Day: 2/5/2010

CPT Alex Smith, CPT Tin Le, MAJ Chun Chan

Our Senior Residents recently found out where they will be going after graduation in July! Not knowing your next duty assignment is always good for a little anxiety for service members and our families. At least in the Dental Corps, though, the personnel in Washington, DC making the assignments really do try to accommodate people’s desires. I’ve never had a bad assignment but I’ve never really known how the process worked either. I would have believed that they threw darts at a map and that’s how people got their assignments!?! I’ve learned recently exactly how this works, though, because our Program Director is part of the process for all 63B/Comprehensive Dentists. He conducts marathon telephone calls with the assignment manager over a period of weeks, as they go through the list of openings and requests one by one. It has been impressive and encouraging to witness how hard they try to accommodate our Officers. I witnessed this – not because I’m eavesdropping :) - but because I share an office with him and he trusts me not to leak the news. THAT is hard! But I know better…

Having said all that, it shouldn’t be a surprise for our residents that they all got pretty much what they wanted.

CPT Alexander Smith wanted anywhere but CONUS (Continental United States), more specifically Japan or Korea. He is going to Korea!

CPT Tin Le wanted a location where he knew his wife could attend Nursing School. He is going to White Sands Missile Range in New Mexico which was on his list.

MAJ Chun Chan wanted the Northeast and is going to FT Drum, NY.

So, needless to say, they are very happy. They are still focused on their academic and clinical requirements right now – they do still have to graduate!! But they also have had to start attending briefings related to their upcoming moves. So, it’s the beginning of a new beginning for them – an exciting time.

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I've had a lot of time to reflect on ranger school lately.  I certainly didn't appreciate the full value of the experience while I was in it which is very understandable--while you are there all you want to do is get out of there.

Getting the tab is important for career reasons because it's considered very important in the infantry.  People  judge you for it.  That's not the important part though.  There are some great people that don't have the tab and some terrible people that do.  Anyone that has the tab will have a basic level of toughness and discipline though.

What's really important about the experience is the growth I got from it.  You really get perspective on what is required of you as a soldier in difficult circumstances.  Doing the right thing--the things that will make your unit an effective fighting force--is completely counter-intuitive in those circumstances.  The stress on you is such you just want to shut down.  The monkey chatter in your head--the endless stream of thoughts on nothing in particular that keeps you from being present in the moment--is constantly going on and on reminding you about how tired and hungry you are.  Eventually though you realize the monkey chatter is not who you are.  There's a deeper part that is much stronger than that, and learning not to listen to the monkey chatter is so important not just in Ranger school but life.

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I get asked the question frequently about cosmetic dentistry in the Army.  This question is usually coming from applicants wanting to joint the Army.  So let's discuss it.

Cosmetic dentistry is done in the Army.  Procedures such as veneers, minor orthodontic movement, composite bonding,  crowns, and even facial surgery do happen for cosmetic reasons.  Personally I have done all of these (except the facial surgery) as part of my practice.  So what factors determine whether you will do these types of procedures?

1) Location.  The reason that location plays a role in the type of dentistry, is that location determines who your patient base is.  If i am assigned to a clinic or a base that treats new Soldiers entering the Army, my practice is going to be predominantly getting those Soldiers out of pain and taking care of emergent needs.  This type of practice would be similar to what you may experience at a community health clinic either in a big city or in a rural area.  Many of the Soldiers entering the Army have not had the opportunity, finances, or desire to see a dentist - and they need a lot of work.  Additionally, they are in a training environment where they are expected to miss very little class.  These Soldiers will typically recieve extractions, root canals, and large fillings.  They are not going to have cleanings, braces, small fillings,  or cosmetic work done.  That type of work will be continued when they get to their permanent base.  If they are National Guard or Reserve they have the ability to sign up for a dental insurance program the government partially subsidizes for them.

If they are Active Duty Soldiers that are done with their initial training, then you will have more flexibility to offer them comprehensive treatment plans.

2) Training.  Dentists are credentialed, or allowed to do certain procedures.  These are set up automatically based upon the level of training a dentist has had.  New dental graduates right out of school will not be allowed to do the same procedures that dentists who have done additional training are allowed to do.  They do have the chance to apply for additional procedures they do.  This is accomplished by working with a specialist, and showing that you have the skill level to perform that procedure.  If the specialist signs off on it, then you have something else you can do.

3) Your boss.  Some supervisors allow greater flexibility than others in the types and amount of procedures they allow to be done.  it is a supervisors job to make sure that the main needs of Soldiers are being met.  Although everyone would like straight, white, perfect teeth - if most of the Soldiers where you are have cavities - that will be what you need to be focusing on (not exclusively).

4) Your skills.  As much as we like to think we know it all, or that our skills are great - the truth is that they may not be.  Sometimes we are our own worst enemies and it takes someone else to protect us (and our patients) from ourselves.  I particularly find this with new dentists that feel that they are very proficient in doing certain procedures, only to find that they still need to work on their skills.  I have been guilty of this in my career as well :)

5) Procedures.  Things like placing implants and braces are not going to be done too frequently by general dentists or even comprehensive dentists (graduates of the 2-yr Advanced Education in General Dentistry). YMMV.  These procedures are done, but will ususally be performed by the specialists (Orthodontist or Periodontist/Oral Surgeon).  General and Comprehensive dentists do restore implants though. Braces in general are not commonly done in the Army.  Orthodontists are limited and usually support oral surgery programs getting cases ready for jaw surgery, supporting residency programs training residents with limited ortho cases, or doing more complex cases on their own. 

6) Soldiers availability.  You may work up a great treatment plan, but if your patient is moving, going to war, or not available because of other obligations - it's not going to happen.

I have enjoyed my time as a dentist, and the range of procedures I can do.  Part of that is definately because of the post-graduate training I have had, but it is also because of great supervisors, and also a good attitude.  I think a lot of what you experience is what you make of it.

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