European Section of ICD The Dental Discipline in Europe in the Dawn
of the Third Millennium 13th June 2008 Athens Greece
Session I Present Status of Dentistry as a Health Profession
John A. Vostros, Professor and Director Periodontal Program
University of Athens In its early days, Dentistry was part of Medicine, through which it acquired the fundamental scientific basis, which was essential for its establishment. However, there was a significant difference between Europe and the U.S.A., as regards the latter. In the U.S., ever since dental training / education was formatted systematically in the mid- 19th century, it was practiced in independent Dental Schools. In contrast, for many years, until recently, Dentistry in Europe was considered somehow a specialty of Medicine, and was taught in independent schools, but always under the wings of Medicine. The fast continuing development of Dentistry, the evolution of specialties and under-specialties, the overwhelming introduction and availability of new materials, techniques, machinery and equipments, are the reasons why Dentistry is forced to seek financial support from sources other than the strict academic institutions, e.g. dental industry, associations with representatives of major dental companies, etc. This situation may up to a certain degree influence the very same practice of Dentistry, with the inevitable involvement of dentists in the scientific marketing. Unfortunately, the existing lack of homogeneity throughout dental education in Europe, the major differences in the level of dentistry among different countries and, furthermore, the historical different courses that evolution in Dentistry has followed in each one European country, have not permitted-until today- the building and the establishment of a common philosophy on issues such as education, clinical training and practice of Dentistry. Should of course this ever happens, it will be an achievement.
Patients’ Dental Awareness, Demands and “Consumerism” and their influence on Clinical Decision Making.
A consumer is a person who buys goods or uses services usually for personal needs rather than those required for the production of goods or services. In seeking dental treatment the consumer becomes a patient whose demands is shaped by his own attitudes, beliefs and desires for aesthetics, form and function and may be modified by their ability to undergo treatment and the relative costs of such treatment.
Patients’ dental awareness stems from a number of sources including commercial activity, such as occurs on television, in newspapers and magazines, from dental care professionals and from friends and family.
This presentation will focus on whether there is an actual difference between the scientific and commercially promoted dental awareness of our patients. It will pose the questions, how does this awareness influence our clinical decision making and how can dentists respond to the challenge in directing and positively modifying dental awareness in patients?
The Industry of Esthetics in Dentistry.
Nitzan Bichacho, Head of the Ronald E. Goldstein Center for Aesthetic Dentistry at the Hadassah Medical Campus, holding the post of expert in Prosthodontics at the rank of professor at the Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel. Esthetics has developed in a successful and prosperous industry that encompasses both medical and dental disciplines. In practicing esthetic dentistry, we merge the art and science of beauty, integrated with high resolution quality dentistry.
Dentists may follow the scientific and authentic esthetic criteria related to the genuine prescriptions detected by the human body and nature. On the other hand they might have to submit to the rather glamorous and artificial directions detected by the media that tend to acquire a universal influence among patients almost equally in North America and Europe.
Clinical decision making in Esthetic Dentistry is faced with this dilemma. Is there an ethical dimension connected to the relative clinical judgment?
The Distance between Evidence Based Dentistry and Clinical Decision Making.
Regina Mericske-Stern, Professor of Prosthodontics, University of Bern, Switzerland. EBD means: 1) best research evidence, 2) clinical expertise 3) patents’ values (Sacket 2000). Best evidence in clinical research is provided by RCT. RCT’s are not always feasible, might not be ethical, they require strong selection criteria and they are based on a limited number of patients. The hierarchy of study designs puts the systematic review on top. Results obtained from this objective method and by scientific rigor are not fully independent from search strategies and individual preferences. Publications on a lower hierarchy level are excluded. But such articles often give information about quality of treatment, specific methods and skills that are important for clinical practice. While the study design is acknowledged to be a major criterion of quality in search of the best evidence for clinical decision- making, the quality of treatment provided in such RCT’s is not sufficiently disputed.
Today, there is some concern that EBD and clinical practice tend to fall apart. The dialog between experts in EBD and the experts in practicing dentistry has to be strongly tightened.
Over-treatment, an Epidemic?
Asterios Doukoudakis, Professor of Prosthodontics, NationalandKapodistrian University of Athens, Greece. A therapy may be considered an over-treatment if it exceeds the contemporary standards of care and the documented necessity of prevention towards a possible future failure. Over-treatment most often appears when new treatment modalities that are not fully documented are applied to clinical dentistry. The lack of evidence based dentistry coupled with the absence of an overall treatment philosophy and the increasing patients’ demands may lead practitioners to provide excessive therapy.
Presently, there are two areas where we can observe signs of over-treatment. These are the placement of implants and esthetic restorations. There is a lack of an accepted protocol, which will guide us to determine the number of mechanical abutments needed to replace missing teeth. Perhaps what we need to develop is something like the Antce’s Law for implant supported prosthesis as a guide for treatment planning. The primary responsibility for over-treatment with esthetic restorations lies mainly with the patients and their demands for ``sparkling smiles``. Dental practitioners must carefully design treatment plans which address the existing pathology, preserving the oral tissues, and should always prescribe to the concept that `` Best Dentistry is the Least Dentistry`` for the patient.
Scientific Documentation, Production and Marketing of Dental Materials and everyday Treatment Modalities.
George Eliades, Professor of Dental Materials, National and Kapodistrian University of Athens, Greece. The rapid development of materials and techniques has highlighted the problem of establishing sound material selection criteria. Since there is limited real clinical research to support new products, the main documentation available is based on laboratory testing. Nevertheless, most of the popular laboratory tests cannot predict clinical performance and some of them may even lack scientific relevance. Therefore, there is an urgent need a) to develop tests for prediction of clinical handling and performance characteristics and b) to shift research towards understanding the complex material-tissue interfaces. Current product promotion strategies are focused on advertising the advantages of oversimplified materials, claimed to provide reduced chair-side time and technique sensitivity. This approach is supported by the high quality work of qualified clinicians, acting as opinion leaders. However, many “new” products are not associated with substantial improvements and some of them, not surprisingly, demonstrate increasing failure rates. Moreover, presentation of patient cases or techniques as documentation of specific material properties is rather misleading. In many cases, and especially in “cosmetic” applications, information is disseminated to public through advertisement of generic “simple” and “effective” solutions, addressing mainly the aesthetic needs. In this type of marketing attention, is paid rather to cues than the content. Such methods may compromise treatment modalities and outcomes.
The impact of Implantology on “Conventional Dentistry” (Should undergraduate and graduate dental education focus more on saving teeth rather than extracting them and placing implants?
Joerg Strub, Professor of Prosthodontics, Albert Lutwigs University, Freiburg, Germany. Implant education became essential components of undergraduate and graduate education in Prosthodontics, oral and maxillofacial surgery, and Periodontology in the 1990’s. The requirements for this clinical educational experience have been expanded. Predoctoral clinical experiences in implants have also been developed with substantial educational objectives, didactic, laboratory and clinical experiences. Implant manufacturers have partnered with dental schools notably with the naming of facilities, professorships, and other direct means of support for dental school based implant education. Concomitant clinical research endeavours complement these educational programs. What will the future of implant dentistry in our universities be? What opportunities for improved education, clinical research, and product development exist among academic institutions, clinicians and the implant industry?
Session IV Life after 40 years of Clinical Dentistry. (How you can be healthier, wealthier and happier than you ever imagined)
Charles Eugster, 89 years old Dentist, Zurich, Switzerland. As you will live to be 90, your body will require considerable care if you wish to be healthy in old age. Three main factors are responsible: Genes, diet and exercise. Stress and environment are additional factors. Building muscle in old age is very important although poorly understood.
The best time to sell your dental practice will be discussed, - together with retirement income. Preparations for a new occupation after retirement should start early, otherwise retirement becomes voluntary unemployment.
However happy your marriage will end – either through death or divorce, prenuptial or postnuptial agreements are strongly advised. Your chances of happiness in old age are greater if you have a partner. Practical tips for a good relationship are given.
The Role of the International College of Dentists in the Dental World of Europe – Open Forum.
Cecil Linehan, Orthodontist, Former Editor ICD Europe, Belfast, Ireland, United Kingdom. “Recognizing service and the opportunity to serve” means that we who have been privileged to be members of the dental profession, and of ICD, have a duty and a responsibility to give something back to the profession from which we have gained so much. There is a mission for ICD in reaching out to the world that is both educational and other. The European Section has been husbanded well over its 50 plus years and is now in a position, through the Philip Dear Foundation, to do something really significant on a planned basis to improve dental standards in parts of the developing world. But planning takes time. How about devoting one half of our annual scientific day to just such a topic?
The European Section of the International College of Dentists wishes to acknowledge NobleBiocare for being the exclusive sponsor of the Athens Meeting’ Scientific Program.