A One Eyed Dentist's View of Myths and Realities in Dentistry
In the future to be called As the Molar Crumbles after the often quoted remark "As the Cookie Crumbles".
Dentistry can be a lonely profession. Most dentists practice in their own office with little contact with other dentists. We strive to provide quality care for our wonderful and sometimes not so wonderful patients. For the most part we are oriented toward providing a skillful artful service on human beings. We are trained to provide that service with the precision of a fine machine tool operator and the eye for beauty of an accomplished sculptor. These skills we are usually well trained for. At the same time we are confronted with the fact that we provide these services not on a lump of clay but on a living biological entity which sometimes intentionaly but usually without malice presents with unique and sometimes impossible to predict and control conditions in which to operate.
In dealing with the latter situation, we are very poorly trained. For the most part we are not naturally comfortable with handling nor are we trained for dealing with very intense interpersonal realtionships. We must be teacher, salesman, psychoanalyst, sympathizer and authoritarian all at once. If that were not enough to ask with our staff we must be boss, businessman, mentor, leader, accountant, lawyer, personal relations manger etc.
My purpose in writing these hopefully brief pages is to provide a shoulder for other isolated dentists to rest on. Yes, other dentists experience those same demands you do. Some other dentists have discovered some of the things we are told are not quite true. I am writing straight from the gut. No holes barred. Some conclusions I have drawn are no doubt brilliant - just ask me! Some are no doubt absolutely wrong! Unfortunately, I have not had the good fortune to discover the follies of the later ideas. The point is I am not afraid to share these ideas with you. Hopefully, you will not be afraid to share your ideas with me and other dentists. We all need to do a lot of talking these days with outside forces trying to herd us into their view of how dentistry should operate. We had better be honest with each other and communicate what works and doesn't work so that we can shape dentistry's future--not have someone else who never had to deal with Mrs. Flatbottom's lower denture decide how dentistry should be done. (Dang I just made my first sexist remark. If I say Mr. Flatbottom does that make the remark politically correct?) By the way I don't really think I am a male chauvinist!
I will Start the ball rolling with a few MYTHS and TRUTHS feel free to email me some of your own. I will give you credit for the ones you contribute!
Myth #1: Occlusion is an exact science.
I never could put my finger on it in dental school. I just couldn't quite go along with the brainwashing that the jaw belonged in a certain position defined by God or the head of the prosthetics department. (I must say right now God had always taken the top position in my hierarchy.) The notion that with all the differences in shapes of teeth, size, position, jaw differences, ethnic differences etc. someone could determine the proper shape for every small facet of the tooth's anatomy to work perfectly. It seemed illogical to even determine exactly how everyone's jaw worked and moved.
I was really in for a shock after I started seeing patients. All different bites, shapes etc. Almost all patients did well--they were unaware of their horrible occlusions and I am sure most live a normal life span with their teeth still intact. Being the wonderful and perfect dentist that I wanted to become, I would try restore to them to the PROPER position with my fancy pantograph. My first problem was that no matter how perfect I was on that *^%$ articulator, the patients mouth must have moved or changed shape. I had to grind the ever loving **#&? out of the restorations. By the time I was finished I was just glad they could close their mouth and leave. Right then and there I realized that something I was being told to believe as gospel wasn't really from the Almighty one. I also started to understand another important axiom of dental knowledge:
Truth #1: The more cooks, the more rotten the brew!
As a general rule if any procedure, occlusion and endo are excellent examples, have endless CE courses and new products coming out to instrumentize, you can be assured the less we, as the profession, really know about the procedure or problem. If there are fifteen articulators out to solve your occlusion problems you can bet no one has really solved the problem. The more different kinds of Apex locators on the market, the more I fear that none of them is really reliable.
Don't get me wrong! I think CE is extremely important and new developments in instruments and other areas are exciting and you should keep up. I do warn you about beating yourself up because you aren't the perfect dentist and don't know everything. We often get caught up on gadgets and techniques more to treat our guilt for not being perfect than to really benefit our profession and patients. Many of us race around looking for all the magic bullets of procedures and instruments instead of using our heads and accepting our profession's limitations.
Correllary: The more we know about something, the more complicated understanding it should be.
the more complicated something is the less we really understand
about it. If you really understand something you should be able to explain
the concept in a couple of sentences.
Myth #2: Just because someone gives a course on it, it works.
Most people giving courses are sincere and want to help their fellow dentists. Some are more interested in making a buck. These later beasts play on your isolation and your guilt to make money off of you. They play on your desire to find a guru that will solve your problems with say endo, practice management, financial matters. Be careful.
Myth #3: Computer updates will make your life better!
Boy what a crock this can be. Many times your are humming along happily with the software you have then, along comes the big improvement. You bite (I couldn't resist) and after hours and hours of relearning etc. you wish you had dentures when you started.
These anecdotes will become a regular feature within the coming months. Please feel free to send me your Truths or Myths--you'll be duly credited and perhaps achieve net-wide fame!