Comprehensive Care: Bio-Techno Convergence and Integration

By Gary D. Glassman, DDS, FRCD(C), Kenneth S. Serota, MMSc, DDS, and Frederic Barnett, DMD

Dentistry is dangerously close to becoming a runaway train. Techno-products abound; they are the engines that drive the service mix. Unfortunately in far too many cases they are an application in search of a situation. The biologic objectives are often ignored or overlooked in the pursuit of bells and whistles and fancy streamlined equipment. Comprehensive care of the oral cavity, analogous to the fabrication of a fine Swiss watch, is potentially being disregarded.

In the example of the watch, the integration of expertly machined parts must be finessed into place with balance and harmony as the foremost consideration. In the case of dentistry, the extraordinary convergence of design, skill and sophistication may achieve the brilliance of aesthetics, but may not achieve the objective of function and sustainability.

Historically, the flaw in the educational experience has been the lack of assimilation of the basic, applied, and clinical sciences in an appropriate timeline. Seamlessly integrating the microscopic with the macroscopic is what creates the ultimate clinician. Once satisfying the biologic fundamentals, any delay in their application to the clinical reality, negates their relevance and impact. The clinician must not lose the sense of foundation, the very cornerstone of the capacity to assess “anything new” with the evidence-based clarity so essential to comprehensive care.

Thankfully, two powerful forces are altering this miscarriage. Dental faculties are adopting more pragmatic, linear, reality centered curricula. At the University of Toronto, Faculty of Dentistry, a new comprehensive care program has been put in place. This new educational reform was the result of a curriculum review by an educational sub-committee under the direction of Dr. Mike Sigal and including the current Dean, David Mock. The major change instituted by the program is that most patients are assigned to one student provider who is responsible for care from start to finish; from initial diagnostic assessment through appropriately phased treatment planning to the provision of rationale patient care. Comprehensive care is introduced at square one of the student’s clinical experience.

The emphasis is on provision of optimal patient care that addresses the oral health needs of the patient and takes into consideration the patient’s wishes. Central to the program’s objectives is the development of a logical step-by-step treatment plan for a well-informed and educated patient. The Comprehensive Care Program emphasizes the educational development of critical thinking, appropriate clinical decision-making and optimal treatment planning skills inclusive of digitally-based case presentation.

The second force is the Internet. The early stages of Internet involvement with dentistry were for the most part run with a prejudice towards the industry. In order to keep the portals running, the focus was on sales of goods and services with the educational component, the “added value” provision. While to a significant degree this has metamorphosed into more forums with education as the primary raison d’etre, for the most part it remains a profit-centered effort. However, some dental associations have created online members discussion forums, which will inevitably lead to a radical exponentiation in the digitized learning curve, facilitate digital presentation, and invariably improve treatment planning skills.

Aside from the obvious camaraderie of online discussion forums, there is an innate refereeing capacity that is inherent to the format. Flagrant commercialism is rarely tolerated; however, the forums that focus on clinical disciplines invariably encourage the participants to present cases and engage in treatment planning discussions. Visual learning becomes a daily endeavour and the primary benefit is that the numbers of contributors present a myriad of options not possible in traditional real time CE venues.

The alliance of web communication, coaching and inevitably training with the shift in curricula at educational institutions to a more evidence-based and sequential learning and planning background will without question raise the bar on the standard of care in the dental profession. What is needed is an increased participation from the members of the profession who are already infused with this approach. With the “engine” coming from the “roundhouse” of institutions, with an integration of infrastructural resources, the coming era in dentistry will indeed be one of bio-techno convergence and those whom we treat will be the recipients of all this magical benevolence.

“At the moment of commitment, the entire universe conspires for your success.” J. W. von Goethe (1783).