Dr Aubrey Sheiham: An unfinished journey

Dr Archie Cochrane (the pioneer of Cochrane Collaboration) inspired and encouraged Dr Aubrey to question many practices in dentistry. He was the first to ask whether six-monthly dental visits of patients bring any good to the patients. He famously wrote in Lancet 1977 that such practice might cause more harm than benefit. His premise was based on the fact that the more dentists look, the more they find; and the more they explore, the more procedures they perform; hence falling into the trap of overtreatment.

Dr Aubrey wrote “persons having dental examinations at intervals longer than six months were not at a disadvantage. They did not have more severe dental caries or periodontal disease than those attending at intervals of 6 months”

Dr Aubrey was the first to highlight the risks of dentists carrying out too early intervention in restoring a tooth. Once a filling is done, it’s highly likely to be replaced. As a result, the tooth preparation would become broader (more comprehensive and more in-depth). Consequently, more complex over time (now known as the tooth-restoration cycle).

Clinical dentistry: A blend of art and science

Clinical dentistry is a blend of art and science where the craftsman (dentist) uses his/ her skills to provide treatment based on scientific principles. However, considerable variability exists among clinicians for treatment decision making, attributing to their education, training and experience.

Moreover, some inherent variability is due to the natural subjectivity involved in the process of treatment planning. One can test this hypothesis by sharing full mouth x-rays series of the teeth to a group of dentists. It would be interesting to explore that the number of restorations they recommend would vary extensively.

In the face of hardship, Dr Aubrey never gave up!

In other words, all of these clinicians can’t be right at one time. Dr Aubrey pointed this out and shared the evidence to substantiate his statement. But many other dentists took this quite negatively. They critiqued Dr Aubrey and labelled him as a dry-fingered dentist (for being associated to dental research and not doing clinical dentistry).

…and went on to threaten Dr Aubrey to be reported to the General Dental Council, UK for ‘bringing the dental profession into disrepute’

Dr Aubrey felt intimidated for losing his employment on account of his conscientious perspective he shared with the community. It was not his opinion that made him face the opposition, but the scientific data that made him stood for the science; unfortunately, no one supported him. People suggested him to go back to his native land, South Africa as his position on dental check-ups was intolerable to the dentists in the UK, but Dr Aubrey inaudibly stayed true to his ideologies. Ultimately in 2004, the National Institute for Health and Care Excellence proved him right and guidelines were published that fully validated his appraisals.

Dr Aubrey: More than a dentist

Additionally, scientists all over the world acknowledged Dr Aubrey for his contributions to our present understanding of the role of a carbohydrate-rich diet in the development and progress of caries. Similarly, the association of sugary beverages and obesity is again the scientific work of Dr Aubrey.

Above all, Dr Aubrey’s contribution to medicine and dentistry are enormous. His work on the social determinants of oral and general health and emphasis on the role of prevention and health inequalities has significantly influenced policymaking and the dental curriculum in institutions. Dr Aubrey’s received many awards, including honorary doctorates. IADR conferred him the Distinguished scientist award for his outstanding contributions to the dental sciences.

The dentist who touched many hearts

Dr Aubrey Sheiham died of mesothelioma in the year 2015. He authored over 250 research papers mentored 52 PhD scholars belonging to 20 countries. To sum up, we can learn that the perseverance and sheer hard work in the right direction yields success no matter how significant is the opposition. That is to say; we should follow the role models in our field to make progress and contribute as an agent of impactful change.

-The author is Associate Professor, Department of Operative Dentistry, Agha Khan University and can be reached at farhan.raza@aku.edu