Department of Dental Medicine

S. Clarke Woodruff

This is a comment on the today’s world of the dental profession, seen from 40 plus years of experience in three different milieus, large bureaucracy—military—, private practice, and a medical network. Dentistry has been inundated with the digital explosion that started with computer dental management software thirty to forty years ago, when we went from peg board systems to DOS based practice management systems, not a “mouse” to be seen, to Windows and Apple based platforms. Next came the digital radiography revolution. After that came the dental version of digital records. This has been followed by the digital/scanning systems that are commonplace in dental laboratories and dental offices alike. All of these changes have brought about significant alterations in the way dentistry is practiced as compared to dental care delivery in the 60’s, 70’s and earlier. The biggest changes that have been made are in the use of reliable ways to replace teeth, namely implants and all the technology associated with that treatment modality.

As these improvements have made for substantial increase in the quality of care and how it is delivered to our patients. I cannot imagine trying to read a radiographic image by starring at 2x3 inch piece of film held up to a view box. Our diagnostic abilities have jumped multi fold to say nothing of the lowered exposure to ionizing radiation for our patients. The capacity to view a 3-dimensional image of our patients is just mind boggling.

Endodontic techniques have made quantum leaps to make them more successful, predictable, and comfortable for the patients and dentist. For the most part root canals do not have to be two of the most feared words in the English language. Rotary instrumentation has become standard operating procedure and has been a major reason for these advancements. CBCT or 3- dimensional imaging has yielded substantial improvements in our diagnostic abilities.

The improvements in organization of our practices via electronic health/dental records and how we manage these practices is so much better than the 5x7 index cards we used to call a dental records of days gone by, and the old paper ledger systems.

"Endodontic techniques have made quantum leaps to make them more successful, predictable, and comfortable for the patients and the dentist"

The next big transition is the way we record and fabricate casts of our patient’s teeth and arches for laboratory purposes. Scanning systems, whether they are used in the operatories or laboratory have brought quantum changes in workflow. This has led to improved delivery times, more consistency, and quality of care when managed by the same standards of the “old way”of doing things. Just because we do it faster, it still must be held to the same standards of marginal integrity, durability, fit, esthetics, occlusion, and cost.

The world of implants and all that goes with that, grafting, treatment planning, surgery, has made for a massive shift in the paradigm of what we can do for our patients. Instead of turning our patients into “dental cripples”, we can offer alternatives to wearing plastic for rest of their lives.

All of this is common knowledge, but I think the next major revolution to come to dentistry will be the more complete integration of dental care to the overall delivery of medical care for our patients. There is a major move afoot to more carefully examine the role improved dental health plays out with a concomitant improvement in a patient’s total body health. This is actually a fairly old concept that goes back to the focal infection theory of the late 19th and early 20th centuries. It was felt that dental infections can spread to other parts of the body, and thereby have an overall effect on a patient’s wellbeing.

Dentists today are interacting more with the PCP’s, family practitioners, and other specialists. Clearances for treatment of prosthetic joints replacement, all kinds of cardiac surgery, from valve replacements done via a blood vessel, TAVR procedures, to open heart surgery, radiation therapy, chemotherapy, and the list goes on and on. We are helping to keep patients alive longer and improving the quality of life, because patients can keep their teeth, and not have to depend upon unsatisfactory dental prostheses.

Because dentists usually see some patients more than their family practitioner, we are in a very special position to help screen patients for hypertension, sleep disorders, cardiac conditions, acid reflux problems, dermatologic lesions about the face, dementia problems, etc. The more we interact with our medical colleagues, the better our common patients will be.

One big way this can happen is, with a patient’s consent, is that we as dentist can access the patient’s overall health record and improve the communication by making appropriate encounter notes, which all care givers, doctors, nurses, PA’s, PT & OT therapists, can view and review. Then all providers will be aware of the role that dentists play in this healthcare team.

This obviously this would require that a dentist be on staff with a local healthcare network. There is major move in our country of consolidation amongst hospitals and networks. The initiative to share information via electronic health records between networks is a very positive development. The proposition of information sharing can become a reality. Most networks have entire departments dedicated to medical information, and CMIO’s, Chief Medical Information Officers. How many of those existed 20 years ago? This is only a win-win for all concerned.

In conclusion, the dental world is becoming a more complicated environment, but a better one. Today’s dentists are much more sophisticated from a technological standpoint than their predecessors. They are not just the newly minted dentists, but many seasoned dental veterans have taken on this new approach to dental care. The result and most important, is better care for our patients.