The great dental debates

Over a quarter of a century ago, a great debate raged within the occlusion community. One side argued for extensive freedom in "long-centric" (anterior guidance). The other camp contended that anterior-guidance posterior disclusion should be immediate or nearly immediate. Every possible venue hosted arguments for conflicting groups, including peer-reviewed and nonpeer-reviewed journals, academic programs, and independent lectures.

Michael W. Davis, DDS

Over a quarter of a century ago, a great debate raged within the occlusion community. One side argued for extensive freedom in "long-centric" (anterior guidance). The other camp contended that anterior-guidance posterior disclusion should be immediate or nearly immediate. Every possible venue hosted arguments for conflicting groups, including peer-reviewed and nonpeer-reviewed journals, academic programs, and independent lectures.

The clear winners in this debate were our patients. Dentists were forced to examine occlusal design and see its relevance to posterior wear, TMD, and muscle fatigue and spasm. Courageous doctors publicly put forth their ideas and many were initially met with severe personal attacks, right or wrong. Doctors whose positions were proven more valid still were obligated to examine another`s perspective to reinforce their own.

During this period, the great pioneer in adhesive dentistry, Dr. T. Fusayama, was publishing data on the efficacy of etching dentin and dentino-adhesive dentistry. His research, published in Japan, was ignored in Western nations for many years. It is fair to ask if a bias exists against nonEnglish-speaking researchers and their studies.

When Drs. John Kanca and Ray Bertolotti followed up on their mentor`s (Fusayama) discoveries, they were soundly attacked. I remember them being verbally heckled at lectures by fellow professionals. Some refereed journals would not publish their research, despite a strong foundation in the Japanese dental literature.

Increasingly, the "dental tabloids" became a venue to get valuable information to clinicians in a timely manner. Too often, academic journals are not refereed by clinical peers, but by academic Luddites, attempting to turn back the clock. A wide gap exists between what is routinely performed clinically with posterior-restorative adhesive dentistry in private practice vs. what is done in dental school. This gap in knowledge and clinical technique is widening daily.

Last year, Dental Economics hosted "The Great Amalgam Debate" between Drs. Bill Dickerson and Joe Steven. Statistics were published for the winner of each debate, based on polling. In reality, there were no losers. Patients benefited from their doctors being forced to re-examine accepted dogma. Is now the time to change to adhesive dentistry? Or, should the change have been made yesterday ... or will it be made tomorrow?

Organized dentistry, its official peer-reviewed journals, and much of academia has largely ignored this and other debates. The void has been filled by private teaching institutes, independent clinical researchers and lecturers, and information from nonrefereed publications. Dr. Harold Heymann, editor of the Journal of Aesthetic Dentistry, validly asks if the new dental gurus are "sages or sirens."

Refereed journals are losing readership. One reason is that the articles in these publications often reflect the views of one ivory-tower-isolated academician communicating with another isolated academician. There is little or no clinical relevance to their testing. Many modern clinicians have a jaded view that the current emphasis on "evidence-based" research from refereed journals is laughable. It only represents a last gasp by academia to regain lost influence.

It`s too bad that much of the old guard can`t (or won`t) keep pace. Maybe this group of dentists can regain relevance by promoting mediocre dental therapies used in past decades and labeling these therapies as "time-tested" and "conservative" dentistry. The insurance industry certainly embraces these short-term, low-cost modes of care.

The current hot debate in dentistry is between advocates of the Dawson/Pankey (Dr. Peter Dawson and The Pankey Institute) theory of occlusal theory vs. the occlusal philosophy of the Las Vegas Institute. Particulars of each side`s arguments are fascinating. Again, all dentists and patients will benefit from this debate in terms of increased understanding.

The most unique part of this modern debate is the fact that it is being carried on outside of the realm of academia, the academic and clinical journals, and organized dentistry. The current debate is being carried on from the lecture podium, in private institutes, and through information posted on the Internet - not in refereed journals.

In a recent issue of the Journal of the American Dental Association (JADA), Editor Larry Meskin lamented about academia not being able to attract or retain qualified educators. That statement is desperately true. Academia and organized dentistry simply lack the ability and clinical understanding to enter dental debates or even appropriately present debate to their constituents.

Initial tactics used to address novel theories put forth by greats like Fusayama and Dawson were to simply ignore them and snub them. Academia, organized dentistry, and their respective publications all paid a high price for not hosting debates. Trust was lost.

Will it ever be possible to recapture this trust ... or is it too little, too late?

Fear, frustration, and anger are all common emotions in reaction to change. It`s important to move through these feelings and confront the challenge of progress. Do modern leaders reflect this level of maturity or are they stuck in the past?

Great debates always will play a part in advancing dentistry and, as a result, new, unconventional leaders will emerge.

Today, a significant shift has developed in the venue for dental debates and the backgrounds of their participants. Is the current crop of dental celebrities on the lecture circuit a group of sages or sirens? I can`t answer that. However, these lecturers and their clinical opinions are highly accessible. Through the Internet, in the print media, and from the speaker`s podium, great debates in the marketplace of ideas are firing away.

Michael W. Davis, DDS, was in private practice in a small town in Maine for 16 years. He recently sold his practice and relocated to Albuquerque, N.M., to pursue interests in adhesive and conservative cosmetic dentistry. He can be contacted by phone at (505) 294-0959.

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