What Are We Missing?

A few years ago, I attended the University of Maryland’s Innovations in the Prevention and Treatment of Early Childhood Caries Conference: an intensive and very interesting update on the status of caries, the disease, and its various treatments.

A few things became quite clear: measuring oral health is difficult. Treating dental disease is challenging, labor intensive and extremely expensive. The currently accepted surgical approach to caries fails often and regularly and has a questionable return on investment: for example, the relapse rate of 52 to 79% after 24 months for children treated in the OR. Sobering statistics.

At one point during the conference, my notes morphed into a mind map. I placed CARIES at the center and  filled the bubbles to the left of CARIES with the inherent qualities of teeth and the disease that destroys them. On the right side of the map I focused on the embarrassing statistics related to this PREVENTABLE disease.

What are we missing?

For one thing, the prevention we do in our clinics is based on a teach and tell model that fails to honor the ability of our patients to manage themselves. At  the conference I learned about promising research projects focusing on filling that gap with Motivational Interviewing to help people change, video games to help teens change their health behaviors, saliva tests being developed in Japan to identify pathogens, the promises of xylitol.

What remains is: our current approach with caries prevents us from seeing the bigger picture: an oral microbiome out of balance from a 21st century diet loaded with sugars and fermentable carbohydrates, (malnutrition?) and compounded by the lack of oral hygiene facilities everywhere.

What is a dentist’s work?

It is hard to be a dentist. It is physically demanding and the work seemingly never ending. But there is more to the stress of being a dentist. In my search for authenticity and integrity, I have struggled with reconciling my construct of a successful dentist with the statistics relating to caries. It seems to me that I worked very hard to make very little difference. I would imagine that you, like me, also struggle with this dilemma, especially if you have a decade or 2 of practice behind your belt. This tension ate away at me, especially when I heard remarks on the cost of care or comments on how financially rewarding it must be to be a dentist. Somehow, I was never completely satisfied with my replies to these comments highlighting the fact that dentists are highly qualified health professionals.

What can we do to fill those gray areas on the diagram?