Written by: Russell S. Taichman, D.M.D., D.M.Sc.
In March 2019, I had an opportunity to see the future. So close, but no cigar.
At the time, I served as Dean for Research at the University of Michigan School of Dentistry. My office was in charge of bringing the guest speakers to campus for our Oral Health Sciences Lecture Series.
Typically, the lectures were held about a dozen times per year and spanned the science of dentistry. Topics included tissue engineering, microbiology, immunology, clinical sciences, materials sciences, gene therapy, artificial intelligence, archeology, cancer, and vertebrate evolution, among others. Sometimes a lecture would appeal to a very narrow band of individuals who were purely focused on bringing better oral health to our nation’s citizens. But some of the talks would span disciplines. With their broad appeal, the room would be packed with guests from across campus.
In either case, a committee of representatives from various aspects of the dental community would get together to identify topics and speakers so that all constituents got to hear something that related to their areas. It was my job to bring something new to the table, something that no one else would think of.
That March, I got it right. I just didn’t see how right I was at the time.
One year earlier, several news outlets reported on the work of Randall J. Nett, M.D., et al (2018). Published in the Morbidity and Mortality Weekly Report (MMWR), a series by the Centers for Disease Control and Prevention (CDC), Dr. Nett’s work was on a cluster of ten dentists and one dental technician who were diagnosed with idiopathic pulmonary fibrosis (IPF) by a Virginia specialty clinic during 2000–2017. Notably, none of the dentists worked in the same dental clinic.
IPF is a progressive lung disease of unknown cause and associated with an extremely poor outcome. Startlingly and significantly, the number of dentists treated for IPF was 29 times higher than the number of dentists expected to be diagnosed with IPF. Unfortunately, no clear cause for IPF was identified. However, work-related exposures were suspected since dental personnel can be exposed to a variety of breathing hazards including dust, chemicals, bacteria, viruses, and other irritants.
The thing is, these dentists were dying of something unknown, but very likely spread by something in the air. And what did Dr. Nett advocate for the profession? First and foremost, more science. But in the meantime, was there a need for dentists to wear respirators? In 2018, that was unthinkable.
So I invited Dr. Nett to share his work and as I began his introduction that day back in March 2019, I set the stage by highlighting a few of the many breakthroughs that have changed how we practice dentistry – three, from my perspective, that really stand out. The initial one happened in 1846 when William G. T. Morton, a dentist, was the first to successfully use ether as an anesthetic during a surgery at Massachusetts General Hospital. The second was the invention of the electric dental drill patented in 1875 by George F. Green. It literally revolutionized patient care, opening the door to how we practice today. And the third happened as a result of the AIDS epidemic in the 1980s. The introduction of universal bloodborne precautions, such as the use of surgical gloves, was monumental. Though I can distinctly remember dentists who had performed oral and periodontal surgery prior to the epidemic complaining that the newly-mandated gloves hindered their ability to “feel their patients.” At the time, I speculated that Dr. Nett’s findings might be the next industry disruptor to again change the way we practice.
Now six months into the COVID-19 pandemic, I wonder what would have happened if we had really seen the road ahead for what it was? Would we have stocked up on N95 respirators and other PPE? Would we have started to develop high volume aerosol mitigation systems earlier? What business or new practice opportunities could have been developed if we had several months’ heads up as to what was coming down the pike? Who knows…
There are many lessons to be learned. The easy one is to pay attention to the news. In December 2019, it turns out that it was predictable that the SARS-CoV-2 infection was going to be a major disruptor. However, the lesson I think is most germane - learning from other fields is good clinical practice. I cannot tell you how many colleagues, throughout this pandemic experience, have said they wish they had paid more attention to virology, blood borne pathogens, vaccines, and public health.
And what if we had heeded Dr. Nett’s lessons a little more carefully? That reminds me of a lyric Robert Hunter wrote for the Grateful Dead song ‘Scarlet Begonias.’
Once in a while you get shown the light
In the strangest of places if you look at it right
I had the opportunity to see the future – and it ultimately affected the way we practice dentistry today.
Randall J. Nett, MD; Kristin J. Cummings, MD; Brenna Cannon; Jean Cox-Ganser, PhD; Steven D. Nathan, MD (2018, March 9). Dental Personnel Treated for Idiopathic Pulmonary Fibrosis at a Tertiary Care Center – Virginia 2000-2015. Morbidity and Mortality Weekly Report (MMWR), Weekly, 67(9);270–273. https://www.cdc.gov/mmwr/volumes/67/wr/mm6709a2.htm
