I had always thought that, by the time I become a certified dentist, I’d be giving free dental treatments to family and friends (just the close ones though, obviously). Well unfortunately, I’m not there yet!
While becoming a dentist I learned a lot of things; from roots canal treatments, extractions, fillings, to almost everything; but well, ALMOST! While there are some things I can guarantee perfection in, some I’m partially comfortable doing but, would rather have a senior do it, and then, one thing that I fail miserably at are CROWN AND BRIDGES.
No part of our training really prepared us for anything that goes into making good quality crowns and bridges, which is truly surprising provided that, it is a major part of our everyday practice; especially if we’re choosing to practice general dentistry. I find it highly unethical to be charging our patients enormous amount of money for crown and bridges which will eventually fail and cause so much trouble to their oral health.
The minor details of being able to deliver a good quality crown/bridge is a farfetched story, when we even lack the basic skill of preparing a tooth correctly for a crown. Well if you’re thinking how dumb is this girl is, who can’t even prep a tooth for a crown, let me enlighten you…
According to a research, the failure rate of crowns and bridges in Lahore alone is around 78%. This research was based on more than 1500 patients, belonging mostly to the upper middle and elite class. You can well imagine what the situation in other parts of the city would be, or in other cities for that matter.
The reason of this alarming rate of failure is that we lack basic training in the field of crown and bridges. I come from the best dental institution of Lahore, and I know how little importance this field is given. Even the residents doing their post-graduation in fields like prosthodontics and restorative dentistry have no clue and hardly spend any time in the crown and bridge department. With our dental training giving such less importance to the matter, how can we expect us to not go out in there and then produce these 78% failure rates?
The importance of impression taking and it’s technique sensitivity, what an ideal crowns should look like, how to communicate with the lab, what are the important steps of try ins and of delivering crowns/bridges, and so much more. The idea of what a tooth should look like after preparing it for a crown is so much more than just ‘flattening’ its surface and shrinking it into a pinky from a hallux. It takes a lot of skill, practice and knowledge to get it right. The skill and practice we totally lack, and are given a PMDC registration to go practice quackery on patients.
I have attended the AEEDC conference in Dubai earlier this year, and having interest in smile makeovers I mostly attended the cosmetic lectures. Not one, but EVERY SINGLE lecture said that THE most important factor in a successful long lasting crown/veneer was the dentist’s skill of prepping the tooth! The lectures were obviously more focused on other things, assuming the dentist’s skill would be immaculate by the time they graduate. That was the moment I realized, no matter how well you know the techniques, no matter how learned you are about these things, it all boils down to your clinical skills.
Recently, talking to a very senior doctor with a high end private practice in Islamabad, I discovered how real the issue was. This doctor had taken the ORE exams, practiced in the U.K.; had done a few super expensive courses in smile makeovers from there too, just to come to the conclusion that our basics are very weak! She commented that after having graduated, everyone in the world expects us to have the basic skill to a point of perfection. All the post graduate courses teach you high quality work and we fail to catch up since we don’t even have good enough skill to be doing the basics. So gauge your clinic skill before you sign up for these expensive courses abroad.
The rules and regulations in the United States demand that foreign trained dentists repeat two years of college, before they can even appear in an exam for practicing dentistry there. That country doesn’t compromise on its quality of work when it comes to the health sector, hence it’s totally justified provided how irresponsibly we’re handed over our license to practice. In these two years they make sure your skill level is perfect before you can go out there to have your own dental practice in their country. For the countries that don’t do this, they are doing a lot of bad dental work.
The need of the hour is that, institutions revise their curricula and practical training in a way that equips the students to go out and give the community best quality of work and for PMDC to devise a bench exam system before giving everyone a license to practice.
Meanwhile, if you want to survive in this highly competitive market where a D.D.S comes and takes all the attention, IMPROVE your skill! Don’t be a dentist that does enormous amount of bad work on patients and then learns their lesson. Work on the basics, before you go out there learning implants and complicated procedures. I wish our training was enough but it isn’t.
There is hope though! There are courses out there that will help you with the basics. I was fortunate enough to find myself a job where I am working with a D.D.S, worked on my basic skills on models and phantom heads and, trying to learn the systems needed for a private practice. Dr. Aqib Mudassar (the Head Dentist) himself has started a course that is helping fresh dentists and even the seasoned ones in learning international standard crown preparatory courses. So go out and look for such extensive and comprehensive courses instead of 2 to 3 day workshops, to really improve your skills for the long term.
The experience of working at a private practice has totally changed the way I look at dentistry. I’ve come a long way since I’ve gotten into the life after graduation, and there is still so much more to learn.
Dr. Bukhtawar Azhar
Bachelors in Dental Surgery
Associate Dentist at Ideal Smile