Conservative Unit: Where Dreams (and Wrists) Go to Die

I was pretty indifferent to Cons before this rotation. I was used to doing fillings, root canals, crown preps — it wasn’t anything new or exciting to me. But what I wasn’t ready for was the sheer number of patients we had to see.

For the first few weeks, all we were allowed to do as house officers was clerking. Once we submitted and got our endo blocks approved (basically extracted natural teeth that we’d practiced root canals on), we could start working on actual patients. We started small — doing GICs on pediatric patients, then regular fillings, and finally root canals, from anterior teeth to molars.

Sadly, we weren’t allowed to do crown preps — which, surprisingly, I loved doing in uni.

Now, the biggest issue in this unit? No space, and way too many patients.

There were only three dental chairs, and yet we were seeing an average of 30 patients a day. Sounds like good clinical exposure, right? In theory. But throw in the usual problems — chairs not working, supplies running out mid-treatment, random delays — and the day quickly becomes long, frustrating, and exhausting. Most days, we didn’t leave the clinic until well after 6 p.m.

One reason for the high patient volume was that this unit was a mashup of multiple departments — fixed and removable prosthodontics, endodontics, and pediatric dentistry. And since most dental patients fall into one of those categories, everyone came to us.

For the entire three months, there was no rest. No real work-life balance. I felt like my entire personality was “clinic.” I’d get home, blink, and it would already be the next morning. My only relief? The weekends. I would count down each weekday like I was in survival mode. But the cruel irony? The weekend would disappear before I could even enjoy it.

It was during this rotation I truly began to understand burnout. Doing the same procedures, in the same cramped space, day in and day out — no variety, no excitement. By the end of the posting, I was mentally one foot out the door.

Another shocker was how different things were compared to what I was taught in Egypt. The equipment, the treatment protocols — everything felt like it was operating in a completely different decade. And I get it — it’s a government hospital. They’re working with what they have. But the gap in resources was glaring.

Take rubber dams, for example. I remember casually mentioning that back in Egypt, every root canal had to be done under rubber dam. It wasn’t optional — it was mandatory. The reaction I got? Full shock. Some of them had never even seen one used on a patient. A few said the only time they encountered a rubber dam was in their final year practical exam — and even then, it was just to identify the parts.

They asked me questions like, “Didn’t it slow down the procedure?” or “How long did it take to place?” or "Did you need an assistant?" But honestly, when you’re trained to use it from day one, it becomes second nature. For us, placing a rubber dam was like brushing your teeth — quick, routine, non-negotiable.

That said, I had to unwillingly adapt to working without it. Doing fillings with saliva constantly creeping in, the tongue disrupting my flow — it was not ideal. But I had no choice. I had to push through and do my best with what I had. And the sad part? Deep down, I knew some of those fillings were questionable. Not because I didn’t know what I was doing, but because contamination was nearly unavoidable in those conditions. Some of them might fail down the line — and that reality sits heavy.

But hey, I know it’s not my fault. I was doing what I could, in the system I was given. And sometimes, that has to be enough.

Then there were the limitations in treatment options. And again — I don’t blame the doctors. They really do their best with what’s available. But it was frustrating. For example, after a pulpotomy or pulpectomy on a pediatric patient, there were no stainless-steel crowns available — which are typically the standard. And when it came to adult patients who had undergone a root canal and crown prep, the only option available was a metal-ceramic crown. No zirconia. No real variety.

Even the root canals themselves were done using manual filing only — no rotary systems, no advanced tools. Just the basics. Slow, tiring, and miles behind what I was used to. 

And don’t even get me started on infection control. I’ll just say: if you know, you know. And if you don’t — consider yourself lucky.

I also have to talk about how, after speaking to so many patients' day in and day out, your people skills improve by force. Whether you want them to or not. Eventually, you just get better at talking to people — building confidence, navigating personalities, reading the room.

Before this, I didn’t even realize how many types of patients there were.

In Egypt, I barely spoke Arabic, so there was always this disconnect between me and the patients. I mostly relied on friends or doctors to do the talking while I did the work. So I never really got to experience what it’s like to manage people — or just how opinionated, difficult, or straight-up exhausting they can be.

Back then, a patient would show up, I’d treat the tooth, and that was it. If they had complaints? I probably didn’t understand anyway. Easy life.

But being here? Different game entirely.

Some patients will ask the same thing over and over, no matter how clearly you explain it. Others will flat-out doubt your treatment plan — which is hilarious considering you are the one who went to school for this. Like when you tell someone they need a crown after a root canal to prevent fracture down the line. Logical, yes? But no. As soon as their pain goes away after the first visit, they vanish — crown forgotten. And then they show up later with a cracked tooth, like this was a plot twist and not exactly what we discussed.

Or you get the self-diagnosing type — they walk in already convinced they know what’s wrong, what tooth it is, and exactly what treatment they need. Then you take an x-ray and realize the situation is the complete opposite. But they won’t accept it because Google said otherwise.

Then there are the parents — the ones who’ve already heard your entire explanation, nod along... and then five minutes later, ask every single thing again. Word for word.

But when dealing with patients, you have to hold your tongue, smile, and remain respectful. No matter how drained or irritated you are. That’s part of the job too — professional patience.

Then there were the kids — each one with their own personality, fears, and reactions.

I met every kind of child in this unit:

• The one who cries nonstop from the moment they enter to the second they leave — even if the procedure doesn’t hurt.

• The anxious ones who ask a million questions and still don’t sit still.

• The ones who need to be physically held down just to get through a filling.

• And special needs kids, whose treatment often has to be deferred completely because there’s no way to proceed safely without proper cooperation — and unfortunately, no conscious sedation available.

It was a harsh reality check that reminded me how important the behavioral management course was in school. Because seeing it play out in real life made me question whether I ever really learned it properly in the first place.

This unit made me truly appreciate the environment I was trained in.
Because looking back... I lowkey had it easy. And I didn’t even know it.

By the end of the rotation, I had gained a lot — sharper skills, better communication, more confidence in my hands and my voice. I saw the value of patience, the power of empathy, and how important it is to adapt when things aren’t ideal — because they rarely are.

But if I’m being honest, no matter how much I learned, I never got used to the long, draining hours. The physical exhaustion, the mental fatigue, the days that felt like they would never end — it weighed on me. And while I grew in many ways, I also realized that growth doesn’t always feel good while it’s happening. Sometimes, it just feels like burnout.

Still, the experience shaped me. It stretched my limits and reminded me that even in the most frustrating, repetitive, and uncomfortable moments, I was still moving forward. Tired, yes — but more capable than I was before.