Wednesday, April 10, 2013
I came to realize in the mid-70s that dentists were as welcomed at Sainte-Justine Hospital for Children as dogs are in bowling alleys. It never dawned on me that maybe it was because we dentists were hogging the operating room.
In 1975, the number one user of operating room time at Sainte-Justine was dentistry under general anesthesia. Tooth decay was the number one childhood disease, 5 times more prevalent than asthma.
Now let’s fast forward to 2009. CHEO, Children Hospital of Eastern Ontario, in Ottawa, Canada’s Capital—the number one single user of operating room time in the hospital is dentistry under general anesthesia. Tooth decay is still outdoing asthma 5 fold.
3 1/2 decades and nothing has changed…How come?
Let’s stay with this question while we look at all that has changed in dentistry during this period of time.
When I was in dental school in the early 70s, the filling material of choice was silver mercury amalgam, the stuff no one wants to have in their mouth today. Implants were in their infancy. The adhesive materials we used to cement crowns or inlays were poor, and for this reason, porcelain was almost totally unreliable. Other tooth-colored materials were a joke. They all discolored, some of them over night. Root canal treatments were well…in the dark ages. I don’t dare talk about it. I’ll scare you to death.
But things were changing rapidly. The year I graduated, tooth-colored materials called composites were transitioning from being self-cured to being light-cured, a significant improvement that afforded dentists the luxury of more working time, and with this, the possibility of bringing more and more esthetic quality to restoring teeth.
This was a true turning point for the profession, and we started seeing patients smiling in the dental office.
While composite materials were bringing more artistry into the dental offices, sophisticated Controlled Memory NiTi Technology made root canal treatment safer and more predictable. Radiography became digitized, giving us instant images while exposing our patients to significantly less radiation. Titanium implants were growing more common, and more reliable.
Brilliant chemists formulated awesome adhesives that could bond to anything—enamel, dentin, porcelain, metals, composites—like Crazy Glue! Gifted ceramists created amazingly beautiful new porcelains. This combination gave birth to adhesive porcelain restorations, the most beautiful and natural looking restorations in the world. And, bleaching made it possible for some fanatics to produce something incredible, toilet bowl white teeth.
While all of this was happening, some of us, driven by the will to excel, started using loupes magnifying our work field 2, 3, 4 times, and making it possible to add finer details to restorations to give them more lifelike appearance. Some of us even went on to use microscopes, magnifying the work field even further to provide the best dentistry possible.
And that’s the problem. Dentistry went from being an already narrow-minded profession in the 70s to burying itself in the ever-increasing narrow mindedness of technology. And because of that, we all failed to notice that fillings do nothing to change the course of caries, the disease entity of which tooth decay is the end result. We are building the scaffolding of our profession, failing to realize that we have placed our ladder on the wrong wall.
Here are more statistics to prove this. In 2007 a 12-year-old boy died in Maryland as a result of a tooth infection. In 2009, 3 dozen children were admitted at CHEO because of tooth infection-related facial cellulitis, a life threatening condition. Many more children were treated as outpatients with IV antibiotics and emergency extractions. In retirement homes teeth cause more pain than any other body parts. These are statistics and stories you might expect to hear from Third World locales, because we know tooth decay is preventable, and we know how to prevent it.
This brings a question: Are we awake? And if not, is it ethical to sleep on the job? Is it ethical to continue practicing dentistry the way we are?
Globally, with the current model for dentistry, we see, in our clinics, only a small number of privileged patients who can afford our care while we possess a body of knowledge that has the power to significantly and positively impact health on a much larger scale.
What I believe will make the biggest difference in oral health, and health in general, is our ability to share our knowledge. Not just teaching our patients proper brushing and flossing techniques, but our ability to move along the learning continuum, from teaching and telling, to coaching, inspiring and mentoring toward health.
To achieve this, we need to move from sharing information—how to brush and floss—to sharing knowledge of what hygiene and oral health can mean to overall health. Or even better, to explore how we can distill the vast body of knowledge we possess into pearls of wisdom we will give back into our communities and beyond. This will have much bigger impact on oral health than drilling and filling teeth.
The enamel on our teeth may be the hardest of all body parts, but it also has the least ability to heal. Enamel in a non-renewable resource. It is the sharing of our wisdom that will change the statistics and make the preventable disease that is caries far less common.
This transformation of dentistry is an enormous challenge for which we will have to muster much courage. If we can take on this challenge, ending tooth decay could become the single biggest achievement of the 21st century with impact reaching far beyond oral health. It could also change the statistics of third world countries, because it is a sustainable, inclusive change that can happen anywhere and will not require the building of million dollar clinics.
Perhaps, when dental drills fall silent in operating rooms, children, free of oral pain, will have restful nights. They will be able to eat comfortably and speak with ease. They will learn better and will not be afraid to smile. And dentists will be welcomed everywhere.