Oral Health Group

A Clear and Present Reality

May 1, 2007
by Kenneth S. Serota, DDS, MMSc

The focus on aesthetics has dominated both the dental profession and dental industry for the past decade. Fortunately, the pendulum’s arc has reversed and dentistry is reframing yet again. The profession is revisiting treatment planning, with all its fundamentals and rudiments, from a more functionally integrated perspective. The transition has impacted most upon the specialties, which traditionally have operated independent of one another or at best with minimal linkage. The result has been an enhanced interdisciplinary approach with the concept of comprehensive care now hallmarked by the unification of dentistry and its disparate treatment modalities.

The most dramatic evidence of this is demonstrated by implant driven therapies. Orthodontists are training to place mini implants for the purpose of anchorage. Endodontists can predictably retreat procedural failures; however, if these teeth are determined to be non-restorable, they are replaced with osseo-integrated fixtures. Endo/ortho/prosthetic treatment is alchemized to grow bone where there was none and obviate aggressive bone harvesting procedures. Everything from enamel matrix derivatives to bone morphogenic proteins to stem cell research is directed towards cellular and structural reconstitution.


The continued melding of the specialties with the overlap of specific technical skills mandates advances in integrated education and hands-on training. Fortunately, technologic sophistication in online education, force feedback or haptics and real time hands-on education provide the means to deliver this information effectively and efficiently to a nexus of profession, industry and patient base.

This expanding team based reconstructive approach mandates the use of convergence technologies in order to ensure timely and accurate education and communication. We must move records, not patients. We must keep our knowledge base current 24/7/365. The concept of hotel venues for continuing education is oxymoronic. There is no continuance; it starts and stops and offers no capacity for furtherance of the learning process. The use of snail mail to treatment coordinate is anachronistic. We are still slow to incorporate technology in order to elevate the standard of learning and the standard of care.

For example, the euphoria over the soft launch of the Apple iPhone was met with little or no interest by the Japanese who literally run their informatic and financial lives off cell phones that use bandwidths twice the speed of the fastest broadband provider in North America. Interfaced with optical readers, every conceivable need is met inclusive of entertainment. The world is flat and we in North America have to accept that we are no longer the front runner in the information age; in fact, we are lagging behind the rest of the world because we had to retrofit our communications infrastructure. The same will be said of our associations, organizations and institutions if they don’t mandate universal connectivity within the profession. Failure to advocate for online education and collegial communication is a lack of will and vision.

In 1999, The Washington University School of Medicine and a company called Site-C developed a ‘card’ that provides doctors at computers quick access to patients’ medical records. This smart card, which looked like a credit card, was tested on a population of pregnant women, though researchers “believed” it could be adapted to other patient populations. Imagine if the next generation of cell phones included medical and dental record keeping applications. Organized dentistry needs to listen to Gartner, Inc., one of the world’s largest technologic advisory firms. One of their recommendations for CIO’s of Fortune 500 companies was to monitor how both Apple and Microsoft are creating a new generation of cheap servers to act as a central household repository for all digital communications. If the baby and echo boomers have an Xbox that will soon run their homes and lives with an internet driven interface, then educational material for the dental profession and for their client base must use the same technology to learn, to train and to comprehend the dynamic changes occurring.

In 2000, The University of Toronto and Sheridan College joined forces to establish a new combined program that was designed to teach U of T biomedical illustration students to apply emerging animation technologies to the field of medical and dental illustration. There are currently thirty-four students in the biomedical illustration department of the University of Toronto alone. 3D animation is not the realm of Pixar and Dreamworks; Harvard University selected XVIVO, LLC, a Connecticut based scientific animation company, to customize and develop an animation that would propel Harvard’s Molecular and Cellular Biology program to the next level of undergraduate education. Merck Source, one of the online divisions of Merck & Co., Inc. is replete with 3D animations addressing every conceivable medical condition. Visit www.learnhealthsci.com and look at the endless list of press releases for companies that are using animated movies, e-learning and rich media to instruct on the protocols for dental products.

The linkage to a more sophisticated provision of dental education and care is transparent. Integration of the disciplines in dentistry will occur at a more accelerated pace and with less disruption if we as a profession utilize convergence technologies… the 3D animations used to train for new techniques can also be modified to be used for patient education. Both require nothing more than access to a website and a media player or to an e-mail address and Acrobat Reader. The latest version of Acrobat from Adobe produces multimedia packages for course assignments and research by assembling material from web pages, photos, scanned book pages, PowerPoint presentations, and other PDF files into a single, searchable electronic file. The size of these files are invariably no larger than an image taken by a digital camera and can be sent over the Internet with the same ease.

Organized and institutional dentistry must reframe and restructure to maximize the use of the resources we as their members provide them. They must do more than provide the tools for convergence; they must mandate its usage. Dynamic convergence mechanisms incorporating the traditional, the atraditional and the endless parade of innovations that outdate themselves literally once they are in production will result in a new kind of education…. The principal goal of education is to create those who are capable of doing new things, not simply of repeating what other generations have done (Jean Piaget (1896-1980) Swiss cognitive psychologist). The objective is not the replacement of books and journals. Rather it is to optimize the potential inherent in digital and rich media to expand the message delivered by offline media in the online milieu that is now an integral part of our world.

In December 2004, Google made an arrangement with the New York Public Library and the libraries at Stanford, Harvard, Michigan and Oxford, to scan their stocks, making their contents available online via Google Book Search (books.google.com). Ultimately, it is thought, some 30 million volumes will be involved. Microsoft, meanwhile, has made a deal with the British Library to scan 100,000 books, 25 million pages, this year alone. Google has now scanned one million books. The world’s knowledge will shortly be enshrined on the Internet and accessible through an array of devices that will remotely connect from everywhere on the globe. The generational change in health science knowledge continues to shrink which mandates immediacy in communication to keep current and now even our patients have the potential to access this information. As informatics and communication technologies break down traditional barriers and facilitate an unprecedented linkage between professionals and their client base, a more integrated, cohesive and unified reality w
ill evolve; that is the ultimate truth. “Truth is incontrovertible, malice may attack it and ignorance may deride it, but, in the end, there it is.” (Sir Winston Churchill)

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