The Incursion of Corporatism into the Dental Profession
Corporatism is defined as “a political / economic system in which power is exercised through large organizations (businesses, trade unions, their associated lobbying efforts, etc.) working in concert or conflict with each other; usually with the goal of influencing or subsuming the direction of the state and generally only to benefit their own socioeconomic agendas at the expense of the will of the people, and to the detriment of the common good.1
Corporatism, according to this definition, is invading the dental profession. Corporate entities are creating and promoting technology to advance self-serving interests without regard to what is really best for doctors and their patients. With the advent of AI, it is clear now more than ever, that if corporate entities are allowed to steer the profession into the future, future outcomes for patients will NOT compare favorably to past outcomes. Corporate entities are focused solely on profit—where economics and “workflow” rule the roost. Conscientious professionals, on the other hand, care about quality and the longevity of outcomes as well as the relationships they have with their patients. There is a major disconnect between these two schools of thought.
Do you remember that game we used to play as kids—“telephone?”2 The game began with someone whispering a statement to a friend. Then, the statement is whispered down a line of game participants. The end result is often a complete distortion of the original statement. Dental Education has been passed down through generation of students like a game of telephone, and distortion is the result in the area of crown and bridgework. The basic principles that are now being taught by dental educators did NOT come from dentistry’s original teachings.
For example, it was known in the early 20th century that butt-joint restorations (restorations made to a prepared ledge of tooth structure) have a high incidence of recurrent decay. Butt-joint restorations can never be truly sealed at the micron level where bacteria live. There is a general misconception that modern bonding materials can seal this gap. The truth is that no one can be sure about what is actually sealed at the micron level.
The restoration design that has the best track record came from Dentistry’s roots. The design mimics the Mason Jar cover—the best-known means ever devised for food preservation.
The Mason Jar concept compensates for all the inaccuracies that lead to recurrent decay and loss of retention. With this design, the restoration is extended beyond the ledge to grip onto uncut tooth structure. With this design, restorations have superior retention and recurrent decay is virtually non-existent—even in individuals with a high susceptibility to recurrent decay.
The restorations that have the longest track record and best outcomes were designed in this manner and they came from Dentistry’s roots: gold crowns and bridges with processed acrylic facings. Many of these restorations lasted in health for 50 years or more!
With the advent of porcelain in the 1950s, practitioners quickly found out that all-ceramic restorations did not have the same degree of retention and were quite susceptible to recurrent decay. Unlike gold restorations, all-ceramic restorations are butt-joint restorations that can never be truly sealed.
The computer revolution brought forth a technological “advancement” called CEREC. These machines designed crowns on the computer and milled them out of a block of ceramic material. Was this novel application of computers truly an advancement? NO! The outcome is a butt-joint ceramic crown that is no different from the porcelain jackets that were baked in the oven in the 1950s. There is no difference in the outcome! However, corporate entities have money and power and the ability to influence thousands of practitioners worldwide that they should buy this $100,000 machine to make these “crowns in an hour.” Particularly vulnerable are new dentists who have no idea how crown and bridge dentistry evolved. Extra funding for dental schools led to promoting this technology in the schools. Today’s dental education does not even include a discussion of how crown and bridgework evolved and what approach has the REAL track record for longevity and successful outcomes.
Patients and dentists alike are mesmerized by new technology. I am no luddite, and I love technology! It is so cool. But I know the difference between good technology and bad technology. New dentists do not. They have been indoctrinated to believe that all technology is better than “old fashioned” or traditional crown and bridgework. Patients, too, are impressed with the idea of “Star Wars” dentistry and many actually believe that if dentistry came out of a computer it must be better. Nothing could be further from the truth!
It is easy to see that just like the game “telephone,” the original basic principles have been distorted. The restorations which had by far the best track record have gone by the wayside. Corporate entities cannot make big money from them. Now, the advent of AI promises to ensure their complete disappearance from the marketplace.
The US-based company Perspective recently announced that the first AI robot prepared a crown on a patient in just 15 minutes, which the company claims is 8 times faster than a human specialist. The crown preparation was scanned, and a restoration was milled out of a block of ceramic and cemented in place, with the AI robot autonomously carrying out the entire operation. Dr Chris Ciriello, CEO and founder of Perceptive, proclaimed that ‘this medical breakthrough enhances precision and efficiency of dental procedures, and democratizes access to better dental care, for improved patient experience and clinical outcomes.3
What is the outcome? The same butt-joint all-ceramic crown! It is clearly NOT better! The entire profession now believes that butt-joint dentistry is good dentistry. AI corporate entities promise to etch this misconception in dental education forever—all in the name of profits and “workflow.”
I believe in honest evaluation in terms of quality and longevity. This approach is the hallmark of professionalism and separates professionals from mere dental mechanics. If the future of dentistry is to be bright, dentists who care about honesty and quality work must take the reins and guide the profession into the future. Dentists must take hold of AI and make sure it enhances dentistry for the patients and not for the corporate entities whose sole concern is their own self-enrichment.
As Max Tegmark noted in his book Life 3.0: Being human in the age of Artificial Intelligence, “Our future isn’t written in stone and just waiting to happen to us—it’s ours to create. Let’s create an inspiring one together.”
1https://www.wordnik.com/words/corporatism
2https://empoweredparents.co/how-to-play-telephone
3Hunter, William; “The Robodentist will see you now;” https://www.dailymail.co.uk/sciencetech/article-13717983/robot-dentist-AI-completes-procedure.html.
4Tegmark, Max; Life 3.0: Being human in the age of Artificial Intelligence; Vintage Books; A Division of Penguin Random House LLC; New York; 2017; p.335.