Dental Update: fifty years and going strong

Dental Update is a jewel in the crown of dental publications. It has provided pithy, contemporaneous editorials and articles of immediate practical relevance, together with a range of other valuable information and, for the last 26 years, verifiable continuing professional development. It has been a tremendous asset for those studying for postgraduate qualifications and, for many, it’s the journal in which they published their first paper. Dental Update is firmly established as a highly regarded source of ‘finger on the pulse’, ‘must-have’ knowledge and understanding in the everyday practice of dentistry.

Launch

Dental Update was launched in May 1973. The Editor was Dr Abraham Marcus of Update Publications Ltd, supported by Dr CE (Ted) Renson as Consultant Editor, then a Senior Lecturer in Conservative Dentistry at the London Hospital Medical College Dental School.

The inaugural, anonymous editorial was presumably written by Abraham Marcus and Ted Renson, who in 1978 went on to become Professor of Conservative Dentistry at the University of Hong Kong, and one of the founders of the Prince Philip Dental Hospital. The vision for Dental Update, a sibling, by 5 years, of Update founded in 1968 as a clinical journal and source of continuing education for general medical practitioners, was to provide a dental equivalent to Update ‘directed, in the main, to the general dental practitioner’. To achieve this goal, Dental Update had to be ‘grounded in the realities of the daily work of the (dental) practitioner’. And the continuing education provided had to be based on ‘what some of us might describe as the ordinary stuff of dental practice’.

Dental Update’s intended audience was wide. Dental Update was initially produced every 2 months and sent, free of charge, to all ‘general dental practitioners, practitioners working for local authorities, to dental professional staff in the Schools and Hospitals and to undergraduate students at clinical level’. Others not included in the free circulation could purchase single copies of Dental Update for 50p, inclusive of packing and postage.

The plan was to provide ‘a wide range of interest in each issue’, reflecting the activities of centres for postgraduate dental education across the UK – ‘selecting the best of the best to be shared nationally in print’, as a core component of the journal. A further section of the journal was to comprise series of commissioned articles produced by ‘distinguished teachers’, starting with ‘The extraction of teeth’ by Professor Paddy Killey and Dr Lester Kay, and ‘Preventive Dentistry’ by Dr Leon S Silverstone, who went on to be a prolific contributor to Dental Update. Other content was to include some revision of basic sciences, picture quizzes, ‘table top demonstrations’, and coverage of non-clinical aspects of the practitioner’s work – ‘organisation and management, premises and surgery design, staff and equipment’. Ted Renson was very keen on articles being presented succinctly and in plain English.

The cover of Volume 1, Number 1 is reproduced in Figure 1 and Table 1 gives details of the contents and authors.

Attraction and impact

A huge attraction and distinguishing characteristic of the newly launched Dental Update was full colour production. At the time, few dental journals produced anything in colour, and when they did it was usually at considerable cost to the author(s). To receive a full-colour journal, packed with information of immediate practical relevance, produced by the then high-profile leaders in their respective fields, and free of charge had a huge impact – it was a most welcome ‘freebie’, especially for anyone wishing to advance their knowledge and understanding of state-of-the-art, ‘coal face’ dentistry. The contemporaneous nature of Dental Update was reflected by the adverts included in the first and subsequent early issues of the journal:

• Adaptic: ’ the first choice (composite)
• for all anterior and selected posterior restorations …more than 100 million restorations completed…’;
• Flagyl: ‘…treatment of active ulcerative gingivitis … as effective as penicillin’;
• Ledermix: ‘The full treatment for exposed pulps, pulpitis and hypersensitive dentine;
• Valium Roche: ‘… the best sedative presently available’.

10 years on

In his tenth anniversary editorial, written in Hong Kong, Ted Renson ‘indulged’ himself by stepping ‘to one side of the cloak of anonymity’ behind which he had ‘sheltered these past ten years’ to reflect on the success of Dental Update. By 1983, Dental Update was being published 10 times per year, at the attractive annual subscription rate of £10.00 (£8.00 for students). Based on an expanding subscription list and a pre-eminent position in independent readership surveys, Ted claimed that Dental Update and the Dental Update team had achieved the founding aims and objectives of the journal and, in the process, improved on the initial high standards of the publication. Also, by this time, Leon Silverstone, who had been appointed Professor of Cariology and Associate Dean for Research at Colorado University, had produced the first Dental Update book based on his series of preventive dentistry articles first published in the journal. A second Dental Update book entitled ‘Oral Disease’ was edited by Ted Renson.

Quotes from editorials included in the first 10 volumes of Dental Update, which many may consider to ring true to this day include:

• ‘…objectives of undergraduate (dental) education cannot now be achieved by the present course’;
• ‘… the myth of complete and comprehensive NHS oral health care has been encouraged and maintained since 1948 by successive governments’;
• ‘…dentistry is low on the NHS priority list and the day may be at hand when a fundamental reappraisal of the place of dentistry in the NHS will be carried out’;
• ‘No government is ever likely to be honest enough to say we no longer feel it necessary to fund adult dental services, but there is good evidence for believing that this is a view held by many MPs’;
• ‘ …a great deal of restorative treatment provided at present is a result of ‘grey area’ decision making … a case for shifting the emphasis upon restorative work to prevention’,
• ‘…the NHS has attracted perhaps 60% of the population as regular seekers of dental care. Clearly, the time has come to attract the remaining 40% of society.’

Other highlights of the first 10 years of Dental Update included ground-breaking articles on dental photography, assisted four-handed dentistry, a link to help prepare candidates for the MGDS RCS Eng examination, and a growing reputation for the journal in which to first advertise new, innovative materials in the UK (eg in 1978, Fotofil (ICI Dental) – the first visible light-cured composite), and contributions by then up-and-coming academics (eg Crispian Scully¹), many of whom went on to become leaders in their respective fields of special interest and expertise, and regular contributors to Dental Update. This reflected the then focus on oral and dental research of immediate practical relevance to practice, predating ‘academic drift’ (the process whereby new knowledge and understanding gradually loses close ties with the realities of everyday practice) in oral and dental research.²

Reflections on the Renson years

Ted Renson continued as Editorial Director of Dental Update until 1996. Over 23 years, he had contributed to every issue of the journal, with many of his editorials and commentaries having been datelined from exotic and unusual places. His proud boast was that he always made his deadline. ‘Truly, but often only just’. In glowing tributes to Ted, published in a special ‘leave taking’ piece in the journal,³ the many eminent contributors emphasized Ted’s hallmark, personable, ever-welcoming, helpful approach, tempered by his sharp wit and incisive heart-of-the-matter style. The author of this history featured in the ‘leave taking piece’ concluding his tribute to Ted with ‘…Dentistry needs personalities like Ted… without them who will say what the silent majority only think?’ At the end of glowing tributes, a small boxed piece reads:

‘We are delighted to announce that Dr Trevor Burke will be joining Dental Update in the capacity of Editorial Director, from the May issue’.

Four years prior to Ted Renson standing down as Editorial Director of Dental Update, the journal published a ‘dental commentary’ reflecting on the previous 25 years (1967–1991). This commentary comprised excerpts from editorials and commentaries. The excerpts, most of which came from Dental Update pieces, reflected the journal’s, and Ted Renson’s continuing interests in patient care, preventive dentistry, the constructive use of epidemiological data, NHS administration, the education of dental students, conditions in general dental practice and, above all else ‘the good name of the profession of dentistry’.⁴ Examples of these excerpts, excluding excerpts from the first 10 years of the journal (supra vide) include:

•  Doubling the Demand for Dental Care, Dental Update, September 1985 ‘Because the non-attenders also suffer from a higher prevalence of dental disease, it is more than probable that dentists in the UK are being called upon to treat only half the quantum of disease that really exists among adults in the population. As a healing profession we have a duty to seek ways and means of converting this huge need into an equal demand. Here, clearly, is an area where collaborative clinical research and practice would be to the advantage of both the community and the profession.’
•  The (Dental) Contract and Coronary Heart Disease, Dental Update, June 1990

‘The life of a GDP is stressful. The major stressors which have been identified and documented include time-related pressures, high case-loads, financial worries and staff problems. Other stressors would include nervous patients, equipment breakdowns, defective materials and poor working conditions and, indirectly, even some of these have been laid at the door of the benighted contract!’

Other reflections on the 1983–1995 ‘Renson years’ (ie the later years of his time as Editorial Director), are many and varied. The journal consistently produced contents of wide general interest, ranging from articles on innovations in clinical practice⁵ to the hazards of the practice of dentistry,⁶ many other topics aside. In 1989, the first supplement to Dental Update was edited by RS (Ronnie) Levine.⁷ The topic of the supplement was saliva.

At a time of many developments and changes in the clinical practice of dentistry, Dental Update was a godsend for those who wished to keep up to date. Ted Renson, who was a keen conference attender, was to be congratulated on encouraging and, where necessary, commissioning timely articles that would provide practitioners with state-of-the-art information and guidance, published together with articles that reinforced core knowledge and understanding. He never relented on seeking to provide the readership of Dental Update with the ‘best of the best’. It was an honour and pleasure to be asked to produce a paper for Dental Update by Ted Renson (Box 1), with the added bonus that you could include as many colour illustrations as necessary, and you received an honorarium for your trouble!

The Burke years

As mentioned above, the position of Editorial Director of Dental Update passed to FJ Trevor Burke (Figure 2) in May 1996. At that time, Trevor was the recently appointed Professor of Primary Dental Care, University of Glasgow. Trevor’s appointment as Editorial Director proved to be popular and good for Dental Update. Little was it appreciated that Trevor would go on to hold this position with distinction through the 50-year, golden anniversary of the journal (Figure 2).

In his first editorial, Trevor advised readers that:

‘Results of a recent survey⁸ have indicated that it (Dental Update) is considered the best by UK dentists for keeping clinically up to date, a position it also held in 1992.

Trevor went on to say:

‘This is no mean demonstration of the position in the field of continuing dental education which Dental Update holds at present, and in which it has been a prime mover for almost quarter of a century.’

In declaring that there would ‘more of the same’, Trevor stated:

‘…Dental Update will continue to strive to produce material of interest and relevance to clinical practice’

This was a commitment repeated in all subsequent anniversary issues of the journal.

Trevor Burke, like his predecessor, Ted Renson, has not shied away from saying what the silent majority think and others in high-profile positions would say only in private conversations, if at all. With his background in general dental practice, followed by his highly successful academic career in general and restorative dentistry, Trevor has been well placed to comment on affairs in dentistry. Also, rather like a chat-show host, through rubbing shoulders and interacting with practitioners, students and the great and the good, rising stars and colleagues of the moment, Trevor has been uniquely placed to be a commentator, soothsayer and seer of contemporary dentistry. Themes he often returns to in his circa 240 editorials to date include the perverse effects of UDAs (units of dental activity) in the provision of NHS dental care, the importance of lifelong learning, pitfalls and negative outcomes of dental tourism, excessive intervention – ‘tooth cutters’, specifically extensive preparation solely for cosmetic enhancement, concerns about the ‘corporatization ‘ of dentistry in the UK and ‘green dentistry’.

Box 1.A footnote on Ted Renson.Ted Renson, son of a dental practitioner, wireless operator and gunner in Lancaster bombers in World War II, and highly acclaimed clinical academic, who never really retired, continued on, following his 23 years as Editorial Director of Dental Update, as an active dental journalist and to create and edit Primary Dental Care – the journal of the Faculty of General Dental Practice (UK). Ted, who, as stated in one of his obituaries (Br Dent J 2005;199:p4) had the gift of eternal youth, ‘…a Peter Pan figure who matured around 60 years of age and never got older…’, died peacefully at his home in Spain on 1 July 2005.

Trevor is a ‘larger than life’, ‘glass half full’ person who sees opportunity wherever his travels and thinking take him. For example, at the turn of the century, possibly basking in ‘millennium optimism’, following the failure of the ‘Millenium Bug’ to cause ‘IT Armageddon’, and despite widespread anxieties over what the future might hold, specifically among ‘front line’ general dental practitioners, Trevor proclaimed:

‘I detect a new buoyancy among the profession as we enter the new millennium’.

Also, from time to time, Trevor has lamented patients’ unreasonable expectations. For example, in 2008 he wrote:

‘Some patients may be happy to pay vast sums of money for their personal trainer, but not so happy for their oral health trainer. The big challenge therefore is to educate patients to pay for no, or less intervention and for prevention’.

This is as true today as it was then.

A view among aficionados of Trevor’s editorials is that Trevor has become more reflective and philosophical over the years, stemming from around 2010 when he mused:

‘Business and dentistry are, indeed, inextricably linked, but it is good for our patients that (in most cases) good care prevails over the motive to make money’.

That said, Trevor is to be congratulated on the remarkable archive of timely, thoughtprovoking, sometimes hard-hitting editorials he has created, many with great titles, for example: ‘How wet is wet?’ and ‘Adhere today, gone tomorrow’.

If you wished to study the recent history of dentistry in the UK, Trevor’s editorials would be a good place to start. Also, Trevor is to be commended for his element of surprise. There is always that frisson of anticipation when picking up a new issue of Dental Update to read Trevor’s latest epistle – a hallmark of an accomplished editor.

Front covers

One of the added features to Dental Update during Trevor Burke’s time as Editorial Director has been striking full colour, front cover images (Figure 3).

Contents

A review of the contents of Dental Update, based on a Medline search, which indexed the journal from launch in 1973 until 2017, and a subsequent online (MAG Online library) search, 2017 until April 2022, the time of starting work on this history, identified 5873 articles, excluding editorials and comment/opinion pieces. The number and percentage of articles in different aspects of dentistry are given in Table 2 (noting that some articles have considered more than one aspect of clinical practice):

While, in hindsight, it could be argued that some subject areas could have received more attention (eg oral surgery and dental materials) over the 50 years of Dental Update, such findings could be viewed as a failure of leaders in certain fields to take advantage of the superb platform provided by Dental Update to communicate with the ‘broad church’ readership of the journal. Such considerations aside, the spread of topics covered has been commendable and relevant to the ever-changing environment of everyday dentistry. Importantly, Dental Update has been bold in presenting its readership with articles that should be read, rather than pandering to immediate interests and favoured topics of the day.

There have been a large number of significant papers published in Dental Update over the past 50 years – too many to list in full in the space available. ‘Stand out’/‘wake-up-call’ papers, specifically for practitioners who relied on Dental Update for new knowledge and understanding during the editorship of Ted Renson, may be considered to include:

• EAM Kidd: Dental suffragettes;⁹
• AD Wilson: The development of glassionomer cements;¹⁰
• WM Tay and MJ Shaw: The Rochette adhesive bridge;¹¹
• JR Grundy: The hazard of aerosols;¹²
• R Rippon: The challenge of dental care for the handicapped;¹³
• EF Corbet: Periodontal treatment: does it work?;¹⁴
• KJ Lewis: The delivery of prevention in general dental practice;¹⁵
• E Paul: Are you sitting comfortably;¹⁶
• JD Muir: The removable appliance: the Cinderella of British orthodontics;¹⁷
• RJ Elderton: Current thinking on cavity design;¹⁸
• AWG Walls and IE Barnes:Gerodontology: the problem? (First in a series of 15 articles);¹⁹
• RM Watson et al: Osseointegrated implants: principles and practice;²⁰
• AC Shearer: Bleaching of teeth;²¹
• CE Renson: Hollow pledges and the NHS;²²
• Burke FJT et al. Contemporary concepts in the pathogenesis of the Class V non-carious lesion.²³

Exceptional papers during the ‘Burke years’ are identified by Trevor elsewhere in this anniversary issue.

Other contents of Dental Update have included Letters to the Editor and responses from authors, abstracts – hard work to produce for every issue of a journal (compilers Peter Carotte and Richard Oliver), (Damien) Walmsley’s Web Watch, which was highly informative, specifically for IT dinosaurs, Physical Signs for the GDP – a tour de force by Steve Bain, John Hamburger et al, and tremendous series of papers such as ‘Aspects of human disease’ by Crispian Scully CBE et al.

Supplements

Dental Update has had very few supplements in the first 50 years of its publication. Notable among the Dental Update supplements is the supplement by Crispian Scully and Daljit Gill, first published in March 2010 and sponsored by Denplan, providing a listing of the ever-increasing number of acronyms in dentistry.²⁴ This supplement and its subsequent iterations were great pieces of work, specifically for those engaged in dental publishing and administration, let alone non-dentists in the dental world often bewildered by dental ‘alphabetispagehetti’.

Innovations

In addition to having been the first full colour dental journal in the UK, and the innovative approach and format devised by Drs Marcus and Renson, Dental Update can claim a number of innovations, notably the introduction of a ‘continuing assessment section’ in 1997, which preempted the availability of verifiable continuing professional development (CPD) credit arrangements in other journals. Verifiable CPD became available in Dental Update in 2000.

Other innovations included an annual acknowledgement of reviewers, a reader’s panel (initially May Hendry, Philip Shaw, Russ Ladwa, Len D’Cruz, Martin Forde and David Watson), highly successful, journal-related educational conferences and study-day roadshows, taking in cities across the UK, and a journal website and app, allowing, among other things, journal content to be downloaded.

Editorial Board

The founding Editorial Board included a number of the then luminaries in UK dentistry, including Professors GL Slack, IR Kramer, RD Emslie and CH Tonge, together with a powerful group of individuals sharing common interests and activities in the provision of high-quality postgraduate dental education. This group comprised: Dr D Greer Walker, Postgraduate Dental Dean, British Postgraduate Medical Foundation; Mr J Farrell, Postgraduate Dental Adviser, University of Bristol; RA Peebles, Consultant Oral Surgeon and Postgraduate Dental Tutor, Kingston Postgraduate Medical Centre; Mr HLM Williams, General Dental Practitioner and Chair of the Dental Health Committee of the British Dental Association, and Mr DH Robertson-Ritchie, General Dental Practitioner and Postgraduate Dental Tutor, Chichester Postgraduate Medical Centre. Looking back, this Board was surprisingly southeast centric for a journal intended to have UK-wide appeal.

Over the years a sizeable number of eminent, high-profile individuals, dental glitterati, have served on the Editorial Board of Dental Update, including in more recent years, and in no particular order: Edwina Kidd, Chris Stephens, Linda Shaw, David McGowan, Roger Watson, Richard Ibbetson, Chris Emery, J Bernard (Bernie) Kieser, Richard Palmer, Damien Walmsley, John Frame, Robin Davies, David Ricketts, Jonathan Sandler, Kathryn Harley, Alisdair Miller, Crispian Scully CBE, Richard Ibbetson, Robin Seymour, Richard Oliver, Len D’Cruz, Tif Qureshi, Andrew Skelton, Philip Ower, Avijit Banerjee, Subir Banerji, Steve Bonsor, Daniel Brierley, Andrew Chandrapal, Len D’Cruz, Chris Deery, Ian Dunn, Pynadath George, Ken Hemmings, Mike Lewis, Louis Mackenzie, Ewen McColl, Tara Renton, David Ricketts, Jonathan Sandler and Fiona Sandom.

Edwina Kidd, appointed by Ted Renson in 1988, holds the record for the longest serving member of the Board. Professor Chris Steven’s comments on the occasion of his retirement from the Board speak volumes on the working and camaraderie of the Board:

‘I will miss the friendship and educational stimulus of the Board meetings, the company and wit of its (notorious) dinners and the crate of well-chosen wine at Christmas’.

Concluding remarks

Dental Update is a long-established, highly regarded, ‘must-be-read’, multidisciplinary journal of substantial standing, specifically among its intended readership. Two, world-class and internationally renowned editors (Ted Renson and Trevor Burke) have nurtured and championed Dental Update through its illustrious history, giving it, as intended, immediate relevance to the contemporary practice of dentistry. The dental literature has been enriched by Dental Update and, most importantly it has, as originally envisaged, met many, different educational needs, thereby enhancing the care of countless numbers of patients. In the words of Sir Paul Bramley in the twentieth anniversary issue:

‘Dental Update is a precisely targeted, effectively illustrated and, above all, widely read journal – a great contribution to continuing education’.

As true today as it was then.

In the words of Stuart Thompson, Publishing Director of Dental Update) for the past 23 years, Dental Update:

‘presented in a relaxed and understandable tone using great dental photography, offers subscribers valuable solutions to everyday problems; every article, typically written by clinicians for clinicians, must be relevant to today’s dentistry and for GDPs operating at the coalface of dentistry’.²⁵

Congratulations to Dental Update, specifically to Ted Renson, Trevor Burke and the editorial and production teams over the years, as well as to all those who have contributed to the tremendous success of the title over its first 50 years. Long may Dental Update continue to educate and inform through the publication of timely, wellresearched articles grounded in the realities of everyday practice.

Happy 50^th Anniversary Dental Update!