The Associate Editor: Change With the Leaves

Autumn is upon us, and it is a reminder to many of the constant change in our environment. I grew up in Virginia, where in the distance, one can see the Blue Ridge Mountains gently rise and fall along the horizon. If we were there right now, we would be dazzled by an endless array of autumn colors as cooler temperatures and shorter days cause the dense summer foliage to give up its green. In a few weeks, this vibrant fall palette will be gone, yielding to the barren brown of trees and earth and the gray of winter skies.

Too often, change is viewed in negative light. To change, we must leave a place in which we are comfortable and move to one in which we are not. This can result in anxiety, uncertainty, and fear. Changes within the dental profession are no different than in other aspects of our lives. Practicing dentistry becomes a series of skills that improve with repetition. Changing the way we do something will typically cause a temporary lapse in the quality of our performance. This is why, I believe, most dentists do not readily embrace changes in the way they practice or in their profession.

I would like to offer a different perspective on change. Sometimes we consciously make changes in our lives that initially make things more difficult for us, but which ultimately lead us to better places. When we look at changes that have occurred in the dental profession in recent years, it is easy to see that many have had a profoundly positive influence on our patients and on us. Take, for instance, the discovery made in the late 1960s by Dr. Rafael Bowen. The new restorative material he developed, which we know as composite resin, and the technique of bonding that material to tooth forced dentists to change the way they practiced dentistry -- from restoring teeth, to treatment planning, to implementing preventive techniques. Few would argue against the fact that the addition of composite resin to our dental armamentarium has dramatically improved the quality of life of many thousands of patients worldwide.

A change that occurred even earlier in the last century was the introduction into everyday practice of safe and easily administered local anesthetics. Most of us have patients whom we have heard bemoan the days of their childhood visits to the dentist, when they often had dental treatment performed without anesthetic. Today we are able to render virtually painless dentistry. As a result, we are able to perform technically difficult procedures with greater ease because our patients are more comfortable. New generations of dental patients are growing up without ever experiencing the pain and suffering that their parents and grandparents did.

The list of improvements in dental technology over the last century could easily fill an entire issue of the Journal. Their common thread is that each required dentists to learn new information and acquire new skills and, at the same time, abandon the ways of the past.

Sometimes changes occur in our profession that may initially raise controversy or divide us. With mutual understanding, cooperation, and a willingness to change how we practice, these new concepts have also immensely benefited our patients and the profession. The 20th century saw a change in types of dental practitioners with the birth of dental specialties. We have seen vehement opposition to the recognition of new specialties in the dental profession by those who feel it will further fragment us or by those who fear personal loss of control or a diminished scope of practice. The development of dental specialties, however, has unquestionably raised the level of care we, as a profession, are able to provide our patients. I’m sure there are many practitioners amongst us who have gladly referred out a difficult case to a capable specialist because they could not or would not want to treat it.

On a similar note, we have seen the creation and development of dental hygiene as a viable allied dental health profession. Dental hygienists have taken their place alongside dentists, becoming prominent and important members of the dental team. This group of highly skilled and dedicated individuals has been responsible for elevating the periodontal health of our patients to substantially higher levels, allowing many of our patients to maintain most or all of their natural teeth for a lifetime. While the relationship between the dental and hygiene professions has been tenuous at times, the ability of both groups to work through their differences has and will continue to be of direct benefit to patients.

We also face changes that are beyond our control and, if unchallenged, may have a profoundly negative impact on us. Through a united effort of all dental professionals, we cannot only overcome these potentially damaging challenges, but also turn them into positive changes. The Chinese express this concept in their philosophy. One saying translates, "Where there is crisis, there is opportunity." Recall the AIDS dental "crisis" of the 1980s. When news of a potential transmission of the disease from a Florida dentist to several of his patients made its way into the headlines, we feared the public’s trust in the safety of dental visits would be forever diminished. In response to this challenge, the dental profession rallied. New infection control standards were developed and quickly accepted and implemented. In fact, amongst the health care industry, dentistry became the model for the practice of these new standards. Fear or erosion of trust on the part of patients was replaced by a renewed sense of security and respect for the profession.

What will spawn the next great changes in the dental profession? What challenges must we face? Some are already on the table in front of us: the controversy over and challenge to the use of amalgam, a growing crisis in dental education, escalating debt of dental school graduates, even the restructuring of this association to meet the ever-changing needs of its members. I would argue that somewhere in all of these challenges lies opportunity for positive change.

Let us resolve not to view change as a negative experience but rather as an opportunity on which we may grasp and elevate our profession and ourselves. Change is a natural phenomenon and the more readily we accept this, the more likely it will be a positive experience. Even as autumn leaves change, fall, and fade into memories, we know that it is only nature’s way of preparing us for the new color and new life that spring promises.