Barry Musikant
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ONE OF THE various endodontic websites that I visit, an endodontist mentioned
that he believed dentists without formal training in endodontics, such
as the specialty training an endodontist receives, are not in a position
“to know what they don’t know.” He went on to say that endodontic
procedures on molars in particular require so much skill and sophistication
that acquiring this skill would be impossible for general dentists.
He further implied that any endodontist teaching molar endodontics in two-hour
or two-day courses is in reality doing a disservice because the dentists
will be performing procedures in which they will make mistakes that they
won’t even know they are making. These mistakes include missing canals,
canal distortions, perforations, misdiagnosis, and poor treatment planning.
That was a mouthful, but he touched on areas
where I put a lot of my energy, namely teaching dentists who profess a
desire to learn more predictable techniques on all teeth, including molars.
I have a problem with his philosophy for several reasons. First,
I am by nature not an elitist, and while I have high regard for what we
as endodontists do, I do not believe that it is outside the capacity of
dedicated dentists to learn. Over the years, a number of dentists
have limited their practices to endodontics without taking a sanctioned
two-year program to achieve their specialty practice. Most of these
dentists are highly competent because they have applied themselves as much
as possible to mastering their craft. Personal motivation is the
key factor in attaining mastery of anything. If one has it, one will
learn.
For the many dentists we have taught who will
continue to practice all phases of dentistry, most are at the time of taking
our course rotary NiTi users who are not happy with the level of stress
associated with the techniques they are using. They have gained a
certain degree of competence with their present techniques and want to
learn safer and more predictable ways to achieve comparable results.
The courses we give—from the two-hour to the two-day—include an introduction
to microscopic endodontics. Even in the two-hour course, the dentist
will spend at least 45 minutes under the scope looking for accessory canals,
appreciating what truly adequate access means, removing all decay, seeing
where leakage is occurring, identifying fracture lines, and better assessing
whether the tooth is salvageable or not.
The two-hour course is an introduction to the
far more intense two-day course in which the participants will spend a
minimum of eleven hours working on at least ten teeth, mostly molars, often
under the microscope. We purposely seek teeth with varying degrees
of curvature so that the dentist can learn the versatility of the systems
we teach, how a single well-designed system can be flexible enough to be
used in many ways to address the needs of any particular case. The
courses teach the benefit of continuously practicing access, instrumentation,
and obturation on extracted teeth. This is a way to increase one’s
experience while familiarizing oneself with any new system that is being
introduced and should continue long after the participant has taken the
course.
Despite the intensity of these courses of either
short or long duration, they do not make a dentist the equivalent of a
well-trained endodontist with his two years of training and total dedication
to endodontics. However, what is most important to convey to dentists
is the potential complexity of cases, thereby increasing their ability
to decide whether or not this is a case the dentist should take to completion.
I will never set an arbitrary cutoff at which the dentist should decide
to refer out. Each dentist is an individual with his own skills and
drive. I cannot say in a dogmatic way that molars are not within
the purview of any general dentists. Furthermore, excluding general
dentists from endodontics is not realistic. There is far more endodontics
required than can be done by the available endodontists. And if we
are going to be completely honest, we must also admit that there are some
dentists out there who do better work than some endodontists. So no hard-and-fast
rule can apply. Like much of what I have seen over these past 37
years in dentistry in general and endodontics in particular, the tone set
by some individuals is often a reflection of their own self-estimation.
If one thinks himself better than others, it will often lead to an exclusionary
nature where contempt is more obvious than a desire to teach. A true
teacher in my estimation wants the pupil to become better than himself.
To have the freedom to enjoy this goal, one must live by a higher set of
values than protecting one’s own turf. When it comes to knowledge
and know-how, we are richer if we learn how to pass it on effectively,
with warmth, enthusiasm, and encouragement.
Effective teaching will uncover jewels of talent
who stand a better chance to grow because they were met with encouragement
rather than belittlement.
This gets us back to those who do not know
what they do not know. The individual who said this must know that
we do not know that we don’t know. Only a person who knows that he
knows that we don’t know what we don’t know could use this statement as
a generalization. To believe that one has this level of awareness of the
abilities of all other dentists is a sign of such omniscience that one
would think a heavy dose of humility would accompany this profound gift.
Unfortunately, those who know that they have this gift generally don’t
know that they lack humility or even recognize the need for it.
November - December 2006
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Effective
teaching will uncover jewels of talent who stand a better chance to grow
because they were met with encouragement rather than belittlement.
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