Just Drifting

Walking to dental school one day, I met one of our professors, carrying a cage.

A conversation ensued.

‘May I ask what is in the cage, Professor?’

‘You may, Mr. Hellyer – it’s a monkey of the species Macaca Irus.’

‘Really?’.

‘Yes ………. we are investigating the mechanism of mesial drift in monkey’s teeth. You know what mesial drift is, Mr Hellyer?’

‘Well, er, yes, it’s the, er, the tendency of posterior teeth to move forwards towards the midline, erm, along the line of the dental arch.’

‘Quite right, and do you know what causes it?’

‘Well, no and erm, presumably that’s what you’re going to tell me.’

‘I wish I could. So far we have eliminated muscles of the tongue and cheek as causative mechanisms and are now investigating the effects of the transseptal fibres in the process.’

‘Really? How interesting.’

My voice belied the words, and probably went up an octave. I was at a loss on how to continue the conversation, knowing nothing about monkeys and not a lot more about mesial drift. So, in an attempt to move the topic onto safer ground, I enquired about the life expectancy of the research animals.

‘Do they die very often?’ I asked.

To which the dry response came

‘Only once, Mr Hellyer, only once.’

And at that point, fortunately, we reached the basement of the dental hospital and the exalted scientist ascended the lift to his research lab and I moved swiftly to my student locker.

At least mesial drift was relevant to something I would see daily in my future career - tilted teeth, disrupted contact points and occlusion, food packing and root caries. All common problems in the ordinary world of general practice and an understanding of the mechanism might help to prevent some of them.

Today’s undergraduates are likely to have rather different conversations with their scientists, due to academic drift, which appears to be more of a concern these days.

A recent paper suggests that Academic drift is (please excuse the academic definition but it’s quite important) “the process whereby knowledge which is intended to be useful gradually loses close ties to practice while becoming more tightly integrated with one or another body of scientific knowledge.” This was brought home to me by a recent Twitter conversation with a distinguished dental researcher. He tweeted that his team had found a method to make nanoscale calcium phosphates. I enquired about how these clever little molecules benefited patients and the response was …..

‘They are used as an injectable mouldable bone graft substitutes.’

‘Application to bone grafts around dental implants, then?’

Silly me. Follow the money.

‘The focus of our translational discussion has been around orthopaedics and trauma [which are] major commercial drivers.’

There may (my italics) eventually be applications to perio, MRONJ and endo, he said, and all of his research is relevant to dentistry but they ‘do not work in a silo because much of what we do also connects to other societal, healthcare, business and environmental challenges.’

It’s not only the money. In a recent paper in BDJ Open, Puck van der Wouden and colleagues note that academic excellence is ‘driven by incentives aiming at high citations and impact factor scores.’ High impact factor scores are associated with ‘top journals’ which tend to be focussed on basic sciences, not applied science. They found that in the 15 years from 2000, dental institutes have increasingly published non-dental research in journals of basic science and clinical medicine. The relevance of this non-dental research to dental research and practice, they say, may be limited.

As a consequence of academic drift, then, it seems that scientific citation fame and research grant fortunes drive the dental research community away from the practical issues which affect dental care professionals in their daily lives. Mesial drift? Pah, there’s money in that!

Universities of course are increasingly dependent on research grants for finance and status and this drift to more remunerative research topics is perhaps understandable at that level. But the comment of my Twitter interlocutor about not existing in a silo is interesting. The basic science being carried out in dental schools undoubtedly builds links and contacts with non-dental science and there are many common interests and pathways. But surely the danger is that within dental institutions, the scientists themselves are building their own silos, and becoming detached from the practicalities of dentistry, creating completely separate ‘science’ silos and ‘clinical’ silos. In doing so, they risk becoming detached from that other university responsibility, the teaching of dental students to become those safe clinical beginners desired by the General Dental Council.

If the education and practice of dentistry itself becomes detached from the scientists, then there is a danger dentistry becomes like the monkey in the cage, trapped in the service of basic science and our long fought-for, scientifically educated profession dies and returns to being an apprenticed trade.