A paradigm shift in our profession?

So what motivated me into becoming a dentist? I have been asked this question many times. I blame my dad. He was the self-professed ‘world’s worst dentist’, but the world’s best ‘people person’. He hated the craft of dentistry but was phenomenal with people and he loved his patients. We lived in Long Island, New York and he was known as ‘Doc’ to everybody and everyone loved him. What I really admired about him was that he was always available to people and I loved his creativity, this really influenced my future career.

I decided that I didn’t want to go to medical school, I didn’t want to have to deal with life and death situations. I became a dental technician and decided that dentistry was the sensible option for me as it combined my love of science with creativity and dealing with people.

I left the US when I was 20 and moved to Denmark where I worked as a dental technician, graduated from the Royal Dental School of Copenhagen in 1983 and eventually ran a full time general dental practice. Then, in 2001, the opportunity came up for me to work in a specialist referral practice in Windsor and so, along with my new wife, I took the decision to move to the UK.

Back to my roots

A few years ago, I decided to move away from practising in a specialist referral only environment and get back to my roots, focusing on general dentistry and oral health, with an emphasis on preventative care. So at the age of 58 I borrowed too much money and set up my new practice.

My focus has always been on the patient outcome rather than the dentist’s income. I’m passionate about what I do, I love what I do and I love coming to work. I believe in our profession but I don’t believe in corporate dentistry, I see it as extracting maximum profit for minimal responsibility. I believe in working on a one-to-one basis with my patients and I still do things today that drove me into dentistry in the first place, putting the patient at the centre, making them the focus.

My special interest is a minimally invasive biomimetric (MIB) approach to contemporary dentistry. Basically what this means is less is more. It’s very simple – the less we do the better for the teeth and oral health. Every procedure we do as dentists, be it in the NHS or at a top end private practice, has a limited shelf life, so the less we do to help people out of their problem or objective problems the better it is. MIB is restoring what nature gave us with man-made techniques and materials with minimal intervention, using synthetic materials to recreate the natural look and function of the teeth.

Earn your patients’ respect

So how does this fit in with patients who demand brighter, whiter, straighter teeth, you may ask? Patients requesting cosmetic treatments need to understand the implications. Every time we touch a tooth we hurt it biologically, once we cut through the enamel into the dentine we are amputating living tissue. The patient must be told this in advance, as part of informed consent, and be told the average life span of most cosmetic dentistry is about 10 years. If a 20-year-old is asking for veneers, there’s a chance they will need seven remakes in their lifetime if they live to be 100, and every remake will hurt the teeth even more. In my opinion many clinicians need to give patients more information, including what to expect in the long-term from any invasive cosmetic procedure.

Today’s public is very media-influenced, as we are all exposed to the current ‘celebrity’ culture, with many television and Hollywood stars presenting the ‘perfect’ straight, bright white smile. It can be a challenge to dissuade patients that many of these procedures will have long-term consequences, however, I believe we should be stronger and advise patients that these treatments may not be the best thing for them and that they need to think about their overall dental health.

So what would I say to a 25-year-old dentist looking to progress their career, whilst enjoying treating their patients and building a healthy, successful practice in the fullness of time? First you must earn the respect of your patients, once you have this, the financial rewards will come. Be patient. Get some skills. If you have the chance, go on a full-time post-graduate university course. Learn the right way under continued supervision. Also, learn how to say no to a patient by improving your 'soft skills’, as this will help you guide the patient so they can make the right decision for themselves. It’s called the ‘daughter test’. If it’s something that I’m not prepared to do on my daughter, I’m not doing it on the paying patient. That’s the bottom line.

After 30 years in this business I can appreciate how dentists leave university with extensive debt and get on the gravy train, and unfortunately I have seen many quickly lose interest in their chosen profession. It is my mission to guide and inspire young dentists to a better, more fulfilling dental career that delivers a life-long learning pathway for the benefit of patients.

David Winkler received his DDS from The Royal Dental College of Copenhagen, Denmark, in 1983 after having worked as a dental technician for three years. He is the founding president of the Scandinavian Academy of Esthetic Dentistry, past-president of the European Academy of Esthetic Dentistry, and a founding member of the British Academy of Aesthetic Dentistry. 

He is a member of the International College of Prosthodontists and a fellow of the International College of Dentists. He sits on the editorial and advisory board of the Journal of Esthetic and Restorative Dentistry, and Practical Procedures and Aesthetic Dentistry. He had a private practice in Denmark from 1983-2001 and has been working at Castleview Dental, Windsor since 1998. David will be providing the informative lecture, Ethics in Aesthetics – A paradigm shift (sponsored by NSK UK Ltd) on Friday 9 May at Clinical Innovations 2014 in King’s Place, London. For more information, visit: www.clinicalinnovations.co.uk or www.nsk-uk.com.

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