Question for Pediatric Dental Residents

[BigDreams3]

Hi guys!
I have made this post in an older thread but I still have not gotten a response and I was wondering if this thread would be able to help me haha.
I am currently an undergrad student and have been interested in dentistry since grade school but unfortunately I don't know a lot of contacts and things such as that. I am interested in pediatric dentistry as that has always been something I can see myself doing especially working with special needs children. Anyways this might sound completely random and unrelated but I never really understood the concept of residency. Like for Pediatric dental residency when you are in your trauma rotation or what have you are you doing surgeries alone? Are you participating in the surgery with other residents that are on call? Are you more on the sideline observing and instead handling the pre-op/post-op? I believe that residents are also on call so does that mean they will be the ones taking the surgery in that specific instance but not under regular conditions? Can a resident shed any light on this? As a side note I know it differs from program to program I was just wondering what the general similarities are between all the programs. Thanks in advance I appreciate you taking the time out to answer!

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[Flossoraptor2015]

Residency is to help gain greater experience and specialized techniques to handle more difficult/complex cases. Dental school is training in basic general dentistry so you learn the fundamental didactics and basic clinical skills (restorative, etc.). You probably will not get a ton of clinical pediatric experience in dental school since you will be seeing a wide range of patients and be exposed to a range of dentistry (Oral surgery, prosthodontics, periodontics, endodontics, operative etc.) Doing a pediatric residency will give you an opportunity to work with more children as well as more medically complex cases that might require more intensive treatment (Like in a hospital/OR). Typically you try to complete the dental procedures (restorative/fillings, cleanings, extractions) in the dental clinic. The OR is used for patients who can not tolerate the dental procedures in the dental clinic (Ex. behavior management) or if the dental treatments are so extensive that it would be better to complete all the procedures at the same time when the patient is sedated. If you are thinking of more intensive surgeries that might be more the realm of oral surgery (ex. orthrognathic surgery, certain severe trauma, etc.). I don't think you would ever go into an OR by yourself since you will always have an assistant/faculty/another healthcare provider to monitor the patient under anesthesia.
On call is for non-clinic hours (nights, weekends, holidays) and is for emergencies (ex. trauma or infection). In my experience you are typically trying to stabilize the patient and then will follow-up for any more complex procedures during clinic hours. (Examples: trauma to teeth so splinting and reassessing at a later appointment). Again different programs vary so it is an important to ask current residents about the program during the interview to find out more on the responsibilities of on-call and amount of hands-on experience.
If you are interested in pediatric dentistry and are still in undergrad I would recommend contacting your local pediatric dentists and seeing if you could arrange a time to shadow or at least interview them. It might be a little more difficult now because of the pandemic but I think this experience would be highly beneficial to you. It would help you build up your dental contacts as well as let you see the daily work of a pediatric dentist.

 

[Dent55]

Coming out of dental school there is still so much more to learn. My dental school had a VERY strong pediatrics program and I still had only seen a small bit of pediatrics. Every pediatric residency is different and I dont know enough about other programs to compare, but I learned a tremendous amount during the two years and can share my experience. I treated patients with an independence similar to private practice, but with attending pediatric dentists monitoring to make sure we were treating according to the best current evidence/research. We had a team of co-residents and faculty available for guidance or questions that came up during clinical care and we had an organized didactic curriculum. Through the balance of structure and independence I developed the confidence to tackle rare cases or new issues I had never seen before... to a level well beyond that coming out of dental school. On call, we worked with the other hospital teams to handle cases. So for example, sometimes I would work directly with GP, ENT, OMFS, Gen Surg, Pediatric Medicine, Hematology, etc. in the emergency department and each of us handled our part. Our part was mostly suturing intra-orally and extra-orally, evaluating and treating trauma directly to the teeth, evaluating and handling dental infections, evaluating for bone fractures or other issues outside our typical scope and calling the appropriate other teams to consult. There was a significant responsibility on the shoulders of the individual resident on call, but there was always a "second call" (a senior resident), a series of attendings available if needed. These backups were only called a couple of times a year as the on-call resident was responsible for researching evidence-based protocols on their own to their greatest ability. If I needed to do my pediatric dentistry portion (like splint primary teeth or suture) and required sedation for the patient, I consulted anesthesia and we could lightly sedate a child in the ED. If emergency cases required general anesthesia (to reset bone after trauma or immediately exo a tooth causing a rapidly escalating dental infection too severe for our normal abx protocol), in my hospital, the OMFS teams took over. The pediatric dentistry team went to the OR only for pre-planned dental treatment on a child who for behavior/safety issues or due to complex medical conditions needed the treatment to be done while sleeping in the hospital setting. In those cases, again, the attending was present for questions or concerns (or, early on, to monitor our clinical technique) but there was independence to handle the treatment as if we were independent providers. We did rotations through pediatric medicine, anesthesia etc. and mostly shadowed their work. During our anesthesia rotation we had a minimum number of cases to shadow and had to intubate a number of cases under the guidence of the anesthesia team. But, while it was an interesting experience, it would take significantly more time and experience than that to become an expert at it. Our residency was in pediatric dentistry and our time was focused on acquiring the skills and knowledge to be a pediatric dental specialist. Hope that gives you some insight as to what at least one program was like. Also - pediatric residencies often have dental student externs that rotate through... you could always contact the programs and see if they'd allow a pre-dental extern to come shadow for a few days to see a program in action and learn more. Good luck!

 

[BigDreams3]

Residency is to help gain greater experience and specialized techniques to handle more difficult/complex cases. Dental school is training in basic general dentistry so you learn the fundamental didactics and basic clinical skills (restorative, etc.). You probably will not get a ton of clinical pediatric experience in dental school since you will be seeing a wide range of patients and be exposed to a range of dentistry (Oral surgery, prosthodontics, periodontics, endodontics, operative etc.) Doing a pediatric residency will give you an opportunity to work with more children as well as more medically complex cases that might require more intensive treatment (Like in a hospital/OR). Typically you try to complete the dental procedures (restorative/fillings, cleanings, extractions) in the dental clinic. The OR is used for patients who can not tolerate the dental procedures in the dental clinic (Ex. behavior management) or if the dental treatments are so extensive that it would be better to complete all the procedures at the same time when the patient is sedated. If you are thinking of more intensive surgeries that might be more the realm of oral surgery (ex. orthrognathic surgery, certain severe trauma, etc.). I don't think you would ever go into an OR by yourself since you will always have an assistant/faculty/another healthcare provider to monitor the patient under anesthesia.
On call is for non-clinic hours (nights, weekends, holidays) and is for emergencies (ex. trauma or infection). In my experience you are typically trying to stabilize the patient and then will follow-up for any more complex procedures during clinic hours. (Examples: trauma to teeth so splinting and reassessing at a later appointment). Again different programs vary so it is an important to ask current residents about the program during the interview to find out more on the responsibilities of on-call and amount of hands-on experience.
If you are interested in pediatric dentistry and are still in undergrad I would recommend contacting your local pediatric dentists and seeing if you could arrange a time to shadow or at least interview them. It might be a little more difficult now because of the pandemic but I think this experience would be highly beneficial to you. It would help you build up your dental contacts as well as let you see the daily work of a pediatric dentist.

Thanks for the response!
Yeah I wanted to definitely shadow this summer but unfortunately wasn't given the opportunity for obvious reasons

 

[BigDreams3]

Coming out of dental school there is still so much more to learn. My dental school had a VERY strong pediatrics program and I still had only seen a small bit of pediatrics. Every pediatric residency is different and I dont know enough about other programs to compare, but I learned a tremendous amount during the two years and can share my experience. I treated patients with an independence similar to private practice, but with attending pediatric dentists monitoring to make sure we were treating according to the best current evidence/research. We had a team of co-residents and faculty available for guidance or questions that came up during clinical care and we had an organized didactic curriculum. Through the balance of structure and independence I developed the confidence to tackle rare cases or new issues I had never seen before... to a level well beyond that coming out of dental school. On call, we worked with the other hospital teams to handle cases. So for example, sometimes I would work directly with GP, ENT, OMFS, Gen Surg, Pediatric Medicine, Hematology, etc. in the emergency department and each of us handled our part. Our part was mostly suturing intra-orally and extra-orally, evaluating and treating trauma directly to the teeth, evaluating and handling dental infections, evaluating for bone fractures or other issues outside our typical scope and calling the appropriate other teams to consult. There was a significant responsibility on the shoulders of the individual resident on call, but there was always a "second call" (a senior resident), a series of attendings available if needed. These backups were only called a couple of times a year as the on-call resident was responsible for researching evidence-based protocols on their own to their greatest ability. If I needed to do my pediatric dentistry portion (like splint primary teeth or suture) and required sedation for the patient, I consulted anesthesia and we could lightly sedate a child in the ED. If emergency cases required general anesthesia (to reset bone after trauma or immediately exo a tooth causing a rapidly escalating dental infection too severe for our normal abx protocol), in my hospital, the OMFS teams took over. The pediatric dentistry team went to the OR only for pre-planned dental treatment on a child who for behavior/safety issues or due to complex medical conditions needed the treatment to be done while sleeping in the hospital setting. In those cases, again, the attending was present for questions or concerns (or, early on, to monitor our clinical technique) but there was independence to handle the treatment as if we were independent providers. We did rotations through pediatric medicine, anesthesia etc. and mostly shadowed their work. During our anesthesia rotation we had a minimum number of cases to shadow and had to intubate a number of cases under the guidence of the anesthesia team. But, while it was an interesting experience, it would take significantly more time and experience than that to become an expert at it. Our residency was in pediatric dentistry and our time was focused on acquiring the skills and knowledge to be a pediatric dental specialist. Hope that gives you some insight as to what at least one program was like. Also - pediatric residencies often have dental student externs that rotate through... you could always contact the programs and see if they'd allow a pre-dental extern to come shadow for a few days to see a program in action and learn more. Good luck!

Thank you so much for this response! I was always confused when I was reading forums on sdn because a lot of pediatric residents talked about how they would be "on call" or handling trauma cases. I never knew residency was hospital based until I did a little bit more research on my own mainly because most pediatric dentists are in a private practice setting as opposed to a hospital setting. Personally I enjoy the more humanitarian side of pediatric dentistry (ie. serving in underprivileged areas as well as other countries). I was just looking for some more clarity on what exactly was the responsibility of a resident as I can imagine being in an OR or taking trauma cases is extremely stressful. Thanks again for the reply!

If you don't mind me asking, what specific hospital was your residency done at?