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Table of Contents   
GUEST EDITORIAL  
Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 101-102
How to be a prudent dentist in the 21st century


M.A., D.D.S., F.A.C.D., F.I.C.D., San Francisco, CA 94108, USA

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Date of Web Publication1-Mar-2014
 

How to cite this article:
Cohen S. How to be a prudent dentist in the 21st century. J Conserv Dent 2014;17:101-2

How to cite this URL:
Cohen S. How to be a prudent dentist in the 21st century. J Conserv Dent [serial online] 2014 [cited 2019 Dec 15];17:101-2. Available from: http://www.jcd.org.in/text.asp?2014/17/2/101/128032
Back in the 18 th and 19 th centuries, dentistry was considered a "trade" and dentists (often mentored by another dental tradesman) in those times would simply extract teeth, "find a hole and fill it" or make dentures. And, of course, almost all of these procedures were accompanied by awful pain for the desperate patients. In the public's perception, dentistry and pain were linked together like a double helix. Dentistry began to ascend in the 18 th century due to the visionary efforts of the famous French physician, Pierre Fauchard who wrote the first scientific book (Le Chirurgien Dentiste [1] ) on dental anatomy and various dental diseases. Nevertheless, dentistry still remained essentially a trade.

In the 20 th century, dentistry was elevated to a profession due to the hard work of some inventive and prescient men and women, but the dissemination of their discoveries and advances in dental science was quite slow because means of communication were quite slow and uneven. Toward the end of the 20 th century everything began to accelerate as our world digitized, including the number of discoveries and the means of communication. In fact, communication became almost instantaneous with the advent of faxing, cell phones, text messaging, E-mailing, etc. We could communicate around the world in just a few seconds! Nevertheless, too many of our colleagues were reluctant to embrace the new dental materials, instruments and technologies as well as the better means of communication - the "Luddites" of dentistry.

So, here we are now in the early part of the 21 st century and we are all bearing witness to the accelerating digital transformation of our dental profession as we expand from the analog 2-dimensional era to the digital 3-dimension (3D) enabling new concepts, materials and technologies to emerge. But as our analog world dissipates, how do we thoughtfully assess all these new technologies and materials? Almost every month we see full page glossy ads for the new digital "this or that" with some familiar names or faces praising the new (fill in the blank). If the names or faces that we recognize recommend the new product or technique, then surely it must be goodright? Well, sometimes. Today the prudent dental practitioner must ask some penetratingand sometimes uncomfortablequestions (in dental vernacular, we must "drill deeper"), including:

  1. Where are the published studies to support the claims made? Have you noticed in the fine print of some ads that the studies that were carried out are unpublished because they were carried out "in-house" by the company's employees? In cases like this, who exactly vetted the investigation? Frankly there is no peer-review of these studies, so I urge my dental colleagues to request a published peer-reviewed investigation before giving serious consideration to adopting a new product or device.
  2. Who funded the published investigation? If the company that stands to gain financially funded the results of the study, a bit of skepticism is appropriate. In other words trust, but verify. The fact that the sponsor of the investigation funded the study does not necessarily detract from its quality or conclusions; nevertheless, independent corroboration is prudent, when possible.


And what about the author(s) of the published investigationdo they stand to gain financially from readers embracing what they recommend? In fact, most of you have noticed that many peer-reviewed dental journals now require authors submitting manuscripts for publication to reveal any financial gain they stand to make if the paper they submit is published. Yes, sadly, this is now a requirement to assure fidelity of an investigation.

  1. And what about the design of the study? Do the Methods and Materials used in the investigation support the conclusions drawn?
  2. Are there other independent (i.e., not funded by the commercial interest) studies published in peer-reviewed journals that corroborate the conclusions drawn from the study that is cited?
  3. Did you pay a subscription fee for the journal? Free "journals" often have a sponsor who is marketing a product in the guise of a journal.
  4. When a respected doctor with a recognizable name lectures on a particular technique, device or material, it is appropriate to politely inquire (unless it has been mentioned or written earlier) if the lecturer is a "consultant" for the company's device or material. If so, it would be prudent to seek additional independent corroboration of any recommendations made by the lecturer. A dental consultant for a commercial company will report on the best aspects of a product, but sometimes limitations, deficiencies or side-effects of a product may not be fully disclosed. Remember the old adage, "Let the buyer beware". Some of you already know this from your personal experience. Look in the bottom drawer in one of your treatment rooms and you might find a device or material that was extolled as the "best" by a lecturer on tour touting a new concept based on a company's internal research. Does this resonate for you?


Dear readers, we all want to believe what we hear or read from authors and lecturers, but the times and moral values have changed, so the "bar" has been raised for credibility and trust.

There are so many demands on our time that most of us simply do not have enough time to thoroughly read and filter published papers as suggested above. There is another way to assess the gravity and credibility of a paper and that is to check with the cochrane collaboration (CC). The CC, which is an independent non-profit global organization dedicated to vetting the quality of evidence-based published papers, may give its "seal of approval" to properly designed systematic reviews of randomized controlled trials. In fact, one branch of the CC is located in the city of Vellore, Tamil Nadu, India! There are very few CC papers vetted in dentistry; nevertheless, a clinician can place his/her trust in those papers in dentistry approved by the CC.

The prudent practitioner might also consider checking the website of the nine dental specialty organizations, because they would provide the most current clinical practice guidelines. All dental specialties are international in membership, but they are all established under the rubric of the international American dental association (ADA). Within the ADA, there is a center for evidence-based dentistry (EBD). EBD is an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence that is patient-centered. In other words, EBD is about providing dental care based on the most current scientific knowledge. Few of us have the time to read everything relevant to advances in our field, so EBD provides a critical summary of systematic reviews in abstract form. Furthermore, EBD will provide the hierarchical rating (strength of the evidence) of individual or multiple studies.

Some dentists may appreciate the diagnostic importance of a cone beam computed tomography (cone-beam 3D X-rays) but understandably may be reluctant to adopt this technology due to its relatively high cost. Other dentists (the "early adopters") may obtain a loan from a bank to buy a Cerac™ crown milling machine, but then may feel that almost every patient needs a Cerac™ crown in order to justify the economic investment the dentist made in this newer technology. These two points of view are the outliers before a new technology is embraced by the majority of our profession. To enable most dentists to employ these state-of-the-art technologies in a timely way without economic stress, some countries (or States within countries) allow diagnostic centers to open and provide the 3D service (cone beams, 3D printers, Cerac™ crowns, etc.) for dentists in much more economic and practical way. Of course some of the larger dental laboratories have already added Cerac™ milling to their other services for the dentist.

Remember the timeless adage that if a doctor takes good care of his/her patients, the patients will take good care of the doctor. For the doctor to take good care of his/her patients, the doctor must practice with the most current clinical knowledge and technology. Good doctors do not need to spend a lot of time and money on advertising because patients will spread the doctor's skills far and wide……and that is the best advertisement of all!

 
   References Top

1.Fauchard P. Le Chirugien Dentiste. Vol. 2. 1728.  Back to cited text no. 1
    

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Correspondence Address:
Stephen Cohen
M.A., D.D.S., F.A.C.D., F.I.C.D., San Francisco, CA 94108
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0707.128032

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