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Building a Periodontia Practice without Camouflage*
ili
THE JOURNAL O F THE
American Dental Association V ol. 12
JANUARY, 1925
No. 1
©
Original Communications BUILDING A PERIODONTIA PRACTICE W ITHOUT CAMOUFLAGE* By A R T H U R H . M ERRITT, D.D.S., F.A .C .D ., New York City
(Read at the eleventh annual meeting of the American Academy of Periodontology, Atlanta, Georgia, October 7-10, 1924)
P
E R IO D O N T IA may be defined as that branch of dental practice which has for its purpose the care and preservation in health of the sup porting tissues of the teeth. It natu rally follows that, if this definition is correct, periodontia is the cornerstone of dentistry. Remove it, and the whole structure of dentistry fails; for unless there is preservation of these tissues, all other dental operations are, in their very nature, temporary, just as the care be stowed on the superstructure of a build ing is temporary if the foundations of that building are neglected. Such care *This paper and the papers of Dr. Schott, Rich, Stillman and Garvin were presented as a symposium on periodontia practice.
may postpone, but cannot prevent, eventual loss. Because these things are true, because it should be the first concern of den tistry to prevent or recognize early the manifestations of disease in these tis sues, to the end that the teeth be pre served in health, it is obvious that per iodontia cannot, and should not be divorced from general practice. It is the alpha and omega of dentistry, for, fail ing in this, it fails in all. It may go on perfecting its restorative technic, re pairing the ravages of decay, replacing lost teeth, and doing all this in such a way as to be the epitome of perfection, and yet fail of complete success, because it has neglected to do first things first. 3
4
The Journal o f the American D ental Association
It must be evident, therefore, that periodontia is not a logical specialty of dentistry. There is no line clearly sep arating it from general practice as in orthodontia. It has in fact been built upon dentistry’s failure. It is the stone that was rejected by the builders, which shall yet become the head of the corner. Perhaps it is not too much to say that it is dentistry’s camouflage— an attempt, as it were, to disguise its own shortcom ings, by pointing to the specialty that has grown up within its ranks, and shifting to it the responsibility that logically rests upon its own shoulders. While admitting all this, it must not be forgotten that we are face to face with a fact and not a theory. That fact is that there is an almost universal need of more periodontia. This is especially true of preventive periodontia, and this need must be met. But it can never be met by a handful of specialists. It is a problem belonging not to periodontology but to dentistry. The multiplica tion of specialists will not solve it. It is a problem of education not of the few, but of the many. And this is clearly the duty of the periodontist. It is not enough that we as an Academy go on perfecting our technic in treat ment, increasing our numbers and in fluence, however important these things may be. We should do all these things, but we should do more than this. We must go to our educational institutions and make clear to those in charge the fundamental nature of periodontia in dental practice, to the end that the stu dent be taught the principles and prac tice of preventive periodontia as of first importance, instead of fixing his atten tion on the art of dentistry, thereby fos tering in his mind the already deeply rooted impression that “ filling teeth” is the beginning and end of dental prac tice. The practitioners of dentistry must also be included. They need the help and encouragement that we as members of this Academy can give them.
They must be made to realize the pre ventive nature of most of the diseases affecting the periodontium and put such knowledge into daily practice. The im portance of prevention and early recog nition of diseases of the periodontium must be stressed on all occasions. This is the duty of the American Academy of Periodontology. I should like to see it undertake, through its committee on educational bulletins, the preparation of such a bul letin, thus doing for periodontia what it has so excellently done for other branches of dentistry. In fact, I shall feel that this symposium is largely a failure, if it does not eventuate in a campaign of education, not on how to build up a practice in periodontia with out camouflage, but on how to make periodontia what it should be, an essen tial part of daily dental practice. Meanwhile, periodontia as a specialty must carry on. Its boundaries must be extended and its usefulness increased. Things must be faced as they are, while we are trying to make them what they should be. While it is clearly the duty of the general practitioner of dentistry to give preventive periodontia the first place in his practice, it is not improb able that, as long as the emphasis is placed on restorative dentistry, there will be those who will fall into neglect, allowing incipient cases to reach an advanced stage, and creating, in this way, the need for the periodontist. It may be doubted also, whether the gen eral practitioner of dentistry will as a rule, acquire the necessary skill to cope successfully with the advanced case. In saying this, however, it must be remem bered that the advanced case reached that stage only because preventive treat ment, easily within the ability of the average dentist, was not given. And, while it may be too much to expect of erring man that he shall always see his duty and do it, it should be the goal to ward which we as a profession should
Schott— Dental Hygienist and, Assistant in Periodontia Practice
strive, not forgetting, that a “ man’s reach should exceed his grasp, or what’s a heaven for.” Moreover, there will always be those who, through temperament and expe rience, will achieve a larger measure of success in the treatment of periodontal lesions than is accorded to the average,
5
with the result that the demands made on his time for such services will in fact force him into specialization. This is as it should be. The doorway into periodontia as a specialty should always be through general practice. Upon no other foundation can a successful prac tice in periodontia be built.
THE DENTAL HYGIENIST AND DENTAL ASSISTANT IN PERIODONTIA PRACTICE By C. H . SCHOTT, D .D .S., Cincinnati, Ohio
(Read at the eleventh annual meeting of the American Academy of Periodontology, Atlanta, Georgia, October 7-10, 1924)
H E presentation of a symposium on periodontia practice resolves itself into the consideration as to how we can, by better systems and methods and by added study, increase our efficiency so as to serve our clientele more satisfactorily, command wider ap preciation and secure greater remunera tion for our services without the sacri fice of life itself. It is because of our failure to recognize the importance of better systems and methods that we are compelled to labor eight or ten hours a day for a mere living, though I reluc tantly acknowledge that many are ob taining this living under false pretenses. Even if it were possible to get a living with very little effort, we cannot afford to do so; we cannot afford to coin our brains into dollars, to make mere dollarchasing the ambition of our lives. As professional men and women, there should be something bigger in us than that— something that will not allow us to sell ourselves so cheaply. N o one can respect himself unless he makes the greatest effort to use to the best of his ability, his personal powers and re sources.
T
In order, therefore, to establish a bet ter system in periodontia practice, we have had brought to us through the de velopment of special training schools the dental hygienist, trained primarily to care for and to promote mouth hygiene among the masses, in the schools and in institutions. As I have been requested to discuss the place of the dental hygienist and dental assistant in periodontia practice, I find, on considering the subject, that it can be interpreted in two ways: the dental assistant and hygienist may be two persons or one and the same person. I am assuming that the second interpre tation is intended. In the first place, I am opposed to permitting the dental hygienist to act also as a dental assistant although this procedure is being followed in many offices. I feel that it detracts from the dignity of the position of hygienist to have that person also serve in the less dignified work of assisting at the chair. I do not mean to imply that in itself the work of the dental assistant is undignified, but I feel that patients have more respect for the position and serv
THE JOURNAL O F THE
American Dental Association V ol. 12
JANUARY, 1925
No. 1
©
Original Communications BUILDING A PERIODONTIA PRACTICE W ITHOUT CAMOUFLAGE* By A R T H U R H . M ERRITT, D.D.S., F.A .C .D ., New York City
(Read at the eleventh annual meeting of the American Academy of Periodontology, Atlanta, Georgia, October 7-10, 1924)
P
E R IO D O N T IA may be defined as that branch of dental practice which has for its purpose the care and preservation in health of the sup porting tissues of the teeth. It natu rally follows that, if this definition is correct, periodontia is the cornerstone of dentistry. Remove it, and the whole structure of dentistry fails; for unless there is preservation of these tissues, all other dental operations are, in their very nature, temporary, just as the care be stowed on the superstructure of a build ing is temporary if the foundations of that building are neglected. Such care *This paper and the papers of Dr. Schott, Rich, Stillman and Garvin were presented as a symposium on periodontia practice.
may postpone, but cannot prevent, eventual loss. Because these things are true, because it should be the first concern of den tistry to prevent or recognize early the manifestations of disease in these tis sues, to the end that the teeth be pre served in health, it is obvious that per iodontia cannot, and should not be divorced from general practice. It is the alpha and omega of dentistry, for, fail ing in this, it fails in all. It may go on perfecting its restorative technic, re pairing the ravages of decay, replacing lost teeth, and doing all this in such a way as to be the epitome of perfection, and yet fail of complete success, because it has neglected to do first things first. 3
4
The Journal o f the American D ental Association
It must be evident, therefore, that periodontia is not a logical specialty of dentistry. There is no line clearly sep arating it from general practice as in orthodontia. It has in fact been built upon dentistry’s failure. It is the stone that was rejected by the builders, which shall yet become the head of the corner. Perhaps it is not too much to say that it is dentistry’s camouflage— an attempt, as it were, to disguise its own shortcom ings, by pointing to the specialty that has grown up within its ranks, and shifting to it the responsibility that logically rests upon its own shoulders. While admitting all this, it must not be forgotten that we are face to face with a fact and not a theory. That fact is that there is an almost universal need of more periodontia. This is especially true of preventive periodontia, and this need must be met. But it can never be met by a handful of specialists. It is a problem belonging not to periodontology but to dentistry. The multiplica tion of specialists will not solve it. It is a problem of education not of the few, but of the many. And this is clearly the duty of the periodontist. It is not enough that we as an Academy go on perfecting our technic in treat ment, increasing our numbers and in fluence, however important these things may be. We should do all these things, but we should do more than this. We must go to our educational institutions and make clear to those in charge the fundamental nature of periodontia in dental practice, to the end that the stu dent be taught the principles and prac tice of preventive periodontia as of first importance, instead of fixing his atten tion on the art of dentistry, thereby fos tering in his mind the already deeply rooted impression that “ filling teeth” is the beginning and end of dental prac tice. The practitioners of dentistry must also be included. They need the help and encouragement that we as members of this Academy can give them.
They must be made to realize the pre ventive nature of most of the diseases affecting the periodontium and put such knowledge into daily practice. The im portance of prevention and early recog nition of diseases of the periodontium must be stressed on all occasions. This is the duty of the American Academy of Periodontology. I should like to see it undertake, through its committee on educational bulletins, the preparation of such a bul letin, thus doing for periodontia what it has so excellently done for other branches of dentistry. In fact, I shall feel that this symposium is largely a failure, if it does not eventuate in a campaign of education, not on how to build up a practice in periodontia with out camouflage, but on how to make periodontia what it should be, an essen tial part of daily dental practice. Meanwhile, periodontia as a specialty must carry on. Its boundaries must be extended and its usefulness increased. Things must be faced as they are, while we are trying to make them what they should be. While it is clearly the duty of the general practitioner of dentistry to give preventive periodontia the first place in his practice, it is not improb able that, as long as the emphasis is placed on restorative dentistry, there will be those who will fall into neglect, allowing incipient cases to reach an advanced stage, and creating, in this way, the need for the periodontist. It may be doubted also, whether the gen eral practitioner of dentistry will as a rule, acquire the necessary skill to cope successfully with the advanced case. In saying this, however, it must be remem bered that the advanced case reached that stage only because preventive treat ment, easily within the ability of the average dentist, was not given. And, while it may be too much to expect of erring man that he shall always see his duty and do it, it should be the goal to ward which we as a profession should
Schott— Dental Hygienist and, Assistant in Periodontia Practice
strive, not forgetting, that a “ man’s reach should exceed his grasp, or what’s a heaven for.” Moreover, there will always be those who, through temperament and expe rience, will achieve a larger measure of success in the treatment of periodontal lesions than is accorded to the average,
5
with the result that the demands made on his time for such services will in fact force him into specialization. This is as it should be. The doorway into periodontia as a specialty should always be through general practice. Upon no other foundation can a successful prac tice in periodontia be built.
THE DENTAL HYGIENIST AND DENTAL ASSISTANT IN PERIODONTIA PRACTICE By C. H . SCHOTT, D .D .S., Cincinnati, Ohio
(Read at the eleventh annual meeting of the American Academy of Periodontology, Atlanta, Georgia, October 7-10, 1924)
H E presentation of a symposium on periodontia practice resolves itself into the consideration as to how we can, by better systems and methods and by added study, increase our efficiency so as to serve our clientele more satisfactorily, command wider ap preciation and secure greater remunera tion for our services without the sacri fice of life itself. It is because of our failure to recognize the importance of better systems and methods that we are compelled to labor eight or ten hours a day for a mere living, though I reluc tantly acknowledge that many are ob taining this living under false pretenses. Even if it were possible to get a living with very little effort, we cannot afford to do so; we cannot afford to coin our brains into dollars, to make mere dollarchasing the ambition of our lives. As professional men and women, there should be something bigger in us than that— something that will not allow us to sell ourselves so cheaply. N o one can respect himself unless he makes the greatest effort to use to the best of his ability, his personal powers and re sources.
T
In order, therefore, to establish a bet ter system in periodontia practice, we have had brought to us through the de velopment of special training schools the dental hygienist, trained primarily to care for and to promote mouth hygiene among the masses, in the schools and in institutions. As I have been requested to discuss the place of the dental hygienist and dental assistant in periodontia practice, I find, on considering the subject, that it can be interpreted in two ways: the dental assistant and hygienist may be two persons or one and the same person. I am assuming that the second interpre tation is intended. In the first place, I am opposed to permitting the dental hygienist to act also as a dental assistant although this procedure is being followed in many offices. I feel that it detracts from the dignity of the position of hygienist to have that person also serve in the less dignified work of assisting at the chair. I do not mean to imply that in itself the work of the dental assistant is undignified, but I feel that patients have more respect for the position and serv