From Where I Sit “Who's driving our dental bus?”

Dr Dan Henry, a general dentist in private practice, has written a clinical article about tooth preserving gold foil restorations in this issue of Operative Dentistry. It is refreshing to see someone talk about tooth preservation, since it doesn't get much press these days.

Perhaps you've heard the story about the alarmed patient who asks the dentist why it costs so much money for such a small gold restoration. The dentist's answer was that the gold restoration was free. The cost was for saving all that enamel. Dan Henry's article has shown clearly that conservative and properly placed gold foil can save all that “white stuff.”

Many might think that Dr Henry's article is an “archeological find” in this day and age of cosmetic dentistry and the selling of “extreme” makeovers. Historically, demonstrating a portion of your clinical skills during licensing board examinations was measured by your clinical performance in placing direct gold.

It is reassuring to know that today, in private office settings, there are dentists who are preserving tooth structure for a lifetime of comfort, function and health through the use of compacted gold. Upon serious reflection and careful analysis, one could argue that direct gold clinical skills serve students far beyond just the clinical application of direct gold. Many dentists know that there is a direct correlation between learning how to handle gold foil and the clinical application of other clinical materials.

What has happened in our profession that has brought on a dismissal of the use of gold as “old fashioned?” People have the impression that having gold in their mouths is ruinous to a person's self-image or esteem. Is this profession-driven or manufacturer-driven? Is the current knowledge base that needs to be covered during one's dental education so large that basic clinical skills and materials training cannot be taught in the allotted curriculum time?

Or

Have we lost the teachers who actually have the clinical skills to teach basic tooth preserving preparations and application of the full range of reliable and serviceable dental materials?

Or

Have we gotten to the point where the cost of a dental education and/or establishing an office are making it necessary for practioners to consider treatment options based more on the financial needs of the practice than on the dental health needs of the patients?

Why would an article from a general dentist providing simple gold foil restorations to patients provoke such questions? Simply because this observer has become alarmed by what he sees and by what he hears from former patients and employees over the past six years.

When professional practice advisors started advising us on business practices to maximize the efficiency and productivity of our offices, they were extremely helpful. Particularly in helping those of us who had spent more time focusing on how to do the dentistry than on how to run a business. When dental supply houses moved into setting up dental offices and selling us the latest of “this and that,” we needed to ask ourselves, “Who's driving this bus?” Perhaps by NOT asking, we have allowed the business world of bottom lines and sell–sell—sell to permeate our thinking in the management of patients' decisions regarding their dental needs/wants.

Now why would someone say THAT?

People are not dumb. When dentists buy a Cerac Machine (substitute your own high-priced gadget), what happens? They have to use it—sell crowns to pay for it! Sure, the turn around time is shorter. Sure, it's a great service to the patient, but do all teeth need crowns?

“In-office bleaching” is great PR for the white-tooth-conscious patient. It is a great “production” center for the auxiliary staff. But, don't OTC (over the counter) options cover this need/want of most patients?

Most states now require that patients be given a choice of restorative materials. We are expected to fully inform our patients before we perform restorative procedures. If you are not including the long proven various forms of gold, then I would suggest that you are not complying with this mandate.

I hope that we have not lost sight that we are in the “prevention” of disease—the preservers of tooth structures “profession.” I hope that we have not been “sold” on the idea that it is only by removing all that enamel and having A1 shaded teeth that we can best serve our patients.

I think that we need to ask, “Who's driving our dental profession's bus?” more often.

It behooves all of us (even those who don't know what they don't know) who aspire to excellence in dentistry to ask this question of ourselves. If we don't like the answer, then seek out a clinical study club or work with colleagues who have the skills. If you do not have the skills to use gold properly, then contact either the American Academy of Gold Foil Operators at www.goldfoil.org or the Tucker Academy of RV Study Clubs at www.rvtucker.org for information.

Are you keeping the keys to your dental bus?

Doing so brought ALL the rewards this dentist ever needed during 40-plus years in general practice.