TOP 3 CLINICAL MISTAKES OF NEW GRADUATE DENTISTS (AND HOW TO FIX IT!)
It is my pleasure to introduce a special guest writer - Charlie Cage, DDS, MS. Dr. Cage is currently serving as assistant director of the AEGD program at 32nd St Dental Branch Clinic. Originally hailing from the Caribbean, Dr. Cage went to dental school at University of Nebraska Medical Center - School of Dentistry and completed a residency in Operative dentistry at University of North Carolina at Chapel Hill. Dr. Cage currently oversees over ten first-year grad dentists (one including myself) and has a wealth of knowledge to share. Her passion for general dentistry and education inspired her to create her own webpage (https://drcharliecage.com/operativedentistry/). If you’re interested in learning more about Operative dentistry, dental education, and exploring the health and wellness space, check out her page!
Given her unique background in dental education paired with specialty training in operative dentistry, I wanted to gather some clinical pearls pre-dental students, current dental students, and new practicing clinicians can gleam. In this short 4 minute read, we will be discussing the top 3 clinical mistakes new clinicians make and how to avoid them to ultimately provide quality dental care for our patients.
Without further ado, here are Dr. Cage and I’s shared words of wisdom:
Mistake #1: Lack of communication with dental staff/technician: It’s stressful! You’re a new provider, trying to make a great first impression with your employer/dental school faculty and satisfy your patients. During all, you have not mastered the harmony of working with a dental assistant. It’s the ultimate juggling act for dental students entering clinic or new graduates.
Most new graduates can benefit in production, efficiency, and facilitate a positive working team environment by having a fostering a working relationship with your immediate second set of hands chairside. The key is to properly calibrate expectations and delegate roles when you first meet your tech. Consider covering these topics with your assistant prior to working together:
- Have a list/photo of the materials (restorative materials, bonding agent, micro brushes, instruments that you like to use)
- Highlight what role you want the assistant to be responsible for (ie. Assistant will light cure and hold the shield, assistant will take BP, oral rinse, open instrumentation prior to you entering room, etc.).
- Offer an opportunity to debrief with your assistant and welcome two-way open feedback.
- Be open and observant to different communication styles. The assistants are your extended hands and achieving a harmonious relationship can greatly improve the relationship with your team.
· Protip: If you are in a practice where you routinely work with different dental assistants, it can be helpful to have a quick print out accessible for your assistants of photos of your preferred set up.
Mistake #2: You are not documenting your own work. This can take the form of pre and post op photos, post op radiographs, or wax ups. There is a lot to be learned from documenting and reflecting on your own work.
I started taking digital photos of my work and created a digital catalogue of my work. To quote a notable NYT Best Seller Author of “Show Your Work!”, Austin Kleon take home point is the novice stage is the best time to start documenting the work you do. For tips on how to get started with capturing dental photography chairside, check out Dr. Cage’s articles linked here: https://drcharliecage.com/stop-fogging-dental-photography-mirrors/ and https://drcharliecage.com/get-started-with-dental-photography/
- Protip: Take the time to invest into a DSLR digital camera, ring flash, and macro lens. To make this professional investment more cost effective, you can buy used camera parts. You can also write this purchase off as a tax deduction.
- HPSP Pro tip: the HPSP program will reimburse up to $1500 of digital camera purchases. I purchased a brand new DSLR, ring light, and macro lens. A great way to earn credit card points.
Mistake 3: You are not properly cord packing to maximize your chance of that sweet final impression on first try! Admittedly, cord packing is a technique I am still mastering. Doing so with intention makes the difference between one and three final impressions, saved chair time, and an a more pleasurable experience for the patient. Refer to the suggested workflow below and illustration to best understand cord packing:
For a double cord packing technique:
Step 1: Determine the necessary height of your margin. This will depend on the existing margin of the previous restoration, decay, probing depth, biotype, if the tooth is in an esthetic zone, etc. Ideally, it is best to keep your margins supragingival unless you are working in an esthetic area.
Step 2: Take your smaller cord (size depends on patient’s biotype) and soak in water with the goal of achieving apical displacement. (See image for reference below).
Step 3: Utilize your second cord (one larger size than previous) to achieve lateral displacement. Soak the second cord in a hemostatic agent and leave in sulcus for 5-7 minutes for ideal tissue management.
Step 4: Prepare to take your analog or digital final impression. Remove the 2nd cord and STOP. Evaluate if you can circumferentially see your margins. If not, do not blindly take the final impression. Instead, apply mechanical pressure by repacking the 2nd cord.
To trouble shoot, consider changing size of cord, converting to single cord technique, crown lengthening, or evaluating restorability.
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