By Sunaina Puri, Associate Dentist
You know that moment when you look around for the adult in the room and realize it’s you?
That was my first year out of dental school. Not necessarily the clinical work itself, but the moments when you finish a prep and there’s no attending to check it off before you move on to the next step. Everything is yours: the margin, the occlusion, the radiographic interpretation… everything.
I graduated from the International Student Program at CU Anschutz and went straight into corporate dentistry, not necessarily by choice, but because most opportunities available to new grads are often in corporate dentistry. The gap between those two environments was stark and surprising. And I’m not talking about a knowledge gap, because dental school teaches you how to do dentistry. What it doesn’t teach you is how to do dentistry at a productive pace, see three patients at once, manage paperwork, and do it all while an emergency walks through the door at 5 p.m. on a Friday.
In school, my clinical days looked like this: lecture, one patient in the morning, lecture, one patient in the afternoon. Each patient block was 2–2.5 hours, with faculty checks at each progress point. In practice, a fully booked schedule can mean seeing up to 30 patients. Gone are the days of treating one patient at a time. On a normal morning, I am running three chairs at once: an exam in one room, numbing for fillings in the next, and an emergency in the third.
Emergencies are no longer scheduled blocks, like EM rotations in school used to be. In school, I rotated through the emergency department, and those visits were scheduled and blocked out in my day so I could focus on them. Now, emergencies walk in during an already full schedule. The swelling, the broken tooth, the lost crown at 4:45 p.m. I triage on the fly.
The ideal plan meets the real plan. Textbook comprehensive treatment planning is still always the foundation, but now treatment gets phased around emergent needs and is often affected by what the patient can afford and what they’ll actually choose.
Good outcomes are mine, but complications are mine, too. In school, there was always someone to fall back on if something went sideways: a resident or even faculty to bail us out. In a multi-doctor practice, that cushion still somewhat exists, and a colleague can step in when a tooth won’t get numb, a root tip breaks, or a file separates. But most of the time, the complications are mine to solve.
If you’re still reading, just know that none of these are complaints. I very much love my work, and I’m just doing it within a different framework than I’ve been used to.
The Approach: What I Actually Changed
I recognized what needs me and what doesn't. In school, you are often your own four hands in four-handed dentistry, doing everything from seating the patient, taking radiographs, isolating, performing the dentistry, walking the patient out, unwrapping and disinfecting rooms, writing notes, and getting the final check mark. In practice, you have a team to support you, and you have to learn to let them. I wrote out every procedure I do regularly and marked the steps that legitimately require the doctor: the anesthetic, the prep, the check, and the dismissal conversation. Everything else, including seating, radiographs, setup, and post-op instructions, can be handled with the help of my team so we can stay efficient.
Running three chairs isn’t always about moving faster. It’s also about recognizing when you’re needed and when you’re not.
I standardized my exam so pressure couldn't shorten it. Under a full schedule, the first thing that erodes is the thing nobody is watching. I refined my exam sequence so it runs identically whether I have twenty minutes or six. Consistency, the same order, the same way to chart findings, and the little phrases and analogies I use that I know by heart works every time.
I built my own checkpoints to replace the attending. In school, every prep, diagnosis, and treatment plan was checked by faculty before I moved on. I replaced that with three non-negotiable self-checks: margins under magnification before I take an impression or scan, occlusion checked in the chair and confirmed by the patient, and a final radiograph read before the patient is dismissed rather than at the end of the day.
I learned to present the ideal plan and sequence the real one. The full comprehensive plan still gets presented. But instead of asking a patient to commit to eight appointments and a number they can’t process, I present the whole picture and then phrase it: what has to happen now, what should happen in the next six months, and what can wait a little longer. Patients accept the phase in front of them far more often than they accept the total.
I made a triage rule for walk-in emergencies. When an emergency lands mid-schedule, the goal is always to help, get the patient out of pain, and put them in a better headspace to return for definitive treatment at a scheduled time. I ask three questions before I touch anything
It isn’t always possible to fix the problem the same day, and some of those visits are intentionally palliative, but that’s still helpful.
I use my colleagues deliberately, not as a last resort. The cushion in a multi-doctor practice only helps if you ask early. You know 10 mins in that an extraction is going to be tough, so why not ask for help when you know rather than wait 40 more to do the same thing.
The Outcome: Results and Lessons
The measurable side first showed up in the schedule’s integrity. I started to notice that I was managing my time better, not running behind, and filling the schedule more effectively because I was more aware of how much time I needed and for what.
The team matters way more than you realize and expect. Assistants who know you inside and out are what keep the day from getting bottlenecked when something unexpected happens.
Something that hasn’t changed is that in school, you ace an exam and feel like a natural-born genius, and in practice, the work humbles you. Every six months, I look back and think about how I could have approached something differently and what I didn’t know then. This way of thinking holds so much value for me because it shows that I am constantly learning.
If you're a new graduate:
Your clinical training is not the gap. Reps, pace, triage, and sole responsibility are the gaps you can bridge if you treat them as learnable skills, not personality traits.
Write down which steps of each procedure actually require you and delegate the rest. Learn to trust your team.
Build fixed self-checks to replace the faculty check—margins, occlusion, contacts, radiographs, whatever you need—until they become second nature.
Ask for help early in a complicated situation rather than waiting too long.
If you own or manage a practice:
The adult in the room is you now. The good news is that the room can be built to make that manageable, and every dentist reading this has a 4:45 emergency story of their own.
Learn about the author:
Dr. Sunaina Puri is a first-generation dentist based in Colorado and is currently in her third year of practice as an associate. She graduated from the International Student Program at the University of Colorado and is passionate about mentoring new graduates and foreign-trained dentists through her Instagram, @doctornaina.