The Future (of Dentistry) is Unwritten

• April 11, 2011
• Dr. Catherine-Anne Walsh

The recent gathering of the Australian dental force in Brisbane for the ADA’s Congress was a fascinating show of where dentistry in Australia is today.  The record, 4000 strong crowd presented on the first day, eager to collect their mandatory continuing professional development points. What many of us probably did not expect was to find ourselves inspired, our belief in our core purpose as health professionals strengthened and our resolve reignited to be involved in our profession as advocates for the future! 

“BACK TO THE FUTURE”
Is it just me or does every one of these congresses seem to have the word “future” in the theme? This year it was “Back to the future”. At first, I must admit, I smirked at seeing it in the pamphlets, but as the weekend progressed, it dawned on me that as cliche as the expression may sound, it really sums up where dentistry is headed! In some ways, we are going back to basics, in others, we are on the cutting edge of groundbreaking science and innovation. It is the combination of existing, old research, made more elegant by modern science and packaged for modern human values that will probably determine the future course of our profession and it looks like this future is not full of laser beams after all! 

STEM CELL TREATMENT

Day One, the Plenary Sessions, “Star” speakers of the congress come out to shine and give us all a sneak peak at what they have up their sleeves for the following three days. 
The real “Stars” of the morning for me are fluorescent green cells with pink and purple nuclei and short tail like endings, enlarged thousands of times on the big screen of the auditorium, gathered in what looks like a big ball of color and life! 
You really don’t have to know anything about cell biology to see that the picture on the screen is life itself, in its most primitive, primary form, a whole universe at its birth! These are the “apical mesenchymal stem cells” surrounding a developing root tip of a growing permanent tooth.  The beauty of these cells is that they have the potential to differentiate into many different types of cells under different conditions. In this application, they are regrowing nerves and blood vessels in a tooth which would have otherwise been declared dead, in need of root canal treatment or even worse, an extraction! The other wonderful thing is that these cells save the teeth of children. Want to know an even more magical fact about Prof. Hargreaves’ stem cell treatment (aka REGENDO, short for Regenerative Endodontics (root canal treatment))? It can be done right now, it is being done right now, it can be done by any dentist and it costs less than root canal treatment! It is beautifully simple and practical and IT WORKS!  “PARADIGM SHIFT” or HAVE WE BEEN LIVING UNDER A ROCK SINCE 1960’s? 

Day Two, I decide to attend a lecture on the new paradigm shift in caries control (tooth decay). Not a “hot” topic, judging by attendance. Most of my colleagues are next door listening to a lecture on implants and how to restore mouths with no teeth. I choose to check out how to stop people from losing teeth, go figure! Being the one to always go against the grain, I AM SHOCKED to find PREVENTATIVE dentistry is becoming mainstream! 
The “future” of dentistry lies in managing chronic dental disease, which researchers discovered in 1961 to be a transmissible bacterial disease! Talk about going “back to the future”! The take home message of today is to the dental fraternity to become more like physicians: holistic in approach, patient centered and minimally invasive, not surgeons: focusing on the restoration and replacement of teeth, not on prevention of their further deterioration…here I really couldn’t stand the fact I wasn’t the first one to think of this approach. However, it makes me want to jump up and say:”Hallelujah!”
DENTISTS- BIGGEST WATER POLLUTERS

Day 3: By now, the speakers are familiar, lecture theatres marginally less crowded and the highlight lecture of the day for me is presented by the representatives of the FDI (World Dental Federation) and the Australian Dental Association Victoria Branch on the UN initiative on Mercury, which is paying special attention to water contamination by dentists due to the disposal of mercury-containing amalgam filling waste into the waste water system. The consensus is that a phase-out period is inevitable for amalgam as a dental material. At the same time, an interesting public health debate is taking place on the impact that the inevitable phasing out of amalgam material in dentistry will have on access to care and overall quality of dentistry. In short, amalgam is easier to use, quicker to apply and more forgiving when placed in challenging situations. Alternatives to amalgam today are much more technique sensitive, slower to apply and not as durable when used in challenging situations. However, it is not only Mercury the world is worried about. Waste disposal and its ability to degrade safely are very high on the agenda of all governments. All restorations in the mouth are non-biodegradable. Removing any of them and flushing them down the drain is just as risky and problematic as is flushing of amalgam or chemicals, we just don’t know the exact consequences from these other materials. What we know about amalgam is that the Methyl Mercury content in our waters affects the fish and the birds and in the food chain does trickle down to humans! 
The way I see it, if you can avoid contributing to an environmental and public health issue, avoid it! Amalgam has been phased out in some Scandinavian countries and this move, while initially leading to reduced access to public health service (which is already a huge issue in Australia), changed the way Dentistry is practiced in these countries. This initial negative effect was offset with a strong, concerted effort of the dental community and governments to educate the public on PREVENTION of dental disease! WHO (World Health Organisation), FDI (International Dental Federation) and individual governments should have their agendas firmly pointed in the direction of more education, motivation and reward for GOOD HEALTH, not poor health. The current public health care funding schemes  (even private ones: private health funds seldom rebate diagnostic services, both in medicine and in dentistry) do not reduce incidence of disease or make us healthier. This “ambulance at the bottom of the cliff” model of healthcare funding is doing little for the health of our future generations. There needs to be a considerable shift in our thinking and our values to start taking responsibility as a community, as parents and as individuals, for our own wellbeing.
 We have no excuse- we live in the most prosperous country in the World at the moment and we must translate our financial prosperity into wellbeing of our countrymen. 
 AND THE WINNER IS…
And the winner of the greatest, brightest, most inspiring “Star” of the Congress for me: Mr Garry Pearson, the CEO of the ADA Victoria Branch. His team have demonstrated amazing initiative and leadership in collaborating with other bodies from different levels of the Victorian State Government, Environmental Protection Agency and the Australian Industry Group to establish a truly remarkable initiative “Dentists for Cleaner Water”! They epitomize the future of dentistry and deserve accolades for their achievements. I just hope that the rest of the State Branches of the ADA and the State and Federal Governments can look at what happened in Victoria and their amazing results on reducing amalgam output into waste water and reproduce this across the country! 
And there it is, the not so brief account of what really inspired me at the recent ADA Congress in Brisbane; a bit of old science, a bit of new science and a wake-up call to all of our colleagues to act, to get involved in promoting exceptional standards of modern, minimally invasive, prevention focused dentistry. 
It is our responsibility to share our knowledge of how the public can protect themselves. It is also our responsibility to “do not harm” and not just to our clients and other humans, but also to the environment, and we have a long way to go in achieving this goal. “The future is unwritten”, but if we are to write it, we must collaborate with others, we must get used to sharing knowledge and ideas, we must consider ourselves a part of the large community of leaders, who will no doubt, change the world as we know it. Or as John Legend would put it “future started yesterday, we’re already late”.