The hallmark of a true dental professional is continuous learning. A professional’s dental education actually begins on the day of graduation. Dental school can only provide a rudimentary education with limited clinical experience. Continuing education is therefore key to building one’s knowledge and skills in order to become a fine practitioner.

Continuing education is the common thread that has defined my career. God knows how many thousands of credit hours I have amassed in my 49-year career. I was told to keep a running list of my continuing education courses in 1988, when mandatory continuing education legislation was passed in New York State. That list is now 62 pages and counting!

Unfortunately, I have found that not all continuing education is good continuing education. I have sat in countless classrooms where I absolutely detested the material that was being presented. But I still attend classes because I believe it is important to see what is being done “out there,” even if I don’t agree. I am also keenly aware that even though I possess a great deal of knowledge, I do not know everything. I’m always eager to learn something new.

How to Evaluate Continuing Education

“Are you easily impressed by the fame and reputation of speakers?

Are you being taught skills that you can directly apply to your practice or are you simply being entertained?

Is the speaker really honest about what he or she is presenting?”

These are important questions to ask when sitting in the continuing education classroom. Look closely at what is presented and what is actually said. Don’t be impressed by reputation, status, or fame. These badges of honor will not help you build your knowledge and skills.

Attendees should look at continuing education courses with “two” eyes:

A “critical” eye that seeks a sound philosophical, scientific and engineering basis for what is being presented.

A “practical” eye that translates the presentation into sound clinical advice and skills that can be directly applied to your clinical practice.

Many presentations fail to pass muster when both of these eyes are opened.

Using Your “Eyes” in the Continuing Education Classroom

These are true stories of presentations I have attended that failed to pass muster when examined with both “eyes:”

1. Special Conference: On one occasion, I attended the Ninth District Dental Association’s (NY) Restorative Conference (which was named to honor my father and mentor Dr. Elliot Feinberg). A famous instructor was the guest speaker, and he had an idyllic reputation as the director of a well-known continuing education institute. I witnessed this icon spend an entire morning showcasing one patient, for whom he fabricated a “roundhouse bridge” in one piece that was inserted in two visits. The instructor boasted about the enormous fee he received for this case. No follow-up X-Rays were offered to demonstrate whether this case actually worked or how long the case lasted.

Any diligent practitioner of full coverage restorative dentistry knows that roundhouse dentistry is NOT precision dentistry, no matter how beautiful it appears. It is impossible to make a roundhouse case in one piece that actually fits. First, parallelism is almost impossible to achieve for an entire arch of teeth since teeth on one side of the arch are unlikely to be exactly parallel with the teeth on the other side of the arch.

Second, manufacturers’ instructions specifically state that the materials are not designed to be used in this manner. Manufacturers recommend fabricating smaller bridges because dimensional changes occur from repeatedly heating materials in large sections close to their melting points. Full arch splinting is best achieved by tying smaller bridges together, and there are several methods that can accomplish this feat.

It seems to me that the majority of dental practitioners don’t realize that just because a bridge “goes on” does not mean it actually “fits.” These are two very different concepts. Bridges that don’t actually fit will be prone to recurrent decay and failure. Bacteria are 2-10 microns in size and will easily sail through the gaps between the prepared teeth and the restoration. It is unscientific to assume that cements and bonding materials will completely seal gaps at the micron level where bacteria live.

What was most disturbing is that I was perhaps the only attendee who was not impressed with the speaker and his presentation. Clearly the presentation did not live up to the speaker’s stellar reputation. Economics and esthetics alone should never be the focus of a scientific presentation—health and longevity should take precedence, and attendees are entitled to see evidence of both.

2. Major Convention: On another occasion, I attended a course at the Midwinter Meeting in Chicago with my colleagues from the Westchester Academy of Restorative Dentistry—Drs. Elly Devine and Sam Jacobs. (Both are deceased). The three of us assisted my father and mentor, Dr. Elliot Feinberg, with demonstration courses on live patients in Scarsdale, NY through the Ninth District Dental Association. (My father gave in-office demonstration courses to dentists for over 40 years!)

There must have been 1,000 attendees in this huge auditorium, and there were dozens of TVs in the room so that attendees could see up close how an extremely famous instructor was treating a live patient. The instructor prepared a bicuspid for a single crown and proceeded to take an impression.

While preparing for the impression, the instructor joked about the sulcus being the “inner sanctum.” That remark indicated that he did not have any idea about the depth of the sulcus, what was in the sulcus, and whether it was free of calculus or other debris. The instructor then packed thick cord into the sulcus so that the cord completely “disappeared.”

The impression was taken with a triple tray and elastic materials while the cord remained in place! A sulcus this deep is actually a pocket, and periodontal pockets are not conducive to long-term health. A sulcus that is no more than 3mm in depth cannot completely hide thick retraction cord.

Sadly, there was not a single whisper of contention from anyone in the room. It seemed to me that the entire audience was too mesmerized by the fame of the instructor to critically evaluate what was actually demonstrated.

3. Study Group: I belong to a small study group in Arizona that is affiliated with a well-known dental institute. There are about ten individuals in the group–both generalists and specialists. Typically, the group views and discusses video courses downloaded from the institute’s website. At one of the meetings an instructor from the institute presented a patient who had lost a central incisor in accident as a child. Her mouth had been restored with a three-unit bridge extending from the right central incisor to the left lateral incisor. Both of the abutments had root canal therapy, and one had a post.

Due to changes that occurred over many years, the patient required replacement bridgework. There was a substantial discussion in the video about the use of posts, and the instructor correctly pointed out the importance of a ferrule (good grip on the root surface) in restoring nonvital teeth.

The finished case, however, showed no such ferrule despite the extensive discussion. I pointed out to the group that posts are not necessary if there is adequate ferrule. In fact, it is well documented that posts are harmful because they increase the likelihood of fracture of nonvital teeth.

There was no consideration of basic engineering principles in design of the bridgework in the video. But for me, the pièce de resistance was the fact that the opposite lateral was prepared for a veneer instead of being incorporated into the bridgework. Does this make sense?

Clinical evidence from 70+ years of bridgework indicates that the best support for anterior bridgework is to extend the bridgework from canine to canine. The canines have the longest roots and are the cornerstones of the arch. The addition of the canines to the bridgework would have provided extra support to the nonvital lateral incisor, and if something happened to the lateral incisor, the bridgework could remain without having to remake the entire case. At the very least, the bridge should have included both lateral incisors for extra support.

What is disturbing to me is that not a single attendee questioned what was shown. There seems to be a universal lack of confidence with crown and bridgework skills. A common theme of the instructional videos shown to the study group is that the instructors would rather go to great lengths to place implants and prepare adjacent teeth for veneers rather than to create anterior bridgework. Seventy years of documented evidence demonstrates that bridgework is easier to accomplish, less invasive, has a far better prognosis, and a superior track record. Yet it is becoming uncommon to see this treatment option seriously considered.

It is my observation that most cases that are presented in lectures and publications are fabricated on healthy individuals with perfect gingiva. Usually, these subjects are young. Almost anything will work on young patients because younger individuals have greater tolerance. As a patient becomes older, however, tolerance declines, and cases that are less than ideal become more prone to failure.

Except for practices that specialize in pediatric dentistry, the bulk of patients in most dental practices are middle-aged and older. Many have chronic conditions like diabetes, heart disease, and cancer. Some patients were born with weak mouths and have roots that are short, straight, and conical. The true test of a sound technique is the percentage of cases that hold up in these individuals despite the aforementioned conditions. Such cases are rarely shown.

Most case presentations usually finish with pictures taken on the day of insertion when the gingiva looks healthy and beautiful. There is no question that dentists like to see exquisite porcelain work. But attendees should use both eyes to look beyond the surface beauty. Here is a question that meeting attendees should seriously consider:

“If you found out that the beautiful case presented wasn’t ultimately successful, would you look differently at the treatment that was presented? Would you think twice about adopting that protocol for your patients?”

Meeting planners should insist that presenters show evidence that cases succeed. Finished X-Rays and follow-up of at least five years are what I want to see at continuing education courses. Are changes in periodontal bone minimal and gradual over time? If so, those patients are likely to retain their teeth, which is the point of corrective full coverage restorative dentistry.

Attendees should recognize that one or two cases in a presentation can seem more like “anecdotes,” rather than as supporting evidence for a particular treatment plan or technique. A strong presentation will illustrate basic principles with numerous cases. It is the percentage of cases with successful outcomes that determines the efficacy of a particular technique or philosophical approach. Case longevity and health are the ultimate criteria for successful outcomes, not esthetics on the day of insertion or financial reward.

Does the instructor say one thing and do another? Such a scenario is not uncommon. If attendees are paying attention, clues can be gleaned from what is presented and what is said. Robert Ringer, a motivational speaker and author, emphasizes that it is important to “question everything—even if it represents generations of conventional wisdom.”

What is the Take-Home Message?

Albert Einstein once said that “education is what remains after one has forgotten what one has learned in school.” After attending a continuing education course, only information that is useful will actually be retained. To get the most out of continuing education, attendees should ask these questions after class: