I’m not much of a historian, but I am a big fan of those cartoons on television called “FRACTURED FAIRY TALES.” For those not old enough to remember, the cartoon featured Professor Peabody, a canine college professor and his child student, Sherman. The two traveled through time, stumbling on great historical moments, armed with “new” information, attempting to change the course of history. I always longed to see an episode where they would find themselves witnessing the world’s first toothache. That day probably marked the beginning of dentistry. On that day, Sherman and the Professor would have witnessed the fundamental nature of the field of dentistry ... a man with a problem looking for a man with the tools to fix it.
The more things change, the more they stay the same. Man has always been concerned with comfort, general health, and from what we know about George Washington’s teeth, function. And yes, even cavemen probably cared about the way they looked. Today’s tools would have made the job a whole lot easier. Man has always been pragmatic. In other words, we are problem solvers. Give us a broken fence, and we will find the right tools to fix it.
The history of dentistry has been a quest to find better and better tools. Things were that way when I graduated from dental school some 30 years ago, when I became a “doctor.” You see, from that red-letter day of the world’s first toothache until the end of the 20th century, the role of the dentist hadn’t changed much. Essentially we were mechanics, still fixing, still rigging, and still solving obvious problems.
But that was then. Now the role of the dentist has evolved into what many have only spoken about for years. We now have tools at our disposal that allow us to truly become “physicians of the oral cavity.” Don’t take that term lightly because even our caveman friend would have been able to see the divine in his savior.
Maybe we have become jaded by the mechanic role, but our patients truly want us to fill a greater role.
My own history in dentistry mirrors a sort of minievolution. Early on in my career, although I always had an obsession with comprehensive care, I was fixated on mechanical solutions. The primary tool in my office was my handpiece. I lived by the drill. For many, the water-cooled, air-driven turbine is the heart and soul of practice. It is the hunter’s rifle, the fisherman’s rod, and the surgeon’s scalpel. It is an implement of treatment. It clears out areas for better vision and helps shape the landscape for future work. It doesn’t have very much diagnostic value.
Many dentists feel if they don’t run the handpiece, they aren’t doing anything of much value. Insurance companies feel the same way. Dental practices are designed with the handpiece in mind.
As I evolved in practice and as the profession evolved, periodontics became more important. The health of the soft tissue became supreme in the late 1970s and 1980s. Doing a comprehensive examination meant adding in a complete periodontal charting. Now don’t get me wrong; periodontists had been doing this for years, but it wasn’t until the 1970s that pioneers like Robert Barkley and Paul Keyes popularized modern periodontal treatment for mainstream dentists.
Soft-tissue management was all the rage. Dental consultants created new models of practice that focused on hygiene services. The public became more aware of the meaning of bleeding gums and periodontal pockets. Floss sales reached an all-time high. Electronic toothbrushes showed up on the gift lists of many people during holiday seasons. The main topic of dental conversation at weekly book club meetings turned from tooth decay to gum disease.
Women’s magazines were filled with articles on preventive dentistry, and a book really became popular when it revealed that human life could be extended up to six years by flossing. Finally, a connection between dental health and general health was conveyed to the public. Dentists always knew it was there but had a hard time relaying it to their patients.
Back in dental school, we were taught about the connection between nutrition and dental disease, but using that knowledge in a practical way only led us to tell our patients not to eat sweets. Duh! Now we know a lot more about the role of dental hygiene and nutrition in terms of quality of life and longevity. We became intimately connected to a process – inflammation. The doors were opening for dentists to become more than mechanics; we graduated to becoming caretakers, or gardeners of the oral cavity.
Don’t laugh. The gardener has a very important role, certainly more than the handyman. The gardener is responsible for understanding disease processes and how to prevent disease. Along with this role came more diagnostic responsibilities, but even more important was the responsibility to communicate and motivate patients toward better health.
During the 1990s, something happened that really changed the role of today’s dentist. Although cosmetic dentistry had been around forever, new tools and materials allowed dentists to provide the most magnificent looking dentistry to their patients. Everyone had a new product. Laboratories and manufacturers devoted all of their efforts to this born-again field. Continuing education became all the rage. Institutes sprung up like weeds, and new philosophies were born. Mainstream dentists became cosmetic dentists overnight.
With that new role came new responsibilities, because this type of dentistry is expensive and fragile. In other words, it had to be meticulously planned out. New courses on examination and treatment planning filled many curriculums. Leadership skills were even more necessary now with this greater responsibility. The dentist was now an architect ... a designer.
Once again the role has changed. It’s amazing that the dentists were content to be mechanics for so many years. During the last 30 years, the evolution has taken us to new heights, and with that comes the respect and dignity that is afforded to most doctors.
Today’s dentist is very concerned with his or her role in comprehensive dentistry. Certainly the rewards, both financial and spiritual, can be great when we treat people comprehensively. But this still doesn’t make someone a physician of the oral cavity. I hear teachers telling their students that they will become a physician of the oral cavity when they take the time to do a proper examination and treatment plan. Well, that’s just not enough.
We have tools today that remove us from reductionistic (tooth), Newtonian dentistry and enable us to treat people much more holistically. We have better diagnostic tools and more epidemiological data available that will help us take that quantum leap we have witnessed during the last 30 years. It can really be an exciting time for dentists, not only in the arena of design and treatment, but also in the easily undervalued area of diagnosis. We need to stop looking at the leaves and pay more attention to the roots of the trees.
This column is concerned with helping you become a physician of the oral cavity. I will be discussing some of the newer philosophies and the tools that go along with them to help you implement everything your patients really want from you.
I have to go now. I think I hear the Professor and Sherman trying to stop the guillotine before it comes down on poor Marie Antoinette’s neck.
Barry F. Polansky, DMD, practices in Cherry Hill, N.J. Author of the book, The Art of the Examination, and publisher of “Dental Life,” he is on the visiting faculty of the Pankey Institute. E-mail Dr. Polansky at [email protected].
