What Dentistry is like in Canada

If you studied in Australia then you know a Canadian international dental student, or two, or possibly half your graduating class.   The question the Canadians and many of the Aussies wonder is, how different is dentistry in Canada compared to Australia? The quick and dirty answer, which I tell my patients when they find out I went “down undah” for dental school, is that it's not.  Sure, there are some differences, yet not so much in the clinical dentistry as much as the way things are organized.

Over the next few weeks we're going to describe what you need to know to be prepared to return to Canada or to make the working holiday dream a reality. The differences lie not just in the materials but also the organisation, business structure and clinical details. To help get your head around it this will be a series covering 

1. Clinical Differences
2. Children and MSP
3. A Day in the Life

Part 1 - Clinical Differences

Evidence based dentistry uses the same research no matter what your time zone. As the research we base our clinical decision-making on is the same, the methods that we use to restore teeth are very similar.  There are always differences between practices in what is available to work with. This is true if you are going to a clinic down the block from your dental school or going to a clinic an ocean away.

There are always differences between practices .... This is true if you are going to a clinic down the block from your dental school or going to a clinic an ocean away.

First off it seems many Canadian dentists love carbide burrs.  You can ask your CDA for an 010 diamond and they are going to look at you like you are from outer space… or from Australia.  For some reason in Canada, a country that adopted the metric system before I was born, has opted to use the imperial system for bur measurement.  A 557 is equivalent to a 010 and a 330 is roughly a 080. Don’t worry your CDA gets really good at translating what you ask for and you usually end up with what you want.

Dental Assistant - Right?

Don’t call a Certified Dental Assistant, an assistant or else they get very offended! In Canada there are two levels of assistants.  One a “chair side” is only able to hand you things, suction and clean the room. A Certified Dental Assistant (abbreviated as a CDA) is trained to hand you things, suction, clean the room, place rubber dam, make temporaries, take impressions, take radiographs, do a prophy, and generally make your life a whole lot easier.  If you are really lucky you can get a CDA with extra modules such as prosthodontics, which means they can make temporary bridges and pack cord or orthodontics, which means they can place spacers and change wires etc.

Hygiene Checks?

Another staffing difference is there are hygienists in most offices. They are the ones doing all the perio charting, supra and sub-gingival debridement, and take radiographs at the checkup exams.  They are also the ones the patient is most used to giving them grief about not brushing or flossing. When you walk in to do a checkup ask the hygienist how things are looking. They have spent the last ¾ of an hour talking with the patient and scaling the teeth, they are going to be able to basically point out anything that they see that doesn’t look right. They also like being asked for their opinion. By regulation they are not allowed to diagnose caries, but they certainly know what it looks like and are happy to draw your attention to areas they are worried about.  

There are Hygienists in most offices

Yes this makes your life as a dentist way easier; you are going to be freed up from having to do any scaling or prophy. Let’s take a typical crown preparation where you are replacing an old failing amalgam to have a new core: You can walk into the operatory (Yes, they're called operatories in Canada, not surgeries), greet the patient and check what tooth you are working on, give LA and walk away, if you are running really behind because of an emergency you can even have your hygienist administer the local anesthetic (most really hate giving IANs for some reason).  Your CDA will then take a shade, and a preliminary impression to make the temp. You come in remove the old amalgam, and your CDA can place the matrix, etch, prime and bond for you; but most of us prefer to do these ourselves. You place the core, prepare the tooth and walk away. Your CDA with a pros module can pack the cord, you come in take the impression, check it and leave the CDA to create the temporary.  The patients are reassured if you take the time to sit down and check the temp and give the CDA the go ahead to temporarily cement it.

The 76N Please - The What?

In terms of other equipment differences, most dentists in Canada trained with American pattern forceps, so what are most offices equipped with? American Pattern. Try to use them, but if you absolutely hate them, order some forceps you are comfortable with. It will make your life easier, your office manager or owner may be upset that you just asked for a thousand dollars worth of forceps, but if it turns an hour long extraction into a fifteen minute extraction it’s probably worth it.

Every clinician has his or her favorite brand in terms of materials: Be adaptable!  Don’t walk into a new office and expect everything to be the same as in dental school, it is worth trying something different, who knows you may like it. I just prefer the feel of a diamond to carbide, and I really don’t like American pattern forceps.  But man I love the handling of 3M Filtek.

Dentistry Is Dentistry

Overall, there are some rather large differences in the day to day operations between Canadian and Australian dental offices but the procedures to remain the same. In Canada we have more staff to take on routine work, such as hygiene, which leaves us with more time to tackle the more intricate and complex work that we were trained to do. It also means that we pay more staff high wages to compensate for their experience and education. The transition in terms of procedures and materials is an easy one - and is perhaps even quite beneficial as we can take what we deem to be the best of each world.

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