An Interview with Dr. Gordon Christensen

Inside Dental Technology (IDT): What is the most common question that dentists ask you either at your group seminars or your private teaching and how do you answer it?

Dr. Gordon Christensen (GC): Dentists want to know “what works” for myriad dental challenges. They do not need volumes of research to convince them. They either trust or do not trust the person teaching. I answer the questions with research as a base, much of which we have done ourselves, backed by the clinical observations of thousands of experienced clinical dentists. To paraphrase the originator of the now trite phrase evidence-based medicine (dentistry), David Sackett, MD, “Neither research nor clinical observation can be used alone. They must be combined to make a clinical decision.” In my opinion, we have lost the real intent of Sackett’s definition. Research plus clinical observation equals clinical decisions. Neither alone is enough—I strongly believe that statement. American dentistry has married the phrase evidence-based dentistry ad nauseam. In my opinion, we need to return to our roots. We are dentists; we prevent and treat oral diseases; we are honest, educated people; and our clinical judgments after experience are valid. Combine your personal judgment with whatever research appears to be legitimate, and you are a genuine professional who can stand behind clinical decisions.

IDT: How much do dentists rely on others, like you, to interpret the science for them?

GC: As I stated before, dentists trust or do not trust the instructor. I consider myself to be an observer of research, an observer of the opinions of the thousands of dentists I see annually, and a condenser and interpreter of that information. Much of the current research that is published in dentistry is not clinically relevant. In fact, it can actually be misleading. Someone has to sort the wheat from the chaff. That is my job, along with many others.

IDT: How do you ensure that there is no conflict of interest in your reviews?

GC: Clinicians Report’s scientific and clinical staff meets on a routine basis with manufacturers who present information about their products to us. We then evaluate those that appear to be promising. There is no money exchanged for the evaluations. If a product fits the characteristics listed above —ie, it is faster, easier, better, or less expensive—it is likely to appear in the Report, for which, again, there is no exchange of money. We are entirely supported by subscriptions from around the world, income from courses, and donations. Whatever works well in both basic science research and in clinical observations wins, regardless of the company.

IDT: Tell us more about the work that is exciting you these days.

GC: CAD/CAM in-office and laboratory is taking over the indirect restoration marketplace. It is moving faster than any other concept I have seen, other than perhaps air-rotors many years ago. I see the metal age in dentistry rapidly disappearing—for good or bad. Zirconia and lithium-disilicate restorations are taking over the market.

IDT: I know one of your concerns is the state of educational support for the dental laboratory industry. Can you comment on this problem and offer suggestions for improving it?

GC: In 6 years of independently sponsored laboratory summit meetings, we have identified several major challenges in the current laboratory profession:

The lack of accredited dental laboratory technician educational programs and the need for active recruitment for dental laboratory students. The ADA and NADL need to be stimulating these programs.

The need for dental laboratory certification and dental technician certification. This must come from state legislative mandate, not weak national “resolutions.”

The growing gray market and the continued expansion of laboratory products from offshore laboratories. This will continue to grow until China has a middle class, raises fees, and uses more of its own crowns and prostheses.

The almost total absence of interaction between dentists and laboratory technicians in dental schools, continuing education programs, organizations, or in clinical dentistry. Again, there is a need for an ADA mandate that laboratory schools and dental schools should interdigitate.

All of these areas need significant observation and change. The ADA and the NADL are now working with the Laboratory Summit group to attempt to solve some of the problems. The final outcome is still to be observed.

IDT: If you got a do-over, what would you change about what you have done or not done in the profession?

GC: I love dentistry—I would do it again without any hesitation. I would not change much in my life or the life decisions I have made. I sincerely wish that dentistry and the other phases of medicine were still one. It was a mistake for our forefathers in 1839 to separate us from our colleagues. If I were doing my education again, I would probably get the MD union card to augment, but not replace, my dental degree. However, in spite of that misdirected decision by the leaders in medicine of long ago to segregate, dentistry has done very well for patients, and for those of us fortunate enough to be dentists.

ID: What is the best lesson you learned along the way?

GC: History repeats itself. Just wait long enough and “whatever” will come around again. Do not be too fast to accept the newest thing on the market. Wait until many others have had some experience. Do not think that technology will replace us. Some of the currently hyped technology is merely a replacement for, but not better than, conventional treatment. The dentistry of 30 or 40 years ago actually lasted longer and perhaps served better than some of our current dentistry—however, it was metal and ugly.

Gordon J. Christensen, DDS, MSD, PhD is founder and director of Practical Clinical Courses (PCC) and senior consultant of Clinicians Report (CR).