Editor - Publisher Statement
The
below paper has been readapted into a format for reading in the
newsletter. The paper was presented at the 87th Annual Scientific
Session of the Academy of Prosthodontics in Scottsdale, Arizona on May
19, 2005. As requested by the meeting’s program chairman the paper
served as an introduction to three following papers related to: 1)
prosthodontic paradigms, 2) the future of dental specialties, and 3)
the relationships between dentistry and dental laboratory technology.
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PROSTHODONTICS
Past, Present and Future
Prosthodontics,
a subject so broad with so little time to discuss it should probably
take its place with the age old opening examination in Physics, that
exam being “define the universe and give two examples.”
The suggested theme of “Prosthodontics: Past, Present and Future”
could be better said as “Where have we been? –– Where are we? –– and
Where are we going?” This wording, of course, stresses the “we” because
prosthodontics, even though we’ve struggled time and time again with a
definition for it, is really about prosthodontists––the people who
built it, the people who work in it and those who will sustain it in
the future. There would be no prosthodontics were it not for these
trained people, and the sooner we as trained prosthodontists define
ourselves as specialists in dentistry, the better. Let’s not be bashful
about calling ourselves what we are: “prosthodontists, specialists in
dentistry, who do things general dentists can’t or are not trained to
do.”
The Present
Our
present day condition, the “where are we as trained prosthodontists”
can easily be summed up in one word––Optimism! One truly has to be
optimistic about where we are today. Why?
•
Even though the current news paints a pessimistic view of the Social
Security program as it relates to an ever increasing aging population,
we know an aging population is to our benefit. And worry not, these old
timers do have money for the things they truly need and want, and the
things we as specialists can better provide.
• Even though we see pessimism in the decreasing numbers of trained
prosthodontists graduated or certified in relation to an increasing
population, we truthfully know that such a scarcity leaves space for
those of us already trained. A future crisis? Yes, but for those of us
practicing now, no.
• We see a decreasing applicant pool from U. S. schools entering our
training programs. But we know the great expansions and rapid
progresses in China, India, Korea, Taiwan and other countries that are
now “developing” brings increasing numbers of eager applicants to our
shores. These applicants need and want our training. We also know a
continuing, vigorous global economy is creating the very conditions in
their homelands that will beckon them home following our training. A
dollar is a dollar, and why should our deans, our states and our dental
schools care where the dollars come from? We can do better than to
waste our training programs.
• We are maintaining advanced training programs that are better,
longer, and much more complicated than those of the past, but we know
too that this makes us much better able to manage the superb technical
advancements at our disposal today. The appearance of materials from
commercial and industrial uses has become a blessing for dentistry, and
the prosthodontist’s extra training gives imparts an ability to quickly
find wider uses for these materials, uses which are especially unique
in patients with missing tissues that cannot be restored further by
surgery.
Those trained additionally in maxillofacial prosthetics have always
been and continue to be on the forefront of successful material use.
Dentistry and prosthodontics owes them a great debt of thanks. Also,
those who have developed the research, knowledge, training and
disciplined clinical protocols that have led to success in implant
dentistry deserve an equal recognition and thanks.
Our patients become the real benefactors of our special skills, and
prosthodontists and those in maxillofacial prosthetics and implant
dentistry deserve much more credit than they receive for advancing the
use of new materials and techniques.
• And yes, we see a population growing without bounds on the coasts, in
cities and in warm weather areas. This change in demographics puts
prosthodontists at a great advantage in being in the good places where
they are needed, where they truly want to be, and where all of the
benefits of a specialty practice can easily be developed.
Looking at our present? Optimism is the word! We are among the most fortunate few!
The Past
Most
of the giants of our specialty were not giants because they were
fellows in a certain academy or any other prosthodontic organization.
Neither were these men great visionaries. Rather, they were men with
overriding and overwhelming clinical problems needing solutions. They
saw needs in their patients, but no immediate answers in the science as
it existed. In the old days, they would travel, mainly by train,
meeting sometimes for as long as two weeks, carrying the gear they
would need to prove their techniques, even bringing their patients on
occasion. They gathered in their budding prosthodontic organizations,
and they argued and tested and talked and taught
their philosophies and techniques in occlusion, tooth form, gnathology,
articulator design, removable and fixed partial denture technique,
overdentures; and yes, they became knowledgeable in their therapeutic
mission, learning and understanding well the tissues they worked with
and managed, right down to the cellular level. These exposures took
these men away from general dentistry and they grew in a very special
field––prosthodontics. It would be difficult to name all of these
pioneers in prosthodontics, the Icons of our specialty, because in
trying to do so some of the greats would be forgotten; some wouldn't
receive the credit they were due and some, because of humility,
wouldn't want special recognition on a list of “greats.”
But it should also be quickly recognized that we are now blessed with
talented, smart female Icons. Females, who in their own right and in
their own time have made this and other disciplines of dentistry very
special places. They hold their own! We have seen them grow quickly as
organizers, nationally and internationally known clinicians; those
holding academic appointments as professors and associate professors,
presidents of organizations, board examiners, editors, and yes even
deans. Even though starting late, there is no limit on what these
female Icons will accomplish, making the specialty of prosthodontics
better and better in every regard from here on out.
Looking to the future
Discounting uncontrollable influences from the outside world, the
specialty's future looks entirely optimistic. Fortunately we don’t and
won’t have the insurmountable ethics or bioethics problems of medicine.
Fortunately we have not been plagued with lawsuits from patients. The
attorneys have found more fertile fields. A great benefit in dentistry
is that we routinely restore to health. Even better, we impart pleasing
natural appearances and seek a function that is totally physiologic.
Our special treatments result in a measurable reduction in future
breakdown. The newsletter has repeatedly pointed out that specialists
in prosthodontics have added these values for every dollar spent.
Fortunately we have grown as profession separate and apart from
medicine. In most circles we continue to be identified as such. To our
credit, our organization’s foundations are raising their heads and
contributing more and more to scholarship assistance. Dr. Stephen
Campbell’s published Research Grant and Award Program summary stated
that 10 prosthodontic organizations will grant close to $50,000 dollars
in 2005. This is good, but it’s not great! It would be much better if
this was a target for individuals. We as individuals should move
advanced prosthodontic education ahead in our giving priorities. We
cannot and should not avoid attending to this continuing critical need
in our specialty. Finally, best of all, we can’t “outsource”
prosthodontics. Our treatments are hands-on. Delegating and outsourcing
have not and will not become parts of this specialty's strengths. All
things considered, prosthodontics as a recognized specialty has a very
bright future!
Future pessimism in a sea of optimism
Peering into the future, there are two areas you will want to keep on alert:
I. In a word, “medicinizing” our dental schools may finally eliminate
dentistry as a separate profession. In doing so the word we now hear in
such a progression, if indeed it is a progression, is “integration”, an
integration with medicine. In addition, dentistry seems to be looking
to broaden its academic worth by tying itself to other medically
related schools or colleges. This creates what are now called
“beneficial synergies.” [Read the ProsStars Newsletter,
May 2005] The words “integration” and “synergies” are beginning to pop
up all too frequently in our “change engine vocabularies.” Even the
Executive Director of the American Dental Association, Dr. James
Branson, spoke of “links which could fundamentally alter the
integration of medicine and dentistry” when he addressed the fall 2004
meeting of the American College of Dentists. He doesn't mean using our
many trainings cooperatively to treat a patient in the best possible
way. He means “integration” with medicine in research, training and
practice facilities––with medicine in the drivers seat, of course. We
know medicine is not dentistry and dentistry is not medicine. They are
two separate professions; two professions separate by evolution and
practice, structured pragmatically. Let’s hope that we are not talking
the talk, soon to be walking the walk becoming only a small part of
organized medicine.
II. A second caution in our look to the future might see our specialty
changing. If it changes so that we all become only implantologists and
cosmetologists of the teeth we will be tossing away the great body of
scientific knowledge and skills developed in the training, which we all
have acquired in our advanced prosthodontic education programs. We as
prosthodontists are more trained and attuned to the many subdivisions
of dentistry than any other specialty in dentistry. This is our forte,
and we should not sidetrack the long road to being the “complete
prosthodontist” for the sake of a making a quick dollar in a couple of
the fads of the day.
Pessimisms in the sea of optimism? Let’s hope not, but let’s just say a warning shot has been fired across the bow!
Finally––The entire spectrum:
Prosthodontics, Past, Present and Future
In
retrospect there are few who would want to exchange places with the
“greats” of the past. The battles they fought in order to create and
elevate a learned dental specialty were necessary and they are our
history, but it’s not necessary for us to relive those battles of the
early and middle decades of the past century in order to be proud of
our status today. Let’s just remember our prosthodontic forbearers
plowed some tough ground in laying out our future, and it has become
the present we are enjoying.
Now as we arrive in this century, leaving those formative years behind
us, Winston Churchill said it well when he spoke in the United States
at the beginning of World War II. He said “we didn’t come this far
because we were made of sugar candy.” Prosthodontists are the best of
the health care team, and we are eternally grateful for the pioneers in
prosthodontics that made us what we are. We are not made of sugar
candy, but most assuredly we are highly trained specialists in every
sense of the word!
Our good status today and our optimism cannot help but spill over into
the future. Prosthodontics will continue to be rewarding. It will be
challenging. We can be certain that we will be extremely fulfilled in
our chosen profession and in our chosen specialty. We are indeed among
the most fortunate few!
No, rewording that, our patients are indeed among the most fortunate
few! Thank God for our many talents––and the way we use them. NDW
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