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In a recent article titled Storm Clouds on the Horizon published in JCDA, Dr Peter Doig, President of the Canadian Dental Association, states: “The fulfillment that comes with belonging to a profession that has contributed to the well being of Canadians is tempered by the long term forecast of our professional future.” Many worrisome trends lead Dr Doig to make this statement. As identified by the Canadian Dental Association’s last environment scan, these trends are:
- access to care for vulnerable populations
- lack of public funding for treatment of these populations
- decline of public respect for dentists
- rising levels of student debt
- changing demographics of dental care providers
- increasing corporatization of dentistry
Dr Doig goes on to state that “It takes courage to think differently and have confidence in your own abilities to meet challenges directly.” Interestingly, courage shares the same latin root as heart, the core of the self, the place where we integrate what we know intellectually and what we feel deeply in our soul. If we simply stop for a moment and listen to our heart, what new perspective do we gain on the 6 issues listed above?
As stewards of oral health knowledge, how can we change the dialogues around issues 1 and 2 when we know, intellectually, that the incidence of early childhood caries is reversely proportional to maternal educational level?
If we want respect, perhaps we can offer utmost respect first, to the patients who seek our care, to members of our team, to our colleagues… inviting all to see teeth and the mouth as amazing engineering marvels better served with pro-active risk management than reactive fillings.
Let’s face it, dentistry as we know it today is expensive, time consuming and labour intensive. These facts explain issues 4, 5 and 6. They also make dentistry only accessible to people who can afford our care, leaving masses of people out of the system we have created.
So how do we get more of the respect we want? Here are some suggestions to ponder upon:
- Diagnosis: incorporating risk assessment and diagnosing the earlier signs of caries activity with a tool such as ICDAS
- Risk Management: recognizing that caries is a multifactorial disease that requires a multi-faceted risk assessment and management approach, networking with all health stakeholders
- Treatment Planning: making home care written prescriptions as well as clinical strategies to reduce bacterial loads and remineralization top priorities in every single treatment plan
- Products: incorporating instruments that make it scientifically possible to follow the progress (or regress) of a lesion and products scientifically known to positively influence the demineralization / remineralization cycles
- Knowledge: generously sharing our knowledge with our colleagues and distilling our knowledge into pearls of wisdom for the general public to help make a difference… especially for the vulnerable populations
There will be rays of hope (and respect) piercing through the clouds that have built in the horizon if we are willing to engage more of ourselves in genuinely caring for our patients as whole human beings first and well before we offer any fillings, veneers, crowns or implants. There will be rays of hope (and respect) if we have the courage to engage in conversations that matter with ourselves, with each other and with all stake holders in oral health.
When I first started with CAMBRA 12 years ago, I decided to do it because I knew it was the right thing to do. I had been doing everything for my patients that I was taught to do, and they continued to get new cavities, my restorations failed and I was finally ready to admit that what I was taught in dental school wasn’t working. I knew there had to be a better way to treat the disease, I just didn’t know where that would lead. At the time I actually had thoughts that if CAMBRA really worked well, I might be slowly putting myself out of business. I was okay with that thought because I figured I’d slow down and eventually retire, so perhaps that would work out okay anyway. Foremost, I just wanted my patients to stop getting cavities. I had some successes and some failures along the way, but an interesting thing happened. The patients that I was able to get healthy suddenly wanted to do more restorative care. I continued to get busier, my practice continued to thrive, even through the recession. That’s when I began to understand what Bob Barkley had tried to teach us 40 years ago, patients don’t really start doing dentistry until they stop getting cavities.
CAMBRA is probably the single biggest practice builder I’ve experienced in 34 years of practice.
CAMBRA will ultimately make a practice busier and more successful, but the true value is in the improved relationships with patients. When you truly have their best interest at heart, and express to them that you are interested in helping them stop their decay cycle, they have a much deeper trust in you. The greatest value is in helping people get healthy and developing a great relationship with them in the process. That makes practicing dentistry much more personally satisfying and rewarding. Having great relationships with your patients is always a great thing. They appreciate you more and tell you, and they spontaneously refer their friends and family to you. In fact they insist that people come to see you. So now I routinely have patients travel several hours to see me. It’s a wonderful feeling knowing I can help these people. Dental caries is an awful disease.
V. Kim Kutsch, DMD received his undergraduate degree from Westminster College in Utah and then completed his DMD at the University of Oregon School of Dentistry in 1979. He is an inventor, holding numerous patents in dentistry, product consultant, internationally recognized speaker, past president of the Academy of Laser Dentistry and the WCMID. He has also served on the board of directors for the WCLI and the AACD. As an author, Dr. Kutsch has published dozens of articles and abstracts on minimally invasive dentistry, caries risk assessment, digital radiography, and other technologies in both dental and medical journals and has also contributed to several textbooks. He acts as a reviewer for several journals including JADA. Dr. Kutsch serves as CEO of Oral BioTech. As a clinician, he is a graduate and mentor in the prestigious Kois Center and maintains a private practice in Albany, Oregon.
In August, I published a blog post titled “What are you Willing to Change to Help Your Patients’ Oral Health?” written by Dr Clive Friedman, Don Morrow and Jennifer Irwin. A piece that, I hope, has led you to approach prevention from a Motivational Interviewing perspective to elicit your patients’ own desire to change. I hope that you are also finding out that this approach builds trust and relationships.
Today I offer you excerpts from a book I just finished reading: “A Few Words From The Chair | A Patient Speaks to Dentists” by David Clow and available from AMAZON
David feels that dentists could be the most important health professionals patients know in the health care crisis we are experiencing now… if only we chose to spend more time building relationships. He also offers ideas on how to do so. David feels that we can inspire our patients by seeing ourselves, not as dentists, but as whole persons practicing dentistry and by making our hopes and dreams part of that practice.
The paragraph below, about half way through the book, caught my attention because it is often difficult to dissociate, in dentistry, the business aspect from the clinical aspect of our work. Now that I have read David Clow’s book, I feel that there may be no need for dissociation; that business and clinical can live in harmony with one another. Here is what he writes about the Hippocratic oath:
“All of the Hippocratic oath is a value proposition.” he writes in his book . “It talks about you and your business relationship with me, implying in each word and between every line that I, the patient, am real (if that sounds obvious, take my word, many patients do not feel real to their health care providers, and many providers don’t care); that I have challenges before me that you can remediate; that you have to hold yourself to high standards of conduct to do it; and that should you fail to keep those standards, you break the bond between us that you aspire to uphold, and therefore break the oath.”
“You revere the words of the oath for their long history and their sanctity in your vocation. From my angle, Hippocrates was a business writer. A great one in fact. Two thousand three hundred years after the initial version, after numerous translations and alterations, and the business practicality of that oath is still as hard and bright as a steel probe.”
“Everything else has changed, but the character of the practitioner is still front-and-center. The oath doesn’t just tell you just to have character. It tells you to use it.”
How will we apply the principles of CAMBRA next week?
For the past 6 weeks,I have been busy taking classes on Coursera and even doing some homework! It is my last week of learning Caries Management By Risk Assessment (CAMBRA) and the potential it has to shape our future and the future of our the dental profession as we know it. I worry about what will happen when this Coursera.org course is over. One of the reasons I worry is that, as I reviewed some of my peers’ homework, every week, there was an essential factor consistently missing: the HOW. Every week I read mostly good reviews, some even brilliant, of the articles we had to read on caries risk assessment and caries management. However, in almost all of the homeworks I reviewed, the additional paragraph on HOW the key elements of each article could be applied in a clinical setting missed the point or was missing all together.
We all have a good grasp of WHAT CAMBRA does. HOW we will implement the CAMBRA principles into our daily lives as health professionals NOW is the question we need to answer.
I see CAMBRA as a solid foundation on which to begin the creation of a new model for dentistry. A model in which dentists are highly skilled physicians of the mouth as opposed to being highly skilled technicians. A model in which, early detection of a complex imbalance before it leads to irreversible damage known as tooth decay, together with clear steps to re-establish balance, will have a positive impact not only on oral health (short and long term) but also on overall health.
It is with this in mind that I invite all of you, yes all, not only dentists, to join this blog post in which we can share ideas on HOW we already use or will implement CAMBRA not only in our dental clinics, but also invite others, health professionals, perhaps educators too, to add Caries Risk Assessment to the routine evaluations of the people they care for.
I look forward to exchanging many ideas.
There was a time in the 50’s and 60’s when prevention really took off in dentistry, setting the profession as a role model in health care. However, like the effects of fluoride, this approach plateaued and we seem to have lost our momentum. Perhaps because of our intense focus on the highly technical aspect of restoring teeth?
While there has been a many folds increase in money spent towards oral care, tooth decay is still the number one childhood disease of the 21st century, 5 times more prevalent than asthma. So here is my question to you: what would The Scarecrow short animation picture look like if we applied the above facts to the creation of a dentist version of it?