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Politics of LANAP 0

A post by Dr Wes Hadix was posted on a Dental Site that was so well written I decided to repost here.

Initially a Periodontist posted 
I visit Laser Dentistry forums on occasion for a brief escape from reality and comic relief.  Every so often, there are some great cases being presented.  Otherwise, it’s like being hounded in the Expo Hall on the last day of a dental convention. The bias is so thick you can cut it with a knife. 

Someone please discuss HONESTLY, where are we headed with lasers in dentistry? Are we doomed to repeat a bunch of case reports and testimonials? Where is the NIH, The ADA, The AAP? Cowards! If we dentists have a shred of integrity left, then we must demand the UNBIASED research. Without it, we are doomed to lose our credibility with the public and with our peers. Please God, don’t tell me about Ray Yukna’s paper one more time or ill puke! It’s one of the weakest forms of evidence on the tree of research. It’s not that I don’t appreciate his contribution, but too many people hold onto it like the last life boat on the Titanic.  It may keep you afloat, but just barely. I don’t even think that Ray believed he would have had the only credible piece of literature on the histologic proof of laser periodontal regeneration THREE years after publication (positive or negative).

Now this is a topic worthy of discussion for those with some guts!

“Question with boldness even the existence of God; because, if there be one, he must more approve of the homage of reason than that of blindfolded fear” ~Thomas Jefferson

Dr Hadix’s response

Where we are headed with lasers in dentistry:  Let me paraphrase Einstein:  “For every brilliant idea, there are a million mediocre minds.  And many of them are Dentists.”  Where we are headed is like every other aspect of dentistry that does not recieve approval or blessing of the specialist oriented political machinations.  There are dentists who use and embrace lasers, and for every one of those, statsitstically, there are 20 more who don’t know enough about lasers to fill a parapgraph, much less used them to any great extent to understand and appreciate what can and cannot be done with them.  LIke a cult, the Evidence Basers don’t want anyone to do anything that isn’t blessed by the Holy Grail of Double Blinded University Based Unbiased Research.  Trouble is, nothing of the sort exists.  Nearly evey study or researcher has a bias or axe to grind, and as far as interpreting the results of lies, damned lies, and statistics,  results of a studies are crunched in manners that seem to follow quantum mechanics more than logic.  While this is an admitted and humorous overstatement, I like to think of Evidence Based followers as sort of research socialist/facists who don’t think the great unwashed practioners can make good treatment decision for their patients unless in comes from a Great Study.  The day I have to practice and be forced to put my clinical judgment and knowledge of the patient behind an ‘approved approach’ is the day I’ll quit this profession.  

There are three types of dentists:  Those that embrace new technology, those that reject it, and those that criticize it.  We are going the place with lasers that our profession has gone with amalgam.  With periodontal disease.  With implants.  With radiography.  The smart, patient centered practioners know what works for them and their patients; activist practioners don’t have enough of their own patients and they feel the overwhelming urge to dictate how everyone else practices.

But the real question here is:  why do you care where ‘we’ are headed with lasers?  The more important question is where you yourself are headed with lasers and why.   If you’re so hot for some ‘unbiased’ research,  open your wallet, close your practice, and do it yourself.  It is in the works, but as we all well know, to design research that would meet the demands you place on it takes a lot of time, alot of money, and a lot of committment.  Persons with most of those qualities are currently involved in trying to meet these requests, but I guarantee, in the end, no matter how well designed the study, no matter how convincing the evidence, Charlie Cobb will fail to mention it in his next review of the the topic.  And on it will go.

If you’re looking for a sweeping kumbaya of the profession around lasers, it’s not going to happen.  Smart people will continue to embrace the technology and use it well; these are the practioners who have taken the time to learn the topic for themselves so that they can make their own decisions instead of waiting for someone else to make them – sort of intellectual captitalism, if you will.  Most others will mill around, afraid step outside of the narrow trickle of the ‘mainstream’, having been cowed by specialist groups not to use these New Things, they’re dangerous and will cut down on the referrals to my periodontal practice where I’m more interested in extracting teeth and placing implants than I am in possibly saving them with laser assisted therapies.  Or any other therapies that allow GPs a viable method of treating their patients, for that matter.

Finally, if you want to puke over Ray Yukna’s study, just leave, go back to the ‘reality’ you escaped from,  and don’t come back unless you can show one thing in your life that even comes close to the contributions Dr. Yukna has made to dentistry and periodontal treatment.   We don’t need your kind here.

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