Their first patients
September 27, 2019
Editor's note: In November 2017, the ADA News launched Becoming a Dentist, a series of stories that follows three dental students at the University of Maryland School of Dentistry — Dan Yang, LaShonda Shepherd and Ben Horn — during their journey to becoming dentists. See all the stories in the series at ADA.org/BeADentist.
Baltimore — It’s the moment Ben, Dan and LaShonda have been anticipating ever since they began dreaming about becoming dentists: the first time they treat real patients.
The summer between students’ second and third years at the University of Maryland School of Dentistry marks their initiation to the school’s dental clinic. After two years of gross anatomy and mastering the fundamentals through simulation labs and lectures, the now-third-year dental students are finally getting to treat real people with real teeth. From administrative duties and radiographs to developing treatment plans and executing procedures, this is what they signed up for.
“It’s exciting and a change,” Dan said. “This is what we’ve been waiting for.”
“Finally,” Ben said.
| Urgent care: Ben, right, completes an injection while fourth-year Jason Holtman assists.
Clinic integration begins in June with a two-week orientation, after which each student is placed into one of 10 general practice tracks, known as GPs. Each track has its own faculty team on hand to provide guidance. Throughout the year, the students also are assigned to specific “blocks” of study. During the summer, for example, LaShonda, completed the pediatric and screening blocks; Dan completed the panoramic X-ray, urgent care, and screening blocks; and Ben completed urgent care and oral surgery blocks as well as spending a few days learning to screen patients.
A typical day might include screening patients in the morning and assisting on a periodontal procedure in the afternoon as LaShonda did one day in June. Or it might mean spending the first half of the day exposing radiographs before taking a turn in urgent care as Dan did on another. On one particularly exciting day, Ben found himself shadowing in the oral surgery department in the morning and assisting on a periodontal surgery in the afternoon.
It’s challenging, particularly in the beginning, as they adjust to the transition.
“No matter how prepared we all feel going into third year, working on a live patient is inevitably going to be different,” Dan said.
In addition to seeing and treating patients, the students also take turns learning to use all the equipment in the clinic, including how to take X-rays, both panoramic and a complete radiographic series. They are also responsible for paperwork that includes scheduling, making sure patients pay and fill out the proper forms, and performing the lab work that accompanies the procedures.
“I find myself leaning on the D4s and asking them what feels like hundreds of questions,” Ben said. “The good thing is that they have been great and always seem to be able to take the time to help out. Oftentimes my questions are met with, ‘I remember how it was last year, you feel like you don’t know anything.’ And we chuckle.”
The students are assigned patients and also are encouraged to add new patients through referrals. Another way to build a patient list is through patient screenings. Each student is responsible for spending a full day every five weeks doing screening blocks, which include taking patient histories.
“It’s great because you don’t know what you’re going to get, and it might lead to an interesting case,” LaShonda said.
But patients can come from all sorts of places. In April, Ben ran into a former lacrosse referee he knew from California and later wound up scheduling him as his first patient.
“He sat there for morning and afternoon sessions while I kind of fumbled through everything. I feel well-trained, just slow! He was a trooper to sit there for roughly seven hours and I know I’ll never, ever forget it,” Ben said.
Perio assessment: Dr. Hanae Saito looks at a patient's chart as LaShonda looks on.
Fellow UMSOD students – usually the fourth-years—also help the third-years find treatment opportunities. That’s how LaShonda found herself in the periodontics unit on a Thursday afternoon in August. Fourth-year student Kyle Armstrong knew LaShonda needed to perform a periodontal assessment and helped connect her with one of his regular patients.
As LaShonda performed the assessment, she was supervised by Dr. Hanae Saito, clinical associate professor in the school’s division of periodontics, who also examined the patient. Dr. Saito showed LaShonda how the patient had larger pocket depths than they initially assumed and showed her how to hold the end of the perio probe so she could feel the cementoenamel junction while the two updated the probing depths on the patient’s chart.
“We’re newbies, so the CEJ is sometimes hard to detect, especially in cases of altered passive eruption,” LaShonda said. “During my treatment plan presentation to Dr. Saito, I learned that [advanced gingivitis cases] might cause increased probing depths due to excessive gingival tissue — and not necessarily attachment loss. This reinforced the importance of examining patients radiographically and not solely relying on the clinical/perio examination when making a diagnosis.”
X-ray block: Hygienist Jacqueline Dailey and Dan pose for a photo during a break from screening.
During his X-ray block, Dan worked with Jacqueline Dailey, a registered dental hygienist and clinical assistant professor in the school’s department of oncology and diagnostic sciences, who instructed him on how to take panoramic X-rays.
“We're going to need to have you take off your glasses, OK, sir? Do you have any other removeable items such as necklaces or metal appliances in your mouth or anything like that?” asked Dan of his first patient, who shook his head no. “Will you please hold onto these handles and place your chin on this flat area while we adjust the machine?”
Over in the urgent care section, Ben and fourth-year student Jason Holtman consult with a 17-year-old patient and her mother regarding the patient’s cracked No. 31 tooth. The patient arrived in pain and complaining of sensitivity.
After consulting with Dr. Gregory Winter, the supervising dentist, and the patient’s mother, the decision was made to extract the tooth. Mr. Holtman then performed the extraction, while Ben assisted.
“I’m loving clinic,” Ben said. “The military guy and engineer kind of loves the process of everything so far. Charting, analyzing radiographs, methodically carrying out procedures, being busy and getting work done, etc. The unknown creative side of me is being challenged and pushed, and I’m loving it.”
The summer clinic is just the tip of the iceberg for now. Each student is tasked with completing a list of clinical requirements before they are able to graduate. During the fall semester, they have classes on Tuesdays and Thursdays, and work in the clinic Mondays, Wednesdays, and Fridays, with the occasional Thursday night appointment.
Is it harder than they expected?
“My takeaway from this summer is to be very organized, come to clinic prepared, and to take on procedures early,” LaShonda said. “You’ll never feel ‘ready,’ but you will start to feel a lot more confident with each patient encounter, so get the experience.”
“A highlight for me this summer is definitely how much I’ve learned already. I wouldn’t even dare to say that I’ve seen the most patients or anything like that but just being in clinic means you can have exposure to a lot of different types of patients,” Dan said. “I’ve treated patients in oral surgery, endo, perio, and the general dentistry clinics. I’ve also enjoyed shadowing at the ortho clinic. The hardest part about clinic is exactly something that we haven’t been able to simulate the past two years: patient management. Every patient comes in with different needs and different expectations.”
Supervising: Dr. Gregory Winter examines one of Ben's patients during his oral surgery block.
“I love providing care to the patient,” Ben said. “Every time a patient comes and sits down in the chair you gain experience, which ultimately makes you a better provider and that feels good to be improving at a fast rate. It doesn’t matter if it’s just learning to more efficiently take a medical history or performing a large restoration, I feel like I’m learning tons each day, and that’s fun. It’s also challenging.”
In September, the Class of 2021 officially celebrated its transition from classroom to clinic when all of the third-year students received their white clinic coats during the school’s White Coat Ceremony.