Hamilton AI (1976), Operative Instruction – Adequate or Not?, Operative Dentistry, 1(4) 129.

Operative Instruction-Adequate or Not?

During the past decade or so, in many dental schools, the time allocated to teaching operative dentistry has been reduced-in some instances, drastically. Curriculum committees and school administrators have made the reduction, on the one hand to introduce new subjects, such as community dentistry, into the curriculum and, on the other hand, in the belief that the discipline of operative dentistry is now less important to dentists because soon most of it will be provided by dental auxiliaries. Departments of operative dentistry have tried to compensate for less teaching time by teaching more efficiently, by eliminating some exercises from the preclinical program, by accepting less clinical experience, and by resorting to witchcraft. The product of these changes is now on display.

Few accolades, if any, have greeted the results. On the contrary, most appraisals of the competence of recent graduates indicate they are not as well trained as formerly. These observations have come from practicing dentists, from members of departments of operative dentistry, and from examiners for dental licenses-all of whom are admirably situated to observe trends in clinical competence. “Not so,” say curriculum planners and administrators, “you give us opinions only, not hard evidence. When you have quantitative data we shall be willing to listen to you.” It should be noted, however, that no such data were required by the curriculum planners when they decided to reduce the time for operative dentistry.

Assessing clinical competence in operative dentistry is a complex task. Standardized quantitative methods of evaluation typically have not been used, so little quantitative data are available for purposes of comparison. The absence of quantitative data, however, does not mean that useful qualitative distinctions cannot be made. It all depends upon the level of precision required. For example, it is perfectly valid to stand at the North Pole and, without referring to a thermometer, state, “It is colder here than it is in Seattle.” Our senses are adequate for making this distinction. On the other hand, the temperature of a water bath used for the hygroscopic expansion of inlay investment must be held constant within a degree or two or the casting will be inaccurate. For the water bath, then, a thermometer is needed. Thus, depending on the precision required, qualitative judgments may be entirely satisfactory. They may be, in fact, the only means of evaluation available.

To complicate matters, many of our decisions have to be made on the basis of incomplete information. This is because the information may not be readily available, may be impossible to obtain, or may involve excessive costs of time, effort, and other resources. We must assess the relevance of each bit of information at hand and, relying on experience, try to reach the best decision. The absence of quantitative information does not absolve us from using what qualitative information is available.

For the sake of those of the public that require dental treatment, and for the sake of the students, who are not getting their money’s worth in dental education, curriculum planners and administrators would be wise to heed the opinions of dentists that know most about the quality of clinical operative dentistry and to give back to operative dentistry the curriculum time it has lost, even if, as a consequence, it means that graduates will be less skilled in examining ears and taking blood pressures. No time should be lost in deciding on the restoration, given the glacial speeds with which universities usually operate–except, of course, for bad policies; they can be instituted immediately.

A. IAN HAMILTON