The last semester at University of Louisville Dental School was full of “final stretch” stresses, including finishing our graduation requirements and taking the final portion of the national licensing boards and a series of proficiencies and exams to demonstrate that we were qualified in all areas of dentistry.
Board exams—a combination of written exams and patient-based clinical competencies—were by far the most stressful part of the semester. At that point we were used to taking written exams, but the patient portion was a killer. We had to find our own patients and they needed to fit the Board’s exact criteria.
The first patient had to be someone in need of full quadrant scaling and root planning which means he must have significant perio pockets and radiographic-evident calculus on most of his teeth. That’s a lot more difficult to find than you might think. The next two patients needed to have interproximal decay into the dentin but not too close to the pulp. Also, the patients had to be healthy and reliable, and you needed to find backup patients because if any of your patients don’t show up, you fail.
When you have 85 students all desperately trying to find people who fit this criteria, it gets hectic. Most of the current patients at the school had very large cavities and various other health conditions that ruled them out as candidates. We held mass screenings to find patients, but with little luck. I found mine by screening the University of Louisville’s medical students, which was my saving grace.
You get a defined amount of time for each exam for each patient. The first stage is the preparation. After finishing your prep, you send your patient to the grading area where he has to wait about 45 minutes to be evaluated. That’s a long time for your patient to wait in line wearing a rubber dam! If the graders don’t like your prep, they may ask you to change and resubmit it and wait another 45 minutes. Then you have to repeat this process for the restoration stage. You have four hours to complete the filling. That might sound like a lot of time but if a couple things go wrong, it can be disastrous.
The criteria to pass the exam are rigid. For instance, if you don’t finish in the allotted time, you fail. If your rubber dam isn’t just right, you fail. If your patient winces when the graders touch the prep, you fail for inadequate anesthesia.
Worst of all is that when you finish the boards, you have to wait four to six weeks to find out if you passed. If you fail any portion of the exam, you have to retake that particular section. By the grace of God, I passed!
I’m Finally a DMD!
I entered the practice my grandfather, Dr. Boyce “Boo” Nunnally, founded in 1965 in Louisville, KY. My uncle, Dr. Greg Nunnally, currently runs the practice. So, that makes me the third-generation Nunnally to be part of it.
I’ve been around this practice my whole life, so I feel very comfortable here. As a new dentist, I thought my main challenge would be to gain patient acceptance and respect, but that hasn’t been a big problem. This is probably because people are placing confidence in me that was earned by my grandfather and uncle.
I briefly considered specializing in prosthodontics, but I believe I made the right choice by entering the family practice. I like the thought of watching families grow and being a part of their lives. As a GP, I can tackle anything I want and refer what I don’t. It’s been exciting and very rewarding these first several months, and I’m beginning to get a grip on what the real world of dentistry is all about.
Was I prepared to treat real-world patients right after graduation? Yes and no. I was confident in my hands-on dentistry skills but I had a lot to learn about how patients are treated in a “non-university” setting. At the school, we had several three-hour appointments just for diagnostics. We would mount casts, take all sorts of radiographs, identify the patient’s concerns and chart everything about a patient. We wouldn’t present a treatment plan until after nine to 12 hours of chairtime plus additional time outside clinic to consider the options. In private practice, patients want to know their options right then and there.
The biggest challenge so far has been the diagnosis of emergency patients and developing treatment plans that are appropriate for the patient’s health and meet his expectations. School was based mainly on comprehensive care yet so much of private practice is based on emergency care. Every day I get patients coming in with cracked teeth, abscesses, tooth pain they can’t quite pinpoint, sensitivity that comes and goes, sore gums or muscle pain. And they want to know you can fix it and be confident in doing so. Instant diagnosis and remedy is what the patients demand and need.
It’s going to take years to get proficient at knowing exactly what will work for each patient. All I can do now is take my time and provide as much diagnostics as I can. But when a patient says a tooth hurts and every diagnostic procedure I do hits a dead end, it’s nerve racking.
It’s also difficult when a patient only wants to receive limited treatment and ignores things I know will come back to bite him, such as refusing to crown a tooth that’s been endodontically treated, replace broken/decaying restorations or address periodontal issues. In these situations, all I can do is inform the patient and then hope he beats the odds.
Of course, all my work goes to my father’s laboratory, Derby Dental Lab in Louisville, in which I worked since I was 16 years old. I know the technicians and materials so I’m able to communicate well and obtain great outcomes for my patients.
But I know most new dentists aren’t like me. Since we learned so little of it in school, my classmates don’t really understand laboratory work and may not be able to communicate as well. However, on the plus side, they have a lot more faith in lab technicians than dentists of the past. My classmates had a huge respect for the lab business and look at technicians with some awe. New dentists want to do dentistry; they don’t want to be technicians and they look to laboratories to make their jobs easier.
From what I’ve seen, labs have a great opportunity to foster relationships with recent graduates by providing education and support. If you start to educate them right off the bat, they’ll become loyal clients. They’ll put a lot of stock in what you say and will adjust their work if you demonstrate it’s necessary to receive a quality prosthesis.
Dental school was a long and challenging road, but I couldn’t be happier to be back in the real world and walking down the next part of my dental career path. I hope I can be a resource to the laboratory industry and provide some insight into the needs and thoughts of the modern dentist.
Pictured above: Dr. Eric Nunnally (middle) with his wife, Mary, at his graduation from the University of Louisville Dental School.