Sharing Pearls of Wisdom

I came to realize in the mid seventies that dentists were as welcomed at Ste 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 single user of operating room time at Ste Justine Hospital for children was dentistry under general anesthesia. Tooth decay was the number one childhood disease, 5 times more prevalent than asthma.

Lets fast forward to 2009. CHEO, Children Hospital of Eastern Ontario, in Ottawa, Canada’s Capital: 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… Why?

Let’s have a look at what has happened in dentistry during this period of time.

When I was in dental school in the early seventies, the filling material of choice was silver amalgam, mercury fillings no one wants to have in their mouth today. Implants had not been invented yet. Adhesive materials we used to cement crowns or inlays were poor, and for this reason, porcelain was almost totally unreliable. Other tooth coloured materials were a joke. They all discoloured, 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 coloured 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 aesthetic quality to restoring teeth. A turning point for the profession: we started seeing patients smiling in the dental office.

All the 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 placed in a human jaw for the first time. Brilliant chemists formulated AWESOME adhesives that could bond to ANYTHING: enamel, dentin, porcelain, metals, composites… like CRAZY GLUE!      Gifted Asian 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, making it possible to add finer details to restorations, giving them more life like appearance. Some of us even went on to using microscopes, magnifying the work field even further, creating the best dentistry money can afford.

And that’s the problem! Dentistry went from being an already narrow minded profession in the  70’s 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 Third World statistics. Tooth decay is preventable.

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 will be our ability to share our knowledge. You will tell me that your dentist or hygienist already does that,  teaching you proper brushing and sharing with you the merits of daily flossing. And you are right, we do a lot of this. But we need to move along the learning continuum, from teaching and telling, to coaching, inspiring and mentoring. We need to move from sharing information – how to brush and floss – to sharing knowledge, 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 of 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.

This transformation of dentistry is an enormous challenge for which we will have to muster much courage. If we can find the courage to 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 sustainable, inclusive 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.


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