I recently began a 6-week clinical rotation at Salud clinic in Longmont, Colorado. On my first day, after I performed my clinical examination, I presented my treatment plan to my preceptor. After she performed her own exam, the patient’s treatment plan looked entirely different. After listening to my preceptor’s rationales, it became clear to me that her treatment planning principles were significantly different from those we employ in my school clinic.

When it comes to something as fundamental as caries diagnosis, it’s surprising how much discrepancy there is among dentists about how to treat a lesion, or if a lesion should be treated at all. Although we may share the same foundational knowledge, our philosophies can vary greatly. And so, it is important to review concepts from our first year of dental school, including adhesion and bonding chemistry, ideal preparation shapes, and even proper ergonomics to establish a baseline. These topics will continue to be relevant throughout our dental practice, and help us make tough calls. There are a few simple ways to review your fundamentals:

1. Volunteer to be a teaching assistant for D1 or D2 pre-clinical courses

Being a T.A. requires you to know a broad base of information. Underclassmen will ask you to clarify tough concepts, which will challenge you to deepen your understanding of the topic.

2. Read dental journals and articles

Reading dental magazines such as ADA News, Dental Economics, or Dentistry Today will brief you on new studies that challenge popular thought.

3. Join study groups or discuss procedures with your colleagues

Discussions with your colleagues about how you perform procedures can help you systematically review your basics.

Reviewing your basics is essential to becoming the best clinician you can possibly be. Challenge yourself to think systematically, and to rely on scientific reasoning when making clinical decisions. By doing so, we create consistency in our practice, and make decisions based on a little more than just intuition. 

Throughout dental school, there is a multiplicity of course and clinical requirements that students must complete in order to proceed through the years and graduate with your doctorate.  Often mentioned, but hastily glossed over, is the option of finding oneself a mentor.  A mentor is someone who can help guide your way through the field of dentistry, evolve your understanding of what it means to be a dentist, and assist in narrowing down the fields/specialties in dentistry you may choose to follow.  It may seem like second nature and/or common sense to find someone who has experience in the field and can offer a wider perspective of dentistry.  However, coming from a new program and as part of the inaugural class, there are many other things on the minds of faculty trying to establish a brand new dental school. 

Now in my fourth year, I realize how important it is having a mentor and the role they can play in the evolution of my own career.  Their experiences can shed light on certain areas of dentistry that some students may not have the luxury to explore on their own.  I strongly believe and cannot emphasize enough the importance of finding a suitable mentor during your fourth year or even earlier.  For prospective students or even first and second years students, this may seem a little preemptive.  With all the other responsibilities students must take care of during dental school, I can assure you it is not.  The earlier you find one, the more you are exposed to their knowledge and understanding of dentistry which will help you make decisions about the path you choose to take in our honorable field.  You can always get an early start by joining ASDA, ADEA, AGD, or shadowing dentists if you have the time, and doing research, etc to network and meet people effectively increasing your perspective on your career of choice. 

Where the mentors and their mentorship really come into play is during your fourth year when students are on rotation.  The fourth year, in essence, is all about transitioning into the real world.  What better way to have an upper hand on this process than by having a mentor who’s past experiences have been helping guide you along the way throughout dental school.  Even if you plan on doing a residency, they can help guide you in the right direction or realize what it is that you do not want helping you narrow down your choices. 

Here at UNE, we have practice management courses available, however, they can only teach you so much without real life experience or exposure and this is exactly where and why these mentors play such an important role for current students and future dentists.  The knowledge and experience that they impart on us is so valuable it may in fact be priceless.  According to a recent survey our class's student government conducted, more than half of students are planning to go straight into the real world job market and start working, 80% of which plan to join as an associate, which is why I believe it is absolutely crucial and imperative to your career and life to find a mentor.

When presenting a treatment plan to a patient, we have to explain all available options, including why specific restorative materials are superior or contraindicated in certain situations. The trends are shifting more towards esthetic dentistry and less consideration is being given to long-term prognosis. If finances are an issue, patients might compromise and not choose the “optimal” option. Whichever factors drive the patient, it is up to us to educate them to the best of our ability to make sure they understand the implications of choosing a material.

Many choices of restorative materials exist for patients presenting with cavities, tooth wear, trauma or cosmetic issues. All materials have different properties and require various techniques for placement. Ideally, a restorative material should be identical to natural tooth structure, including physical properties, biocompatibility, esthetics and application. Some long lasting restorative materials are composite resin, amalgam and gold.

Direct resin based composite restorations have increased in popularity because they closely replicate the appearance of natural teeth. However, are they the most superior material for posterior restorations? It is important to remember that posterior restorations need to withstand greater occlusal forces. The current resin-based composite materials have improved enormously, but research still shows that for posterior restorations, they are at a disadvantage in comparison to amalgam due to decreased longevity and bacteriostatic properties. Resin based composite allows for a more conservative preparation, but is more technique sensitive. Overusing resin-based composite can be detrimental to the patient’s teeth in the long-term, due to shorter longevity of the material and decreased strength of the tooth every time the restoration needs to be replaced.

Amalgam is the most cost effective of the three materials and has great strength and longevity. Amalgam is easily placed, can withstand high occlusal forces, and has a marginal seal that improves over time. However, due to misconceptions about mercury and poor esthetics, amalgam is not a favorite for many patients and dental professionals. Clinicians must be aware that it is unethical to replace sound amalgam restorations by preying on patient’s misinformation or solely to make a profit. Amalgam can produce staining on the teeth over time or fractured cusps can result due to the preparation technique and wedging effect. An additional limitation of amalgam is different expansion and contraction characteristics in comparison to natural tooth structure. Still, it is a great material to be used on high caries risk patients.

Gold’s popularity has also decreased due to esthetics and cost. Gold does not discolor the tooth and, up until resin based composite increased in popularity, it used to be considered esthetic for posterior restorations. Some dentists still use gold and have learned to do exceptional esthetic dentistry through techniques like the invisible onlay or adequate placement of intracoronal restorations. Gold restorations have excellent durability, an almost nonexistent marginal gap on the cavosurface and will not exhibit marginal wear. The coefficient of expansion is similar to natural tooth structure. Gold is very biocompatible with gingival and supporting tissues and does not contribute to allergic responses. Even thought the procedures have become more efficient, gold foil technique is no longer taught in most dental schools or postgraduate programs.

Adequate informed consent is imperative before starting any procedure. It is important to stay knowledgeable about the latest products and to be aware of existing research and the longevity of the materials. As dental professionals, we should know how to work with all restorative materials and how to educate the patient to choose the most adequate option for their treatment goals.