Oral Health Group

Heroic Dentistry – Courage or Folly?

December 2, 2016
by Dr. Fay Goldstep

Goldstep, FayEvery day we come to the rescue of our patients by taking them out of pain, combating the results of an accident, reversing the ravages of time or simply getting them ready for a special day in their lives. We become heroes to our patients. We can do this simply and easily because of the knowledge that has come to us through our clinical as well as scientific education.

On occasion, we are faced with decisions on restorative treatments and periodontal therapy for situations that we may not have encountered before. We need to use vision, judgment, and our clinical experience to come up with the appropriate methods of treatment. It is not a one size fits all approach. How far should we go to save a tooth? What new techniques are available to treat the situation?


The concept of “herodontics” has had a bad rap. It is the approach of trying to save a tooth, no matter what it takes, undertaking measures far beyond reasonable to salvage it. Is this the right approach in the world of where implant dentistry has become a standard of care? On the other hand, should we jump right in and suggest implants as the first line of treatment for a failing tooth? What about the prevalence of peri-implantitis? Implants are not a panacea. The all-or-nothing approach does not work. We need to customize our treatments to our individual patients.

What are our patients’ needs?
Treatment should heal and not harm. (Not as obvious as this sounds!) There should be benefits in health, function and/or esthetics. Specifics of longevity vs conservation of tissue are unique to each patient’s circumstances. The results should be sustainable over a reasonable period of time and not overwhelm the patient’s finances.

So let’s do away with the catchy phrase “herodontics” and roll out “heroic dentistry”…

Patients’ needs sometimes require heroic measures – pushing the envelope and going out on limb. There have been many controversies in the past – esthetic/cosmetic dentistry, etching dentin, posterior composite resins, and implants. Many off-label indications of the past are now the standard of care.

Bioactive materials – glass ionomers, resin modified glass ionomers, giomers, and silver diamine fluoride are some of the new tools of heroic dentistry – saving teeth and doing so with confidence!
Clinical dentistry goes hand in hand with dental research. Adding science can make the difference between folly and courage. We must keep current and be aware of new advances. When we push the envelope, we must do so with the firm foundation of scientific evidence. This issue of Oral Health will discuss some of the new clinical tools for heroic dentistry and tips on how to read the science and incorporate the conclusions.

I would like to dedicate this issue of Oral Health to my real-life hero Dr. Irwin Smigel who passed away recently. He was a pioneer in dentistry who pushed the envelope for his patients and for dentists world-wide. He enhanced his patients’ lives every day through clinical excellence and enhanced the profession by generously sharing his knowledge and wisdom. Irwin, you are my hero! OH

About the Author
Dr. Fay Goldstep has lectured nationally and internationally on Proactive/Minimal Intervention Dentistry, Soft-Tissue Lasers, Electronic Caries Detection, Healing Dentistry and Innovations in Hygiene. She has been a contributing author to four textbooks and has published more than 60 articles. She sits on the editorial board of Oral Health. Dentistry Today has listed her as one of the leaders in continuing education since 2002. Dr. Goldstep is a consultant to a number of dental companies, and maintains a private practice in Richmond Hill, Ontario. She can be reached at goldstep@epdot.com.