Dental students spend more time at school than their own houses with people they see more often than their own families. So what exactly happens inside this home-away-from-home? Let’s take a walk through the halls and see what clinics and classrooms we can find within the dental school walls. Each school is different, so I will often draw from the school I know best, my very own University of Alabama-Birmingham (UAB) School of Dentistry. However, the basic principles of treatment planning, comprehensive treatment, rotations, and more stand true across the country. I hope this article, and all subsequent editions of The Bridge, will introduce pre-dental students to the wide scope of dentistry provided within a dental school and spark conversation from dental students about what we love and don’t love about how our schools operate. With that, let’s walk right in!
Treatment Planning Clinic
The Treatment Planning Clinic (TPC) is the first encounter most new patients have with a dental school. At UAB, our treatment planning appointments last three hours, and I have heard from students at other schools that their treatment planning protocol takes up to three appointments. During a treatment plan, students interview patients for medical history and caries risk, perform oral cancer screenings and intraoral exams, record restorative and periodontal charting, take indicated x-rays, and present treatment plans and prices to patients. These appointments usually entail long conversations to uncover patients’ motivation for seeking treatment and to educate the patients about their needs and options.
After accepting a treatment plan, patients are then assigned to a student dentist to complete treatment in the Comprehensive Care Clinic (CCC). Some complex patients may require additional appointments in the CCC before they can be fully treatment planned. Treatment planning patients may also be referred to a specialty department for specific treatment. For example, a patient needing root canal therapy may be referred to the Endodontic Clinic, or a severely medically compromised patient may be referred to the Hospital Dentistry Clinic.
Limited Care Clinic
The Limited Care Clinic (LCC) is another way a patient can enter the dental school system. The LCC is intended for patients with limited, emergency issues who are not regularly seen at the school. Usually these patients are in pain. During a limited care appointment, students review medical history and perform a limited oral evaluation to determine the cause of the patient’s issue. Students may take x-rays or perform additional diagnostic tests to help narrow down the culprit. Patients are then usually referred to the appropriate clinic for treatment – usually for root canal or extraction. Limited care patients are encouraged to seek comprehensive care in the TPC once their emergency is resolved.
Comprehensive Care Clinic
You can think of the Comprehensive Care Clinic as your typical general dentist’s office. The CCC is where students perform the majority of their dentistry, and appointments there can include everything from fillings to crowns to dentures to veneers. Students have a family of around 30 patients for whom they are responsible and see on a regular basis.
The CCC is divided into six “bays.” Each bay grouping is comprised of approximately 12 fourth-year students (D4’s), 12 third-year students (D3’s), and two “bay leaders.” Bay leaders are faculty members assigned to look over the students in their bay, help with cases, and make sure that students are on track to finish their requirements successfully. In the clinic, your bay (or family) is your support system. Your bay-mates and your bay leaders are the ones that you seek first for help, for a shoulder to cry on, and for requirements you can’t quite meet.
To make the clinic even more confusing, there are both bay groupings and physical bays. Bay groupings are as described above, and physical bays are rows of chairs grouped together. UAB’s CCC has 76 chairs divided into seven bays – six bay groupings, with the seventh bay alternating as a periodontal or prosthodontic bay. Each day, a physical bay has eight students treating patients with one faculty member overseeing this group of students. Students must check in with attending faculty members at certain steps in a procedure before they can proceed. This acts as a type of quality control and a means to learn different techniques from different faculty.
Every school has their version of both types of bays. Some schools call their vertical integration teams “families,” which are comprised of D2’s, D3’s, and D4’s that treat the same patients and delegate procedures based on complexity. Some schools also divide their clinic into junior clinic and senior clinic, with cases, again, delegated based on complexity and skill level.
The CCC also includes a supply room and sterilization. The supply room has disposable items such as impression materials and anesthetic. Sterilization keeps our instruments clean and has equipment like the Nomad (portable x-ray head) that can be checked out by students.
Students use this lab to complete work for their CCC patients. This work includes pouring impressions, waxing teeth, setting denture teeth, mounting cases, making custom trays, and more. The lab has all of the machines students need to complete their work, and each student has a lab locker where they can keep their equipment and cases they are currently working on. All work is completed on the student’s own time. Luckily the lab is always filled with fellow students, which makes this lengthy, tedious homework lots more fun.
At UAB, eight angels sit in the lobby. These angels are our patient coordinators. Coordinators help schedule our patients, handle paperwork and payment, and allocate patients to students based on their needed requirements. Each bay has its own coordinator which allows for even more individualized attention. Not all schools have patient coordinators. In this case, students are completely responsible for their own scheduling. Remember to be thankful if you are blessed with the help of a coordinator!
Pre-Clinical Dental Lab
Pre-Clinical Dentistry Lab (PCD) is the classroom where students first learn how to perform dentistry and is unanimously the most fun part of the first two years of dental school. First- and second-year students (D1’s and D2’s, respectively) are in school from 8AM-5PM Monday through Friday and spend about 12 hours per week in PCD. Students learn skills that build on each other and culminate in a student prepared to treat live patients in the dental clinic. Students also use this time to goof off, make friends, and binge watch Netflix during the hours and hours of practice.
Each student is assigned a seat with a manikin head, drawers for their equipment, a TV displaying the instructor, and a station with handpiece motors, suction, and air. (Fun fact: Mannequin and manikin are both used to describe dummies. The spelling “mannequin” is generally used in the fashion industry and “manikin” in the medical field.) In addition to the PCD instructor, a few faculty members are available to check work, and a dental technician is on-site to fix any equipment problems and provide insight into the magic of lab work.
During their first year in PCD, D1 students learn how to carve teeth from wax. Waxing teeth teaches both hand skills and dental anatomy. Around wintertime, D1’s get to pick up the handpiece and learn operative dentistry or “drilling and filling.” All of this work is performed on a manikin and plastic teeth (because most students demolish their practice teeth on their first couple dozen attempts).
During the second year, D2’s dive into prosthodontics. They begin with fixed prosthodontics (crowns and bridges) and move on to dentures and removable partial dentures. D2’s also collect extracted teeth from local dentists and learn how to perform root canals on these autoclaved, natural teeth. Again, all work is performed on manikins, so no patients are harmed in the making of these future dentists. Although the timing of waxing, fixed prosthodontic, removable prosthodontic, and endodontic modules vary across schools, PCD (or pre-clinic, as it’s called at many schools), is the universal method for students across the country learn hand skills before entering the clinic.
Specialty Clinics – Pediatric, Orthodontic, Periodontic, Prosthodontic, Endodontic
There are five main dental specialties: pediatrics, orthodontics, periodontics, prosthodontics, and endodontics. These specialties often practiced in unique clinics housed within dental schools. Each specialty clinic will usually house its own residency program, and dental students also work or shadow in these clinics. Each specialty clinic acts as its own office, and students can refer their patients to these clinics for more intensive treatment by residents and follow these cases to completion. Having these specialties in-house is helpful to both students and patients. Instead of visiting four different offices for four different consultations, a patient can see a prosthodontist, a periodontist, an endodontist, and a restorative dentist, all in one appointment at the school. Students running these consults learn to think about these cases from different viewpoints and are able to handle more complex cases. Not all schools have all five of the main specialty programs, so make note of which specialties are available at schools you visit.
If the dental school faculty were kindergarteners, Faculty Practice would have a big, hand-painted sign reading “KEEP OUT!” hanging on the door. Faculty Practice is a private practice for full-time faculty to treat their own patients, and students are generally not allowed inside. I picture Faculty Practice as an oasis where faculty perform top-notch dentistry without nagging students, maintain their hand skills, stay up-to-date on new techniques, and earn additional income. To be honest, I haven’t stepped foot in this clinic long enough to find out if this is true. This is the equivalent of the mysterious Teacher’s Lounge of our youth.
On the top floor of the dental school, far away from the leering eyes of patients, sits the student lounge. This is a student-only area with lockers, refrigerators, couches, and plenty of tables to scarf down nourishment between class and clinic. This room is usually filled with students blowing off steam over lunchtime or spending downtime studying. Lots of students (including myself) bring their own lunches, but there are just as many culinarily-impaired students who grab food from nearby restaurants. Some schools also have in-house cafeterias or nearby hospital cafeterias available. For those who need silence during their break time, study lounges are also available – an oasis for the last-minute crammer. There is an unspoken no-talking policy, and the room stays relatively quiet year-round.
The only thing significant about dental school classrooms is how much time students spend there: around 22 hours of required attendance per week during the first and second years and 10 hours third and fourth years. Each classroom is equipped with a recording system so students can re-listen to lectures. Most lectures are given in PowerPoint format and available online to students.
Many health professions schools across the country have converted to a systems-based curriculum. This means that basic science is taught in a Fundamentals course and anatomy, physiology, pharmacology, pathology, etc. are taught in Systems courses and organized by body system (ex. renal, musculoskeletal, endocrine, etc.). Because the content is generally identical across multiple health professions, D1 and D2 students will often take their Fundamentals and Systems courses with optometry and medical school students in a separate building on campus. Dental students also often have the honor of learning anatomy on cadavers. Some schools do not have this resource, but there is real beauty in learning the intricacies of anatomy on a real human body.
As you can see, a lot of action is packed into a dental school. Each dental school is unique, but the astounding amount of work that happens within a dental school’s walls is universal. Conferences have allowed me to network with dental students nationwide, and I have enjoyed learning how our schools operate differently. Does your school function similarly, or do you have a different set-up – for better or for worse? I’d love to hear your thoughts!