Taking failures personal in dental school

[AnneSoul]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

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[TanMan]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

First, understand that the mouth is a very complex and inhospitable environment. There are many variables that you can't control such as oral hygiene and parafunctional habits.

Second, we're not mechanics and biology is a lot more complex. I think what's more important in your stage is to move forward by understanding what is considered a failure and how you can correct it for next time. In your example, not all pain to biting is caused by hyperocclusion, s/p a fill. This is where your time to shine as a future doctor comes.

How I would look at it:
Patient CC after a fill - pain to biting. Go through the SOAP method. Ask the patient, is it sensitive only to biting or cold/hot/spontaneous too? This tells you pulp status. Is the pain lingering? Is it going anywhere else (referring)? Is it a quick shock, a dull throb, etc..? Also look at preop condition. Was the tooth sensitive to begin with? If not, then what aspect of the procedure could have caused it? Insufficient irrigation? Dull/chattering burs? Poor isolation technique? Insufficient curing? and so on...

After gathering subjective information, gather objective information. Does pain to biting occur only on the fill, a specific cusp, pain to biting, pain to release, lingering or sudden pain, any STTP present? radiographic bone loss? parafunctional wear? pulp/periapical status? Once you gather your objective data, what's your assessment and plan to treat?

Most of the time, pain to biting depends on where it hurts to bite. Pain on tooth structure (if there was no pre-op pain) but not fill usually indicates iatrogenic fractre during prep. Carbides are notorious for this if you were using a carbide that isn't smooth cutting or even slightly off axis. Pain on fill but not tooth structure, with composite, typically indicates bonding failure. If there's pain to cold, the bonding failure usually occured at the bond-tooth interface. If there's no pain to cold, the bonding failure usually is at the bond-composite interface. (Edit: assuming no pulp/periapical pathology)

Now, what does this have to do with taking failures personally? You shouldn't even have the time to think about how it's your fault. It's never your fault. Look forward, look at what happened, look at how you can correct it, and how you can prevent it in the future. If you think you are a failure, you are if you give up and don't do anything to get the patient out of pain, especially if the patient wasn't in pain before. However, to get the patient out of pain, you need to understand what happened. Once you develop a deeper understanding of cause-effect in dentistry, you know what happened and you can do the procedure again and hopefully not have the same symptoms.

Look forward. Like anything in life, nothing is 100%. We strive for it, but nothing is absolutely certain. The best you can do is to move on by learning what you did wrong and not doing the same thing again. If your supervisor signed off on it, in the very least, the work was acceptable.

I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

So, this is the part of self-loathing and you must break this cycle. You can blame yourself, but you need to set things right. You may have failed at your task, but there are many variables outside of your control. It's not all your fault because of that. You just need to understand what went wrong and how you can improve. Iterative improvements are key to becoming a successful clinician. You say the patient won't come back again... they probably won't depending on the severity of the pain you inflicted, but if they came back because of the pain, it means they still have some trust for you to fix it. The least you can do is to make sure they feel better before permanently saying goodbye. Even if they don't come back, there's thousands of other patients for you to see. You will improve your handskills unless you get some type of neurological disorder or accident that destroys your hands/wrists/arms.

If your supervisor passed you, take it as you either did clinically acceptable work or you got lucky... and some people are just chronically lucky.

 

[oralcare123]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

I think the problem stems from your family. What you described is unhealthy - talk to a specialist

 

[AnneSoul]

First, understand that the mouth is a very complex and inhospitable environment. There are many variables that you can't control such as oral hygiene and parafunctional habits.

Second, we're not mechanics and biology is a lot more complex. I think what's more important in your stage is to move forward by understanding what is considered a failure and how you can correct it for next time. In your example, not all pain to biting is caused by hyperocclusion, s/p a fill. This is where your time to shine as a future doctor comes.

How I would look at it:
Patient CC after a fill - pain to biting. Go through the SOAP method. Ask the patient, is it sensitive only to biting or cold/hot/spontaneous too? This tells you pulp status. Is the pain lingering? Is it going anywhere else (referring)? Is it a quick shock, a dull throb, etc..? Also look at preop condition. Was the tooth sensitive to begin with? If not, then what aspect of the procedure could have caused it? Insufficient irrigation? Dull/chattering burs? Poor isolation technique? Insufficient curing? and so on...

After gathering subjective information, gather objective information. Does pain to biting occur only on the fill, a specific cusp, pain to biting, pain to release, lingering or sudden pain, any STTP present? radiographic bone loss? parafunctional wear? pulp/periapical status? Once you gather your objective data, what's your assessment and plan to treat?

Most of the time, pain to biting depends on where it hurts to bite. Pain on tooth structure (if there was no pre-op pain) but not fill usually indicates iatrogenic fractre during prep. Carbides are notorious for this if you were using a carbide that isn't smooth cutting or even slightly off axis. Pain on fill but not tooth structure, with composite, typically indicates bonding failure. If there's pain to cold, the bonding failure usually occured at the bond-tooth interface. If there's no pain to cold, the bonding failure usually is at the bond-composite interface. (Edit: assuming no pulp/periapical pathology)

Now, what does this have to do with taking failures personally? You shouldn't even have the time to think about how it's your fault. It's never your fault. Look forward, look at what happened, look at how you can correct it, and how you can prevent it in the future. If you think you are a failure, you are if you give up and don't do anything to get the patient out of pain, especially if the patient wasn't in pain before. However, to get the patient out of pain, you need to understand what happened. Once you develop a deeper understanding of cause-effect in dentistry, you know what happened and you can do the procedure again and hopefully not have the same symptoms.

Look forward. Like anything in life, nothing is 100%. We strive for it, but nothing is absolutely certain. The best you can do is to move on by learning what you did wrong and not doing the same thing again. If your supervisor signed off on it, in the very least, the work was acceptable.




So, this is the part of self-loathing and you must break this cycle. You can blame yourself, but you need to set things right. You may have failed at your task, but there are many variables outside of your control. It's not all your fault because of that. You just need to understand what went wrong and how you can improve. Iterative improvements are key to becoming a successful clinician. You say the patient won't come back again... they probably won't depending on the severity of the pain you inflicted, but if they came back because of the pain, it means they still have some trust for you to fix it. The least you can do is to make sure they feel better before permanently saying goodbye. Even if they don't come back, there's thousands of other patients for you to see. You will improve your handskills unless you get some type of neurological disorder or accident that destroys your hands/wrists/arms.

If your supervisor passed you, take it as you either did clinically acceptable work or you got lucky... and some people are just chronically lucky.

Absolutely right.Thanks a lot for spending your time to help me.
You told me once that dental school =/= real dental practice and I am always trying to keep that in mind.
Unfortunately I am not one of the chronically lucky students but what happens is that whenever I do any procedure correctly (which is not that frequent), I say this is due to luck only.
Also we are seeing very few patients (one operative/endo clinic every other week) and as a D4 I think this is not enough at all, but I keep reminding myself that my skills and knowledge will develop as soon as I start practicing.

I think the problem stems from your family. What you described is unhealthy - talk to a specialist

I think it could be a part of the problem.You mean something like perfectionism or pressure from family to do the best?

 

[Pablo Sanchez]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

To jump from "My restoration failed" to "I will never be a good dentist my hand skills will always suck" is a bit drastic. We are learning. Right now is the worst you will ever be at this, as you get better with each new experience.

Think about it this way. If it weren't for dentists (AKA you), your patients would have absolutely no way to stop their caries. Whether your intervention works or fails, it is at least an opportunity for them to get the treatment they need. Without you they'd have nothing, and no chance at combating oral disease. You're doing the best you can to treat them.

 

[AnneSoul]

To jump from "My restoration failed" to "I will never be a good dentist my hand skills will always suck" is a bit drastic. We are learning. Right now is the worst you will ever be at this, as you get better with each new experience.

Think about it this way. If it weren't for dentists (AKA you), your patients would have absolutely no way to stop their caries. Whether your intervention works or fails, it is at least an opportunity for them to get the treatment they need. Without you they'd have nothing, and no chance at combating oral disease. You're doing the best you can to treat them.

Very true.l gave only an example that happened today but I meant that these troubles happen to me frequently and I am not noticing that much improvement in my work.
Thank you for your encouragement, it helped a lot, because you are right, this period of my practice is the worst and it couldn’t be worse in the future.

 

[DrJeff]

I first started treating clinical patients in dental school over 25 years ago now (Wow do I feel OLD typing that!! ).

I have seen LOTS of my own work fail. Any dentist who practices on more than 1 patient more than one time, is going to see their work "fail" (Heck on some of my original patient's whom I have treated in my practice where I've been now for almost 20 years, I've seen some of my 2nd and even a few 3rd generation works fail.

Tanman eloquently stated the challenges that the work we place in our patient's mouths have to face 24/7/365.

Sometimes when something "fails" it may be purely 100% on the patient (for example that class IV composite on #8 where you tell the patient that they shouldn't bite into say a carrot stick with it for fracture risk, and then they go and use that tooth to say open a bottle with it) - You shouldn't feel guilty at all about that, but some will

Other times, you may have missed a hairline fracture in a tooth, which ultimately causes the tooth to fail after you've done the endo and crown on it. It happens. This happened quite often in my era, and now, as Cone Beam CT imaging becomes more widely prevalent, thankfully more and more of those hairline fractures which ultimately make some teeth unrestorable, are being picked up before you go to restore them.

Other times you may find out that what you thought was the proper treatment plan, was too conservative, such as what you though would be enough tooth structure left around say that DL cusp of #30 for a class II composite verses a crown, wasn't actually enough tooth structure to prevent cusp fracture after the patient had been chewing on it for say a year.

You work on teeth, you see successes and failures. You certainly can learn from both.

As one of my residency mentors used to tell me and my other fellow residents, "you practice dentistry in the hopes that one day you may get it right. And when you think you've got it right, often a new way to do things, that is probably better, comes along for you to continue practicing with. Never stop learning from both successes, and certainly never stop learning from failures, Those failures, while emotionally often are tougher, are the things that without a doubt will make you a better clinician going forward"

 

[pubhealthdent]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

Failure in dental school is a blessing in disguise. Better to mess up now and learn how to fix it while you have faculty to help guide you then to do it while you're in the real world and possibly without a mentor to guide you through it. Better to see those post-op pain/sensitivity complaints now where faculty can help guide you through what to look for. Better to figure out how to retrieve a root tip from an extraction gone bad when you've got an oral surgeon looking over your shoulder. Its in those moments that you'll learn little tricks of the trade that otherwise you may have missed out on.

One of my faculty at graduation told me he had no doubt I would be a great dentist because of how terrible some of my preps were in sim clinic. He went on to explain that while yes some of my work was terrible the first time they checked it, I listened to their tips/guidance to resurrect some truly horrendous work.

Its okay to get down on yourself, but just throw your pity party for a sec and get back out there. Learn from your mistakes and move on.

 

[HatInTheCat]

Let’s cut to the chase and save the long paragraphs. Criticism is there so that you’re not causing harm to the public once you graduate. Own your mistakes, learn from them, and move on.

It’s just dentistry, not your life.

 

[LaughingGas]

One of my favorite quotes is " It's just f***ing tooth". 99% of times is patient's problems and we are there try to help them. You have to think "well, if you did take care of your teeth, I wouldn't have needed to drill your tooth".

 

[oralcare123]

Absolutely right.Thanks a lot for spending your time to help me.
You told me once that dental school =/= real dental practice and I am always trying to keep that in mind.
Unfortunately I am not one of the chronically lucky students but what happens is that whenever I do any procedure correctly (which is not that frequent), I say this is due to luck only.
Also we are seeing very few patients (one operative/endo clinic every other week) and as a D4 I think this is not enough at all, but I keep reminding myself that my skills and knowledge will develop as soon as I start practicing.


I think it could be a part of the problem.You mean something like perfectionism or pressure from family to do the best?

You never learned or felt that mistakes are normal. This usually stems from upbringing in a family where children must perform perfectly.
Please, talk to a psychologist, whom you supposed to have on campus or whoever is available. It takes time and a professional to train you to permit yourself to be imperfect
Even with best intentions sometimes the result is imperfect. You need to learn to avoid critical mistakes: like using rubber dam during endo or tie a floss around a clamp. Imperfections, which don't affect health or function much are OK
Never say, that you are a failure.
In regards to a postoperative sensitivity - there are many causes. Some people have it, some don't
Best of luck to you

 

[AnneSoul]

Failure in dental school is a blessing in disguise. Better to mess up now and learn how to fix it while you have faculty to help guide you then to do it while you're in the real world and possibly without a mentor to guide you through it. Better to see those post-op pain/sensitivity complaints now where faculty can help guide you through what to look for. Better to figure out how to retrieve a root tip from an extraction gone bad when you've got an oral surgeon looking over your shoulder. Its in those moments that you'll learn little tricks of the trade that otherwise you may have missed out on.

One of my faculty at graduation told me he had no doubt I would be a great dentist because of how terrible some of my preps were in sim clinic. He went on to explain that while yes some of my work was terrible the first time they checked it, I listened to their tips/guidance to resurrect some truly horrendous work.

Its okay to get down on yourself, but just throw your pity party for a sec and get back out there. Learn from your mistakes and move on.

The problem is that our supervisors treat us as experts and so they do not accept mistakes, so they really make me feel that my skills should be better and say: a D4 student should master this by now why you are not able to do it!
But you are very right and I will keep it always in mind.

 

[AnneSoul]

One of my favorite quotes is " It's just f***ing tooth". 99% of times is patient's problems and we are there try to help them. You have to think "well, if you did take care of your teeth, I wouldn't have needed to drill your tooth".

Very true
Thanks a lot

 

[PerioDont]

The problem is that our supervisors treat us as experts and so they do not accept mistakes, so they really make me feel that my skills should be better and say: a D4 student should master this by now why you are not able to do it!
But you are very right and I will keep it always in mind.

most D4 students will never master anything IMO. that is why you are a student. Heck you probably won't master anything your first year out. that is why they call it the PRACTICE of dentistry.

seems like a strange expectation from a d school instructor. most d schools make no sense though so I'm not surprised.

 

[Molar Whisperer]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

I can almost relate to your struggles. You may be an immigrant who grew up in a repressive environment like me. My dad always tells me we have to do everything better than the privileged whites or we starve. I grew up in a small town where the whites are mostly poor and uneducated (except for the top 1%) so doing better wasn't hard. Life is too short to constantly beat yourself up. Your life is ticking away as you feel bad about yourself. Like many here recommend, seek professional treatment. For many foreign cultures, it may be signs of weakness to get help but screw that. Your family and peers don't have to know.

 

[AnneSoul]

most D4 students will never master anything IMO. that is why you are a student. Heck you probably won't master anything your first year out. that is why they call it the PRACTICE of dentistry.

seems like a strange expectation from a d school instructor. most d schools make no sense though so I'm not surprised.

Agree with you!
I do not know why they behave like that-make me feel they were born as professors

 

[AnneSoul]

I can almost relate to your struggles. You may be an immigrant who grew up in a repressive environment like me. My dad always tells me we have to do everything better than the privileged whites or we starve. I grew up in a small town where the whites are mostly poor and uneducated (except for the top 1%) so doing better wasn't hard. Life is too short to constantly beat yourself up. Your life is ticking away as you feel bad about yourself. Like many here recommend, seek professional treatment. For many foreign cultures, it may be signs of weakness to get help but screw that. Your family and peers don't have to know.

100%
Although I do not like psychiatrists because they immediately prescribe medications which I do not like at all. I am trying to treat this conservatively- your advice here and encouragement is helping a lot.Thanks a lot!

 

[Molar Whisperer]

100%
Although I do not like psychiatrists because they immediately prescribe medications which I do not like at all. I am trying to treat this conservatively- your advice here and encouragement is helping a lot.Thanks a lot!

You can try psychologists who specialize in dysfunctional behavior. My dentist sister could not stop thinking about her job and sees one. She is constantly thinking of insurance narratives for crowns, Covid affecting her clinic, etc. It is a process and won't be cured in a short period. I think you will respond greatly to positive insights.

 

[oralcare123]

The problem is that our supervisors treat us as experts and so they do not accept mistakes, so they really make me feel that my skills should be better and say: a D4 student should master this by now why you are not able to do it!
But you are very right and I will keep it always in mind.

Dental schools pay little, attracting all sorts of wrong people to teach
Remember - you pay to be educated. You create jobs for dental school's employees. They should respect you, if they don't - understand, that they are a-holes. Stay quiet until graduation, but don't beat yourself up
It takes time to learn and master

 

[mrdeez]

Let’s cut to the chase and save the long paragraphs. Criticism is there so that you’re not causing harm to the public once you graduate. Own your mistakes, learn from them, and move on.

It’s just dentistry, not your life.

I mean...I failed an exam because I was too conservative with pulpal depth by 0.1mm on a class 1 prep. People who slipped and drilled through the tooth into the patients brain received the same result based on the grading system. One of them causes significantly more harm clinically than the other. I understand your point but pre clinical grading isn’t always logical in regards to “causing harm to the public”.

 

[HatInTheCat]

I mean...I failed an exam because I was too conservative with pulpal depth by 0.1mm on a class 1 prep. People who slipped and drilled through the tooth into the patients brain received the same result based on the grading system. One of them causes significantly more harm clinically than the other. I understand your point but pre clinical grading isn’t always logical in regards to “causing harm to the public”.

Great. So now that you understand the essence of pre clinical grading, move on and take lessons from others on how to get the grades you need.

 

[mrdeez]

Great. So now that you understand the essence of pre clinical grading, move on and take lessons from others on how to get the grades you need.

Huh? I was pointing out the statement “criticism is there so that you’re not causing harm to the public” isn’t always true. My grades weren’t the point, my point was to illustrate that the curriculum design does not always correlate with public safefty. Especially in pre clinical courses.

 

[HatInTheCat]

Huh? I was pointing out the statement “criticism is there so that you’re not causing harm to the public” isn’t always true. My grades weren’t the point, my point was to illustrate that the curriculum design does not always correlate with public safefty. Especially in pre clinical courses.

Ok. Your thoughts.

Happy holidays!

 

[2TH MVR]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

We've all been there. Do not blame yourself or take it personal. Learn from the experience and add it to your memory bank. Move on.
You will soon realize that you are not treating a mouth full of teeth, but patients with varying degrees of psychiatric issues. People are not normal. I'm not normal lol.

You could have done everything perfect ..... and the patient may have still been unsatisfied. Unfortunately this will not go away once you are in practice. Wait till you start to get negative reviews from patients.

You can't please everyone. Just learn and move on.

 

[Molar Whisperer]

Hello there
How do you manage to not taking failure personal in dental school
When a procedure that I am doing fails,I always tell myself that I am a failure and won’t be a good dentist
It doesn’t always fail, like for example,my patient was complaining about a filling that I did to her that it is painful on eating although I did check the occlusion and it was fine
I immediately started blaming myself
I am a failure, I should have been more careful, the patient won’t come back again, I will never improve my handskills, I don’t deserve the grade the supervisor gave me and so on

Do you have experiences with such thoughts? I would be happy to hear.

This video provides some interesting perspectives...How to Grow from Your Pain - YouTube. It is by a NY Times best selling author. He brings up an example of 2 monkeys: paranoid monkey vs chill monkey. I want to disagree with his view on which monkey should be (in my reality) Mack Daddy. Like 2TH MVR mentioned, every dentist will encounter negative reviews. If you haven't, then you haven't practiced long enough. Your skin gets thicker as you mature and you could care less about negativity as long as you did your best. The practice of dentistry is a marathon and not a sprint (unless you quickly changed careers). A line Al Pacino once said in a movie paraphrased, when people get squeezed, many will fold, some will focus. Your patients and peers will easily know the real you.