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  • Rachel Jackson

Carranza's Clinical Periodontology by M.G Newman, H.H Takei and F.A Carranza

Updated: Mar 10, 2021

When the topic of periodontology came up for the cover series, I immediately reflected on my time as a dental hygiene therapist, my training, my current practice and my time as a tutor. What is Periodontology to me? What do I see Periodontology is to others? and, Where might the skills of an artist fit in?

Carranza’s Clinical Periodontology received over 50% of the votes within the Periodontal section of the BDA library centenary survey.

Serving our profession for approximately 70 years and translated in French, Spanish, Portuguese, Japanese, Korean, Slavic and Italian. The book is now on its 13th edition, which was published last year and is enjoying great success as the most widely used textbook in the world on Periodontology and Implant dentistry.

Over the years there have been several authors including, Irving Glickman, Fermin Carranza, Henry Takei, Perry Klokkevold and Michael Newman. I was lucky enough to chat to Dr Newman on the run up to this edition. He was delighted to hear that the book had been chosen to mark the BDA Library’s centenary year.

Recently Periodontology has taken the spotlight. With constant scientific research developments that support new guidance and prominent dental figures modernising the face of Perio. This has made that colourful discipline I know exists, rightfully stand out. So, with that in mind, I decided that the artwork had to be striking; it had to stand out. To create that strength, I wanted to take an abstract approach in both perspective and composition.

“As Periodontists we like millimetres and microns” Dr Newman explained. As a medical artist and photographer so do I. I find nothing more fascinating than looking at the patterns, textures and colours of science. Taking this approach to my artwork was the start of 'Medink' itself, whilst looking to visualise and record theory as a dental undergraduate. Medink actually stands for ‘Medicine’, ‘Education', 'Dentistry' and well, 'Ink' is the Art bit.

Developing a style

So, an image showing the beauty of the histology that makes up the periodontium itself, was then the subject. I looked at the artwork I had produced previously for ideas (above).

The latest edition of the book has access to over 1,500 images and illustrations. Some of these, represent the only known photos of lesions. "We teamed up with the group in Turkey who have one of the most detailed collections of periodontal pathology in existence and we made it available as an atlas for our readers". A perfect feature for me as I set about looking for accurate photographic representation of the periodontium.

"The book has many famous contributors consisting of Key Opinion Leaders and clinical role models as well as world renowned scientists. Information at the leading edge certainly adds to the trustworthiness but is always carefully put into the proper perspective. Which complements the usability of the information.” A recent edition has also been created specifically for dental hygienists. It is no wonder that the book has become a source of trusted information. Important to the clinician who treats patients every day.

"Importantly we were/are the first book to have added many chapters on evidence-based dentistry, critical thinking and clinical significance". Today the book has an important online referral option with an abundance of online content too. Containing many features including test prep questions, animations and case format challenges. “This is appealing internationally because the educator and reader can adjust their goals more individually". Just like the clinical learner, the patient and the disease itself; “One size does not fit all”.

During our discussion I am starting to appreciate the value of the book in its commitment to collective meaning making and communicating with the dental profession across the world. Creating innovative ways to reach the educational needs of its developing workforce. Yet perhaps it is no surprise though, that a discipline as multifaceted as periodontology would have accomplished this. One that holds hands with medicine and relies on communication with wider team's and the patient themselves, to treat it's disease. Periodontology is as much about teaching patients as it is anything else. In fact, I am of the opinion that we should teach dental undergraduates the theory of teaching but that’s another story.

So now I am focused on shape and composition and how I might represent that multifaceted nature in an image. The shape had to be circular because for me that is the shape of the word 'holistic' which mirrors the vital patient and surgeon relationship, and the book's approach to education. It is also the shape of the words Dr Newman used to describe the book "basic, fundamental". He also used the word "resource" and owing to the book's comprehensive 'blended learning' approach to the delivery of information. Those microscopic elements had to blend together within the circular shape. Symbolic of the periodontium’s unity and strength whilst showing the beauty of nature’s complexities.

The creative process

I had started with a more abstract colour palette, looking at colour electron micrographs, but abandoned that in favour of a more natural look. This was my own choice actually, no influence. I just wanted to show beauty in what we have, in what nature has given. Not in a superficial way because that goes against a Periodontist’s view I think…and my view too.

The Final Piece

As we discussed the BDJ project Dr Newman explained that "Clinical judgement is a skill and is on the “artist” side of being a good doctor. Part of this is situational awareness, which is also a skill that can be learned". Which made me think of the artist Leonardo Da Vinci. Who was so empowering because he was not frightened of collective thinking, cross-discipline and to add that perspective, knowledge and skill to his own "toolbox". Operating with a degree of autonomy and self-determination. This approach is important in treating a dental disease that is firmly influenced by the turbulent bio-directional nature of systemic health and disease and greatly managed through patient education. 'Blended learning' of the Renaissance, one might say!

Dr Newman continued to inform me of the 'Clinical Dentist Channel', "An important new online offering for PracticeUpdate members that brings together experts in all branches of dentistry to discuss and provide users with the latest clinical information that matters most in oral health".

We discussed the effect of the recent pandemic on dental undergraduate education. "The world of digital dentistry, accelerated by the Covid-19 pandemic is a gift". I agree, it is a chance to reinvent it! I was speaking to Professor Avijit Banerjee recently who is of the same opinion "Yes, this is a time of great uncertainty, but also of great opportunity. The traditionalists will perhaps struggle with new norms, old models will be forced to change (clinical, business etc) but your generation should be early adopters for change and embrace it. As a profession as a whole, we tend to dwell on the negatives too much at times and as new young professionals, you now have the opportunity to change this outlook and drive opportunities forwards".

Dissatisfaction with the present is evidence of unwillingness to accept new ideas and give up old ways of thinking. Dr Newman and I reflected on the importance of innovation in a remote context and how I appreciate that his book already demonstrates the power of this.

Dr Newman then introduced me to the 'cognitive task simulation' platform ‘Touch Surgery’. The 'Anatomy for Maxillary Sinus Floor Augmentation' tutorial is fantastic! The simulation clarity and realistic animation, that incorporates visual and written theory can reach many learning styles. Taking you from the patient, to the science that supports planning inside and out. It starts to bring about an appreciation for 2D to 3D form and spatial awareness before the application of practical skills. That ends with a test of knowledge.

With platforms like this we can balance traditional didactic teaching (not replace mind you) in favour of the notion of “transcendence”. The creation of environments, activities and methods that focus on individual learner needs, developing a deeper understanding and habits of mind that aid future learning. "Technology will make your jobs better, more fun and more rewarding". Very true and very important, as we consider todays learner type too. The dental student has changed, the dentist model has changed. We must consider the future generation.

I asked "What does it replace?", "Nothing" he said, "It only enhances". I was glad Dr Newman said that because whilst technology has taken us further in many ways. If we consider it to be the only answer, it runs the risk of taking us further away from other aspects of our duty and they matter a great deal.

In my opinion technology can better enhance knowledge and clinical skill, but we cannot ignore the human dimension of the dental surgeon-patient relationship. If we do, we risk losing touch with the personal side of illness, where dentistry becomes a drifting technological island separated from its mainland i.e. the patient. We must remember the power of the ‘person’ from an ethical and legal perspective. Science and technology are a remedy for only half of the problem; a scientific basis to understand the body. Yet the other half; the anguish of a sick person, remains an art and solved internally. "Being a good surgeon is knowing when to cut not just how to cut" Dr Newman concluded.

So, we are back to the skills of an artist who often naturally connects with their environment, with emotions, with the person. Communication not just in the written or spoken word but through a visual. As I do, in my own way, for each BDJ cover. The ability to sense what a patient needs and how to transfer our knowledge and craft reminds me of the artist Pablo Picasso who could convey an huge amount of information in a single stroke. That’s what we have to do as dental professionals. Yet those strokes are different for each patient as they enter our care.

Given the pressure on us to manage the demands of today’s society, social media, regulation, technology, the need to constantly revive our skills and knowledge and let’s face it, the impact all of this has on us as human beings. It's even more a reason to be an artist, be like Leonardo and Picasso, be a Periodontist and create for education.

Thank you for taking the time to read the Blog. I hope you like the artwork and reading about my journey so far. If you would like to be contacted when the artwork goes on sale. Please leave your details here.

British Dental Journal; current issue available here

Up next we have the first of four texts from our historic collection:

'The Surgeon Dentist' by Pierre Fauchard (1728) and translated by Lilian Lindsay in 1946.

Before this project I knew very little about the history of dentistry. Yet I have become very fond of it and it was in fact this area that led me to this commission. Plus, a chance meeting with two strangers. But more about that in the next Blog...

For regular updates on the progress of the artwork follow:

Instagram @rjmedink

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Jul 29, 2020

I enjoy reading the back story to these works. Appreciating the huge amount of preparatory work!

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