Recently, I received a copy of a letter from a well-known craniomandibular pain management practitioner in Ohio. It is a very disturbing letter written by the practitioner to his “Many Friends and Patients” explaining why he signed a consent agreement with the Ohio State Dental Board to suspend his license to practice for scheduled periods of time, even though the practitioner did not admit to any wrongdoing nor does the agreement conclude he has done anything wrong. So, what happened? After hearing his story, those in the field of craniomandibular pain management might surmise that this happened because the practitioner, in an effort to relieve his pain patients suffering from ischemic bone disease, dared to be at the forefront in the science of utilizing a new noninvasive, ultrasonic device to locate bony lesions (termed cavitations) in human jaws. Having a Ph.D. in the basic sciences, a curious mind and a strong desire to improve patient care, the practitioner evidently found it impossible to back away from the opportunity to participate in a scientific study designed to assist the FDA in determining if this devise should be approved for use by dentists to aid in diagnosing jawbone cavitations. His research was positive, and while the FDA did approve the sale and use of the ultrasonic device, apparently, a segment of the insurance industry, according to the practitioner, looked very unfavorably upon the device, as well those who used the device along with prescribed therapy. Although I understand that litigation ultimately resulted in an apparent financial settlement favoring the medical technology company that developed the ultrasonic device over an insurance company, the Ohio State Board of Dentistry made the decision to investigate the practitioner. The investigation concluded with the practitioner having “exhausted all personal financial means by which to continue this long legal battle,” signing a consent agreement that the practitioner's license would be suspended for scheduled periods of time during 2007, as well as other stipulations the practitioner must follow.
Over many years of practice and involvement in dental education, I have witnessed the evolution of the field of craniomandibular practice from a unilateral philosophy of tooth oriented treatment to an inclusive patient participation approach with a much stronger base in the science of physical medicine. Many in our field have been on the cutting edge of this evolution. In that position, they have suffered arrows of criticism and mountains of hardship, but fortunately for all of us and for our patients who have benefited from improved care, they were not deterred. Public conventional wisdom paints a mind-picture of a dental practitioner today who is somewhat more advanced than the image of Painless Parker of years gone by and who now uses many advances in technology and technique. Still, the new and improved picture of the dental practitioner does not allow our public to truly recognize or understand the scientific basis or merit of our profession. Like the practitioner from Ohio, if you challenge today's conventional image of dentistry by providing your patients with what you believe to be scientific cutting edge patient care in the field of craniomandibular practice, you may find yourself figuratively hanging from a thin thread of support that, if severed, can lead to emotional and financial disaster. So what can be done to effect change? All change, in my opinion, must start with education. If we are to traverse variations of the Painless Parker image and if we are to avoid the catastrophe our fellow practitioner in Ohio is experiencing, then the roots of dental education must change. We must insist that dental education be expanded to include a much stronger exposure to evidence-based, physical medicine. This is an area that most practitioners in craniomandibular practice have, with time and experience, recognized. We can continue to learn the science and the nuances of physical medicine from experience and from others, as we should, but until the knowledge base of dental education is changed, we may never correct the inaccurate perception of a modified Painless Parker public image of dentistry. We may never have rightful recognition by the public, other health professionals, or by the dental industry that we are truly a vital key to overall human physical wellbeing. Yes, our profession is now generally recognized for promoting the importance of oral health to overall health, but for the most part, this is limited to the potential ramifications of oral bacterial imbalance and infections to general health. While this is very significant, information promoting the relationship of good oral health to good general health usually excludes the interrelationship of craniofacial pain and dysfunction to the anatomic and physiologic systems of the human body. Thus, a very important segment for the overall wellbeing of an individual has little recognition. To me, we currently have a choice of abdicating our responsibilities for craniofacial pain and dysfunction management, continuing our current course of individualistic progress, or we can strongly insist that dental education, at its core and throughout the formal educational experience, include clinically relevant, evidence-based instruction in head and neck anatomy, physiology, microbiology, pharmacology, and neurology, all with emphasis on physical examination and diagnosis. This is, I believe, the most effective long-term method of changing the overall image of the profession of dentistry, particularly as it applies to craniomandibular practice. If we are to progress beyond our current course, the American Alliance of TMD Organizations, the organizations they represent, and each individual member must join together, step forward, and make a bold move to effect positive change for our future. It's a challenge that we must face. It is said we learn life's lessons vicariously and through experience, so let us learn from the devastating dilemma of our fellow practitioner from Ohio.
When I first heard of the many tribulations of the practitioner from Ohio, I was reminded of the story of David and Goliath. I am sure you remember the story. Goliath, a Philistine giant from Gath, stood over nine feet tall. His armor weighed over one hundred pounds, and he was a fearless warrior who had trained as such most of his life. When he issued a challenge to battle any member of the Israelite army for freedom or slavery of the entire country, no one from the Israelite army stepped forward. However, to the disbelief of those present, David, a diminutive shepherd, who had witnessed the challenge while visiting his brothers in the assembled Israelite army, did step forward. He had faith he could defeat the giant. Armed only with his shepherd's bag, staff, a sling, and five smooth stones from a nearby stream, David faced the giant. Goliath rushed to the attack to hurriedly dispose of this ruddy-faced boy, but David stepped forward, and with his sling and only one stone, slew the giant. The Philistine army fled in disbelief and fear with the Israelite army pursuing them all the way back to Gath. Freedom for Israel, at the time, was assured.
Like members of that Israelite army, few today have a desire to face a giant, but we surely must admire the Davids of our world who do. This is my constitutionally protected opinion, what is yours?
William F. Slagle D.D.S., M.Ed.
Dean Emeritus
University of Tennessee College of Dentistry
Seminole, Oklahoma
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