Halacha and Handpieces; Drilling Down on Dental Ethics

With Dr Harris Sidelsky

Specialist in ProsthodonticsBDS (London) LDS RCS (England) MS (Michigan)

Presentation to Alpha Omega London – 4th February 2026

I’ve been in dentistry since the mid-1960s — and just to be clear, that’s 1960, not 1860. Many of the older people here will know that dentistry was founded to combat disease. There has probably never been a more appropriate time than now to remind ourselves of that, and to show up, be present, and take responsibility for what we do as a profession.

When I was asked to speak, I was given complete freedom on the topic, so I came up with a title almost instinctively. If it feels as though I wander a little at times, forgive me — because in many ways this talk reflects how dentistry itself has evolved. 

What I want to do tonight is quite simple. First, I want to look at how dentistry has changed over the 60 years I’ve been practising. Second, I want to highlight one hugely important change that has gone largely unnoticed, or is being ignored. And finally, I want to talk about what makes a career in dentistry successful and meaningful — because when you reach a certain age, you want to be able to look back and say that your work mattered, and that you enjoyed it.

So what actually changes, and what stays the same?

The one thing that does not change — and this is absolutely fundamental — is this: if you want to be a happy and fulfilled dentist, you must be there for the patient, not the patient there for you. That principle underpins everything. I was once told a story about a rabbi who said to someone searching for meaning in their life, “If you want to find yourself, give yourself away.” That single sentence perfectly describes what dentistry should be. If you genuinely put the patient first, happiness in your career tends to follow.

Over the years, I’ve met far too many dentists who simply don’t enjoy being dentists. I remember classmates talking about retirement in their mid-30s — after spending six years training for a profession they couldn’t wait to leave. That should make us stop and ask ourselves: are we building a career we enjoy, or just counting the years until we can get out?

When I qualified, dentistry was very different. We leaned over patients with poor ergonomics and guaranteed ourselves bad backs. Procedures were slow, physically demanding, and largely restorative. Caries was rampant — truly a disease epidemic — and dentistry had to respond to that volume. High-speed handpieces didn’t exist, suction was primitive, and four-handed dentistry was unheard of. Sedation practices were, by today’s standards, frankly alarming.

Then came major changes. The air rotor transformed how we worked. High-volume suction followed. Hygienists arrived in the early 1970s and completely changed the landscape of preventive care. 

But if I had to choose one development that altered dentistry more than anything else, it would be fluoridated toothpaste. That alone reshaped disease patterns and quietly removed the foundation on which many restorative careers had been built.

Later came bonding agents, adhesive dentistry, digital radiography, and computer-aided systems. Each innovation was initially met with scepticism — often dismissed with “that will never work” — until it quietly became standard practice.

And yet, despite all this progress, many of us continued practising dentistry in essentially the same destructive way.

Around the year 2000, something appeared that fundamentally challenged that approach. Minimal intervention dentistry wasn’t just a new technique — it was a complete paradigm shift. 

For the first time, dentistry formally prioritised disease prevention and management over drilling and filling. Early diagnosis, risk assessment, remineralisation, and preservation of tooth structure became the focus. When I first read about it, I realised I couldn’t continue practising the way I always had. It changed everything for me.

Despite this, over-treatment remains a serious problem. We still see unnecessary crowns, full-mouth rehabilitations, and aggressive interventions where conservative care would have been enough. I’ve seen patients whose mouths were restored beautifully — and completely unnecessarily. The profession still struggles with knowing when not to intervene.

The pictures above are of a patient I had seen in the past.  He had some wear which could have been treated with a minimal additive approach.

As you can see from the follow up picture the dentist chose to crown every tooth in his mouth.  The patient is very happy with the outcome as is the dentist but....Essentially, a case of wear, where the dentist could have just opened the bite and dropped some composite on the posteriors and added to the anteriors. Instead every single tooth was reduced for crown fitting.

What’s interesting is that regulators now expect dentists to manage disease, not just repair damage. There have been cases where dentists were struck off not for poor restorations, but for failing to control caries or periodontal disease. Whether we like it or not, responsibility for prevention now firmly sits with us.

But here’s the uncomfortable truth: dentists don’t control caries — patients do. Our job is to educate, motivate, and support them. Hygienists are vital, but unless patients take responsibility, disease returns within days. The most effective tool we have isn’t the handpiece — it’s communication. Asking the right questions, helping patients understand consequences, and getting them to own their choices.

This applies just as much to restorative decisions. Patients often say health matters most — until you ask them to choose between gold and white restorations. Our role isn’t to dictate, but to inform honestly and clearly. If a patient chooses aesthetics over longevity, that’s their right — but they must understand and accept the trade-offs.

At the heart of good dentistry is respect for tooth structure. Crowns are often destructive and irreversible. Wherever possible, we should be preserving, repairing, and reinforcing — not cutting healthy tooth away simply because it’s quicker or more familiar. That requires proper understanding of anatomy, occlusion, and form. Without that knowledge, we can’t truly restore teeth — we can only fill holes.

This case is from the early 2000s. The patient had been born in an African country and came to see me because she was unhappy with her appearance, particularly her lower teeth. The lower teeth had over-erupted, and there was significant wear on the posterior teeth.

Today, this type of case would often be managed differently, but I’m describing how I approached it at that time. In the early 2000s, I preferred not to prepare  the teeth. Instead, we began with a wax-up, which was fabricated by the laboratory technician. The wax-up included interstices that allowed space to build up the areas I wanted to restore.

Although the process was time-consuming, each individual tooth received a small piece of composite. A white material was used as a locator for each tooth, ensuring that nothing shifted during placement and that the required space was maintained. While this technique has largely been replaced by direct composite methods today, it provided fully developed anatomy before final placement, which made the procedure very predictable.

Once everything was positioned correctly, the restorations were fixed in place. All contacts were preserved and remained intact. The final result was stable and aesthetically pleasing, and that completed the case. 

The clinical cases I’ve shown illustrate that excellent outcomes can be achieved conservatively, ethically, and predictably. They also show that dentistry can be deeply satisfying when practised with care and intention.

So in the end, what makes a meaningful career in dentistry? It isn’t speed, income, or volume. It’s service. It’s integrity. It’s knowing that you treated patients as people, managed disease rather than chasing procedures, and left teeth better — not just restored.

If you do that, you won’t spend your career counting down to retirement. 

You’ll look back and say,

I enjoyed this. It mattered.

Thank you.