“We have met the enemy, and he is us”
____ Walt Kelly
“It is a well-known phenomenon that we do not notice anything happening in our surroundings while being absorbed in the inspection of something; focusing our attention on a certain object may happen to such an extent that we cannot perceive other objects placed in the peripheral parts of our visual field, although the light rays they emit arrive completely at the visual sphere of the cerebral cortex”
Rezsö Bálint 1907 (translated in Husain and Stein 1988, page 91)
This quote was taken from an article from Perception (1999) authored by Daniel J. Simons and Christopher F. Chabris. The article’s title is “Gorillas in our midst: sustained inattententional blindness for dynamic events”. Why I am quoting from a journal dealing with psychology? That’s a good question and even if you didn’t ask I’m going to tell you why because that’s what editors do. With the ascendency of titanium implants into the dental armamentaria over a decade ago endodontists have felt threatened and marginalized. We have been totally focused and disquietingly absorbed by the perceived menace of implantology to our specialty. Just as Sauron, the Dark Lord of Mordor (from The Lord Of The Rings), with his piercing eye looking elsewhere failed to see the Hobbits come to destroy the “One ring that rules them all”, our specialty fails to acknowledge the threats to us from within.
The AAE’s underfunded public relations effort has failed to produce the palpable results we had hoped it would. The American Association of Orthodontists spent millions of dollars and had little data or metrics to show their public relations campaign was cost effective or beneficial .They were perceptive enough to pull the plug when they realized enough is enough. Are you satisfied with the public relations campaign now in place and funded annually by a $125 assessment to you? This camapign has had no meaningful oversite. Where are the metrics that demonstrate any measurable success associated with this program? This campaign should have been discontinued after 4 years of spending almost $2,000,000 dollars on an ineffective and wastefull effort. Are our leaders being fiscally responsible to the membership in view of the global economic downturn? I believe this unwarranted largess begs that question. These monies could have been better spent improving the infrastructure of our post graduate endodontic programs and bolstering a faculty shortage that will reach irreversibly catastrophic proportions in the next ten years or less. As baby boomers continue to retire in ever increasingly large numbers an already acute faculty shortage will metastasize into an educational nuclear winter. The AAE could have been decidedly more pro-active in fostering distance learning programs to help support our overworked and underpaid post graduate faculty. How much longer does our leadership expect us to pay $125 per annum as an additional tithe to our annual dues?
I have said for a long time now that implants are not the enemy. Rather, it is the practice of using implants as an insurance policy for poorly treated root canals that has us repeatedly complaining and or bemoaning our loss of stature in the dental community. Regrettably, this is a self inflicted wound. It’s really not important who delivers the implant. I don’t care whether the implant is placed by a GP, endodontist, oral surgeon or periodontist . That is inconsequential. However, the major problem occurs when we, as endodontists, are left out of the diagnostic loop and perfectly healthy teeth are condemned for extraction. When a diagnosis is made predicated on inappropriate dental algorithms, ignorance, greed and limited or no understanding of the culture of referral we lose authority and relevence as a specialty. We should be training our endodontic postgraduates to be proficient in endodontics and single tooth implant placement. The specialty of endodontics is in the unique position to provide our patients with an unbiased treatment plan best suited for their needs. Periodontists, Oral Surgeons and Prosthodontists are not prepared to provide endodontic services nor should they. We can do both expeditiously and ethically too.
The only way your voice will ever have any consequence to the rest of your dental colleagues who place implants is when you start placing them as specialty also. The AAE’s decision to promote endodontic treatment through the all too transparent and somewhat banal effort to cast doubt about implants does not help our cause. Lower maintenance on endodontically treated teeth is never going to be a prime concern for those with missing or hopeless teeth. How many of our colleagues will be concerned about the long-term effects of maintaining an implant when deciding whether to extract or treat a tooth endodontically? The endodontic/implant algorithm requires significant clinical and academic dialogue with a healthy amount of research and interdisciplinary collaboration mixed in. Ataractic articles that only endodontists read are self-serving and only promote collegial dissonance.
What is our mission and are we doing everything we can as a dental specialty to instruct and inform our referrers and the public? I think if we look in the mirror, we will be able to find the answer.
The Man in the Glass
By Dale Wimbrow, (c) 1934
When you get what you want in your struggle for self,
And the world makes you King for a day,
Then go to the mirror and look at yourself,
And see what that guy has to say.
For it isn’t your Father, or Mother, or Wife,
Whose judgment upon you must pass.
The feller whose verdict counts most in your life
Is the guy staring back from the glass.
This is the first in a series of editorials from the editor of the New Jersey Association of Endodontists (NJAE) website. The opinions expressed in these editorials are solely those of the editor and do not represent the views of the American Association of Endodontists, the AAE’s Executive Committee, Board of Directors , or members of NJAE. Comments to the editor are welcomed. Letters to the editor will be added as they are received. We also encourage guest editorials. Please submit your editorials or comments by email to email@example.com.
Marc Balson, DDS, FACD, Editor of the NJAE Website