Mannequins to Mania

Aavan K Matharu, fourth year BDS student, Trinity College Dublin, gives her key pointers for a smooth transition to your clinical study years.

Introduction:

The transition from pre-clinical years to clinical years is one that many dental students look forward to. It becomes a momentous occasion where we can apply all the theory and practical skills, we have learned from the mannequin lab to actual patients and clinical situations. However, this overwhelming realization comes with its demands and challenges. As I reflect on my own experience, there is no doubt that I have learned a great deal not only about myself and how to make my clinical experience fulfilling but also how to tackle these challenges.  

To help you achieve a smooth transition, here are a few pointers I have put together to tackle the clinical years to come.

Bracing the Clinical Experience:

1.Dive deep: As we start clinics, it is normal to experience nerves and opt for simpler procedures. However, delving deeper and putting yourself in clinical scenarios within limitations, which test your knowledge, confidence, and clinical skills, are critical to your development early on as a student. It is important to encourage your learning and try to make the most of dental school while you are there as clinical time is already so limited due to the pandemic.

2. The Plus 2 Rule: Attempt to do procedures at least twice or more during your clinical years. Chances are that when you do a procedure for the first time, you will make mistakes and learn a lot from it. However, when you do the same procedure, for a second time on a different patient, you will be faced with other challenges and essentially a different way to apply your knowledge. Although this can be challenging depending on the amount of time you are given for clinics, try your level best to achieve this as it will teach you resilience and problem solving earlier on.

Pre-Clinical Advice:

  1. Know the why to a procedure: When creating a treatment plan/preparing for a procedure such as a composite filling or root canal, it is critical to know WHY you are doing it. Understanding the importance and order of what you are doing creates confidence and allows you to reflect on the benefits/risks of the procedure as well as the ethical reasoning behind what you are doing for the patient.
  2. Ask a friend lifeline: Discussing topics with friends/upper years beforehand can be very helpful. See what your friends have done, what their process was in doing the procedure, stressful parts, etc. Discuss how they communicated with patients, common mistakes, and how they organized themselves to get a better understanding of what to expect and how you can learn from their experiences to ameliorate your own. 
  3. Keeping an orderly fashion: One of the most helpful things I learned was to organize my instruments in the order I was going to use them. This can really help in stressful times when you don’t want to be looking around for instruments and materials but are rather using them as you go along.
  4. Stick to the essentials: It is important to understand which instruments can be filtered out during a procedure. During a composite filling, for example, there is no need to have the entire operative kit laid out.  Instead, narrow down the essential instruments to items such as a mirror, contra-angle sickle probe, flat plastic, and micro brushes, etc. This will create more space on your bracket table and will reduce the overwhelming feeling when looking for instruments.

I hope these tips/tricks are useful to you during your exciting progression into clinical years. Remember to embrace your transition kindly and to focus on yourself as a growing clinician. All the best!

Author bio

“I am a fourth-year dental student presently attending Trinity College Dublin. Over the past three years, I have developed a keen interest in Endodontics and Restorative Dentistry. With one year of dental school remaining, I would love to be able to expand my knowledge in regards to what these fields offer by performing research with specialists and attending relevant conferences.

Apart from dentistry, I enjoy drawing/sketching and immersing myself in astronomy and cosmology. I also adore traveling and visiting multiple countries within four different continents has given me the opportunity to appreciate new cultures, food, and languages.”

Aavan K Matharu

Getting back to dentistry

Hamna Khan, fifth year BDS Student, University of Manchester, gives you her tips for a successful new academic year after an extended break from clinical practice.

It’s that time of year again for us to buy our planners, top up our stationery and wipe the dust off our clinic shoes! Only this time, things are going to be a little bit different. It’s completely normal to feel anxious or nervous about the upcoming academic year, so here are some tips on how to settle back into the operator chair and kick-start your studying.

Online teaching

Without a doubt, this will be the new normal and adjusting to this style is vital. You will need to learn to adapt to online teaching, so get to know your new virtual tools. Our future studies are expected to be this hybrid-learning model so embracing this as soon as possible will boost your chances of success. Whether sitting in a cafe or at your bedroom desk is how you work best, meshing your ideal study surroundings with your university teaching this year is how you will engage and absorb the most information. 

Reviewing theory

Not having the time won’t be an acceptable excuse this year so if you haven’t already, start looking back at previous years’ notes. Brush up on those topics you don’t feel as confident in and know procedures inside out so there’s no time to waste when faced with one. 

Articles

Whilst extra reading was important before to complement your studies, reading recent articles now is more valued than ever. It’s key to stay up to date with the latest Covid-19 guidelines and the pandemic’s ever evolving impact on Dentistry as a profession. Regardless of your year of study, Covid-19 will have changed aspects of your degree and it’s good to know how and why. The FGDP website and various social media channels prove to be great resources to help with this.  

Use your time wisely

Being back at University will definitely mean life’s on the go again but you will almost certainly still have spare time and many hours off campus. Planning in advance and time boxing will help you maintain focus on your studies. Also, breaking up your work into smaller chunks can help you adjust back to life as a dental student. Aside from your dental learning, it’s essential to stay productive and not slip back into the laid-back routine many of us will be familiar with after having so many months away. Pencilling in regular physical activity to stay fit or volunteer work where help is needed are just a couple of the many things you can do. 

Pace yourself

Many of us will be eager to get back into the thick of things but just know it’s okay to not get that alginate impression first time like you used to be able to do! It would be ideal to continue from where you left off but we’ve all missed out on clinical experience and we’ve all been away from the drill just as long as each other. You may need to do some extra practice to get rid of your rustiness, but don’t be too hard on yourself because before you know it you’ll have bounced back! 

Find your support system

Dentistry can be challenging as it is and confiding and leaning on others is something that is part and parcel with the degree. During these unprecedented times, spending quality time with friends and family or anyone who you feel uplifts and encourages you will support you in your journey and enable you to carry on. Although our University experience is likely to be different to last year, it is still important to embrace student life as much as possible, either in person – respecting the relevant Government guidelines, or virtually. Engaging in the campus community remains a powerful and long-lasting benefit of these five years at University.

I hope this helped you feel more at ease and good luck with the year!

Author bio

I am currently in my final year of Dentistry at the University of Manchester. Over the past four years, I’ve gained insight into a variety of different fields and look forward to expanding my understanding in order to find the path best suited to me. I enjoy building rapports with patients and improving their quality of life through dental care.

Outside of University, I spend time with my family and friends and enjoy travelling abroad but also exploring the scenic places the UK has to offer!

Hamna Khan

Specialising in restorative dentistry

Dr Tom Willan, General Dental Practitioner in Yorkshire, describes the career journey that led him to specialise in restorative dentistry.

I qualified from Leeds university in 2011 and began working in general practice in West Yorkshire. The variety and flexibility of life as a GDP appealed to me and after my Longitudinal Dental Foundation Training years; where I had posts in orthodontic practice, community Dental Care and general practice I began working life as an associate. 

After working in a busy NHS practice in Leeds I moved to my current practice, Horbury Dental Care, in a small town outside of Wakefield. Horbury Dental Care is a large practice with 10 surgeries and a referral centre for implant dentistry, restorative dentistry, treatment under sedation and periodontics. Shortly after working here I felt it was the right stage in my career to consider undertaking further postgraduate to improve my skills and further my career. 

I am glad that I was patient; waiting 5 years before undertaking further postgraduate training; as I felt that gave me real life experience as core foundation for me to build my knowledge from. I researched the numerous post graduate courses on offer and chose the FGDP Diploma in Restorative Dentistry. The course had been thoroughly recommended by colleagues and I felt offered a fantastic blend of academic, clinical and hands on experience. 

The course consisted of 14 modules where small group teaching, lectures, hands on teaching and assignments developed my knowledge in all aspects of day to day restorative dentistry. Periodontics, Endodontics, Composite Bonding, Crown and Bridgework, the restorative aspects of implant dentist and prosthodontics were all covered. 
I found the course thoroughly enjoyable and I feel I have gained confidence and developed as a practitioner as a direct result. I found the course days enjoyable and developed a strong bond with my cohort. I surprised even myself with how I enjoyed the written assignments as they were all on relevant topics and helped contribute to my clinical work. 

The course was assessed by the assignments and also clinical casework. I submitted 8 case reports and 20 mini case reports on clinical cases from my practice over the 2 years. These were challenging but again developed my confidence as they were constructively analysed by my course tutor, who was approachable and very generous with his time to support my learning when needed. 

I was pleased to find out in December 2018 that the hard work had paid off and I had passed my final case assessments and I have now been awarded the FGDP(UK) Diploma in Restorative Dentistry. I would whole heartedly recommend the restorative diploma to any GDP looking to improve their clinical skills, knowledge and confidence.

Author bio

I qualified from Leeds university in 2011 and have worked in general practice in Yorkshire since then. I currently work at Horbury Dental Care, a large practice near Wakefield which is a referral centre for implant dentistry, restorative dentistry, treatment under sedation and periodontics. I recently decided to specialise in restorative dentistry and after two years of study have now been awarded the FGDP(UK) Postgraduate Diploma in Restorative Dentistry.

Dr Tom Willan

Reducing risk at the chairside

Dr Antony Visocchi, General Dental Practitioner and Independent Dental Expert Witness, explains how practising with ethics, morality and integrity will help you reduce the risk of litigious action.

We all know that dentistry is a challenging profession. In these days of increased legislation, tighter financial constraints and a blossoming blame-culture, working in a busy practice whilst taking care of your patients is a very tall order.

Having now worked for over 20 years in general dental practice, I have gained a great deal of knowledge and experience and I have drawn together some of that experience which you may find helpful. 

In my opinion, the best way to deal with the threat of litigious action is to minimise the chances of it happening in the first place. Nonetheless, complaints will occur. What we can do, is practice in the patient’s best interests with the ethics, morality and integrity that will allow these matters to be dealt with quickly and as painlessly as possible. 

I would advise you to ensure you maintain good relationships with colleagues and patients, you can communicate well, are empathetic, are humble and are confident that you follow a robust system that is employed each and every time, regardless of the apparent insignificance of the task. This will not avoid complaints, but it should stop most in their tracks and allow a degree of assurance that you have done your best. In the end, that is all any of us can do.

Communication

Of all the virtues to master, I think communication is king. Use simple techniques when discussing matters with your patient. For instance, sit the patient upright, wheel yourself to the front of the patient so your eye levels are the same, use good eye contact and remember to listen to the patient. 

Be precise in your speech, avoiding jargon, and use terms appropriate to the patient. Constantly check if the patient follows what you are saying by asking; “does that make sense?”, “do you have any questions?” and “what do you think?”.

Try to assume an air of confidence, even if you don’t always feel that way! This is very important when dealing with matters that do not go to plan. Not only does this keep a lid on things, but you will have a better chance of getting things back on track. 

Humility

I recommend carrying yourself with humility. Yes, you are a highly qualified health care professional who worked extremely hard to get where you are. However, regardless of the qualifications you have achieved and the string of letters after your name, it all counts for nothing if you do not have the humility and empathy to go with it. 

Build strong relationships

Spend time at the beginning of your career building relationships that will provide a stable, supportive, empathetic and appreciative base for your working life. This will be invaluable if you find yourself backed into a corner. Patients will be more forgiving and colleagues will go that extra mile.

Mistakes will happen

You will make mistakes. If you don’t, you will not learn and will not become the clinician you want to be. Your mistakes have to be embraced. Be prepared to hold your hands up, apologise when appropriate to do so, and genuinely convey that you will do all you can to put it right.  Don’t ignore a complaint and hope the problem goes away. It is always worth reflecting on what happened to prevent the situation recurring. 

Vigorous systems

I think it’s a good idea to establish a vigorous system to follow. Get in the habit of writing contemporaneous, clear and accurate clinical records. If you use custom screens or autonotes, be sure to personalise them to the patient you are treating. Always ensure some “free writing” is added to the notes and the custom screen and/or the autonotes are not left as the sole entry.

Advice sheets

Have a bespoke advice sheet for all your common procedures. Record when these are given to the patient but ensure you also go through it verbally. It is not normally recommended to complete complicated or extensive procedures at the same appointment that consent was obtained. In that case, you must remember that consent is a dynamic and ongoing process. When the patient comes back, ask them if they read the advice sheet, understood it and are still in agreement that the treatment is what they want. 

Make the advice sheets simple but include all requirements; all the treatment options; advantages and disadvantages of each, risks, what would happen if the treatment was not accepted, success rates, long term consequences. A flow-cart works well. This is a good way of ‘testing’ if the patient has understood your proposals. You can then confidently record in the clinical records “satisfied informed consent obtained”.

Additional aids to communication can be added to the advice sheet and used to good effect; photographs, diagrams, Youtube videos. If you suggested that they watch a video on Youtube, again, you can as at the next appointment “what did you think?”.

Don’t give in to patient demands

Refrain from doing treatment that the patient demands which you do not think is in the patient’s best interests. If the patient insists that they want treatment which is against your advice or better judgment, in my opinion it’s best to bail out! This is not an easy conversation, but it is far easier than dealing with a complaint. 

Respect and trust

Win your patients’ respect and trust. If a patient has sleep-loss, constant pain and/or a swelling – I always try and do something straight away to help them even if my schedule is tight. If  something does not go right in the future, you have a solid, trustworthy relationship with the patient, hopefully making them less likely to complain.

Like everything in life, a balance must be struck. First and foremost, I believe that, in order to allow us to maintain ethics whilst having longevity in this profession, we must first look after ourselves. You cannot pour from an empty cup. My advice, then, in order to tread a sound and safe professional ethical path is to strike a balance when treating all our patients between compassion and professional detachment. But please always remember the line from the Hippocratic Oath; do not treat a tooth, pathology or an edentulous saddle but a “sick human being”.

The views and opinions expressed in this post are not necessarily those of the College of General Dentistry.

Author bio

I have been in general dental practice for over 20 years. I provide expert witness reports for the General Dental Council and dental indemnity providers as well as clinical negligence and personal injury solicitors. I now split my professional life between clinical care, mentoring colleagues, dental practice compliance advice, dento-legal work, dental practice inspections, teaching and examining. In 2016, I attained the Cardiff University Bond Solon Civil Expert Witness Certificate and am now undertaking an LLM in Medical Law and Ethics as well as working to complete the portfolio for FFGDP(UK).

Why taking photos is an essential skill in dentistry

Mohammed Ahsen Arshad and Ahmed Ahmed, fifth year BDS students at Plymouth University Dental School,  explain the importance of good photography skills in dentistry and how to get accurate and effective images.

Being able to take good photographs is key skill that dental care practitioners (DCP) must possess and develop, as it allows them to do a multitude of things including: 

  • keep an accurate record of patients’ presenting dentition
  • convey more information when referring to lab, especially helpful in anterior restorations 
  • provide a powerful diagnostic aid when treating and referring patients  
  • allows DCPs to illustrate the effectiveness of their treatment  
  • useful for auditing restorations especially when considering Aesthetics 
  • marketing clinical abilities as a dentist through social media and clinical articles.  

In dental school you will be provided with a camera and undergo some training but the best way to learn is to practice and get comfortable with the setup. Quite often this is the first time you will encounter a Digital Single-Lens Reflex (DSLR) and have to shoot manually. Learning to take photos in dental school will aid you in exit case presentations, and much more, and is an invaluable skill which you will carry throughout the rest of your career.

Consent  

Before you can take any photographs you must obtain valid consent and explain the purpose of the photographs. This could include recording wear, presentations, comparing shade after bleaching, educational purposes for illustrating soft tissue/hard tissue lesions. You must also inform the patient where these pictures may be used or posted. Photographs are often anonymized so patients need not worry about their confidentiality.  

Camera setup and settings 

In a standard setup you will need:

  • your camera body,
  • a macro lens (the larger the focal length the further away you can be from the patient whilst taking photos)
  • a ring flash.

Before you can make any adjustments you need to understand the basic function of each setting. As changing each one will lead to different results. 

Aperture is the size of the opening in which light passes through and is controlled via F values. 

Speed is how long the camera is open for this can be as little as 1/8000 seconds and as high as 30 seconds. 

ISO is sensitivity to light – as it increases the camera becomes more sensitive and can range from 100 to 6400. 

White balance is the process of removing unrealistic colour casts, so that objects which appear white in person are rendered white in your photo. It is best to set the camera to daylight or 5500k.  

Top tips  

Use a scratch free mirror and don’t let it fog up. You can achieve this by warming your mirror up under some warm water beforehand.  

Keep the focal length the same in before and after photos, in side-by-side comparisons this will look much better.  

Don’t be afraid to move the patient, yourself and the chair as positioning is key  

Communicate with the patient and your nurse   

Use small cheek retractors  

Eliminate debris and distractions (saliva, makeup and lipstick) 

Ask for advice – your supervisor will have much more experience than you, ask them to show you how to take the best photos and how they do it

Finally, practice on each other.

Recommended settings 

Extraoral:  

Exposure mode: M 

Aperture:F9 

Speed: 80 

ISO: 200 

Intraoral: 

Exposure mode: M 

Aperture: F22 

Speed: 200 

ISO: 200 

Recommended positions   

Front view 

  • Teeth should be in full contact 
  • Show as much gingivae as possible 
  • Midline of the face should be used as a vertical midline of the photo 
  • Position of the camera directly in front and 90 degrees to subject 

 Lateral view 

  • Contra-lateral central incisor and contralateral lateral incisor and canine should be visible.  
  • Centre the photo on lateral incisor/canine region 
  • Vertical midline of the photo should be the lateral incisor/canine 
  • The horizontal midline of the photo should be in the incisal plane. 

 Upper occlusal: 

  • Patient position: Fully reclined, take photographs from behind patient if possible. 
  • Always use mirrors or retractors if possible. 
  • The buccal contour of upper centrals should be visible near the edge of the photo. 
  • Frame the photo so mirror edges are as minimized as possible. 
  • 45 degrees to the mirror surface 
  • Show as many teeth as possible. 

Lower occlusal:  

  • Patient position: Slightly reclined and head tilted back. 
  • Always use mirrors and retractors if possible 
  • Eliminate fog on mirror, can be done by warming mirror up with hot water 
  • 45 degrees to the mirror surface 
  • Show as many teeth as you can 
  • Photo should show: Incisal edges of incisors and facial and lingual embrasures.  

Author bio

I am entering the final year of the BDS curriculum at Peninsula Dental School. I look forward to treating patients and further developing my skills as a clinician. I have found a particular interest in restorative dentistry, OMFS and oral surgery. 

Outside university, I like travelling and learning about different cultures, reading about anthropology, playing chess and enjoy sports such as cardiovascular endurance training, swimming, football and basketball. In the future I look forward to graduating and starting DFT in 2021.

Ahmed Ahmed

I am entering my final year of study this year at Plymouth university. I look forward to graduating and starting DFT in 2021. Whilst at university, I have found an interest in oral and maxillofacial surgery in particular head and neck cancer surgery. 

Outside of university, my hobbies include playing sports, travelling and photography. Last summer I went to Japan and discovered a new passion for baseball which I hope to pursue further.

Mohammed Ahsen Arshad

My Situational Judgement Test from home

Katie Huane, fifth year BDS Student, University of Manchester, passes on her top tips for making the most of your time during self-isolation and keeping up with your peers.

In the run-up to the lockdown 2.0, my biggest worry was gym closures meaning I’d be back to jumping around doing HIIT workouts in my front room with my heaviest dumbbell weighing a measly 1.5kg. Little did I know I would be stuck in my house for the next 12 days, unable to go for walks outdoors, get a take-away Pret hot chocolate and worst of all, miss critical clinical time at the Dental Hospital. 

When I first got the notification from the NHS Track and Trace app, I was stunned. I racked my brain tirelessly to understand how and where I could’ve contacted someone with Coronavirus. Still to this day, I have no idea.  

In the coming week, I had planned an acrylic denture delivery, a crown fit, an oral surgery clinical skills session (practising raising flaps on pig heads!) and my DFT Situational Judgement Exam – a heavy week to say the least. 

I was initially frustrated at the prospect of missing all of these things and was worried about what it would mean for my progression as a dental student – getting sufficient patient contact on clinics is always a concern, especially as patients fear the hospital in the current climate. 

Having contacted the dental school regarding my isolation, I had to tackle the next task of how to sit my SJT exam from home (which would otherwise be sat at a Pearson Vue test centre). I had to fill out a reasonable adjustment form and hope for the best. 

Luckily I had two days until I was due to sit the exam. This exam was set to determine my rank out of all the graduating dentists in the UK and hence the place I would live and practice for my Dental Foundation Training for a whole year. It could be on my doorstep (Manchester) or it could be as far as the Isle of Man (no pressure). 

After a string of emails to and from the test centre, a software issue, a borrowed laptop and a full bookcase covered in plain-white bed sheets, I sat my 2.15pm SJT exam from home. 

It’s a long wait until we get the results (June 2021), so in the meantime I will be focusing on other aspects of Dental School, my fitness and most importantly…Christmas! 

Below I have outlined some tips for other dental students struggling with self-isolation and how to have a productive fortnight indoors. 

Top tips for self-isolation

1.    Mindset is key 

Overall, lockdown has been smooth-sailing for me and I believe I owe it to my positive attitude. Some things I told myself repeatedly were:  

•    You’ll be drilling and filling for the rest of your life – don’t panic over a couple of clinic sessions missed. 
•    These things happen for a reason, whether it’s to rest and recover or that you didn’t do enough baking and DIY in the first lockdown.
•    2 weeks off Uni doesn’t mean you won’t graduate!
•    You’ll look back at this period of your life when you are working a full time job and wish you made the most of the chance to stay in bed on frosty mornings!

2.    Keep yourself busy 

Some things that have kept me occupied include: 

•    Webinars (some of my top picks are the Dentinal Tubules Webinar series for dental students, Dentinet Student webinars, and Finlay Sutton’s denture series on YouTube). 
•    Writing/getting published – this is just one way you can enhance their professional profile as a dental student and pass some time during your isolation period.
•    Entering undergraduate essay competitions. 
•    Practice your manual dexterity in other ways – painting, carving teeth made from wax, etc. 
•    Catch up on lectures. 
•    Keep up-to-date with important documents on COVID-19 in dentistry to keep yourself and others safe. 

3.    Avoid social media 

FOMO = Fear Of Missing Out. Throughout my isolation period, I’ve consciously put my phone away which not only makes me much more productive, but it also makes me feel 100x better for doing it too. You gain NOTHING from seeing your dental school peers on clinic treating patients and doing all the things you should be doing. Easier said than done but make sure you are limiting time spent on Instagram, Facebook and all other social media platforms. 

4.    Get moving 

Nothing sets me up for a more productive day than a workout at 8am and quick stretch after. Not only does it boost my mood but getting out of your desk chair does wonders for your back! 

5.    Routine 

Keeping a consistent morning and bedtime routine is key. Wake up, workout and eat breakfast all before you turn your phone on in the morning. Get in bed nice and early that evening, read a book and sleep. Repeat. 

Normality feels like a distant memory but I can’t wait to get back to the dental school to see some familiar faces, both patients and peers…5 days and counting!

Author bio

I’m currently a final year dental student at the University of Manchester. Over the past couple of years at dental school, I have discovered a particular interest in Paediatrics and Oral Surgery. I am also President of the Dentman Global Oral Health Forum, a volunteering society committed to providing oral care globally as well as within the local community. 

Outside of dentistry, I love experiencing new cultures and have an Instagram page dedicated to travel as well as university life (@flightsandfillings). I was lucky enough to spend two consecutive summers in New York working on a children’s summer camp as a swimming teacher. 

I’m also into fitness, and if I’m not in the dental hospital, you can probably find me in the gym!

Katie Huane

Clinical reflections dissected

Aavan K Matharu, fourth year BDS student, Trinity College Dublin, shares her advice on writing an effective and meaningful clinical reflection.

As we treat patients in dental school, we begin the process of learning, growing, and understanding the importance of patient management and care. This process comprises of a unique experience, specific to each patient and individual, and essentially contributes to the development of a clinician. One of the most important things to keep in mind after assessing patients and completing their treatment is a reflection, of which many of us must complete for our portfolios during dental school. 

Carrying out a good clinical reflection becomes one of the many skills that are integral to the ongoing growth throughout one’s professional career. To help you understand the purpose of a reflection and how they are written, here are a few pointers I have put together to help you ace your portfolio or even help you deliberate on your clinical experiences.

  • What is the purpose of a reflection? 

The main idea behind a reflection is to understand what you did for the patient, why it was relevant, and what successes and challenges you had along the way. Each reflection is unique not only from a patient standpoint but also from a clinician’s perspective, and its importance lies in what you took away from the experience as a whole. When reflecting, think about how you felt during the procedure (was it stressful, was it rewarding), what you achieved, and what you struggled with or would change for next time. Giving yourself this opportunity allows you to better yourself, learn from your experiences, and overall, progress holistically as a growing clinical practitioner. 

  • Choosing a Model

Reflections can be structured using various types of models such as the DIEP model or the O’Driscoll model (what, so what, and now what). Most dental schools recommend these templates as it gives a reader/writer a simple, but well-rounded idea around what the reflection entails. As a student or clinician, the best way to choose a model is to select the one that best resonates with you and your thinking/writing style. This will help to guide your thought process while keeping your reflections on track and avoiding long, unnecessary essays. 

  • Avoid Explaining the Treatment

When writing a reflection, do not explain the entire treatment provided to the patient. Feel free to summarize the diagnosis and the treatment provided but do not describe how you performed the root canal, prepared a tooth for a crown prep, etc. Instead, explain how you had difficulties and successes while doing these procedures and how the procedures made you problem solve as a clinician. For example, if you completed a restoration, reflect on certain experiences (such as if the patient was nervous or had a limited mouth opening) and ask yourself questions like:   
–    How did you problem-solve?
–    How did you communicate?
–    Was there anything you did to make the patient more comfortable?
–    What could you have done that could have made the experience better for you and the patient?… and so on.

  • Make it Bespoke 

Some patients come with many challenges whereas others are simple and straightforward. One thing all your patients have in common is that they are all helping you grow as a clinician. So, when reflecting/writing about each experience, be unique and genuine in the way you critique how each patient tested you and helped you flourish. No two patients are the same, and the way you treat patients, communicate with them, and take care of them will always be slightly different. 

I hope these tips are useful to you during your portfolio write-up. Keep in mind that a reflection is all about how and why you did what you did but also what you could have done better from all aspects of the treatment. All the best! 

Author bio

“I am a fourth-year dental student presently attending Trinity College Dublin. Over the past three years, I have developed a keen interest in Endodontics and Restorative Dentistry. With one year of dental school remaining, I would love to be able to expand my knowledge in regards to what these fields offer by performing research with specialists and attending relevant conferences.

Apart from dentistry, I enjoy drawing/sketching and immersing myself in astronomy and cosmology. I also adore traveling and visiting multiple countries within four different continents has given me the opportunity to appreciate new cultures, food, and languages.”

Aavan K Matharu

My experience of studying whilst managing a chronic illness

Shona Sawhney, fifth year BDS student, Barts and the London, explains how she has been studying for her degree whilst managing a chronic illness and shares her advice for anyone in a similar situation.

In my third year of dental school when my clinical experience was just beginning, I began to notice changes in my health. Over a period of 3 months, extreme fatigue and stiffness slowly progressed to severe joint pain. Not only was I struggling with exams and passing gateways, but even my day-to-day routine outside of university. 

The potential impact of my symptoms became apparent when I was told by a specialist, “You really need to think about another career.” I was devastated but this reaction from others would come to be the norm.  I had worked exceptionally hard to gain my place at dental school, and through a chronic illness over which I had no control, I felt my future plans slowly slip away.

Dentistry is an ever-changing profession, and whilst this can be exciting, it can also be incredibly stressful. For this reason, I always tried to ensure I had an outlet to relieve that stress, this was mainly through exercise. However, as my condition worsened, I struggled to maintain these outlets, I felt I had no way to relieve the stress I was under. 

When starting 4th year, I had been beaten by the suggestions of a “career change,” and that “dentistry isn’t for you anymore.” I accepted that I would be unable to do what my peers were doing. The thought of me completing my crowns gateway test that I had yet to sit, was almost laughable. I can honestly say that I have never felt more alone. 

Every time I entered the clinic, I would inform the tutors of my condition, which I found particularly hard. This is not what I wanted to be known for or defined by and feared I would yet again be told this profession is not for me. I was genuinely quite shocked when I was asked by a tutor in clinics one day, “What can we do to help you?”. I almost cried, I felt like an outsider to the profession for a long time, and I finally felt heard and listened to. 

This highlighted to me the importance of accessibility in dentistry, not just for our patients but also dental professionals. When seeking advice from a number of tutors and staff, I saw how the simplest of changes made a drastic impact on not only how I felt physically after clinics but also mentally too. For example, seeing oral surgery patients exclusively in the afternoon rather than the morning meant that my body and mind were prepared if I was required to perform an extraction. To quote the incredible Mohamed Jemni, I noticed that “The disability is not the problem, the accessibility is the problem.” (Jemni, 2013).

In hindsight, I now see just how hard I was being on myself. Initially, when my health condition deteriorated, I would force myself to do things even if I knew that my body was not physically up to performing the actions. And if I could not carry out the task, I got mad and angry at myself. It was a perpetual self-destructive cycle. Learning to celebrate the small victories and being kinder to myself has helped me manage my conditions, instead of belittling myself, and saying “you must pass this,” I instead say, “I am proud of you for trying your best.” 

I was often told that dentistry was not for me due to my condition, and this is not true in the slightest. There is a place for those with chronic illnesses to be key members of the dental community. My advice to those in a similar circumstance is to give yourself the same kindness you would give to others in your situation and do not be embarrassed to speak out and ask for help or adjustments to make dentistry more accessible. Lastly, to never give up on your aspirations despite what others may say, because to have a disability does not mean you miss ability; with the right support and adjustments, anything is attainable. 

Jemni, M., 2013. Breaking The Silence Of Deafness.

Shona was a speaker at the Disability Awareness in Dentistry webinar, organised following a shared commitment by the CGDent, FGDP and BDA to promote equality, diversity and inclusivity in the profession. A free recording of the webinar is available to CGDent members and ProDental subscribers and comes with one hour’s CPD (a £20 fee applies for non-members/non-subscribers).

Author bio

I am currently in my final year of Dentistry at Barts and the London. Within dental school I have enjoyed seeing patients from all different walks of life. I really enjoy talking to patients about their dental anxieties and building their confidence to visit the dentist regularly and improve their oral health, which has given me a future interest in community dentistry!

Outside of university life I run an Instagram page (@shocreates) to highlight my digital art related to chronic illness, and advocate for disability within dentistry. I also love to work out and try different cuisines around the world!

Shona Sawhney

Keeping it clinical

Kiri Paul, fourth year BDS student at King’s College London, explains how she has been maintaining clinical skills during the pandemic.

Currently we are all in a situation that implores us to put our drills down, to step back from our passion for a while for the safety of our patients. A strange concept for this profession that is used to being so hands on when it comes to helping people. Naturally, we all take a break from dentistry now and again whether it be the summer holidays or a half term, but nothing like what we currently face. It is clear that we are missing out on clinical exposure right now, so I thought to myself what can I do to stay connected to my clinical skills? 

So, here are some things I have been doing during this time to keep it clinical: 
 

Clinical evaluation 
Right now, it is important to know where you are at clinically – at King’s we keep a quota sheet that helps us keep track of how many fillings or dentures we have completed. It would be a great idea to draw something like this up using your clinical diary or memory.  It is important to self-evaluate your clinical experience so far, what procedures do you feel confident and less confident in. This evaluation and visual representation of what you have completed so far will help you pinpoint what you need to focus on when we return. 
 

Reaching out 
We are lucky to be part of this great field where clinical professional development is a way of life. The dental community supports one and other so make sure you are making the most of this during this time. Fully immerse yourself into the community through joining dental community organizations, watching Instagram lives, join Facebook discussion groups and watch webinars. Take this opportunity to learn some new clinical techniques and stay up to date for when you arrive back in the clinic. 

Currently, I am part of the Dentinal Tubules community where they have provided a wealth of support and free learning opportunities with a fun twist during this time that I will forever be grateful for. My university community has provided me with daily case discussion forums followed up with an online meeting to actively practice treatment planning. This could be something you take up with a group of dental students to help keep your skills sharp. The FGDP is a great place to gain firsthand experience and support through student blogs and student Bites so be sure to check it out.

Keep your back, neck and arm muscles strong
Check out licensed personal trainers on YouTube or Instagram for some great work outs you can do at home with everyday items to keep those clinical muscles in check. 
 

Manual dexterity 
Doing everyday tasks to keep your manual dexterity going strong is a great idea. I am getting back into my hobby of painting. If painting is not for you – give manual dexterity tasks a quick Google and have a glance at the list.
 

Skill up 
We all have a passion for dentistry and this circumstance gives us some time to focus in on those topics/ papers we find interesting. Research into new areas. Also, keep in mind that some course providers are offering lock down discounts.   
 

Balanced days
I have found it is so important to balance my day with not just learning but with other things I enjoy. When I am not keeping it clinical – I am working out, cooking, baking, painting or doing brain training games with my white German Shepherd. 

I wish you well and hope that this blog post has given you some ideas on how to keep it clinical. 

Author bio

I am currently studying in my 4th year of Dental school in the heart of London at King’s College London. During my time at university, I have immersed myself into the community by joining a number of committees and student bodies. I have enjoyed setting up extracurricular academic opportunities, representing the student body voice and working towards making the faculty more environmentally sustainable. My time at University has reinforced my passion for dentistry and I plan to work as a GDP for a few years before embarking on a specialisation. 

In my free time you would usually find me socialising, teaching, reading, shooting clays, meditating or taking long walks with my white German Shepherd, Bella.

Working in a Maxillofacial unit in a District Hospital

As a DCT 1 in a District Hospital in Yorkshire, Dr Kenny Strain takes us behind the scenes of a busy Maxillofacial unit, describing the range of treatments he has been providing.

I’m currently a dental core trainee [DCT] 1 working in the maxillofacial team at Rotherham District General Hospital in South Yorkshire. I wanted to give you a bit of a glimpse into what it’s like to do dental core training in a district hospital.

I completed my foundation training in Barnsley, I enjoyed my time in practice and felt like I learned a huge amount but I was keen to get some more surgical experience as this was an area of dentistry that I had not had a huge amount of exposure to as an undergraduate or during my FD year.

I researched various options in terms of getting more experience of oral surgery and there are quite a few to choose from. There is mentoring/shadowing, hands on courses which can be small group based and involve patient or more class room based and use pig mandibles to provide a hands-on experience. The other main option is to apply for a position as a dental core trainee.

Within the Yorkshire Deanery, all of the DCT 1 positions are a 12-month contract working in Maxfac. The positions are either in teaching hospital, major hospital or district generals. From speaking to previous DCTs, I got the impression that working in a major unit would involve more oncology treatment and I was keen to work in a unit with a more general focus and therefore I opted for a district hospital.

At Rotherham we work on an 8-week rota covering Rotherham and another hospital in Mexborough. The rota will cover doing on-call duty or being assigned to work with a consultant as their senior house office [SHO] for the week. SHO is a term still used in some hospitals and corresponds roughly to a DCT.

The consultant team at Rotherham / Mexborough is made up of 5 consultants with a variety of interests ranging from skin cancer, head and neck cancer, trauma, orthognathic and TMD. The variety of specialist interests of the consultants mean that no two weeks are ever the same.

This week I’ve been working with the lead consultant for head and neck cancer, we had a major oncology case involving a radical neck dissection, there have also been new patient assessment clinics for patients referred on a 2 week wait suspected cancer pathway. On these clinics you can either be helping the consultant or seeing new patients and then presenting them. I’ve also been in the day surgery unit this week working with one of the staff grade oral surgeons, these sessions involve treating patients under local or general anaesthetic. Types of treatment carried out are often surgical extraction of wisdom teeth, difficult teeth or extractions for patients with severe dental phobia. Working on the day case list, it is not unusual to carry out full clearance on patients.

As I was saying, no two weeks are the same and last week I was the on-call SHO. Being on-call is probably the busiest part of the job. Our rota has various on-call slots, it can be days, nights, weekend days or weekend nights. All of these on-calls can be very different. On-call days is definitely the busiest and will test your administration and delegation skills to the limit. It’s not unusual to have calls to go see patients in A&E and paediatric A&E at the same time as you are managing patients on the ward, discharging other patients and ensuring that they are going home with the correct medication, arranging follow up appointments for patients, helping out in theatre and getting phone calls for advice from GPs and general dentists.

On-call nights can be very different, there is much less of the administrative work to do and more dealing with patients presenting to A&E or getting referred from other hospitals that don’t have a Maxfac team. The types of patients that you’ll see at night varies massively from shift to shift. Some nights involve lots of trauma such as fractured mandibles and zygomas or lacerations. The next night you may see patients with dog bites, children with dento-alveolar fractures and dental abscesses.

Since working in Maxfac I’ve seen a wide variety of dental abscess from can barely tell there is anything there to Ludwig’s angina and calling your consultant at 2am to ask them to come in as the patient is going straight to the emergency theatre.

I’ve really enjoyed my time working in Maxfac and would highly recommend it. Initially your skills and knowledge will be pushed to the limit and you’ll be learning constantly, but with time and a bit of experience you will get the confidence to deal with situations you may only have read about in a text book. At the end of your year in Maxfac, you’ll realise that not only will your dental and surgical skills have improved but your medical knowledge will have expanded and you’ll have a solid foundation for working in practice or for further specialist training.

Author bio

I initially studied dental therapy and dental hygiene at the School of Clinical Dentistry at the University of Sheffield. I Covered all areas of Oral Health, Periodontal treatment and Dental Therapy.

After graduating I took a full-time position in practice as Hygiene/Therapist working in the Lake District. When I wasn’t fixing teeth I was running marathons or climbing rocks. After working in practice for just over a year, I decided to return to university to study dentistry at the University of Aberdeen. I really liked Yorkshire and was keen to return, so I completed my foundation training in Barnsley. I’m currently a dental core trainee [DCT] 1 in the maxillofacial team at Rotherham District General Hospital in South Yorkshire.