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President’s Message: My Journey Through Dentistry—Just “Doing my Best”

“The best preparation for tomorrow is doing your best today”—H. Jackson Brown, Jr. 

For me, looking at things historically helps give me perspective which helps me cope with the present and a means to plan. I can still remember my first day of dental school. After completing my studies at UCLA and receiving my bachelor’s degree in Biochemistry, I did a brief stint doing industrial development for a pharmaceutical company. Deciding that research was not for me, I was ready for a new challenge, one that would afford me the opportunity to use my manual skills, interact with patients and other health professionals, run my own business on my own terms, and contribute to the betterment of society and the health of my patients. Our first class was dental morphology where we were expected to carve a full set of teeth out of small blocks of carnauba wax and to understand the intricacies and detail of tooth anatomy—a far cry from the workings of a biochemistry laboratory. Perhaps sensing our anxiety over this complex and seemingly impossible task, our strict and somewhat intimidating professor gave us a piece of advice that still sticks in my mind— “Just do your best and everything else will follow”.  

Four long years later, having graduated dental school, I felt competent and confident to pursue my goal to become a fine and independent dental practitioner and to apply the principles and skills that I had learned to provide the best and most ideal treatment possible. But I soon learned that “doing my best” wasn’t always that easy. Clinical dentistry and the dental profession were already rapidly changing. The gold and alloy restorations which I had meticulously mastered were giving way to cosmetic and implant dentistry. In addition, the advent of HMO dentistry was infiltrating the dental market, changing the way dentists practiced and managed their practices. With a lack of knowledge of these new dental procedures and the threat that I wouldn’t be able to practice the way I had envisioned, it was soon time for a change of plans. 

I was always intrigued by endodontics and performing endodontic procedures while in school and in practice. Endodontics seemed like a stable specialty—perhaps not likely to change much. As a professor teaching removable prosthodontics, I had learned the importance of saving the natural dentition. So, I applied to and was accepted into an advanced endodontic program and proceeded to become a confident and “competent” newly graduated endodontist, ready for a solo practice. But much like my previous experience, the winds of change caught up with me once again. New technology, techniques, and practice models once again changed the landscape of endodontic practice. And once again, I needed to redefine what “doing my best” really meant and how I would ultimately achieve my goals. This time, frustrated to a degree, I became skeptical and cynical, and questioned the future of the profession I had so passionately chosen and loved.  

The moral of this story here is that no matter how hard we try, change is inevitable. Sometimes it serves to advance our specialty, and sometimes it is frustrating and seemingly sets us back. I had experienced both the good and the bad of progress, but in the end, I wanted to be progressive and part of the solution to the problems which afflicted us. To this end, I turned to involvement in the AAE and becoming an educator to “do my best” to advance, support, and strengthen our profession. I consider these to be the most significant and fulfilling professional decisions I have ever made. 

What does the future hold for us as a specialty? It is a fair question considering the new, powerful, and existential threats to our specialty of endodontics and to endodontic practice. At the base of these threats is a general failure to recognize the vast differences in the skill levels of general dentists versus endodontists in delivering endodontic care to our patients. This failure occurs at multiple levels—the public, insurance companies, organized dentistry, local and state legislatures, and dental educational institutions. It is truly a difficult task to stem the tide of this lack of knowledge and respect. 

Earlier this year I had the opportunity to meet with the directors of several dental insurance companies. Together with fellow AAE members Alan Gluskin, Elizabeth Perry, and Ken Wiltbank we were able to discuss our concerns regarding endodontic procedures and insurance reimbursement. Our message was loud and clear—that the knowledge and expertise of endodontists clearly makes them more competent and successful in delivering endodontic care, and that the sequalae of poor or substandard endodontics not only puts the health of the public at risk, but potentially affects the economics of their business and their ability to fund dental care equitably. In addition, we voiced our concerns regarding quality control instituted by dental carriers and urged them to be more diligent and discerning when considering reimbursement for substandard endodontic procedures. We spoke of codes and procedures which make endodontic therapy more predictable and with improved outcomes and urged the directors to consider compensating endodontists for these advanced procedures.  

Unfortunately, today many of our members face the stark reality of having dental insurance reimbursements reduced. Admittedly, these actions bring into question the ability of endodontic practitioners to work with insurance carriers heading into the future. More importantly, it raises concerns regarding access to quality endodontic care and health equity for the citizens of our country. The AAE has vehemently disapproved of these unfair reductions. We have communicated with state legislatures, state dental associations, and dental insurance companies to express our dissatisfaction. We have supported “Question 2”, a ballot measure in the state of Massachusetts which will potentially limit medical loss ratios and force insurance companies to spend more of their resources on patients and reimbursements. We have reached out to our membership with our message and with a survey to gather information about how these changes will directly affect you. We urge everyone to participate in this survey as we continue to approach this difficult situation, and to create grassroots campaigns through your local and state dental societies and state legislatures. As always, we assure you that the AAE is working to help you. 

Our endodontic educational system is in crisis. There is a shortage of endodontic educators (endodontists) in our dental schools. In an era where undergraduate dental students are taught to be “Super Generalists”, students are often expected to treat cases that are above their capabilities, often in the absence of qualified instructors, and in environments where requirements supersede patient welfare. This ultimately affects the quality of endodontic therapy in our communities and fuels the misconceptions regarding the validity and relevance of endodontic therapy to save teeth. The AAE and Foundation for Endodontics encourage all endodontists to become educators, even if only on a part-time or limited basis. The future of our specialty depends upon us, and we can make a difference. 

Yes, I am concerned about the future of our specialty. And yes, it isn’t getting any easier to “do your best”. But the solution is not to give up, become disillusioned, or to become frustrated. Rather the solution is to continue to do our best, become involved in our cause, and continue to deliver the best possible care to our patients as we fight for our goal to save the natural dentition. I will continue to do my best to deliver my messages supporting our expertise, quality, and the superior care we provide our patients. What will you do? Please become involved in our cause.