Dental Technology Must Not Supersede Centrality of the Patient
Adi A. Garfunkel, DMD; and D. Walter Cohen, DDS
Medical and dental technologies are used to improve the lives of individuals suffering from many afflictions. From artificial heart valves, pacemakers, and joint replacements, to digital dental impressioning and implantology, these advances all share a common goal: helping people live healthier and longer.
The definition of health is multidimensional and includes physical, mental, and social domains. While today there are a plethora of remarkable treatments to minimize morbidity and maximize health, the question one can ask is, “Are we really improving patients' quality of life?” That is, are patients enjoying better mental, physiological, and social status thanks to our treatments? The evaluation is subjective with both positive and negative aspects.
Quality of life is related to, among other factors, one's oral health. Improvements in a person's appearance, eating ability, overall performance, and how one feels in general—all of which can have a profound psychological impact—are at the forefront of our professional objectives as dentists. Of course, the eradication of pain and infection accompanied by discomfort are considered “sine qua non” for successful treatments.
Naturally, the creation of a beautiful smile and a perfect occlusion is desirable both physically and physiologically. However, the expenses involved in achieving these objectives in many instances could contribute to other problems, such as socioeconomic ones, over which the dentist has no control. Therefore, it is our obligation to offer a treatment plan that is accessible for a specific patient, one that will offer satisfaction without creating reasons for frustration.
When it comes to the many new dental implants, esthetic restorations, veneers, revolutionary endodontic treatments, and bone augmentation materials, are they accessible for everyone? Are we investing enough time and effort in accentuating the centrality of the patient, the philosophy of health principles, the history of medicine, and the teachings of medical sages, both antique and modern? What is the true benefit of the use of technology if it is not distributed among all who need it?
This dilemma is not only dentistry's; consider the costs for such life-saving medical treatments as bone marrow or organ transplants and exorbitantly expensive medications. We cannot hide behind Hippocrates's teaching, “The greatest medicine of all is teaching people how not to need it.”
The dental academic community is obligated to educate the future generation of dentists not only on how to use and implement new technologies, but also on the centrality of the patient and his or her quality of life (ie, physical and mental health as defined by the World Health Organization). The old and even the present paradigms of dental/oral health-related quality of life have to be adapted to the multifaceted needs of the patient with both a broad vision and yet specific consideration to the individual patient.
Obviously, achieving such goals are part of the obligation of doctors belonging to the public health branch. While there is a need for specialists in all fields of dental medicine, general policies, budgets, and institutional leadership need to be identified and reinforced. Are public dental health budgets adequate? Are the investments being made in the development of, for example, new dental implants or digital dental impressions, comparable in public dental health to those made in the private sector?
Principles of health were separated from those of faith and religion in the time of the Talmud (fifth centuryAD). This created a strong link between the freedom of choice and the ethical responsibility for one's health. Today, we are facing a climate of many opinions, with numerous treatment options available, and we must discipline ourselves to make the right choices. Many consider the doctor an emissary of God, so risks should be avoided.
Dentists themselves need to redirect their main educational emphases. Dentists are quick to participate in professional technical-oriented conventions, and, in fact, they flock to them by the tens of thousands. By comparison, participation in forums on patients' general health and the treatment of the health of medically complex patients is relatively limited. We should be partners in the development of approaches that improve the patient condition and prevent dangerous situations. This is achieved by identifying the needs for specific health policies and providing quality care even to needy groups of populations, in both developed and developing societies.
The Fundamental Motivation
In the second century AD, Galenus, using the views of his predecessors, defined concepts of causation and molded them in a consistent synthesis. Our educational institutions have to “remember the fundamental motivation, the drive to simplicity and generality in explanations.” Treatments, the prominent physician and philosopher suggested, need to be put on “a sound ethical foundation,” and “a balanced, harmonious, optimal functioning” must be created.
Yes, causal analysis has to be in the forefront of medical thinking, as Hippocrates described in the fifth century BC. We must direct the development of the dental profession in its light. Moral responsibility is not less important than the responsibility of being technically competent. We are responsible for our actions both legally and morally.
Can dental implants be placed in the jaw of an irradiated patient? Yes, but only after applying specific protocols. Can extractions be performed in anticoagulated patients? Yes, however there must be a deep understanding of the implication of relevant blood tests. Can we treat dentophobic patients? Certainly, but the use of sedation and general anesthesia becomes imperative.
Technology has changed our world. Clinicians must be aware of the interrelationship between oral health and systemic health. The advances in medicine and dental medicine have given providers more understanding of these relationships. Through it all, the patient should remain at the center of our attention. Hippocrates was revered for his ethical standards in medical practice. If these were valid 25 centuries ago, they should certainly hold true in our era as well.
About the Authors
Adi A. Garfunkel, DMD
Professor Emeritus, Professor and Chairman, Oral Medicine Department, Dean Emeritus, Faculty of Dental Medicine, Hebrew University Hadassah Jerusalem, Jerusalem, Israel
D. Walter Cohen, DDS
Chancellor Emeritus, Drexel University College of Medicine, Philadelphia, Pennsylvania; Editor Emeritus,Compendium