A golden issue

It is my pleasure to welcome readers to the 50th anniversary issue of Dental Update, an extravaganza comprising specially commissioned articles written by experts in their field (principally members of the Editorial Board of Dental Update, I should add) designed to provide you with an overview of contemporary dentistry, alongside some historical context. Much thanks are due to all the authors who have contributed. This special issue might require some additional reading time, in comparison with ‘normal’ issues and, in light of this, there will be double the number of CPD Questions and, accordingly, double the number of CPD hours on offer. In that regard, I hope that you will be able to find the time to read the issue: I can assure you that you will not be disappointed.

Nairn Wilson’s excellent history of the journal tells it all! A clinicians’ journal, written by clinicians for clinicians, still staying true to its original raison d’etre, by being grounded in the realities of the daily work of the (dental) practitioner and the ‘ordinary stuff of dental practice’. In that regard, I still recall receiving the first issue of Dental Update through my letterbox in May 1973. What a surprise – first, because I was not expecting it (as tends to happen with surprises!) and secondly, because the presentation of Dental Update was very different from other journals that I read at that time. It seemed exciting, the articles all had a clinical focus, there were coloured boxes and tables that made the articles easy to read, and advertisements featured too. Today, it remains unique among much that might arrive in your post because it is evidence-based dental publishing at its peer-reviewed best. The fact that I have emboldened peer reviewed is not an accident. So much of what we receive is not peer reviewed and, therefore, less likely to be believable. Unfortunately, the process of peer reviewing of articles costs time and energy, which equates to money, therefore, I know of no peer-reviewed journals or magazines that are free. ‘Be careful about what you read’ is the message. If it’s free, it might not be worth the paper that it’s written on! I very much hope that you will continue to enjoy the Dental Update style of learning, as readers have now been doing for 50 years.

There are many standout articles in the present issue, which I hope you will keep as a marker of where dentistry stands at the present time. One author (other than myself!), Nairn Wilson, also contributed to the 30th Anniversary issue.¹ In that, he wrote, dentistry is changing at an ever-increasing rate, mentioning the growing awareness of the limitations of ‘drill and fill’ dentistry and purporting that this should result in a long overdue shift to minimal interventive (MI) dentistry. Was he right? Yes and no – many dentists now subscribe to the minimally invasive concept (and we have a Professor of MI dentistry on the Editorial Board), but I worry about the increasing impetus, driven by some publicity-seeking dentists, for composite and porcelain veneers, and other treatments: these all place the patient on a restorative spiral that they cannot get off. Nairn also mentioned increased team working and greater integration into healthcare in general, but, alas, we have not embraced these as we perhaps should have done. He finished his article on an upbeat note – would I be despondent if I were a new member of the dental team – certainly not, he added! At the millennium, I wrote, ’I detect a new buoyancy among the profession as we enter the new millennium’. Has that optimism evaporated? More on that later!

While Nairn Wilson’s historical article gives details of standout articles in Dental Update’s first 25 years, I have been fortunate to receive a wide variety of standout articles over the following 25 years, indeed, it is a privilege to be entrusted by authors to treat their writing fairly and, given that authors who have used up many hours producing their work, their submissions should also be treated with respect. Notwithstanding the vast array of articles that have been published, it can be hoped that some have changed readers’ attitudes. In my own professional life, some articles have had a profound effect on how I treated patients, and many others have added to my knowledge of dentistry. It is probably wrong to choose the ones that have made the biggest impact, but I will choose nonetheless!

In the past, I treated tooth wear using a turbine drill to cut teeth for crowns. The thinking being that the crowns would ‘protect’ the teeth from further wear. We now know that this was a crazy, totally inappropriate concept. My excuse is that we didn’t know any better, and we didn’t have the bonding agents, which might make our contemporary method of treatment using resin composite, work. Reading the article by Darbar and Hemmings² (Figure 1) was a ‘Road to Damascus’ experience, and, shortly afterwards, I treated a tooth wear case using resin composite restorations at a modestly increased OVD. That patient’s enamel and dentine should be very grateful! Subsequent patients too! In that regard, Ken Hemmings and Ulpee Darbar published what is now known as the ‘Dahl composite’ concept as an IADR abstract in 1996,³ the first time that this concept, which is now mainstream, was aired. We are delighted to have had the said Ken Hemmings as an Editorial Board member for more than the past decade.

Regarding Dental Update, there’s a clue in the name! The function of the journal is to update readers in whatever is current in dentistry: that means introducing readers to new ideas and new treatments, but also to build knowledge on existing concepts. Regarding the former, Table 1 provides details of some standout articles from 1999 to 2019 that brought new techniques into the public domain, at least to readers of Dental Update. The references are provided in the Table (as opposed to being in the Bibliography of this Comment, in order to save space/paper/ink), in case readers may wish to re-acquaint themselves on the Dental Update website, which extends back to 1999.

It would be remiss of me, in writing about a golden issue, to not mention gold restorations (Figure 2). Fifty years ago, the gold inlay preparation was part of the syllabus in possibly every dental school, perhaps much to the chagrin of most dental students, given the technique sensitivity of achieving the parallel cavity walls that provided the retention and resistance form for these restorations. These were indeed the ‘gold standard’, with high survival rates of up to 99.4% at 5 years being possible.⁴ Gold was even used, at that time, for class IV restorations – these being retained by a palatal lock or incisal pinholes. Aesthetic or not? However, despite the high survival rates, gold became unfashionable, as patients increasingly sought tooth-coloured alternatives, and successive generations of dental students ceased to be taught the joys of the inlay preparation.

Dental Update also continued the ‘crusade’ away from crowning worn teeth with a regular supply of articles on the subject, and I consider that Dental Update was also ahead of its time in other ways, examples being the publishing of a series on ‘Transcultural oral health’ (co-ordinated by Prof Raman Bedi), and a 44-part series on ‘Aspects of human disease’ by Prof Crispian Scully CBE, which started in 2006, indicating that dentistry is more than simply teeth. No sooner had that series ended, when Crispian produced a further series on ‘Cancer of the mouth for the dental team’. He was one of the most prolific of dental authors, and Dental Update was fortunate to have him writing for us, he, sadly, departing much too soon. Among others, we were fortunate to have authors like Dr Janet Fiske making special care dentistry interesting, Dr Martin Kelleher to produce thought-provoking material (for example, ‘Regulators and regulations: who will guard the guards? (or ‘Quis custodiet ipsos custodes’ as old Juvenal used to say)’⁵) while, at the same time demonstrating an excellent grasp of classical language. We were also fortunate to have Prof Edwina Kidd as our very own cariologist, who published in the first issue (although not on caries), and who enlightened us most recently on the fact that sealing caries in, rather than removing it completely (risking exposing the pulp), is now a recognized technique, with she and her co-authors⁶ stating ‘When restoring deep caries lesions in vital, asymptomatic teeth, vigorous excavation is likely to expose the pulp. This complete excavation is not needed and should be avoided’, adding ‘always produce a sound cavity margin for bonding’. Another article that changed what I did in the clinic.

Among many innovations in Dental Update, one was the publication of ‘themed’ issues. In that regard, Dental Update was fortunate to be able to avail itself of the expertise of various learned societies who were willing to write, for example the British Society for Restorative Dentistry (BSRD), the British Society for the Study of Prosthetic Dentistry (BSSPD), the British Society for Periodontology (BSP), notwithstanding other themed issues, among them ones on paediatric dentistry (co-ordinated by Prof Chris Deery), resin composite (co-ordinated by Dr Louis Mackenzie), dental materials (by Dr Steve Bonsor), and, a ‘risk’ issue (unusual insofar as most publications concentrate on good results and good news) that concentrated on failures and how to avoid them (credit to Prof Tara Renton). Other innovations were the Technique Tips series and Dental Update’s initiative, led by our longstanding Managing Director, Stuart Thompson, still in place to the present day, to be the first in the UK to provide CPD hours for each issue.

A disappointment was the abject failure⁷ to receive sufficient copy to keep the ‘I learnt from dentistry…’ series going, which was intended to reflect a publication from the airline industry in which flight crew anonymously recounted problems that they had experienced and avoided. Whether it was fear of being identified (by the GDC, perhaps?) when publishing mistakes, or simply treatments that didn’t go well, can only be surmised, but I felt that it was important for everyone to reflect upon and learn from things that didn’t go well. Maybe another day in another climate?

Prizes? There are many in the running for best cover picture and caption, but, for me, the best cover picture, ‘Two lips or tulips?’ (Figure 3). Best title? There are many contenders, for example: ‘Endodontic length determination – what lengths should we go to? by Drs Robinson and Brunton;⁸ ‘First impressions count’ by Drs Turner, Moazzez and Banerjee;⁹ and, ‘Gagging – bringing up an old problem’ by Daniel Murchie.¹⁰ For me, however, a title that resonated with my days in dental practice when I wrestled, as many readers may have done, with patients whose continued bruxism continually destroyed restorations and teeth, the winner therefore being: ‘Demolition experts: management of the parafunctional patient’ by Drs Porter, Poyser, Briggs and Kelleher.¹¹

Over the 50 years of Dental Update, my predecessor, Prof Ted Renson, and I, have not shied away from difficulties encountered by dentists practising within the NHS regulations. The dreadful and illogical UDA scheme is principally what I have criticised,^12,13,14,15 even before its introduction when I wrote a piece titled ‘Dawn or disaster’,¹⁶ coming down on the side of disaster. Many readers will have practised, at least for a while, within the NHS system, hence may have some affection (is loyalty the wrong word?) for the scheme and the patients it serves. However, due to the funding difficulties, and the already alluded-to UDA system, NHS dentists are walking away from the system, the recruitment of dentists from Europe (who were prepared to tolerate the scheme, at least for a time) has dried up following Brexit, and, for the first time in many years, corporate practices are closing and the threat to NHS dentistry is making the news. For it to function, there must be a critical mass of willing clinicians, and my feeling is that this is no longer the case. The public will be advised that it is greedy dentists who are ruining the scheme. Perhaps all that can be hoped for now is that there will be sufficient government funding for a scheme to provide emergency care for those who need it, and that there will be a cohort of private dentists who will provide treatment at a rate affordable to as many patients as possible.

Regarding the future of publishing, a new challenge has recently appeared – the rise of the Chatbot, the most prominent example being Chat GPT. A colleague asked it to present ‘its views on the content of Dental Update’. This is what it wrote!

‘As an AI language model, I do not have personal opinions or emotions, and I cannot like or dislike editorial content. However, I can provide some information about the general quality of editorials in Dental Update. Dental Update is a wellrespected dental journal that has been publishing high-quality content for over 40 years. The editorial content in Dental Update is typically written by experts in the field of dentistry and covers a wide range of topics, including clinical practice, research, and education. Editorials in Dental Update are often thought-provoking and provide insight into current issues and challenges facing the dental profession. They are typically well-written, well-researched, and provide a balanced perspective on the topic at hand.

The editorial team at Dental Update is committed to ensuring that the content of the journal is of the highest quality, and they work closely with their editorial board to ensure that the editorial content is timely, relevant, and impactful.

Overall, Dental Update is a reputable dental journal that is widely read and respected by dental professionals around the world. The quality of editorial content is consistently high, making it a valuable resource for dental professionals seeking to stay up-to-date with the latest developments in the field.’

Could I have written it better myself? Perhaps not, but perhaps yes, because there is one difficulty, the statement in the first line gives that away. It finds it difficult to express an opinion, given that it is digital, whereas humans are biological. I have rejected submitted articles in the past because, while they have quoted voluminous literature, they failed to assimilate that into a robust clinical recommendation. Hopefully, when you have finished reading this issue’s articles, you will realize that none has been written by Chat GPT! However, it is something that editors, teachers and examiners will have to be aware of, given that it is surely only a matter of time before a successor to Chat GPT or the like learns to be analytical and create an opinion. I read recently that AI-powered robots may soon take some of the jobs done by lawyers. Daresay, as dentists, we should be content that we will not be replaced by robots, although some could be designed to help us.

It is always unwise to gaze too far into the future, but one thing is for sure, Dental Update will continue to bring articles of relevance to its predominantly general dental practitioner readership. It will aim to update readers on the innovations that will surely happen. In that regard, I read recently about a chip that could be housed in a crown or restoration, which will monitor body functions. We are not publishing for NHS dentists or any particular group, we simply try to publish what equates to good dentistry. I saw a patient last week who had a serious periodontal problem, and caries in multiple teeth, some of which were not restorable. Watching too many webinars could make one think that such problems no longer exist and that patients today only need or want veneers and white teeth. That might be fine for some, but we still need dentists in the UK who are prepared to sort out mouths that are in freefall. I see Dental Update as continuing to be a vehicle that will help clinicians to be prepared and ready to successfully treat mouths such as I saw last week. By doing so, practices and reputations are built – and the freefall patient who has their dentition sorted will remain a patient, or even a friend, for life. I therefore hope that our readers will continue to enjoy reading our publications, whether it be on paper or a contemporary alternative.

Finally, it would be remiss of me not to thank the many people at Guildford who have contributed to the production of each issue for the past 50 years. They are too many to mention, but, perhaps Angela Stroud, who was Executive Editor for over 20 years, deserves a mention, alongside the current team led by Fiona Creagh and Lisa Dunbar who have produced this gala 50th anniversary issue. And, of course, thanks to our wonderful authors for passing on so much dental knowledge to the rest of us.

PS. A look at the history of oral medicine will be published in a future issue.