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:

  1. access to care for vulnerable populations
  2. lack of public funding for treatment of these populations
  3. decline of public respect for dentists
  4. rising levels of student debt
  5. changing demographics of dental care providers
  6. 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
  • Knowledgegenerously 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.


  1. Dentistry has amazing challenges coming ahead, indeed. How can we both be at our best clinically, while remaining affordable and not only cater the wealthy ? I am still looking for an answer…

  2. Yes Pierre, you are so right: dentistry is heading into challenging times. You ask a very good multi-dimensional question and I too am searching for answers. I feel that there are answers all around us and within us. The answers are simply eluding us so far, perhaps because we don’t talk about this type of issues enough, but if we come together in groups across the country in conversation around the difficult question you ask we will find answers.

  3. Richard Anderson

    When I read the JCDA article, “Storm clouds on the horizon”, it summarized many of the issues that I have been pondering. It identified many of the large problem areas that affect our profession. Marielle, I find your reflections on these issues both illuminating and refreshing. Your call to action has worked. I, for one, will be adding my voice to the conversation. I really appreciate the suggestions that you listed. I want to ensure that all people receive oral health education, and necessary preventive and treatment interventions. This will benefit our society. This will help our profession regain respect.

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