The Young Dentists' Survival Guide - skills every young dentist should own

 It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.

-Charles Darwin

The world now has changed drastically due to the increasing level of competition. It now has the primal law of survival of the fittest. Dentistry as we discussed last time, is no different. With new inventions and innovations coming up at a pace where one will miss a lot with the blink of an eye, standing out with a unique set of skills is considered the only way. A health science that depends largely on materials and technology, dentistry often runs on trends set by newer materials, technologies, and sometimes even fellow dentists themselves.

In a world where everything is evaluated in terms of results and output, the dentistry market is often driven by high-end products, equipment, and techniques. Today, patients are frequently confused, and occasionally misguided by what they observe- that dentist is an implantologist; that one does single sitting RCT (root canal treatment), uses rotary; that one is good knows ortho-treatment/tooth positioning without using wires, that dentist knows laser treatment; that doctor uses Botox. Even we dentists also experience the same when we are at the market or are approached by others with various different materials, workshops, courses, instruments, and whatnot. Anything shiny attracts people; that is how our psychology works. While patients look for cost-effective, aesthetic, so-called hi-tech, and long-lasting options in the shortest time possible, dental surgeons look for saving chair-side time with patients, cost-effective investments, easy to learn techniques, sometimes fancy items, and above all, anything that makes us stand out and attracts more crowd. After all, like it or not, clinical practice has a lot of business involved, or sometimes, it is business.

There is a saying- if you aim for the moon, if you miss, you will still be among the stars. Well, I am a much-grounded person. And I have learned that if one is thorough with the basics, the foundations are strong and the sky is the limit for what one builds on that foundation. Sure one should learn new things with an open mind, but it will only be a waste of time and resources if the basics are not clear. Moreover, one should know that the patient showing potential for implant placement or laser surgery is quite rare and needs proper convincing. Our time in dental school is a roller-coaster ride, where 5 long years seem too little for us with too much to learn. It is not surprising for us if we are not well-versed with something. One tends to miss a thing or two when there is always the sword of examinations hanging over the neck. Therefore, for young graduates, learning the basic skills properly is much more important.  Moreover, in the five years we are so engrossed with books and clinics we learn very less about people dealing and practice. After all, most dentists are entrepreneurs of their clinical practice.

With that being said, here are some tailor-made topics that young dentists must learn during their initial years, with proper support from seniors and peer groups:

·     Oral anatomy and histology: exposing pulp during tooth preparations, breaking of the tooth and/or restoration, painful occlusal grinding or tooth preparations, file breakage, root canal perforations, adverse effects due to local anesthesia, the number goes endless and I can bet anything on the fact that almost every dentist have encountered once in clinical practice. The deep-rooted cause- dental anatomy and histology, and physiology classes seemed boring in the 1^st year, or have been quite forgotten by internship. Which cusp is larger, where the pulp horns lie in close proximity to enamel and dentin, which direction the enamel rods are in at which one-third of the tooth, where does the mandibular nerve and the maxillary artery or the greater palatine artery courses from, these are things that should be on our fingertips.

·    Pathology, Physiology, and pharmacology: often minor mistakes in dental procedures may lead to major complications which can be prevented with proper knowledge of pathology and physiology. Working in an area with a large number of blood vessels around has its own share of problems. Hence, a thorough knowledge of the cardiovascular system, heart diseases, inflammations, coagulation, hemostasis, etc. as well as of reading vitals, and necessary evaluation is what makes a dentist, a doctor. Though the spectrum of medicines is very less when it comes to dental practice, it becomes easy to remember the detailed pharmacology of antibiotics, NSAIDs, muscle relaxants, proton-pump inhibitors, various kinds of toothpaste, intra-canal medicaments, ointments, and mouthwashes. However, indications and alternatives should be known to provide supportive symptom-based treatment.

·     Prosthetics: while tooth preparations, should be regularly practiced as per indicated crown/bridge, one should master simpler techniques like impression taking with various materials, gingival/gum separating techniques using cords, various luting, and restoration materials. One should have a profound concept of what material should be used in which case. A good eye for precise shade selection and tooth selection is an added advantage over the technician and a key to satisfied patients.

·  Operative dentistry/endodontics: tooth preparation and access cavity preparation are a must. A typhodont set and previously extracted teeth should always be preserved and kept handy for practice. Also using old files and gutta-percha points helps develop the tactile sensation required for endodontic restorations. If possible one should also learn to use tooth isolation techniques with dry gauze and a rubber dam. In case someone has weak eyesight and is planning for a loupe or microscope, make sure to expertise using it on typhodont and extracted teeth. Also, proper polishing skills help to stand out from the contemporaries in restorative treatments. It helps to retain aesthetics, along with preventing discoloration and staining.

·    Ergonomics: spending long hours in the dental set certainly strains the muscles and nerves. As a result, proper posture, chair positions, and illumination are necessary. Long hours of dental procedures over a lengthy period of time in poor posture are harmful to the spine and eyes of the operator. More importantly, it hinders the proper application of force, visibility, and grip resulting in decreased work efficiency and in case someone is short of luck may cause accidental injuries. Thus one should be well-versed and practiced about proper chair height, patient operator distance, the distance of the light source, position of auxiliary and patient position to ensure comfort, safety, and efficiency.

·    Oral surgery: while most oral surgery patients are either restricted to extractions and impactions, or arrive as emergencies, or directly visit hospitals after referrals in case of severe injuries. Mostly in case of injuries like dentoalveolar fractures, dislocation of the temporomandibular joint, or lacerations, one should rely mostly on instincts, presence of mind, and improvisations. Still, learn internal fixation with K-wire (Kirchner’s wire). Importantly one should know in detail about different types of sutures used in dental surgeries with their indications. Practicing sutures on old cushions or rubber cloth/Macintosh sheets is quite helpful.

·  Medical emergencies and management of medically compromised patients: one of the most important and wide topics that one should definitely learn is this. You do realize that no one is there to cover for you such cases as was the scenario in college. Nothing to be frightened of. Detailed learning about such management, particularly of patients with ischemic heart diseases, epilepsy, hypertension, syncope, etc, and learning at least about basic life support (BLS) and about emergency medicines may help you save the day.

·   Dental Recordkeeping: believe it or not, dental recordkeeping is one of the most important aspects of practice. As per the statutory bodies, records should be maintained in a standard proforma for a period of three years from the commencement of treatment. The Indian dental association advocated that dental records should be maintained for a period of 8 years. Knowing about software applications to maintain digital records for an extended period of time helps efficiently as well as ethical clinical practice. Archived records can be helpful for references, in the case of medico-legal disputes as well as in comparative identifications from a forensic perspective.

Practice management:  the moment dentists start their own clinical practice they become entrepreneurs. While the skills required are already learned rigorously for 5 to 8 years and practiced time to time, this is something never taught and is often overlooked. It is a must for a young dental graduate with a new clinic to know how to take a strategic approach, enhance leadership skills, effectively market his/her practice and drive the financial performance, for survival in the highly competitive market. Acquiring business and marketing skills will help grow and reach new clientele. While a true leader learns from following instructions, standing on your own and being responsible for your team is what makes a dental practice grow, which works not only with the doctor but also the auxiliaries.

https://dental.thedawsonacademy.com

 As our elders say, “practice makes perfect”. However, there is also a saying, “manners maketh man”. While the points discussed earlier are eventually covered with years of revision and practice, it is our behavior which we are remembered by. Not only that, but there are a few soft skills that are either innate or acquired with experience, and need to be polished.

·         Interpersonal skills: a casual conversation is always effective. More importantly, that conversation should correspond with the no. of ears and mouths we have. When we start talking with someone about something random other than the ailment, it kind of releases the patient’s stress and allows him/her to feel comfortable. This further helps build an understanding with the patient and thus allows proper history taking as well as knowing the patient’s fears. Keeping the competition aside, having respect and good terms with fellow dentists, also helps in getting solutions for tricky cases. Good interpersonal and communication skills are essential for successful practice.

·         Attention to detail: good observation not only helps in having flawless completed work but also helps detect other secondary ailments or indicators of other systemic diseases, which may lead to subsequent appointments, thus developing a clientele. It also helps develop our critical thinking for devising better treatment plans. A dentist should be a critical thinker, irrespective of his/her merit to augment the appearance, color, shape, alignment, and size of the patients’ teeth

·         Manual dexterity: never can a dentist be imagined without nimble and steady hands. I am pretty sure that I don’t have to mention how precise work do we have to do. Working in a confined area with a rich blood supply and numerous delicate tissues does require steady hands. A good practitioner has great hand-eye coordination and controlled strength application.

·         Compassion and honesty: any profession becomes nobler with honesty. In the case of medical care, it also encompasses transparency with the patient and protecting the patient’s rights. Additionally, a visit to the dentist is seldom pleasant for the patient. But if we can empathize with the patients to convince them that we do understand their perspective, will try our best, and respect them, the job becomes much easier. We can make much more difference by participating in community service and providing affordable dental care.

·         Enthusiasm: an enthusiastic dentist-patient radiates energy not only to the team but also to the patient. It increases the coordination among the team, boosts leadership skills, and also helps develop trust with the patient. Lively conversations ensuring that they feel secure and the center of your attention, likely make them inclined to become regular patients of yours and also recommend you to others.

·         Calmness: if someone asks what the cure for white-coat hypertension is, just say “the calmness of the doctor”. A calm demeanor has manifold benefits- helps to work patiently and meticulously in a highly sensitive area, formulate a treatment plan, coordinate the team, build up confidence with the patient, as well as get through tough cases and situations.

·         Artistic flair: there is an age-old internet content that says “DENTIST = Doctor + ENgineer + arTIST”. Well, it has been correctly said so. Having a bit of artistic flair helps a dentist achieve excellent tooth preparations, restorations, denture work, etc. After all, there is a reason we call it smile designing, and something called aesthetic dentistry exists. In a broad sense, while most patients are quite unaware and indifferent about the protection and maintenance of oral hygiene and the structure and function of the teeth, everybody is concerned about aesthetics.

·         Ability to work under pressure: a clinical practice is very different from working in a hospital or in the dental college because there is nobody to cover for yourself, to supervise and guide you. You are all on your own. Because of this, sometimes the dental chair can be all sorts of horrors- complications, emergencies, medically compromised patients, and often disputing unsatisfied patient parties. In such intense situations, one should be able to hold him/herself together and skillfully as well as effectively manage such circumstances. Every patient is unique and often conventional measures don’t work. A dentist should know to innovate and think out of the box. Sharp problem-solving skills are, therefore, a must.

·         Urge for learning and adaptability: in a fast-paced world where everything is being updated almost every day, keeping up is both a challenge and mandate. A doctor’s whole life is about keeping up with the world of medical science and advancements. When it comes to practice, a fluidic nature to adapt to market trends and recent tech is what defines survival. A love for learning only makes it easier.

Dentistry, irrespective of its challenges is a noble as well as fun profession. But the more competent the young contemporaries become, the greater is the chance for the field to flourish. In the end, the most essential characteristic needed is patience. We all need time, and with patience, time becomes a good friend.