Chew On This

by David Cowan, DDS, FICD(C), FADI, FACD, FPFIA

The body is a most wonderful physical and biological creation. However, there are certain observations that are difficult to comprehend and explain. How unusual it seems, that our Maker created us with two eyes, two ears, two lungs, two kidneys, two ovaries or two testicles, but only one liver, one heart, one brain, and only two sets of teeth.1 Some parts have been omitted to save space.2 Was this to lessen the number of specialty departments in our hospitals?3 I think not.

In respect to the dentition, we all know that since we are living longer today–100 years ago the average lifespan in Canada was 47, hence a third set of teeth was hardly necessary. Today, the average lifespan in Canada is 82 for females and slightly less for males. Add to this that our once beautiful teeth get worn out, broken down, discoloured, diseased, loose, sensitive and much less functional–hence the creation of dentists.4

Our services are certainly utilized by all ages of our population, but I believe it seems agreeable to all of us that the most difficult and stressful segment to treat is the elderly. For many of our senior citizen patients, complete dentures might be one of our options, which in many cases is probably easier for the dentist to provide but in most cases is the most unsatisfactory and most difficult for the patient to endure.5

Our knowledge, skills and caring must be based on the highest levels of learning, practicing and integrity. Our patients show kindness and trust in coming to us, therefore, we must inform them of the possible complications, alternative treatments, advantages and disadvantages of each, costs, risks and outcomes. If one is unable to provide the necessary services for the patient, then consultation or referral should be made to colleagues.

Why does the dental profession have such a high suicide rate? I believe it is because we care so much and struggle with the demands and expectations placed upon us to perform our services to perfection. The dentist is not obligated to accept or treat everyone. We should help a patient in pain or at health risk from acute conditions and then treat or appropriately refer.

The oral cavity provides us with a very difficult working environment. It is small, dark, wet,6 moves a lot, has feelings, is also occupied by an inquisitive tongue, and is attached to a conscious person (except under general anaesthesia), who at best would rather be golfing or skiing–all of which is stress producing.

It is also stressful when our once beautiful crowns, bridges, fillings, etc., start to wear out and need replacement. When we are re-examining our own patients and discover failures this seems more stressful and difficult to explain to the patient. It seems easier when we greet a new patient and have to deal with the wearing out of another dentists’ treatment. We must never be critical of the other dentist to enhance our own image. Integrity should rule.

Today, many patients expect our dentistry to last forever. I tell my patients that not even Ford or GM produce vehicles that last forever even when used on a daily basis as we do our dentition.7

Of course the most stress-producing factor in our daily practices is the clock. Running behind and keeping patients waiting drives us up the proverbial wall. Somehow this problem does not exist among physicians and I can’t explain why.8 We must never compromise, cut corners or let our standards slip. It is unethical to knowingly provide substandard care.

Because our Maker did not give us that third set of teeth and because people are living so much longer, our dental schools are undergoing major changes to train new grads and retrain older ones. Curriculums are also undergoing major revisions to meet the demands of the new millennium.OH

1. This comment does not come from any religious scripture.

2. Not in the human body but for this article.

3. Mike Harris would say ‘of course.’

4. Hence the creation of this journal.

5. Thank-you G.Z. for bringing implantology to North America.

6. I don’t mean our dental offices and clinics.

7. And abused by parafunctional driving habits.

8. It could be a financial factor.

Dr. Cowan is an Assistant Professor, Faculty of Dentistry, University of Toronto and has a private practice in Toronto.