The Tooth behind My Dental Journey (part 2)

Read part 1 first, if you haven't already!

Let’s talk more about Dental School then…

Very early on you are repeatedly told that you are different from the vast majority of courses you are not just a student you are a DENTAL student. What difference does this make you ask, well …?

You have very real people under your care and for them you are their DENTIST not just a student, you begin to realise that although dentistry would be a lot easier if you were just dealing with teeth it’s not because you are dealing with people. But honestly this isn’t something to keep you up and night OR to get overwhelmed about.

It just means that you have to be slightly more conscious of your actions at times because you’re entering a public position of responsibility where you will be dealing with sensitive information. So you should be considerate of what image you portray because you never know when you can bump into a potential patient or colleague.

The course itself…

In first year I spent most of my time in lectures or anatomy classes at the medical school on the edge of campus and ventured to the Dental School for observation of older years on clinics and further teaching.

The modules we had covered basic human biology and the five main organ systems of the body. In addition to lectures I had some small group sessions to go over concepts covered, discuss cases which involved applying lecture knowledge and also for anatomy sessions.

Anatomy content is taught by staff in the medical school and matches up with lectures on the respective topics. This was by far the hardest aspect of University for me…anatomy seems like a foreign language but there are countless resources available to help support you and being given time for concepts to sink in can really help. It was only when I entered second year that anatomy finally started making a bit more sense to me, but it was definitely something that I couldn’t neglect.

Once you get into second year you start feeling more like an actual dental student, especially as you start the Oral Biology module. We began to have more practical sessions introducing us to clinics towards the middle of the year, at one point we even get paired up with each other to practice giving 3 injections of local anaesthetic (LA) to each other. You really do test friendships when it comes to this!

Then towards the end we started practicing procedures on phantom heads which continued until Christmas time in third year. It was exciting being able to practice carrying out fillings, crowns, veneers and other treatments on plastic and real extracted teeth before seeing patients. Alongside this we also had teaching regarding clinical practice to support our knowledge about the rationale behind these treatments.

It was a very logical approach that made sense to me and meant that by the time I started seeing my own patients this year I felt a bit more prepared. Even though I definitely have a long way to go in terms of improving my practical skills and knowledge it has provided me with a good platform to build on.

Starting Clinics and seeing my very own patients…

I won’t lie I was waiting for this opportunity from the minute I decided I wanted to do dentistry. In the build up to this I had several practice sessions carrying out basic history taking, examinations and treatment planning on peers in my year BUT there’s an obvious added pressure when it’s no longer your best friend in the dental chair!!

Surprisingly, I managed to sleep soundly the night before my first session as a “real dentist”. It went quite well as we only have one patient in a single session for the first few weeks and you are closely supported by several qualified members of staff, dental nurses and peers.

When you see any of your patients for the first time you do a detailed medical history, social history (asking about diet and oral hygiene habits), dental history and carry out a clinical examination. At each stage you ‘present’ the information about your patient to a member of staff and they can discuss the case with you.

You get taught how to do these ‘basics’ well quite early on and it’s important to try and get into good habits in terms of making detailed notes, maintaining a professional demeanour and good posture.

Fast forward a few weeks later you’re now carrying out fillings and radiographs (x-rays) on your own, with supervision and support as and when needed but become more and more independent as time goes by.

Let’s reflect…

After each patient you fill out online reflections to record your treatments/interactions with them. Reflection is a huge part of the course and feedback is literally the only way to grow on clinic.

I don’t like making mistakes…I don’t think anyone does BUT as cliché as it sounds it will happen a lot when you first start out. It can be easy to get overwhelmed by this so it’s really important that you reflect and talk it out with your peers and tutors so you can get the advice you need, and adapt your approach as quickly as possible. When you’re doing a practical course you learn a lot by simply doing, which can come with making some mistakes.

What to do when things go wrong…

I had a patient who came in for a repair of her ‘metal’ filling, I’d seen her before to book this in and we get on really well. The session started off as planned, I explained what we were doing, explained the options available – we ended up deciding that it was better to remove the entire metal filling and restore the tooth with a white filling material instead to which she agreed and was more than happy. It was my second time doing a filling like this.

After discussing this with my clinician, we were all good to go, I got on with the session giving her LA and although I struggled to place the filling because of its location I eventually finished it. Time to check it…and it falls out, the entire filling that I had placed, and started to shape literally came out as I removed a band I had placed around the tooth. It was towards the end of the appointment on a Friday, clinic was about to finish and the nurses/most of my colleagues had started to leave.

I explained to the patient that I needed to redo the filling again because it had come back out and then went to my clinician to explain what happened and we discussed reasons why it could have failed (likely because it had been contaminated with saliva because it was so close to the gum line).

I was panicked to say the least and felt really nervous about having to go back and redo everything that it had taken me over an hour to do all over again within half the time and with less support. And embarrassed to see the patient.

But when I went back to the bay where my patient was I knew I had to be more calm and collected and fix my mistake. Luckily a saviour in the form of one of the nurses on clinic appeared and she helped me for the remainder of the procedure, we got the filling completed and my clinician also helped me with shaping it towards the end (due to time constraints).

The patient was relieved that it had been completed (and that she could finally escape I’m sure) and after ringing her back a few days later (praying that it hadn’t fallen out again) she confirmed that it was fine and she had no problems with it at all.

I could literally go on and on about what I learnt from this session BUT long story short I learnt not to panic. You don’t have time to do this! I’d like to think it was only human of me to get flustered when the filling came out unexpectedly but when you have a very real patient on the other side of the clinic, it’s important to remain calm and approach the situation logically.

I’m just at the very beginning of my clinical journey and don’t yet have nearly enough experiences in enough procedures to call myself skilled by any means. However, I think that I’m slowly trying to become more open to criticism (which is something I can find difficult) and instead trying to learn as much as I can from each experience be it good or bad.

Overall I get on really well with my patients so far and have learnt from advice given by clinicians and peers to be as transparent and prepared as possible, always acting in the best interest of the patient.

I can’t explain how satisfying it is when a patient thanks you for the first time, even for something as ‘simple’ as taking the time to explain what your treatment plan is and the other options they have available.

They like being part of the discussion and it’s important you include them in conversations (not just for consent) but because they live with the consequences of what you do. Our interactions with patients can be brief sometimes but they do have impact and it’s important to be open to new experiences so you can constantly improve.

This is easier said than done and is something that I hope to get better at as time goes by.

Words by Karishma Dewitt (Third Year Dental Student)