Time to diversify

01 September 2014
Volume 30 · Issue 9

Tif Qureshi discusses the importance of broadening your skill set.

As GDPs, we often talk about the need to diversify, but I believe there are some things that we should be doing routinely, that we are not.
I would argue that, routinely, the majority of dentists don’t take enough photographs or have the facility to do so. Photography isn’t just about before and afters, it’s about tracking the dynamic changes in a patient’s mouth. The more photography dentists are doing, the more they’ll see things changing, be able to intercept problems earlier and ultimately improve, because they will be able to critique their own work in more detail.
I believe every dentist should take a photography course. At this year’s BACD conference in November delegates have access to such a course and I think it would prove beneficial; dentists should be using a camera every single day. Perhaps controversially, I believe that all students should have dental cameras as part of their training too, as it becomes harder to motivate dentists to use them later on. Because photography is about tracking, observing and looking at changes, a dental chart can be supplemented with series of photographs that can be compared over time.
What I’ve seen from taking photographs for almost 20 years now is that mouths do change far more than we might realise. We are quick to react to what we would consider normal pathological problems, like tooth decay, but there are other issues that we are not bringing to our patient’s attention as much as we perhaps should.
For example, tooth wear may not be immediately painful, but it can be destructive, cause occlusal and functional issues and aesthetic problems. If we are using photography effectively, we can monitor tooth wear properly and intervene at a far earlier stage when it is easier to treat.
Part of the problem we face is the perception of how to treat wear. You would imagine from reading many articles on the subject that many think treatment of tooth wear requires splints, and then ceramic work. I would argue this is wrong. What dentists should be doing is intercepting tooth wear with composite build-ups far earlier on and to use the Dahl principle on cases where anterior guidance is starting to reduce, effectively building a splint into the patients mouth with no-prep restorative composite.
Another issue often ignored is tooth crowding and continued tooth movement, something that large parts of the profession simply do not acknowledge. You can attend some of the best courses of restorative dentistry where they which will teach you how to do fantastic full mouth treatments, but they won’t mention the patient’s teeth may move over time.
This is related to a solid study by RM Little, which I believe is one of the most important articles in dentistry. It shows, unsurprisingly, that much
orthodontic treatment is unstable and needs retention for life, but even more
importantly, for patients that did not have orthodontics at all, their teeth move just as much. This goes back to dentists not photographing teeth enough and visualising the changes. 
With a few simple things such as photography, the interceptive treatment of tooth wear and application of what we understand from Little’s study, we
could all be working in a far more preventative way. It doesn’t take a lot of effort to achieve.
References available on request.