The D-3 Experience IV

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

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

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

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

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

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

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

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

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




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

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

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

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






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




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




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

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

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

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

Happy thanksgiving all!

Experience?

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

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

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

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

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

RUN DOWN:

7 – Periodic Oral Evaluation (6 month exam)

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

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

9 – prophylaxis (mostly on kids)

5 – fluoride application (all kiddos)

5 – class II amalgams

1 – MOD amalgam

15 – class V composites

1 – class III composite

2 – three-surface posterior composites

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

1 – FGC (planned, starting sometime next month)

1 – SS crown

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

1 – Direct pulp-cap

4 – core build-ups

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

1 – pulpotomy on a screaming child

1 – RCT pre-molar

8 – Quads of SRP

3 – Arches of Full Dentures

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

22 – Extractions

1 – Surgical Extraction (which was awesome)

2 – occlusal guard (one done, one planned)

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

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

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

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

Wow.