End of The Trilogy

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

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

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?

Perio: 100.00
Restorative: 96.21

I'm going to be a dentist.

Get Me Outta Here!

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!

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

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.