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James B. Fine, Senior Associate Dean for Postdoctoral Academic and Student Affairs at Columbia University Medical Center in New York, is a tall, elegant man, with a noticeable enthusiasm for dentistry, particularly for the field of Periodontics. He’s in fact co-author of the landmark text “Clinical Guide to Periodontics”, probably the first and most comprehensive source for the management of periodontal diseases, and he has a long experience as a teacher, clinician and researcher. In the following interview, Dr. Fine states an obvious truth for most dentists, but not yet for most patients or governments: that dentistry is an essential health service.
The logical extension to Fine's clearly defined concept is that erasing the discrepancy between the perception that dental professionals have of oral health and the loose ideas of the public about it, is the smartest strategy to ensure the real development of dentistry in the future.
Achieving this goal however requires a really united dental profession at a global level, sustained in time, and decisive help from other health and patient advocate groups as well as the dental industry. Ignoring it, as it has been done for too long a time, carries the danger that dentistry will become not only more and more isolated, but probably an obsolete science as well.
In what ways has the Covid-19 pandemic changed your practice/school?
The true impact of the pandemic on all aspects of the dental profession will not be known for years. The economic effect on the profession will take time to analyze. The cost of doing dentistry has increased. It has also reinforced the need for infection control to be performed at the highest level. Distance learning now has become the norm, not the exception. Also, we need to do a better job at communicating with the public that good oral health is important and the dental environment is a safe one.
“The pandemic has reinforced the need for infection control at the highest level.”
What are the positive and negative aspects of this change?
It created improved infection control and an increased awareness of patient to healthcare worker transmission of diseases. Healthcare workers many times drift away from proper hand hygiene and appropriate use of PPE.
There was definitely an increased cost to these new protocols. The cost had to be either passed on to the consumer or absorbed by the practitioner or institution. This impacted the economic structure of the profession to a certain degree.
Many patients still remain reluctant to return to the dental office or clinics during the pandemic.
Vaccine mandates and mask mandates in many states also provide difficulties for many individuals both patients and healthcare providers
What kind of biosecurity measures have you put in place?
The measures taken are in three areas.
First, it is testing and vaccination of all personnel especially those patient facing.
Second, is taking a thorough Covid-19 history and temperature on all patients.
Third, the modification of the facilities with HIPPA filters, UV, deep cleaning on a scheduled basis, use of negative pressure rooms for all high aerosol producing procedures, monitoring air turnover rates.
Fourth, social distancing in waiting rooms, elevators and common areas.
Are patients aware of them?
Our priority was informing patients that dentist always practiced infection control and now there was an increased effort to control aerosols from the equipment. And to constantly decontaminate surfaces and public areas of the facilities. Information was placed on our websites, electronic bulletin, posters and social media. It is continually updated.
What are the effects of the pandemic in the processes of teaching and learning?
Zoom and Microsoft Teams technologies turned out to be great tools for teaching and learning. It allowed us to partner with several dental schools that are geographically separated for joint courses and lectures in real-time. Going forward this will allow topics to be taught by leaders in areas or fields that some institutes may lack the resources to provide. Especially in areas like biomaterials, data science or immunology. However, there is still a need for in person education. And allowing for group dynamics and innovative approaches to pedagogy.
Do you think technologies such as AI and VR can improve practice on patients?
AI and VR will eventually have an impact in the future. The immediate impact on the profession will be from an increasing incorporation of an integrated electronic healthcare record with our medical colleagues, hospitals and Dental Service Organizations. This will provide “big data” and allow the profession to see outcomes of therapies and make adjustments to best practices to improve patient care. Dental and medical insurance companies are already using this information to direct patients with certain conditions and diseases to have appropriate dental care. The connection between improving diabetes control and oral health has been established. The benefits of an integration between medicine and dentistry are important to insurance companies.
How do you get now dental info about congresses, courses, clinical advances?
Marketing is much more sophisticated now even in the dental industry. So we monitor social media sites, and email from the dental industry.
How often do you watch/participate in online lectures?
All our continuing education and many student lectures are now given on Zoom for the time being. Come January of 2022 we hope to be in person or a combination of in person and zoom.
“The benefits of an integration between medicine and dentistry are important to insurance companies.”
Are these online lectures still useful or have they reached their saturation point?
For many individuals taking continuing education online has reached a saturation point. There is a desire for hands-on courses once again.
Online will remain and programs will become hybrids of using both technology for remote learning and hands-on workshops.
What‘s now most important for you from a professional standpoint?
I believe Covid-19 showed that the dental profession can be vulnerable to unforeseen events and economic downturns if it is not recognized as an essential health service for the public at large. We need to change this view with our governments and our patients. We talk about that good oral health is important for overall health, but we ourselves haven’t totally convinced everyone that this is truly the case. And there are both economic and societal benefits for embracing this connection between oral health and overall well-being. Eventually, we will get there, but it requires effort from the dental schools, affiliated dental industries and organized dentistry to make the case to governmental policy makers and the public.
NOTE: Dr. James B. Fine is Senior Academic Dean for Postdoctoral Academic and Student Affairs, Professor of Dental Medicine in Periodontics at Columbia University Medical Center, and Attending Dental Surgeon on the Presbyterian Hospital Dental Service. He also serves as the Chief Practice Director of Faculty Practices at the College of Dental Medicine, and is the author of “Clinical Guide to Periodontics”.