Now in his third year at the University of Louisville School of Dentistry, technician-turned-dental student Eric Nunnally has entered the clinic phase of his education—and he's loving it.
It's time to do some dentistry! Real dentistry. No more cutting textbook preps on plastic teeth mounted in fake heads. No more sitting in lecture halls 30-plus hours a week. National Boards Part I, passed. I'm a junior now, and finally treating patients in clinic. I have waited years for this moment, and now it's time to step up to the plate.
For the next two years, our major focus is to become proficient in treatment planning and clinical patient care. I've been seeing patients for a couple of months now and my initial experience has been exciting, terrifying and rewarding all at the same time. Each week I see a total of 10 patients. Five are rotations through the specialty programs to get hands-on experience in oral surgery, endodontics, pedodontics and periodontics, and the other five are three-hour appointments with patients who are assigned to me (appointments are long because professors need to check our work after each step).
I've performed a few emergency procedures but, for the most part, I've been capturing patient information by performing basic workups involving X-rays, diagnostic impressions, perio charting, hard tissue charting, cancer screening, and obtaining and reviewing medical histories with pathology consults. Starting this semester, I'll perform dental procedures at each appointment and I must also complete a specified number of crowns, dentures, RPDs, direct restorations, prophys, etc. before I graduate.
The Joys—and Challenges—of Patient Care
I love working with patients! However, when my first patient sat in my chair and put his trust in me to provide quality dental care, it was a whole new kind of stress. As I looked over his X-rays, filled out the tissue charts and weighed the treatment plan options, I kept thinking, "I don't remember anything!" But once I got over my initial jitters, I realized I was much better prepared than I thought.
A professor explained to me that for many patients, leaning back in the chair and opening their mouth is the most vulnerable position they experience; it's important to build their confidence in me. It's amazing to see how our dentist/patient relationship can flourish if I take the time to talk with and listen to the patient in order to understand his needs and expectations.
The process of evaluating a person's oral condition and deciding which procedures are required to restore the patient's oral health is tougher than I imagined. Because there are so many options and schools of thought, a good part of dental care is open to dentist interpretation and personal preferences. There are rules that guide you, but in the end it's up to the individual dentist to decide which treatment is appropriate for each patient's needs and acceptance.
In general, our goal is to save as many teeth as possible and restore form, function and beauty, while keeping the cost within a reasonable range. Since we can't withhold treatment plans based on what we think the patient can afford, we generally present patients with two options: the one we feel is the "best" plan as well as a less expensive solution. For a partially edentulous patient, for example, I'll present a plan that involves implants, bone grafting, sinus lifts and porcelain-fused-to-noble metal crowns, but I'll also present a second plan that involves an RPD.
Evaluation is also challenging because a lot of my patients are in severe pain and/or are in need of very involved treatment. A number of them have never had regular care and several have so many dental and medical problems it's hard to know where to begin treatment.
However, the challenges are worth the end result. The first time I was able to eliminate a patient's pain and experience his joy and gratitude, it gave me a new perspective on my dental career. The services that dentists and technicians provide can make a major impact on peoples' lives, and it's been a thrilling and humbling experience.
Going forward, I'm hoping my lab background offers me a little more freedom when it comes to patient care. For instance, the school has strict rules about material choices and the focus is on "tried and true" techniques. However, since my professors respect my technical background and often ask me for input on lab procedures, restorations and materials, I hope to have more leeway in choosing newer materials and restorations for my patients--like full-coverage zirconia or custom implant abutments--and possibly more opportunities to tackle more difficult prosthetic cases.
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