By Colson Smith
The Four Legs of the Dental School Marathon
One of the main questions I get about dental school from pre-dental students is, “What’s it like?” The short answer is, “It depends!” Dental school changes drastically from D1 to D4 year. For the most part the change is gradual, almost like the seasons. Winter fades to spring and spring to summer and so on and so forth. It’s a slow process, with the temperature changing steadily as the weeks pass. Dental school operates in much the same way. You’d probably drop dead if you were asked to do a crown prep on a patient your first day of school, but by fourth year it’s a task you wouldn’t think twice about.
Although the transitions in dental school tend to be gradual, it still fluctuates in difficulty. Dental school is a series of ups and downs. Much like undergrad, some semesters are harder than others. Unlike undergrad though, all of your classmates will have the same coursework each semester, so you’re never the only one who’s overloaded with tough classes.
As a disclaimer, dental schools do vary in their curriculum. No two schools are exactly the same, but this article is intended to outline the general template of dental school curricula. Each school has unique elements about their curriculum. The most common differences between schools are rooted in how much clinic exposure they allow their underclassmen and how the human science courses are organized. Since all dental students must pass parts one and two of the National Board of Dental Examiners tests, the dental curricula around the nation is somewhat standardized. By and large, each dental school aims to have their students’ curriculum on par with that of same year students across the country. A D1 student in Alabama can commiserate with a D1 student from California about gross anatomy. Likewise, a D4 student in New York could empathize with a student in Arizona about clinical requirements. Without further ado, let’s dive in to what each year entails.
D1: Buckle up! First year of dental school is a whirlwind. It’s been said before, but the first year of dental school is truly the most fun you never want to have again. The good news is most schools will try to ease the transition, at least initially. If your school has any mercy, your first couple weeks will involve orientation, reviewing syllabi, and maybe even a free lunch here or there. Spending nearly 40 hours a week in class takes some getting used to, especially after taking around a 15-hour a week course load throughout college. With all this time in school comes lots of time around your new classmates. Some great bonding occurs over those first few weeks before studies pick up.
The real bonding begins with the onset of your basic science courses, or “fundamentals” as most schools call them. These courses are designed to be a review of your undergraduate science curriculum. It’s a way to get everyone on the same page and make sure everyone starts out with the same science foundation. Since not everyone graduated with a science major, this part of the curriculum is more difficult for some students than others.
The first year really reaches its climax when gross anatomy begins. This is the point in the semester when you have to dig deep. It is arguably the hardest part of the entire dental school curriculum. Nothing bonds you with your classmates quite like long nights in the cadaver lab arguing over which branch of the facial nerve you have pinned in front of you. This part of the D1 year has been affectionately referred to as “Valley of the Shadow of Death.”
When you’re not studying anatomy or fundamentals, you’re likely in the preclinical lab working on your hand skills. At first this mainly involves waxing up teeth. Once you’ve begun to master waxing and recreating tooth anatomy, you get to start drilling. You’ll begin by cutting simple preps in plastic teeth. Most students look forward to the preclinical lab portion of the day, because it’s a chance to use a different part of your brain. You get to focus on using your hands to accomplish a task rather than relying on sheer brainpower to memorize information from books and presentations.
D1 year is tough, but when you reach the end you have established that you have what it takes. It’s proof to your school and to yourself that you can handle the rigors of professional school.
D2: Take a deep breath. D2 year is generally easier than D1 year. By this point, you’ve established your study habits and are ready to tackle any didactic coursework they can throw at you. You’ve also built up some hand skills and are much more comfortable in the preclinical lab. The first half of D2 year is aimed at getting students ready for boards. The second half is aimed at getting students ready for clinic. As you’ll find out, these are two very different goals.
The fall semester is all about boards preparation. The heavy science curriculum from D1 year flows over into D2 year with the continuation of courses dealing with the human body. Some schools organize this part of the curriculum into organ systems, while others organize it by the more traditional method into pharmacology, microbiology, pathology, immunology, etc. If you’ll remember, this is one of the major differences between schools. Most schools encourage their students to take part one of the national board exam at the end of the D2 fall semester. Several schools devote the last month of the semester to dedicated boards preparation. Your school wants you to succeed on the boards, because the boards pass rates are a reflection of the education you are receiving at the school. The curriculum is designed with the ultimate goal of having students pass boards and become licensed dentists. Part one of the boards covers the full gamut of information from the first year and a half of dental school, including basic sciences, anatomy and physiology, ethics, and tooth anatomy.
The spring semester of the D2 year is generally a more relaxed semester. Boards are done, and the focus shifts to clinic preparation. Things are busier than ever in the preclinical lab. By this point, most schools have you working on crown/bridge and removable prosthodontics in the lab. Clinical integration, where you begin to have face time with patients, is also in full swing. Most schools have students in the clinic working with patients in some capacity by D2 spring. This is the other aspect of the curriculum that varies greatly school to school. Some schools allow their D2’s to be in the clinic seeing their own patients for simple operative and periodontal procedures. Others just have their second year students in the clinic observing and assisting the upperclassmen.
D3: Here goes nothing. The biggest transition in dental school is the transition to clinic at the start of the third year. It’s the moment you’ve been waiting for. After all this time preparing to treat patients, you’re doing it. From the first day of third year, you’re essentially functioning as a dentist under the supervision of a licensed faculty dentist. Most general dentistry procedures are within your scope of practice from the first day of clinic onward. This can be intimidating, since every appointment you have your first few weeks is your first time doing the given procedure on a person. With clinic work comes lab work. Most schools require third year students to do the bulk of their own lab work. After working all day in the clinic, it can feel like salting fresh wounds when you get done and realize you have a couple hours of lab work to do before you can go home for the day.
Although clinic takes up the majority of the day, many schools still find time to have their students endure lectures as well. There’s usually one morning and one afternoon clinic session, and each might be preceded by a one-hour lecture session. Most of the classes at this point are geared towards clinical procedures and are taught by the various specialty departments around the school.
Many students find the most stressful part of third year to be the clinical requirements. Clinical requirements just refer to the number of a certain procedure you must perform to graduate. Schools vary greatly in the number of procedures they require of their students, and much of this is dependent on patient flow. Most of your clinic time takes place in the school, but there are also external rotations. Again, it depends on the school, but much of what the work you do on external rotations does not count toward school requirements.
By the end of third year, most students have begun to figure out patient management and have started to improve their efficiency in clinic. Similar to D1 year, it’s a year about proving you can handle it. It’s the last major transition in dental school.
D4: You’re practically there. D4 year is about getting out! Requirements are still alive and well for fourth year students, but most seniors hit the ground running with requirements. Since you still have a patient base from the previous year, it’s easy to get started right away with seeing patients and getting requirements completed.
The most stressful part of fourth year is completing national boards and state licensure exams. In addition to finishing requirements at school, fourth years are required to obtain their national and state certifications to be able to practice dentistry after graduation. There is generally no time off built in to the schedule for either of these exams. The licensure exam is offered on the weekends, but the step 2 of the boards can be taken most any day of the week. Students are largely left on their own to complete these tasks on their own time.
Fourth year involves much less didactic work than any other year. Fourth year students are generally allowed to send off more work to the laboratory, and thus spend less time in the lab themselves. Tack on to this the fact that you’re much faster in clinic, and D4 year does come with more free time than any year thus far. Once requirements are done and you have completed treatment for all of your assigned patients, fourth year is essentially complete.
Much of the free time for D4’s is spent planning life after graduation. If you’re applying for residencies, you’ll be interviewing during D4 fall and hearing back either late fall or early spring depending on the program. If you’re going out into the workforce, job hunting can take up a significant amount of time.
Before you know it, you’re walking across the stage and receiving your diploma. You might think back to D1 year starting fundamentals, or D2 year studying for boards, or D3 year seeing your first patient. You’ll remember what it was like at each step, and you’ll feel like it was four lifetimes rolled into one. Inevitably, someone will ask you, “What was it like going to dental school?” You might find the most accurate answer is, “It depends!”
About the Author
Colson Smith is a third year dental student at the University of Alabama Birmingham School of Dentistry. He is an avid outdoorsman and enjoys spending time outside with his friends, family, and three-year-old black lab.