By: Jean Johnson for Dental1The British dental comedy about a “molar-mangler”…
I.J. Zizzbaum proved to be a rather gloomy cove. He looked like a dentist with a secret sorrow. In reply to my "Good afternoon," he merely motioned me to me chair with a somber wave of the hand. One of those strong, silent dentists.
I, on the other hand, was at my chattiest. I am always that way when closeted with a molar-mangler. I dare say it’s the same with you. I suppose one’s idea is that if one can only keep the conversation going, the blighter may get so interested that he will shelve the dirty work altogether in favour of a cozy talk. I started in right away.
"Hullo, hullo, hullo. Here I am. Good afternoon, good afternoon. What a lovely day, what? Shall I sit here? Right ho. Shall I open my mouth? Right ho."
"Wider, please," said I. J. Zizzbaum sadly.
… I hunted in my mind for some soothing speech that would bring the roses back to his cheeks, but all I could think of was a statement to the effect that recent discoveries in the Congo basin had thrown a new light on something or other. I had this on the authority of the National Geographical Magazine.
It didn’t seem to cheer him up to any marked extent. Not interested in the Congo basin, probably. Many people aren’t. He simply sighed rather heavily, levered my jaws a bit farther apart, peered into the abyss, sighed again as if he didn’t think highly of the contents, and motioned to his A.D.C. to cluster round with the gas-bag.
- “Laughing Gas,” by P.G. Wodehouse, 1936.
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A dental care timeline
1880: Twenty-eight dental schools established by this year.
1930s: Council of Dental Therapeutics oversees the evaluation of dental products and establishes the ADA’s Seal of Approval program.
1950: ADA works with Congress to proclaim February 6 as National Children’s Dental Health Day.
1951-52: ADA establishes training programs for first dental laboratory technicians and then dental hygienists.
1991: first women ADA president, Dr. Geraldine Morrow.
2005: Today the ADA has 152,000 members.
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The fact that Wodehouse’s piece is quite dated sets our minds at ease. Clearly dentistry has come a long way from 1844 when only the spell of nitrous oxide gave relief from the not-so-polite pliers dentists used to extract teeth gone awry. Indeed, with the establishment of the first dental college in Baltimore, Maryland in 1840, and the organization of the American Dental Association (ADA) in 1859, the profession set the stage for over 150 years of growth. Growth that has led us to the state-of-the art practices today in which a range of specialists augment general dentistry. In 1880, during the era when many professions began training practitioners formally in college degree programs, 28 dental schools were established in the United States. Like any new enterprise, though, it was slow going. By 1899 the professional association (called the National Dental Association for a number of years) had attracted fewer than 250 members, and it took until 1913 for the organization to start publishing a journal which served as a forum for the exchange of professional thought and research.
That said, two early dental specialties emerged quickly when a fledging group of orthodontists organized themselves in 1900 under the American Association of Orthodontics, and the American Association of Oral and Maxillofacial Surgeons was founded as a professional organization in 1918.
By 1955 – a mere 50 years ago – the larger field of modern dentistry was starting to emerge as the profession we know today. A National Board of Examiners was in place, ADA membership had grown to around 50,000 and the first postgraduate programs – aside from those in orthodontics and oral surgery which were already established – started training dentists. Eventually the field branched into nine ADA-recognized sub-specialties: Advanced Education in General Dentistry, General Practice Residency, Endodontics, Oral and Maxillofacial Surgery, Orthodontics and Dentofacial Orthopedics, Pediatric Dentistry, Periodontics, Prosthodontics and Dental Public Health.
The American Association of Endodontists (AAE), for example, which was founded in 1943, was recognized by the ADA as a specialty of dentistry in 1963. Like all dental specialists, endodontists study an additional three years beyond dental school and have masters’ degrees in their specialty area. Endodontists treat problems that involve the tooth pulp and the word endodontic comes from the Greek words that mean “inside the tooth” (if you’re thinking root canal here, you’re on target). The AAE currently has more than 6,500 members worldwide, including approximately 95 percent of all eligible endodontists in the United States.
Similarly, the field of prosthodontics developed sufficiently by 1970 organized under the banner of the American College of Prosthodontics. Specialists in the restoration and replacement of teeth, these dental experts install crowns, bridges, dentures and implants. Prosthodontists are sometimes called ‘smile specialists’ and have pioneered many of the aesthetics procedures patients enjoy today.
Clearly, the field of dentistry has evolved considerably from P.G. Wodehouse’s British molar manglers. But with so many choices, how do patients know when they need a specialist?
According to prothosdontist, Nancy Arbree, D.D.D., M.S., for example, “general dentists refer patients with complex needs that affect more than one tooth, or patients that have high cosmetic expectations to prosthodontists.” Arbree adds that she and her colleagues have three years beyond dental school and are experts in diagnoses related to compromised teeth. In other words, general family dentists should fill the bill unless issues related to teeth start reaching complicated levels.
Gary Larson’s experience is a case in point. The third-generation fisherman lives in Seattle, Washington. “I inherited lousy teeth from my Norwegian ancestors, and then my love of sweets just made them worse. I started loosing teeth in my twenties and in my thirties and forties all the crowns and bridges came along,” Larson said. “By the time I hit my fifties, even some of the bridges and crowns started failing and I eventually had to get a partial plate. That was the beginning of the end because one tooth had to bear the load of the partial and finally it started to give out. I eventually talked to a prosthodontist and he said that if I’d come to see him earlier, I could have saved more of my teeth. I was afraid of the cost, though, so I can’t blame our family dentist. Every time I’d see her, I’d say ‘get me by as cheap as you can.’ What I didn’t realize was that I really would have saved money over the long haul if I’d gone into the experts earlier.” Larson sighs. “Of course, nobody could tell me that at the time.”
Endodontist, Chris Lampert, D.M.D. of Portland, Oregon, agrees that you get what you pay for, and that penny wise is often pound poor. “One of the biggest legal issues right now with general dentistry is ‘failure to refer.’ Oral surgeons and orthodontists are older specialties, so there aren’t many problems there, but prosthodontics and endodontics are relatively new and so sometimes these options might not come into the discussion as readily as they could.”
Lampert points out that although it can be difficult deciding whether to have the family dentist do the root canal or to venture out to the endodontist’s office, specialists are highly practiced in what they do. “We do five or six root canals a day. Compare that to general dentists who might do five or six a week or even a month.”
So that’s the story on dentistry. From humble beginnings in a gaseous haze of nitrous oxide, to so many sophisticated choices that professional turf wars ensue and patients have to stay well informed so they can participate in decisions related to their long term best interests.
So stick around, and we’ll continue to track the field and keep you up to speed. That way, like dentists everywhere for the past 150 years have hoped, we can all meet the world with confident, easy smiles.
