Embracing Real-World Dentistry

An External Rotation Experience at MacDonald Ranch Modern Dentistry

By Brooklyn Janes

Embarking on a new journey in the field of dentistry can be both exciting and intimidating. As the first student from Roseman University to participate in an innovative external rotation program with PDS Health (formerly Pacific Dental Services) in Las Vegas, I had the unique opportunity to step beyond the familiar confines of school into the dynamic realm of real-world dental practice. This pilot program is not only new to Roseman, but it is also unlike any other program offered by dental schools across the country. I was fortunate enough to work alongside the exceptional Christopher Martinez, DMD, (above, pictured next to me) at MacDonald Ranch Modern Dentistry. This experience would become a defining chapter in my educational journey, pushing my clinical boundaries and shaping my future as a dental professional.

Throughout this monthlong experience, I discovered not only my strengths, but also my limitations and areas needing improvement. This journey of self-awareness was eye-opening, revealing the specific skills I need to focus on as I finish my last year of dental school. Often, I found myself thinking, “Wow, this is what it would be like to start working as a dentist!” I was grateful for this glimpse into real-world dentistry because it showed me how to better prepare for my first job after dental school.

One key lesson was in patient management, especially with children. I never encountered difficulties with a child patient in the clinic, so managing a very fearful and screaming child during my rotation was humbling. Dr. Martinez constantly pushed me to reach my full potential, even when I wished he would take over certain procedures because I doubted my ability to complete the treatment. His belief in me taught me the invaluable lesson of surrounding oneself with mentors and employers who inspire and challenge you to be better and remind you that you can handle difficult tasks.

I didn’t realize beforehand how amazing it is to have someone clinically advanced enough to not only point out your mistakes, but also give constructive feedback. This experience has influenced my considerations for when I apply for my first job as a dentist, making me realize the importance of having the support of other dental professionals.

Digital Dentistry

Once I got acquainted with the office, Dr. Martinez had me practice a crown prep on a posterior molar using a diagnostic cast. He provided valuable feedback on proper reduction measurements and how to use specific depth-cut burrs. After refining my crown prep, I learned how to use the CEREC® CAD/CAM 3D scanner. It took some time to get the hang of it, but digital scanning is amazing and much more comfortable for the patient. Once everything was digitally scanned, I could see my prepped typodont tooth on the computer screen. The software asked for information, such as the type of porcelain material, the tooth being prepped and the shade color. Using artificial intelligence, the computer generated an anatomical crown with appropriate anatomy that fit well with the rest of the arch. I could adjust the minimal thickness of the crown material in certain areas, the occlusion and the contacts if needed. I was also able to draw out my margins on the computer so that the machine knew where the crown would extend.

By doing most of the lab work on my own, I learned how to improve my crown preps while working in the mouth, as I became more aware of what to look out for. Seeing the crown margins enlarged on the computer screen is very different from looking through your loupes while working in the mouth. You can see all the imperfections and inadequacies up close. Once I had my crown design looking how I wanted on the 3D impression, I submitted the file to be milled out on the CEREC milling machine. It only took about 10 minutes to have a new porcelain crown made and ready to be seated on my cast. This was my first experience with same-day crowns!

Once I got the hang of completing a same-day crown, I was able to implement these procedural steps on actual teeth. Dr. Martinez guided me through every step of the procedure to ensure everything was going well. During my time, I was able to complete multiple same-day crowns. This was such a unique experience because, in dental school, it could take up to a year or more for a student to practice on a typodont in the simulation clinic before being able to complete a crown on a real tooth in the actual clinic. With this rotation and the technology I was able to use, I shortened this time frame to about one week. I learned exponentially more in this short amount of time by being in Dr. Martinez’s office and working alongside him.

Bringing Joy and Confidence

One of my favorite moments at MacDonald Ranch Modern Dentistry was witnessing how heartwarming dentistry can be. Dr. Martinez teaches esthetic dentistry within the company, and I understand why: He does many esthetic cases and has a real niche. One patient in particular had dealt with a discolored front tooth for many years that also protruded too far anteriorly. She was severely self-conscious about it. Finally, the day came when she committed her morning to achieving a new smile. Everything was designed in-house and digitally, allowing Dr. Martinez to custom-fit the shade and tooth shape to the patient’s profile and smile perfectly. Once the design was made, the same-day ceramic crowns were milled, polished, stained, glazed and fired. The entire procedure went so smoothly. Once all the anterior crowns were cemented in and the dental assistant gave the patient a mirror to see her new smile for the first time, the patient cried because she was so happy. The coloring of her teeth was more natural and complemented her skin tone, and the shape of the teeth looked and also functioned much better. The patient was so excited that she wanted to buy herself some new lipstick for her new smile. I loved being a part of this life-changing experience for her. I was grateful for the opportunity because it made me realize why I chose this profession: to bring joy and confidence to others through dentistry. Another valuable lesson I took home from my rotation was the importance of treatment plan presentation and case acceptance in the role of a dentist and dental practice. One of the responsibilities of a dentist is to be an effective teacher and communicator. I recognize how challenging it can be to explain complex disease processes to a patient who doesn’t have a biology background or to guide someone through the entire process of receiving new dentures when they are unfamiliar with regular dental visits.

During my rotation, I observed Dr. Martinez masterfully break down complicated concepts into simple, understandable terms. He used analogies and visual aids, like the posters on the walls, to help patients grasp the importance of their treatment plans. He also emphasized the significance of the oral-systemic connection (which PDS Health refers to as the Mouth-Body Connection®), which instills a sense of urgency in patients regarding their oral health. Treatment planning isn’t just about fixing or saving a tooth; while presenting treatment options, we are also helping patients improve their overall health.

While we all learn this as dental students, it’s easy to forget to incorporate this type of verbiage when talking with patients. Dr. Martinez played a significant role in making patients feel comfortable and informed, which in turn increased their willingness to accept and commit to their treatment plans. His approach highlighted the essential role of communication in ensuring successful patient outcomes.

I am incredibly grateful for Dr. Martinez’s trust in allowing me to provide care for his patients and to work alongside his team. Under his guidance, I not only expanded my restorative clinical skillset, but also developed a deeper understanding of what it means to be a compassionate practitioner and leader. I extend my sincere appreciation to Ryan Moffatt, DDS, MPH, from Roseman University, who helped implement this new external rotation at my school.

What Makes a Good Leader

My perspective on leadership and teamwork in dentistry has evolved from my experience at PDS Health. Previously, I viewed specialists as the primary leaders in dentistry. While this remains true to some extent, I am now inspired by the way PDS Health is structured, placing significant weight and responsibility on the general dentist and practice owner.

At PDS Health, specialists travel to the general dental practice to better serve their patients, providing a broad range of services and exceptional care in one location. As the practice owner, Dr. Martinez ensured everyone was on a path to success. He supported his specialists, including oral surgeons, periodontists and endodontists, while also assisting his employees, such as practice managers, front desk personnel, dental assistants and other dentist associates. I noticed the positive relationships he had with each team member.

In this setting, Dr. Martinez, as the general dentist and practice owner, served as the central point of contact and primary leader. I thought it was fascinating that within PDS Health, it is the general dentist who orchestrates the entire practice. Seeing this unique dynamic, I realized that a good leader isn’t always about being at the top of the educational ladder or the one with the most degrees. A good leader focuses on the success of the people around them. If those around you succeed, you will also succeed.

Brooklyn Janes is a fourth-year dental student and AGD chapter president at Roseman University College of Dental Medicine. To comment on this article, email impact@agd.org.