RESEARCH
AND
JOHN J. SHARRY,
Section editor
The need
for
John J. Sharry,
EDUCATION
reappraisal
in prosthodontics
DAD.*
Medical University
of
South Carolina, Charleston, S. C.
P
rosthetic dentistry is facing a turmoil which is unprecedented in its history. A whole spectrum of societal changes will so alter public attitudes toward prosthodontics that survival will demand close examination of future courses open to the profession. All specialties in dentistry have their share of problems. The important ones include: problems of identity, problems of incentive, problems of education, and problems of public relations. This article will discuss these problems as they relate to prosthodontics. PROBLEMS
OF IDENTITY
What is a prosthodontist? Dentists know, but do other health professionals know? Does the public know? Except in the large cities in the United States, they do not! How does prosthodontics differ from general practice? People know how oral surgery, orthodontics, and endodontics differ. The pedodontic and pediatric professions are so closely related that the public can figure it out. But what does the prosthodontist do that is special? We can say that he deals with a portion of dental practice which is not only common to the general practitioner but brings the latter a large portion of his income. Further, if prosthetic dentistry were excluded as part of the practice of the general practitioner, he would be left with so little to do that the likelihood of recruiting students into the practice of general dentistry would be slight indeed. Prosthodontists (unlike other specialists who have treatment procedures in common with general practitioners) have not convinced general practitioners that they are better prepared to treat prosthetic problems. Prosthodontists have, except for one facet of their practice, a fragile claim to specialty. That part is maxillofacial prosthetics, and it has made prosthetic dentistry better known among other health Presented *Professor,
before
the
Department
Greater
New
York
Academy
of Prosthodontics,
New
York,
N. Y.
of Prosthodontics.
83
84
Sharry
professionals than any other single facet of practice. on the maxillofacial prosthodontist’s skills to improvr general welfare of patients. PROBLEMS
Surgeons soon come to depend the postoperative recovery and
OF INCENTIVE
In the United States, the enrollment in dental school postdoctoral programs in 1974 was: orthodontics, 656 students; periodontics, 340 students; oral surgery, 321 students; pedodontics, 255 students; endodontics, 213 students; and bringing up the rear, prosthodontics with 133 students.’ Why is this? It is simply a fact that students who would spend 2 or 3 years studying a specialty and, subsequently, would subject themselves to the cost and inherent stress of examination by a specialty board must question what improvements can be expected in their lives. Perhaps in the large cities, prosthodontists may operate as specialists with most of their patients referred by general practitioners. But in other cities, dentists do not refer patients, because they depend on prosthetic dentistry for much of their income. Why should they refer to another practitioner, no matter how qualified? Instead, the prosthodontist, having announced his speciality practice and after waiting vainly several years for those referrals, usually slips quietly into general practice wherein he gains 95 per cent of his referrals from hir ozen patient.s. After he has built up his practice, he may then become selective and emerge some years later as a true specialist in prosthodontics. By this time, he may wonder whether he could not have done it all just as well without expensive specialty training. We are being naive if we claim that substitutes such as self-satisfaction and sense of achievement are more valuable than dollars. The fact is that most dentists will not undergo the long expense and trial of going to dental school if they cannot look forward to a decent income as well as interesting work. A 1971 survey of practice indicated that of the 15 per cent of respondents who listed themselves as specialists, prosthodontists earned the least.’ Endodontists had a mean salary of approximately $54,000; orthodontists, $43,000; oral surgeons, $39,000; pedodontists, $36,000; periodontists, $35,000; and prosthodontists, $30,000. G eneral practitioners earned approximately $28,000. We must face the fact that if prosthodontists earn only $2,000 there is little reason for a student to take a year more than general practitioners, prosthetic training. He might as well go directly into practice. Let us examine another statistic relevant to this problem of incentive. A survey conducted for the American College of Prosthodontists indicated that of approximately 300 fellows of the College, 18 per cent worked in private practice; 15 per cent, in academics; 8 per cent, in government: 34 per cent, in military service ; and 17 per cent worked at a mixture of private practice and academics.” Approximately 85 per cent of oral surgeons and orthodontists who are diplomates of their boards have private practices. These are important statistics, for they suggest that unless the prosthodontist has an institutional base, there is not a compelling reason, outside of his own drive and pride, to hazard examination by the American Board of Prosthodontics. Last, in considering incentives, let us inquire into the examination procedures of the American Board of Prosthodontics to determine whether those procedures are as
Need
for reappraisal
in prosthodontics
85
good as possible or whether we have been satisfied with a slow evolutionary move from tradition, while the pressures of contemporary society demand determined and resolute action. The first question which must be answered is whether the examination is as objective as it could be and whether it could easily survive critical examination by fellow health professionals or the public. In the first place, is it not odd that a candidate for the prosthetic examination must actually treat a patient in front of the examiners during a week of great pressure, while surgeons, who will perform intricate cardiovascular and neurosurgical techniques where the very life of the patient is constantly involved, are examined without so much as tying a suture in the presence of examiners? Medicine long ago abandoned such tactics, and we still require that a candidate undergo an examination which he can fail for reasons which have nothing whatsoever to do with his skills! For example, if the patient walks away before the examination is over, regardless of the cause of the action, the candidate fails the examination. It is time that we join most fellow dental specialties and all medical specialties in developing an objective examination which will not depend upon the treatment of a patient at the testing place. Those examinations act as an artificial barrier to those candidates who are perfectly knowledgeable but easily intimidated by unique pressure. Further, there is nothing laudable or defensible about an examination in which the chances of failure are equal to or greater than the chances of success. Logic rejects the explanation that the education of current candidates is insufficient for them to pass the examination. How can we ever know, when a major part of the examination procedure is so surely subjective, as likely measuring individua1 response to the situation as the educational process. I know of steady attempts to improve the examination-the earnest quest for accountability. But as long as subjective judgment predominates, we shall be governed by the dynamics of committee functions. I have served on national committees with some of the most prestigious scientists, clinicians, and educators in the United States of America. I know how committees can be influenced by forceful men, especially if the hour is late, the day has been wearing, and one’s own knowledge of the particular issue is inadequate. Not only must we devise more critical systems for our Board examination, but we must hurry! We must see to it that the systems not only will set standards for the candidates to pass the Board examination but will set requirements for one to become a Board examiner. Those requirements must be more inclusive than merely the ambition or willingness to serve. Further, our new system must include procedures for removing incapable examiners if, by chance, they should be appointed. Next, we must inform the unsuccessful candidate of the reasons for his or her failure. And the candidate should be able to correct the difficulty and reappear for examination as soon as practicable rather than wait the 2 years now required. The more objective the examination, the more defensible it is and the less reason there is for withholding information from candidates who have failed. Board examiners are very interested in this goal but find it a difficult matter to resolve. An objective examination can resolve it.
86
Sharry
PROBLEMS
OF EDUCATION
Most dental students tend to equate prosthodontics with complete denture treatment, and they know that education in complete denture treatment is based too much on art and too little on science. Some measurements vary “2 to 4 mm.” (a 100 per cent variation), and the student chooses 3 mm., because he is sensible. Students can learn textbook facts, but as far as the treatment of patients in the clinic is concerned, they often spend their time learning the way of the instructor and not the regimen. The Council on Dental Education encourages inclusion of a variety of subjects in the curriculum which in other days just did not exist. For example, all dental schools should increase the teaching time for hospital dentistry and behavioral science in their curricula. With the addition of each “new” subject, somethin% c has to c, 40. for one cannot keep adding hours to a curriculum and increasing the number of years of education for a dentist. As a result, accommodations have been made within the curriculum. Improved teaching methods can often cut down time expenditures. Furthermore, those of us who have been faculty members for 20 to 25 years recognize that we did not always have an excellent plan and well reasoned logic for using the number of hours made available. There were certain territorial imperatives that prompted the prosthodontist to make sure that he used 66 hours if another specialty was allotted 66 hours. Use ol curriculum time was influenced more by past usage than knowledge or science. Furthermore, there is little sense in asking a teacher earning $30,000 a year to deliver a lecture on definitions which can easily be read from any book or when the lecture could be better delivered with a slide-tape series the student can take home. Few faculty members are either thrilled or thrilling when they give that annual lecture for the tenth year wherein they show a slide of a hoe, binangle chisel, explorer. or scaler. They are generally bored, as are the students. I rush, however, to take issue with those educationalists who believe that the whole curriculum can be put onto machines. It cannot! Conceptual matters cannot be learned from machines. Concepts stimulate questions, and the teacher has to be present to understand and answer the earnest questions of students. Machines, even computers, cannot be programmed to provide answers to questions not even conceived by the programmer. The whole matter of curtailment of curriculum hours in prosthetic dentistry is complex. Until the system of delivery of dental health care in the United States changes, administrators in dental schools ought not to surrender the proper clinical education of their students to education in corollary matters. A solid perspective must be maintained which places prime emphasis on the skills involved in the treatment of patients. We probably will come to the day when auxiliaries perform a large number of the treatment procedures which dentists now perform, and then we can change the emphasis, but not until then. EXPECTATIONS
FOR THE FUTURE
What can we now expect for the future! First? the type of practice to be experienced bj, students who graduate this year \vill he entirely different from the practice of 10 or 20 years ago. Solo practices lvill decrease, primarily because third-party payments are here to stay. As a result, many factors will impel us toward group pram-
ylrIEr3;i
Need
for
reajpraisal
in prosthodontics
87
tices. In our country, whether or not we have a private-enterprise system of insurance, such as Blue Cross, a dental service corporation, or national health insurance, we will have an increase in the volume of accounting procedures which will make it prudent for practitioners to associate with others to save costs. An accountant is paid $15,000 a year whether he is working for one man or three associates; furthermore, one dentist alone cannot keep him busy for a full day. Sufficient economy will result SO that associations or partnerships will flourish. The demands of peer review systems which will accompany all third-party arrangements will so affect solo practitioners that those disadvantages that some dentists may have previously worried about in regard to partnerships will diminish in importance. Dentists will no longer be able to hide bad judgments, shortcuts, or greed. They might as well take all the economic benefits of partnerships; the quality of their work will be under inspection anyway. These last considerations will affect less than 10 per cent of dentists, but they will influence even those 10 per cent who so diminish our profession. Group practices will probably proceed, with more dentists forming partnerships. Very soon the concept of the health maintenance organization proposed by the Com1970’ mittee for Economic Development in the early s will prevail, and the delivery of total health care to patients will include dentistry. Dentists will then see great advantages in associating with physicians in the provision of health care. When that happens, the level of care for the patient will improve. For whenever it occurs, the connection between earnest physicians and earnest dentists has always resulted in better care for patients. There is no finer example of this relationship than the maxillofacial prosthodontist and the oncologic surgeon. The patient’s treatment when these two work together is always better than if they work separately. One of the serious problems which we will face in the education of prosthodontists (both in undergraduate and postgraduate programs) is that of finding enough patients. Presently, dental schools offer treatment at low costs, and thus, patients are encouraged to come to these institutions. When a system of health insurance, whether public or private, becomes a fact, what will be the incentives for patients to go to dental schools for treatment ? If patients pay the first $50.00 of treatment costs, they will save little money by going to dental schools where they have to wait and are inconvenienced. SOLUTIONS
TO
PROBLEMS
IN PROSTHODONTICS
So, there are problems, and there are constant and serious attempts to solve them. My worry is that the pace of work may not match the urgency of the need. Solutions of many problems can only follow on facts, which are in short supply. We should not proceed toward solutions on the basis of opinion when facts are gatherable but have not been gathered. We sometimes equate quantity with quality, believing that having less than we used to have means being worse off than we used to be or that having more than we used to have means being better off. In the face of an urgent need for documentation, we should not fret, instead we should urgently push for it. In the face of a need for objectivity, we should not fear to abandon the past. We include among us, an enviable share of thoughtful, energetic, and decent men and women. What we might need is a wider horizon; conversa-
88
.I. I’~orthct. January,
Sharry
tions with those who are not prosthodontists; results of those conversations combined with actions will enrich our future.
Dent. 19i7
those who are not even dentists. The constructive thought instead of rash re-
References Survey of Dental Educational Institutions, J. Am. Dent. Assoc. 88: 931-933, of Dental Practice, J. Am. Dent. Assoc. 84: 636-639, 1971. of Membership, American College of Prosthodontics, 1974, Unpublished.
1. Annual 2. Survey 3. Survey MEDICAL
UNIVERSITY
COLLEGE
OF DENTAL
80 BARRE
S. C. 29401
ARTICLES
TO
Telemetric positions-A
A. Schorn,
D.D.S.,
Resin
regist,ration Skurnik,
ISSUES
and Richard
for interocclusal
D.M.D.,
functional
J. Goodkind,
occtusal
D.M.D.,
MS.
butted
margin
co&act
records
D.D.S.,
Effects of overdentures D.D.S.,
restoration
and Edwin
for orienting Tanaka,
H. H. Thayer,
FUTURE
of anteroposterior report M.S.D.,
ceramic-metal
B. Sozio,
Face-bow
L
IN
D.D.S.
A precision
Yoshinobu
APPEAR
determination preliminary
Harry
Ralph
CAROLINA
MEDICINE
ST.
CHARLESTON,
James
OF SOUTH
1974.
with
J. Riley,
u fucial
D.M.D.
ear prostheses D.D.Sc.
upon
remaining
and A. A. Caputo,
oral structures
Ph.D. ,
AND
JOHN J. SHARRY,
Section editor
The need
for
John J. Sharry,
EDUCATION
reappraisal
in prosthodontics
DAD.*
Medical University
of
South Carolina, Charleston, S. C.
P
rosthetic dentistry is facing a turmoil which is unprecedented in its history. A whole spectrum of societal changes will so alter public attitudes toward prosthodontics that survival will demand close examination of future courses open to the profession. All specialties in dentistry have their share of problems. The important ones include: problems of identity, problems of incentive, problems of education, and problems of public relations. This article will discuss these problems as they relate to prosthodontics. PROBLEMS
OF IDENTITY
What is a prosthodontist? Dentists know, but do other health professionals know? Does the public know? Except in the large cities in the United States, they do not! How does prosthodontics differ from general practice? People know how oral surgery, orthodontics, and endodontics differ. The pedodontic and pediatric professions are so closely related that the public can figure it out. But what does the prosthodontist do that is special? We can say that he deals with a portion of dental practice which is not only common to the general practitioner but brings the latter a large portion of his income. Further, if prosthetic dentistry were excluded as part of the practice of the general practitioner, he would be left with so little to do that the likelihood of recruiting students into the practice of general dentistry would be slight indeed. Prosthodontists (unlike other specialists who have treatment procedures in common with general practitioners) have not convinced general practitioners that they are better prepared to treat prosthetic problems. Prosthodontists have, except for one facet of their practice, a fragile claim to specialty. That part is maxillofacial prosthetics, and it has made prosthetic dentistry better known among other health Presented *Professor,
before
the
Department
Greater
New
York
Academy
of Prosthodontics,
New
York,
N. Y.
of Prosthodontics.
83
84
Sharry
professionals than any other single facet of practice. on the maxillofacial prosthodontist’s skills to improvr general welfare of patients. PROBLEMS
Surgeons soon come to depend the postoperative recovery and
OF INCENTIVE
In the United States, the enrollment in dental school postdoctoral programs in 1974 was: orthodontics, 656 students; periodontics, 340 students; oral surgery, 321 students; pedodontics, 255 students; endodontics, 213 students; and bringing up the rear, prosthodontics with 133 students.’ Why is this? It is simply a fact that students who would spend 2 or 3 years studying a specialty and, subsequently, would subject themselves to the cost and inherent stress of examination by a specialty board must question what improvements can be expected in their lives. Perhaps in the large cities, prosthodontists may operate as specialists with most of their patients referred by general practitioners. But in other cities, dentists do not refer patients, because they depend on prosthetic dentistry for much of their income. Why should they refer to another practitioner, no matter how qualified? Instead, the prosthodontist, having announced his speciality practice and after waiting vainly several years for those referrals, usually slips quietly into general practice wherein he gains 95 per cent of his referrals from hir ozen patient.s. After he has built up his practice, he may then become selective and emerge some years later as a true specialist in prosthodontics. By this time, he may wonder whether he could not have done it all just as well without expensive specialty training. We are being naive if we claim that substitutes such as self-satisfaction and sense of achievement are more valuable than dollars. The fact is that most dentists will not undergo the long expense and trial of going to dental school if they cannot look forward to a decent income as well as interesting work. A 1971 survey of practice indicated that of the 15 per cent of respondents who listed themselves as specialists, prosthodontists earned the least.’ Endodontists had a mean salary of approximately $54,000; orthodontists, $43,000; oral surgeons, $39,000; pedodontists, $36,000; periodontists, $35,000; and prosthodontists, $30,000. G eneral practitioners earned approximately $28,000. We must face the fact that if prosthodontists earn only $2,000 there is little reason for a student to take a year more than general practitioners, prosthetic training. He might as well go directly into practice. Let us examine another statistic relevant to this problem of incentive. A survey conducted for the American College of Prosthodontists indicated that of approximately 300 fellows of the College, 18 per cent worked in private practice; 15 per cent, in academics; 8 per cent, in government: 34 per cent, in military service ; and 17 per cent worked at a mixture of private practice and academics.” Approximately 85 per cent of oral surgeons and orthodontists who are diplomates of their boards have private practices. These are important statistics, for they suggest that unless the prosthodontist has an institutional base, there is not a compelling reason, outside of his own drive and pride, to hazard examination by the American Board of Prosthodontics. Last, in considering incentives, let us inquire into the examination procedures of the American Board of Prosthodontics to determine whether those procedures are as
Need
for reappraisal
in prosthodontics
85
good as possible or whether we have been satisfied with a slow evolutionary move from tradition, while the pressures of contemporary society demand determined and resolute action. The first question which must be answered is whether the examination is as objective as it could be and whether it could easily survive critical examination by fellow health professionals or the public. In the first place, is it not odd that a candidate for the prosthetic examination must actually treat a patient in front of the examiners during a week of great pressure, while surgeons, who will perform intricate cardiovascular and neurosurgical techniques where the very life of the patient is constantly involved, are examined without so much as tying a suture in the presence of examiners? Medicine long ago abandoned such tactics, and we still require that a candidate undergo an examination which he can fail for reasons which have nothing whatsoever to do with his skills! For example, if the patient walks away before the examination is over, regardless of the cause of the action, the candidate fails the examination. It is time that we join most fellow dental specialties and all medical specialties in developing an objective examination which will not depend upon the treatment of a patient at the testing place. Those examinations act as an artificial barrier to those candidates who are perfectly knowledgeable but easily intimidated by unique pressure. Further, there is nothing laudable or defensible about an examination in which the chances of failure are equal to or greater than the chances of success. Logic rejects the explanation that the education of current candidates is insufficient for them to pass the examination. How can we ever know, when a major part of the examination procedure is so surely subjective, as likely measuring individua1 response to the situation as the educational process. I know of steady attempts to improve the examination-the earnest quest for accountability. But as long as subjective judgment predominates, we shall be governed by the dynamics of committee functions. I have served on national committees with some of the most prestigious scientists, clinicians, and educators in the United States of America. I know how committees can be influenced by forceful men, especially if the hour is late, the day has been wearing, and one’s own knowledge of the particular issue is inadequate. Not only must we devise more critical systems for our Board examination, but we must hurry! We must see to it that the systems not only will set standards for the candidates to pass the Board examination but will set requirements for one to become a Board examiner. Those requirements must be more inclusive than merely the ambition or willingness to serve. Further, our new system must include procedures for removing incapable examiners if, by chance, they should be appointed. Next, we must inform the unsuccessful candidate of the reasons for his or her failure. And the candidate should be able to correct the difficulty and reappear for examination as soon as practicable rather than wait the 2 years now required. The more objective the examination, the more defensible it is and the less reason there is for withholding information from candidates who have failed. Board examiners are very interested in this goal but find it a difficult matter to resolve. An objective examination can resolve it.
86
Sharry
PROBLEMS
OF EDUCATION
Most dental students tend to equate prosthodontics with complete denture treatment, and they know that education in complete denture treatment is based too much on art and too little on science. Some measurements vary “2 to 4 mm.” (a 100 per cent variation), and the student chooses 3 mm., because he is sensible. Students can learn textbook facts, but as far as the treatment of patients in the clinic is concerned, they often spend their time learning the way of the instructor and not the regimen. The Council on Dental Education encourages inclusion of a variety of subjects in the curriculum which in other days just did not exist. For example, all dental schools should increase the teaching time for hospital dentistry and behavioral science in their curricula. With the addition of each “new” subject, somethin% c has to c, 40. for one cannot keep adding hours to a curriculum and increasing the number of years of education for a dentist. As a result, accommodations have been made within the curriculum. Improved teaching methods can often cut down time expenditures. Furthermore, those of us who have been faculty members for 20 to 25 years recognize that we did not always have an excellent plan and well reasoned logic for using the number of hours made available. There were certain territorial imperatives that prompted the prosthodontist to make sure that he used 66 hours if another specialty was allotted 66 hours. Use ol curriculum time was influenced more by past usage than knowledge or science. Furthermore, there is little sense in asking a teacher earning $30,000 a year to deliver a lecture on definitions which can easily be read from any book or when the lecture could be better delivered with a slide-tape series the student can take home. Few faculty members are either thrilled or thrilling when they give that annual lecture for the tenth year wherein they show a slide of a hoe, binangle chisel, explorer. or scaler. They are generally bored, as are the students. I rush, however, to take issue with those educationalists who believe that the whole curriculum can be put onto machines. It cannot! Conceptual matters cannot be learned from machines. Concepts stimulate questions, and the teacher has to be present to understand and answer the earnest questions of students. Machines, even computers, cannot be programmed to provide answers to questions not even conceived by the programmer. The whole matter of curtailment of curriculum hours in prosthetic dentistry is complex. Until the system of delivery of dental health care in the United States changes, administrators in dental schools ought not to surrender the proper clinical education of their students to education in corollary matters. A solid perspective must be maintained which places prime emphasis on the skills involved in the treatment of patients. We probably will come to the day when auxiliaries perform a large number of the treatment procedures which dentists now perform, and then we can change the emphasis, but not until then. EXPECTATIONS
FOR THE FUTURE
What can we now expect for the future! First? the type of practice to be experienced bj, students who graduate this year \vill he entirely different from the practice of 10 or 20 years ago. Solo practices lvill decrease, primarily because third-party payments are here to stay. As a result, many factors will impel us toward group pram-
ylrIEr3;i
Need
for
reajpraisal
in prosthodontics
87
tices. In our country, whether or not we have a private-enterprise system of insurance, such as Blue Cross, a dental service corporation, or national health insurance, we will have an increase in the volume of accounting procedures which will make it prudent for practitioners to associate with others to save costs. An accountant is paid $15,000 a year whether he is working for one man or three associates; furthermore, one dentist alone cannot keep him busy for a full day. Sufficient economy will result SO that associations or partnerships will flourish. The demands of peer review systems which will accompany all third-party arrangements will so affect solo practitioners that those disadvantages that some dentists may have previously worried about in regard to partnerships will diminish in importance. Dentists will no longer be able to hide bad judgments, shortcuts, or greed. They might as well take all the economic benefits of partnerships; the quality of their work will be under inspection anyway. These last considerations will affect less than 10 per cent of dentists, but they will influence even those 10 per cent who so diminish our profession. Group practices will probably proceed, with more dentists forming partnerships. Very soon the concept of the health maintenance organization proposed by the Com1970’ mittee for Economic Development in the early s will prevail, and the delivery of total health care to patients will include dentistry. Dentists will then see great advantages in associating with physicians in the provision of health care. When that happens, the level of care for the patient will improve. For whenever it occurs, the connection between earnest physicians and earnest dentists has always resulted in better care for patients. There is no finer example of this relationship than the maxillofacial prosthodontist and the oncologic surgeon. The patient’s treatment when these two work together is always better than if they work separately. One of the serious problems which we will face in the education of prosthodontists (both in undergraduate and postgraduate programs) is that of finding enough patients. Presently, dental schools offer treatment at low costs, and thus, patients are encouraged to come to these institutions. When a system of health insurance, whether public or private, becomes a fact, what will be the incentives for patients to go to dental schools for treatment ? If patients pay the first $50.00 of treatment costs, they will save little money by going to dental schools where they have to wait and are inconvenienced. SOLUTIONS
TO
PROBLEMS
IN PROSTHODONTICS
So, there are problems, and there are constant and serious attempts to solve them. My worry is that the pace of work may not match the urgency of the need. Solutions of many problems can only follow on facts, which are in short supply. We should not proceed toward solutions on the basis of opinion when facts are gatherable but have not been gathered. We sometimes equate quantity with quality, believing that having less than we used to have means being worse off than we used to be or that having more than we used to have means being better off. In the face of an urgent need for documentation, we should not fret, instead we should urgently push for it. In the face of a need for objectivity, we should not fear to abandon the past. We include among us, an enviable share of thoughtful, energetic, and decent men and women. What we might need is a wider horizon; conversa-
88
.I. I’~orthct. January,
Sharry
tions with those who are not prosthodontists; results of those conversations combined with actions will enrich our future.
Dent. 19i7
those who are not even dentists. The constructive thought instead of rash re-
References Survey of Dental Educational Institutions, J. Am. Dent. Assoc. 88: 931-933, of Dental Practice, J. Am. Dent. Assoc. 84: 636-639, 1971. of Membership, American College of Prosthodontics, 1974, Unpublished.
1. Annual 2. Survey 3. Survey MEDICAL
UNIVERSITY
COLLEGE
OF DENTAL
80 BARRE
S. C. 29401
ARTICLES
TO
Telemetric positions-A
A. Schorn,
D.D.S.,
Resin
regist,ration Skurnik,
ISSUES
and Richard
for interocclusal
D.M.D.,
functional
J. Goodkind,
occtusal
D.M.D.,
MS.
butted
margin
co&act
records
D.D.S.,
Effects of overdentures D.D.S.,
restoration
and Edwin
for orienting Tanaka,
H. H. Thayer,
FUTURE
of anteroposterior report M.S.D.,
ceramic-metal
B. Sozio,
Face-bow
L
IN
D.D.S.
A precision
Yoshinobu
APPEAR
determination preliminary
Harry
Ralph
CAROLINA
MEDICINE
ST.
CHARLESTON,
James
OF SOUTH
1974.
with
J. Riley,
u fucial
D.M.D.
ear prostheses D.D.Sc.
upon
remaining
and A. A. Caputo,
oral structures
Ph.D. ,
