The New Birth of Dentistry

Are Dental Students Trained to Accept the New Order?

Dr. E. Melville Quinby Presents Some Pertinent Points in Professional Progress in

“THE NEW BIRTH OF DENTISTRY”

 

                A critical survey of any field of activity is liable to be hampered at its commencement, by the feeling that any criticism of the status quo, whether destructive or constructive in character, favorable or unfavorable, will be resented vigorously by many, especially those whose creed is of the type of “My Country, right or wrong—My Country”! Such people, apparently, seem oblivious of the fact that there is nothing static in the tide of human affairs, that processes of evolution affecting this planet, and later, its inhabitants, have been in operation for untold millions of years; and that such operations are continuing. Those, who have eyes to see, and ears to hear, are bound to testify.

Another difficulty to be encountered in a survey of this character, is the selection of an historically accurate starting point in the development of the particular field of activity under discussion, which in the present instance is that of Dentistry. At once in using this work we are conscious of a difficulty because the definition of Dentistry is the art or profession deals with the science and art of prevention, cure or alleviation of disease.

There is a very important distinction herein; and the first point to be established is a recognition of the fact that the term Dentistry hitherto has represented a much too restricted field of operation: and that if the term Dentistry is to be retained, it must, like Medicine, include all the measures necessary to render a Health Service to the community. In other words there is a crying need for a New Vision in dental practice—this idea was first suggested by the writer in a paper read before the State Dental Society (Mass.) in 1916, with the title of “The Renaissance in Dental Practice.”

But we should hark back for a real awakening to the period of the Reformation, for a contemporary of Martin Luther (1483) viz. Paracelsus (1493) spent his life time in a determined onslaught against the traditional practices of medicine, which had been dominated by the influence of Galen (130) for 1400 years. Paracelsus was undoubtedly the pioneer of modern medicine, especially in chemistry and Materia Medica. N. B.

There was no registered Pharmacopoeia in Europe until 1542 in Nuremberg, the year after the death (premature) of Paracelsus. This fact is not generally known—but should be! So instead of choosing our starting point at the birth of dentistry (1839) as a profession in Baltimore, when the medical faculty refused to foster the new-born, and the infant was relegated to an independent career, we prefer to ignore the Baltimore verdict as to the rightful relationship of dentistry, and insisted that a dental health service is no mere poor relation of medicine, but is a legitimate offspring from the parent body, and in all fundamental principles and practices is inextricably woven into and part and parcel of, the body corporate. So we as dentists are greatly indebted to Paracelsus and the period of the renaissance.

Until the fact of our real relationship with medicine is universally adopted and               acted     upon by all educators, it will be impossible to arrange a curriculum or a course of training,                adequate to produce practitioners capable of supplying a real health service, dental or medical.    The solution does not rest on any of the 1-3; 2-3; 2-4; or 3-4 systems of pre-professional and              professional education.

It lies far deeper, viz: in the academical period if training—(we hesitate to use the word education, which is the result of a life-long attempt to sift the chaff from the wheat of what we hear and see). And in referring to the academical period of culture, we have special reference to the classical influence in helping to mould our powers of thinking, and in general to coax the units of our complex mental machinery into such alignment, that a reasonable quality of function may be expected, we do not hesitate to condemn, in the strongest possible manner, the reckless elimination of Latin and Greek from the primary and high school training.

To any student of the English language, and especially that in common use in the literature of the professions, it must be evident that the preponderating influence in nomenclature or terminology is either Latin or Greek or both. As a teacher one has only to read any group of papers written by students in medical or dental schools to realize the want of appreciation of this fact, as instanced by lack of understanding of a question couched in professional language; and in many instances also of faulty spelling.

Unless one is acquainted with the language of the part to be studied, the difficulties in the path of the student are very considerably enhanced. Furthermore, if this unfortunate practice of elimination is continued, all the scientific books will have to be translated into the vernacular. This will be a stupendous task, and one in our opinion, quite unnecessary!

Dental Terminology is Confusing

For examples of confusion in terminology (dental), we may consider Pyorrhea Alveolaris—a misnomer intrinsically—but used in common parlance; and all the others such as Periodontitis, Paradentosis; Periodontoclasia, Paradontoclasia, Traumatic Occlusion; Occlusal Trauma; Traumatogenic Occlusion; Occlusal Trauma; Traumatogenic Occlusion, and many others suggested by seekers after truth, but more or less wasted, because not appreciated.

One of the most flagrant instances of inappropriate terminology is “Prophylaxis, “ meaning literally to “guard against”—so that a “Prophylactic” treatment means “a guarding against” treatment, which might mean a dose of castor oil to clear up an intestinal stasis; so far as any specific action on a definite location of the body is concerned!

On the other hand through an acquaintance with the Greek lexicon, a word was coined which means cleaning or polishing teeth by scraping, filing or planning, viz; Odontexesis. But there is very little satisfaction in forming new words nowadays outside of the vernacular—hence “Mouth Health” instead of “Oral Hygiene.”

It was not without reason that one writer has referred to the Greek philosophy as the greatest intellectual asset known to humanity, or words to that effect, the fact being that such training tends to stimulate the thinking apparatus to the extent that one is fitted to grapple with the more complex problems, and to see them in whole rather than in part.

A vocational training prepares one to do some one thing, but a classical course helps one to think. The one method tends to constriction of outlook, the other to a much more catholic or all embracing point of view.

A concrete example of this hypothesis is dentistry, as practiced from 1839, when the needs of the public seemed to center on measures for relief of toothache; the removal of diseased teeth; the supply of substitutes (prosthesis); and restoration of decalcified dental areas by filling.

In other words, the acquisition of mechanical skills was the motivating factor in training. To this day the average layman, of the 25 percent of the community who think of dentistry at all, thinks of it in terms of a mechanical operation, something to be made and applied with much discomfort to some unfortunate tooth or other. In like manner, the average dental student, unless he has had an intensive pre-professional training, on entrance to the dental school has a layman’s concept of his future work, and enters upon his course with the avowed purpose of acquiring the necessary mechanical skill.

Steps should be taken to modify this concept, on the first day of entrance; cards with large lettering might be placed in all conspicuous parts of the lecture rooms with the legend:

DENTAL HEALTH SERVICE

Teeth                                                                                   Supporting tissues

50 percent                                                                                50 percent

as the minimum basis for a dental health education. This may seem like a kindergarten method, but we must remember that the whole point of view—the emphasis on certain preconceived factors—must be changed or modified, and this mental orientation must be expected to be slow. The next important step in the training of efficient dental health practitioners is the cultivation of a medical point of view in dealing with mouth conditions, rather than the purely dental one.

Complete Diagnosis Must be a Routine Practice

This involves much more taking case histories, after the methods used by medical students in their duties in the surgical and medical wards as dressers and clerks. In other words, all the steps necessary to form a diagnosis must be followed as routine practice in each and every case; and this training should be commenced at an earlier part of the curriculum, so that it may become more or less automatic, rather than a-mere gesture of an ultra-refined attitude towards the work in hand.

The most potent stumbling-block to progress in acquiring the medical point of view in dentistry is the strenuous opposition to the so-called merging of dentistry with medicine, which is sponsored by some of the most powerful men in the profession. In the report by the Carnegie Foundation on Dental Education, Professor Gies said that although the practice of dentistry cannot be made an accredited specialty of medicine, it should be developed into “the equivalent of an oral specialty of the practice of medicine.”

To an opponent of Dental Autonomy this seems to be an unfortunate decision, and to a captious critic might seem to savor somewhat of the “Quibble” status.

Efficiency in Dentistry Demands Medical Training

However, the main point to settle is whether the present restricted training of the dental student with a minimum of general medicine, is capable of producing efficient practitioners in a real dental health service. The writer feels that in order to appreciate the benefits of general medical training it is necessary to undergo such training; in fact that it is quite impossible, all things being considered, to realize to the full, the effect of such experience without taking a course in medicine. It is time to get rid of this spell of self-delusion with which we are prone to envelop ourselves. (Witness the daylight saving craze—when in order to get up at 6 a.m. we must advance the clock so that we appear to rise at 7 a.m. Leave the clock alone!)

We think we are correct in saying that without exception the most strenuous opponents           of the complete medical course, have not had that training themselves. If this is not literally                 true, the author will be happy to apologize!

But certain pertinent questions are in order: 1st. Is dentistry a health service, 2nd does the average dental curriculum suffice for such training? (If the answer to this 2nd is No,) then—3rd should be done to rectify the situation?

It should be observed that in all this criticism the word average is stressed repeatedly, because there is no intention or excuse for belittling the ideals and methods of some of the modern dental schools—without mentioning names. In some of the said institutions the training is of such quality as to stimulate a desire on the part of the students to make research and teaching their life-work rather than the practice of dentistry.

But as regards the average general practitioner, who is really responsible for the dental health welfare of the masses, it would be far from wise to encourage the notion that it is possible without a medical training to act as if he, the general practitioner aforesaid, had undergone such training. A few lectures on general medicine, and hints on the gathering of data from which to form a diagnosis coming during the senior year as part of a finishing process, are by no means sufficient, because the effect is likely to be transient only.

Before going further with this thesis, it should be distinctly understood that the writer has no intention of, or justification for, any belittling of the magnificent work that has been done especially, in the realms of prosthodontia and exodontia, and other branches of oral surgery; but he must insist that reparative measures in general, however beautiful per se, have had very little, if any, effect in stemming the tide of decalcification (dental).

With regard to periodontal lesions, although a gallant attempt has been made by the Academy of Periodontology for twenty years to inculcate principles and practices for prevention, alleviation or cure of pyorrhea alveolaris, it has failed to impress either the public or the professions by and large, with the necessity for dealing with supporting tissues of teeth, on an equal basis with the teeth themselves. And yet it is claimed that as many teeth are lost from pyorrhea as from caries, and that pus pockets extending over a possible are 7 or 8 times as large as the tonsillar territory, contribute a menace to general health from focal infection, as powerful as that from apical disease.

In other words the 40,000,000 people who have any acquaintance with the dentist at all have failed to acquire a moth consciousness so necessary for preventive measures, in this field. As for the remaining 90,000,000, if they could come mouth-conscious to the extent that they are car (motor) conscious, they would discover the appalling fact that they “were harbouring an enormous amount of disease among them”, that “we must continue the education of the public” and that “the prolongation of the life of every individual is up to that individual.”

Disease Breeds in the Mouth

Dr. Charles Mayo, just quoted, makes many more pertinent remarks anent this subject in an outstanding article in Mouth Health Quarterly June 1935, and we find the statements so much in line with the basic thought underlying this thesis, that we take the liberty of quoting further:

“I have looked on the mouth as a particularly likely place for foci of systemic infection to be found, and I have been a campaigner for removal of devitalized teeth, and of teeth about the roots of which abscesses have formed. This effort has led me to plead for closer co-operation between physician and dentist in the practice—of preventive dentistry. I am not thinking only of the prevention of dental decay or pyorrhea—but of injury to the joints, the muscles and the viscera rising from disease in or about the teeth. I have always felt that the practice of medicine includes dentistry; that dentistry is the practice of a special branch of medicine as ophthalmology, or any of the other specialties of medicine. Those who practice preventive dentistry practice preventive medicine.” Dr. Mayo goes on to suggest that while it may be too much to expect all dentists to be doctors of medicine, all dentists should know much more about medicine, and physicians and surgeons should know much more about dentistry!

Mr. F. W. Broderick of England is conducting a research whereof he writes “If I can prove my point, then dentistry becomes the very spearhead of preventive medicine.”

All of the foregoing leads us back again to the question as to whether the oral cavity as an integral factor of the whole or body corporate is likely through disease of its component parts to become a menace to the health and well being of the whole system. If this is a fact—and it appears to the writer that by no flight of a normal imagination can it be deemed otherwise—it is evident that a policy of laissez-faire, or one of hiding our heads in the sand, so as to make us oblivious like the ostrich, will no longer pass for a righteous or scientific conduct of our professional duties, either medical or dental.

Dentistry Must Consistently Progress

Once more we revert to the vital question: Is the dental student trained to supply a health service with full knowledge of the intimate connection between mouth conditions of health and disease and systemic conditions? The next question is to what extent the average physician realizes this connection and is prepared to extend his studies to include the mouth and to be willing and anxious to co-operate with the enlightened dentist.

If it is true that, according to one authority, it would take all the practicing dentists of this country 12 years to deal with the repair work needed by the entire nation, then it is obvious that for this generation a compromise will have to take place as to what must be expected of the average dental practitioner. When or if the tide of dental devastation is under control, then a more comprehensive schedule can be considered seriously.

But in the meanwhile the few who are able financially to spend more time in medical and dental schools can take advantage of the more comprehensive training. But this is a large subject, and the writer hesitates to enter this field of discussion at this time. Maybe in a further article there will be an opportunity. Suffice it to say now that to justify our position as custodians of the public health, steps must be taken at once to qualify ourselves for such responsibilities.

In the meanwhile a summary of some points which must be grasped in pursuit of a comprehensive view of the facts which “Nutrition and Dental Health” wish to demonstrate may be in order.

SUMMARY

  1. The need for a new vision in dental health service; there has been a lack of appreciation of the scope of dentistry in this field.
  2. A real appreciation of possibilities in this respect entail a much more intense study of anatomy, physiology, histology, bacteriology, endocrinology, biology, general medicine and surgery, also gynecology, which is apt to be forgotten, but important.
  3. The realization that the etiology, pathology and treatment of oral lesions are still wrapped in mystery, and evidently require a more extended line attack.
  4. And as a corollary, the mixed etiology of all oral conditions must be recognized as a most important fact. No one factor ever caused anything in health or disease. So do not stress any one factor to the exclusion of others possible, if elusive.
  5.  “Mouth Health” service is still in the stage of infancy, and for full growth and development requires the fullest co-operation of the parents and foster parents, viz. medicine and Dentistry. N. B. This necessities an extension of the medical curriculum in the direction of dentistry; and a much greater extension of the dental curriculum into the field of medicine.
  6. Teaching of the fundamentals of mouth health must be incorporated with the general health programme as part of the daily teaching in the schools—kindergarten, primary and high.
  7. In fact all persons having supervision over young people should be prepared to encourage the principles and practices leading to mouth health.

 

E. MELVILLE QUINBY, Boston, Mass.