If Aldous Huxley were alive and well, and seated in London’s Shaw Theatre during the first of the Oral-B Up To Date seminars, he surely would have leapt to the stage to congratulate Prof Iain Chapple on his blistering performance; for while Iain may not be as eccentric as Huxley was, he certainly succeeded in presenting a ‘brave new world’ to his fixated audience.
He flawlessly articulated the profession’s call for a public healthcare system that rewards quality instead of mere quantity, where quality is defined by the prevention of disease instead of the treatment of it. Too slowly, but surely, the ever-gaping cavity between the demands of public healthcare and those of dentists may begin to arrest and narrow, and the shackles of red tape may loosen their grip around our neck’s and allow us to focus more on our patients. Finally, a realisation that
with an increasingly ageing population public healthcare delivery is functioning on borrowed time, as well as borrowed
money, and a radical national strategy is urgently needed.
Enter the need to measure and assess risk. Measuring and compartmentalising information is indeed how Huxley explained human intellect in his prescient novel, so it should come as little surprise that measurement of risk enables us to control how we treat disease. Iain’s enthusiasm for effective risk screening seemed perfectly understandable given that apparently no
two experts possess the capacity to agree on the parameters of such risk.
At the end of his talk, Iain informed us that although this brave new world was perhaps a decade away, pilot schemes were already in practice and the feedback from them was overwhelmingly positive. Both patients and their practitioners reinforced the solid body of evidence that showed targeted treatment based on careful risk assessment was enabling more people than ever before to keep their teeth; and that is undoubtedly our ultimate goal. Exploring the brave new world
Delegates went from optimism for the future to a sobering warning about our present, as Prof Avijit Banerjee encouraged a
healthy but imperative scepticism of technology. As professor of cariology at King’s College London Dental Institute at Guy’s
Hospital in London, he was perfectly placed to elaborate on minimally invasive dentistry and the limitations of caries detection technology.
An audience receptive in agreement readily absorbed his passionate pleas for a greater understanding of the technology we use. While no shortage of caries detection technology exists, Avijit demonstrated how their improper use could worryingly
lead to more unnecessary damage of tooth structure.
The accuracy of some of these detection devices would offend even Sherlock Holmes, and despite countless tests and research, it seems that visual diagnosis and careful probing with a blunt ended instrument are still as valid as the laser devices that promise to furnish your surgery like Q Branch from a Bond film.
Avijit relished in reminding us how keen dentists were to cut things, and how satisfying some find it to resolve the apparent pandemic of healthy teeth. But holstering handpieces for a moment and merely considering the extent of the carious activity could not only prolong the life of the tooth, but also potentially negate the need to harvest its pulp.
Fortunately for trigger-happy dentists diseased with the pathological habit of hacking into teeth, alternatives do exist. Air-abrasion can be more effective than diamond-encrusted burs at carefully removing tooth structure minimally invasively, and undoubtedly less painful too. Indeed, it has proved itself as operative dentistry’s equivalent of the nicotine patch, but alas with the same limitation of providing no tactile feedback. Bio-active glass may encourage remineralisation of a hydroxyapatite structure around it, and polymer burs have the potential to be more selective in removing carious dentine. Chemo-mechanical excavation involves collaboration between a caries solvent and an abrasive tip or brush to selectively remove the infected dentine within the solution.
The technology is out there and improving every day. The old amalgam blocks will eventually be phased out and replaced by adhesive restorations in cavities cleaned by technology that will understand the difference between sound, affected, and infected tooth structure.
The recurrent theme of the evening seemed to be that however resigned we may become to the grind of our dentistry, the new advances and strategies on the horizon are exciting and hopeful. They promise a brighter future where we will
make it possible for more of our patients