Ask Dr. Christensen

Recently, at a local dental society meeting, I was engaged in a conversation with several practicing dentists who have hired new dental school ...

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Gordon J. Christensen, DDS, MSD, PhD

Helping new dentists gain clinical competency

Q Recently, at a local dental society meeting, I was engaged in a conversation with several practicing dentists who have hired new dental school graduates as associates. The general opinion was that the new graduates needed and wanted more clinical experience and knowledge. Their opinion was that the new graduates were different from what they had seen in previous years. You have been a dental educator most of your career. What can be done to improve this situation?

A Can you remember when you graduated from dental school? You might have felt clinically competent for a short time, but for most of us, that self-confidence faded rapidly as we saw clinical conditions that we had never encountered, and occasional clinical failures began to challenge us.

It has been my observation while providing hundreds of CE programs to thousands of dentists that today’s dental graduate entering practice has many more challenges than the dentists of a few generations ago. It is a matter of fact that dental educators have far more to teach today than in the past.

Knowledge in dentistry has expanded enormously. A few examples of the relatively new innovations are digital radiography, cone-beam radiography, dental implants, CAD/CAM, lasers for soft and hard tissues, zirconia crowns and fixed prostheses, rotary endodontic procedures, patient demands for esthetically perfect restorations, and bone grafting, not to mention the myriad new clinical materials and their related technique-sensitive procedures.

It is well known that most new graduates are deeply in debt. Dental education is extremely expensive. It is not uncommon for new dentists to have a school debt of $200,000 to $300,000. To compound this financial challenge, new graduates have yet to obtain the clinical experience to build practice speed. Therefore, their production is only a fraction of what it will be when they mature in a few years. How much time was required for you to gain practice speed and clinical confidence?

Additionally, every new dentist requires time to not only build speed but also maintain high-quality oral care. Their overall goal must be to provide excellent, high-quality patient care.

As a result, there is an associated financial problem for new dentists in many communities. It is my observation that although numerous potential dental patients do not have access to oral care in some remote communities, most metropolitan communities are saturated with dentists. Many new dentists want to practice in a city or town and not a remote area. Additionally, new dental schools are starting on a routine basis, and they have the potential to further saturate the market. It is nearly impossible for a new graduate to initiate a new solo practice. It is a well-known fact that most new dentists associate with mature dentists, join a “corporate” dental practice, enroll in a general practice residency, go to a specialty educational program, join the Public Health Service, or go into the military. None of these have salaries conducive to paying off large educational debts.

As I provide continuing education courses in many locations, another frustrating factor has become evident. I have shared the following observation with other continuing education speakers, and they are seeing the same situation. Many new dentists are not attending CE courses. A typical CE course usually has only a few dentists in the “one to five years out of school” category.

In my opinion, this is extremely unfortunate, since this inexperienced period in their careers is when they need to be exposed to many different philosophies, techniques, concepts, materials, and devices. I also feel that they should be involved with organized dentistry and should interact with their peers. Where are they receiving their CE? Many new dentists have told me that they visit the Internet for much of their CE. Something else I’ve heard is that they do not feel they need CE since they have just graduated from dental school.

Pertinent questions — Are these new graduates correct in their opinions? Should they attend CE? Should they go to dental society meetings? Should they be involved with organized dentistry? Is it important to associate with other dentists? Is it acceptable to simply practice, occasionally visit the Internet for dental information, and isolate themselves from traditional forms of professional interaction?

In my strong opinion, they need help! How can the profession — you and I — help the upcoming dentists become clinically competent and financially secure as rapidly as possible? The following information is a call to action for experienced and successful dentists to help newly graduated dentists overcome these challenges.

Organized dentistry involvement

Most readers of this column are members of the American Dental Association. Most of you attend, at least some of the time, your local, state, and national ADA meetings. You may not agree with everything that happens in the organization, but that’s the same in any large organization in which you’re involved. You have remained an ADA member because you see value in the organization and your membership. Can you and I transfer that feeling to our younger dentist acquaintances?

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Fig. 1 — Hands-on courses are especially valuable for all dentists, since they actually work with the techniques and products they are learning.

Dental societies now offer help for new graduates as they integrate into practice. May I suggest that local dental societies increase their activity with new graduates by assigning a mature and committed dental society member to every new dentist who sets up practice in their communities? This assigned member will have the responsibility to befriend the new dentist, talk to him or her, and take the new dentist to dental society meetings. At the meetings, the member will have the responsibility to introduce the new dentists to dental society leaders and members, and make sure they’re comfortable and socializing with the other members.

A logical outgrowth of taking the new dentist to the meetings is taking him or her to the state or even national meetings. Soon, the new dentist will begin to feel a part of the larger body of dentists and value the ADA membership. The conversion from an independent, nonintegrating practitioner to a supportive member of the profession will take place.

Continuing education

This task may be more difficult than encouraging dental society involvement for young dentists because many CE courses require tuition and a day or more out of the office. Nevertheless, an invitation from a respected dentist can encourage the new dentist to attend a course in which he or she has an interest (Fig. 1). According to the ADA, there are about 5,000 new dental graduates in the U.S. each year. If even a few successful dentists would accept this responsibility, many of the well-recognized challenges for young dentists would be overcome.

As a provider of CE for several decades, we offer special tuition to new dentists who have been out of school up to and including five years. They may attend Practical Clinical Courses programs for half tuition. Additionally, dental students may, on a space available basis, attend our annual Clinicians Report (CRA) Dentistry Update course for free. Numerous organizations provide discounts for new practitioners. I suggest that CE organizations not currently providing discounts do so.

Finding and organizing the new dentists in your community is not hard if it’s coordinated through the local dental society. However, locating and inviting new dentists to continuing education must be proactive. Someone has to organize it, and someone has to actually do it. Are you ready?

Study clubs

Most of you reading this column belong to some form of dental group or organization, including study clubs. As with other activities discussed in this column, I have observed that study clubs are having difficulty attracting young dentist members. Most of the study clubs I speak to are filled with middle-aged and older dentists. Those of you who are active in a dental study club recognize the value of the knowledge you gain.

I have long been a member or mentor of several study clubs. Many of the most important aspects of dentistry I have learned have come from my involvement with both academically oriented and hands-on study clubs. Not only is the education from the instructor valuable, so are the discussions with other study club members. Another important and positive aspect of study clubs is the fellowship that develops, which leads to lifelong friendships, trust of peers, referral of patients, and a feeling of belonging.

Do you value your membership in these organizations? Do you want others to share in the experiences you have enjoyed during your career? Helping new dentists become involved in these organizations is no different from the other organizations I have discussed. Someone in the study club must be in charge of new member recruitment. New dentists must be involved immediately in study club activities and leadership to ensure continuing activity (Fig. 2).

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Fig. 2 — Study clubs taught by experienced practicing dentists are invaluable for new graduates.

Web use

Using the web is an effective way to increase knowledge. We offer a service on a weekly basis called “Ask Gordon” in which I answer the most asked questions of any specific time obtained from our repertoire of nearly 50,000 questions asked of Clinicians Report each year. You may see the “Ask Gordon” feature on Facebook, YouTube, Twitter, and our website,

Of course there are many other great sites on the web, such as PubMed or Google Scholar, to name just a couple.

Dental patients

With the financial stress of the recession and the overpopulation of dentists in numerous geographic areas, attracting patients is highly competitive for any dentist. How can we help new dentists in a tangible way? Almost all new dentists need patients in order to start their practices. Some mature dentists are busy enough that they are able to send overflow patients to their younger peers. This gesture is beneficial to the new dentist as well as the referring dentist.

I suggest that dental societies assign experienced dentist members to assist new dentists coming into their communities. These older dentists can help new dentists significantly by getting them settled into the dental community and referring patients to them.

What have I identified and suggested in this answer?

Today’s new dentists face significant challenges that appear to be more severe than those faced by past generations. They are deeply in debt, and because of the multiple new techniques and materials available in the profession and the lack of time to teach about them in dental school, many new dentists have not yet developed clinical speed and expertise. Therefore, they have difficulty managing the financial stress of a new practice, new marriage, home and car payment, children, and paying off their student loans.

As you would expect of new graduates, they do not have depth of clinical understanding or significant clinical experience, and, as with all of us at that stage, they need additional education and experience. In spite of that, it is my observation that they are rarely attending organized dentistry meetings, formal continuing education, study clubs, and other dentist social interactions. Many limit their continuing education to Internet programs and forums.

It is obvious that older dentists need to encourage younger dentists to become involved with the many interactive and influential programs with which we are involved, including participation in organized dentistry, attending formal continuing education courses with peers, participating in both didactic and hands-on dental study clubs, and getting involved with successful mature dentists in their geographic areas. The need to help newly graduated dentists is obvious, and experienced dentists can provide that help!

Our continuing education group, PRACTICAL CLINICAL COURSES, has provided an ever-changing course for many years that we are told is invaluable for new as well as mature dentists. It helps to develop a team and to identify the most effective techniques and products in the profession. The course is “Faster, Easier, Higher Quality Dentistry,” and is provided periodically at the home base of Clinicians Report and Practical Clinical Courses in Provo, Utah. Go to or call (800) 223-6569 for further information.

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization initiated in 1981 for dental professionals. Dr. Christensen is a cofounder (with his wife, Rella) and senior consultant of CLINICIANS REPORT (formerly Clinical Research Associates).

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