The well-worn path to excellence

Dec. 1, 2003
As an endodontist, I cringe when I read advertisements for continuing-education courses that trivialize the experience of delivering root-canal therapy into a mechanical procedure done just for profit.

Richard Mounce, DDS

As an endodontist, I cringe when I read advertisements for continuing-education courses that trivialize the experience of delivering root-canal therapy into a mechanical procedure done just for profit. Endodontics discussed and taught in such a crucible gets demoted to a commodity rather than a blend of compassionate service, art, path to professional satisfaction, and, lastly, a source of profit. My bias is that endodontics cannot, for the most part, be performed both fast and well. Of course, some teeth lend themselves to more rapid treatment, but many do not. It is hard to argue for 10-minute anterior root canals and 20-minute molars, especially without a surgical microscope as I recently saw advocated in a national magazine. I am reminded of the old adage: "There is what you know, what you don't know, and what you don't know that you don't know." With all due respect to this quote's author, he didn't know what he didn't know. The procedure, if done properly, simply cannot be done well in these time frames.

How then to blend speed (or more appropriately "efficiency") in delivering endodontic care with excellence? In other words, how can one improve endodontics to give the most satisfaction for both doctor and patient and ultimately do so in a manner where there is fair compensation (profit) to the doctor?

Attaining speed and excellence in root-canal therapy requires a blend of experience, seeking out the master teachers, learning from one's mistakes, patience, methodical skepticism, and, most of all, taking the time to do the work to the best of your ability. There are no shortcuts to excellence, but there is a well-worn path. Along this path:

o Learn from the masters. Among others, these are the master teachers - attend their courses: John Stropko, Steve Buchanan, Arnaldo Castellucci, Fred Barnett, Dave Rosenberg, Martin Trope, Cliff Ruddle, Gary Carr, Joe Maggio, Gary Glassman and Joey Dovgan.

o Practice on extracted teeth. There is no better place to make mistakes or practice with new technology.

o Have manufacturer's representatives demonstrate their products in your office. Listening to these representatives and comparing their recommendations to those of the various speakers above can make for an interesting learning experience. Doing so also will reinforce the fact that there is a huge diversity of opinion about the best way to get to the desired end point in endodontic therapy, the complete obturation of the root canal space.

o Seek ideas from Web-based educational resources.,,,, and are good sources of information amongst Internet-based resources.

o Avoid the dog and pony show — attend hands-on courses. Courses have the most value when they are hands-on.

o Develop a close relationship with your endodontist. Watching your endodontist work and having a close relationship is of great value. Ideally, your endodontist should be willing to allow you to observe and also should share information willingly. Fueling your appetite for endo won't take food off their plate, it will grow more food.

o Consider buying and learning to use a surgical microscope. Loupes and the naked eye do not compare to the surgical operating microscope. If it were your mother having a root canal, you would want it done under a microscope. The microscopic view will amaze you — enough said.

Hopefully, this brief column has given you some insights and motivation to elevate your endodontic quality as well as your efficiency. Good luck as you join the others on this well-worn path.

Dr. Richard Mounce is in private endodontic practice in Portland, Ore. He lectures worldwide and has published numerous articles in the Journal of Endodontics. Dr. Mounce also writes "Endo Made Easy," a bimonthly tips feature for Dentistry magazine, and a quarterly column for Endodontic Practice in the UK. Contact Dr. Mounce via email at linek [email protected]. Visit his Web site at

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