Indian Journal of Dental Research

LETTER TO EDITOR
Year
: 2010  |  Volume : 21  |  Issue : 1  |  Page : 147--148

To do or not to do? Class II: Reflections of a conscientious dentist


V Susila Anand 
 Professor, Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Chennai - 600077, India

Correspondence Address:
V Susila Anand
Professor, Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Chennai - 600077
India




How to cite this article:
Anand V S. To do or not to do? Class II: Reflections of a conscientious dentist.Indian J Dent Res 2010;21:147-148


How to cite this URL:
Anand V S. To do or not to do? Class II: Reflections of a conscientious dentist. Indian J Dent Res [serial online] 2010 [cited 2021 Feb 24 ];21:147-148
Available from: https://www.ijdr.in/text.asp?2010/21/1/147/62788


Full Text

Sir,

The objective of undergraduate conservative clinical examination is to evaluate the competency of a student in conservative dental procedures. It is often asked whether a single exercise can do this. Sadly, for obvious reasons of time constraints, it is difficult to conduct more than one exercise. However, to understand what this key competency is, we have to analyze the very principles of conservative dentistry, in the first place.A conservative dentist should be thorough with the core objective of the subject, conservation of tooth structure, improvement of the overall health of the tooth and its contiguous structures and improvement in the self esteem and overall performance of the patient.

There are no rewards for guessing why Class II amalgam restoration was chosen as an examination exercise, since time immemorial. [1],[2] By claiming that it is a myth that Class II is more difficult than other exercises, this impression is instilled in the young minds of students by their teachers. Only, novices are trying to shy away from truth and reality. Experienced and knowledgeable dental practitioners unequivocally agree that Class II is indeed a challenging task. [3],[4] Then it is only common wisdom to deduce that a student able to perform a good class II would certainly be able to perform other exercises with more ease and perfection.

Students and examiners should realize what is reasonably expected of a student in a clinical examination. It is not just the dexterity and skill in executing a good class II, but understanding the principles of the subject, sound knowledge of how to manage the patient and any mishaps that may iatrogenically result, be it a cuspal undermining or pulpal exposure. A well done Class II amalgam restoration can end up in a pin point exposure. After all, mishaps do occur even for experienced practitioners. Hence it may not be enough ground for failing a candidate. The ability to realize a mishap, honesty to accept the same and the versatility in expeditiously managing should actually fetch more marks than a mediocre class II.

Though it may take long to bust exam blues, positive efforts taken and demonstrated by examiners will be a stepping stone in this direction. The controversy over amalgam usage is far from over and hence, teachers who crib over keeping Class II amalgam as examination exercise, actually have not dispensed it off in their own practices. [4]

If mercury toxicity is the true concern in voting against class II exercise, then it should be replaced only with class II composite. And if this is accepted, everyone better realize that Class II composite is a tougher and time consuming exercise than amalgam. [3],[4] As Dr. R.C. Keene puts it, the choice of a particular restoration should be only profession-driven and not manufacturer driven. [5] But the true reason for selecting exercises other than Class II amalgam is the dearth of cases. Two decades back, there was a need for only 35+ Class II cases during examination that happened once a year in the city. But today 800+ Class II cases are required every six months. Four years down the line, 1600+ Class II cases would be required every six months as some more new colleges would compete for the cake. Does the city have so many class II cases? Hence instead of crying wolf, calling names and defying truth, let us all honestly accept the open secret that dearth of Class II cases is the reason for opting other exercises.

The current knowledge boom seemingly has resulted in less time for imparting basic clinical skills and materials training to our students. Also apparently we are in dearth of teachers who actually have the clinical skills to teach basic tooth preserving preparations and probably the cost of setting up a dental office is making it necessary for practitioners to consider treatment options based more on the financial needs of the practice than on the dental health needs of the patients. [5] All these factors contribute to the dilution of standards in dental education, which will make our students turn a laughing stock in foreign soil. Whatever be the exercise, we should not loose sight of the fact that conscience should prevail in conducting a fair and standard examination. We should prepare the students to take on global challenges, given the sheer competition at home and overseas. And many licensing authorities in foreign countries still have class II as their exercise to qualify to practice even general dentistry.

So the dental degree awarded in India should in no way be inferior to those in other countries just because we have done away with class II, in which case, we are doing a disservice to our students. And the ultimate goal of undergraduate clinical examination should be to make the Indian dental degree on par with others from developed nations.

References

1Bernardo M, Lius H, Martin MD, Leroux BG, Rue T, Leitao J, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc 2007;138:775-83.
2Jackson RD, Morgan M. The new posterior resins and a simplified placement technique. J Am Dent Assoc 2000;131:375-83.
3Mjor IA. Long term cost of restorative therapy using different materials. Scand J Dent Res 1992;100:60-5.
4van Meerbeek B, van Landyut K, DeMunck J, Hashimoto M, Peumans M, Lambrechts P, et al. Technique sensitivity of contemporary adhesives. Dent Mat J 2005;24:1-13.
5Keene RC. From where I sit "Who's driving our dental bus?" Operat Dent 2008;33:473-4.