The Rationalization of Restorative Dentistry by: Wehazit Mussie

History

The foundations of modern dentistry did not come about till between 1650 and 1800, starting when Pierre Fauchard published his book The Surgeon Dentist. Fauchard defined many new methods of caring for and treating teeth, such as dental fillings and dental prostheses. Before Fauchard’s developments, dental practices were unregulated, not done by medical professionals but by barbers. This odd arrangement was mainly because barbers had the tools necessary for extractions, like razor blades. The 19th century was when barbers and dentists became separate professions as new methods of prevention and restoration emerged and various materials and procedures were introduced (Titor, 2016). John Greenwood, George Washington’s dentist, is credited for dental-related innovations such as the first foot-powered drill. Dental fillings with amalgam, a mixture of several metals used for teeth fillings, were introduced to the United States in 1833 by the Crawcours brothers. In 1825, Samuel Stockton commercially manufactured porcelain dentures, and while the use of porcelain dentures is not as common, they are still the results of Stockton’s processes (Titor, 2016). These innovations all created the foundation for modern dentistry.

Dental Implants

Dental implants are materials used to replace missing teeth through dentures, crowns, and bridges. These materials are strong, easily manipulated to match the patient’s mouth, and often so meticulously crafted that they are mistaken for natural teeth. For dentures, two materials are used most often. The differences between acrylic resin and porcelain have to do mainly with longevity, with acrylic resin lasting longer and cost, with acrylic resin being cheaper (Science Direct). Crowns and Bridges are other standard dental restorative methods that have been greatly improved. PFM crowns are durable and aesthetically pleasing, so they are commonly used. Bridges, which fill in the space caused by missing teeth, were modernized in the mid-1900s by Dr. Per Ingvar Brånemark, a Swedish physician, who discovered that titanium and bone tissue could fuse and create a bond. He placed the first dental implant with this method, which was found to support bridges. This method is still used today due to its durability (Science Direct). It decreases the time a patient has to go to the dentist as they last many years. Innovations in dental implant surgery are continuing to arise.

Yomi, a dental robot, has shown a successful robotic platform for dental surgery. Yomi assists in providing the surgeon with assistance in the placing and planning of the dental impact by guiding the doctor's hands. It makes treatment more efficient as the surgeon can quickly change the surgical plan. Yomi provides many benefits, including a faster recovery to patients, as it allows for every step of the procedure to be planned out, including the precise location of the implant. There is also less room for error since the technology is based on its precision, and treatment can be changed with much more ease, preventing delays. These benefits may allow treatment to be completed in fewer visits, saving significant time.

Electronic Health Records

Electronic health records are another way that efficiency is increased within dental practices. It is reported that 67% of dentists use electronic health records in their practices (Asan 2013). These electronic health records contain important information related to insurance, patient history, and treatment plans (Asan 2013). Information can now be shared in seconds with fellow providers if necessary. In these ways, dental practices became much more efficient, allowing dentists to see more patients and reducing appointment times.

Education

As Dentistry became a more established and defined profession, formal systematic educational institutions became necessary. In 1840, Horace Hayden and Chapin Harris founded the first dental college that opened in Baltimore ( Baltimore College of Dental Surgery) through a charter by an act of the Maryland General Assembly. This established the Doctor of Dental Surgery degree. The school's founding served as the prototype for dental schools, and dental schools were popping up (Titor 2016). By 1876, there were 15 dental schools scattered throughout the country. These schools established a uniform dental education system, allowing for a more controlled and regulated practice. Today, there are 70 accredited dental schools in the US. Prospective students of dental schools are required to take various prerequisites in most STEM courses during their undergraduate studies (ADA). They must also take the Dental Admission Test (DAT). Using the DAT and the prerequisites requirement ensures dental students have uniform knowledge about subjects necessary to succeed in dental school. The uniformity and standardization within these processes aim to ensure that the students provide and perform similar qualities of work with little room for variation.

Laws and Regulation

Implementing laws and legislation for dentistry is beyond necessary to ensure that dental practices are safe and provide quality service. It is regulated federally, with federal laws applying to all dentists and state laws applying to dentists within the state they practice. For most states, dentistry is regulated through a unique Dental Practice Act. The Dental Practice Act lists the specific legal requirements within each state that dentists and their practices must abide by. The State Board of Dentistry implements these legal requirements. These boards can revoke a dentist's license, limit their practice, and provide suspension if found guilty of wrongdoing. In tandem, legislation and bodies that carry out that legislation make dentistry safer and uniform since not abiding by the strict set of guidelines results in harsh penalizations. The Occupational Safety and Health Administration (OSHA) is another way dental practices are made safer. Congress created OSHA to make workplaces safe for workers through setting standards, training, and outreach since harmful bloodborne pathogens, pharmaceuticals, and chemical agents are a constant threat. OSHA implements standards that dental practices must follow to limit exposure to those dangers. They can inspect workplace conditions to ensure they abide by OSHA regulations. If a practice violates regulations, it can be fined and even shut down. In implementing safety standards, practice is made more efficient because dental personnel doesn't have to worry about hazardous stressors but instead can focus on the patient.

Corporate Dentistry

Corporate dentistry is a relatively new endeavor, aiming to improve competition while providing opportunities for new dentists entering the field. In recent years there has been a drastic rise in the corporatization of dentistry which threatens the essence of the healthcare profession by being heavily profit-focused, not patient-focused. It also affects the very necessary patient-doctor relationship. While people could argue that this relationship is unnecessary, studies have shown a positive correlation between this relationship and positive outcomes.

While there are significant drawbacks to corporatization, there are also benefits to corporate dentistry, allowing for more predictable prices, which can be suitable for low-income individuals. Corporate practices also invest a significant amount of money into skill advancements. The positives and negatives make it difficult for irrationality to combat, which means finding a balance between ensuring quality care and predictable prices is necessary.

Conclusion

The transformation of restorative dentistry from unregulated, unprofessional practice to an innovative, professional field has shown what rationalization can do for a profession. Advancements in technology have made dental practices more efficient by making all aspects of treatment and treatment planning more individualized for the patients. Modern education institutions and accreditation have provided practitioners with comprehensive field knowledge, leading to a more controlled and standardized workforce. My research has shown me that rationalization has been a driving force in almost aspects of modern restorative dentistry, intentionally and unintentionally. Efficiency, predictability, control, and calculability are present in various ways. It has also shown me that with rationalization comes irrationalities, especially with the increase of the corporatization of dentistry that aims to hyper-rationalize dentistry to many faults. The rationalization of restorative dentistry has proven significantly beneficial. However, there are various faults, and as time goes on, there will be even more shifts toward rationalization due to the introduction of various technologies. Still, staying true to the essence of care dentistry is founded upon is necessary.