dental education
Why do patient’s think that all cavities cause pain? I think you have to look at the history of preventative dentistry to understand how this myth got started. The prevention of dental disease is a relatively new science. Dental insurance wasn’t common until the ’70’s and fluoridation of drinking water was widely instituted at about the same time. Prior to the ’60’s or ’70’s, it was uncommon for patients to see their dentist every 6 months for cleanings and exams (preventative care). Patients rarely made an appointment to see their dentist unless they felt pain. And, in most cases, this pain was caused by a deep cavity. Extraction of the tooth was usually the treatment of choice at that time because root canals were not commonly done.
You notice I said the pain (toothache) was caused by a deep cavity. If the patient had seen the dentist before the pain started, the tooth could have been saved with a filling. But patients didn’t see the dentist”until it hurt”. When they saw the dentist, he/she said the pain was from a cavity. Thus the association of pain with a cavity. The fact is that patients in those days were walking around with millions and millions of painless cavities. The only ones they knew about were the deep, painful ones.
Of course, preventative dentistry is more widely practiced and utilized these days. Technology for the detection of small cavities has improved immensely. A patient who sees the dentist regularly should never suffer from a cavity so large that it causes pain. Of course, if a patient goes several years between dental visits, they may develop cavities large enough to cause pain. However, the type of cavity that we find on routine check up exams is painless and can only be detected using our newer detection tools.
It’s a little unfortunate that small to moderate cavities don’t hurt. If they did, patients would get them taken care of before they became large and costly. The sale of junk food would drop also because people would begin to associate junk food (a major cause of cavities) with pain!
In my next blog, I’ll explain a little of the physiology and anatomy that causes deep cavities to hurt but small to moderate cavities to be painless.
Many recent studies have linked gum disease to other health problems. Pregnant mothers are always very concerned with improving their chances of giving birth to a healthy baby. Here’s a simple way to do so.
A University of Pennsylvania study of 160 pregnant women with gum disease found that successful treatment lowered the rate of premature delivery from 23 percent to just 7 percent. In other words, expectant mothers with gum disease have a much better chance of avoiding premature birth if they keep their gums healthy.
Gum disease releases bacteria that can lead to early labor. Having regular professional cleanings removes these bacteria. It’s really that simple.
Patients and people who have seen my website often ask me what I mean by “Not All Dentists are Created Equal”. I’m also asked why we do things a little differently in my office than what they have experienced in other offices. Patients are often amazed by how thorough, gentle, and personalized we are in my practice and they ask “where did I learn to practice dentistry this way” and “why don’t other dental offices do it the same way”? Well, it all goes back to the concept of life-long learning.
Most patients assume that all dentists are trained in the same way, and, therefore, have the same skills and knowledge. And, in the first four years of our training, this is basically true. We (dentists) all start out with the same basic training. We spend four years in dental school learning anatomy, physiology, pharmacology, and basic dental techniques. I say “basic” because four years is not enough time to teach advanced techniques. It’s also not enough time to give us much experience. We get that when we get out of school. By the way, the training that we get in dental school is so basic that it really doesn’t matter which dental school we go to. Our true skill as a dentist is developed after we get out of dental school.
Once a dentist has graduated from dental school, he/she is free to start practicing by buying a practice from a retiring dentist, or associating with a group practice. Either way, they are immediately practicing on patients. Some dentists go into the military where they can gain several years of valuable experience treating military personnel before they go into private practice. Then there are dentists who want to receive extra training and experience by enrolling in a Dental General Practice Residency. This was my choice after dental school.
A GP Residency is a voluntary 12 month program of intense advanced training and experience. There are a limited number of slots available in GP Residencies, so only a limited number of dental school graduates can get in. There is an application process that involves a review of your dental school grades, recommendations from your dental school instructors, and personal interviews. I did my general practice residency at Denver General Hospital (now called Denver Health) in 1976-1977. At that time, there were only 6 or 8 slots available for general practice residencies in the whole state of Colorado. The number of available residency slots has not changed much in the last 30 years, so it is still very competitive.
So, some dentists start treating patients in private practice immediately out of dental school with very little actual experience. They learn on the job. And yes, they learn on you, the patient. Pretty scary, huh? The dentists who get their initial experience in the military or in a residency are supervised by other experienced dentists, and where the patients are receiving free or reduced fee dentistry.
Since I had obtained so much “hands on” experience at Denver General, I felt pretty confident about my skills and knowledge when I started private practice in 1977. Little did I know how little I knew. As we all know, we gain skills and knowledge as we gain experience. We all received basic training in driving a car before we were given a license to do so on our own. Yet we all know that the 16 year old driver has a much higher accident rate than the 30 year old driver. Our automobile driving skills improve as we spend more and more time behind the wheel. So it is with a practicing dentist or any other professional. Experience counts! Just another reason why “Not All Dentists are Created Equal”. Some dentists have more experience than others.
However, experience is not the only factor. There are many 30 year old dentists, that in my humble opinion (IMHO), are better dentists than 50-60 year old dentists I have been acquainted with. This is were the concept of “Life-Long Learning” comes into play. Once their formal dental education is over, dentists are on their own to learn new skills, keep up with new research findings, and learn the new techniques and technologies. Some states require a few hours of Continuing Education per year to maintain your license to practice. But, IMHO, it isn’t enough to even keep you current, let alone become highly skilled. As a matter of fact, the State Dental Board of Colorado has NO continuing education requirements for dentists. In Colorado, a dentist can stop learning right out of dental school and still perform dentistry on his/her patients for the rest of their career.
So, what really separates the “average” dentist from the “master” dentist? Life-long learning! And I am proud to say that I am a member a profession that highly encourages dentists to continually upgrade their knowledge and skills on their own, and at their own expense. And it isn’t cheap. That is another reason why “Not All Dentists are Created Equal”. Some dentists are passionate about continuing education and some don’t do any.
So, how does a dentist get continuing education? There are multiple avenues for learning once you are out of dental school. You can:
- Read journals, listen to instructional CD’s, or watch instructional DVD’s (there are hundreds published just for dentists), or do on-line learning
- Go to seminars There are thousands of these available every year and they range from 1 hour to several weeks of 8 hr days in length.
- Take part in group discussions with other dentists on line or in study groups.
Just to give some perspective on the commitment needed to become a master dentist, I’ll tell you about a discussion that I had with a young dentist the other day. This particular young dentist graduated from a good dental school about a year and a half ago and then did a General Practice Residency in Denver. He started into dental practice just a few months ago. He has had a good basic dental education to this point but wants to do what is necessary to become a master dentist. We were discussing his different options for continuing education to accomplish this goal and he told me that it would cost him about $45,000 over the next few years just to get started. This will all be out of his own pocket. Personally, I have spent over 1,000 hours in continuing education classes since I started private practice. I don’t even want to think about what it has cost me.
There are many other ways for a dentist to obtain continuing education, but I won’t even try to list them all here. IMHO, a passion for continuing education, or lack thereof, is the main reason “Not All Dentists are Created Equal”. Unfortunately, it isn’t common for a dentist to divulge his/her continuing education experience to his patients. I guess it would be considered bragging by most of us. But if you do want some idea of how “current” your current dentist is, you might consider asking them about courses they have recently attended, or articles they have read, or on line learning they have done, etc.
