Natural dentition: Risk of extinction?
During the past few years, there appears to be an increase in continuing education. Many of the courses are about implant dentistry. The conventional courses that form the basis of learning the skills of saving teeth have been fewer in number. Everybody wants to learn how to surgically place a dental implant. It appears that some apparent “need” of patients has driven clinicians to subscribe to these weekend courses in surgery so they can respond to these patient “needs.”
Patients see their dentist regularly to save their teeth, not to have their teeth sacrificed for implant dentistry. Are we sending the wrong message here?
Once the courses are finished, most clinicians receive the golden label of approval, a dental certificate of completion that they can hang on their dental mantel at the office. On Monday morning, they become changed and charged individuals. They have been pre-programmed to now look at patients as potential implant patients. Their approach to dentistry has changed overnight. In the past, they spent four to five years in dental school learning most of the skills to save teeth.
These skills involve different forms of dentistry, not limited to periodontics, operative dentistry or endodontics. They spent countless hours learning about how to negotiate root surfaces in debridement, root canal curvatures in endodontics and multiple techniques in operative dentistry to save teeth. But overnight, all that has changed. Why spend so much time saving teeth, when you can remove them and place a dental implant at half the time? Is this really better for the patient?
Why burden the patient with multiple periodontal procedures to save teeth when the alternative is here? This approach seems to be contagious in the thinking of clinicians today. Many are concerned that dentists are not promoting the right approach to saving the integrity of the natural dentition. This attitude is so contagious that even some endodontists are learning to place dental implants. Is this not a clear conflict of interest? What is their motivation?
Are we doing enough to teach dentists how to diagnose and prognose the ailing dentition? When does the ailing dentition become a failing dentition? When is it appropriate to choose implant dentistry over conventional, time-proven and predictable conventional dentistry? The removal of key aspects of dental training creates dentists who are not confident to diagnose or render the necessary procedures to save teeth adequately.
Their clinical skills in recognizing and managing ailing dentitions are limited. Their ability to recognize when and where dental implants may be used can be influencing their ability or motivation to save teeth. Are we not creating a conflict of interest for our patients? The true “need” should be to go back to basics and learn how to save teeth first, so patients are able to keep the most natural dental implant of them all.