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The most important invention in the history of dentistry and what it teaches us about the future

2017; Elsevier BV; Volume: 148; Issue: 10 Linguagem: Inglês

10.1016/j.adaj.2017.08.024

1943-4723

Joseph P. Crowley,

Medical and Biological Sciences

If asked to name a single invention that has made the greatest impact on the practice of dentistry, which would you name? I was asked this question recently by a first-year dental student who wanted to learn more about the history of our profession. I thought first of amalgam, the standard restoration material for almost 2 centuries. Among more recent innovations, I thought about computer-aided design and computer-aided manufacturing technology, which opened the door for game-changing advances in all fields of dentistry. I cannot imagine practicing dentistry daily without either of those 2 discoveries, but neither of these was my answer to the student. My answer was the high-speed handpiece, otherwise known as “the drill.” Drill technology has advanced over centuries. The high-speed drills that are used today first appeared in the 1950s, developed in major part by scientists at the ADA Foundation Volpe Research Center.1ADA Foundation. Dr. Anthony Volpe Research Center.http://adaf-ae.idevdesign.net/∼/media/ADA_Foundation/Files/VRC_Brochure_ADAF.ashxGoogle Scholar Today’s technology descended from hand- and foot-powered drills that were standard in the 19th century but the technology is even older than that. The first foot-powered dental engine dates back to 1790, using components reportedly borrowed from a spinning wheel belonging to the inventor’s mother. Hand and bow drills were introduced by Pierre Fauchard in the 1700s.21963-1984: shaping the future.JADA. 1984; 108: 561-580http://dx.doi.org/10.14219/jada.archive.1984.0388Abstract Full Text PDF PubMed Google Scholar “It is hard to imagine dentistry without high-speed drills…” a 1984 article in JADA stated. “Before the drill was invented and when it was not available, diseased teeth were extracted.”21963-1984: shaping the future.JADA. 1984; 108: 561-580http://dx.doi.org/10.14219/jada.archive.1984.0388Abstract Full Text PDF PubMed Google Scholar The evolution of dental drills drove the evolution of dental practice, but this centuries-old mainstay in the dentist’s kit could easily be replaced by current laser technology or another yet-to-be-developed technology; if not during my lifetime, then probably during the lifetime of the dental student who asked me the question at hand. To me, what sets the dental drill apart as a game-changing invention in dentistry is neither that it has a long history nor that it may be superseded by a fantastic new technology. Rather, it strikes me that a great volume of what has been developed in dentistry would not have come into existence had the drill not been developed, and subsequently redeveloped, over centuries. Would basic restoration techniques, which today are commonplace, have been developed? And if the methods were never developed, would the dental materials we use have been created at all? We will never know the answers to those questions, but modern dentists owe a debt of gratitude to the researchers, scientists, and inventors who over decades have solved problems by taking existing knowledge and building on it to create something new. Their curiosity is the reason the dental profession as we know it exists today. Scientific endeavors demand our constant investment and support. Progress in dentistry depends on the discoveries that are the products of these endeavors, but investing in and supporting them is easier said than done.Scientific endeavors demand our constant investment and support. Progress in dentistry depends on the discoveries that are the products of these endeavors, but investing in and supporting them is easier said than done. Each of us is faced with daily decisions about how to use our resources. Those resources are limited, and so we have to determine what has the most value. The trouble is that most of us are inclined to allocate those resources to efforts that produce the greatest immediate value, and not necessarily the greatest overall value. In the case of many scientific endeavors, that overall value may take years to realize. Scientific endeavors demand our constant investment and support. Progress in dentistry depends on the discoveries that are the products of these endeavors, but investing in and supporting them is easier said than done. We have to realize that scientific progress is incremental. When game-changing research, materials, or inventions are presented, many of us are quick to forget that innovation does not occur overnight. It is easy to ignore the long and winding path that leads to new discoveries. Doing so minimizes our role in investing in and supporting scientific endeavors that may not produce actionable results for years but are the bedrock of a science- and evidence-based profession like dentistry. The American Dental Association is a science- and evidence-based organization. These are some of our core values.3American Dental Association. ADA core values and precepts.http://www.ada.org/en/about-the-ada/ada-core-values-and-preceptsGoogle Scholar We have to live those values in everything we do. For you, the oral health care provider, that means that we invest our advocacy resources to secure funding for research. It means that we provide guidance and expertise regarding critical and emerging issues that impact the dental profession and public health. It means that we actively lead the development and implementation of standardized approaches for testing dental products. It also means that we use our reputation as America’s leading advocate for oral health to help patients live healthier lives. For example, when I was a kid, there were no consistent and widely accepted science-based recommendations for oral health care at home. Brushing for 2 minutes twice a day was not a mandate in my home growing up. I’m not sure my parents were given proper directives on personal care, so I only heard “go brush.” At night, my siblings and I would run the toothbrush over our teeth a few times before jumping into bed. That was in the 1950s. For many years, the American Dental Association has made recommendations to help patients prevent oral diseases and support a healthy lifestyle. Earlier this year the ADA Council on Scientific Affairs began a rapid review of the evidence examining these recommendations and revised them based on its findings. The revised recommendations are⁃brush your teeth twice a day with a fluoride toothpaste;⁃clean between your teeth daily;⁃eat a healthy diet that limits sugary beverages and snacks;⁃see your dentist regularly for prevention and treatment of oral diseases. A report of the Council’s findings is forthcoming. My experience as a child with an inadequate home oral care routine is becoming less and less common as evidence-based recommendations take root in homes across the country. The American Dental Association’s recommendations inform conversations that mothers and fathers have with their children as they teach them the basic skills that allow them to care for themselves. It is the foundation of our effort to prevent dental disease. For me this is a personal reminder that the American Dental Association must continue to take a leadership role by taking a long view when it comes to science- and evidence-based endeavors, and allow the time, space, and resources that are requirements of discovery. Although progress may be incremental, we cannot expect to help patients live healthier lives and help dentists do their work more effectively unless we take the small steps that are part of this long journey. Our commitment to be science- and evidence-based is not only useful in helping us achieve our mission as America’s leading advocate for oral health, it is essential. It is at the core of everything we do. That means we must—we will—make continued investments in our ADA Science Institute and the ADA Foundation Volpe Research Center, as well as work together with researchers around the world. It is unlikely that Pierre Fauchard could have imaged that the hand drill he introduced to dentistry might some day be made obsolete by laser technology. Today we follow his example by continuing to invest in progress. It is the foundation of what will exist tomorrow. In October 2017, Dr. Crowley will be installed as president, American Dental Association, Chicago IL.