Open to the World

Canada must be among the most welcoming countries in the world for new immigrants. This fact was brought home to me forcefully in my clinic recently when during one afternoon I saw 4 patients in a row who were new Canadians. These people came from all corners of the globe and their previous experience with dentistry was interesting, to say the least.

One patient, from a central Asian country, presented with pain on 36. The tooth was restored with an amalgam that seemed, on the radiograph, to extend into the pulp chamber. The patient said that one dentist in his country had told him the tooth had been ready for restoration, while another had told him it wasn’t. Obviously the former prevailed. With no filling material in any of the canals, there was just a cotton roll in the pulp chamber under the amalgam. Dealing with this patient reminded me that the standard of dentistry practised elsewhere has a real impact on practitioners in Canada.

 Recognizing that many of the issues facing our profession today are international in scope, CDA takes its international involvement very seriously. We can give so much to those countries where oral health knowledge and care lags behind ours. We can also benefit greatly from the expertise that resides in other countries and the political experience gained by others in their efforts to promote quality care through the best possible delivery systems.

At this month’s annual board of governors meeting, CDA will host 2 dignitaries of world dentistry: Dr. Jacques Monnot, president of the Fédération Dentaire Internationale (FDI), and Dr. Peter Swiss, president of the British Dental Association (BDA). It is a mark of the high esteem in which Canada is held in international circles that these gentlemen are visiting us.

I invited Dr. Swiss to contribute an article to the JCDA because of perspectives he has gained as BDA president, editor of the FDI World magazine and a member of an FDI committee. Dr. Swiss eloquently makes the point that while we may have a variety of reasons for expanding our horizons on the international level, we can be sure that dentistry and oral health everywhere will benefit through collaboration across borders.

One area where Canada is looked upon as a world leader is in the development of clinical practice guidelines (CPGs) in dentistry. Even if we are considered to be at the leading edge, we still have a long journey to travel before we produce guidelines. In Part II of their series on CPGs in Canada, Drs. Sutherland, Matthews and Fendrich give an overview of how these guidelines will be developed. It is clear that the effort will take much time and many resources and will require collaboration between numerous organizations. It strikes me that the profession will have to collaborate internationally if we wish to develop a decent number of meaningful guidelines in a reasonable time frame.

The authors comment that topics ripe for the development of guidelines are those where there is considerable variation in practice. Surely one of these areas is the diagnosis of the early carious lesion. As Drs. McComb and Tam point out in their article, the diagnosis of early occlusal caries in particular has become incredibly challenging. They highlight the fact that the most traditional methods of caries diagnosis still seem to be unsurpassed, notwithstanding the promise held out by new technologies and research.

 Speaking of research, I was struck by the statement cited in Part V of Dr. Susan Sutherland’s series on evidencebased dentistry asserting that much published biomedical research “belongs in the bin.” Dr. Sutherland’s latest article gives you tools to critically appraise articles relating to therapeutic and preventive interventions and contains a set of questions that will be useful when you retrieve articles from Medline or other databases.

Incidentally, the full text of all articles in the electronic version of the JCDA is now directly available through the Medline database. Through this mechanism, dental colleagues around the world who are seeking good-quality information have an opening on the best material from our discipline published in Canada.

John O’Keefe
1-800-267-6354, ext. 2297