I will go out on a limb here and tackle one of the most controversial topic in Dental Practice or even in Healthcare Practices in general especially in the current political climate that’s going on in my own organization.

I now fully understand the saying that wisdom comes with age because truly our perspective also changes with age. It is also influenced by the variety of experiences that somehow influence us the way we see and believe in things. If we never experienced it, we can never connect to the given situation. Sometimes we just pretend to understand and even worse be the claimer of all that is good and almighty about you but really in fact you have no idea what it truly is and how will you really react if the actual situation occurs to you. So, for the sake of argument, let’s us all put down our battling swords, our biases, and truly look at this in a perspective that is in tune to us being all professionals and if at the end of my blog you’re still in a war freak zone, then, I hope you can find in you to agree to disagree in dissenting opinions without being personal about it.

I. The Objective of Both Principles - As a person who became disabled by the mistake of a physician and now crippled for life, I think I’ve earned the right to say how truly important it is the “first do no harm” oath for our patients’ sake and that we try the best we can to avoid at all cost the possibility of making mistakes. Unfortunately, we are humans and we can’t exempt ourselves from the probability of committing errors and no matter how small or big it maybe it will have the inevitable consequences. Now, having said that I have to ask why there’s a ruckus between which is better, biological practice or scientific or commonly called as evidence based practice? Because in my research both have the same objectives which is to make sure that our patients will be safe in our hands. True, the manner of methodology maybe different but the objectives are the same, to make sure to do no harm to our patients. The contention of the biological practitioners is that based on their survey biocompatibility of the materials used is at the lowest totem pole of importance for patients and even practitioners themselves. Well, that’s truly something to be concerned about, isn’t it? However, in fairness to those who believed in scientific methodology, almost all materials used in our patients as dental practice evolves through the years, they all went through a variety of tests and studies before it even went and be available in the market into our patients’ mouth, so, what’s the problem? Of course, we can fight about how corrupt the world is and blah, blah, blah and we can all go back and forth with a better answer. But, at the end of the day, in my humble opinion, both are working to make our dental materials safer and better for us to use to our patients, so, why do we have to fight about which one is right? Isn’t it the best judge of that are the individual choice of the practitioners as well as the patients? Can’t both promote each own methodology without totally destroying the other or even outright disagreement? Both principles are here for a reason and there’s nothing wrong if we can adapt one or two of the methodology of the other if it in the end that is the best choice of treatment to our patient. After all, they are the basis of why we are fighting for what we believe in, right? Maybe by opening our minds to possibilities rather than concerning more on who’s right or personalities involved, we probably can accomplish better safety measures to the treatment of our patients, don’t you think so?

II. The Evidence of Methodology - Each have their own evidences on why one is better than the other. Fine, that’s good even great. It means each way of practice have a basis as why one practitioner will believe more than the other. Then, continue to preach what you believe in, however, don’t shove it in everyone’s throats what you preach. Allow each individual practitioner the time to think and choose what’s best for his/her own practice. Again, this is not the issue that if a practitioner chooses one rather than the other, that the preacher’s belief automatically is wrong. It just means that each dentists listening to what you preach has their own reasons why they believe more one preacher from the other. It is like religion, each person have the right on how they practice their faith. One religion can shout all they want that if you don’t practice their religion you will go to hell but it is still up to the individual to have the right which way to go. Anything that is too much or too less never amounts to anything that is good. That is why most of the wars and terrorism nowadays are about religion. Which is ironic because all religions’ basic principle is to do good to others, yet, here we are killing each other for the namesake of faith. Now, I don’t know about you, but, if we as practitioners will end up being enemies because of this, then, what are we really fighting for? Is it really the belief of our methodology in the way we practice to be better dentists to our patients or really something else?

III. The Act Of Leadership - I believe that we can’t control anybody except ourselves. We can’t dictate what one should feel and believe in, so, we need to be leaders in our own way. If you feel you are a leader spouting out what’s right and yet don’t practice being a decent human being at the very least, then, what kind of a leader are you? We can’t always blame others when we justify our own actions by the very thing we are fighting against. I find it cynically amusing that the very people who are supposedly working for peace are doing everything it can not to achieve it. People is quite a strange creature it seems, we always say to be “Be Yourself” yet we harshly judge when one is being oneself. So, in the end, no one is being oneself. The true oneself is only shown during a challenge. I will share with you a story I read in one of the FB posts that I believe is totally true in real life.

FISH 🐠 STORY

“The Japanese have always loved fresh fish
But the water close to Japan has not held many fish for decades. So to feed the Japanese population, fishing boats got bigger and went farther than ever.
The further the fishermen went, the longer it took to bring the fish
If the return trip took more time, the fish were not fresh.
To solve this problem, fish  companies installed freezers on their boats.
They would catch the fish  and freeze them at sea. Freezers allowed the boats to go farther and stay longer.
However, the Japanese could taste the difference between fresh and frozen fish and they did not like the taste of frozen fish The frozen fish fetched a lower price.
So, fishing companies installed fish tanks. They would catch the fish and stuff them in the tanks, fin to fin.
After a little thrashing around, they were tired, dull, and lost their fresh-fish taste. The fishing industry faced an impending crisis!
But today, they get fresh-tasting fish to Japan.
How did they manage...?
To keep the fish tasting fresh, the Japanese fishing companies still put the fish in the tanks but with a small shark The fish are challenged and hence are constantly on the move.
The challenge they face keeps them alive and fresh!
Have you realized that some of us are also living in a pond but most of the time tired and dull....?
Basically in our lives, sharks are new challenges to keep us active.
If you are steadily conquering
 challenges, you are happy.
Your challenges keep you energized.
Don’t create success by enjoying a state of inertia. You have the resources, skills and abilities to make a difference.
Put a shark in your tank this year and see how far you can really go….”

So, what does it mean? Well, having both the Biologic and Evidence-Based leaders in our midst is great because as practitioners we all become alive with the challenge of what we can aspire to be in the practice.  I guess, those who are adamantly fighting for each side are the sharks that make us all, practitioners, to become alert on where to finally take a stand and practice the way we believe is right for us as an individual. Sometimes I wonder if there’s really something to fight about because I believe we all want to move towards a better dental practice, so, I guess the debate between the two proponents are the shark of challenges that will make it interesting for all of us to be better dentists to our patients. There’s no room for us to be in the state of inertia and dwindle to a boring dental practice.

IV. The Responsibility - Each of us have the responsibility to continually learn and be professional about our profession as dentists. We can’t automatically just disregard one issue just because it is not scientifically proven. A lot of what we use now started with a postulate and are considered garbage before. Simply put, although, there’s nothing wrong with clinging to evidence-based practice, there’s also nothing wrong in delving and exploring the possibility of what is right now may be wrong later on. Remember, the earth is flat before but now everyone accepts as round? Even if we go basic like which one is true, the evolution versus theology of how the world began? We will never be able to reach the end of that debate. There are some things that only time can tell and if it has to go through the process of proving one wrong, then, so be it. But, we can’t simply suppress others’ freedom to go through the process of learning which more often than not go through trial and error. And, true, there will be patients like me who will suffer from these errors while learning what is right, but, I still believe that behind those errors is the simple but important thing called “intention/s”. I never believe that the doctor who made me cripple intentionally wants to hurt me and if I will look back to the acceptable methodology of how a physician can inject a child before whether vaccine or mine at that time, anti-tetanus, is totally different now. It is cases like mine that encourages people who became physicians or scientists to develop better ways to precisely avoid those now. Without cases like mine, the world by which we do our treatment will become stagnant wherein a silicate restoration is still our choice of tooth-colored restorative material in anteriors rather than composite resins. It is the responsibility of professionals like us to continue to work on what’s best and if along the way create a dissension amongst us which way to go, then, so be it. However, if the leaders of our community suppress our very basic right of freedom, then, we will all never grow. It is not bad to be different because difference is what makes us all unique and it is our responsibility to accept and respect that rather than ostracize the very essence of who we are as individuals. It is our responsibility to create an atmosphere that will allow us to venture into our imagination on how we can make a difference. As they say, knowledge can bring you from point A to Z but imagination can bring you anywhere. Let’s take responsibility to watch our own actions as professionals and respect each one to have the right to choose and explore what can or may be good to the growth and development of our own dental practice.

V. The Balancing Act - As I’ve said anything in extreme will amount to nothing good, so, we find the balance. Even in losing weight and living healthy requires balance. Because if you go to extremes of not eating and eating too much, it will both result to unhealthy you. It is the same here. We all just have to find balance. For example, on the issue of Amalgam. The main contention is the mercury, right? I think all evidence-based proponents will agree with the biological ones that mercury is not good. Now, the question is, should we all ban Amalgam use as a filling material? Well, in my book, let’s try to find a balance. I, myself, is not into banning amalgam on the basis of having the freedom to choose which type of filling material I can use to my patient depending on the situation. It has been proven to be truly an effective and cheaper way of restoration. Having said that, I am not against either to the biological practitioners of telling us, who wants the freedom to choose amalgam as a filling material, the required responsibility of disposing it as an act to protect our environment. Having freedom is not totally free. It does come with certain responsibilities. So, we can but not limited to do the following:
(a) Using chair side traps.
(b) Installing amalgam separators compliant with ISO 111432.
(c) Using vacuum collection.
(d) Inspecting and cleaning traps.
(e)Collecting and recycling amalgam.

Okay, okay, okay, I know most of these don’t come cheap but nothing really important in life is, if we all going to be honest about it. What we want is to have our cake and eat it too. So, therefore, for those who find every reasons to give excuses of not disposing amalgam properly and still want to use it, in the end, it seems they are only looking at their own fences. If we are going to be honest about it, we don’t want to because all of these will come from our own pockets in order to properly practice the use of amalgam as a filling material nowadays. So, where is really the thought of doing what is best for our patient thing as a reason? Fine, you saved your patient some money for having amalgam as a restoration and by evidence-based it is durable and lasts longer than composite resins but what’s all these money saving and last longer filling reasoning if there’s no more safer earth wherein we can all live in to make the former matter? We are already experiencing the effects of global warming when before it is just an exaggerated imagination of a few environmentalists. We don’t even know before what that is and no one wants to minimize the cost it will entail the change that needs to be done. For instance, the avoidance of use of plastics in businesses is expensive. So, look us all now? Almost all businesses have changed from plastic to paper. Some times we really have to think more than we can actually see. It doesn’t mean you can’t see, it doesn’t exist. We just have to balance our actions base on the very principles we are fighting for. If we want the freedom to choose then we have pay for its dues to have and enjoy it without wrecking havoc to others who are not of the same choice thinking as you do. So, at the end of the day, I like to have the freedom to choose amalgam without others telling me what I can and cannot use but, at the same time, I will need to be responsible enough to do the things I need to do to ensure that I am not enjoying my freedom at the expense of others. It is like my neighbors who’s doing Karaoke until wee hours of the morning because it is someone’s birthday and they have the right to subject all their neighbors to their “singing” voice as if there’s no tomorrow and they are in a concert arena with thousands of people anticipating to listen to their hoarse and crackling voice best left to be heard in the confines of their bathrooms. To say otherwise, you are one scrooge of a neighbor who can’t be neighbourly because you can’t simply understand how expensive it is for them to actually do this celebration inside the Karaoke bar, since, you can afford. Does that make it right to disturb others because you are simply practicing your rights to do so? And, poverty is a righteous excuse not to think about the welfare of others besides yours? Are you getting what I am saying?

In Conclusion:

I don’t fully understand what’s the fight is all about. As such, maybe I am the wrong person to have a say on this. However, this is what I know are true:

• One, the actions of each group depend really on what their real intentions are. The intentions maybe good but the person/s who are implementing them may not be.
• Two, it is generally NOT the materials that makes them harmful for others but the people who are using them.
• Three, freedom should NEVER be suppress BUT it comes with the price of responsibility for those who wants it.
• Fourth, learn to listen to what others may say and I will quote one of my favorite poem ever: “Go placidly amid the noise and haste, and remember what peace there may be in silence. As far as possible without surrender be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even the dull and ignorant; they too have their story.”
• Fifth, the last, but, certainly not the least, let’s do unto others what we want others do unto you. We are all sinners here and that’s without exceptions including myself. Look at yourself first before pointing fingers on others. See what truly lies within you and start from there. You can make changes without being in power but do your small things within your scope. If we are going to be honest as dental practitioners, start with infection control in your clinic. This is one issue as a professional one should look into and really practice.

  I have learned that the most difficult challenge in life is being a good person. Everyday each of us encounter that challenge and no amount of religion or faith we practice can save us from ourselves being inertly selfish people, so, we do what we can in our simple ways to truly make a difference to do good in the ability we can do. There’s really nothing to fight about if we all truly and sincerely just want the good things to happen and if we indeed come in a cross road of having to choose which way to stand then let me end this blog with this prayer:

  “God grant me the serenity
  To accept the things I cannot change;
  The Courage to change the things I can;
  And the wisdom to know the difference.

  Living one day at a time;
  Enjoying one moment at a time;
  Accepting hardships as the pathway to peace;
  Taking, as He did, this sinful world
  As it is, not as I would have it; Trusting that He will make all things right
  If I surrender to His Will;
  That I may be reasonably happy in this life
  And supremely happy with Him
  Forever in the next.
  Amen. “

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