Oral Health Group

Think Different(ly), outside of the box?

October 1, 2014
by Dr. Peter Birek

The other day a young Canadian training in the US wanted advice for his return to Toronto to establish practice in periodontics (Toronto, the centre of the universe as we natives think of it, as if there were no other places to go, live and work). I was happy to talk to him; after all, I have nearly three decades of practice experience. Simple, isn’t it, just answer two questions, I told him. HA, as my kids would say, here you have it! Np (that is “no problem” for those who don’t live with daily texting and alike).

First, the “wise owl” said to the “young man” that he should answer the questions of where periodontics is going and what is in its future? Figure out what changes will occur based on anticipated trends, scientific breakthroughs, or changing patterns of referrals. Then, solve the second question related to economics of practice, density of “gum gardeners” in a given geographic area, emerging trends of “dental entrepreneurship,” and “corporatization” of dental practice in general as it relates to the practice of periodontics.


Then, the “wise owl” realized that these questions have been asked since he started practicing, and long before that, and after that, repeatedly, without anybody able to answer them with high degree of predictability – simply put, we were unable to predict the future of this relatively narrow field that blends the art and science of periodontics.

For the life of me, I cannot find the reference to a particular study I read in a reputable science journal. The authors asked two groups of scientists in a rather narrow field within the wider category of science called molecular biology. The answers of scientists belonging to the group of well-established leaders of the narrow field were compared to the opinions given by young and bright scientists who were at the start of their careers but already working in the very same field. The answers were then reviewed for accuracy of prediction in five years’ time; a relatively long period in this particularly fast-moving field of knowledge. To my surprise, the predictions of the leaders were clearly inferior when compared to the foresight of the younger cohort. Why is it that this “wise owl”, who spent a few decades in and around the periodontal garden, could not answer the two questions –and, in particular the crucially important first one? Perhaps this is due to a constraint that our cortex develops when we are too close to an issue or too comfortable in our environment. More likely, once we are “in the box” we can hardly think “out of the box”.

There are examples in recent history of people who could think “outside of the box” and were daring to act on it. Steve Jobs was one of them (he coined the grammatically incorrect phrase of “think different” as if to taunt the establishment). He and his team at Apple Inc. had predicted what appeared to be the “unlikely future” and had the guts to act on it. In contrast, those at Research in Motion – (RIM that gave us the Blackberry) could not think outside of their rather rich and well established “box”. The people at Apple acted on a daring prediction and made it happen. Whereas those at RIM were constrained within the “little black boxes” that were already in 90 million hands paying for the benefit of having a Blackberry, most of them working in the top corporate world among them the US military and US government. Their lack of foresight lead to the sad state of what once was the brightest star of Canadian entrepreneurship.

Although this “wise owl” still cannot answer the two questions with decent accuracy, here are some of my views of the future as it pertains to periodontics and dentistry in general:

The more we distance ourselves from being “health care providers” rather than “businesspeople of dentistry” the cloudier our future will be.

As long as we dentists–including periodontists and all other specialties–address the problems of our patients with integrity at a highly professional and ethical level, we will continue to be respected and most likely thrive.

Those who shape the science of periodontics perhaps should dare to think “outside of the box” once in a while avoiding repeating already established findings or try to prove obvious facts that perhaps don’t need to be proven via established scientific methods.

Those who shape the art of periodontics should stay within the scientific boundaries but without fear of opening an unusual “box” that lands at their footsteps.

As for my young friend here is my advice: don’t ask for advice, you can find it (in) yourself. HA. Here you have it! You are welcome. Np. OH

Dr. Birek is an Associate Professor in the Department of Periodontics and staff surgeon with the Oral Reconstruction Unit at the University of Toronto. He maintains a private practice in Periodontics and Implant Surgery in Toronto. Peter is the Peridontology editor for Oral Health Journal.

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