Sumter S. Arnim, D.D.S., Ph.D.: Texas leader in evidence-based dentistry.

Many lessons can be learned from the career of Dr. Sumter Arnim, chief among them that we have a professional obligation to apply scientific knowledge to the practice of dentistry and to involve our patients in their dental care, and to share this translational knowledge with one's colleagues. Arnim's work was an honor not only for the University of Texas Dental Branch (now, The University of Texas School of Dentistry at Houston), but for every school and student with whom he interacted. Our profession is better for having had Sumter Arnim as one of its members, and he can be credited with having played a leadership role in what is now known as evidence-based dentistry in Texas, the United States, and beyond. One of the authors of this paper (JVJ) had the opportunity to be a student at the University of Texas Dental Branch during the time that Dr. Sumter Arnim was faculty member. Dr. Arnim was deservedly respected by his students and faculty colleagues alike, due in no small part to his dedication to dentistry. This dedication to the profession was well known, as Dr. Arnim had been accepted to Yale University Medical School, but soon after enrollment there, he elected to pursue a Ph.D. degree in Pathology, rather than M.D. Dr. Arnim constantly stressed the bacteriologic nature of dental disease and the value of prevention to his Dental Branch students, serving as Director of the Postgraduate School with great distinction. His steadfast belief in the biological basis of dentistry was manifest in his frequent admonition to the student body: "You can either be doctors or hardware merchants." Finally, it is ironic that in 2011, the American Dental Association has reiterated some of Arnim's career themes in its current publication on barriers to oral health in the United States, with primary messages that include, "Prevention is essential. A public health model based on the surgical intervention in disease that could have been prevented after that disease has occurred, is a poor model," and, "Treating the disease without educating the patient is a wasted opportunity."

Local anesthetics, pulpal blood flow and C. Edmund Kells.

Historically there was an attempt by many dental practitioners to implicate anesthetic solutions in the death of the dental pulp. However, their implications may or may not have been valid, as damage to the dental pulp may have resulted from excessive and deleterious restorative procedures on teeth that were anesthetized. Unfortunately little was known about the anesthetic solutions at that time, their composition, which included vasoconstrictors, and their potential to alter pulpal blood flow. This paper will explore both the historical perspectives and concerns regarding the impact of anesthetic solutions on the dental pulp through the eyes of Dr. C. Edmund Kells, along with the contemporary perspectives and realities through the eyes of science, sound research data and clinical practice.

A new paradigm for operative dentistry.

It is over 100 years since GV Black gathered together most of the knowledge then current on the caries process and set clear parameters for the discipline of operative dentistry. His four-volume treatise set standards that were relevant for the times and, in fact, were so well described that they remained dominant in this discipline until quite recently. However, over the last 50 years there has been great progress in scientific method and in knowledge of the common diseases of the oral environment, including the caries process, so maybe it is time for change. The term "paradigm" describes a philosophy of science, a generally accepted model of how ideas relate to one another, forming a conceptual framework within which scientific research is carried out. Black defined the paradigm within which further research was to be conducted during the following years and the profession accepted his lead. However, it is not expected that the parameters of a profession should remain unchanged over a substantial period so it is suggested that the dental profession should, at this time, recognize a new paradigm. Improvements in scientific method have led to a better understanding of the oral environment, resulting in extensive changes for this profession. It is suggested that the standards set by Black should be now consigned to history and an entirely new paradigm adopted. First, the profession must recognize that dental caries is a bacterial disease and its primary efforts should be directed towards identification and elimination of the disease prior to initiating repair of the damage that it has caused. Preservation of natural tooth structure is then the next responsibility. There should be maximum use made of preventive strategies, including remineralization, followed by minimal intervention cavity designs and the use of bioactive restorative materials to restore the lesions. The profession should be prepared to move on.

A 100-year journey from GV Black to minimal surgical intervention.

Over the past 140 years, dentistry has matured from the original tenets of GV Black by moving from "extension for prevention" to a minimal intervention approach. This is part of an evolution that stresses a medical, rather than a surgical model for caries management. This transition has been facilitated by the introduction and advancement of adhesive dentistry, which encourages preservation of tooth structure. Even with these changes, some of the original writings of Black are still relevant today: "The day is surely coming...when we will be engaged in practicing preventive, rather than reparative, dentistry."

Jonathan Taft: dentistry's great forgotten hero.

One of the greatest figures in the development of the dental profession to the high status it enjoys today is all but forgotten. Jonathan Taft was dean of the second dental school in the world and wrote the most important clinical textbook of his time, one that was reprinted in many editions over a quarter of a century. Later appointed dean of the new University of Michigan Dental School, he instituted innovations in admission requirements and course of study that were copied by all subsequent schools and are the standards adhered to today. The editor of one of the most important dental journals for 44 years, a record unmatched to this day, he set the standards for modern dental periodical literature that have done so much to elevate dentistry that today it stands on a par with medicine as a truly science-based profession. He served dentistry in many capacities: president of the American Dental Association, founder of the National Association of Dental Faculties, and founder of the National Association of Dental Examiners. Over his lifetime, he published almost 200 professional papers and probably attended and lectured at more dental meetings than anyone of his day and since. His memory should be resurrected, and the profession must be made aware of the great debt it owes to this intrepid fighter for a better dental profession.

First evidence of pre-Hispanic dentistry in South America - Insights from Cusco, Peru.

Intentional dental modification (IDM) derived from archeological or ethnographic contexts has been extensively documented across the globe. Despite the wealth of information on IDM for personal ornamentation and ritualistic purposes, evidence of IDM for therapeutic reasons among early Native Americans is poorly known and limited to a handful of cases. We report two upper canines from two pre-Hispanic individuals dated to the Late Horizon Period from Cusco (Peru), each showing a conical perforation on its incisal surface. Analyses were performed using traditional radiography, computed tomography and scanning electron microscopy. The depth and symmetrical location of the perforations at the center of the crown suggest that these two teeth were artificially drilled, rather than affected by taphonomic factors. The poor oral health of the individuals, the location of the perforations on the incisal surface, and evidence of intentional manipulation of the pulp chambers (as supported by their overall morphology and presence of striations and deep marks along the walls of the perforations) provide a strong case for the occurrence of prehistoric dentistry in the New World. The two canine teeth reported here represent the first pre-Columbian examples of IDM likely performed to ameliorate a dental pathology (presumably associated with the infection of the dental pulp) found in Peru and in the rest of South America.

Operative dentistry in the second century BCE.

An archaeological excavation by the Israel Department of Antiquities and Museums recovered the skeletal remains of 25 people buried in a mass grave dated to approximately 200 BCE. Subsequent analysis of the dentition showed one skeleton with a 2.5-mm bronze wire implanted in the maxillary lateral incisor. This is the first archaeological evidence of operative dentistry in ancient Israel, as well as the earliest date for this specific treatment in the world.

Interview by Gordon J Christensen: Enjoying life as a dental professional.

The life characteristics that contribute to a happy professional life are easy to identify. However, many of us do not strive to incorporate them into our lives. In this article, Dr. Rex Ingraham has shared his ideas about the factors that have contributed to his happy and long professional life in dentistry, as well as to his satisfying life in retirement. All of us would do well to adopt some of these characteristics into our own lives.

Dental cutting: the historical development of diamond burs.

This brief history of the dental diamond bur is intended to provide both a historical perspective and an evaluation of the current state of bur technology. An understanding of the origins of dental diamonds and the issues facing manufacturers transforms the dentist from a simple user into an informed consumer. The author contends that this can improve dental care and enable the dentist to collaborate with manufacturers in developing improved dental burs.