5 life lessons I’ve learned from pulling teeth

Greetings from the sunny shores of Sydney! My name is Tyler and I am a dental student at the University of Sydney with less than a year to go until I am finished. Having been in school for a few years now, I’ve dabbled in all the dental disciplines. Though I’ve enjoyed endodontics (root canals) and prosthodontics (dentures and crowns), I have to say my favourite specialty is oral surgery so far.

While it is our last resort as dentists, sometimes an unsalvageable tooth requires an extraction and there’s something incredibly rewarding about removing an offending tooth, delivering this treatment pain-free and ultimately relieving the patient of discomfort at the end of the appointment. It is often one of the scariest things to have done to you, but I enjoy making the worst outcome a pleasant experience.

Today, I want to share with you some bite-sized lessons I’ve learned during my time spent in extraction clinics.

1. Do as you think, not as you’re told
I’m not suggesting to be rebellious, I suppose a better way of saying that is to have a healthy dose of curiosity and objective skepticism.

I was once scheduled to extract a tooth from an older man whose hearing and English were not so good. Something didn’t add up as I was doing my tests: The tooth indicated on the notes to be removed was actually perfectly fine, which made me question whether I was somehow messing up my examination. That’s when I realized the radiograph was actually backwards—we were looking at a mirrored image of the x-ray, so essentially what we thought was the left side was actually the right. Someone wrote down the wrong tooth in the notes and it didn’t get picked up until I noticed it.

I always ask myself: Why should this tooth be removed? If I can agree, I continue. If I don’t, I question the instructions I’ve been given.

Even the best of us are prone to making mistakes, but that’s why it’s important to be judicious for even the most routine of decisions, especially when there’s no going back. Think twice, cut once!

2. Fake it ’til you make it
No one ever feels truly confident starting something brand new. Anyone who tells you otherwise is either exceptionally gifted, a little bit delusional, or just straight-up lying. My extensive experiences as a kid pulling out my own baby teeth somehow did not prepare me adequately for the first few times I stepped up to my patient forceps in hand, about to pop out one of these chompers in our dental hospital’s exodontia clinic (exo = take out; dont = tooth).

If you didn’t know, the numbing “local anaesthetic” solution we give you only takes away the pain. But you still feel pressure… and the vibrations. The same kind of vibrations my patient is feeling as their head is rumbling as my forearms are visibly shaking from muscular fatigue as a result of gripping these instruments so hard trying to maintain the appropriate angulation, pressure, and technique as I’m coaxing this tooth out of the bony socket it’s called home for the last 50 years.

As I’m rehearsing in my head all the movements I need to do, memory runs wild trying to recall every bit of information I’ve learned to help me make it through the next few minutes as beads of sweat start trickling down my face like teardrops on Taylor’s guitar. I’m legitimately not even an anxious person, but in that moment, the panic is real. Not the most confidence-inspiring situation for the patient, let me tell you from second-hand experience. The seconds felt like minutes and the minutes felt like hours.

That was my first ever extraction, or an “exo” as we call it for short, and though it only lasted about 8 minutes, man oh man, it was the longest decade of my life. It didn’t help that my first-ever patient came in with dental anxiety, which made everything even more nerve-wracking from the start. But fortunately, every exo since then has been much better because I’ve learned that the patient panics when they see you panic. So the secret, whether you’re removing teeth, giving a speech, or coaching high school track kids (all true stories from my life by the way), is just pretending to know what you’re doing until you actually get there: Just fake it ’til you make it.

3. Plan for success but prepare for failure
You have to have a plan. I always tell my patients that we need to do something called “treatment planning,” which is a fancy way of saying we need to take the entire first appointment to figure out where we’re were starting from and planning all the treatment they need to resolve their problems and fulfill their needs. It’s like planning a road trip with friends—you need to establish a roadmap of all the places we need to visit on our way to our dream destination. Yes, it’s important to hit all the tourist attractions, but there’s also necessary checkpoints like gas stations and Macca’s (Australian slang for McDonald’s) breaks if we want to survive the journey. It also doesn’t do anyone any good to set out without an idea of what direction you need to head in because driving fast in the wrong direction sets you back more than it propels you forward. Furthermore, despite our best intentions, things inevitably go wrong.

The reality of patient care (or life in general) is that almost nothing goes to plan. I am known in my cohort for being meticulous for my appointment plans. My treatments are always tailored to every individual patient with my procedures scheduled down to the minute. I take great pride in my preparation for clinics, and though I am getting much better at anticipating the unexpected twists and turns of healthcare, it’s not uncommon for appointments to not go to plan.

As you can imagine, there are a number of points during a surgical procedure where things can go wrong. The patient might fail to attend (FTA); the patient may have skipped their medications that day (resulting in excessively high blood pressure or blood sugar levels beyond what is safe to treat); maybe there’s a global pandemic shutting down the entire hospital for months on end. In short, you can’t do the procedure. Tough luck. The anaesthesia might not work (due to infection, due to natural resilience or desensitization due to drug use, due to operator error, due to accessory innervation). Maybe the tooth won’t come out; perhaps it’s trickier than the x-rays suggest. Maybe the roots flare too much, or perhaps the roots are ankylosed to the bone. And when you finally pull the tooth out, maybe a piece breaks off, or maybe a part of the floor of the maxillary sinus comes along with it and now you have an oroantral communication (OAC).

Of course, 💩 happens, but if you know the possible ways a plan can fall apart, you’ll be better prepared to handle things if and when that happens.

4. With great power comes great responsibility
I think Uncle Ben said it best, but there’s an enormous amount of trust given to dentists because we’re specialists in a field and making judgment calls to proactively treat our patients. When this treatment comes with a high cost, there’s a natural tendency to question why a currently asymptomatic tooth requires preventative treatment when there’s nothing perceptibly wrong with it.

But there’s often a lot of problems we’re unaware of in our own mouths, and by the time you detect there’s something wrong (e.g., you’re experiencing pain or sensitivity or maybe you see/feel a hole in the tooth) it’s often far too late. In our quest in detecting and preventing problems, there is often a fine line between being reasonably cautious and overprescribing treatment. Even in student clinics, obviously there is no money involved, but I still try to educate my patients on why they need a filling replaced or a tooth removed.

Have you ever seen a radiograph of a tooth? Ever notice how the dentist always shows you this black and white image and explains it to you as though you can understand what’s going on? I really try to do my best to explain to my patients, but the reality is for a field that literally operates in black and white, we’re actually dealing in a lot of grey area. What one clinician may deem as being a cavity to drill and fill, a more conservative dentist may opt to wait and see. It’s a fine balance, one that I myself am trying to master. I strive to be the kind of dentist who is conservative, informative, and acting in the best interests for my patients as they can’t reliably decide for themselves what the best course of action is because they didn’t spend four years in dental school. I made myself a promise to do only what I think is needed and not more than what my patient requires—I promise to pull the tooth, the whole tooth, and nothing but the tooth.

5. Loss is a part of life
Sometimes even despite our best intentions, things just don’t last. Whether we’re talking about relationships or our dentition, there comes a time when certain circumstances just don’t allow us to keep the things we hold dearest to our hearts (or our jaws). I’ve seen perfectly good teeth need removal just because of an unlucky accident. I’ve seen some pretty bad teeth hanging in long past their “expiry date.” There are always examples either way you look at it, but the reality is that we are doomed to lose that which we do not put the effort in to maintain.

Teeth are lost for a number of reasons, but the big ones are trauma, erosion, periodontal disease, and decay. These are natural processes for the most part, but they are indeed avoidable if only we put in a small effort every day to be diligent with good oral hygiene habits. Floss between your teeth before brushing. Brush your teeth twice a day (ideally 30 minutes after eating/drinking) and most importantly before going to bed. Use a fluoridated toothpaste. Spit—don’t rinse your toothpaste with water after brushing.

If you hate your dentist, do these three simple tricks to put them out of a job! It doesn’t take much, but for some reason, it takes a lot out of us at the end of a long day to invest just 5 minutes doing the simple stuff for our teeth. Missing a day here or there is not the end of the world, but missing a day here or there regularly, however, will indeed add up.

At some point, the teeth that have been neglected will come around to me to have to pull out in order to prevent further pain or infection. Prevention of the problem is always better (and less expensive) than treating the problem! By the time you notice there’s an issue, it’s generally getting to be too late.

Other things like watching what you eat (keep sugars and acidic foods/beverages low), snacking less, and drinking plenty of water will help save your teeth down the road. There are so many things we do on the daily that are bad for our teeth that the average person wouldn’t expect to have such drastic effects on our dentition… but we’ll save that info for another time.

OzTREKK Student Ambassador: Tyler Nguyen
University: The University of Sydney
Program: Doctor of Dental Medicine
Follow Tyler on Instagram: @dmd.toothpics

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