Year : 2014 | Volume
: 5 | Issue : 3 | Page : 81--83
Expanding the scope of dental practice into biodontics
Edward F Rossomando
Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
Edward F Rossomando
263 Farmington Ave, Farmington, Connecticut 06030
|How to cite this article:|
Rossomando EF. Expanding the scope of dental practice into biodontics.Dent Hypotheses 2014;5:81-83
|How to cite this URL:|
Rossomando EF. Expanding the scope of dental practice into biodontics. Dent Hypotheses [serial online] 2014 [cited 2020 Aug 13 ];5:81-83
Available from: http://www.dentalhypotheses.com/text.asp?2014/5/3/81/136743
When the history of the dental profession for the last decade of the twentieth century is written, the name Harold Slavkin will no doubt be singled out as he has been a driving force pulling and pushing dentistry into the genomic era. While Director of the National Institute of Dental and Craniofacial Research he was tireless in educating the profession in the importance of genomics in diagnosis and treatment of dental diseases. When he writes and speaks on genomics for his scientific and academic colleagues, a word often heard to describe him is 'visionary'. In the March issue of the Journal of the American Dental Association, in an editorial titled 'Revising the Scope of Dental Practice: Enter Genomics', Dr. Slavkin, once again, asks his readers to share his vision of how genomics fits into today's dental practice.  Unfortunately, visionary is a word more appropriate for the last decade of the twentieth century, before cell phones and iPADs. In the twentyfirst century visionaries have been eclipsed by 'entrepreneurs'.
Unsuccessful expansion efforts by dental visionaries
When saliva testing for the AIDS virus became possible, dental visionaries suggested that dentists collect saliva for testing.  And when nicotine patches were first introduced to help stop smokers from smoking, dental visionaries thought that the dental office would be an ideal place to promote the patch.  When Botox emerged as a treatment to remove wrinkles on the faces of socialites and celebrities there were dental visionaries who suggested dentists expand their practice to include Botox treatments.  Unfortunately none of these visionary ideas took hold. Botox was grabbed by dermatologists who immediately lobbied their state legislatures to keep dentists out; salvia testing for AIDS was a non-starter because dentists didn't want to give their patients a bad news; and the nicotine patch? Dentists just didn't want to bother.
The common denominator to explain the failure of each of these visionary ideas is none of these involve fixing something. General practice dentists get paid for fixing things - filling decayed teeth, replacing a lost tooth or several teeth or all the teeth. Dental specialists get paid for fixing things too - orthodontists fix misaligned teeth, oral surgeons fix impacted teeth, and endodontists fix diseased pulps. Dentists, including specialists, get paid when their treatment involves fixing something.
Expanding dental practice
But Dr. Slavkin's is absolutely correct in insisting on an expansion in the scope of dental practice.  Since the 1990s others, including this author, seeing a crisis for the profession looming, have called for such an expansion. , Like global warming, however, these calls have gone unheeded. By 2014 these calls have become shouts and one would think it would be impossible for organized dentistry to ignore the noise; but it has. Even the threat from the ever growing ranks of others taking market share, like midlevel providers and chain store dental offices in malls across America, could not induce the leaders of organized dentistry to have even one workshop or conference on how to respond to these threats. , This myopia persists despite the fact that a recent report from the American Dental Association's (ADA) Health Policy Research Center has documented a decline in dentists' average net income from 2006 through 2009 and further, that even in 2014, their income has not rebounded to pre 2000 values. 
When the market share of other professions like mental health declined, the response from states win the American Psychology Association (APA) was to expand psychologists' scope of practice by acquisition of prescription writing privileges.  Organized dentistry should be proactive in promoting acquisition of a new competency by dentists to offset the loss of market share. In 2014 there is no shortage of opportunities for dentists to expand.
In his editorial, Dr. Slavkin recommends expanding the scope of dental practice to include the diagnosis of 'craniofacialoral dental birth defects as well as chronic human disorders (such as dental caries, head and neck cancer, oral pharyngeal cancer, and periodontal diseases)".  This is an excellent suggestion and one that will be adopted at some future date. Unfortunately, in my opinion, kits for diagnosis of oralbirth defects, like cleft lip and palate, are not yet suitable for inoffice use while those for dental caries and periodontal disease have not found acceptance by dentists in the United States.
Expanding practice using biobased materials
In contrast, 2014 is a perfect time to expand dental practice by incorporating biobased materials. For all of the twenteith century, dentists have restored, replaced, and repaired decayed and lost teeth using bone, ivory, metals, plastics, and composites. What all these materials have in common is that they are foreign to the body. I have referred to those dental practices that use foreign materials as xenodontic dental practices. 
To expand dental practice we should restore, replace, and repair using biobased materials including biomimetic materials and stem cells. I have referred to those dental practices that replace xenodontic materials with biobased materials as biodontic dental practices.  Biodontics has been defined as the repair, restoration, and replacement of lost tooth structure using biobased materials of cellular origin.  Success with biomimetic materials and progress in tissue reconstruction with stem cells suggests these two areas are ideal for creating new procedures that only dentists are qualified and licensed to perform, thus precluding infringement by other less qualified providers. Only dentists, educated in basic sciences such as biochemistry, immunology, and physiology as well as the clinical skills needed for working in the oral cavity, are qualified to undertake regenerative dental procedures to reconstruct hard tissues (like enamel and dentin) and soft periodontal tissues (like bone and connective tissue structures) that had been lost during caries, tooth removal, severe periodontitis, and root canal infections. Dentists have the knowledge and expertise to control healing and stimulate tissue regrowth and regenerate those damaged and diseased tissue. The goal of biodontists that practice regenerative dentistry is to reconstruct the hard and soft toothsupporting tissues lost following decay, gum disease, or root canal infections.
Intergrating biodontics into the dental school curriculum
If the threat from outside dentistry is to be avoided and the continued decline in dental income is to be stopped, dental practice for the twentyfirst century must be expanded to include the biodontics curriculum of basic science and clinical use of biomaterials. As most dental schools include basic science in their curriculum this requirement is already satisfied. Developing curricula to introduce clinical competency in the use of biomaterials should also not be a problem. ,
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