Dentistry is Broken: Here is How We Can Fix It.

by Dr. Allan Coopersmith, BSC, DDS, FAGD, FADI, FICD, FCARDP, FACD, FICDFE; Nathalie Fiset, RDH

Poor oral hygiene leads to gum and dental disease (the most prevalent disease in the entire world), causing pain, misery and expense, yet in spite of all scientific and technical advances, there has been no reduction of dental disease in the last 10 years. Every dentist and hygienist knows that caries and gum disease are almost totally preventable with good oral hygiene. Dental disease is a concern for the individual and for society. Dentistry must transition to a more holistic view, advocating preventative efforts and early diagnosis to combat the global burden of dental disease.

Our profession has focused on the absolute best technically advanced (and expensive) equipment and therapy to treat a disease that is almost totally preventable, yet the disease has persisted adversely affecting oral and total body health.

Advances in radiology can detect the smallest caries that never should have started. Cone beam radiography can surgically direct implant placement that should not have been necessary in the first place except for the fractured root which is often the sequela from root canal therapy because the incipient cavity progressed to damage the nerve.

High tech scanners and milling machines can produce beautiful and accurate prosthetics for teeth weakened by repetitive previous restorations caused by bacteria left around and between the teeth.

When all else fails, we implant both bone and titanium roots and try to recreate healthy teeth and gums which we all started with in the first place.

Unfortunately, the problem of poor oral hygiene and maintenance that created the need for an implant initially, persists, and begins the cycle of mucositis leading to peri-implantitis and extraction.

The majority of all this advanced treatment will be accomplished by young and inexperienced dentists ready to start on their journey to “Drill- Fill- and Bill”. Patients and professional alike – we are all frustrated with restorative failures where no-one wins.

We have to stop the madness! We have the tools to clean bacteria away from teeth that causes more than 95 percent of dental disease.

Addressing the global burden of oral diseases constitutes a major public health challenge that requires shifting the focus from the existing treatment paradigm to one that emphasizes disease prevention and oral and total body health promotion.

Dentistry has to re-define itself and become a leader and proponent of disease prevention and health promotion. The three most important things we have learned after teaching and practising dentistry for over 65 cumulative years is that:

  1. Dental disease starts between your teeth where your toothbrush or mouthwash cannot reach to clean.
  2. The interdental space is the most neglected yet most vulnerable part of our mouth. It is neglected because of non-compliance.
  3. Dental disease is one of the most prevalent diseases in the entire world causing untold pain and misery and expense and almost all of it totally preventable with good oral hygiene.

So where do we start?

Our journey starts where dentists and hygienists have to take a leadership role to educate, motivate, and facilitate people to “Clean Between” their teeth with floss, brush, pick or water jet.

The interdental space is where the most destructive dental disease happens.

Class 2 caries are the most difficult to access, restore and seal. Lack of enamel to bond, access and visibility, contact and margin placement, and finishing are much more difficult and humbling, requiring frequent replacement.

The un-keratinized interdental col is fragile and vascular and is where bacteria begin to invade the gums and bloodstream causing oral and systemic disease.

The success of a dental office should be measured by their oral hygiene – and not treatment – department. This is the area that is valued most by purchasers and generates the most recurring profit with the least effort and most joy. Everyone wins.

We would much rather see our patients in the hygiene room than the treatment room – and we tell them so and show them how using the 5Rs: Recall, Remind, Reinforce, Repeat, Re-imagine.

You know what they say. Give a man a fish and feed him for a day. Teach him to fish and feed him for a lifetime.

About the Authors

Dr. Coopersmith graduated McGill School of Dentistry with the Thornton gold medal and continued on as a General Practice Resident at the Albert Einstein Medical Centre. He has devoted his career to educating, motivating and facilitating oral hygiene and promoting oral and total body health. He currently practices General and Cosmetic Dentistry in Westmount Quebec, Canada.


Nathalie Fiset is a registered hygienist who has been teaching and practising oral hygiene for 26 years in Montreal. She graduated with honours at College de Maisonneuve. She is a co-inventor of the PerioTwist interdental cleaner and delivery device.

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