“Train The Brain”

by Dr. Mark H. E. Lin

I feel honoured to have been chosen as one of the editorial board members for the November (Prosthodontic Specialty) issue of Oral Health. Please allow me to extend a special thank you to my predecessor, Dr. Bruce Glazer for his valuable contribution to this position that he has held for the past 14 years. During his tenure, Dr. Glazer has always passionately strived to gather the highest quality articles for our readers. On behalf of the entire Oral Health Team as well as our readership, I would like to acknowledge his years of dedication and hard work as the outgoing editorial board member for prosthodontics. Congratulations, on a well-deserved retirement. We wish you continued success & fulfillment in your future endeavors.

Dr. Glazer has left large shoes to be filled. It is my humbled intention to continue the legacy he has established by continuing to provide our readers with the most clinically relevant, and when possible, scientifically based articles related to clinical dentistry in the field of Prosthodontics.

Throughout my two decades of private clinical practice I have taken countless hours of continuing education courses. It has been a deeply rewarding experience for me to teach part time at the University Of Toronto to undergraduates and postgraduate prosthodontics residents as well. I have also had the privilege of lecturing nationally and internationally in various professional study clubs, meetings and conferences. These experiences have led me to make some important observations about emerging trends in our clinical thinking as dentists. There is an ubiquitous tendency among dentists to focus heavily on the clinical & technical aspects of dentistry. Most dentists have an inclination to want to learn HOW to do a certain procedure. They wish for a step-by-step recipe or process to each individual clinical procedure. During courses we often focus on WHICH materials to use and we want the exact procedural steps that will yield the most clinically predictable and desirable results.

It is my observation that prior to learning the technical aspects of any clinical procedure; the clinicians should ask themselves a very important question: WHY am I prescribing this treatment for this particular patient? Prior to the execution of the recommended treatment, the dentist should think carefully about the indications, risk factors and contraindications. The clinical dentist must prudently & deliberately assess the risks of complications or failures along with benefits of treatment outcome and associated biologic costs of each individual procedure.

To change our paradigm we must self reflect and ask ourselves the following question; during an average 8-hour day in clinical practice, how many minutes do I dedicate towards careful, comprehensive treatment planning and formulation of the diagnosis for each procedure? Most dentists are reactive and provide immediate treatment solutions to resolve our patients’ symptoms and disease process. However, we must evaluate if a correct written diagnosis has been assigned to each recommended treatment. Clinical examination and signs gathered from the diagnostic records along with symptoms elicited from our patient, the dentist should formulate our list of diagnosis for a specific case. Weighing the risks and benefits of each viable treatment option, we provide our recommended treatment plan. The responsibility lies on the shoulder of the dental practitioner using judicious diligence in formulation of viable treatment options and recommended treatment options.

As dentists, we are the doctors of the oral cavity and associated hard and soft tissue structures, and as such, our ability to provide an accurate diagnosis is critical prior to recommendation of any treatment protocol. A diagnosis is defined as the identification of the nature of an illness or disease problem. A random audit of any patient’s dental chart would usually reveal a list of treatment with corresponding insurance codes or professional fees, yet it would be very rare to find the corresponding differential or definitive diagnosis to the treatment codes or fees. In order to formulate any diagnosis, it requires an understanding of the intra and extra oral disease process. Symptoms described by our patients are defined as a subjective physical or mental feature that is regarded as indicating a condition of disease, particularly such a feature that is apparent to the patient. Signs gathered by our clinical examination and diagnostic records as defined as an objective measurable indication of a disease detectable by a medical / dental practitioner even if not apparent to the patient. Based on the signs and symptoms gathered, the dentist should utilize rational evaluation to carefully determine the correct diagnosis for each tooth, periodontal complex, occlusion, aesthetics and the entire stomatognathic system. In addition to the diagnosis, the dentist should evaluate the possible etiological factors that contributed to the disease process in the first place.

For example, prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or maxillofacial tissues using biocompatible substitutes. Tooth replacement therapy could involve removable and / or fixed prosthesis. The removable treatment options to replace missing dentition can range from partial to full removable or implant retained dentures. The fixed treatment options can range from veneers, crowns, bridges and implant retained prosthesis. While these are all viable clinical treatment options for tooth replacement therapy, the more important question that precedes these recommendations should be why did our patient require extraction of the natural dentition. If caries or periodontal disease, the two major leading causes of tooth loss, were probable etiological factors, then prior to tooth replacement therapy, the patient must demonstrate control and management of these disease processes. Otherwise, a knee-jerk reaction to replace the missing dentition with bridges or partials would be doomed to the same pending failures in the near future. I am confident that some readers are in agreement with this obvious treatment approach. In fact, all undergraduate dental students understand this concept before they can proceed with prosthetic phase of dentistry.

These are the basic foundations that should be ingrained in our brains from school but we abandon these treatment concepts in clinical practice. Albert Einstein quoted “Education is what remains after one has forgotten what one has learned in school”.

When our patients consent to our care and present for treatment they are in fact putting their trust in not only our clinical skills but our sound judgment as well. As dentists we must value this privilege and never take it for granted. As a profession it should be our hope that our patients will value our intellectual capacity to diagnosis effectively even more than they value our clinical skills alone. It is our duty to remember that we can only formulate an accurate diagnosis after careful examination, evaluation and deliberation. Therefore, in order to exercise our clinical and technical excellence, we must firstly be able to make the correct diagnosis and prevent etiological factors. In the words of the great Albert Einstein consider this quote and its application to the practice of dentistry: “Intellectuals solve problems, geniuses prevent them”. We must all “Train The Brain”
to the multifactorial etiological factors, evaluation of individual patients’ needs and formulation of accurate diagnosis before prescription of any clinical treatment recommendations.OH

Dr. Mark H. E. Lin graduated from the University of Detroit Mercy for his dental program. He then completed a one-year General Practice Residency program at the Miami Valley Hospital in Dayton, Ohio. He practiced general dentistry for 13 years then returned to complete his postgraduate training in the specialty of Prosthodontics at the University Of Toronto. He maintains a full time specialty practice as a Prosthodontist at Dr. Mark Lin Prosthodontic Centre.