Dental Fuel Episode 5: Clinical Mistake with Dr. Emma Guzman-Vizcarrondo

On Dental Fuel episode 5, we are pleased to welcome Dr. Emma Guzman-Vizcarrondo!

Dr. Emma Guzman is a General and Cosmetic Dentist, practicing in New York City. She completed her Doctor of Dental Surgery degree at the University at Buffalo School of Dental Medicine and was a general practice resident at Bronx Care in the Bronx, New York.

Dr. Guzman currently practices in Brooklyn and her main focus is changing her clients’ lives by improving their smiles and ultimately their health.

Dr. Guzman-Vizcarrondo is a member of the American Dental Association, National Dental Association, Academy of General Dentistry, and Delta Sigma Delta Dental Fraternity. She is a member of the Second District Dental Society New Dentist Committee.

She is dedicated to mentoring, volunteerism, and service. Dr. Guzman-Vizcarrondo is originally from Brooklyn, New York, and her parents immigrated from Livingston, Guatemala. She has five siblings and several nieces and nephews.

She enjoys dancing, cooking, traveling, and spending time with family and friends. Dr. Guzman shares her experiences and mistakes with our listeners! She brings her energy and spunk to our episodes where you will surely enjoy the conversation held!

🎙️ Listen to Dental Fuel Episode 5 on Apple Podcasts

Dental Fuel Episode 5: Clinical Mistake Transcript

In Dental Fuel episode 5, Dr. Guzman speaks about a clinical mistake!

Dr. Tanya Sue Maestas

Emma Guzman, welcome to dental fuel. How are you doing today?

Dr. Guzman-Vizcarrondo

I am doing amazing. How are you doing?

Dr. Tanya Sue Maestas

I am so excited to have the opportunity to speak with you today. And to share a little bit about your story with our listeners.

Dr. Guzman-Vizcarrondo

Yeah, I’m very excited to be here and I’m super excited that we get to reconnect since you know we knew each other from ASDA.

Dr. Tanya Sue Maestas

Yeah, good ole ASDA making connections since way back when?

Dr. Guzman-Vizcarrondo

Yes, yes. Absolutely.

Dr. Tanya Sue Maestas

Emma, please tell our listeners Where are you right now?

Dr. Guzman-Vizcarrondo

Okay, so currently I am in Brooklyn, New York, and ever since I graduated from dental school, I came back to the city. So I was working in the Bronx. I’ve been in Harlem. I’ve been in Long Island. I’ve been in Bushwick.

Right now I am settled in the Park Slope Area. If you’re originally from Brooklyn, we used to call it downtown Brooklyn back in the day but now it is coined Park Slope right across the street from the Barclays Center.

I am the Senior Associate dentist at Tend Dental in Park Slope.

Dr. Tanya Sue Maestas

Super exciting and I am excited to talk a little bit about Tend but tell our listeners are you from the New York area?

Dr. Guzman-Vizcarrondo

Yes. My family is originally from Guatemala. But I was born and bred in Brooklyn.

Dr. Tanya Sue Maestas

I love it. So tell us a little bit about Tend. I think that this is a group that several of us have heard about kind of in the news in the last few years or so.

But I’d love to know more about the practice how you fit into that practice how you came to find Tend and tell us everything about Tend.

Dr. Guzman-Vizcarrondo

Okay, perfect. So Tend is what we may know as a dental service organization. So it’s actually headed by someone who is not a dentist, but we have a lot of dentists in hand making sure things go the way they’re supposed to be.

So from the beginning, we had you know, Dr. Markslandoff, which is somebody who is a big name and NYU he originally was working with the creators of Tend to, you know, make sure they had all their P’s and Q’s together on the dental side.

And then now, actually, Dr. Chris Salierno is you know, Chief Dental Officer at Tend. So, you know, very much so our focus on patient care, making sure we’re giving them quality care.

Tend originally started prior to the pandemic, and they had a few locations but the pandemic hit, you know, and they really, you know, went in in terms of you know, how we can make this company better, how we can restructure to design and completely revamped and since then has opened 20 plus locations.

So we have 26 locations around the country, and we’re actually going into the Connecticut territory next. So we have locations all around New York City, Boston, DC, and Tennessee, which is where our headquarters are and then we’re going into the Connecticut area.

So the way that the offices are structured there are usually around four to five dentists per office we have seven plus hygienists multiple dental assistants, and it’s a it’s a pretty good team. We have our welcome bar which would be about four to five people which is our front desk, you know every studio has a manager, assistant manager that handles all the things that I don’t want to handle.

And then in my role as a senior associate, I am the lead dentist at my location, you know managing our junior associates and our associates.

The junior associate is someone that is a year or two out of school, the regular associate is anyone that has two or three or more years of experience. So you know in my role, you know I have to mentor besides doing dentistry and you know handling anything clinical when it comes to clinical issues when it comes to supplies, things like that. I have my hand in that.

Dr. Tanya Sue Maestas

Very exciting. You know us at igniteDDS and myself, we are Chris Salierno fans for sure. So it’s exciting, you know, to see his role with Tend.

So tell me, did you go into Tend straight out of graduating from dental school?

Dr. Guzman-Vizcarrondo

Oh no, I did not. I was practicing. I was in traditional private practice as an associate. For many years. I actually didn’t join Tend until my fifth year of practicing.

Dr. Tanya Sue Maestas

Very cool. And how many years out are you?

Dr. Guzman-Vizcarrondo

The sixth year now.

Dr. Tanya Sue Maestas

Exciting we’re learning as we go right?

Dr. Guzman-Vizcarrondo

Yes, now it’s like six years? I feel old. We are still babies! We are new dentists!

Dr. Tanya Sue Maestas

Exactly, exactly. Did you do an AEGD or GPR at a dental school?

Dr. Guzman-Vizcarrondo

I did a GPR at Bronx Lebanon, which is now Bronx King.

Dr. Tanya Sue Maestas

Very cool. And I know that you know, New York requires PGY one of some kind. But if you didn’t have to do a residency, would you have done one?

Dr. Guzman-Vizcarrondo

I think I still would have. I think I still would have just because I feel like dental school just taught us just what we need to do to survive. Right?

I went to the University at Buffalo, and I believe that they trained us very, I was very happy with the training I got especially you know, once you go into residency, and then you kind of feel like oh, okay, I know how to do this, this is how I do that.

So I believe we got great training, but there you know, there’s a limitation. Especially in dental school when it comes to the amount of students doctors there are versus the amount of patients, right?

So I know like towards the end is like, I didn’t get my bridge requirement, all right, got to do a typodont. Didn’t get my endo requirement. So it’s like, did I learn what like I needed to learn? Yes, but in terms of the practice of dentistry, I didn’t get enough practice.

So I feel like how do I not do a residency? You know, and there are some people in my class who went straight into practice, kudos to them. But I definitely think that that year helped me in terms of my speed in terms of confidence, because the foundation was already there, right?

Dental school gave me that but when it came to knowing how to deal with patients dealing with difficult patients, you know, I didn’t just have my peer director and just say Hey, Doc, hey, he’s getting rambunctious can we can you know, come in here with me, you know, it was a little bit more hands-off residency, but you know, you still got someone to back you up.

But for me, it was absolutely necessary to at least build that confidence.

Dr. Tanya Sue Maestas

Very well said. I feel similarly for my residency. It just helped build confidence, helped me with treatment planning, helped me ask more questions outside of, you know, hey, outside of that pressure of when we were in dental school, were hey, we just need to get through our requirements so we can get out of here, right?

Dr. Guzman-Vizcarrondo

Right, It’s like, um, it’s like, yeah, you absolutely need this amalgam. Right. But I’m trying to get my amalgam requirement done. You know, and of course, you know, not to disservice the patients, amalgam is a great material but in private practice, would I really be doing that? Like it’s, 31, who cares about the color? You remove that requirement, and now it’s like, okay, what do you need? Why do you need it? Right?

Comprehensive treatment planning, not saying we didn’t learn that like, yes, learn the concept. But when it came to what we did in dental school, there were limitations, right?

In terms of time, a comprehensive treatment plan is going to take four years in dental school with the amount of time we take to do our visits and the way things are scheduled what specialty we want to be in, you know when you are in residency you really start to look at those things.

Dr. Tanya Sue Maestas

Yes. 100%. So here at Dental Fuel, we are dedicated to learning from each other’s mistakes, and we’re here to ask the tough questions about mistakes that we have made in practice. So my first question to you in your short career so far is, can you think about a clinical mistake that you’ve made and how you manage it?

Dr. Guzman-Vizcarrondo

Yeah, so I have one that I would say, stuck with me because it was my first like, mistake, right? And it happened in residency and then I have other stories for other things that happened in practice because things always happen. Right?

And I would say that the mistake was something that happened clinically, but I will say that my mistake was the way I treatment planned it. So you know, we had tooth number 30 bombed out, decay close to the bone, furcation involvement, and I’m trying to be a hero.

And I’m just like, let’s do the Endo. We’ll do an endo we’ll do the crown weakening well do post-crown all these things. The patient bought into it. And I’m doing my Endo. And then I cleaned out the canals and I’m, I’m going in with my rotary. And then I start to see blood where I wasn’t seeing blood before. Im like ok let’s irrigate, let’s irrigate, we’re irrigating the blood just keeps flowing. Let’s give it an x-ray. Right? So then I see a nice line right through the middle to my first perf.

I was distraught. I didn’t know what to do. I was just like, my God now the patient is losing a tooth. I didn’t even know what to do. I left the room. I go to my attending. I explained what happened and they look at the x-ray and then once it’s like, yeah, okay. What are you going to do now?

I’m close to tears, and they are like what are you going to do now?

You perfed right through the furcation. Can we save this? I’m like, I don’t let me look for endo, and they were, like Emma? Can we save this tooth? And I was like no.

So, you know, it was at the point where then, one of the things is that knowing when heroics is not really going to be a service to the patient.

And one, too, when you do the heroics, knowing that the bad thing may happen, right? It wasn’t the expectation was like I know this is a tricky one. But when something like that happens, it felt like the end of the world to me, I felt like I ruined this patient’s mouth, you know, and then my attending was so cavalier about it, but to be honest, I felt like that definitely made me feel better because they’re like, you tried to save the tooth, you couldn’t.

What are the next steps for the patient? And I was like okay, you know, extract, bone graft, implant, and they are like okay. So set the patient up for that and see if they want to do it today. And I was like you want me to go tell them that I perfed the tooth?

Dr. Tanya Sue Maestas

Can you help me do it, please?

Dr. Guzman-Vizcarrondo

They were like we are not going to tell them, no. You have to go tell them.

So you know, I had to go in there and have the conversation. But they were just like, okay, yeah, you told me that it was gonna be a difficult case. And I was like, okay, so I’m the only one that’s at the point of tears, ok cool. So like that, that situation has never left my brain because it’s like, everything is not the end of the world.

One, too, when you make those decisions to try to do heroics, or, you know, to go with the option, that may not be the most ideal option or maybe the option that has a guarded prognosis, you have to know like, how do you bounce back? If the outcome is not ideal, if what happens in the chair is not ideal, and being 100% candid from the beginning, right, I think that that’s what saved me in terms of rapport with the patient.

Was that from the beginning, I said, how difficult it was going to be. Now, did I go to the extent of saying that the tooth may have to be extracted? No, because in my mind, I’m like, oh, we’re gonna do Endo, it’s going be fine, right?

But I think that that is such such such an important thing that has stayed with me. I kind of went, especially when we’re working on something tricky, you know before I even touch the tooth, I go in, like, look this may not end how we want it to end.

I already sent the prescription to your pharmacy just in case. We have the referral right here waiting for you just in case right? So you know, when it works out, then great that proves us of a good job, right? But when it doesn’t work out, we’re prepared for what we’re going to do next. I have the referral ready. I already sent the prescription and I don’t have to worry about doing that, now, and it doesn’t look like I made a mistake, right?

It’s something that happens clinically and I feel like when it comes to dentistry is very hard for patients to understand that line, right? Whereas it’s like you did something my tooth didn’t hurt before, right?

So I would say that that was one of the biggest things clinically that, you know, happened very early in my career, I think probably two or three months into residency where after that I had to be like, okay, you know, you have to be very candid with people, even when they might not understand you need to make them understand to a degree that you know, when things do happen, and they do every day, if you do enough dentistry, bad things are gonna happen.

You’re going to have outcomes that you don’t want. You have to be able to manage that. And I would say just from that, you know, mistake which is like, is it a complication that could happen?

Yeah, but then after you’re thinking, like, oh, what am I going to aggressively? Like, you know, you start you start playing back the situation, and as such mistakes do happen, right? Like it’s part of the nature of what we do.

You know, we see a crown. It looks amazing. Then we seed it we don’t push it down far enough. The cotton roll doesn’t go down far enough. You see the post opp is open. What do you do now? I immediately tell the patient. Like look, this is not to my standard. I know, it’s been two visits already. But we’re gonna have to cut this bad boy off and do this over again. Like, this is actually not your last visit, you know?

Especially you know, you do enough endo. You’re gonna get, now six years later, have I had more than one perf? Yeah, you know, at the initial, I don’t do as much endo now. But, you know, earlier on in my career, I was doing endo every single day.

If you’re doing endo every single day, you’re gonna get a perf, you’re gonna get a broken file, you’re gonna get over operation and it’s just learning how to deal with it with having those hard conversations with the patient beforehand, making sure that they actually read the forms and consent.

A lot of the time they don’t, right, so and then when complications happen, it’s such a surprise after. Im like this was listed as one of the things right? so sometimes, you had to go over it verbally, right? Even though it may feel like this is redundant, they already read it.

But sometimes you have to do that. Just because they really don’t read it a lot of times they just sign it. And then now when I tell you, oh a file is broken, what you broke a file in my tooth? This is one of the complications of endo, I thought you read it, right?

So you know a lot of the times I make it my business to either go over the to set myself or tell the DAs like you have to list them out. Like these are the things we need, to talk about. So when complications do happen, we’re able to manage it a bit easier. Is anyone happy when complications happen? No. But we’re able to manage it a bit better.

Dr. Tanya Sue Maestas

Yeah, so two things that I’m hearing here are one patient communication huge managing expectations, you know, patient expectations, and your own expectations as well too, because things can go south that is dentistry for you, even though you think things may go one way.

They may absolutely take a full turnaround and go the other way.

Dr. Guzman-Vizcarrondo

Yeah, and giving ourselves grace like everything like any complication that happened the world was over Im a horrible dentist.

Now it’s like does it still bog me down? Do I still lose sleep over things like, I will lose sleep over a crown delivery that I did not like the way that seeded right?

Even though I told the member even though we took a new impression I, I lose sleep over it. Not as bad as before. But it still happens.

Dr. Tanya Sue Maestas

I think we’re all the same. We just ruminate and replay the day and nitpick at the millimeters that didn’t go right from the day but it’s hard.

Dr. Guzman-Vizcarrondo

Yeah, it’s like, did they not bite all the way did I not push down hard enough? And then you’re just like, what can happen? Oh, and now I have to block him again for the delivery. And you are just thinking about all the things.

Why is this happening you have to be like this is dentistry, this is the practice of dentistry.

Dr. Tanya Sue Maestas

Exactly it’s so true, the practice of dentistry. We go to work every day to practice and get better at dentistry. Absolutely.

Join us on our next episode with Dr. Grossman talks about any financial mistakes she made.


Tanya Sue Maestas, DDS

Tanya Sue Maestas, DDS

Dr. Tanya Sue Maestas graduated from The University of Texas School of Dentistry at Houston in 2018. During her dental school career, she served as the national American Student Dental Association President and became involved in organized dentistry. After graduating, she completed an Advanced Education in General Dentistry Residency in 2019. Upon completion of her residency, she returned to the El Paso Borderland community where she serves as a Dental Director at La Clinica de Familia in Chaparral, New Mexico. She also serves as a faculty member at the Woody L Hunt School of Dental Medicine in El Paso, Texas. She remains involved in organized dentistry and holds various leadership roles in organizations including the American Dental Association, Texas Dental Association, Academy of General Dentistry, Texas Academy of General Dentistry, Hispanic Dental Association, and others. She currently serves on the ADA Council on Communications and previously completed the ADA Institute for Diversity in Leadership Program. She was recognized as an ADA 10 under 10 winner, Incisal Edge 40 under 40, and previously nominated as one of Texas New Dentists of the Year. She currently hosts New Dentists on the Block where she helps showcase the New Dentist story and build connections with new dentists around her and Dental Fuel a podcast dedicated to sharing and learning from industry leaders’ mistakes. She has a commitment to providing dental care to the Borderland community and hopes to encourage the next generation of dentists to give back to the community.