Monotonous and risky work?

[TheSwede]

I had the privilige to shadow a dentist yesterday. He is a general practitioner that is active in allmost all fields.

I got to see crowns being put to place, old crowns being removed, panorama x-rays, a filling and an implant operation (he made an incision and separated the gums and got to the cheek bone and put two screews into place).

I was very fascinated by the way he worked. Everything was done in a professional and effective way. He told me that earlier on he managed to treat 32 patients a day by working with two chairs in two rooms with a nurse in every room. That made me reevaluate things that I feel stressful.

Anyways. There were three things that concerned me about becoming a dentist.

1. He made people bite in some clay and sent it to the dental lab and so on. He told me that it had to be really really exact in order for the dental-technician to make as perfect crowns, bridges etc as possible. This felt really hard. Is it really that hard or is it just me as an outsider that feels that way?

2. The risks. When he put the implant into place he told me that it may have looked easy but that it wasn't. He drilled two screws into place in the lower cheek bone. Had he drilled too deep he could have puncture a big nerve and the patient could easily bleed to death. He told me that the margin was about a couple of milimetres. That scared the **** out of me but he was very relaxed.

How do you handle those kinds of risks? A person bleeding to death if I screw a bit too much? Yikes!

3. The monotonous nature of the work-subject. I got to see very varied treatments but one thing that struck me was that we were only doing teeth; either it being an implant or a crown it was still deeth. There were no more excitement. I mean teeth can only come in a number of ways. How do you handle that? Day in and day out only teeth? How do you look upon that?

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[DrJeff]

I had the privilige to shadow a dentist yesterday. He is a general practitioner that is active in allmost all fields.

I got to see crowns being put to place, old crowns being removed, panorama x-rays, a filling and an implant operation (he made an incision and separated the gums and got to the cheek bone and put two screews into place).

I was very fascinated by the way he worked. Everything was done in a professional and effective way. He told me that earlier on he managed to treat 32 patients a day by working with two chairs in two rooms with a nurse in every room. That made me reevaluate things that I feel stressful.

Anyways. There were three things that concerned me about becoming a dentist.

1. He made people bite in some clay and sent it to the dental lab and so on. He told me that it had to be really really exact in order for the dental-technician to make as perfect crowns, bridges etc as possible. This felt really hard. Is it really that hard or is it just me as an outsider that feels that way?

2. The risks. When he put the implant into place he told me that it may have looked easy but that it wasn't. He drilled two screws into place in the lower cheek bone. Had he drilled too deep he could have puncture a big nerve and the patient could easily bleed to death. He told me that the margin was about a couple of milimetres. That scared the **** out of me but he was very relaxed.

How do you handle those kinds of risks? A person bleeding to death if I screw a bit too much? Yikes!

3. The monotonous nature of the work-subject. I got to see very varied treatments but one thing that struck me was that we were only doing teeth; either it being an implant or a crown it was still deeth. There were no more excitement. I mean teeth can only come in a number of ways. How do you handle that? Day in and day out only teeth? How do you look upon that?

First off, the apprehension/anxiety you're having right now after seeing what you saw is quite normal. I can also assure you that while many of the materials/instruments that you saw seem complex, generally speaking once you've used them a few times, they tend to be very user friendly, and with each new generation/evolution of a material/instrument they tend to get even more user friendly

Risk wise, well the joy of being a general dentist, and a specialist for that matter, is you do what you feel comfortable with. If in treatment planning a case, you feel that the treatment that's needed is beyond your level of expertise, then you don't have to do it and can refer to someone who can.

If a bleeding emergency happens, well, during your dental eductaion process, you learn how to manage situations like this

Monotony wise, well yes you are working on teeth all day long, but believe me when I say that no two teeth are alike and also the no 2 people that the teeth are attached to are alike, so there is a bunch of variety day in and day out!

 

[nydds25]

Most health practitioners deal with "monotonous" work in the sense that it is on a limited part/organ system. Take ophthalmology, one of the most desired medical specialties. Its eyes all day, every day. Cardiac surgery is all bypass and valve replacement all day every day.

 

[TheSwede]

You guys are right. I'm just so keen in not making a mistake and undergo 5 years of dental school in Sweden. I just want everything to be perfect, but there are not perfect professions.

You find one that you enjoy and that means everything.

 

[HupHolland]

I had the privilige to shadow a dentist yesterday. He is a general practitioner that is active in allmost all fields.

I got to see crowns being put to place, old crowns being removed, panorama x-rays, a filling and an implant operation (he made an incision and separated the gums and got to the cheek bone and put two screews into place).

I was very fascinated by the way he worked. Everything was done in a professional and effective way. He told me that earlier on he managed to treat 32 patients a day by working with two chairs in two rooms with a nurse in every room. That made me reevaluate things that I feel stressful.

Anyways. There were three things that concerned me about becoming a dentist.

1. He made people bite in some clay and sent it to the dental lab and so on. He told me that it had to be really really exact in order for the dental-technician to make as perfect crowns, bridges etc as possible. This felt really hard. Is it really that hard or is it just me as an outsider that feels that way?

2. The risks. When he put the implant into place he told me that it may have looked easy but that it wasn't. He drilled two screws into place in the lower cheek bone. Had he drilled too deep he could have puncture a big nerve and the patient could easily bleed to death. He told me that the margin was about a couple of milimetres. That scared the **** out of me but he was very relaxed.

How do you handle those kinds of risks? A person bleeding to death if I screw a bit too much? Yikes!

3. The monotonous nature of the work-subject. I got to see very varied treatments but one thing that struck me was that we were only doing teeth; either it being an implant or a crown it was still deeth. There were no more excitement. I mean teeth can only come in a number of ways. How do you handle that? Day in and day out only teeth? How do you look upon that?

My fixed prosth professor (i.e. the one that teaches us crown and bridge) said during our impression lecture that getting a good impression is the hardest thing he has had to do in dentistry and that everything else came fairly easy to him. He says he still struggles to this day getting great impressions. However, as Dr Jeff said, new materials and methods are making this process more dentist friendly. Digital impressions will replace impression materials completely within the next 5-10 years making getting a great impression a cinch! Google Itero and read up on this digital impression system.

Hup

 

[aphistis]

My fixed prosth professor (i.e. the one that teaches us crown and bridge) said during our impression lecture that getting a good impression is the hardest thing he has had to do in dentistry and that everything else came fairly easy to him. He says he still struggles to this day getting great impressions. However, as Dr Jeff said, new materials and methods are making this process more dentist friendly. Digital impressions will replace impression materials completely within the next 5-10 years making getting a great impression a cinch! Google Itero and read up on this digital impression system.

Hup

I agree! Getting a good impression is often the trickiest part of a pros case. That slightly nervous feeling you get while seating the tray never completely goes away (or at least, it hasn't for me yet), but pulling an impression with a great prep and perfect margins is one of those little victories that makes being a dentist satisfying. It sounds strange, I know; hopefully some of the other dentists here can back me up.

 

[La fea]

My little victories-
doing a good prep
carving/finishing a restoration
extracting/ delivering a tooth whole (or what's left of it in the mouth)

 

[diplo123]

I agree! Getting a good impression is often the trickiest part of a pros case. That slightly nervous feeling you get while seating the tray never completely goes away (or at least, it hasn't for me yet), but pulling an impression with a great prep and perfect margins is one of those little victories that makes being a dentist satisfying. It sounds strange, I know; hopefully some of the other dentists here can back me up.

Solution: digital impression machine. Just write it off on your taxes.

 

[Count Orlok]

Solution: digital impression machine. Just write it off on your taxes.

I have never seen or used a digital impression system, but our pros. professor told us that if we suck at taking traditional impressions then we will suck at taking digital impression as the same general principles apply (isolation, clean field, gingival displacement, etc.). I guess one pro of the digital system is if you don't get it the first time you can try again and not have the patient pissed off for getting gagged half to death.

 

[tehrlich]

Digital impressions are MUCH easier in the fact that you are seeing the information immediately. With a physical impression (not "clay" by the way), you have NO idea if it is good until you take it out of the mouth. Sometimes you still don't know until your lab calls you and says to take another one.

With digital impressions, you see right away if everything is there: margins, undercuts, etc.

 

[Waitlisted2009]

.

 

[HupHolland]

Any schools use digital impressions?

doubtful. some schools have a cerec machine which they use to fabricate inlays/onlays and full coverage crowns during a single visit. digital impressions are used to fabricate these restorations, but PVS is still the mainstream impression material for indirect restorations as it is still widely used to private practice, and thus, must be mastered.

Hup

 

[DrReo]

Midwestern will have 1 cerec.

 

[DrJeff]

Digital impressions are MUCH easier in the fact that you are seeing the information immediately. With a physical impression (not "clay" by the way), you have NO idea if it is good until you take it out of the mouth. Sometimes you still don't know until your lab calls you and says to take another one.

With digital impressions, you see right away if everything is there: margins, undercuts, etc.

Any schools use digital impressions?

doubtful. some schools have a cerec machine which they use to fabricate inlays/onlays and full coverage crowns during a single visit. digital impressions are used to fabricate these restorations, but PVS is still the mainstream impression material for indirect restorations as it is still widely used to private practice, and thus, must be mastered.

Hup

What you have to keep in mind, is the digital impressions being talked about above are of 2 different kinds. Basically the "cerec style" and the "itero" style.

In the Cerec style, after you've prepped the tooth and done any needed gingival management, the prepped tooth and it's surrounding teeth are covered with a fine powder, and then the impression is taken based on the reading of that powder by the scanner. After the impression is done, that digital scan of the tooth is milled from a solid block of whatever restorative material you have for your milling machine chairside.

In the Itero style impression, you prep the tooth, manage the tissue, and then no powder is needed, and the "Itero" style machine tells you what angles you need to use the imagining wand to basically take multiple digital pictures of your prepped tooth and the adjacent/opposing teeth. If you miss a certain part of the digital impression, you can go back and retake that 1 shot to capture the detail. From this impression, you can set the margins on the computer screen and then the data points that make up your digital impression are e-mailed to a lab that has the Itero milling machine where they then mill a COPING out of a plastic like material, and then WHATEVER type of restoration you want fabricated (traditional PFM, pressed ceramic, full cast gold) can be made by the lab from that coping.

While somewhat similar in that you get to see your 100% of the time absolutely perfect preps up on the computer screen, how the impression is taken and what type of restoration can be fabricated from it differ quite a bit.

My guess is that down the road, more clinicians that choose to go digital with their impression techniques will end up with an Itero style machine simply because from an esthetic standpoint. Since a good lab tech with a choice of materials will provide more lifelike restorations, especially anteriors, than a milled block of uni-colored ceramic material and some dentist administered chairside staining.

 

[tehrlich]

Any schools use digital impressions?

I know that San Antonio and Baylor both do. Baylor has a "technology" department as well that does research on the different chairside imaging and milling machines.

Many dental schools have Cerec, but most of them do not have the faculty to run them properly, so sometimes it goes into a corner.

 

[tehrlich]

What you have to keep in mind, is the digital impressions being talked about above are of 2 different kinds. Basically the "cerec style" and the "itero" style.

In the Cerec style, after you've prepped the tooth and done any needed gingival management, the prepped tooth and it's surrounding teeth are covered with a fine powder, and then the impression is taken based on the reading of that powder by the scanner. After the impression is done, that digital scan of the tooth is milled from a solid block of whatever restorative material you have for your milling machine chairside.

In the Itero style impression, you prep the tooth, manage the tissue, and then no powder is needed, and the "Itero" style machine tells you what angles you need to use the imagining wand to basically take multiple digital pictures of your prepped tooth and the adjacent/opposing teeth. If you miss a certain part of the digital impression, you can go back and retake that 1 shot to capture the detail. From this impression, you can set the margins on the computer screen and then the data points that make up your digital impression are e-mailed to a lab that has the Itero milling machine where they then mill a COPING out of a plastic like material, and then WHATEVER type of restoration you want fabricated (traditional PFM, pressed ceramic, full cast gold) can be made by the lab from that coping.

While somewhat similar in that you get to see your 100% of the time absolutely perfect preps up on the computer screen, how the impression is taken and what type of restoration can be fabricated from it differ quite a bit.

My guess is that down the road, more clinicians that choose to go digital with their impression techniques will end up with an Itero style machine simply because from an esthetic standpoint. Since a good lab tech with a choice of materials will provide more lifelike restorations, especially anteriors, than a milled block of uni-colored ceramic material and some dentist administered chairside staining.

CEREC AC can do everything that Itero does. You can make SLA models through Sirona. The difference is that CEREC can do the models with fewer pictures.

 

[tehrlich]

This is a video on Cerec Connect. It's big, so give it some time to load.


http://www.cerecassistants.com/pix/cerec connect.wmv

 

[lotexigeus]

UT Memphis has a cerec machine. One of the fist things we did as a D1 was load the software.

 

[Doctor Dj]

Risky hell yeah , not just anyone can be a dentist , you have to own balls of steel occasionally you might **** up , but thats ok ...hey even Maradona missed a penalty kick on the World cup finals.

Monotonous yes , but that depends on how you make your schedule my advice is enjoy dentistry, don't do it just for the money a lot of these loosers get money hungry and addicted to it, along the line they actually start to hate dentistry , those are the twats that actually **** up and commit suicide along the line . also forget about ****** and blow

My advice don't get addicted to money and you'll be just fine .

Cheers Mate

 

[lotexigeus]

word, ****** and blow are for loosers

 

[visbimmer79]

First off, the apprehension/anxiety you're having right now after seeing what you saw is quite normal. I can also assure you that while many of the materials/instruments that you saw seem complex, generally speaking once you've used them a few times, they tend to be very user friendly, and with each new generation/evolution of a material/instrument they tend to get even more user friendly

Risk wise, well the joy of being a general dentist, and a specialist for that matter, is you do what you feel comfortable with. If in treatment planning a case, you feel that the treatment that's needed is beyond your level of expertise, then you don't have to do it and can refer to someone who can.

If a bleeding emergency happens, well, during your dental eductaion process, you learn how to manage situations like this

Monotony wise, well yes you are working on teeth all day long, but believe me when I say that no two teeth are alike and also the no 2 people that the teeth are attached to are alike, so there is a bunch of variety day in and day out!

So, we will learn how to manage situations like that!