Imagine a time when it was considered revolutionary to hear a concert down a telephone line! This occurred in 1892 at the 13^th British Dental Association (BDA) conference in Manchester, courtesy of the National Telephone Company.

I have this information on good authority from the BDA Museum which had a stand at the 2014 BDA conference, also in Manchester. Some 200 delegates went to the 1892 meeting. Apparently one of the highlights was a discussion about the extraction of first permanent molars. The majority of delegates  concluded that “extraction should be avoided if possible unless the teeth were unsaveable.”

How interesting that 122 years later there is a Saving Teeth Awareness Campaign which highlights how important it is for teeth to be saved: www.savingteeth.co.uk

When it comes to technology, however, times have certainly changed. At the 2014 meeting the range of equipment and technology was staggering. Meanwhile, one of the highlights of the 1892 BDA meeting was the application of electricity to dentistry!

Not so long ago, it was predicted that with the advent of fluoride toothpaste and improved care of our teeth, dentists would become redundant.  But those predictions proved wrong, very wrong. Not only do we have more dentists in the UK than 20 years ago, but there are new conditions emerging for the profession to contend with.

One of those conditions is tooth wear. The causes are multi-factorial. Teeth can be worn down by grinding or clenching, known as bruxism, a feature of stress; or by acids in the diet or from acid reflux due to a health problem or bulimia; or thirdly, through abrasion from a coarse diet or vigorous tooth-brushing. More often than not, it’s from a combination of two or even three of those factors.

My colleague Professor Andrew Eder is an authority on tooth wear and I’m full of admiration for the work he is doing to raise awareness of the condition.

I ask him if it’s possible that the increase in tooth wear can be reversed?   He tells me it’s unlikely, since stress is almost unavoidable. Furthermore, erosion is also associated with modern lifestyles and high standards of living and is seen in people who drink a lot of wine, have unusual diets or are dedicated athletes.

All we can do is make sure our patients understand how they can keep the impact of tooth wear to a minimum, which is exactly what Professor Eder and the London Tooth Wear Centre^® are doing.

In the world of medicine, a specialist appointment for a complex medical problem is a regular part of the treatment pathway. As patients, we positively welcome the moment the GP says he or she thinks we should be referred to see a specialist to help diagnose and treat the condition that cannot be resolved in primary care. At no time is there any charge for these appointments – unless you choose to see a specialist privately.

In dentistry, also available as an NHS treatment, but for which the majority of patients pay a fee, the boundaries between general practice and specialist practice are not so clear. Nor is there the same level of specialist care available to NHS dental patients. If you are an adult patient who needs endodontic treatment, for instance, and your dentist says you need to see a specialist, it’s difficult to find a specialist who will treat you as an NHS patient. You might find an endodontist in a hospital to whom you can be referred, but the risk is that you won’t reach the top of the waiting list in time for your tooth to be saved. Medicine and dentistry overlap, but they are still worlds apart.

In the world of audiology, an entirely different system prevails. If you are hard of hearing, it’s possible to be referred to a hospital specialist and then supplied with a hearing aid and batteries, all courtesy of the NHS, with no charge at all.

How has it arisen that we must pay a fee for a crown, for instance, which will save our tooth, but not for a hearing aid? It’s often said that we are more likely to value what we pay for, but many British people are still indifferent to the value of their teeth, despite having to pay for treatment.

Having said all of this, I do notice a sea change. More patients are coming to see me saying they have put their endodontic treatment before a holiday or other indulgence. The heavy metal generation, those whose teeth will need life long maintenance, don’t want to be like their parents, with the glass beside the bed to hold their dentures overnight.

This is very welcome. But I would still like to see all the different health arenas dealt with more equitably – wouldn’t you?

Next year holds an exciting prospect – a 40-year reunion with  all the dentists in my year at Birmingham dental school. There were 75 of us and most are still going strong. Interestingly, one fifth of the group were – and still are! –  women. I don’t think any dental school today would launch a cohort with less than 50% women. I hope this reflects the greater equality in society but it might also be simply that women get better exam results!

I am sad that there are some colleagues who won’t be there: Four have died and two have been forced to leave the register.  Quite a few colleagues have retired although I’m hoping that they will come along anyway.

It’s a shame that the new Birmingham dental school won’t quite be ready. This is going to be the site of the former BBC Pebble Mill studios and will be the UK’s first stand alone dental school and hospital in 40 years. It will open its doors, so I’m told, in 2015. So, in the next two years I will be paying two autumn visits to Birmingham, one in 2014 looking nostalgically backwards in time and then again in 2015, looking to the future of the dental profession.

Competition is an infinitely complex area among dentists and dental specialists. It’s not like supermarket conglomerates battling each other out over price. In dentistry, your friends and colleagues are your competition. People who go to the same meetings or belong to the same societies or love what they do as much as you do.

In my case, this is Endodontics. The Harley Street Centre for Endodontics is competing with dentists who are highly competent at Endodontics and then there are endodontic specialists who run rival practices or work as visiting specialists in general practice.

Do I mind? Do I take a leaf from the book of a supermarket and put up a sign in my window advertising that my price is the same as the Endodontist down the road? The Office of Fair Trading would take a dim view of this, of course, but more importantly, this is not the way I want to promote myself.

What matters most to me is that patients get excellent treatment wherever they choose to go. It is with this in mind that I have worked with Dentsply on the development of WaveOne, which simplifies Endodontics. And the reason that I lecture as much as I do is that I love to share what I know. I’m not sending myelf a herogram here, I really enjoy teaching.

As I write, a new Facebook movement has launched dedicated to Cosmetic Orthodontics by general dentists. This is in reaction to an advertisement placed in the national press advising patients to be wary of the “quick fix” in orthodontics.  I understand that some orthodontic patients can be treated very well in just a few months, while others would benefit from long-term orthodontics or even inter-disciplinary treatment by specialists.

The trouble, I think, arises with the use of the word “cosmetic” which some dental practices are using as a key marketing issue. This is not a word we hear very often in the world of Endodontics. We don’t differentiate between specialist and non-specialist, we just want excellent Endodontic treatment to be available to all our patients, regardless of who provides it.

Right now I’m sitting in Moscow’s Domodedevo airport, in transit to a place called Cheboksary, about 500 miles to the east. I am going to present a 4 hour lecture on the application of endodontic concepts in the development, design and usage of a new endodontic instrument used in reciprocation.

The instrument is Dentsply Maillefer’s WaveOne of which I am a co-inventor. After the lecture I will give a masterclass using the microscope and extracted teeth to illustrate three dimensional obturation with Calamus and Gutta Core, also working with WaveOne.

Actually, I have already done the same lecture twice this week. Firstly, in a place called Khanty Mansiysk in Northern Siberia and Rostov on Don in southern Russia.

Khantiy is the home of many preserved mammoths found in the ice – pictured below. Fascinating archeological park. We lectured to around 100 dentists in a government run clinic. They liked the idea of a single file system. Endodontics can never be simple but we can try to make it simpler.

Afterwards I could have done with an early night but was taken out to eat in a local restaurant to enjoy huge piles of food, mainly fish, and of course many vodka toasts. I have learnt to sip the glass rather than finish it off because there are so many toasts, including mine. Always fun, the Russians are such warm and welcoming hosts.

Rostov is a beautiful place on the Don river. The room was packed with general dentists and local opinion leaders who had travelled over 500 miles to see me. Russia is simply huge

I enjoy my visits to Russia. They are so keen to learn here, especially new technology and as you know I so like teaching.

Sadly, as I travel home, I will miss my beloved Spurs play Chelsea at the weekend, but you can’t have it all!

Mammoths on show in Khantiy, Russia

I was in India for the launch of a piece of new clinical kit that I co-developed over the summer. Like many visitors, I was struck by the extremes.  The standard of dental treatment I witnessed was high yet many millions of people do not even own a toothbrush. Outside of the lecture theatre, I was delighted to go to Leopold’s cafe, the place frequented by the writer David Gregory Roberts. Having read the novel Shantaram several times, largely true and largely set in India, it was amazing to walk in Roberts’ footsteps –  perhaps I even sat on the same barstool as he did…. a bonus of being on an international speaker list.