"OPERATIVE DENTISTRY: The Vanishing Discipline," a reprint with Foreword.

Abstract

More than 30 years after his official retirement from dental education, Dr. Melvin Lund remains one of the most highly respected and revered members of the Academy of Operative Dentistry. In honor of Dr. Lund’s 100th birthday (October 2022), Operative Dentistry is reprinting his Guest Editorial, “Operative Dentistry: The Vanishing Discipline,” originally published in the November/December 2001 issue. Those who have had the privilege to know and work with Dr. Lund know that he is a man of tremendous wisdom and insight. His professional career has spanned nearly eight decades, and his words ring even truer today than they did when he wrote this piece more than 20 years ago.A Founding Member of the American Board of Operative Dentistry (ABOD), Dr. Lund embodies the concept of excellence in clinical practice and education. He firmly believes that dental educators in every discipline, including operative dentistry, “should have training and education beyond the basic dental degree.” He notes, however, that “it would be rare for a school of dentistry to assign general practitioners the responsibility [of teaching] dental students in endodontics, periodontics, or oral surgery, but many voices suggest this as the ideal for operative dentistry training.” This contradiction—between what is acceptable in other disciplines and what is acceptable in operative dentistry—continues to occur in dental schools across the United States and continues to bewilder and discourage many of us currently involved in operative dentistry education.In his message, Dr. Lund outlines several factors that have contributed to the decline in the perceived relevance and value of operative dentistry in dental education. Further, he calls on the AOD, CODE, and ADEA to take steps to address these issues. One positive development, thanks to concerted efforts by the AOD and ABOD, is the American Dental Association’s 2016 recognition of Operative Dentistry as an “Interest Area in General Dentistry.” However, more still needs to be done.Is it too late for Operative Dentistry (note the capitalization) to re-establish, as Dr. Lund states, “the position of influence it deserves” in dental education? Please carefully re-read his editorial. Then, you decide.[As appeared in Lund MR (2001) Operative Dentistry 26 529–530]When someone asks my occupation, I generally reply that I am a dentist and a member of a dental school faculty. If additional interest is expressed, I may say that I teach operative dentistry, knowing that further explanation will be necessary since laymen often associate the term with dental surgery. This is an interesting phenomenon since “operative dentistry” is so clearly defined in my own mind and is, in fact, the very essence of my professional life. Unfortunately, this lack of understanding of the nature and importance of operative dentistry seems to be pervasive at all levels of dental education, organized dentistry and the practicing profession. I believe the reasons for this are many and merit close scrutinization, consideration and, hopefully, correction.Those responsible for teaching the knowledge and skills necessary for the various disciplines within dentistry should have training and education beyond the basic dental degree. This usually requires that these educators focus their activities in a specified area to allow them to present information at a highly informed and current level. The dental specialties are very conscious of this and know that it has a direct influence on the capability of their residents. It would be rare for a school of dentistry to assign general practitioners the responsibility for the primary training of dental students in endodontics, periodontics or oral surgery, but many voices suggest this as the ideal for operative dentistry training.As a discipline, operative dentistry has suffered over the years because we have not been as militant in stressing its importance in dental practice. This has resulted in limited availability of advanced training in operative dentistry, and the growth of an attitude that such training is not really necessary and that all dental school graduates and general practitioners are perfectly capable of teaching all restorative clinical procedures. This is akin to suggesting that a recreational snow skier, such as myself, can offer the same level of instructional expertise as a professionally trained ski instructor. In my opinion, the traditional values that accompany advanced education in all disciplines certainly apply to training and education in operative dentistry. If there are logistical problems for faculty in satisfying the need for advanced education, an excellent alternative in securing credentials beyond the minimum is the American Board of Operative Dentistry certification program. Preparation for the three-part examination (didactic, clinical performance and case presentations) encourages focused study on the part of the candidate and, upon completion, offers tangible evidence of advanced knowledge and skills.Another area experiencing decline within our discipline is the interaction of operative dentistry teachers within and between educational institutions and other dental specialties. Historically, the importance of such interaction received strong emphasis with the formation of ACORDE (A Consortium on Restorative Dentistry Education) in the early 1970s. This project was funded by the US Department of Health, Education and Welfare and allowed all dental schools in the country to work together on a common project— developing expanded function auxiliaries. ACORDE influenced the scope of operative procedures and instrumentation for the duration of its existence. As the project concluded, the value of its communication format gained recognition and resulted in the formation of the Conference of Operative Dentistry Educators (CODE). Initially, the combination of sectional meetings and the distribution of a composite report to all North American dental schools was extremely positive in promoting discussions and consensus on the myriad aspects of teaching operative dentistry. Unfortunately, busy schedules and the pressures of academic life resulted in a decline in active participation by all schools and faculty over the years. Even the activity of the Operative Dentistry Section at the annual meeting of the American Dental Education Association has been cut from more than one-half day to two hours or less. This certainly makes it more challenging for operative faculty to justify the expense and time associated with attending this meeting.What are some of the results of the problems discussed above? Anecdotal reports from dental faculty, various post-graduate programs, the Dental Services sections of the branches of our Armed Forces and some Dental Board Examiners would suggest that the overall clinical ability of recent graduates is not at the levels we enjoyed during the ’60s, ’70s and early ’80s. This is significantly problematic since the intelligence, educational experience and capability of today’s dental student is certainly equal to if not better than that of earlier graduates. One must wonder whether the current trends in dental education are not contributing factors, including: the lack of emphasis on advanced training when hiring operative faculty.the fostered perception that since dental school is preparing general practitioners that generalists should supervise the bulk of the students’ clinical training.the de-emphasis on the importance of operative dentistry as a discipline mirrored in the creation of large restorative dentistry or general dentistry departments with, at most, an operative section or division.the overall reduction in both laboratory and clinical curricular time for operative dentistry with, perhaps, an overemphasis on cosmetic procedures and tooth-colored materials to the exclusion of more traditional and proven techniques.more and more reliance on continuing education programs that are industry driven to not only supplement dental education but also to provide needed funding for the dental school.It seems obvious that in order to maintain a state of health, dental schools should encourage the maximum educational output of all the disciplines in dentistry.Unfortunately, this does not seem to be the direction operative dentistry is heading. Operative dentistry as a discipline appears to be an endangered species and may disappear if steps are not taken now. Certainly, the Academy of Operative Dentistry should be a prime mover in this task, along with CODE and the Operative Dentistry Section of the ADEA. It is time for these groups to stop worrying about being perceived as “interfering” with dental education and take aggressive, positive action to promote operative dentistry and return it to the position of influence it deserves.