Just because you can doesn’t mean you should.

I am no longer a clinician but that doesn’t mean that I have forgotten all the lessons that I learned from 30+ years of full time practice. My instinct meant that I was cautious when dealing with what nature had provided for people. In spite of that during the years 1981-86 I did large numbers of clearances for patients in the practices where I worked and had the services of an anaesthetist (a long time ago I know). 90% of those cases were for the other dentists in the practice, I was the one with the surgical skills and enjoyed the challenges that these “cases” presented. I choose the word case rather than person deliberately.

From the day I started my own practice in 1988 until I (finally) stopped clinical work in early 2013 I did only one procedure that could be considered a dental clearance. It was the right thing to do for the lady at that time, but I remember how it upset me and how I felt I had somehow failed her.

I went on an all day course on restorative dentistry at the Royal College of Surgeons in about 1990 where I fell into conversation with someone who told me he was getting through 4 or 5 “full mouth re-habs” a week. When I asked him how he managed to find the time and the patients, he told me that he only needed to allow 2 hours for a “full mouth” and there were no end of people who were grateful for his saving them from dentures. This last phrase confused me because I had never come across anyone who had lost teeth because they lacked porcelain fused to metal crowns.

My thoughts then spread to how poor my undergraduate education must have been when compared with this chap’s superior skill base (from a well known London teaching hospital) and he had qualified only 5 years before. When I said that I had recently completed my year long training in occlusion he replied that I was wasting my time and money as all that occlusion stuff was nonsense because the technician would just put things where they fitted anyway.

HippocratesI drifted away because he started talking at someone else about new models of Porsche – a subject about which I knew little and cared less.

I resolved that I would have to ‘up my game’ if I was going to be a proper dentist. So my studies with Mike Wise and more meant that I did know more and if anything did less in the line of “full-mouth” work – at least in one stage.

Implants have been a game changer in restorative dentistry, I always referred my patients to someone I knew and trusted, as it was not an area that appealed to me. I am aware that it is seen as a ‘big earner’ and a practice builder by some – and I know many highly skilled and experienced implantologists.

My concern is about those who, because they have the new hammer, tend to see everything as a nail. This was brought home to me last night in a conversation with one of my longest standing clients, a experienced and highly skilled all round restorative dentist who has been undertaking implant work for more than 10 years, when they said to me,“an implant is a great replacement for no tooth but it is a poor replacement for a tooth. The more implants I do the more I like teeth.”

We agreed that just because you can doesn’t mean that you should.

Now that is a dentist I would recommend.

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