Editorials
The ethical responsibility of teaching
Jean-François ROULET DDS, PhD, Dr hc, Prof hc, Professor
Editor-in-Chief
Dear readers, If you were a general, going to war, you would teach your students warfare, strategies and tactical movements to reach your objective to defeat the enemy. In order to do so you accept that people would die, some on your enemy side and some within your own troops. If you were a physician, you would teach your students how to prevent and treat diseases. Would you teach them how to kill a human being? – Of course not, since physicians must comply with the Hippocratic Oath. This simple example shows that in medicine teaching is not that easy. The amount of new knowledge created per year has dramatically increased in every field and the speed of change is still increasing. Unfortunately, it takes sometimes many years until a discovery makes it into accepted clinical routine. For instance, Buonocore had first published a method to bond resins to enamel in 1955. When I was entering clinical dentistry as a student in 1972 we were taught enamel etching techniques as the newest thing. How do we teachers deal with this time difference? A standard way is not to teach new procedures until there is some evidence that the new therapy is effective and does not show any negative side effects. This may be a good way out, but unfortunately, there are more complications. Many years ago, when worldwide adhesive technology was accepted as being clearly superior, I visited a dental school and was shocked to see that they were teaching how to prepare dove tail retentions for Class III composite restorations. I asked why they do this. The answer was that the students need to know this, because it was required by the state board and if they were not able to do this they would fail. Knowing that the board exam is done on real teeth of real patients this creates an ethical dilemma. Hippocrates taught us“ primum nil nocere” so my ethical compass tells me not to teach a dove tail retention, because it definitely requires removal of more sound tooth tissue than required for the restoration using adhesive techniques. On the other hand, I know that my students have a higher risk to fail the board, if they don’ t practice. This creates a conflict of interest, since on one side as a physician I must comply with ethical rules and protect the patients from harm but as a teacher, I am expected to be loyal to my students. A similar conflict with some boards exists in the interpretation of the radiological interpretation of proximal caries in posterior teeth. Many years ago it was unchallenged that when a decalcification was radiographically visible in the proximal enamel and deeper, this was an indication for a Class II restoration. Over the years the knowledge in cariology has increased and we have learned that lesions can be managed as long as the surface is macroscopically intact. It is known from epidemiological studies that approximately half of the lesions that radiologically appear to just have reached the dentin do not show any cavitation. Many years ago techniques have been described how to separate teeth with such lesions, in order to inspect the proximal area. With this, the correct treatment decision can be made. Despite such appealing evidence, there are boards that ignore these facts and insist that the ideal lesion is one that has just reached the dentin-enamel junction. In order to have measurable criteria, a“ board” cavity preparation must be one similar to the ones GV Black has described more than a 100 years ago, which means that not only a cavity is drilled, where according to today’ s standards there is no indication for, but the cavity preparation is not
4 Stoma Edu J. 2018; 5( 1): 4-5. http:// www. stomaeduj. com