Things I didn't learn in dental school - but wish I had

As crazy as this may sound, I always wanted to be a dentist. At the age of three, I declared my intentions to my family and then worked toward that goal.I never wanted to be a policeman, a fireman or anything else (OK ... maybe for a few days I wanted to be James Bond, but that had more to do with the girls and gadgets than anything else).

Of course, when I got to dental school, I absorbed everything I could get my hands and mind on. Because this was all I’d ever wanted to do, and everyone in my life knew it, I didn’t want to mess it up. My problem in dental school was I’m a “why guy.” By that, I mean I always want to know “why.” That little personality quirk has served me well for most of my life, but in dental school ... not so much. There it was taken more as a sign of my rebellious nature instead of a desire to learn and extrapolate one situation into another. 

This little trait was good at getting me into trouble, but short of learning to clean the school toilets with a toothbrush, it didn’t really do me a lot of good in the big picture of my dental education. So what were the shortcomings of my degree in the late ’80s? Let’s take a look and I’ll try to work in things that even current graduates could use some upgrading on.

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Business education

Of all the things I could put into this article, there is no way business education would not be listed as No. 1. Now, in defense of the dental schools, they have a difficult job. They need to give the student the best dental education they can ... all within a span of four years. That’s a tough job. Anything they add on top of dental is just gravy for the student. 

Then, when you begin to think about it, there are four-year undergraduate and master’s degrees in the field of business so trying to equip a dental student with a powerful and well versed background in business is just about impossible. My whole point here is it really isn’t the school’s fault. It’s just the nature of the educational process of making someone truly competent in a highly detailed and scientific field.

My recommendation would be to have anyone interested in pursuing a career in dentistry take some business classes in their undergraduate career. That way, you have an adequate foundation when you begin to practice.

Personally, I was lucky. I grew up in a family that owned a printing business so I was exposed to how to run a business for several years before I entered the UMKC School of Dentistry. My father made sure I was well versed in the basics of running a business because he knew I’d need those skills later on. I’m still grateful for those lessons. Dad, I may not have always made it easy on you, but I’m glad you kept teaching me.

The “whys”

As I said earlier in this article, it’s a blessing and a curse, but I’ve always wanted to know “why.” The further I’ve progressed in my field, the more I’m glad that I have that particular quirk of learning, but I would hope educators teach to that theory more and more. Knowing “how” to do something is critical. I mean, if you can’t perform a procedure, all the “whys” aren’t going to help you ... or more importantly help the patient. However, once a student has mastered the procedural aspects of the task, the “whys,” in my opinion, become a critical part of the educational process. Understanding why allows the student to extrapolate the information learned and apply that understanding to situations outside of the procedure learned.

A brief example of this would be the understanding and use of the relatively new sectional matrix systems we now use for composites. When two-surface posterior composites began to be placed, dentists used what we were trained with-Tofflemire matrices. That system had worked well for decades and so they continued to be used. Unfortunately, the viscosity of composites was radically different from amalgam. This meant contacts created using the Tofflemire system and composite were frequently far from ideal. Understanding the “why” of composites and Tofflemire allowed companies such as Garrison and Triodent to design the new sectional matrix systems that solved this problem. If it were not for the understanding of the process and limitations of existing systems, this problem would persist to this day.

I could list many more examples, but you get the idea. If you know “why” you are doing something, you are kilometers ahead of the game.

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Understanding research

Despite my desire and drive to always be a dentist, I never really had much of an interest in specializing. Perhaps it was my ADD, or maybe after all that schooling, my brain was full. In any case, I graduated and was grateful that I could finally begin helping people. However, I remember the first time I sat down and read a scientific journal. I was overwhelmed with trying to digest the “materials and methods.” I wasn’t at a complete disadvantage because my undergraduate degree had prepared me, somewhat, for understanding scientific literature, but what I read took more effort than I was expecting.

My friends and colleagues who went on to specialize were given much more instruction in deciphering and understanding the literature, especially the critical “material and methods” section.

As our profession becomes much more driven by evidence-based results, understanding how the evidence is determined becomes critical to a complete comprehension of what was done and how reliable this particular piece of research is. Let’s face it. If you can’t comprehend whether a particular piece of research is reliable or not, you can’t base clinical decisions on it. As rapidly as our profession advances, it is imperative that those of us in the trenches be able to base our day-to-day clinical decisions on a solid understanding of the most recent science available.

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When the rules don’t apply

When we are in school, the dental school curriculum is designed to train you as well as they can given the constraints of time. They only have four years to take you from a lay person to a doctor/surgeon. That’s a pretty tough job. They not only need to teach you “not to be dangerous” but to be competent and able to handle a profession that is anything but routine on a daily basis. There’s a reason why CE courses are usually full. It’s because no matter how much we learn, we can always learn more. I frequently think of the quote from Socrates-“As for me, all I know is that I know nothing.” Sometimes, in the middle of a good CE course, that’s exactly how I feel.

While I can’t fault our dental schools for what they don’t teach (as I said, it’s a tough job, and one that I wouldn’t want), I wish there was a way they could take some of the “whys” referred to above and help us deal with outside-the-box situations. That’s because no matter how many rules I learn or how many routine situations I face, there are times where I’m going to be forced to go “outside the box.”

As a diehard geek, I love the Matrix movie trilogy. There’s a great line in the first movie when Morpheus is training Neo how to fight inside the matrix. When describing the rules of physics inside the matrix, Morpheus says, “Some of them can be bent; others can be broken.” On occasion, this can apply to the practice of dentistry as well. Now the healing arts are one of the few places in our world where rules are followed fervently and with good reason. However, it would be nice to have some basic guidelines on when we might consider bending those rules.

At the end of the day, we all want what is best for the patient, and having an idea of when bending the rules is in their best interests would be helpful to all of us.

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Wrapping up

When we discussed this article, my colleagues at DPR and I thought it would be an interesting and helpful topic. As I began to outline the article, I realized there is hardly anything I do clinically the way I was taught. Now I’m a bit of an outlier as far as technology goes so perhaps that contributes. However, with the proliferation of advances in chemistry, equipment and the inroads technology has made in our profession, I’d be willing to bet I’m probably not as much of an outlier as I thought before I started this article.

Hopefully, as you read this, you had a couple of “yeah, me too” moments. That’s what I was hoping for. Our profession is a lifelong learning commitment. Here’s to the journey. 

About the author

John Flucke, DDS, is chief dental editor for Dental Products Report and dentistry’s “technology evangelist.” He practices in Lee’s Summit, Mo., and has followed his passions for both dentistry and technology to become a respected speaker and clinical tester of the latest in dental technology, with a focus on things that provide better care and better experiences for patients. He blogs about technology and life at blog.denticle.com.