By: Cory Ball
You just got your final faculty check for a restorative appointment in the clinic. Your patient is thrilled to finally leave the dental school after a three-hour appointment to fix a cavity.
Yes, that’s right. One filling. 4DO. You’re an early D3 dental student and this is among the first dozen or so composite restorations in your career.
You are so excited, you got credit for the restoration, the Garrison ring only popped off twice, you only had to adjust the occlusion three or four times, and graduation day is one filling closer.
The biggest plus: your faculty signed off on it. That must mean it was great. How does the restoration look on the recall x-ray? You graduated, the patient was handed off to the next student, and you never saw any bitewings with your 4DO placed to evaluate.
Geographic Success
This is what we would call geographic success.
If a dentist only stays in a location for a short period of time (typically less than one or two years), he or she would not see many failures in the dental work that was provided.
These failures can include debonded restorations, poorly contoured like if a wedge pushed the band over the margin in your class 2 box, recurrent or decay that was not excavated completely, etc.
Many young dentists, go back to their hometown or stay near the dental school they attended and practice dentistry in a private practice, a corporate office, an FQHC, or some combination of the options.
Humbling Nature of Dentistry
If the opportunity is a healthy one and the young associate stays for multiple recall exams for their restorative patients, they are guaranteed to experience something many dental students do not during school: the humbling nature of dentistry.
Dentistry is hard. There is no doubt about it, dentistry is a challenging profession where we work in a small space with anxious patients that have all kinds of factors that make our job difficult.
It should be paramount for dentists of all ages to deliver their best abilities to each and every tooth they treat. With that, however, comes the reality check of failures.
Dealing with the Emotional Side of Dental Failures
For me, the hardest part of dentistry since I graduated was how to deal with the emotional side of my dental failures. I have confidence in my skills but also knew coming out of school I had a lot to learn and welcomed the challenges ahead.
In dental school, we have that extra set of eyes with the faculty checking our work. In the real world, there are no more extra sets to help. That extra set comes in the form of a bitewing a year or so down the road.
For me, I was not afraid to tell the patient “this restoration we completed for you is not optimal, I would like to replace it for you”. I was more disappointed in myself and frustrated about why I couldn’t have done it perfectly the first time.
Crown #18 was completed- bitewings were taken just over a year later. These are educational tools to show patients. This patient was shown the less-than-ideal mesial margin as well as the shadow presented under the distal margin. We explained why we wanted to replace this crown for him to make the situation right.
In the first couple of years of a young dentist’s career, he or she will develop routines, patterns, preferences, and protocols on how procedures will be performed in their hands.
Unfortunately, in my experience, those first couple of years were a bit of a trial and error time where I had to learn what worked great for me, what didn’t, and how to incorporate things to become more efficient while still delivering a safe and effective dental service to my patients.
Tooth #3 had a DO composite restoration completed. The bitewing x-ray looked clinically acceptable. Decent contours, margins appear closed, and no decay was noted on the x-ray. Upon a clinical examination at the patient’s next hygiene visit, we saw an inadequate seal and leakage at the margin.
We informed the patient of the need to replace and provide him with a better restoration.
Repetition is Key for Young Dentists
Repetition for a young dentist is a key aspect of developing hand skills and learning what works and what doesn’t; however, that should not be the only thing a young dentist relies on.
Dental school is only four years. Sure, while we were going through it there may have been days that felt like at least eight years long.
The reality is, unfortunately, the dental school that we all attended cannot possibly prepare us for every situation that will come up. And four years alone is not enough to stop learning.
It has been a crucial part of my development as a young clinician to take continuing education classes.
CE courses are a great way to learn what products are out there and what techniques are available that may not have been taught in dental school.
Tooth 29 had a MOD composite restoration. It appears to us on the bitewing that our sectional matrix was not properly sealed. It was replaced for the patient to give her a healthier and properly contoured restoration.
Failures will Become Less and Less
As my career has progressed, I have seen fewer and fewer failures but continuously am learning from the ones that do pop up.
While they still are frustrating, it is a normal part of dentistry and one that a humble and honest young dentist can make him or herself a better clinician by learning.
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Photo by Andrea Piacquadio
