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Embrace differences for better patient care

May 20, 2022
The majority shouldn't always rule. Change in dentistry is often slow and stubborn, but in the long run closing ourselves off to new points of view stunt our profession’s growth.

The astronomer Copernicus was a trailblazer for debunking the belief that the sun revolved around the Earth.1 His radical idea clashed with a widely held belief. Given that this was also believed for a long time, acceptance of the actual truth presumably took time as well. Given our current knowledge and evidence, this slow transition seems baffling. This history lesson is a prime example of how certain beliefs tend to die hard, while credible ideas are alienated.

While Copernicus's story is far removed, it’s worth considering whether present day examples bear a similar theme. Do prevailing ways of understanding an idea remain too dogmatic in many disciplines? Do proponents and blind followers of these ideas leave little room for debate, making it difficult for a minority of voices to go against the grain? You may recognize this as a universal challenge for many subjects.

The theme has manifested itself in modern-day economics. “Textbook” theories, long defended by economists, have helped explain the workings of the economy. To the reluctance of many experts, these theories are now being called into question. The US economy has revealed some unexpected behaviors that have not coincided with mainstream understanding. There is a list of examples, and a couple are recognizable: a mounting national debt that’s not proving to be truly catastrophic, and a lack of evidence that present-day trickle-down economic policy serves its all-inclusive purpose. Possible explanations for these are beyond the scope of this article, but they boil down to the fact that the economy is more complex than originally thought, or at least as explained by conventional knowledge.

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Stopping short of claiming any expertise in economics, consider some reasons why these convictions prevail. First, one’s initial exposure to any established idea can be greatly influential. A lack of experience will naturally make someone go along with the status quo. Consequently, the idea will find strength in numbers. Second, there is an aspect of these convictions that is often overlooked. Rarely do they coincide with modern reality, specifically as it relates to the existing complexities. Enough time must elapse before updated thinking takes root. Third, consider anecdotal evidence. Despite its merit, this evidence remains on the fringe of complete acceptance. This is especially true of disciplines that demand adequate evidence-based research. The majority will naturally lean on what is tried and true.

Relevance to dentistry

You may be wondering about this topic’s relevance to dentistry. I aim to provide a lens through which dental practice can be critiqued. As they relate to clinical concepts and applications, do certain truths have too much of a stronghold? Does herd mentality exist and reinforce certain convictions in dental practice? Surely many dentists have found themselves in echo chambers, only to realize that they’re a member of a silent minority, cautious not to ruffle too many feathers, but they wonder, “How does everyone not see it my way?”

While clinical examples help validate this theme, they merely provide context. They do not suggest that certain practice philosophies hold more legitimacy. Thus, I will only briefly mention clinical examples. My main takeaways are how the theme prevails in the dental profession, and the parallels that can be drawn to why convictions hold strong in general.

Learning anything for the first time will likely influence a person’s mindset. Dental practice is no different. As a certain clinical concept remains dominant, it will influence most practitioners’ understanding of that concept. Any alternative will have difficulty gaining acceptance. There are many reasons some clinical concepts hold primacy. However, for those who follow an alternate philosophy, they may argue that all research does not necessarily point in one direction.

One clinical example relates to post-extraction socket preservation, specifically for cases that involve four wall defects. While pointing to some unpopular research, a minority of practitioners say such circumstances do not always require grafting, or that bone volume is not ultimately affected. Without becoming too immersed in a clinical debate, one can reflect on the general reality of how a competing claim can be drowned out.

More recognizable topics

To crown or not to crown? To treat or not to treat? When to take the conservative or more aggressive approach is probably the most contentious clinical topic in dentistry, especially in the restorative realm. Those who watch and wait may not be popular in the eyes of those who predict more dire outcomes. For those who have more faith in composites and conservative indirect restorations (inlay and onlays), it may seem preposterous to use full-coverage crowns on certain teeth.

As this debate has no end, it’s not uncommon for a lone wolf to feel like the other side has the megaphone. Consider my clinical example in the context of how a practitioner’s conviction may not always be up to speed with modern possibilities. In a general sense, advancements and options abound when fabricating a restorative solution. For those willing to learn and take a leap of faith, many camps of thought have a renewed faith in more conservative restorative approaches.

Full-coverage crowns have been (or still are) the ultimate fail-safe solution for many dentists, but the pendulum is slowly swinging in favor of inlays/onlays/overlays, arguably making it a more appropriate solution for prolonging the longevity of failing teeth. Pure composite dentistry has also gained traction in parts of the esthetic world, bucking the idea that only indirect restorations can achieve the most ideal outcomes

Last, many dentists have experienced anecdotal success stories, particularly with approaches perceived to be on the fringe of acceptance. These approaches are not isolated stories but were probably introduced in individual case studies. Those who dare to replicate may find that they have buy-in as well. The complete acceptance of these techniques is still in question, as it struggles in a profession that strives to be evidence-based.

Consider margin elevation to close crown margins. As most puritans have been taught, crown margins should always end on solid tooth structure. However, there is a strong minority that can present evidence to the contrary. Regardless of where one stands, it’s worth asking how much anecdotal cases should be allowed to enter mainstream discussion.

Again, the clinical examples are not meant to insinuate any firmly held convictions, but stress that opposing opinions can be unfairly at odds. The arguments and clinical examples are not limited to the ones I discussed. It’s a fairly open-ended discussion.

At this point, one may be scratching their head over this notion of displaced voices or convictions. Considering dentistry allows for clinical autonomy, isn't this ultimately a nonissue for any given practitioner? This somewhat misses the point. It’s still important to consider our openness toward colleagues and the profession as a whole, especially during discussion. While acknowledging that change is often slow and stubborn, it’s easy to forget we may be stunting our profession’s growth in many instances. Adequately embracing differences can ultimately lead to better patient care. Perhaps we would do well to constantly remember that our profession is dynamic, while humbly being conscious that we only know what we know.

Editor's note: This article appeared in the May 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.


  1. Nicolaus Copernicus. History. November 9, 2009. Updated October 24, 2019. https://www.history.com/topics/inventions/nicolaus-copernicus

About the Author

Sagar Shah, DDS

Sagar Shah, DDS, is a practicing general dentist in the Bay Area. He earned a BS from Vanderbilt University and his DDS from NYU College of Dentistry. He has always been interested in the psychosocial dynamics that surround various subjects. Regarding the dental profession, Shah hopes to explore and encourage critical thinking around topics that are considered outside the box. Dr. Shah can be reached at [email protected].

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