Definition of Endo|Gen
Endo|Gen /’ɛndəʊ’dʒɛn/ n. A blog providing up-to-date and practical information addressing the wide variety of problems encountered by dentists in their practice of endodontics, whilst respecting the need to integrate it with the evidence-base that underpins high quality root canal treatment. [alt. of Endodontic|Knowledge]
What is the background to Endo|Gen?
The chances are you qualified with minimal knowledge of, or experience in, root canal treatment (RCT) and, with this basic understanding, you were expected to just get on with it. Perhaps you sought the advice of other dentists in your practice, but later discovered that the usefulness of their advice was limited by them doing what they did only because someone else had suggested it to them in the distant past. Although their technique had always seemed to work for them, ‘work’ only meant producing a good enough white line, close enough to the radiographic apex that it would satisfy any dental officer who happened to see it that the RCT was good enough. Unfortunately, if the quality of your endodontic treatment is only ever assessed by the perfection of its 2D white lines on a radiograph, then it’s only natural that your techniques will tend to be honed towards a perfect 2D white line above all the other highly desirable qualities of an ideal 3D RCT.
Likewise, in the early part of my career, I fished around for advice, scraps of information and tricks for faster and less stressful endo. I attended many courses, which mostly involved a few hours at some bland local hotel learning about some fantastic new instrumentation, which was always conveniently available at a discount from the manufacturer’s sales team, waiting at the back of the room with a broad smile on their face. Although they helped pique my interest, these courses didn’t do much to improve my endodontic skills and, like many other dentists, I accumulated a stockpile of redundant equipment that didn’t live up to its promise. When the internet came along there was an explosion of easily accessible information, but it was mostly fragmented, anecdotal, unsubstantiated and lacking an evidence base or it was product specific and trying to sell me something. Despite being exposed to so much information (which, incidentally, qualified for many hours of verifiable ‘continuing professional development’), I retained the 2D white line assessment of success, those cases with unexplained recurrent disease and so, so many questions about why such and such doesn’t work for me; I remained stuck in an endodontic rut. Nevertheless, rather than throw it all in and abandon endodontics to the endodontists, I decided to do something about it and took my pursuit of endodontic understanding a little more seriously.
Paradoxically, my first real eye-opener to high quality RCT was internet sourced and was the mass of knowledge shared on the original ‘Roots’ forum. This is not today’s Facebook group of the same name (which evolved from it), but was an email forum, now defunct, started by Ken Serota from Toronto. There is a nice summary of its aims here and if you wish to see what it was like, a large number of the Roots posts have been archived here with a collection of case reports here. Roots introduced me to the rigorous, integrated and evidence based approach taken by recognised specialists from across the world. At the time, very few dentists in the UK were using microscopes and the concept of time-consuming microdentistry was anathema to the majority of state subsidised UK dental practice, but Roots was full of photos taken through surgical microscopes that bore little resemblance to what I was seeing, even with my loupes. I realised that I was missing out on an awful lot, both visually and intellectually, and that there was much more to understanding endodontics than signing up for a few hours a year in dreary hotel seminar rooms.
What I was not getting from my piecemeal approach to learning was that simultaneous immersion in all aspects of endodontic science and care which ultimately leads to synthesising the underlying concepts with clinical practice and consequently gaining a thorough grounding for clinical endodontic practice. In his memoir, Pour Me: A Life, AA Gill gives a very elegant explanation of the difference between a piecemeal approach to learning and integrated knowledge:
Well now I know lots of things. Lots and lots and lots of things. Lots of things about lots of things about bigger things – but they’re not joined up things. For as long as I can remember I’ve stored away facts like a mad old muttering man clipping newspapers. The facts aren’t useless in themselves, in the sense that words aren’t useless, but they are only purposeful if they’re combined into phrases and sentences. A solitary fact, a single unattached nugget of knowledge, is an orphaned lego brick…… knowledge is not a synonym for clever. Clever is not in the same bed as wise. In fact, knowledgeable might be an indicator of lack of wisdom.AA Gill Pour Me: A Life
I conceded that I needed to take a more methodical and academic approach to learning, so I took the plunge and enrolled on a PGCert in endodontics, continuing on to an MSc.
So, why Endo|Gen?
Firstly, many dentists at different stages in their career have confirmed that their experience of endodontic education reflects my early experiences. It’s not so long since I was in their position and I can recall the problems I struggled with before starting the post-grad training. So, just as my accumulated experience would have been so useful to me a few years ago, I am sure it will be useful to other dentists now.
Secondly, once the masters course finishes you loose the pressure of deadlines and the pressing motivation to continue learning; you leave with a feeling of being cast adrift and left to your own devices.
Hence, Endo|Gen, where I will primarily discuss the clinical endodontic problems (and relevant wider dental issues) we all meet frequently, hopefully integrating the evidence and rationale for the practical solutions, avoiding the “orphaned lego brick” approach to learning which it is so easy to fall into. So, while Endo|Gen is primarily maintained to help other dentists, whether newly qualified or experienced, it should give me an incentive to keep reading and maintain a routine of critical review and writing.