(16) Effectiveness of Strategies to Improve Extraction Experience in Dental Students

Abstract: Each year, approximately 7,000 new dentists graduate from over 60 dental schools in the United States and its territories. The experience of graduates in complex procedures such as molar endodontics, complicated extractions, and implant placement varies by institution and is often perceived to be inadequate. Continuing education companies often target new graduates with lucrative courses, some spanning as little as a few hours, to arguably help give new dentists the skill set to perform these procedures. The Department of Oral and Maxillofacial Surgery and Pharmacology (OMS) at the University of Pennsylvania has implemented several strategies daily allowing recent graduates to be more competent in extractions. Strategies being employed include; pairing of third and fourth year student in each operatory, having students/residents/faculty at multiple levels available to assist students when necessary, introduction of the oral surgery honors program, being able to medically clear urgent care patients for same day emergency extractions, protocols to which patients can be scheduled for a consult with a procedure at the same appointment, and extraction of teeth at locations besides the dental school OMS clinic such as community sites. We retrospectively reviewed the data on recent graduates of the University of Pennsylvania School of Dental Medicine to monitor trends in the amount of surgical and non-surgical extractions dental students graduated with. Reported data only included surgical and non-surgical extractions completed in the OMS clinic under the supervision of the Department of OMS, and excluded extractions completed in other clinics. We surveyed graduates, residents, and attendings on the effectiveness of strategies implemented to improve extraction experience and commented on the findings. Over the past 8 years, fourth year dental students at the University of Pennsylvania School of Dental Medicine have been graduating with an increased number of extractions completed. 2024 students had a mean of 40 extractions (28 nonsurgical and 12 surgical) compared to 2016 students who had a mean of 35 extractions (33 nonsurgical and 3 surgical). There was a large peak in extractions before COVID, between 2017-2019, with a gradual decline up until restrictions were completely lifted on July 1, 2024, with new implemented strategies bringing numbers up back to pre-COVID numbers. Extraction numbers have not decreased despite an increase in the class size of approximately 27% from 143 students in 2016 to 181 students in 2024. Students have also had valuable experience extracting teeth at other sites, particularly our community oral health locations and our personalized care clinic. Students, residents, and attendings have reported that the model in which the OMS clinic is run contributes to a better patient flow, more opportunities to learn from cases, in addition to opportunities to work more closely with faculty, residents, and attendings to become more efficient in extracting teeth. There is no concrete number of extractions that a student can complete to guarantee their confidence in doing extractions after they graduate dental school. Implemented strategies such as pairing of students, having a hierarchy of available help, consult with procedures on the same day, and urgent care appointments have deemed helpful in enabling students to graduate with more completed extractions and more confidence in doing them.

References:
Ali, Kamran et al. "Assessment of Undergraduate Students in Tooth Extraction Competence— a Cohort Study." Eur J Dent Educ vol. 25, no. 3, 2021, pp. 607-13, doi:10.1111/eje.12638.
Sari, Merve and Ugur Derdiyok. "The Self-Confidence of Dental Students in Oral Surgery." Odovtos – Int J of Dent Sci, 2021, pp. 537-50, doi:10.15517/ijds.2021.47854.
Figure 1: Mean number of extractions recorded per dental student at the University of Pennsylvania School of Dental Medicine OMS clinic from 2016 to 2024.