NYU Dental School Final Paper

The reason why I decided to apply to the Center for Special Dentistry or “The Private Practice Elective” as it is referred to at NYUCD was not because I needed more clinical time, I believe that NYU gives plenty of opportunity to improve one’s clinical skills. The main reason was to get a real life experience working in a low volume, high fee dental practice and to observe all aspects of patient and office management.

Unlike the majority of the dental students I have significant real life experience working in the dental office. Before I started NYU I was managing dental office for approximately four years and I am familiar with a lot of the aspects of the practice and patient management. However, the office that I worked for was in a completely opposite side of the spectrum of dental practices. It was a high volume low fee office located in Harlem, mainly catering to Medicaid and union plans. After working in that type of environment I was very comfortable dealing with most of the patients that would come to NYU. I felt that my clinical skills were fine, but I wanted to get exposed to all aspects of treatment of patients that can afford elective work. That is why when I read the description of the elective and visited the Center for Special Dentistry I thought that this was a perfect opportunity to acquire the knowledge and skills that in was missing.

The Center for Special Dentistry is a state of the art dental facility that focuses on providing exceptional personalized care to each and every one of the patients. When I first came to the center I immediately noticed the size and layout of the facility. The place is big with large reception area and open desk layout where receptionist sits in the same room with the patients and not behind the bulletproof glass window and the door with the buzzer that can be opened only from the inside. This kind of open room or open desk environment makes patients feel more relaxed and it is very important considering the fact that a lot of dental patients are phobic.

The second thing that I noticed that corridors were not 36 inches as a minimal width required by law, they looked almost double of that width allowing for easy passage of several people at the same time without them bumping into each other. Corridor walls have large black and white photographs of New York giving the place this upscale atmosphere.

The operatory rooms are also mach larger than 7×8 that I was used to. They are large airy and all have nice view of Madison Avenue.

As I mentioned before the facility is state of the art. It is completely paperless, you will not see a file cabinet with charts and you will never run into a problem where a chart is misplaced. Charts were replaced with Dentrix practice management software. It is the most advanced dental practice management system on the market at this time. It allows for patient’s chart to be seen from any operatory and if necessary remotely from outside of the office. The software has a built in chair-side charting capabilities and incorporates digital imaging. Every operatory has built in digital extraoral and intraoral cameras and images go directly into Dentrix and get incorporated into patient’s chart. In addition to the extraoral and intraoral cameras every operatory has digital x-ray unit and in the similar manner as the images X-Rays also get incorporated into the software. Digital practice management has several advantages over the regular paper based. Perhaps one of the main once is the fact that one can back up the data including the images and in case if something happens to the office, data can be restored with no loss of patient’s information. Second recall and patient tracking system can be automated. Also with addition of the optional module billing can be done paperless through Dentrix. One can also track account aging.

As I mentioned above one of the things that I wanted to get out of this elective is the ability to effectively deal with patients who have no problem paying for elective treatment like implants and veneers. In my opinion that was one of the main things that I got out of the program. Dr. Dorfman has a very unique approach to all of his patients. Because the practice is strictly fee for service and is not booked 1 month in advance Dr. Dorfman and his staff can spend a lot of time with each and every patients listening to their fears, concerns and expectations. In my eyes the only way for the doctor to provide good quality care is to approach each patient the way it is done at The Center for Special Dentistry. The main reason why many people avoid seeing a dentist is not finances. It is a fear of a dentist or dentistry. Usually it has to do with past dental experiences where the patient was treated in the insurance clinic where the doctor does not even have time to properly anesthetize the patient. Where it is not the doctor and patient who decide what kind of treatment the patient will get. The decision is made by the insurance company. A person, who never went to dental school, never saw the patient gets to decide what the right choice of treatment is. As incongruous as it sounds this is the kind of dental experience most of the patients who go into insurance practices get. The experience that most of the patients in the insurance practice get starts in the waiting area along side with ten to fifteen other patients. Once you got an appointment that some time you have to wait for months you get into the waiting area where receptionist is sitting behind a bullet proof glass. There you spend up to three hours. After that you being sent into the chair, doctor walks in gives you anesthetic and leaves. When after a few minutes he comes back he starts to drill without any explanation of what is going to be done or verification if the anesthetic is working. Usually the actual chair time is less than thirty minutes and patient gets very little if any feedback in terms of what is being done and what is next. The Doctor physically does not have time to spend with the patient because the fee that the insurance company is paying is too low. In addition a lot of the doctors that work in this kind of setups ether never had or lost the ability to provide quality care that all patients deserve.

Sometimes the fear of dentist and dentistry comes from parents. The parents’ fear of dentist transfers to the kids and now kids are afraid if the dentist.

Dr. Dorfman has different approach to patients. Each patient gets as much of undivided attention as needed. Every question is being answered and every concern is being addressed. The big portions of the patients that come to the practice are phobic patients with previously failed dentistry. This kind of patients takes up a lot of time. And that is one of the reasons why these patients can’t be successfully treated in the insurance practices. I have seen many patients come in with fear and leaving with a smile.

There are other things that I learned during the time I spend in practice. One of them was the amount of time that Dr. Dorfman spends on the informed consent. The informed consent is a very important part of treatment. Before beginning of any treatment Dr. Dorfman compiles personalized informed consent. This is much different from the standard consent that most of the offices use where there is one very general page written in the very legal language that most of the people do not understand and no one really bothers to read and just sign exactly the same consent regardless of the procedure being performed. The consent that Dr. Dorfman writes are formulated to reflect only the procedures and complications related to the treatment that will be performed. The language of the document is very plain that anyone can understand. It also encompasses the period after the treatment and patient’s responsibility to maintain the restorations because no matter how good the dentist is if the patient will fail to properly maintain the restorations they will fail regardless of the quality of work. Unlike other practices where patients just given the consent to sign. In the Center for Special Dentistry patients are being explained every paragraph before they sign.

One of the biggest parts of the treatment is treatment planning. It is very important when you do complex multidiscipline treatment plans that all of the specialists will have a common idea of what is the final result should be. Every case gets careful review and if the services of the specialists needed patient sees the specialist before treatment plan is complete. In the regular office where there is no specialist available onsite patients being sent to different locations and specialists usually don’t know why are they taking out a particular tooth or doing a bone graft they do not see the big picture. In contrast in the Center for Special Dentistry every specialist before they do anything has a conference with Dr. Dorfman and discusses that “big picture”. They also have access to patient’s electronic chart view the x-rays, images and previous clinical notes. This collaboration of restorative dentists and specialists brings better final results and greater patient’s satisfaction. Not only patient does not have to travel to another unfamiliar office they get the best possible treatment in the environment that they came to trust.

This collaboration of the specialists and restorative dentists in addition to the stress-free environment for the patient assures accurate treatment planning. It also provides better, controlled environment where patient feels that everyone in the office has their best interest in mind. This environment facilitates accurate and seamless execution of the treatment and makes patient active and interested participants in all steps of the process.

I saw people’s smiles transformed and people’s attitudes toward dentistry and life change. Patients would come in uncomfortable to smile, shaking from anxiety and would leave relaxed, self confident, with a big smile on their faces. I saw the satisfaction that the doctors and staff gets from being able and having time to help each and every patient that comes through the door. This environment is unachievable in the insurance practice, they simply don’t have the time.

In the past year I learned a lot. I experienced many interesting and rewarding parts of my profession that I have never seen before and saw many aspects of dentistry for the first time. I saw the venues of achieving my coals and proof that it is possible. None of this would be possible if I did not spent time at The Center for Special Dentistry

Thank you, Dr.Dorfman, for a wonderful, life-changing educational experience that goes beyond dentistry.

Igor Elperin

NYUCD Class of 2010

Recipient of the 2010 Academy of Osseointegration’s Outstanding Student in Implant Dentistry Award

Recipient of the 2010 NYUCD Award for Outstanding DDS Excellence

Member of

AACD, AGD, AO, ADA, ASDA, ADEA

Categorised in: Dental Student Experiences

This post was written by Dr. Jeffrey Dorfman