The Art of Endodontics
Updated: Oct 4, 2020
Winning the endodontic category of the library’s centenary survey with 77.8% of the vote, this title has a new edition due out in this month.
Now with new editors, this textbook began life in 1976 edited by Stephen Cohen, Clinical Professor and Chairman, Department of Endodontics at the University of the Pacific, School of Dentistry and Diplomate of the American Board of Endodontics. Along with Richard C Burns, later President of the American Association of Endodontics.
Like all the cover artworks, I try hard to gain as much insight into the subject as I can to better represent a specific field in dentistry.
I was lucky enough to chat to Dr Julian Webber, a very experienced endodontist who was the first dentist in the UK to qualify with a Masters Degree in Endodontics from a university in the USA and has practiced within central London since 1978. In 2014, Julian was honoured for his Outstanding Contribution to Private Dentistry. “Pathways of the Pulp has been the GOLD standard and a definitive guide to the science, theory and clinical practice of Endodontics for over 40 years”, he said. “The book chapters are written and updated with each edition by leading world experts in the field of Endodontics. Each chapter provides readers with an up to date evidence-based approach to the topic. Recent editions have been available in an “e” version with each chapter updated continuously as new evidence is published around the world”. Julian reflected on his time as a student at North-western University Dental School in Chicago “the book was part of a huge portfolio of reading material we had to complete on a weekly basis and formally review. At the time the contents were digested from cover to cover”.
For me, as an undergraduate dental student, my rather existential approach to my education has me continue to connect art with science. Endodontics was, in fact, the first time I connected the art and science of dentistry. Producing the pencil drawing ‘Endo Jelly’. After reading, observing, researching and chatting to specialists in this field, I created what I believe is the ‘spirit’ of endodontics, complete with ‘sealer puffs’!
For the BDJ Cover five, I decided to carry on with the idea yet now looked to add more elements. I sent a mock-up to Melissa Arts editor of the BDJ, and when I said I was going to turn ‘Pathways to the Pulp’ into a Jellyfish, I had some explaining to do. Yet just as the editor of the book states “endodontic concepts and perception can be best acquired through graphics”. The team trusted in my idea and has in fact turned into a firm favourite of theirs.
“There are a huge number of illustrations in the book from full-colour photos to radiographs and drawings. For me, the technique sections and related images had a great influence on the concepts and clinical techniques of Endodontics as practiced by me to this day” said Julian. The authors have allowed readers to download any images for personal use too.
As an artist, my mind is enhanced by visuals, but importantly, right now, it is fundamentally how I learn. The teaching material and theory that I was exposed to, quickly brought about an appreciation for the need to connect with the tooth both in a visual and tactile manner.
I am taught endodontics by Dr Ian Jones at the Institute of Dentistry Aberdeen who very quickly ensured we were guided visually down that rather complex, unforgiving canal path towards a successful outcome. To be a great teacher, I believe you do not have to be the fountain of all knowledge, but you do have to be able to bring something into the world that did not exist before. Not to only teach specific things but to develop in the subject the capacity to learn, and this is what the book ‘Pathways of the Pulp’ and my tutor inspired in me. A classroom environment that is supported with goals that develop deep understanding and habits of mind that will aid future learning.
Consequently, good observation, connecting with anatomy and morphology along with fine tuning motor skills and tactile feedback, creates a 3D image in the mind’s-eye. The processing of visual input to guide proprioception of the hands. I remember observing the specialist endodontist Dr David Cohen last year who maintained fully connected through tactile feedback whilst he would chat away casually throughout the appointment.
It can be taught too, away from the clinic, we would do this as art students. Try this; Get yourself a pencil, a piece of A4 paper and an object. Something relatively simple in shape but even better if you have something anatomical like a plastic skull. Place the object behind you or to the side but out of view. With your non writing hand ‘feel the object’, do not look at it. As you do this, try to visualise each inch you are recording with your fingertips. With your writing hand draw what you feel. This uses the same sensory areas of the brain both in visualisation and connection to motor skills. If you do this often enough, you become more accurate in your ability to appreciate spatial awareness, textures and sensory feedback within your fingertips. Continue and increase the complexity of your object and your sensory capacity. This skill is also useful in other areas of dentistry such as analysing an edentulous ridge, periodontology and the inspection of lesions.
This skill is required for endodontics. In essence, that connectivity creates transparency between you and the patient. Using the transparent nature of the Jellyfish would expose the important complexities of the canal systems and this concept.
Interestingly enough one of the first editors the late Richard “Dick” Burns who was Assistant Professor in the Department of Endodontics at the University of Pacific School of Dentistry, San Francisco, was a prize-winning watercolour painter. He also wrote and illustrated an award-winning cartoon for ten years in the Journal of the California Dental Association through the 1970s. <This illustration was inside the front cover of the second edition of ‘Pathways of the Pulp’ (and possibly the first) and shows all the contributors on their pathway. “Many of these guys were considered as “greats and giants” in the field of Endodontics”, Julian explained.
To recognise the co-author Richard C Burns’ artistic abilities and medium of choice I had chosen to use watercolour to create the artwork for BDJ Cover 5. You can find my guide to watercolour in Part 2 of this Blog.
The title of the first chapter is the ‘Art of Diagnosis’, and as x-rays form a part of that I studied the patterns and textures on a typical periapical radiograph. You will find this at the bottom of the artwork. Here the cloudy contrasting osseous grains were created covering a very wet watercolour surface with clingfilm and allowing it to dry. This pooled the paint into layered, angular shapes.
The Jellyfish composition shows movement through its aquatic environment, symbolising the freedom of patency as one would achieve during canal preparation. The rush of releasing bubbles flow from its claret tendrils, mimicking the tissue dissolving and saponification reaction of sodium hypochlorite.
With each cover artwork, I have the golden opportunity to connect with authors and specialists in their field. An opportunity that many dental students would love to have, so I always ask those people for some advice for dental students:
Julian said “Never accept second best. Use the hands that God gave you to master excellence in all areas of clinical dentistry. Read and keep up to date with all the latest research and remember your learning starts when you qualify as a dentist. It does not end when you qualify. The ultimate goal of any dentist is to save teeth and maintain the natural dentition in form and function for a lifetime”.
Thank you for taking time to read the blog!
The next book to inspire the BDJ cover series is another from our historic collection.
A System of Dental Surgery by Sir John Tomes and his son Charles Tomes.
We commemorate a man who spent his life working towards the improvement of dental practices and qualifications.