CONSERVATIVE DENTISTRY-Still A Relevant Practice?

We often hear of different branches or if you like different specialties of dentistry and when I remember conservative dentistry I wonder if the word conservation is still relevant when we consider what it entails to prepare an abutment or several teeth to fabricate crowns and bridges in order to preserve human dentition. The question is do  we really conserve the teeth we claimed to preserve?
Let's begin this way: when a tooth has a hole or the crown damaged and the clinician considered it vital then he opts for prescribing a number of appliances namely: inlay, pin lay, pin ledges, crowns, bridges etc. Any attempt to make any of the aforementioned conservative restorations results in further reduction of the crown thereby exposing the tooth to more danger by loss of supporting tooth structure. For instance if a crown was prescribed the tooth structure has to be further reduced. A lot of teeth have been lost or weakened in this process. At least a third of the total tooth structure of other healthy teeth is removed if a bridge is prescribed. How can we confidently say that teeth have been conserved? The crowns or bridges made are held to the remaining tooth structure by dental cement which often may lose its grip with time resulting in patient's continuous visit to the clinic. It should not sound as an evil but unless the tooth can not be saved by other means of treatment conservative procedure should be sparingly used. It has been reported in the literatures that 2/3 of a tooth supporting structure is lost when they are prepared for crowns or bridges. Should we still continue to pursue the objectives of conservative dentistry?
Root Canal Therapy (RCT) is definitely a practice that has saved millions of teeth globally but we cannot say of conservative appliances like crowns and bridges. Having said this are conservative appliances no longer suitable in contemporary dental practice? Of course not.
It behoves the dentist to weigh several options before decisions are made bearing in mind the several immediate and long term consequences of conservative appliances.

Dentist's License Withdrawn For Life For Extraction

http://m.actionnewsjax.com/news/news/local/board-approves-voluntary-surrender-license-dentist/nmQt8/

....on till thy kingdom come dental curriculum.

The convention in the fabrication of dental appliances is to make appliances first in wax pattern then the wax pattern could be further processed into either acrylic, porcelain or metallic material and a host of other materials. In the present digital age we are moving away from this sequence to digital production that eliminates physical impression of the mouth, physical replica of the oral cavity (dental model) and all that happens in the Plaster room. This paradigm shift is definitely going to speed production and create new challenges. What does this mean for the entire dental professionals worldwide and especially in Africa? Dental technology students seen in the picture below are fabricating dental appliances in wax and happily doing so but how much of what the future holds in their profession do they know? Even undergraduate dental surgery students who happily returned to the lab with an alginate impression have not realised the enormous changes that await him in the nearest future. The future is definitely very bright but how fast are we responding to the imminent paradigm shift. Whether we like it or not change has come, it is not business as usual both in the dental clinic and the lab. In this century it is archaic to graduate students without them ever seeing or handling oral scanner, milling machine, model scanner, and virtual impression. It may sound ambitious to think this way but it is because we are in a system that is reluctant to change its ways of doing things. Till thy kingdom come curriculum will produce till thy kingdom come professionals and practice. Come to think of it dental patients are not going to remain 'ignorant' forever so the earlier we in the dental profession respond to the present development the better. Students are travelling to take elective courses and on return what impression of their teachers and institutions will they continue to hold when they see the wide differences between what a teacher there could do and what the teacher here is capable of doing. Please no excuses we must rise for a change.
We cannot continue to lag behind, we must make a change so that the coming generation of dentists and dental technologists will not blame their teachers for not responding fast enough to give them the best that this century offer them.

Interns' Senthforth

Reginald Duhu, Jumoke Fadayomi, Eniola, Titus and Kingsley Asogwa

First Experience in Complete Denture Set-up

Every undergraduate dental student commences skill development from the dental laboratory being the first place before clinical years. To this end denture fabrication forms part of the many laboratory procedures that laid the foundation for skill development which continues to clinical years until graduation.
The pictures below show the first attempt a student had after complete denture setup procedure was demonstrated. Although this only shows one of the few examples of a poor beginning but definitely a good start to a long journey in skill development.
The first three pictures show the starting point and the fourth the eventual end which produces a complete denture setup in modelling wax.

RE: TRIMMING DENTAL MODEL

The conventional approach to fabrication of dental appliances is to take impression with alginate or rubber based material then pour the impression in dental stone for subsequent laboratory procedures that will culminate into fabrication of prescribed prostheses. The world of fabrication of dental appliances is fast changing from the plaster/production room to digital spaces. How do I mean? You no longer need to deal with physical impressions anymore in some few laboratories in advanced world but virtual impressions are made and from there virtual fabrication is done and virtual information is passed to the milling machine which eventually produces the prosthesis. Milling machines can handle a number of materials ranging from metal to plastic and others. Although it is not yet bed of of roses for the dental industry but there is hope that in the coming decades fabrication of dental prostheses will move completely from plaster rooms to digital spaces.
Where is Africa in all these tremendous breakthroughs?

TRIMMING DENTAL MODEL

It can be such an unpleasant experience to work in a dental lab and the tap is not flowing. This captures the situation where sachet water is used to supply water to the trimming disc as the technologist positions his model for trimming. It is messy and difficult to coordinate water supply and trimming of model under this circumstance. How many of such dental laboratories do we have in developing countries around the world? How can developed world help even with refurbished dental equipment to offset the the bill of the lab while they face the common problem-provision of water.

New floor made for prosthetic lab

This 14th day of May 2015 marks the completion of the tilling of the floor of dental prosthetic laboratory after more than two decades of having terrazzo floor.

THE NEED FOR SKILLS DEVELOPMENT IN HEALTHCARE (Updated1).

Skills in the healthcare can be viewed from different perspectives. Skills set that involves the development of manual dexterity in the use of equipment, materials and tools for carrying out various diagnostic and treatment procedures are those that this write up will focus. These skills are just required to operate equipment and promote the use of tools that aid health workers in delivery of services to their patients. Unfortunately, health professionals do not want to be associated with tools thinking that it is better associated with vocations like Carpentry, plumbing, and other artisans related vocations. It is not true. On arrival at the hospital anywhere around the world the immediate contact after initial registration with the records is a medical doctor's physical examination of the patient and this require stethoscope and if dental clinic dentist's mirror. For effective diagnosis the laboratory must be engaged. Again the use of equipment, tools and materials become indispensable for quality care. Where then is the use of tools and equipment regarded as belonging to the artisans alone? In the dental care the use of equipment and tools and materials from the beginning to the end of oral care proofs an efficient dentist. Manual skills are therefore very indispensable as it is about handling of tools and equipment for service delivery. Research is replete with the use of tools in healthcare beginning with the use of plants and animal for testing and discoveries of new diseases and treatment options. In the administration of drugs the use of tools and equipment has been identified as aiding efficiency. Despising the notion that healthcare is tool and equipment based is therefore parochial and signifies inefficiency.
Dental Training and practice.
How did dental training and practice start and what do we think about equipment and tools? An indispensable truth is that dental surgery degree programme last for a minimum of four to six (4-6) years depending on country but it is clear that acquisition of manual skills is an unavoidable part of clinical skill development.
When does a dental student begins his journey into skill development? The first four years is a long journey into the faculty of dental sciences but an important stage is when he gets to see in practical terms all that he has been taught in the classroom. The said time was when he gets to the dental laboratory to probably see and handle artificial teeth, dental model of the mouth, variety of tools, equipment and materials needed for the rest of his training. The long journey into clinical training begins with the exposure to skills acquired in the dental laboratory namely: skills for operating and controlling high and low speed machines; skills for manipulation of materials from liquid state to the solid state;  skills for understanding different behaviours of materials for fabrication of dental prostheses and patient care; skills for understanding behaviours of different patients; skills for overcoming fears of handling materials and equipment and the eventual benefits of gaining confidence to handle them; skills for resilience in the face of difficulties; skills for management of materials and equipment productively; skills for mitigating risks in handling equipments and other hazards. Dental laboratory procedures and courses are expected to help undergraduate dental students face the future in further clinical training and the future as dentists.
Skill in Healthcare
Healthcare is replete with the use of materials and tools. A number of them are hereby listed: X-machine, ECG, dental chair, .........; hand tools; scalpel, stethoscopes etc. Needless to list so many of them as they are well-known but certainly they are just many and are evolving. Therefore, it is a simple understanding that manual skills are a must for anyone to work as a health professional. Health professionals are those who are involved in patient care and hence no one working in the health sector is excluded in the use of tools and equipments in service delivery.

THE MERGER OF DENTAL LABORATORY AND CLINIC

Many would wonder how could dental lab and clinic merge? What does it mean by this merger? A time will come that you don't need to train separately as a dental technologist and a dentist but a single curriculum will exist that will train a dental doctor that will either specialise in rendering laboratory services or clinical services. An individual will have to make that choice. At this time dental services will be fully digitised and laboratory fabrication processes will move from plaster room to digital spaces. A careful  look at trends in training and skill acquisitions in developed world by dental companies is blurring the distinction between lab and clinical skills. Even digital dentistry will clearly suggest merger and the involvement of dental professionals and none dental professionals in fabrication of dental prostheses will become a serious concern. The fast changing needs and awareness on the options of treatment by dental patients will be very strong such that patronage will move from the present conventional dental clinic/lab set up to CAD/ CAM theatre where dental clinic and dental lab will share common spaces. In Nigeria we are practicing dentistry as bequeathed to us by the British and as it stands today (in the UK) all cadres of dental professionals can acquire skills related to his specialism ( sometimes a little deviation is observed) by registered education provider after basic training under the present curriculum.  In Britain dentists could acquire one time exclusive lab skills through these education providers if he shows interest while clinical dental technologist are taking clinical training and skills-merger is imminent and will definitely become the norm in the coming decades.  In Britain GDC document on scope of practice for all dental professionals allows other professional to carryout some clinical procedures under the watch of a dentist-for me that is the beginning of the merger. Laws and regulations will allow flexibility in dental treatment and enforcement of law will get rather flexible. Unfortunately, how is Africa responding to this imminent paradigm shift?

DIGITAL DENTISTRY

The buzz in dentistry is digital this digital that. Dental professionals in Nigeria seem to be sleeping except for few talk about it no one seem to be doing something concrete about it. Regulatory agencies are asleep and associations are just showing little or no concern. Software engineers are dictating the way we should practice our profession and when the advanced worlds is done they will dump it on us. TOKUNBO  CAD/CAM will soon arrive and dental professionals will start falling on each other to begin from the obsolete version of the technology. Should we not emulate China who sponsor their citizens to countries where these developments are happening in order to import the latest to their country. Politicians are not looking at that now but how to share the national cake. Believe it on not virtual impression and models are real and milling machines are getting cheaper. None dental professionals who can use those software will soon make the first dental prostheses. May be then we will wake up to the reality that will soon tell both the clinic and the lab that there is need for concerted fight for the survival of our profession.
Should we wait until this start happening before we start doing something? This is a wake up call to anyone in dentistry whether dentist or technologist.

Undergraduate Jnr OP-Tech Exam Session

Undergraduate dental students preparing to submit their complete denture setup in 2015