Lest We Lose Sight: A Reprint with Foreword

If you're like me, you often find items of value when you're looking for something else. Such is the case with the editorial by our colleague, Dr. Robert Keene, on the following page. Dr. Keene wrote this piece more than 12 years ago. It first appeared in Operative Dentistry in January 2013. It is not the first editorial that we have chosen to reprint and probably will not be the last. We reprint them because the topics remain relevant, or perhaps unresolved, even after many years, and deserve our continued or renewed attention.Dr. Keene is a charter member of the Academy of Operative Dentistry, past president of the American Academy of Gold Foil Operators, and one of the first members to earn certification by the American Board of Operative Dentistry, the proud holder of Certificate #007. As a private practitioner, he has dedicated his professional life of more than 60 years to service, teaching, mentoring, and, advocating for dental health among the underserved here and abroad. His perspective in this editorial is unique in that it addresses three important issues: (1) patient autonomy; (2) our responsibility, as dentists, to honor patient autonomy by offering a breadth of care options (and not limiting patient choices because of our own limitations or biases); and (3) dental schools’ responsibility to adequately train students to provide that breadth of care. These issues are as critical today as they were in 2013, and each could easily occupy an entire journal issue. I'll let you ponder them for a moment…Patient autonomy is a key component of evidence-based practice.1 We must consider the patient's preferences when deciding on a course of treatment, and we must not arbitrarily limit their choices. Another mentor of mine, Dr. Mel Lund, related a story in which he presented a treatment plan involving only lower cost direct restorations for a terminally ill, although not incapacitated, patient. The patient was noticeably displeased and replied, “Is that the best you can do? Please give me all the options and let me decide.” Dr. Lund's point was this: Do not make value judgments for patients regarding treatment choices. We can recommend, but the final decision belongs to the patient.Admittedly, honoring patient autonomy can be difficult, especially when patient choices do not align with our recommendations. In those instances, we should ask ourselves:In Dr. Keene's editorial, it seems the conflict had more to do with provider (student) inexperience than with an unrealistic patient request (we'll revisit the resin composite vs amalgam question in an upcoming issue, since that's not the central issue here). Fortunately, the student's instructor saved the day for both the student and the patient.This brings up Dr. Keene's third point—the obligation of schools to provide a robust education that includes training in all dental materials. What if the patient above had requested a gold inlay or (gasp!) a compacted direct gold restoration? Those may certainly be valid treatment options, and there are, undoubtedly, many faculty who are capable of teaching these procedures. But how many dental schools still Include these materials in their curricula, except for perhaps historical reference? Will schools permit a “rogue” instructor to teach something not in the curriculum? And even if they do allow it, what happens when those instructors “of a certain age” decide to retire, taking their expertise with them?As Dr. Keene mentions, “if the dental educational system refuses to provide a complete dental education (i.e., skills in all dental materials) for their students, we are all—both dentists and patients—in deep trouble.” Dental schools would be prudent to cultivate the necessary expertise now, rather than later, before the last shred of knowledge walks out the door.But all is not lost. Graduate programs in Operative Dentistry provide a ready source of potential new faculty trained in the range of direct and indirect restorative materials and techniques available. Most graduate programs also include instruction in educational methodologies and experience in both didactic and clinical teaching. Abundant evidence suggests that graduates of these programs are highly sought and go on to become indispensable preclinical, clinical, and research faculty. Schools seeking new Operative Dentistry faculty should look to these programs to fill their needs. Further, schools with Graduate Operative Dentistry programs should reconsider any plans to suspend or discontinue them, “lest we lose sight” of their value. We owe this to our students and patients.