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