Simulation Spotlight: A Dental Charting and Examination Procedures Q&A

In this edition of Simulation Spotlight, we’re talking to Dr. Anita Sandhu. A qualified dental surgeon and medical aesthetician of 14 years’ experience, Dr. Sandhu is an enthusiastic advocate for scientific communication. As one of Immersify’s expert Quality Assurance consultants, Dr. Sandhu reviews and edits a range of dental simulations, 3D assets, and learning experiences. 

In this Q&A, Dr. Sandhu discusses how her clinical experience has shaped her perspective on the nuances of histories and examinations. She reflects on those elements of practice which can sometimes receive less emphasis in time-pressured curricula, especially when it comes to: 

• Conversing with patients for a more comprehensive understanding of medical histories 

• Cultivating a strong ‘chairside manner’, particularly in relation to uncomfortable areas of concern 

• The centrality of occlusal assessments to effective treatment 

Why do you think dental and oral examination procedures are so foundational to patient care, especially for new graduates? 

In my experience, the examination is really made up of two elements: the practical and the conversational. 

On the practical side, we’re checking for any obvious areas of concern: dental decay or broken teeth, for example. And we’re also checking for indicators of gum disease and cancers. So, in that sense, dental and oral examination procedures can be seen as an opportunity to check soft and hard tissues. 

At the same time, there’s a lot more insight to be gained at this stage by talking to the patient. A physical exam can absolutely give you some idea of diet and brushing habits, but (as any dentist will tell you!) these don’t always match up with the narrative the patient offers, especially when nerves or uncertainty affect how they communicate their habits. 

That’s why the oral examination is such a valuable chance to build rapport: with the right techniques behind you, it’s possible to get the most value out of a conversation, making the rest of the process that much easier. 

MORE EXPERT-LED INSIGHTS ON FOUNDATIONAL HEALTHCARE TECHNIQUES | 'Simulation Spotlight: ABCDE Assessments Q&A'

What does a thorough intraoral and extraoral examination look like in practice, especially in terms of those patient communication elements? 

I’d go so far as to say that extraoral examinations can encompass listening to patients. Even a casual aside can be really revealing. When a patient experiencing some form of pain mentions how stressful their week’s been, that can introduce nuances into how a dentist proceeds. Is this a broken tooth, or is all this stress making the patient’s immune system run at a lower ebb?  

This is something I had to learn on the job: steering conversations in such a way that patients are comfortable enough to chat, getting what you need out of the exchange, but still being sure to get to the reason they’re there. 

Dental charting is a key focus of early clinical training. Thinking back to your own experiences, what’s most important for students to get right from the start? 

Your right and left! 

It might sound a little ‘dental charting for beginners’, but any dentist will tell you: for a student in an unfamiliar setting, it’s easy to forget that your right (and the patient’s right) is the computer’s left. Combine that with the fact that students won’t be charting themselves, but with a nurse potentially accustomed to a certain approach, and it’s easy to see how mix-ups happen. 

This is another instance in which those communication skills come into play. This can be nerve-wracking for a student or a new graduate, but it’s so important to talk to the nurse you’re working with and articulate whether you intend to chart clockwise or anti-clockwise, from the bottom left or the top right, and so on.  

On the subject of the computer, it’s also worth getting familiar with the program you’re using before you see a patient. Knowing how you chart a six-point periodontal exam, where to enter pocket depths, and how to record soft tissue findings because every system does it a bit differently. 

Even basic dental instruments can feel overwhelming for beginners. Thinking back to your own student days and your subsequent time as a practitioner, how have you built your confidence with the tools of the trade? 

In all honesty, it comes down to repetition. At university, it was drilled into us: ‘this is what you need for an exam’, ‘this is what you need for a filling’, and so on. That structure really helped, and it trained us to understand what a basic kit should include. Every dentist adds their own personal touches, but you’ve always got that solid foundation to fall back on. 

I remember always starting with the fundamentals: mirror, probe, tweezers, periodontal probe, and a three-in-one tip. I’d usually include a few cotton wool rolls, too. Some people do; others might not. And as you go, you learn to read the situation. If I saw in the chart that a patient had periodontal disease, I’d ask my nurse early on, ‘Please can you grab me a Williams probe?’ That way I wasn’t wasting time later: I knew I’d need it. 

But you also learn that nurses are managing sterilization loads, so if you start pulling instruments you don’t end up using, that’s not great for the team. There’s a fine balance between doing your job efficiently without stepping on anyone’s toes. And that took time to figure out. I remember it being tricky at first: that mix of wanting to be proactive while staying mindful of the people around you. 

GET DENTAL LEADERS' PERSPECTIVES ON STUDENT CONFIDENCE AND WELLBEING | '5 Key Takeaways from "Beyond the Buzzword: Rethinking Technology as a Catalyst for Curriculum Transformation"'

How important is it for students to develop early familiarity with core dental instruments’ names and uses? 

It’s hugely important. With that familiarity instilled, you start to notice little triggers. You might be reviewing a patient’s perio chart and you’ll know exactly what you need. 

As you build a relationship with the people around you, you’ll habitually refer to instruments by different names. But having a firm grasp of exactly what you’ll need in a given situation, grounded in that early familiarity with the tools that you’re likely to encounter in practice, is so important for projecting an air of competence and authority. 

When you’re a fresh 23-year-old graduate encountering an unexpected problem during a checkup, that level of understanding and preparation makes all the difference in the world! 

INTERACTIVE INSTRUMENT TRAINING HAS VALUE FOR DENTAL BRANDS, TOO. HERE’S HOW | ‘Product Knowledge Training Is Under Pressure. Here’s How Gamified Digital Simulations Can Help’ 

How does reviewing a patient’s medical history fit into the broader assessment process? 

As with instruments, preparation is key here. I’d advise students to always look through the notes in advance: don’t leave it as a surprise in the appointment.  

This matters because a thorough medical history, in dentistry as much as any other healthcare setting, is crucial. You need to know what medication patients are on, as this really can impact your dental treatment plan. Not to mention the importance of understanding what the patient’s allergic to. 

And, yet again, this highlights the ongoing role of communication in effective patient care. If you’ve got a brand-new patient with no written history to fall back on, it’s essential to be able to get across the importance of accurately conveying what medications they’re on. Unlocking that willingness to share has implications that go way beyond the convenience of a good rapport. 

DISCOVER THE BENEFITS OF IMMERSIVE MEDICATION PRESCRIPTION TRAINING | ‘How Immersify’s Simulation-Based Learning Transformed UCLA Dental Students Into Trusted Prescribers’  

Where does occlusal assessment come into play, and what makes it tricky for students to master? 

Occlusion? Honestly, it felt really daunting at first. 

It’s such a huge part of dentistry, playing a massive role in everything: periodontal health, tooth mobility, sensitivity, restorative success, even aesthetics. It underpins so much of what we do.  

And it’s only when you’ve got a firm grasp of occlusion that things start to click: Oh, that’s why the crown fractured. That’s why the veneer failed. That’s how occlusion links to my patient’s aesthetic concerns. Suddenly you’re connecting the dots, and it transforms how you plan and deliver treatment. 

It might not sound exciting at first, but if you can get the basics of occlusion right, honestly, you can run with dentistry. It gives you a foundation for everything else.  

Why can occlusion be a tricky topic to learn? 

Occlusion is a very visual subject, which means it benefits from a variety of multimodal resources: images, practical examples, case studies, and so on.  

Having that exposure early on builds recognition. It creates familiarity, so when you see it in practice, it registers: I've seen this before. My brain knows what this is. That kind of visual grounding makes a big difference to student confidence. 

And the advantages of that foundation come to the fore when you enter clinical practice. If occlusion isn’t properly understood, restorative work can be compromised, and it’s easy to misattribute those issues elsewhere. 

YOU'VE SEEN THE SIM. NOW FIND OUT HOW IT HELPS | 'Does Digital Simulation-Based Learning Actually Work? What the Evidence Says For Healthcare Education'

What do clinicians wish they’d been told about histories and examinations earlier? 

The importance of the art of conversation. 

And I feel that needs to be broken up into its discrete elements. I’d have benefitted from being taught how to start a conversation, how to explain everything I’m doing to the patient, how to convey my findings to the patient, how to talk about suspected cancers, and how to politely and effectively end a conversation. 

When you suspect a lesion (which you absolutely will find in an examination sooner or later), you have to handle that with a huge amount of care, and at the age of 23, it can be difficult to proceed in a calm and reassuring manner. And in my experience, there’s room for more structured approaches to assessing how well a student can communicate. 

This is something I’ve encountered anecdotally across the profession. Dental communications courses are packed with everyone from brand-new graduates and people who’ve been practising for 30 years. 

Do you think today’s dental curricula lack the time and space to cover soft skills like patient communication, and could a flipped classroom model help address that? 

Yes, I do. Of course, dental programs need to place a heavy emphasis on getting the information and doing the practical work. They’re essential elements of the process, and there’s only so much time and capacity available to educators. 

But with many students more comfortable behind screens, their natural communication skills may be less developed, making it more important than ever to find ways to incorporate extra space for questions and reflection. 

A flipped model could help. If students access materials in advance, they can reflect on what they struggle with and come to class prepared to ask more meaningful questions. It may also help them gain more practice with awkward or challenging patient conversations.  

Those moments come up often, and structured opportunities to explore them in classrooms can be limited, especially when you think of all the competing demands on curriculum time.  

DISCOVER THE FULL BENEFITS OF FLIPPED LEARNING | ‘Education Leaders: Should Your Institution Adopt a Flipped Classroom Model?’ 

Looking To Support Your Students With Core Clinical Skills? 

Reach out to discuss how Immersify’s wide array of resources, including histories, examinations, and communication, can be mapped effortlessly onto your curriculum. 

This article was reviewed for clinical accuracy and educational relevance by Dr. Martin Ling, a GDC-registered dentist and Fellow of the Higher Education Academy.