E. has some amazing ridges and checks me off to take the initial impressions.

I was too slow on the first impression. I haven’t used the fast-set alginate enough yet so my speed needs a little work. The material was a little too hard so I didn’t get the tray seated deep enough. My second attempt is MUCH better and will work for custom-tray fabrication. I proceed to the mandible. The first impression was crap; I forgot to pull the lip out first and seated the thing too anteriorly. My second attempt was acceptable. Given the fact that I haven’t taken impressions forever, I was happy to get both arches done in four tries. Obviously won’t want to be doing that in a year, but I’ll take it for now.

I next slapped together a quick treatment plan for the dentures and had the patient sign off. I wrote up my note and escorted the patient out. The dentures will cost about 1000 total, the initial exam was 36, and the overdentures will be 300. Not a bad deal at all. She put down 336 and was on her way. I will be seeing her next at the end of May.

I cleaned up my unit and took the impressions upstairs to pour up. All the damn D-1’s were in the wet lab working on occlusion wax-ups..gross. I went back downstairs to the support lab by our clinic and poured the impressions up in microstone. Seeing as I have a lot of shit to study for, I didn’t do the second pour. I popped out initial models and they looked fine, so I will second pour and create the custom trays before her next appointment. And yes, I know I need to get more efficient doing lab work.

Whew, those initial appointments are exhausting.

I also plan on keeping a running total to see how horribly slow I am.

# of Appointments: 1
-COE, Initial Impressions (1)

Outside of class lab time: 45mins (1st pour, initial impressions upper/lower) - mostly just sitting around waiting for things to set.

100th Post

2009-04-24T16:34:00.001-05:00

Wow. I noticed during my last update that I had slapped 99 posts up. That seems like a TON. Granted, I have had this blog going for over two years now, but I still can’t believe I have stuck with it. I know I have been updating less and less over the last year, but given my schedule – I am impressed that I didn’t disappear for months all together if not permanently.

My intentions haven’t changed – I hope to provide blissful procrastination to anyone bored enough to read a dental blog while keeping my fingers crossed that I actually help a few pre-dents and dental students along the way. I know I am terrible about getting back to emails, but I eventually do answer them all.

So I guess this post is just a selfish pat on the back.

Today was 83 degrees and sunny. Soon I will be a D-3, full time in the clinics. Even more importantly, I will be 50% done with dental school.

Now I have to study for the massive load of finals I have in the next two weeks.

Stay tuned:

D-2 experience finale mid May
New blog series on my first F/F denture case
D-3 experience post early June.

Take care all!

Here's To You, Homeless Man

2009-04-13T17:05:00.001-05:00

Here I am walking back home around 3:30pm after finishing another dull double-dip of urgent care duties last Friday. I look across the street and notice two things. Firstly, I see a hummer parked outside of the Seven-Eleven. Next, I see a huge homeless dude with a giant beard standing (literally blocking) the entrance to the store. I’m thinking to myself, that can’t be good for business.

So a guy comes out of the seven-eleven and gets into the hummer. As the tank begins to move out of the parking lot, the homeless man suddenly springs to life and just sort of half-ass kicks the rear bumper, while yelling a lot. Now at this point, I sort of stop. Fortunately I am across the street and can safely observe. The guy in the Hummer get’s out of his car and does the ‘tough-guy’ act.

TG: “Did you just kick this truck?”
HM: YES, YES I DID YOU OL’ MOFOING HIGH YERGESLFLKJ HONK STOP (as close a translation as I could make out)

TG: Don’t fucking touch my car again

HM: THAT AIN’T NO CAR, THAT BE A MOFOING TANK. ONLY BODIES THAT NEED THAT ARE IN A WARZONE. BLARELJARLHGHGHGHGH!!!

At this point the guy realized that this homeless man was totally correct, shut his mouth, got in his tank and left.

I LOVED this exchange. The homeless man pretty much summed up how I feel about Hummers. And he had the balls to not back down from his crazy antics.

I have almost been killed by Hummers on so many occasions now that it was nice to see someone that agrees with me. I can’t turn left when there is a hummer turning left on the opposite side. Why? Because I CAN’T SEE AROUND IT. I could go on, but there is no topping the eloquence of the homeless man. He made my weekend.

So here’s to you homeless man. You may need shower and a shave, but you make more sense the 90% of the people on this planet.

The Random Bites

2009-03-30T15:16:00.000-05:00

While the work load is definitely lighter this semester in terms of pure hours in the school, I can’t help but feel like we have taken a step backwards in terms of dental education. Last semester had me learning how to make dentures, RPDs, provisionals, crown preps, cast-post and cores, not to mention full endodontic therapy. What about this semester? Make way for the active site of COX-1 inhibitors, or how to chart audit. Granted we are learning plenty, but it feels so random and out of sorts.

The implant course has just been an absolute mess in terms of coherence. The lectures are never posted online until several days after the lecture. The problem lies in that these lectures are almost purely picture-based. So you end up with a notebook page full of random notes trying to remember what picture each note applies to once you finally can download the lecture. Don’t even get me started on the absurdity of the quizzes either. The only saving grace for this course is that the lab sessions are generally helpful…but we only have four all semester.

The clinical exposure has been good overall, but as previous posts point out – we just don’t get enough consistent time. Not to mention most of the instructors fail to realize that we are second year students with minimal experience in the clinics. Of course our rotation schedule for the summer probably won’t be finished until a week before we start – so we can’t exactly start booking chairs.

The most annoying part of this semester though is the random annoying assignments. You know, the ‘let’s write up a boring paper based on a poster you read at some meeting’ sort of assignment. I am looking at this list of papers/presentations and here are a few examples:

Patient portfolio - 10-15ish page paper pretty much describing your first complete work-up of a patient prior to treatment planning.

Business report – I have asked about 10 of my classmates, we don’t even remember what this is or when we have to do it.

Attendance papers – basically had to write two papers on random topics to prove we attended two separate functions

Communications reflection – 3 page paper reflecting about your communication skills (had to tape-record yourself talking to a patient).

Chart audit – still haven’t had this yet

Endo case presentation – present diagnostic case in front of endo faculty (power point format)

EBD paper for tx planning – 5 page paper about random EBD topic assigned to your group

EBD paper for implants – 20 minute presentation about random EBD topic assigned to your group (pp format)

There is more crap I’m sure but I can’t keep going. None of these tasks is particularly challenging or even stimulating to the brain. They just become overwhelming by sheer volume. Like a swarm of mosquitoes biting at the back of your neck.

I have spent so much time writing random papers and researching various topics that I feel like my limited clinical abilities have atrophied. Last semester was so intensive clinically-speaking that this current semester feels grossly out of place.

Then again, I must also take into account that I may just be completely tired of second year, and am itching to officially become an ‘upperclassman.’

Who knows..but you can expect one final D-2 experience post to sum up this arduous year sometime in May.

Assisting CRDTS

2009-03-22T10:58:00.001-05:00

I assisted a D-4 with her CRDTS exam yesterday which is the regional licensure exam. Basically you MUST pass this exam to legally practice in the state of Illinois (and several other Midwest states). The 4th years just have tons of big exams to take – which leads me to believe that my upcoming third year of dental school really is the big time learning year without the stress of HUGE non-school given exams.

So this CRDTS exam was pretty intense. I arrived at 7:30am and didn’t leave until 5:00pm. There was no lunch break (or even bathroom break for that matter). There just is no time, as the assistant, it is namely my job to keep things running smoothly for the student. Helping to rapidly breakdown and re-bag the chairs between patients, getting/returning instruments from sterilization, walking the patient over to the grading station for evaluation or mod-requests, and so forth.

The ‘candidate,’ as the upperclassman is referred to by the intimidating test administrators, must complete two major blocks – perio and restorative. Perio was straightforward; the patient comes in and needs to have a quadrant scaled. Two teeth are randomly assigned for probing checks. After the start check (and verificaction that calculus exists on the surfaces to be tested), the student gets 90 mins to do the work. Barely finished on time because there was some really stubborn calculus.

The next portion is the restorative portion. You essentially get six hours to complete two procedures – a class III composite and a class II amalgam. Two patients are pretty much required because the odds of finding one with both lesions in perfect position is unlikely. Six hours is a long time right? It goes REALLY fast, and each trip to the grading station (requesting mods, prep grade, final rest grade) takes a good 15 mins.

I could go into details, but that isn’t the point – I learned a ton, and sort of freaked myself out a bit in the process. Failing this exam is quite common and I saw at least one student get sent home early for missing some decay on the prep. It isn’t the end of the world because you can retake it again in May, but that equates to finding more patients and repeating the entire test which is no good.

The student I assisted made it through the day and only had one evaluator created change (excess flash on the composite). This only docks her some points though, it doesn’t equal an immediate fail. I am taking this exam in two years, but I can already tell it will be the most stressful day of my life.

Now I have one last day of spring break to enjoy before hitting the homestretch (7 more weeks!) of D-2 year.

Something To Think About

2009-03-18T23:56:00.002-05:00

Remember when you were a little kid and you would go off to visit your grandparents? Be it for Christmas, the 4th of July, Thanksgiving, or a wedding, you invariably ended up staying at Grandma's. Now, think back if you will about the things your grandparent's liked doing..oh I don't know..like the music they had. Old timey stuff that..ya know, you would hear on the old radio. That music had a certain feel, it was grandma music. Pleasant and wholesome.

So now, jump into a mental time table. Imagine this latest generation of early 20ish people. Imagine US as grandparents. Our grandkids are going to come over just like we once did years ago to visit. You know what they are going to hear?

Hoes, Bitches, and Bling Blingin'

...Holy crap.

Two Things

2009-03-18T10:01:00.002-05:00

Thing 1: Reading Assignments

Ok, I’m all for learning, I mean I technically am a 20th grader – but I don’t understand some of the philosophies exhibited by our instructors. I mean, these people (for the most part) ALL went to dental school and should remember just exactly how little time you have to casually read 50 pages of journal articles in a single week. Don’t get me wrong, certain TEXT books are great adjuncts to lecture (example = Torabinejad/Walton Endo text). Where I get steamed is all these damn research articles. I weep for the incoming classes if this is how they are expected to learn.

I completely understand the validity of assessing research, but this is not nearly as applicable to learning itself. For example, in our Ortho class, we are commonly assigned 3-5 journal articles to read prior to having the lecture on said topic. Now anyone that has read any sort of scientific journal completely understand how DRY and BORING this type of writing is (UNLESS you are knowledgeable and interested). If I don’t know anything about the physics and biomechanical properties of tooth movement, how can I possibly be expected to cram down 5 journal articles when I have had ZERO exposure to this topic in class? Hell, even if I was in love with ortho, I would have trouble finishing that WHILE managing to not fail all the other assorted classes and busy work they have me doing. It may be just me, but I really can’t get through research based articles without having ANY background about the topic beforehand. I get that we need to learn this stuff, but it can literally take a good hour or two to read one article thoroughly and actually comprehend even when you are familiar with the subject. So when am I going to find an extra 10 hours out of my week to read ortho papers? It simply isn’t going to happen.

Now for an example of how research articles can be used effectively. In our fixed prosthodontics class, articles are used to enhance our learning efficiently, not bog us down. For example, we were given a lecture on pontics earlier this semester – afterwards, we were given two research articles to read with an accompanying question sheet. The questions asked were all found in the articles and relevant to the main points of the lecture. I actually enjoyed reading these articles because we had just been exposed to the topic and I actually could follow the articles coherently without teaching myself everything for the first time. We are often given 1-2 weeks to read these articles and then given a quiz which reflects MANY of the questions already provided. So yea, just two examples on the same philosophy – but one is done well, while the other expects me to read at the same rate as a cyborg.

Thing 2: Dragging grade distribution out

So I just was praising fixed; now I can get pissed at it. This last Wednesday we got our performance exam grades back for our 3-unit bridge provisionals. Only it got dragged out FOREVER. Let me preface this by adding that the grading in this class is VERY tough. Much harder than any other performance exam-based course. I generally do well on PEs but last semester (as rabid fans may recall) failed the first exam and got a 71% on the second. So needless to say, I was a bit stressed out for fear of bombing the third of this gruesome quartet.

8am: We have 1 hour of OS lecture..everyone is thinking…crap..I hope I passed fixed.

9am: Fixed course director comes in, tells us she will get to the exam later – proceeds to lecture about the next project. It is pretty hard to concentrate on the next leg of your academic journey when you still aren’t sure if you survived the last ordeal.

9:30: Director finishes presentation and proceeds to say: “Ok, now for the exams…what was wrong guys? Did you have a bad day? 33 of you failed, that is 50% of the class. You are setting new records in my course, and not the good ones. I am very worried.”

Ok..can we see if we failed yet..NO. She starts showing all these statistics about HOW we did terribly (the failing breakdown if you will).

10:00 – we get into the pre-clinic to start the days project..we don’t have our dentechs because they were being graded

10:15 – still no teachers or dentechs

10:30 – teachers trickle in, dentechs are distributed with NO grades.

10:45 – Some students get grades. I see little dances or looks of utter devastation. The end is near.

11:00 – I FINALLY, FINALLY get my grade. While I did all right in the end, I must have aged about 2 years just waiting.

Point being – PLEASE PLEASE PLEASE GIVE GRADES OUT BEFOREHAND. I honestly cannot focus on anything when I know grades are done, yet I still for some reason can’t see them. The actual percentage really isn’t what keeps me worried, but the fear of having to redo a 3-hour exam is not appealing at all – especially considering how busy things tend to get at the end of the semester.

I would like to add the disclaimer that the instruction in this class is generally pretty damn good. Although the nit-picking can get very frustrating at times, I know in the long run – it will make me better clinically (or at least give me a great eye for when things are not good). I also feel like I finally understand crown preps and how to work with acrylic. I don’t know what happened over winter break, but everything seems much easier. I am not horribly reducing my line angles and I am getting provisionals done faster and faster.

And with the rant out of the way, I shall continue my nice lazy spring break which is barely even 1/2-way over...ahhhhh.

Another Batch Finished

2009-03-04T14:24:00.000-06:00

I am back for another off-afternoon. We had an oral surgery mid-term this morning, followed by our first fixed performance exam (3 unit-provisional in 3 hours). Seeing as I still have trouble finishing these temps in 3 hours, I really have no idea how I am supposed to cut the preps and make the provisional on a real patient in 2.5 hours (not including seating, anesthetizing, and needing constant check-offs). I suppose my provisionals won’t be graded under such scrutiny by clinical professors though which is the only saving grace.

Needless to say, I was practicing over the weekend and generally finishing on time. I can make a functional temp really fast, but fine-tuning and getting everything to look perfect takes hours. I feel like I passed the exam though (no major mistakes). Unfortunately I will never feel at ease until I see the grade.

So aside from a brutal ortho mid-term, I have been getting through this semester pretty well. Spring break is only one week away, and I am edging nearer and nearer the end of this long D-2 year. I must admit, I am ready to treat patients exclusively. It is a lot more exhaustive, but I get so much more out of patient interaction at this point and now I just want the experience. I was assigned another new patient, but I unfortunately won’t have a solid block of clinic time until April which is frustrating. There really isn’t much I can do about it. They are trying to get us into the clinics, but with all the upperclassmen requiring chairs and all of our lectures/pre-clinic coursework, there just isn’t as much opportunity as I would like.

Things are moving along, the weather is getting warmer, the sun is staying out longer, and winter is beginning to die off (finally). Not much else to say, school has numbed my writing sensibilities so I will leave it as is for now.

Time to write some BS paper and study for pharm.

The D-2 Experience V

2009-02-12T21:02:00.001-06:00

As I delve deeper into my last semester as a D-2 student, I feel like spurting fourth another opinionated post about the curriculum this spring. My last post on this matter pretty much outlined my schedule – now I can actually give some thoughts on the courses themselves, after about 6 weeks of exposure.

First off, compared to last semester – things feel much less hectic..in certain ways. For example, I feel like we get a lot of random time off this semester. The D-4s have their boards coming up, which also means they practice with ‘mock boards.’ This gives us a few afternoons/mornings off. The midwinter meeting is coming up which essentially grants us a 4-day weekend. Then spring break is thrown into the mix for good measure. Compare this with last semester, in which we had three days off ALL semester (including thanksgiving). Just getting those little breaks helps a lot – although one could also argue that it makes you lazier and less compelled to do school work.

However, no semester of dental school is ‘light’ or ‘easy’ and there is plenty of random crap we have to do. This semester has definitely topped the list of papers/projects required:

Endo case presentation in which we have to make a PowerPoint presentation based off of a patient we assisted with that required endo diagnostic testing/treatment planning.

Patient portfolio: minimum 10 page typed paper answering an assortment of questions in regards to our first COE patient.

Chart audits: we get to audit charts at some point this semester..fun

Clinic and research Day paper: Just a random assignment that takes up time to complete which is supposed to prove we showed up for clinic/research day.

Mid-winter meeting: same as the C/R day paper..another waste of time. I would go regardless..now this just adds another bothersome task.

Business Report: I don’t know what this is..but apparently we have to do one at some point this semester.

Communications Reflection: Tape-record yourself interviewing a patient and then write a ‘reflection’ on the experience.

Two classes also have EBD papers/presentations…sigh.

I’m sure I’m forgetting some stuff..but this is just to give you the basic idea of all these assorted ‘extras’ we have to do. None of it is really that hard…just easy to forget about..which is not good.

Now onto the actual schedule:

Treatment Planning: This course would have been far more useful last semester..or even over the summer. It is going over stuff we have already had to teach ourselves in order to survive in the clinics. Granted it will probably be more helpful once we start tx planning mock cases..but right now it is a very dull lecture-based class.

Comp Care IIC - Implants: I was most excited about this class – but now I am less than thrilled. It is clear that this module has not been done for many years as it is rather haphazard and unorganized. I don’t like courses that rely on blackboard to post all the lecture material and then proceed to not post half the crap..or post it weeks after we had the lecture. It is really hard to take notes on a lecture that is almost all pictures with no reference material to write on. The first quiz we had was really easy; the second one was ridiculously difficult in comparison. They are also unannounced which is the biggest testament to BS. No sane person has enough time to study every course every night to prepare for pop-quizzes. You need to be able to shift focus as necessary…guess that isn’t how everyone thinks.

I think things will get better now because we have ‘all day lab sessions’ which = no lectures. Unfortunately there is no lab manual or reference material as to exactly what we are doing in these labs..so you pretty much go in blind praying you figure things out. They technically did talk about the lab sessions prior to going..but it was not done effectively..and again – not posted online.

I won’t bitch too much though, because I am managing to learn a lot – I just am not enjoying the course layout..but I guess the directors can only work with the time they get.

The other 60% of our comp care grade is decided on our clinic faculty evaluation and patient portfolio. I really have no idea how our faculty will evaluate us…. I really only have one patient willing to show up..and I hopefully will do some basic restorative on her by the end of the semester (crossing fingers).

I did get my patient in again last Monday..but she showed up late and I had to let an upperclassmen check her out for board lesions…so I didn’t manage to get through the entire perio evaluation…she is coming in again in two weeks. I hope to have a basic tx plan ready to go so I can at least give her a cleaning…then amalgam time!

We also have several P/F components (communications, rotations, ect).

Endo – We have two different endo courses this semester (although we won’t register for one of them until the summer). Basically one is clinical and the other is lectures. The clinical one involves us getting ‘endo experience’ points based on assisting upperclassmen/residents. We also have to present an endo diagnostic case scenario in front of faculty and peers. I have my case lined up..I just need to grab the file and make copies of the radiographs…then I can put the PowerPoint together.

The other course is identical to last semester without the lab component. We have the weekly reading assignments along with the weekly 10-questions T/F quiz. Getting old real fast.

Ortho - This class is giving me total nostalgic flashbacks. I had so much ortho tx done as a child, that seeing all this crap in a professional light is pretty cool. I may actually go back to my orthodontist and see if he’ll let me pull out my case file so I can see how jacked up I was (class III with posterior crossbite). Yea, I totally had the expander, face-max, Nance-appliance…not to mention braces. Ahhh those were the days. The course itself is ok…although I cannot stand some of the lab work…tracings cephs is headache inducing…and all the math/guessing involved is quickly turning me off to ortho as a potential career path. Endo still remains the only specialty of interest to me at this point.

Fixed Prosth. II – I actually like this class more than I did last semester. Mainly because we had two weeks off already (random reasons had us off on Wednesdays…it was awesome). The pacing seems more laid back and we seem to have less to do. We really are only learning how to do bridges..not much else. The performance exams have also been greatly reduced in terms of expectations compared to what the current D-3s did. They had to prepare and provisionalize a 3 unit bridge in ONE exam. We only have to prepare the teeth OR create the provisional (one per exam). This makes things much easier..although I can’t take it lightly as my performance exam average last semester was pitiful..gonna have to make a damn pretty provisional.

Oral Surgery – Not much to say..we have one 50 minute lecture each week..no quizzes..just two exams. Sort of interesting stuff…but some of those pictures are a bit too much for me at 8am.

Pharmacology - saving the best for last right? This class is like biochem all over again. Long boring lectures with little relevance to what a clinician NEEDS to know - not to mention how hard studying for this class is. At least during the D-1 year all we had to do was go home and study....now we have to manage patients, get tons of lab work done, write a bunch of papers/presentations, AND study for this horrible, horrible class.

So things seem less stressful at the moment. Fixed prosth I, dentures, and endo was such a deadly combo last semester that nothing really seems bad in comparison.

Time to get back to slacking off.

A Rarity

2009-02-02T22:44:00.001-06:00

Yes, I finally am going to put forth a positive post that isn’t chalk-full of bitching and moaning..well, maybe a little. So as my life as the beleaguered D-2 continues, I find the clinics becoming more and more integrated with my routine. And for all my whining, I must admit that the school has done an admirable job at getting us exposed to the clinics bit by bit quite early. I couldn’t imagine diving right in as a D-3 without having any prior experience.

Let me elaborate. Many dental schools follow the strict formula of D-1 = didactic, (SUMMER BREAK) D-2 = pre-clinicals, D-3-4 = Clinical. Our first year was straight up didactic with a few pre-clinical courses. Because we go year-round here, the D-2 curriculum can have a good portion of clinic time while still filling in all the pre-clinical lab stuff. So during the summer of our D-2 year, we had an average of around one ½-day per week in the clinics. Granted, this was limited strictly to assisting upper-classmen, but it still got you exposed to a very different environment from the lecture halls/pre-clinic. How many dental students around the country can say they gave an IAN block to an actual patient before they had even been in school for 12 months? We also got sent on a few rotations (radiology/OS/ect.) I would wager we are in the minority on such experiences. We weren’t graded on anything outside of attendance.

So once we hit the fall semester, we were allocated a very small pool of patients. This is where things began to get quite different depending on the luck of the draw. Some of my classmates were doing all out restorative procedures, while others were stuck struggling to get just ONE to show up for an appointment (like me). We had one full day each week devoted entirely towards clinical activity. So even if we couldn’t get patients in, there was still plenty to do/learn. Even by working with upper-classmen, you start to get a feel for the clinical faculty as well as all the bullshit red-tape one must wade through to get ANYTHING accomplished. We had a few rotations, similar to the summer semester. Again, we were really only graded on showing up.

Finally, the spring semester of D-2 fun is upon me along with my last chance to get as comfortable as possible with how zany the clinics tend to be. We now have 1.5 days of clinical activity. Usually 0.5-1 of those days each week is spent on rotation (namely because there really aren’t enough chairs in the clinics for all of us mixed in with the upper classmen.) The rotations seem a lot more in depth now. For example, I spent every Tuesday afternoon during January on a radiology rotation. I now feel marginally comfortable taking radiographs on real patients. I start my Pedo block tomorrow afternoon…kids..ugh.

The only stress is that we are now expected to accomplish things and are graded on performance. This is scary in that it is still relatively difficult to get patients. However, once the D-4’s get closer to graduation, I’m sure they will start piling in. Adding that strain of grading is good though, because it is just edging us a tad bit closer to how full time clinic semesters will be.

I guess I am so upbeat about all this clinic stuff right now because things have actually been working out the last few weeks. I have been learning a ton (even without my own patients). Although today, I FINALLY got one in. She was freshly screened and had ZERO work done on her at the school. In other words, this wasn’t the scraps from another student – this is my own patient – starting from scratch.

As I was setting up my chair and checking out equipment, things just felt unreal. Here I am, about half-way through my 24th year of life – getting ready to do some REAL dentistry all on my own.

So what did I do exactly? Disclaimer: If you aren’t in dental school, you may really want to ignore the rest of this post although I do try to explain things when possible.

The first appointment for a new patient is known as the complete oral exam (COE). The COE encompasses a full medical history, dental history, clinical exam (extra- and intra-oral), risk factor evaluation, full electronic odontogram charting (marking where decay is for example), photographs, radiographs, and impressions. It sounds like a lot – and it IS..especially for someone who has never run through the entire process solo before. Granted, radiographs are usually taken care of prior to the appt. – but my patient only needed 4 bitewings, so I just did them myself rather than waste time sending her to radiology. I got EVERYTHING done except the impressions. I just plum ran out of time. It FLIES by – which is in stark contrast to the grueling 4 hours of lecture I had in the morning.

I also had to tape-record myself doing the initial medical history for a communications course. That just made me even more self-conscious. Ahhh dental school.

Now my patient was only 19; and very mellow – this is good. Starting with nice patients will make dealing with the crazy ones easier down the road. So I do the med hx. She is anemic, and has a latex allergy – that’s it. This was nice, because I hate looking up all the random meds that most patients are on. So far so good, now move on to the dental history. This portion of the exam seems a bit redundant and stupid at times. A lot of the questions are rehashed versions of an earlier question. For example, “why are you seeking treatment at this school” and “what is the chief complaint” are kind of the same thing. Seeing as this was my first time, I asked EVERY question. Even the useless ‘corah anxiety scale’ questions which attempts to quantify how scared a patient is when they visit the dentist.

So here is where I slow down..because I want to actually face the patient – I can’t sit at the computer (which is where all our charting/history info is done). So I am just writing it down on a pad of paper. Once I finish the med and dent histories..I have to go back to the computer and FILL it all out. If there were more spare chairs in the clinic, I would just have the patient sit in one of those first and I could sit at the computer and still be able to talk face to face.

So I go through risk factors next, such as smoking/alcohol/sugar intake/blah/blah. FINALLY I begin the exam. The extra-oral exam seemed completely normal and I flew through that. Now I get inside her mouth (about 1 hour into the appointment). She has all these text book findings that I am almost giddy with excitement. She had a palatal torus and two mandibular tori (these are bony protrusions that are completely normal – not anything to write about…oops). She also had a ridiculously high lingual frenum (thing that attaches tongue to floor of mouth) which pretty much doesn’t allow her tongue much movement. I still am not comfortable evaluating tonsils…I just don’t know what the hell is abnormal. I hope I’m not missing anything obvious.

So after all this..I have to go BACK to the computer and chart all my findings. Half my time was spent just mindlessly typing away. So now the really long part starts – charting all the findings on her teeth. This includes noting minutia such as rotation, drift, and tilt of the teeth along with restorations, active carious lesions, as well as good old fashioned giant gaping holes. Now this patient also was having pain in her lower left quadrant. I naturally was drawn to the molar with the HUGE amalgam sitting on it. But it seemed stable – and she pointed to the tooth behind it. Because her brushing was pretty bad, a whole mess of plaque had completely filled in the hole that was fairly large sitting on the front side of her 2nd molar. I completely missed it my first time through! I marked it down and called for my instructor to check my progress. She found a spots I had not marked along with the few that I had. Seeing as we get no training in actually feeling for caries, I wasn’t too disappointed in my first honest attempt.

Now before my instructor could really complete her own assessment, I had to get the four radiographs. I prefer using the rings (because they are harder to screw up) but this patient also had third molars. Getting that film all the way to the back of her gullet was no easy task. I still managed to turn out 4 decent x-rays in the first attempt. I didn’t quite get the full thirds, but the interproximals is what we really are looking at. There was also some slight overlapping (indicating my film was a bit angled) but it wasn’t enough to really distort the image.

So now the rays are done, my instructor returns and points out a few more carious lesions to add to my odontogram. At this point, it is nearly 4:30 which is that magical moment when all the clinical instructors vanish into thin air. I quickly typed up my essay-sized treatment note and got everything swiped (electronic signature) by my instructor. I luckily found a D-3 who was willing to quickly help me with taking photographs using the super-expensive camera that I was afraid of dropping the entire time. Basically these photographs are good to have when working on the case when the patient is absent – it also allows other faculty to get a better idea of what is going on. Finally – the pictures are most important when preparing case presentations and patient portfolios. Basically we take a few head on shots, a profile, and some intra-oral pics using cheek retractors and mirrors. After I get the patient on her way, I return to upload to the photos ..but the damn batteries had died. Sterilization closes at 5:00pm, it’s 4:50. I run over to the window, get a new battery – run back. Upload everything, delete the camera photos, and barely get the thing turned back in on time.

Cutting it close I know. So I clean up, and finally get out around 5:15. It was a long afternoon, but a good one. I still need to make some impressions, but other than that – I was pretty satisfied with my efficiency. Speed is one of my main concerns at this point – so at least I can handle the basic crap.

I know this post was pretty technical and boring – but this really was a bit of a dental landmark for me, and worthy of remembrance, if for nobody else but myself. I will probably follow this case with my writing as it is my first stab at treatment planning and performing those treatments from start to finish.

Stay tuned for part II, I have her coming back next Monday for the periodontal evaluation…fun fun.

Organized Chaos

2009-01-20T17:32:00.000-06:00

As I delve deeper into the clinical aspect of dental school, I have a hit a bit of a mental rut. I just have had very little desire to get up in the morning and drag myself to school. Partly due to the depressingly harsh winter and partly due to the overall strain the D-2 year of dental school assumes. Speaking with my colleagues across the country, the general consensus is that the second year just really takes a toll on your mentality. With the changing curriculum, I feel as though the transitory students get caught in the unfortunate disorganization that presents with such drastic changes. As I have mentioned many times, I am still sliding under the closing doors of the traditional curriculum, but even my class has felt some of the stirs of change. The idea of these changes are welcome in my eyes, however, the execution of such change is much easier to talk about behind text and statistics than it is to actually pull off.

We have been getting more and more clinic time each semester as D-2s. Up until now, we have been expected to do what we can in the clinics with no real grading involvement. However, this semester has added the stress of grading to our clinical progress. I wouldn’t mind this so much if it simply wasn’t so stressful to actually get things accomplished in the clinic. It is impossible to standardize such experiences. Some of my classmates have done crown preps, repaired dentures, and extracted teeth. I have yet to get another patient to call me back this semester. It is frustrating as hell. Being completely green and in the clinics is also NOT conducive to asking questions. I feel like everyone is too busy to pester. I have also figured out that asking upperclassmen is the most efficient way to learn.

The fact that we have limited clinic time is also frustrating because we are required to do projects which involve multiple appointments. That is difficult to swing when I have maybe 6 blocks of time a month to schedule patients. Those project due dates are going to come up pretty damn fast.

What is more annoying is that certain classes feel SOOO out of place. Pharmacology feels like biochemistry all over again. I thought we were going to get info on actual drugs that are commonly seen in our patients. But no, we need that time to learn more about pharmacokinetics and doing trivial math problems that no practioner would EVER do. I also hate the transition from 50 minute lectures to 2 hour blocks that occurred last summer. I cannot learn when I have to sit for 2 hours straight – I am not alone.

Another enormous problem I have is with technology taking over in the classrooms. I am all for tech, but it seems like an excuse for teachers to get lazy. I don’t like taking quizzes with a remote control and relying strictly on a computer to store the proof that I was actually in class and that my answers were correct. Call me old fashioned, but what is wrong with pen and paper?

We have so many random odds and ends that need to get accomplished it is just frustrating and stressful as all hell. I just feel utterly and hopelessly discombobulated. Still, despite all of this, I hold on to the best advice given to me by a weary, tired D-4; “Everything works itself out, you just have to be patient and take things one day at a time.” This has to be true; the graduation rate at this school is high enough to make me realize that everything will sort itself out. I will eventually figure out how to get rid of crappy patients and get better options. My instructors will eventually accept me as the new clinic student, and begin ignoring the new D-2s – it has to all work eventually.

It is an organized chaos. Trying to comprehend this only results in futile frustration. Hundreds have come before me, and hundreds will come after. Now if you will excuse me, I need to attempt to call the same patients again that will not want to talk to me or come in.

Bleh. The dog days of D-2 year I suppose. It still is kind of crazy that I will be a D-3 VERY soon.

I am as prepared as I’m going to get at this point. Frightening, no?

The D-2 Experience IV

2008-12-28T21:43:00.001-06:00

My break has been enjoyable and lazy thus far, now as I sit here on a quiet evening, I decided to start filling in my weekly planner for next semester. This is my first time using a portable scheduling device and it probably couldn’t have come at a better time. I have tallied a total of 28 opportunities to schedule my own patients. This is about twice as many chances as last semester and I intend to try harder to fill those blocks. Partly because my time won’t be AS consumed with pre-clinical lab work, and partly because I will be treating patients FULL TIME starting in the summer. So yea, a bit freaked out. I only scheduled TWO appointments last semester and one of those failed. Part of this is due to having a very poor patient pool (only 6 or so patients and most of them are VERY unlikely to come in for routine work), but I must admit, I didn’t try contacting everyone multiple times either because passing all my pre-clinical courses took precedence. So now I will have to make a much stronger effort to contact patients straight out of the gates.

As I filled in this planner, I also took a closer gander at the actual classes I will be taking. The semester looks beefier than last (no more half-days), but I refuse to believe that anything could be worse than the fall. Here we go. I will talk about last semester afterwards so skip ahead if you are still interested in that crap. Keep in mind that the semester won’t start for another week, so this is my PRE-game analysis.

Comprehensive Care II – C : 6 credits
-This is largest value comp care has carried since my first D-1 semester. I fear getting an ‘A’ will be EXTREMELY difficult as much of our grade will probably be determined by treating real patients. Unless I get a hefty boost to my current patient pool, I will DEFINITELY struggle to fill my blank schedule. It appears that there is a large implant component with this course. I am pretty sure that we are the first class where placing implants is required to graduate – so with this in mind, we are getting some good exposure to it next semester. I’m not sure if the current D-3’s had an implant course or not – I hope they did, otherwise we will be the inaugural class…and that usually equals unorganized mess. We have the implant module on Mondays. I will have my clinic sessions/rotations on Tuesday afternoons as well as all day on Fridays. While I still get a bunch of open clinic time, I will also be going on a myriad of rotations such as radiology, endo, perio, pedo, ect.

This is my last opportunity to really get used to the clinics before I become a D-3, I hope to take advantage.

Treatment Planning: 2 credits
-We meet on Monday and Thursday mornings for 2 hours. This is a lecture based class that essentially teaches how to treatment plan. I REALLY wish we had gotten this course LAST SUMMER as there have numerous occasions during several courses where knowledge in this area would have been VERY helpful – not to mention it is mandatory before doing any real work on patients. I really hope they finally explain some of the ins and outs on using the axium computer system this school utilizes.

Ortho: 2 credits
-My first experience in orthodontics begins next semester. We have 2 hours of lecture on Tuesday morning and I will be doing the lab portion on Thursday afternoons. Seeing as ortho originally got me interested in dentistry as a child, I am quite interested to see HOW it really works. I don’t see myself specializing in the field, simply because I am not a huge fan of working with kids – but we will see how it goes.

Oral Surgery Lecture: 1 credit
-Pretty much a lecture based class that meets for an hour on Wednesdays. I assume we will be talking about Oral surgery..yea? My first clinical rotation in OS begins in the summer.

Endo Lecture: 1 credit
-Yes endo continues next semester, but only in lecture format. I assume we are to continue learning about endo! Self-explanatory no?

Fixed Prosthodontics II: 4 credits
-Bleh, I really did not like this class at all last semester. I suppose it had its good moments, but the director spends no time with us in the pre-clinic – yet she grades all our practicals (really tough by the way). It would be nice if there were a correlation between what our instructors in clinic say is good, versus what the actual course director thinks is good..because believe me..there is variation. I also am just really sick of working with plastic teeth and imperfect dentechs. What is truly terrifying though is that last semester we didn’t even have to temporize for performance exams, and I still averaged a 70.5% on them. I think we have to do a three-unit bridge prep/provisional for the final… I don’t want to think about it anymore right now…moving on. We meet on Wednesdays again.

Pharmacology: 4 credits
-This is a very D-1ish like class in that it is all lecture based. We meet for 2 hours on Tuesdays and Thursdays. I know this will be a tough class that has the potential to really overwhelm even the best student. I intend to keep up with studying, even if there aren’t quizzes. I have proven to myself that lecture based classes are VERY manageable with proper studying – so I would be disappointed if I don’t do well. It will also be nice to finally have at least a rudimentary understanding of all the drugs people seem to be on – especially in our clinics.

Despite the feeling that things will be less stressful, I still doubt I will do much better grade-wise. The subjective nature of the clinics is not worth getting flustered over – as long as I am happy with my own growth and development, I will deal with average arbitrary scores.

So there you have it – the preview of Spring 09’ – My final test before moving on to the proverbial Xanadu that is D-3 year.

Now for the Fall 08’ memorandum.

I can’t say this enough, but the fall semester (or second D-2 semester) is the champion of tough asses in my book. Everyone seemed to struggle a bit – which made it less frustrating of course. I actually did a bit better than my pre-semester prediction. The only true surprise was that I somehow pulled out an ‘A’ in endo. If anyone has actually been keeping up with my haphazard writings, you may recall I saw NO chance of an ‘A’ in that course before we even started. So that definitely took the sting off of my failure as a prosthodontist. I fortunately locked a ‘B’ in fixed prosth despite pretty much failing both performance exams – this is why studying for written exams is ALWAYS important. However, grades aside, I know I am better at crown preps than those grades show – my practice preps were miles ahead of both exams – I just can’t keep botching up when it counts.

I’m not going to rattle off every class grade, but I ended up doing well enough for my own satisfaction. I didn’t burn any bridges in terms of specializing, which has been my goal since day one. I am proud of my work ethic during the last months and hope it carries over into the years to come, making me a better professional as a result.

While this semester was the toughest, that doesn’t make it the worst. That title still goes to the second semester of the D-1 year. At least now, we are working are asses off towards something of merit – and not biochemistry.

Ok, this post has dragged on long enough; I got some more relaxing to do.

Have a fun and safe New Year celebration!

The Eve of Another Finish

2008-12-18T21:02:00.001-06:00

At around 11:00 in the morning tomorrow I will have completed the most arduous academic semester of my lifetime. Words cannot begin to express how much I actually learned this semester and how much I worked my proverbial tail off. I spent time in the school every weekend this semester. This is not an exaggeration. Granted, this time would not have been unnecessary if I stayed super late on a few weekdays each week, but I think that would have been even harder. 8-5 is more than enough for me.

So while things were definitely more hectic, I found this to be one of the ‘better’ semesters in terms of feeling like I am finally progressing as a future dentist. The first year is so very difficult to associate with clinical dentistry because we spent so little time learning dentistry. So yea, it is quite refreshing to finally be a dental student. Again, the volume of dental skills I have picked up this semester is more than all three previous semesters combined. I honestly feel like I could do procedures on REAL people at this point. Really though, that is what I need to be doing now, plastic teeth and ‘ideal’ preps really aren’t doing it for me anymore. I still have one more semester as a D-2 and I hear it is a bit lighter than the current beast I am about to finish. Unfortunately I will be jammed in the lecture halls a bit more with courses like pharmacology and treatment planning, but I will get to the schedule at a later date.

Basically I am procrastinating from studying for my final tests tomorrow. My last exam was on Tuesday and I unfortunately have somewhat slipped into vacation mode already. This happens to me EVERY time during finals…I just run out of gas. I of course WILL study more tonight…lest I fail dentures, but at this point, I just want to pass and get the hell on with the next wave of classes. This entire fall routine has gotten very old.

My GPA will definitely take a hit this semester..but that is all relative, barring a terrible showing tomorrow, I won’t get any ‘C’s which is my bottom-line goal. The only course where I seemed to excel above average was endo, but I still am happy with my progress in the other courses. Fixed prosth was the only course I would consider a bit of a failure this semester. I nearly failed the second performance exam despite the fact that my previous two practice preps were near perfect, I just wasn’t bringing my ‘A’ game for the exams (I had to remediate the first). Luckily I destroyed the final written exam which allowed me to secure a ‘B’ despite the sloppy performance exams. Only one remediation all semester really isn’t that bad either considering how tough some of these classes were – but it would have been sweet to get through un-scratched.

I also didn’t do so hot in the restorative portion of comp care which is a bit disheartening as these are the procedures I should be good at by now – but again, what you do on a given day on plastic teeth seems a bit variable depending on WHO actually looks at your work. A ‘C’ from one teacher could very well be an ‘A’ from another. What matters is how YOU feel about your work. I feel pretty good about things at this point – but I obviously have a LONG way to go.

I can tell this semester has sucked because my right eye has been twitching uncontrollably at random intervals throughout finals..it is time for a BREAK.

I have my wireless internet hooked up, my PS3 raring for some usage, my bottle of JW blue label just waiting to be sipped, a fireplace yearning to be sat by while it snows; old friends needing some hang-out times, Christmas cookies to devour, New Year’s champagne to toast, and most importantly - zero time in the dental school for 16 days. How’s that for a run-on?

Good to go folks, good to go.

I'm Not Dead...Yet

2008-12-03T20:41:00.003-06:00

Missed an entire month..oops. Things have been horribly busy and stressful and frustrating and fun all at once.

Since I still am getting plowed by school, I will sum it up real fast.

1. Had to remediate my first performance exam ever (crown prep)

2. Succesfully finished my last endo performance exam and would have had a near perfect score if my x-ray didn't get destroyed in the grading bag prior to evaluation. Regardless, I did not have to remediate any endo exams which is great. In all honesty, I find this specialty to be the most interesting so far.

3. Had my first patient appointment for a recall exam (and she showed up!) It went about as perfectly as one could hope. She was young and clearly had been taking great care of her teeth..so there really wasn't much work for me to do! I unfortunately was unable to get any other patients in this semester...oh well, next semester will provide even more opportunities before hitting the clincs full time as a D-3.

4. Finished my first gold crown...it is purty

5. I've decided that dental materials is the most drab topic ever to grace a power point presentation. Maybe if I wasn't expected to cram so much other crap into my head while learning a million new clinical skills I could find some of it useful..or interesting...well...probably not.

6. Lots of other random things, but those were the major events of november...the month that flew by.

2.5 weeks left to this hell of a semester before I get a real vacation. Today was a looooong day..tomorrow should be better aside from the oral path final.

This semester is without question, the hardest academic semester of my existance.

I enjoy it more than D-1 year though, because it is practical to my career.

Now I'm off to watch top chef with my lady and not study because my brain refuses to allow one more sentence of pathology inside.

OFF!

The D-2 Experience III

2008-10-29T18:22:00.000-05:00

While I find time extremely stretched thin at this point, I have had two remarkably relaxed days in a row. I decided to add another chunk of thoughts towards the second year of dental school. This week began as an utter pile of feces. Monday was absolutely the worst day of the semester, by far. Based on my interactions with other classmates, I would venture to guess that I am not alone in this sentiment. It opened with a performance exam in RPD (removable partial dentures). We had to prep rest seats on plastic teeth. These seats essentially help the RPD stay in place and help resist forces. The preps themselves are not too difficult – however, we had to prep four of them with guiding planes in about an hour AND evaluate everything. For those not in the know, a guiding plane is established by shaving the sides of the teeth a bit so that the RPD can fit better and not lock into place in some sort of undercut. So I basically just ran low on time and had to speed through the last prep – which ended up looking pretty damn crappy. I still don’t know how to ‘evaluate’ a guiding plane on plastic teeth without surveying them, but whatever. The director says he is going to go easy on us, but we will see. I smell my first remediation.

So we get all cleaned up around 12:45. We have to be back for restorative at 1:30. Now here is where things begin to suck. I have already vented enough with my peers, so I will avoid becoming immature in my writing, but simply put – Monday afternoon was poor form. I was specifically told the week before, that our most recent project would be turned in NEXT week. I was also told that Monday’s work would be an all-ceramic crown prep and provisional. So what happens? We are told that EVERYTHING is due by 4:00 and that we are doing a VENEER prep and COMPOSITE provisional (something I very vaguely remember doing back in May). So I had zero time to prepare for this change in events, and a lot of my other work was still unfinished because I assumed we had more time because I was TOLD that we did have another week. So ok, they want to simulate the ‘clinic’ and how we are going to be evaluated. I can tell you right now, I won’t be jammed back in a tiny corner about 1 mile away from any materials when I am in the clinic. I won’t need to climb over about 25 units with classmates blocking the isles to get to materials that aren’t even out when I’m in the clinic.

The disorganization was absolutely terrible. And the best part is that if we didn’t finish in time, our grade is automatically a ‘C.’ Incredible. I get that they wanted to try something ‘new.’ But leaving me horribly uninformed about events is not fair considering how much money I pay for this education. It also is a disservice to my own morale as I felt like a horrible excuse for a dental student because everything turned out like crap. This is completely understandable, given the circumstances and simple lack of materials compounded by that horrible excuse for a pre-clinic. The class feels unorganized in general. I hate not knowing what I need to do. I also hate being rushed. Yea I get it, speed is important, but let me freaking get the basics down before you start shoving me to hurry up. If I don’t learn to do it right slowly, how the hell am I ever going to get good at doing it fast?

The grade impact isn’t all that significant, but that’s not the point. My confidence was completely and unnecessarily obliterated by an unorganized and attempt to scare the shit out of us.

Everyone hates pop-quizzes….but pop-performance exams?

So naturally, Monday left me a bit pissed off. Fortunately, the last two days have been complete cake-walks and I have been home by 2:00 each day. I finished up my first full crown wax-up for a #18 FGC. It actually looked pretty good. We sent them off to the lab and they will come back as shiny gold. I am not really doing much school work at home these last few days. I am just trying to relax and mentally prepare for the next big hurdle – endo performance exam #2 on Friday. We are doing full root canal therapy on one maxillary pre-molar that has TWO canals. I am looking forward to working on ONE tooth for a change and putting all three steps (access, cleaning/shaping, obturation) together at once. My only concern is that two-rooted pre-molars seem bit fragile and extracted teeth aren’t the sturdiest of things. So I am a little worried about the crown breaking. Luckily, I have a back-up..so even the worst-case scenario should be manageable.

I haven’t really practiced, but they have us doing SO much homework and lab-work in that class that I feel like I could get by ok. Still, as with most performance exams, I can feel my nerves slowly creeping up on me.

If I make it through Friday, next week will be a completely breeze.

So enough on current events. I have gotten positive feedback for the class-by-class breakdowns, so I will give a mid-semester update on the fall D-2 curriculum here.

Comprehensive Care IIb
-The grading distribution in this course is a bit confusing, and as always – there are SEVERAL modules.

a) Restorative - 37.5%
-well from my earlier rant, I’m sure you can guess how I may feel about this course. This would be a little off though, because I have enjoyed this module for the most part. It has essentially been mock cases that we work out on our dentechs – applying techniques previously learned and attempting to get them done quickly. Again though, I don’t feel ready to get ‘rushed’ just yet – and sometimes, this is VERY detrimental to my learning. We have done a lot of composite work, as well as some crown preps. Made some models, mounted them, and created custom trays. Nothing really new, just more practice (which is always a GOOD thing in dental school). Aside from last Monday, I have liked the pacing and cases. We had to write an Evidence based-dentistry paper, but aside from that – the grades are based on lab work.

b) Clinics – 12.5%
-this is interesting because we are the first class to get in the clinics with our own patients so early. I would be willing to wager that the current D-1s may get their own patients in the summer rather than just shadow like we did. It is very intimidating to get a list of patients that you are responsible for calling and arranging appointments. Seeing as I am only in the clinics on Thursdays, communication with patients calling in gets cumbersome. For example, one of my patients called and left a message for me. It said “please call back.” So I called back and got the ol’ voicemail. Patient called back AGAIN the next day, left ANOTHER message: “call back in PM.” So I called back…VOICEMAIL! I have called this patient about five times now and she has NEVER picked up her damn phone. I left her my email address last time praying she might attempt another avenue at communication…nope. I will call her once more tonight, but after that, she’s on her own. She is young too, so I’m sure she knows how to use email. Who knows. Thankfully I have gotten ONE appointment for next week. However, from my observations, there is a 50% chance she will cancel. Days we aren’t in the general clinic are spent on rotation. I have had urgent care, radiology, and pediatrics already. Pedo was awesome because we essentially got hopped up on nitrous the whole time. One of us would learn how to set everything up and adjust the gas while the other would enjoy its effects. I am convinced that nitrous SLOWS DOWN TIME.

We also have some random assignments to turn in regarding Medicaid and how we plan on being ‘organized students’ as D-3s.

c) Communications - P/F
-I enjoyed this brief module. The information was quite relevant and while some aspects were a bit drawn out, I did learn a few good techniques towards communicating better. We had to attend all the classes and I still have a paper to write about my first patient interview (even though I have already done this in Urgent Care a few times).

d) Periodontics - 50%
-The grade savior of comp care. Although I fear that this semester’s exams will be tough in comparison to previous semesters. We had to find our own patients to come in back in September for the basic perio exam with prophylaxis (cleaning). Once we wrapped that up, we have been doing lectures on Tuesdays for 2 hours every week. Not much else to add.

Ok..enough comp care already…

Removable Partial Dentures
-This class is pretty good. The mid-term was not as easy as I would have liked, but by no means was it unfair. The practical was not horrible, but I definitely didn’t do that well. You basically started out confused as hell during the first month. Then eventually, everything starts to make sense and come together. I feel pretty good about this class so far, but who knows (especially if you didn’t skip the early portion of this post…ugh).

Oral Pathology
-Pathology has been a part of my life since last January. I am ready to part ways. Thankfully, the information this semester is relevant to dentistry.

Fixed Prosthodontics I
-Frustrating at times, ‘ok’ at others. If it wasn’t for provisionals, I truly wouldn’t mind this class. HOWEVER, I think I may have finally got the timing down with the acrylic so that they are beginning to turn out a LOT better. I still need practice of course. My only concern is how bottom-heavy the grading is. We have only had TWO quizzes all semester. There is no mid-term, and only two performance exams packed in late November and early December. Our row instructors are grading our weekly work, but this amounts to very little of the full course grade. The final exam is going to be insane. We have an average of two lectures every week. Some of them are DRY as hell (dental materials). So we are looking at around 30 some lectures to study for the final exam.

Endodontics
-I like that I am learning..A LOT. But I don’t like how long it takes to set up the unit, how annoying teeth are to allocate, x-ray, mount, x-ray again…THAN work. It is VERY tedious..which is appropriate, given how tedious endo is in general. However, I have enjoyed the work more than most courses (namely because working on real teeth feels far more beneficial). Doomsday is this Friday though..I am really fearing that something out of my control will go wrong. I got through the first one unscathed, but I feel like I am due for a catastrophe. Damn I am negative.

Complete Dentures
-This class is simply not organized. That is really all I can say. I don’t feel comfortable doing pretty much anything and everything related to dentures. Your learning experience seems based on two factors out of your control. The instructor you get, and the patient you get. I feel like I get the big picture, and a lot of the lab stuff makes complete sense to me when I see it. However, do I see myself remembering all of these little things when it is my turn to make them? Probably not. The only saving grace is that we have plenty of outside resources and reading to refer to. So I shouldn’t be completely lost. I bet my first patient that isn’t on recall will need complete dentures. Throw me in the fire!

OK, that is it. I figure the bigger the post, the more off-time I am allowed. Fair? I think so.

I do have a pretty good story of my first urgent care experience last week, but I will save it for another time. I got some relaxing to do.

Break.