Clinical Practice

Posted: November 22, 2010 in Uncategorized
The army is really great about allowing me to practice the way I want. Although I spend the majority of my time on Class 3 Operative (gross decay that makes soldiers non-deployable) I have every opportuntiy to practice full spectrum general dentistry. In my practice I perform operative and restorative dentistry, fixed prosthodontics, removable prosthodontics (very limited), perio surgery to include crown lengthening and gingival grafts, non surgical endodontics, oral surgery, and a good bit of preventive dentistry.
As for pedo and ortho – those two specialties dont get a lot of attention in the army. We only treat active duty soldiers, not dependents. As such our pediatric exposure is limited to after hours emergencies. Ortho is also very limited. Due to the deployments few soldiers are able to get orthodontic therapy. Soldiers are not supposed to depoloy with braces. I found pedo very stressful and ortho to be only moderately interesting. I enjoy our young adult patient population. And they are generally taking no medications and have no medical conditions.
I did a lot of great procedures in my residency like placing and restoring implants, surgical endodontics, porcelain veneers, etc. Due to my situation with the unit deploying I dont get to do a lot of that anymore. A big downside to all of this is that I dont get to see the same patients more than once. That is something I really long for. I want to be able to develop long term relationships with my patients and have people WANT to see me. I want people to know my name and want to be seen by me That doesnt exist in the army. Being the dentist for a brigade gives me a little bit of that, but even still this job is temporary.
No one tells me when to restore or what kind of restoration to place – be it composite, RMGI, or amalgam. I get to make that decision based on my clinical judgement. Unfortunately the patient rarely is told the risks, benefits, or complications of each restoration nor are they routinely allowed to choose what type of restoration they receive. Although I am a proponent of the use of amalgam, many patients do not like the way it looks. In my mind that is a valid concern. I think they should be given the information about the materials and, after listening to my professional opinion on what I think is best, be able to choose what they want placed in their bodies.
Money is another great benefit of the army. We have a huge budget and I get to order a lot of supplies. I found a new composite system I wanted so I bought it. I wanted new instruments. Got them too. New segmental matrix system? No problem. Unlike the civilian world in which a corporation is rewarded for being fiscally conservative, in the army if you dont spend all the money in your budget they assume you dont need it. Then your budget gets cut. Works out well for us!
Another great advantage over civilian practice is that there is no bottom line. Sure, they monitor my production but I dont have a quota or anything like that – nor am I paid based on production or collections. I feel no need to “sell” dentistry and I dont hesitate to tell someone that they dont need that filling or crown unless they truly need it. I get paid either way.

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