The End of my Second Quarter at Midwestern

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Facebow

Everyone tells you that time flies in dental school and they were not lying! We’re now at the end of our second quarter and coming into the home stretch. This post is an update about what we have done up through our second quarter at Midwestern AZ.

This quarter we were far more involved in the simulation (SIM) clinic than last quarter. We started basic preparations at the beginning of the quarter and finished with a practical examination involving a class I composite restoration on #30 and a class I preparation on #31.

Week 1

Dental Instrument Setup

Our first day in the SIM clinic this quarter involved a pulp chamber access and wax up of #14. I have to say, waxing molars is a lot more difficult than incisors, premolars, or canines. But, having seen how valuable a good wax up can be in the clinic, I am determined to continue to improve this skill. Some patients love to see what their teeth will look like and wax is a great way to show them.

Weeks 2 & 3

Ivorine Teeth

The following week in SIM we completed a pulp chamber access and wax up of #30. This was our final project involving wax. Although I really enjoy waxing, I was starting to get a little burned out on it. I didn’t practice as much as I should have for the first practical the following week and ended up getting a B- which was the first big academic disappointment of the quarter for me.

No matter though, if you work hard enough you can always recover. Sometimes I need the pressure of falling behind to really push myself harder. I don’t recommend or condone working that way, but I am only human and a bit of forgiveness is sometimes called for. But, more on that later.

Basic Science is Still Hard…

Outside of the SIM clinic we had the usual basic science courses (BASI). Midwestern teaches the basic sciences in a modular fashion, so we study everything about a given body part at the same time. Our first module was fairly straight forward basic gross anatomy. The second module however was the infamous neuro module. We had to study the histology, physiology, anatomy, biochemistry, cellular biology, and pathology of the brain all at once. I was told that more people fail this module than any other.

As I said, the first module was quite easy and was a nice way to ease us into the winter break. The second module spanned four weekly examinations and was a real monster. I did very well on the first exam, much to my surprised. The second exam went very well too. I was on course for an A in the module when I bombed the third exam. I even wrote about it here.

Dental School is a Marathon!

So, getting back to that B- I received on the first practical… Now I’ve also bombed the third exam of the neuro module! Naturally, I was getting pretty discouraged. But dental school is a marathon. You can’t let single failures or setbacks keep you from a strong finish.

That said however, I did have to make some sacrifices. I also didn’t have the energy or the time for other things I would like to have spent more time on. This website was a bit neglected because there were so many technical issues I had to work out that it was too much with my heavy workload at school. So, now that the website is technically sound and on a stable footing I plan to write smaller posts about the quarter as it progresses rather than one giant one at the end.

Anyway, getting back to my academics, there is a happy ending. I managed an A- in the SIM clinic despite that first B-. I also managed an A- on the neuro module despite bombing the third exam. Hard work does pay off in the end!

Week 4

This week we completed our first class I preparations on #19, #20, and #21. Midwestern requires us to do ideal preps as though we were filling with amalgam. That means that we have to obey the rules for retention form, convenience form, outline form, etc. Although we will rarely fill teeth this way in clinical practice, it trains our hands to a higher level of proficiency than if we were merely ‘chasing decay’ as they say. Also, it is easier to standardize the grading criteria when we are all obeying the exact same set of rules.

Class I Preparations

A quick word on grading at Midwestern. Every student has their own numbered mailbox that we place our practicals into. We have a key that unlocks only our mailbox, and the instructors have no idea which number corresponds to which student. This way the grading is double-blind and professors will not grade our practicals with a preconceived idea of what they think we should get.

Week 5

We took those class I preparations from last week and filled them in with our first composite fillings. Many of us also started our facebow projects which was a continuation of the mounted cast project from last quarter. Many dentists deride the facebow as a clunky piece of unnecessary equipment that takes too much time to setup. Other dentists say that it is better to measure things correctly the first time and know that everything lines up.

Facebow with Mount

As a student I tend to agree that it is better to measure correctly. I really hope that the pressures of clinical dentistry will not erode my desire to perform precision dentistry. I really enjoyed learning about the facebows, especially because I was lucky enough to get an instructor who really knows how to use them well.

That brings me to an interesting topic. So much of what you learn depends on whom you are lucky enough to get instruction from. Your bench instructors change each quarter, and obviously the quality is not the same between them all. Some are simply better than others. That said, every one of them has something to teach you, and they more teachable you are the more willing they will be to impart their wisdom to you.

Weeks 6 & 7

During our sixth week we prepped and restored #30 and #31. On our seventh week we had our first taste of indirect vision as we completed restorations on #3, #4, and #5. Working upside down in a mirror is frustrating, but I got significantly better by the end of the day.

We also performed our first head and neck exams on each other, a skill I put to use when I volunteered for H.O.M.E. later that week. Several of us worked with teams of healthcare professionals and students to provide free care and examinations to the homeless in Phoenix.

I have never seen so many homeless people before as I did that night. The streets surrounding the shelter were crowded with people. For me, I only wish that we could do more to help the homeless. But as students and without proper equipment there is often little we can do except refer them on to the appropriate specialist for followup.

Thankfully, the sixth week ended the neuro module. I studied really hard to ace the final test and try to recover my module grade the best that I could. Our seventh week was a fresh start on the cardiopulmonary system

Weeks 8 & 9

Things settled down a lot in BASI and I started to work on this website again. I transitioned from Drupal to WordPress simply because it would take less time and maintenance. That was a pretty big project to squeeze in with everything else. Hopefully now I can dedicate more time to actually posting articles than just maintaining, updating, or fixing the website!

My fiancee and I also spent a lot of time planning for our wedding and an upcoming trip to Hawaii for spring break. I will probably talk about both in future articles.

Class I Amalgam Restoration

Much of our time in the SIM clinic was spent working with amalgam. We first learned how to place class I amalgam restorations and saw for ourselves just how easy it is to work with. No wonder so many dentists love working with amalgam still!

Class I Amalgam Restorations

Class I Amalgam Restorations

The next week we learned about the amalgam removal process. Of course there are stringent guidelines governing the removal of potentially hazardous waste, dental dam placement being one of them.

Dental Dams are your Friend!

Here at Midwestern we are required to place a dental dam for any kind of restorative procedure in SIM. They tell us that they require it in the clinic too, but in my experience I have only seen a dental dam placed in clinic for an endo procedure. That is the standard of care for endo procedures.

But, because we place dental dams so often, we are getting quite good at placing them ourselves. This is great, because it means that I will be able to teach my future assistants well, and in the event that I’m in a pinch one day I can place my own too!

Most dentists do not place a dental dam for every restorative procedure. But there are many benefits to doing so. Dental dams prevent aspiration of burrs or other instruments. Also, when placing composite, isolation is key. A dental dam helps to maintain isolation of a tooth. Furthermore, the dental dam helps patients to keep their mouth open wide so that the dentist has a better working field.

Week 10

Our last week gave us our first exposure to pediatric dentistry. We performed class I restorations on #S and #T. Working with such tiny teeth is harder because the enamel is thinner, the pulp chamber is comparatively larger in proportion to the tooth, and any slip or mistake will be much harder to correct on such a small surface. But our hand skills have improved immensely, and even tiny milk teeth don’t pose as much of a challenge for us anymore.

Pediatric Teeth

My week ended with my second clinical rotation which I wrote about here. I really enjoy getting into the clinic because it’s a glimpse of what we will be doing daily in less than two years.

Second Quarter Conclusions

Our second quarter is behind us and the third begins tomorrow. We have learned how to perform class I composite and amalgam restorations. We have also  This quarter we will learn to do class II, III, IV, and V restorations. It is amazing just how much exposure we get to hands-on dentistry at this school.

I plan to keep up the blog more consistently this coming quarter. I would also love to hear from students at other dental schools someday in the future. If you want to post about your school here then please click the contact link at the top of the page. I would love to hear from you!

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