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Article: How Dental School Works DR. JERRY GORDON
How Dental School Works

If you have ever considered becoming a dentist, I would like to help you to understand everything that is involved. My name is Dr. Jerry Gordon and I am a practicing dentist. Dentistry is a career that I truly enjoy and would recommend to others. However, many people greatly underestimate the time that must be invested in order to become a dentist, the difficulty of those years, and the high cost of educating a dentist. After reading this article you will completely understand the process as well as the commitment involved!

To truly understand how dental school works, we need to start at the beginning. Although the road to dental school is likely to be somewhat different for different people, there is both a required and a recommended course. In general it all starts with a college prep curriculum in high school, followed by specific courses in college, making application to dental school, the dental admission test (DAT), and finally, the dental school interview. Dental school itself is its own universe, and in this article you will begin to understand how each year in dental school brings the student closer to becoming a dentist.

It All Starts in High School
In high school, you need to take courses that will help prepare you for a rigorous curriculum in college, and ultimately, in dental school. You should take college preparation (prep) level courses, including four years of science and four years of math. It's not a bad idea to take either Latin or Spanish as a foreign language: Latin will help to prepare you for understanding the origins of all of the scientific terms you will need to learn in college and dental school. Many scientific, medical, and dental terms contain Latin origins. For example, take the word osteoid that you will encounter in a college or dental school histology (the study of cells and tissues) course. You have 'osteo', meaning bone, and 'oid' meaning resembling. Spanish may also be helpful because countless people speak it, including large numbers who live in inner city areas close to many dental schools. As a dental student and resident, I was fortunate to be able to speak Spanish to people coming to the clinic for dental care.

As you go through high school, prepare for the SAT exam and strive to attain a high grade point average (GPA) of B (3.5) or better. You should try to get into a college that has a good reputation and a respected science department.

College -- Learning the Words Basic requirements to get into dental school
Dental schools, like medical and veterinary schools, require that all prospective students take 2 semesters of the following basic science courses in college: General Biology, General Chemistry, Organic Chemistry, General Physics and all their associated labs. Some dental schools recommend 2 semesters of Calculus. If your college or dental school does not require 2 semesters of calculus, take only 1 semester - it will be more than enough. There are other courses that will be more important to you as a dental student.

Most dental schools do not mandate a college degree to get into dental school, as long as the required courses are taken. It is possible to get into dental school after two (very rare) or three years of college (I completed my requirements in three years), but over 95% of the dental students entering in the fall of 1997 received a 4- year bachelor's degree.

Choosing a Major
To get into dental school, you do not need to be a science major (biology, chemistry, physics, etc.). You can major in English, for example, and as long as you get good grades in the science requirements, you can get into dental school. I recommend that you do major in a science, however, preferably biology.

Making the Grade
Most dental schools require a 3.5 GPA or better in the basic sciences and overall to gain admission. In general, a higher grade point average and DAT score increase your chances of gaining admission to dental school.

Courses you need that they don't tell you about
There are some additional courses in college that I feel are important to take, including: anatomy (the introduction to gross human anatomy is the best), histology, systems physiology, pharmacology, microbiology, and nutrition. Some other courses that will be helpful are biochemistry, pathology, embryology, Spanish or Latin, psychology, economics, marketing, management and sociology. As far as non-academic courses, you may want to consider sculpting or something similar to help increase your manual dexterity. I built model airplanes in college to help improve my ability to work with my hands.

Believe me, if you take these courses before you get into dental school, it will take a tremendous amount of pressure off your shoulders. Also, get involved in extra curricular activities like intramural sports, academic or non-academic clubs, and other social gatherings. Remember, you hope to enter a career that deals intimately with people. Developing 'people skills' is of the utmost importance.

The Basics Strategies for Surviving College and Dental School
'Look next to you -- by the end of the semester, the person in the chair next to you will be gone.' I can't tell you how many times I heard that statement as an ambitious undergraduate student at Rutgers University. Then the professors would tell the class, 'we know you've heard that this course is a weed-out course, and guess what, it is!' Unfortunately, this appears to be true at many universities where a large number of students are vying for spots in dental, medical, veterinary, etc. school. Consider this lesson in attrition that I observed as a student at Rutgers University: When I took general chemistry 1, there were 1200 students, by general chemistry 2, there were 900 students, by organic chemistry 1 there were 500 students, and by organic chemistry 2 there were 250 students!

You may be thinking, 'How hard can college level basic science courses be? I did pretty well in high school, I'll do just fine.' Allow me to inject a bit of reality; university level scientific courses are some of the most challenging of all major fields of study. Here is a random example from a Physics course I took in college: 'In the one-dimensional elastic collision, we can use conservation of linear momentum and conservation of kinetic energy to solve for two unknown velocities after the collision if we know the velocities before the collision. (The associated formula) m1v1f + m2v2f = m1v1i + m2v2i.'

You may find some of the theoretical material found in organic chemistry involving nuclear shielding and chemical shift interesting:

'We find that a field strength slightly greater than Ho is required to flip the spin of the proton in an organic molecule. We say that the nmr signal of the bound proton appears at higher field than the signal of the bare proton and call this difference between the two a chemical shift.'<

These examples represent just two concepts out of thousands that you need to remember and apply to pass the examination. By using some of the tips that I provide, and a lot of discipline, you can prepare and conquer.

I will be the first to tell you that the social aspects of college are extremely rewarding. I made many friends, played intramural sports, and got involved in many other extra-curricular activities. While I place a high value on the development of social skills (i.e. understanding and getting along with others) the top priority at college is to make the grade! If you do not achieve adequately high grades in the basic sciences as well as your other courses, you can forget about getting into dental school. A dentist (or any other health care professional) is given the enormous responsibility of providing the health care for others -- if you cannot keep track of your studies in college, you certainly cannot handle that responsibility. A balanced attack

So, should you barricade yourself in your dorm room for the next several years, memorizing your textbooks? Absolutely not. My college roommate during my freshman year was a 'bookish' type that never went out and constantly had his nose in a book. Unfortunately for him, he did mediocre in his courses, and had no social life. Years later I met up with him again and he told me that he only excelled in his courses after he learned to break up his time with a bit of socializing.

You should manage your time so that you can study enough to master the subject you are studying, socialize with friends or go to an occasional party after you have put in your studying for the day, and exercise several times a week. As straightforward as this sounds, you will be amazed how many people cannot discipline themselves to do this in college. Why, you may ask? I believe the reason stems from either a lack of maturity, not having concrete goals, or having an unrealistic view of the effort it takes to do well in a competitive curriculum. As a student, I felt it was important to enjoy as much of college life as I could, while still doing well in my classes.

Time Management Mantra
If you want to be a successful college student, dental student, or dentist for that matter, you must learn how to manage your time effectively. This means that you will not have the luxury of wasting time. Time must be respected as a precious commodity. A wise proverb reads, 'Half of knowing what you want is knowing what you will have to give up to get it.' In other words, if you want competitive grades in difficult classes, you are going to have to give up some of the things that your 'peers' are doing. I will tell you that I never watched more than 5 hours of television a week in college or dental school, missed homecoming one year to study for an Organic Chemistry exam, and did not play hours and hours of card games like many of my college peers. A typical college day might be structured as follows:

Get up at 8am and have breakfast. Study for an hour. Go to classes from 10 am until 2 pm. Study from 2:30pm. until 4:30pm. Work out at the gym with a friend from 5pm to 6pm. Have dinner at 6:30pm to 7:30pm. Relax until 8pm. Study from 8pm. to 9pm. Then talk on the phone or go to the student center until 10:30pm. I would go to bed at about 11 pm.

You will notice that I broke up studying 4 hours throughout the day without it being a burden and still enjoying the college experience. I am a firm believer in 'putting in the hours' to master new and challenging information. I have known people who could do fairly well on an exam by cramming the night before, while I studied several hours a day for the week before, and a few hours more the night and morning before. I do not recommend cramming (pulling the dreaded all-nighter) because it is extremely stressful and the person generally forgets just about everything they 'learn' right after the test. Although the most important thing is making the grade, in the long run, having true knowledge and comprehension of what you are learning can help you in ways you can never imagine.

Finding and becoming a mentor
A concept that is of vital importance to any successful individual is finding and becoming a mentor. As a college or dental student attempting to get high grades in a competitive curriculum, you will need to learn three very important words: 'I need help'. You need to recognize when you need help and then actually request it or you will back yourself into difficult corners. Everyone needs help from time to time. You will need help choosing instructors, understanding labs, getting old exams and accurate notes to study from, learning new and abstract concepts, and many other things. Are you too smart to need help? There might be a few 'geniuses' out there who know everything about everything, but I have yet to meet one. There is no shame in not being a genius, only in not using the 'smarts' that you do have. A smart person does not try to re-invent the wheel. The key to finding a mentor is to learn who is doing well, preferably in the 'A' range, at a given discipline, and to ask that person for help. You would be surprised how people in general are truly flattered when someone feels that they are worthy of being asked for help. Of course, some people will not help you, so move on. Remember to always be grateful for someone's help, and offer to reciprocate, in some other area that you may be strong in (academic, social, or anything else you can offer). These types of barters are win-win situations. Helping others (who ask for it) feels good. I know, because I did quite a bit of tutoring in college and in dental school. It was a great review for the DAT in college, and the national boards in dental school. One added plus: the people that I helped were grateful, and that is very rewarding. Finding and becoming a mentor is something successful people do throughout life.

Getting into dental school without the required courses
It is not uncommon for people in their mid-twenties and early thirties to express dissatisfaction with their jobs, and income. They may look back on college as a wasted opportunity if they did not get good grades, or dropped out before finishing. It is possible for these people to get into dental school by an unconventional route. They can enroll in a university to take the requirements, or go to a community college. If you take your basic sciences at a community college, you need closer to an 'A' or 4.0 GPA, because the general perception by dental school admission's faculty is that community college level courses are not as difficult as the 'university'.

The Dental Aptitude Test (DAT)
Before you can get into dental school, you must take the dental aptitude test (DAT). Like the entrance exam into other professional schools (the MCAT for medical school for instance), the DAT gives dental schools an unbiased look at how well you have learned the following topics: biology, general and organic chemistry, scientific reading comprehension, quantitative studies (Algebraic equations, fractions, conversions, percentages, exponential notation, probability and statistics, geometry, trigonometry, and applied mathematics problems), and perceptual ability (angle discrimination, form development, cubes, orthographic projections, apertures, and paper-folding). Typical science review courses will adequately prepare you for the science part of the DAT, but the perceptual ability aspect is quite difficult. If you don't have a knack for knowing how an unfolded, irregular, eight sided object with a stripe of paint on several different sides will look when put together, I suggest you get some engineering books (as I did) and practice these skills. The reading section is also quite challenging, and you will wonder whether you should have enrolled in the Evelyn Wood speed-reading course ahead of time.

If you have done well in college, and spend time preparing for the DAT, it should be no problem. I spent one full week before the exam studying for it, and scored in the top percentile of applicants from across the country.

Here are some tips to help your study effectively:
Now that you have a basic idea of the courses and commitment you will need, a general idea of time management, and the personal drive it will take, the only thing left is surviving the difficult curriculum you have chosen. I have learned some techniques that can help you focus and maximize the time you have to learn new material. Remember that there are two ways to take down a tree, with a sledgehammer or an axe. This section is designed to replace that cumbersome sledgehammer that wastes your energies and give you a sharpened axe. What's on the test, professor?

The best way to excel on an examination is to find out what material will be on the test at least a week in advance. You will want to know if the professor asks questions strictly from his or her notes, the textbook, his or her imagination or a combination of these things. The most direct way to find this out is to ask the professor. Many times they will tell you, especially if you ask them discreetly, away from their peers, and yours. Another way is to ask someone who has had the same class and professor before. It is wise to do both of these things and see if there is corroboration. Remember that it is much more difficult to master both text and notes than one or the other. In most cases, the professor will draw heavily from their lecture notes on examinations. This is especially true in dental school. Get the general concept first

When a sculptor creates a human body out of clay, he or she does not start by creating the hand to fine detail. The sculptor first roughs out the general form of the body, and then adds detail to create the finished product. Learning is very much the same. Always try to get the general concept first. If you are learning about the heart, first learn that it is a muscle that pumps blood throughout the body, supplying the tissues with oxygen, instead of trying to memorize where the mitral and tricuspid valves are. After you learn the general concept, then fill in more detailed information. Eliminate distractions

When you study, always try to maximize your concentration. If you have something else on your mind, make an effort to resolve it. If you are preoccupied with those dishes in the sink, do them, and then get back to studying.

Look up from the page
When trying to remember what is written on a page of notes, look up and repeat to yourself the important facts. Then, look down to confirm those facts. Remember, the brain will only remember what it feels it has to!

Use pneumonics
Don't laugh, but pneumonics are very effective for remembering hard to retain lists of facts. A humorous one I still remember from dental school helped me to recall which cranial nerves are sensory (feeling), motor (movement), or both. The cranial nerves number one through twelve (dentists deal primarily with cranial nerve number five, the trigeminal nerve). The pneumonic is: 1Some 2Say 3Marry 4Money, 5But 6My 7Brother 8Says 9Big 10Brains 11Matter 12Most. By remembering this pneumonic, we instantly know that cranial nerve five is both (5B) sensory and motor. Also, try to make up your own pneumonics; it makes it easier to remember.

Get the right mind-set
Attempt to avoid studying when you are exhausted. If you are too tired, your concentration will be weak. If you are studying for long blocks of time, always get some rest before you resume studying. Also, if you are confident and have a positive mental attitude, it is very helpful when studying and when taking examinations.

Reduce your notes
After you have studied all of your notes, try to reduce them. Write down the most important points on a new page, and then re-review the new pages before the exam. Shuffle the order of your notes.

When you study from your notes, change the order in which you do it. Start from the beginning to end, then next time, from the end to the beginning, and then start in the middle, etc. By doing this you will avoid memorizing your notes in order and not really 'learning'' them, and also you will not get study fatigue at the same place in your notes each time you study.

Record your Lectures
When attending lectures, it is often a good idea to tape-record them. This way, you can go back over your notes and correct mistakes, as well as trigger an auditory (hearing) recollection of lecture topics. This technique is especially helpful if you know that examinations will be given in large part from the notes. (In many dental schools, they have a 'note service', where a different member of class receives a tape recording of the lecture, transcribes the notes, and then they are copied and distributed to the class. This is extremely helpful. If your dental school does not do this, develop a 'note service' with your class right away.) If you follow these tips, you will greatly maximize your time, and will likely receive better grades in the process.

Applying to Dental School
After you have completed the college requirements, and the DAT, you are ready to apply to dental school. Fortunately, there is a service that greatly aids students in applying for dental school called the American Association of Dental Schools Application Service (AADSAS). Here is what they do in their own words: AADSAS simplifies the application process by providing one standardized form, relieving students of the need to complete multiple applications. Dental schools benefit by receiving uniform information on all applicants. AADSAS serves only as an information clearinghouse and does not influence the dental schools' appraisal or selection of applicants. Each dental school has the right to request supplemental information from the applicants.

The Dental School Interview
Before you are selected to enter dental school, you will most likely be interviewed. While the most important factors determining whether you get in is your college GPA and DAT score, and to a lesser extent, letters of recommendation, the interview for dental school is quite important. There are definitely some dos and don'ts for the interview. For example, you will need to dress in a conservative, professional style. That means a suit for men, and a dress suit for women. Make sure your personal and dental hygiene are good. You may be asked a wide variety of questions. Always remember to be truthful, and upbeat. Many times it is not what you say, but how you say it. I remember one story where an applicant put down that he liked boating under a hobbies section of an application, which was a lie. The interviewer by chance happened to be an avid boater, and began asking him questions about it. When it was clear that he had lied, he knew he had blown the interview by being dishonest.

Prepare for your interview by asking a few dentists in your area (or your dentist) some questions about their careers, especially what they like about dentistry. This will give you a bit of a background that can help you on the interview. Also, by reading this article, it will give you a great deal of perspective about what it takes to become a dentist.

One question that you will most likely get is, 'Why do you want to become a dentist?' You need to come up with a good answer for that one. In general, keep the answer more on the lines of giving patients quality dental care, and not on the financial compensation you might expect as a dentist.

Never come to an interview with a negative attitude, and always show all people involved the utmost respect. Don't ever cast aspersions on any other person or profession; it is in poor taste, and is considered very unprofessional. Lastly, keep in mind that the person who interviews you will most likely be a faculty dentist or administrator that will have to deal with you, and vise-versa, in some capacity, for the next four years if you are accepted.

Dental School, The First Two Years (Forming Sentences)
Dental School is a lot harder than your high school or college advisers will tell you. That is because the vast majority of advisers have never gone to dental school! I have been there, so I can tell you from experience -- I've known extremely bright people who have failed out of dental school because they could not learn to work with their hands well enough to pass the dental laboratory classes. I have also known extremely dexterous people who were not smart enough to pass the academic portion of dental school. Knowing about the challenges of dental school will help you prepare.

One question people sometimes ask is 'How is dental school different from the challenging college curriculum it takes to get there?' The answer is that there is a vast difference between dental school and college. In college, you may have four hours of lecture four days a week; take about 32 credit hours per year, and have three and a half months off during the summer. In dental school, you have nine hours of lecture and/or lab five days a week, take about 100 credit hours per year, and have only a couple of weeks off in the summer. In college, many students take a part time job. In dental school, that is next to impossible.

Freshman Year
Dental school is a rude awakening for the uninitiated. A colleague of mine in dental school once told me that before he went to dental school, he thought to himself, 'well, I guess you learn the names of all the teeth first, but how can that be stretched into a four year program?' He was (as was I) blown away when he went into dental anatomy class. Here is an actual excerpt form my freshman dental anatomy textbook describing the seemingly simple upper front tooth (central incisor):

The maxillary central incisor is the widest mesiodistally of any of the anterior teeth. The labial face is less convex than the maxillary lateral incisor or canine, which gives the central incisor a squared or rectangular appearance. From this aspect, the crown nearly always looks symmetrical and regularly formed, having a nearly straight incisal edge, a cervical line with even curvature toward the root, a mesial side with straight outline...

Are you asleep yet? Believe it or not, the above description goes on for another ten pages! You may be thinking, 'Do I really want a Lexus that bad?' Seriously, you may wonder why in the world do you need that much detail. A dentist needs to know that sort of detail if, for example, a person comes into the office with broken front teeth. The patient's expectation is that he can go to work the next day and look 'normal'. The first year of dental school is heavily loaded with didactic classes, aka lectures. The medically oriented courses include: gross human anatomy (dissection of cadavers), biochemistry, histology (microanatomy), and physiology. Some of the dental courses include: dental anatomy, dental materials, operative dentistry, occlusion, preventive dentistry, oral biology, complete dentures, all the associated labs, as well as many other courses. The dental labs are where dental students first begin to train their hands to do dental treatment. In dental anatomy, we had to create teeth from melted wax. In operative dentistry, we practiced drilling cavities on plastic tooth replicas. Both the medical and dental classes have numerous written quizzes and examinations.

The dental laboratory has highly stressful practical examinations. During a practical, you would be given a set amount of time to do a dental procedure on a plastic tooth, for instance. The criteria for passing laboratory practical examinations are very stringent, and are often considered one of the most challenging aspects of the first two years of dental school.

The first year of dental school offers very little contact with patients (fortunately for them). Dental students will routinely chart and clean each other's teeth, but that is about it. Unfortunately, the 'weed out' process does not end in college. Students who cannot make the grade can and will be kicked out of dental school. In my freshman class, we started with 101 students. By the end of the first year, there were only 78.

Sophomore Year
The second year of dental school is, in my opinion, the most difficult. The hours of lecture are still numerous (about four or five hours a day), but the amount of laboratory work is tremendous. The medically oriented courses include: microbiology, general pathology, and oral pathology. Some of the dental courses consist of the more advanced aspects of the courses taken the previous year, fixed prosthedontics, complete dentures, occlusion, geriatrics, oral surgery, all the associated labs, and many more. The dental practical examinations become even more difficult, and the work load more intense. There were stretches my sophomore year where there was a quiz every single day, no end to the usual examinations in all of the other courses, and lab work projects that would take into the wee hours in the morning to complete. There were weeks that I put in well over 100 hours, and slept no more than two or three hours a night. This was not the curriculum for the faint of heart!

In the second year, you get a little more 'hands-on' experience. You give you first injection to... you guessed it, another dental student. Just make sure you pick a kind and gentle soul. Still, the 'weed out' process is not finished yet. Even after some dental students get to the second year, a few still cannot make it into the third year. We lost an additional seven students my sophomore year. You may be wondering, 'I can understand the dental courses, but why all the medical ones?' The reason is that you are not just treating teeth -- you are treating a person! The teeth and mouth are connected to the rest of the body. A dentist doing a procedure as simple as a filling is actually performing a surgical procedure. Anesthesia is being used to poison nerve channels, dental tissue is being removed, and so on. What if the patient has an allergic reaction to the anesthesia? A dentist must know what to do in a medical emergency situation. Again you may still ask yourself, 'That explains the medical courses; by why do you need to learn a course like histology, for example?' Aside from being a necessary stepping-stone to other courses, you can use your knowledge of basic science to build confidence and trust with other people who come into your dental office. Just the other day, I had a medical doctor with a PhD in microbiology come into my office. I asked her what she did her PhD thesis on, and she said it was on surfactant. I happened to recall that type two great alveolar cells in the lung secrete surfactant (I learned that my freshman year in histology), and other facts about what it does in the body. She was pretty surprised, and I was glad that I had remembered. I would hazard a guess that she would be more likely to follow through with my treatment recommendations than if I had not known what she was talking about.

The National Boards, Part 1
After you complete the first two years of dental school, you must take the national boards part 1. The first part of the boards deals with testing the cumulative knowledge of your first two years of dental school. You will be tested on gross and microanatomy, biochemistry and physiology, microbiology and pathology, and dental anatomy. The exam is somewhat challenging, but it is really more of a nuisance after you have just completed the hardest year (academically) of your life.

Dental School, the Last Two Years (putting the sentences into paragraphs) Junior Year
The third year is probably the best of the four. They finally turn you loose on real patients, and at last you can start to see why you choose dentistry in the first place. In the third year, the lectures are cut down from four or five hours a day to about two. You still have course work such as pharmacology, radiology, orthodontics, pediatric dentistry, etc., but the labs are replaced with treating patients on the dental clinic floor.

The best way to explain how a very 'green' dental student treats a patient would be; very slowly, and with a lot of supervision. A small filling that would take no more than 10 to 15 minutes in my office today would take nearly three hours in dental school. Here is a hypothetical example of a third year dental student attempting to do two small fillings on his patient:

Gary: Hello Dr. Smith. I have just seated my patient, Mrs. Brown, and want to get a start on treating her. Dr. Smith: Hi Gary, what do you want to do today?
Gary: I would like to treat two cavities today, tooth number 3, occlusal, and tooth number 4, occlusal (the upper right first molar and second premolar have cavities on the biting surface).
Dr. Smith: Let me take a look. (He examines the patient to confirm if there are indeed cavities on the teeth that Gary has said). I notice (looking at her chart) that this patient marked Calan on her medical history. What does Calan do?
Gary: Calan is a calcium channel blocker used for high blood pressure.
Dr. Smith: Maybe we should reschedule her and get a medical consult.
Gary: Dr. Smith, Mrs. Brown's blood pressure has been only slightly elevated, 140/85. I took it in treatment planning clinic just a week ago.
Dr. Smith: Okay, but use anesthesia without epinephrine, and only do the filling on tooth number 3. You do not have enough time (roughly three hours remain in clinic for the morning session).
Gary: Dr. Smith, we learned in oral surgery that a small amount of epinephrine could be safely used in a patient with mild hypertension.
Dr. Smith: Don't argue with me Gary, just don't use it.
Gary: (one hour later) Dr. Smith, I am finished preparing the tooth for a restoration (filling).
Dr. Smith: (fifteen minutes later, he examines the tooth) you need to refine the walls of that prep (shape the tooth better), Gary.
Gary: (thirty minutes later) Can you check my tooth again?
Dr. Smith: (ten minutes later, he checks his watch) Okay, place the restoration. What will you be using?
Gary: I will be using copalite as a liner, and restoring the tooth with amalgam (silver).
Dr. Smith: What is copalite used for?
Gary: Copalite reduces potential sensitivity from the restoration by sealing the dentin tubules.
Dr. Smith: Fine. Gary: (forty five minutes later) Dr. Smith, can you check my restoration?
Dr. Smith: (ten minutes later) It's not very good (in front of the patient), but we're running out of time. Well fix it up next time.
Gary: Thank you for your help Dr. Smith.

This example is not an exaggeration. Dental students are really put through a wringer in the clinic. To some extent, it is necessary. However, there are some dentists on the clinic floor who abuse their power and really try to make life miserable for the dental student. You will learn quickly who they are, and then make every attempt to avoid them.

Senior Year
At last you are a senior. There is far less classroom lecture, and the majority of your time is focused on finishing clinical requirements for graduation. In other words, there are predetermined numbers of procedures required by the school to graduate. For example, you may need to do six dentures, ten crowns, three bridges, five root canals, two biopsies, etc. Finishing the clinical requirements on time is very difficult and stressful. As you saw from the above example, you move at a snail's pace in clinic. You do get to move a bit faster your senior year, but it is still quite slow.

You also need to prepare for the clinical board exam and the national boards part 2. The preparation for the clinical board exam is stressful in and of itself. The dental school gives you a series of mock clinical board examinations that you must pass to qualify to take the real board examination at the end of your senior year.

Here are some other things to think about as a senior:
Avoid the God Complex - I believe that it was Bacon who wrote, 'Knowledge is power'. The amazing part about it is that he wrote that before there were modern dental and medical schools! Having specialized knowledge can make some people feel very superior to others. You may remember Alec Baldwin's character in the movie 'Malice' where he plays a surgeon and says, 'I am God'. While this is a bit of an exaggeration, it does illustrate a tendency that must be avoided when treating patients. Always remember that being condescending to your patients (using jargon and other dentist-speak) puts up a barrier that makes successful treatment difficult, and weakens their confidence in you.

Tips for getting through dental clinic:
Do exactly what your dental faculty member tells you to do on the clinic floor, and never argue. The dental faculty on the clinic floor literally has the power to prevent you from graduating. Don't give them a reason to make things very difficult for you. Know what treatment you are going to do on your patient ahead of time. Know why (i.e. be able to put into words) you are using any material, medication, anesthesia, etc. on your patient (this rule also applies to when you are practicing dentistry in the real world). Don't assume that you will automatically get your degree after four years. Hustle to get your requirements done in the dental clinic. The students in my class that didn't graduate on time (the majority) did not take their clinical requirements seriously enough. Always treat your patients with deference and respect. Remember that they are putting up with having their treatment done by a novice student doctor and at a snail's pace. Also, if they 'disappear' on you before you get their treatment done, you will not get credit towards graduation for the 'work in progress'.

The national boards, part 2
The second part of the national board examination is a two day, sixteen hour written test that covers the following topics: operative dentistry, pharmacology, prosthedontics, oral surgery and pain control, orthodontics (braces), pediatric dentistry (dentistry for children), endodontics (involving root canal), periodontics (involving the gums), oral pathology and radiology, behavioral science, and public health and safety. The exam is comprehensive, and includes many slide questions based on clinical scenarios. Getting out of dental school on time and passing all parts of the dental boards is not common in many dental schools. In my dental school, I was one of the only twenty-one students out of more than seventy that passed all parts of the dental boards and graduated on time. There were at least a half dozen students in my class who had been accepted to dental residency programs and could not go because they were not finished with their requirements.

The clinical board examination
To be licensed to treat patients you must graduate from a four year accredited dental school, pass both parts of the national boards, and pass the clinical board examination. The clinical boards are a two-day process where dental examiners come to the dental school and test every qualified dental student on a series of dental procedures on live patients, and on plastic teeth. There is also a written component to the exam. The test is designed to see if the student is competent enough to practice dentistry without supervision.

Residency and Dental Practice (reading the book)
I strongly recommend that every dental school graduate do at least one year of residency. Unlike medical school where you are generally required to take at least three years of residency prior to being able to practice, a dentist can begin treating patients right out of dental school. The funny thing is, many dental students think that they are actually ready to treat patients right out of dental school. New dental graduates suffer from 'not knowing what they don't know'. Dentistry is far more complex than recent dental graduates realize. By going to a residency (general practice residency (GPR) or advanced education in general dentistry (AEGD)), and taking many hours of continuing education, a young dentist can competently begin to treat patients. Even so, a young dentist will, at times, come up against clinical situations where he or she needs to take the patient's x-rays to an older and more experienced dentist or a dental specialist to discuss what course of treatment is in the best interest for their patient. A highly trained and experienced general dentist can treat the vast majority of a patient's dental needs, requiring referral to a specialist infrequently.

Some dental graduates will consider specializing in a specific area of dentistry. The main residencies are: Oral Surgery (3-4 years after dental school, an MD degree can be obtained in a 6 year program), Periodontics (2-3 years), Prosthedontics (2 years), Pediatric Dentistry (2 years), Orthodontics (2-3 years), and Endodontics (2 years). These residencies offer advanced training in each specific area of dentistry: removal of teeth and jaw surgery, treatment of gum disease, rebuilding and replacing teeth, dental treatment of children, straightening teeth with braces, and root canal therapy, respectively.

What's the difference between the training of a dentist and a doctor?
What you should realize is that a dentist is a doctor -- A dentist has completed a course of study, can diagnose and treat disease, and is licensed to prescribe medications (antibiotics, narcotics, etc.). There is however, a difference between the training of a dentist and a medical doctor. Medical school is more heavily weighted on lectures, and has less laboratory work than dental school. Medical school clinical rotations are more observation-oriented, whereas dental students actually assume the role of a treatment provider for their patients.

The reason for the difference is that the vast majority of direct patient contact for a medical doctor comes in their residency after medical school. Also, a medical doctor is required to take at least three years (in most cases) of residency before practicing.

Which school is harder? Who knows, and who cares? The training of a dentist and a medical doctor are both difficult and require a very strong commitment.

How does what you learned in dental school really apply when treating a patient in your office? Suppose a patient, a 65-year-old female, comes into your office. She has multiple dental complaints and a fairly complicated medical history. You look at her dental chart, and she has marked the following: heart disease or attack, high blood pressure, diabetes, arthritis, and psychiatric treatment. She has had surgery for cancer of the larynx two years ago, which included radiation therapy, and is taking the following medications: one baby aspirin a day, insulin, atenolol, desipramine, and synthroid.

You do a comprehensive radiographic (x-ray) and clinical (hands-on) examination. Here are your findings: The patient has several cavities, gum disease, infected teeth that will require root canal therapy, and severely damaged teeth that will need to be extracted (removed). To replace the missing teeth, she will require fixed bridgework (joined crowns (caps) that fit over existing teeth and replace the missing ones) and dental implants. The patient has informed you that she has no financial restrictions, and wants the best dental treatment available.

The following are questions and answers that you, as a dentist, need to be thinking about. They may shed some light on what you have learned in dental school (and residency) has to do with 'real practice':

What should you ask the patient about her medical history prior to treatment? How long ago did she have a heart attack? All elective (non-emergency) dental care should be delayed for at least a month after a heart attack. Is the patient's hypertension (high blood pressure) under control? How often does she see her doctor, and what has her blood pressure the last time it was taken? Uncontrolled hypertension places the patient at increased risk for another heart attack or a stroke, possibly in your office, during treatment. Uncontrolled hypertension can also cause excessive bleeding during dental procedures making the safe management of those procedures more difficult. Is the patient's diabetes under proper control? What was her sugar level the last time she took it? How often does she take it? Uncontrolled 'brittle' diabetes makes the patient more susceptible to all infections, including dental infections. Surgical dental treatment (dental extractions, gum surgery, biopsies, etc.) may not heal properly, and antibiotics may be less than effective in controlling an infection if one develops. Diabetics are also more susceptible to gum disease. How severe is her arthritis? Are her hands affected? Patients with advanced Rheumatoid Arthritis affecting their hands may impede proper dental hygiene methods (brushing and flossing). The patient may need to be given an electric toothbrush. How long ago she had radiation therapy and does she suffer from dry mouth? Patients who have had radiation to the head and neck may not be able to have oral surgical procedures safely done. Extraction of teeth may need to be done in a hyperbaric oxygen chamber. Complications of her radiation therapy (in close proximity to the oral cavity) can include a dry mouth due to damage of salivary glands. A dry mouth can make a patient more susceptible to cavities and gum disease. You may need to suggest that she chew sugarless gum to increase the flow of saliva or prescribe artificial saliva. Does she takes her medication every day, and in the proper amounts? A patient who does not take her medications may not have her ailments under proper control. Also, if she is not following her medical doctor's advise, there is a high likelihood that she will not follow your advise either. Keep this in mind about the medications she listed: the baby aspirin can cause increased bleeding (inhibits prostaglandin synthesis) and may have to be temporarily discontinued (with the medical doctor's agreement) for certain dental procedures. Insulin lowers blood sugar (it drives glucose into cells) and can cause a serious condition called hypoglycemic shock if the patient has a stressful (physically and/or emotionally) dental visit and does not eat before treatment. The atenolol can interact with the epinephrine in certain dental anesthesia (especially in higher amounts) and cause an increase in heart rate and blood pressure. The desipramine (like radiation therapy) can cause dry mouth and therefore contribute to cavities and gum disease. Should you call the patient's doctor(s) before you treat this patient? Yes, this patient has a relatively complicated medical history and both you and your patient will benefit from a consultation. What should you ask her doctor(s)? You might ask her doctor(s) if her medical problems are under control, request her most recent blood work, the amount of radiation she has received, and discuss with him or her what dental treatment is being contemplated, the amount of physical and emotional stress you expect, and what recommendations he or she has for the management of your patients. Is the patient in pain right now? The patient' 'chief complaint' or 'pain complaint' is usually what brings them to your practice in the first place, and in most cases should be addressed first. What order should the treatment be done in? In most cases, the gums and infected teeth (those requiring root canal or extraction) need to be treated first. Then, the cavities (deep cavities before shallow ones) and teeth that require crowns (caps) and bridges should be treated. Dental implant surgery can often be done in the preliminary stages of treatment because several months will be needed for them to heal prior to using them to replace teeth. Proper planning and sequencing of treatment is one of the most challenging and important aspects of dental care. As you can see, providing dental care is far more involved than you might realize on the surface. Proper treatment requires an in-depth knowledge of basic science, medicine, dentistry, and some psychology. One important thing that should also be pointed out is that excellent patient management skills are needed to complete a complex treatment plan for a patient who has multiple medical problems. You will need a combination of empathy, compassion, and confidence. While empathy and compassion are innate in some ways and learned through 'life skills', confidence is acquired through a process of knowledge and experience.

Is It Worth It?
If you have read through this article and you are thinking, 'Wow! Here is something that really interests me!', then you are probably well on your way to becoming a dentist. A strong desire to become a dentist is one of the most important qualities necessary to survive dental school.

What do you get in return for all of this work? First, you get a profession where you are truly able to help people. Good teeth are amazingly important to the quality of a person's life. You get to help people by relieving their pain and make them look better, and in many cases you will see the results of most procedures very quickly.

There are also financial rewards. A recent study found that the average private practice dentist earns about $178,000 per year. Some dentists earn much more, some much less. That $178,000 may sound like a lot of money to you, but consider that the average dentist starts his or her career over $200,000 in debt for college and dental school loans. Also, to start a dental practice is very expensive. The purchase of equipment, instruments, supplies, rent, etc. for an even a modest, two treatment room dental office can run well over $150,000. It takes a number of years to pay down that debt. I would like to give you one word of advice. If you make money your primary goal, you will have a difficult time gaining the trust of your patients. That is not to say that money is unimportant - you cannot operate a dental practice without it. However, your ultimate goal should be excellence as a dentist and excellent treatment for your patients. If you provide excellent treatment, advice and service, the financial aspect will take care of itself.

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. He is a recognized dental expert for Dr. Oz.

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