Blake's Blog

Art and Science of Dentists

As dentists we are a varied lot. To many, we are a resource in the path to oral health or the relief of pain. To others we have become a necessary partner in the pursuit of vanity. However we may be used or perceived, at our core we are part scientist and part artist. But how much of each? Or is it one more than the other? Let’s start with the dentist as a Scientist.
The Oxford English Dictionary defines scientist as a noun, “a person who is studying or has expert knowledge of one or more of the natural or physical sciences”. The origins of the word are arguably from the Greek word “epistemē”, which essentially translates as reliable knowledge built from strong premises. The Latin origins stem from “scientia”, which most directly means “knowledge”.
Somewhere in our formal education, we were all taught the merits of the scientific method, a pragmatic, logical system with which to deduce verifiable results. This is a good thing for our patients; the scientific method minimizes the influence of bias or prejudice when testing a hypothesis or theory. When a patient presents with a swollen upper anterior lip, we do not instantly blurt out “nurse, I’ll need my extraction set-up, stat!” No, we take a thorough medical history, perform a clinical exam, take the proper images- gather data to help us form a hypothesis and, with enough confirming data, assign a diagnosis. Up to this point we are relying on pure physical and deductive science. It is when we start to treat a patient that the lines blur between art and science.
So let’s look at the dentist as Artist.
A search thorough our OED gives us Artist- noun, a word of (surprise) Greek origins that stems from the word “technĕ”, which is most closely aligned with the mastery of any sort of craft. The Latin word is “tecnicus”, from which we have developed the English words: technique, technology, and technical. Most of us have heard both “technical” guitarists and “masters”. Think Ace Frehley vs. Jimmy Hendrix (Gen Y’s/Millennial’s, these artists flourished before rap was invented). Yes, we can bounce around to “Rock and roll all night” but we are transformed by “Voodoo Child”.
Returning to our patient with a swollen lip; our scientist/dentist has determined that the upper left central incisor has irreversible pulpitis. Our patient has been informed that, among other options, the tooth may best be treated with a root canal followed by internal bleaching and/or some kind of porcelain restoration. The treating endodontist and restorative dentist will most certainly need all of their scientific training to complete the procedures but, that assumed, treatment is where the artist takes over. The endodontist is particular in his workflow, nothing is rushed, every contingency has been prepared for. He strives not for a completed procedure, but for a statement of excellence- a puff from that sealed lateral canal, a healed lesion on the 5-year recall image. Referring clinicians know what his cases look like, his signature echo’s out of his final films. Though he may be able to cite the relevant literature pertinent to treating this case, this endodontist is an artist.
Even after a masterful root canal, our patient has yet to deal with a discolored tooth with an existing failing composite restoration; she has decided to have an all porcelain crown placed. Her restorative dentist is a bit eclectic. He has a nice office, 4 operatories, solid hygiene program, and many who visit notice an “overly large” laboratory area. The office is clean and efficient but not necessarily modern. The dentist spends 30 minutes actually preparing the tooth but another 30 taking records. This dentist has the nerve to charge $1,750 for this crown! But, this dentist does not ship the impression to some unknown faraway land- he does his own lab-work. From the prep to the cement cleanup, this dentist has a vision for the final restoration. Not just functional, imperceptible. Not just the right shade, the “bet you can’t tell which one’s the crown- money shot at some high end lecture” picture of beauty. The dentist’s fees are well earned; he is a master technician, an accomplished artist.
At the end of the day, the question remains: are dentist’s artists or scientists?

That is a question we must each answer. There are days we are both and others where we may be neither. What seems clear is that, as clinicians, a healthy balance is helpful. Albert Einstein perhaps captured some of this debate when he said: “I am enough of an artist to draw freely upon my imagination”