Interview: A fresh perspective on dentistry
Dr Vitor Neves, a dentist who qualified in Brazil and in the UK, believes that the profession needs innovation, but that, to its detriment, dentistry has moved away from biologically based treatment modalities in favour of a more technical approach. Neves, a lecturer and periodontics registrar at the Faculty of Dentistry, Oral and Craniofacial Sciences at King’s College London, recently wrote an opinion piece on the topic for the British Dental Journal, and he discusses it in this interview with Dental Tribune International.
Dr Neves, in your article, you talk about how, in recent decades, dental science has mainly focused on improving materials and everyday clinical equipment. This, you argue, has led to a lack of innovation and a loss of the understanding of human biology as a way of evolving the profession. In your opinion, how did this occur?
If you look at the evolution of dentistry, you can see that many dental materials have increased in quality over time, as more has been invested into improving them. Indeed, material engineering itself has become not only better but much more accessible, allowing for bulky composite resins, for example, to become more reliable and aesthetic.
However, there is a problem with dentistry. It is, generally speaking, much easier to create a device or material product than it is to create a pharmaceutical product. There are many technological advancements being made in dentistry, but there is a lack of pharmaceutical products based on human biology being created, and so the general understanding of our own biology’s potential role in treatment has been pushed aside.
“It is, generally speaking, much easier to create a device or material product than it is to create a pharmaceutical product.”
You started out as a dentist in Brazil before coming to the UK. How has this influenced your approach to dentistry?
Yes, I commenced my dental studies in Brazil and went on to work in my own dental practice there. After that, I came to the UK to take part in a new master’s programme on regenerative dentistry at King’s College London—I was part of the first class to take this degree. I eventually moved on to a PhD at the same university, which I managed to complete last year.
I’ve learned a lot through my studies, and my eyes have been opened to how dentistry moves forward and the type of research that dental, biological and pharmacological researchers do. Here in the UK, it’s surprising to see that dentists are generally not as into research as Brazilian dentists are. What I’ve experienced is that the majority of dental graduates either haven’t had an interesting research experience during their studies or don’t want to do research because they’re not interested, because they want to make more money, or for some other reason entirely. This is not the fault of the dentists—whereas many dental students finish their studies debt-free in Brazil, it’s not often the case in the UK, which can limit one’s options.
Do you think there is time for dentists to learn the ins and outs of human biology during their training, or does the whole approach to dental education need to shift?
I think that all British universities have the capacity to teach biology at a very high level, but it’s a case of making this a priority in their curricula and reshaping the future of dentistry. There’s currently a big shift going on in dental education in terms of putting the patient first, which is a great step in the right direction. At the same time, there have been a lot of cuts to biology-centred teaching, which I find difficult to understand.
What’s needed, in my opinion, is recognition that it’s important for dentists graduating now, or in five or ten years’ time, to base their professional approach on the biology of the tooth, the mouth and other orofacial tissues. In the near future, there will be more robots in the dental clinic placing implants and assisting with surgery, and the emphasis on manual skills and dexterity that currently exists in dental education won’t need to be as pronounced. I think that, instead, dentists should focus on understanding what exactly is going on at a biological level with their patients, and how they can help to heal them.
You can already see the influence of dental robotics at the educational level occurring in the US—for example, Dr Alon Mozes, the founder of a robotics healthcare company, has just joined the Dean’s Advisory Board at the Boston University Henry M. Goldman School of Dental Medicine.
Yes, exactly, Neocis’ Yomi robotic guidance system is being sold in the US and is approved by the US Food and Drug Administration. Soon, it may be coming to the UK.
So, then, moving on from tertiary education, do you see a way of introducing this biological approach to current dentists through avenues like continuing professional development (CPD) courses?
This is actually one of the things that I’m working on with a group of colleagues. I’m currently discussing this with the General Dental Council in the UK and am also part of a regenerative dentistry board in Brazil that is setting the guidelines for what dentists should do when attempting to integrate a more biological approach. CPD is the most important thing in this respect, especially for dentists in the UK.
One CPD course that I’m currently involved with in Brazil consists of 120 hours of coursework over a year. However, I think this kind of education could work in a shorter time frame as well. A three-month course about biological considerations in dentistry, for example, could work to re-educate dentists, as could an online course for those who might have studied the relevant biology at university and since forgotten parts of it.
Frankly, there’s a lot to work with, and it’s a question that I have to ask myself: how can we enable dental professionals to keep learning about this approach without their having to go back and do something like an entire degree in biology? In the end, dentists generally understand how the body works, how it reacts to certain treatments and procedures, but often just need that little extra bit of specific knowledge.
“It’s a question that I have to ask myself: how can we enable dental professionals to keep learning about this approach without their having to go back and do something like an entire degree in biology?”
Is there any research currently being done to support this biological future of dentistry?
The UK is one of the leading countries in this field, actually, as it’s home to one of the few centres in the world that does regenerative dental research, the Centre for Craniofacial and Regenerative Biology at King’s College London. However, there are multiple research groups right now around the UK that are looking into regenerative biology from a dental perspective.
I work with Prof. Paul Sharpe at King’s College London on this topic, but we also collaborate with researchers from the University of California, Los Angeles, Harvard University and Stanford University, as well as with researchers from China, Japan and other countries. It’s a promising field, and hopefully, we’ll be able to shift the mentality of dentists from being based on technology to a biology-centred way of thinking.
Editorial note: Dr Neves’ article, titled “A new perspective to push forward a stagnated dental world”, was published online on 26 July 2019 in the British Dental Journal. More of his current work can be found at his website.