I recommend adhesives to my patients if and when using them improves their quality of life
Born in Lebanon, Prof. Nadim Z. Baba moved to Canada and completed a DMD at the University of Montreal. He received his certificate in advanced graduate studies in prosthodontics and a master’s degree in restorative sciences in prosthodontics from the Boston University Henry M. Goldman School of Dental Medicine, U.S. Baba is Professor of Restorative Dentistry at Loma Linda University, teaching in the advanced education program in prosthodontics, and is an adjunct professor at the University of Texas Health Science Center at San Antonio School of Dentistry, both in the U.S. He maintains a private practice in Glendale, California, and is President of the American College of Prosthodontists. He was one of the speakers at the 2019 International College of Prosthodontists and European Prosthodontic Association joint meeting, which took place in Amsterdam, Netherlands, from Sept. 4 to 7. Prof. Baba was one of the guest speakers at the P&G denture session, which aimed to promote awareness of edentulism as a global oral health issue and emphasized the emotional and functional benefits of adhesive creams for denture wearers. Solutions like blend-a-dent PLUS BEST HOLD are the reason that experts like him are confident that, with a healthy mix of education, tools and a few dabs of adhesive cream, patients with prostheses can feel confident and live their lives to the fullest.
Prof. Baba, you teach and practice part time. Why do both?
I graduated from a Canadian university, so I had to take the boards when I came to the U.S., to get licensed and be able to practice. In the meantime, I could only teach. Once I was able to practice, I still kept my teaching position because I really love the opportunity to share my knowledge with others and find it very rewarding as well to have a chance to give back to the community and my students what I have had the chance to learn and master. I also enjoy the interaction with the students and practitioners. I teach both students studying to become dentists and qualified dentists who want to specialize.
Do you feel that those who want to specialize are more motivated, having already decided on the field that holds more interest for them?
It is a different ballgame. It is much more rewarding to teach students who want to become dentists because they do not know enough yet and you can see them grow. The other students are already dentists and one might have to deal with established mindsets, ego, etc., which can be challenging at times, but it is also rewarding, as they already have knowledge and I help them build on it.
Maxillofacial prosthodontics is a subspecialty of prosthodontics and in itself, it seems, could have its own degree because of the complexities a surgeon might face treating not only problems within the oral cavity but acquired and congenital defects of the head and neck as well. Does an education in prosthodontics cover all its subspecialties or do students specialize in one of the subspecialties within prosthodontics?
In the old days, prosthodontics concentrated on removable, fixed or maxillofacial prosthodontics. Nowadays, if you want to become a prosthodontist, you have to be able to do everything, fixed, removable and maxillofacial prosthodontics, and temporomandibular joint, sleep apnea and implant treatment. After obtaining a DMD, you will study three years more to specialize. If the subspecialty you are interested in is maxillofacial prosthodontics, you will need an extra year to attain a fellowship exclusively in this area, so indeed there is a need for further study to really learn about this subspecialty.
When it comes to an interdisciplinary treatment approach, does the prosthodontist tend to work more with one dental specialty than another and if so why?
Prosthodontics is an interdisciplinary specialty. We have to work with periodontists because of periodontal disease and implants, with endodontists because of problems with roots, with orthodontists because patients want straight teeth before crowns or veneers are placed, with oral and maxillofacial surgeons because patients sometimes need jaw surgery to align the jaws before the prosthodontist is able to restore them; therefore, all other dental specialties play a role in prosthodontics, not one in particular.
Why do you feel dentists are still hesitant to recommend adhesives to their patients, seeing it more as a failure rather than a possible improvement to their patients’ treatment and care?'It is a historical problem. In the old days, doctors would do dentures and think that, if they did not fit properly, they could use adhesives. Therefore, adhesives were associated with failure. In the minds of many generations of dentists, you only used adhesives if the prosthesis did not fit properly and made the patient unhappy. New studies have shown that adhesives play an important role in improving comfort, stability and masticatory performance, and in reducing the possibility of food getting stuck underneath the denture, and thus have a lot of benefits.
Doctors avoid prescribing something if they do not know how it works and thus cannot explain the benefits of using it. I believe that part of the reason might also be that manufacturers might not yet have spent enough time educating dentists.
Do you personally use adhesives regularly or recommend to your patients to use them?
I have a patient who is an orchestra conductor. He came to me telling me that he loved his dentures, which fitted perfectly and were not easily taken out. Even though there was no problem, he still needed to feel totally secure, being afraid that they might come out while conducting, which to him would be most embarrassing, as one could understand. I recommended to him to use an adhesive when he performs and that is what he now does, giving him peace of mind.
I recommend adhesives to my patients if and when using them makes them comfortable and more confident, improving their quality of life.
The issue has to do with adaptation. Some people adapt to whatever they are facing; others do not and even with a perfect denture need more surety.
CAD/CAM is increasingly becoming the norm and a necessity in many aspects of dental care. During your presentation, you mentioned a lack of competent technicians to manufacture prostheses. Why do you think there is such a lack?
Indeed, nowadays CAD/CAM is everywhere, but qualified dental technicians are lacking. Not many people apply to dental technician schools. The labs buy scanners and hire fewer people to do the work required. Workflows have shifted to a different dynamic. Using the computer is easy for manufacturing a denture, but you still need to know the basics of dentistry, anatomy and occlusion to make a good denture. Many labs hire people working with CAD/CAM to make dentures, people proficient in computer technology, but do not have many qualified persons to check on the work produced. Qualified dental technicians are becoming a rarity.
Could you tell me more about the CAD/CAM curriculum you collaborated on with the American College of Prosthodontists?
One of our priorities as an organization is to improve oral health outcomes by advancing technological innovation in patient care, including CAD/CAM. Seeing the need for that kind of education in dental schools, we reached out to Henry Schein, who loved the idea and provided a generous grant to create a digital dentistry curriculum.
We brought together a task force of more than 50 educators from 33 institutions. Over the course of two years, they developed a robust framework with learning objectives and competencies, guides for implementation, and a wide variety of supporting resources, including a textbook, Fundamentals of CAD/CAM Dentistry.
Five American universities tested the digital dentistry curriculum with very positive results. We then opened the curriculum to every dental school in the U.S. and Canada. So far, 66 out of 72 schools have taken up the curriculum, which is an amazing result.
After introducing the curriculum globally during the International Dental Show in Cologne this past March, we again received very good feedback. We’re looking forward to continuing to improve the curriculum based on schools’ feedback and the evolution of the technology. We want the dental community to know that prosthodontists are their partners in delivering the best possible care for their patients through the use of advanced dental technology.
Your term as President of the American College of Prosthodontists will conclude at the end of October this year. How do you feel about your tenure? Have you accomplished the goals you set for yourself in the position?
The term is for a year, so it is necessary to concentrate on what you feel you can accomplish in that time frame. My aim was to create, for the first time in the college’s history, the first stand-alone practice management course and I can say that I was able to do so very successfully.
I also worked on financial literacy for the prosthodontist, resulting in a webinar designed by a financially savvy prosthodontist for any interested prosthodontists.
The college also supported the student loan reform bill called the Resident Education Deferred Interest Act. As we all know, student debt continues to be a huge problem for our members. This legislation is designed to halt interest accrual while loans are in forbearance or deferment for those who qualify for the internship/residency category of either of these payment delay options.
The college became a member of the Coalition for Modernizing Dental Licensure (CMDL). The CMDL efforts are twofold. CMDL will focus on outreach to state dental boards to encourage them to amend their licensure requirements to eliminate single-encounter, procedure-based examinations. It will also encourage dental boards to allow for increased licensure portability and to work at the national level to establish a common core of credentials for licensure that can serve as a basis for licensure compacts among states [for more, see https://www.ada.org/en/press-room/news-releases/2018-archives/october/groundbreaking-report-supporting-modernization-of-dental-licensure-process].
It has at times been difficult to juggle all the responsibilities I have, particularly since I am good at some things and not interested in others. To my mind, getting help from experts can only be positive.
These have been the most important accomplishments for me during my tenure, but I also worked on a booklet written for patients to explain treatment in a way that makes it clear to them as nonmedical professionals. I collaborated with someone who was not a dentist but had some knowledge about dentistry and could write what I wanted to say in a way clear to patients. I wanted to reach patients in a way they could truly understand, without radiographs or surgical photos, only photos showing cases before and after treatment. We wanted to explain to patients the whole process of the treatment being recommended to them.