Allen Ali Nasseh, DDS, MMSc, opines for the hands-on dental education and training of general dentists to improve their clinical endodontic skills.
Q: What’s the current state of dental education, and what are the pressures on recent graduates?
A: Throughout the years, dentistry has become an increasingly complex discipline. During the past few decades, dental specialties have experienced a technological boom mandating retraining for the recent graduates only to stay current with the rapidly moving trends in clinical practice. As a result, the modern dental school curriculum can barely touch the tip of the iceberg when it comes to preparing dental students for the entire array of aspects of modern practice. Forgetting financial pressures of tuition and student loans for a moment, today’s dental students have to learn and manage a larger volume of information during the same 4 years than their predecessors did decades ago. It’s no surprise that many graduates find themselves missing critical information soon after graduation, requiring additional continuing education to make themselves more competitive in the marketplace.
Q: Do students learn enough to comfortably perform endodontic therapy as general dentists?
A: While educational opportunities are available in dental school to learn and focus more on endodontic therapy, the average dental student is torn among advances in operative, prosthodontics, periodontics, pediatric dentistry, orthodontics, endodontics, oral pathology, medicine, and surgery all at once. As a result, understanding the great body of knowledge in each discipline is only offered at the level of sufficiency rather than proficiency. Therefore, the average dental student has to have an inclination for a given discipline to learn more about it in school and thereafter; many students graduate with the bare minimum of endodontic experience and this translates into a lack of confidence in managing endodontic cases later in clinical practice.
Q: Is there anything unique about learning endodontics compared to other dental disciplines?
A: Almost any skill requires practice to master. We have all heard about the “10,000-hour rule” for mastery. We start by learning the theory, but dentistry as a whole requires converting ideas into clinical practice. This is, of course, a painstaking task. This is particularly true in endodontics which, unlike cosmetic dentistry, is a blind procedure. During endodontic therapy, biological theories meet their match in dexterity and the required fine motor skills for successful implementation of cleaning, shaping, and obturation in a small space. I believe that performing proficient molar endodontic therapy in a symptomatic, curved, calcified, 4-canal molar under local anesthesia in a patient with limited opening is one of the most difficult surgical procedures in all of medicine. No wonder iatrogenic problems are common, as done by the novice hand.
Q: Should general dentists do endodontics?
A: Yes indeed, but only if those general practitioners (GPs) feel comfortable doing endodontic procedures up to the highest standards. In the United States, and in aggregate, there are more endodontic cases than the existing practicing endodontists can handle on an annual basis. As a result, there’s a net need for general dental practitioners to do root canal therapy (RCT) to address this shortage. However, standards of care are set by endodontists, and therefore, it is important that GPs who decide to do RCT do so at the same standard of care as their endodontist colleagues. This requires enough formal didactic and hands-on training, along with clinical practice, to allow them to deliver comparable results. Many cases are simple, with one or 2 straight canals, and many GPs may limit their endodontic practice only to such cases. They do the simple cases, while referring the more challenging cases to their local specialist. That’s obviously the best arrangement in which the patient benefits the most. Under total quality management, practitioners stick to what they do best and the patient gets the best quality work given the requirements of each case. However, in some rural areas access to a specialist is not easy. Since standards of care are set by the specialist, in such cases the GPs must improve their skills to levels that approach those of the specialist in order to manage difficult cases. This can only happen by going through accelerated hands-on programs that provide concentrated didactic and practical training for mastership beyond lectures and short hands-on programs.
Q: What types of postgraduate programs are available, and which teach GPs what they need to know?
A: Many different educational opportunities are available for GPs interested in learning more about endodontics. Dentists can attend lectures and presentations at the local and national level offered by state societies and national organizations, such as the American Association of Endodontists. They can attend study clubs where they can learn from local specialists. They can read endodontic articles in scientific periodicals, read endodontic textbooks, watch online videos, and participate in chatrooms. All of these venues add to their theoretical understanding for successful endodontic practice plus help them find local mentors and ask their colleagues questions. Some didactic courses may have a short hands-on training component with an opportunity to implement a clinical technique on plastic blocks or extracted teeth. While these courses are superior to lecture-only courses, they leave some participants with additional needs for bridging the gap between what they’ve learned and clinical practice. As a result, additional centers with a concentrated didactic hands-on curriculum have recently popped up around the country that offer a more directed type of training to a small group. Next Level Endo in Philadelphia is one such center. There are several other such educational centers in the west coast as well.
Lastly, short of going back to school and receiving direct supervision while doing procedures, the highest level of hands-on training and supervision in short session currently available is through the Ultimate Hands-On Training Program, where dentists can get one-on-one supervision from an endodontist during a clinical procedure in the privacy of their own office. These 2-day courses, offered by RealWorldEndo, are designed to implement didactic and hands-on material from the first day of teaching into their treating actual patients in their own office under supervision during the second day. These courses aim to complete the educational circle back into the dentist’s own operatory where procedures are actually performed.
In conclusion, a variety of didactic, hands-on, and clinical services are available to GPs interested in furthering their education and treating teeth at various levels of difficulty. Certainly, for someone willing to learn, the opportunities for learning are increasingly within reach. This is the golden era of education, and a time when patients will enjoy the benefits of saving their teeth through RCT by dentists who are properly trained.
Dr. Nasseh received his master’s in medical sciences degree and certificate in endodontics from the Harvard School of Dental Medicine and his DDS from Northwestern University Dental School. While maintaining a private endodontic practice in Boston (msendo.com), he also holds a staff position at Harvard’s postdoctoral endodontic program and serves as the alumni editor of the Harvard Dental Bulletin. At RealWorldEndo, he is the CEO and president and can be reached at email@example.com or visit the website realworldendo.com.
Also By Dr. Nasseh
Three-Dimensional Instrumentation: The Promise of Minimally Invasive Preparations
Apicoectomy: The Misunderstood Surgical Procedure