How long does dentistry last?

I was thinking about this question in the car yesterday. Many of our guarantees about dentistry lasting for a number of years or giving warranties comes from our own insecurities about our work. The truth is we don't really know. It lasts as long as it lasts. We can identify risk factors associated with early failure such as wear facets, large masseters, plaque accumulation, erosive wear etc and we can take steps to mitigate these risks. Despite this, dentistry lasts only as long as it lasts and we won't know when it will fail until it finally does.

The question can be reversed though to: How long are teeth meant to last? The truth is that patients who require complex dentistry have ruined their natural teeth and their dentistry will fail one day too.

It begs the question as to why we are designed with such fatal flaws and why we are in need of repair. The truth is that no design is perfect. Our teeth are only one of many things that wear and breakdown over time. Disease is a departure from physiological norms and the presence of disease just serves to highlight our fragility. Teeth lasting to the age of 40 is a fine concept when most humans died at 40. The advancement in science and technology has brought a dramatic increase in life expectancy and therefore the need to maintain our bodies to a fit state to a riper age. With these advancements however has come an expansion of riches and lifestyles that are rich in refined sugars and processed fats. The modern lifestyle has developed a dangerous cocktail of longer life and poorer lifestyle.

I was asked a long time ago why we have to brush our teeth when animals don't and they seem to be fine. The truth is that animals do clean their teeth, they just use other methods like chewing on sticks and bones, animals can have dental disease such as cavities and gum disease and animals don't generally eat cakes and drink energy drinks regularly.

It is actually impressive that natural teeth hold up so well considering the torment we put them through on a daily basis. Again, nothing in this world is perfect. With any positive attribute, there is a negative. Tooth structure is highly mineralised which gives it incredible hardness. The dentine is a more flexible material which helps to support the brittle enamel which makes tooth structure incredibly strong. However with this strength comes a weakness. The mineral content leaves the tooth at risk of dissolution from acids.

If we want to get through this life healthy and happy we have to remember that all aspects of life require balance. Just as we are designed with physical strengths and weaknesses we have to acknowledge the imperfection in our behaviours and actions. Too often, the choices we make in ignorance in our youth only come back to bite us later in life and we are filled with regret. The only person that can make the decisions to change for the better is our self. As health professionals we can help to educate and make our patients aware of the consequences of their actions but we can never make decisions for them nor should we try.

My advice would be to take what you see in the world with a grain of salt, question everything and try to make your own judgements about things. You can and should listen to those with more experience but utilise their experience to prop yourself up and forge your own path. You will be surprised when you start thinking for yourself how your opinions can differ from those around you. This isn't a bad thing; disagreement breeds discussion. Try not to get too set in your ways because as you age and experience things your view on the world will change. Mine has changed every year or the past 5 and I would bitterly disagree with myself just 1 year ago on most things.

Dentistry doesn't aim to augment nature, it's isn't a cure for disease but a way to repair what has been broken.