Yesterday, now, or tomorrow?

While researching a recent editorial¹ on contemporary cavity design and, in particular, the designs suggested by Richard Elderton,² I happened upon volume 13 of Dental Update, published throughout 1986. Of particular interest to me was the discovery of the occasional series entitled ‘Dentistry in the year 2000’, not simply because I wanted to glean if there was any truth in the predictions 14 years on (1986 to 2000), but also to ascertain if there was anything which might have pointed readers towards the year 2020. However, it was not solely the ‘2000’ series that took my eye but also the Editorial Comments by Ted Renson.

Readers will be interested to note that, as long ago as 1986, he wrote about the ‘Mercury hazard in dentistry’,³ occasioned by media reports that mercury-containing restorations might be harmful to patients, but pointing out that, if mercury toxicity was a problem, then dental workers and patients (whose life-time exposure to mercury is 10,000 times that of the general population) would have experienced symptoms, which was not the case. Following the Minamata Agreement in 2013, this remains a relevant topic in 2020.

Two papers by Langdon, examining Oral Surgery in the year 2000,^4,5 described surgical techniques which were designed to correct a wide variety of facial deformities and, to my surprise (because I thought these came later!), showed the value of CT scans which, they advised readers, produce ‘horizontal slices’ to reveal in great detail the presence of disease and deformity. He also mentioned the use of microsurgery, which was surely a look to the future at that time. Also, a look to the future was that ‘various forms of implants have been used with limited success’, adding that ‘Brånemark has recently developed a system which results in true osseointegration, claiming a 90% success for mandibular implants over a long follow up period.’ No one seemed to realize how important this paragraph would become in the year 2000 and, obviously, also today.

In another paper in the 2000 series, the title said it all – ‘gerodontics – a challenge to dentistry!’⁶ This detailed the size of the ‘problem’ in 1986 because of an increasingly elderly population predicted to rise by 25% by the year 2000, compared with a general increase in the population of the country of only 4%. The author stressed the importance of proper oral health guidance for the ‘gero’ group, given their potentially changed economic circumstances and possible limited dexterity. Roll on a further 20 years, and I am not sure that anything much has changed.

Perhaps it is my bias towards Restorative Dentistry, but I thought that the papers on this subject provided the best glimpse towards the future, albeit from what might today be considered an elementary level. I exclude from that the Elderton papers on cavity design and his second paper on ‘prospects for the future’.⁷ He was among the first to advise patients that, if they changed dentists, they received more fillings (13.6 vs 7.4 over a five-year cycle) and to advise clinicians that they often did not know why restorations failed, not a statement, at that time, which was likely to have ingratiated him to his colleagues. He also made it clear that, when restorations failed, they were invariably replaced by larger restorations in the repeat restoration replacement cycle. He predicted that ‘patients will demand a preventive philosophy, and that, by the year 2000, large factions of the dental profession will come to realise the inappropriateness of restorative dentistry and switch towards a preventive approach’. Has anyone noticed this today? Elderton also predicted that the median life of ‘routine’ restorations provided within the General Dental Services will have doubled. Alas, not!⁸ Also, alas, his prediction of a boom in preventively-orientated dental practices still has not happened.

While there are papers from current Editorial Board members (Mike Lewis, for example, on white patches,⁹ and myself describing early posterior composites¹⁰), it is worth mentioning that, while Dental Update is a predominantly clinical journal, even in 1986, as today, it dealt with current UK dento-political matters which were current at that time. Two Comments^11,12 covered the hot topic of the time, the approval by the General Dental Council which allowed dentists to advertise. Given that GV Black stated that ‘The professional man doesn't advertise or sell: he serves’, this was an earthquake ruling and the Editor, Ted Renson, condemned the change. In his second Comment on the topic, Ted Renson wrote that ‘we are witnessing a manifestation of a Government-inspired cultural revolution, with our values being ruthlessly turned upside down’, following this up with his anxieties about an intrusion of Government into the implied contract between society and the professions, with the professions being part of a society which does not require the state to govern all its affairs, but which recognizes the independence of those who provide a public service.

It may be considered difficult (indeed, impossible) to predict the future. This look back at a series of 1986 publications demonstrates this, with some of the clinical predictions coming true, in particular, the widespread acceptance of resin composite restorations for posterior teeth (referred to twice in volume 13), and the large number of implants (a brief mention!) being placed today. On the political front, Ted Renson's dismissal of advertising as a retrograde step, and the parallel erosion of professional integrity, has been with us now for such a time that no one comments upon it any longer.

This brings me to the correspondence and comments on the Dental Update website relating to Conor O'Malley's recent guest editorial.¹³ I should remind readers that the clinical articles in Dental Update are subject to peer review, and that, if they do not meet the standards of the reviewers, they are not published. However, Guest Editorials are not peer reviewed, with the author being free to write his/her own views on a particular subject if it is deemed by the Editorial Director that the subject might be of general interest to the readership. Similarly, my Comments, as in the days of Ted Renson mentioned above, are simply that – Comments, which I hope will be of interest. In the case of Conor O'Malley's article, I had hoped that this would alert the profession at large to the need to take better care of, and provide counselling to, those who may be subject to challenges by the Regulator or lawyers, or both. Hopefully this will now happen.

Finally, the advertising in 1986 seemed to me to be less politically correct than today! One, for denture cleaner and denture adhesive, featured two senior citizens riding bicycles, with a heading Confidence boosters! Perhaps it was only the elderly who rode bicycles at that time? Another featured a dancing couple (wearing ball gown and dinner suit, such as might be seen in Strictly Come Dancing) with the male asking the female What's a girl like you doing in a magazine like this? The advert was for a dental laboratory who don't believe in putting a foot wrong and working in harmony with the dental surgeon!