by Michael Reddy, DMD, DMSc
A recent article in The Atlantic, “The Truth About Dentistry,” uses the horrific deeds of an individual to indict an entire profession.
The article purports that dentistry is not a scientifically and evidence-based discipline. Allegations of professional misconduct and fraudulent over-treatment by a specific dentist — incidentally and ironically identified by a peer dentist — serve as “proof” that dentistry is driven by greed, rather than science, to perform unwarranted procedures on unsuspecting patients.
This is wrong.
First, let me say this: Everything we teach and do for patients, as part of one of the world’s best academic health centers, is evidence-based. We at UCSF are leaders in advancing health science. The efforts of our faculty and staff have changed the outcomes of oral health for millions.
Furthermore, the article’s author seems to have missed the existence of the National Institute of Dental and Craniofacial Research, one of 27 institutes and centers under the umbrella of the National Institutes of Health that focuses on specific scientific research areas. Claiming that dentistry is not soundly based in research and evidence is folly.
I am proud of the caliber of scientific research UCSF and other global academic health centers have added to our profession. I am equally proud of how our staff, faculty, student dentists and alumni incorporate this knowledge in their practice. Today, all schools of dentistry incorporate evidence-based dentistry into their curricula. As a research institution, we are major providers of that knowledge for the nation.
The author presents a very narrow view of dentistry. The article points to the 2016 brouhaha over flossing, claiming data is unreliable to support flossing (in conjunction with brushing) as effective in decreasing plaque, even though flossing is known to limit periodontal disease. I would argue there is more to craniofacial science than oral hygiene controlling plaque.
In this instance, the scientific data are, in fact, weak; yet the interproximal cleaning of teeth has not been a high research priority because the practice has been advised for centuries. Rather, the NIH and academic health center studies focus — with little fanfare — on flossing’s relationship to other aspects of complex microbiome infections and the host response to the immune-pathogenesis of dental caries and periodontal disease. In other words: Large studies treating complicated diseases with a piece of string just are not sexy. But just because the general public doesn’t hear about this science doesn’t mean dentistry is not grounded in it.
There are good reasons to floss. Removing impacted food and associated bacteria may help reduce localized inflammation, and it will certainly improve your breath and the cosmetic appearance of your teeth. Also, our salivary flow may decrease as we age or take medication, making the importance of plaque removal even more critical. Floss is cheap preventive self-care that can save time, discomfort and money. Finally, some data indicate adults who floss regularly live years longer than those who don’t; this may represent the association between periodontal health and overall heath.
I am not sure the author realizes that most dentists are not fleecing their patients, nor are they just getting by recommending floss, promoting fluoridation of water or other preventive procedures. These simply are the right things to do to improve oral health, until science points us in a better direction.
