Reflections on 50 years as a restorative dentist

A post by James Dewe-Mathews 

BDS, LDS RCS Eng, MS (Univ. of Michigan) Registered Specialist in Prosthodontics.

Speaking at the American Dental Society of London Nov 2025

A review of the evolution of dental practice incorporating new techniques with the need for a  greater appreciation of craftsmanship, collaboration, and care

James qualified BDS from Guy’s Hospital Dental School, University of London, in 1972, also obtaining the Licence in Dental Surgery from the Royal College of Surgeons and receiving the Newland Pedley Prize for best final-year student. 

He went on to complete a Master of Science degree at the University of Michigan between 1973 and 1975, supported by a Fulbright Scholarship, a University of Michigan Scholarship, the American Dental Society of London Scholarship, and the Newland Pedley Travel Scholarship. 

His professional career began as a House Surgeon at Guy’s Hospital in 1972–1973, followed by a part-time Registrar post at Guy’s Hospital Dental School from 1975 to 1977, combined with part-time private practice. 

He subsequently established a long and distinguished career in private dentistry, practising at 110 Harley Street (1977–1984), 35 Harley Street (1984–2009), and from 2009 onwards at 30A Wimpole Street, London.

James served as President of the American Dental Society of Europe in 2010 and has been a member of the American Dental Society of London since 1975. 

He is also Director of Lab 39 Ltd, a dental laboratory founded in 2004, and author of Occlusion in Restorative Dentistry (1982).

Dr James Dewe-Mathews reflected on over 50 years in restorative dentistry, tracing the evolution of materials, methods, ethics, and values in the profession while emphasising craftsmanship, collaboration, and care. 

He began by describing this philosophy: to use reliable, proven materials that ensure longevity, not fleeting innovation He recounted an early success — a six-unit porcelain-fused-to-metal bridge that has lasted for half a century — as the gold standard all dentists should aim for.

Recalling the “golden age” of restorative dentistry in the 1970s and 80s, James celebrates advancements in restorative techniques and the importance of interdisciplinary collaboration with skilled technicians and periodontists. He stressed the foundational rule that successful restorative work depends on healthy periodontal tissues. Through partnerships with other specialists, he pioneered techniques like long-span bridges and perio-prostheses, transforming patients’ lives by replacing dentures with fixed restorations.

The implant revolution of the mid 1980s brought major change. Inspired by Brånemark’s work on titanium osseointegration, James cautiously adopted implants, focusing on meticulous, staged protocols and biological precision. His collaborative approach achieved near-perfect long-term success — a testament to careful planning and respect for tissue health — in contrast to the rushed, “instant-gratification” dentistry he sees today.

The 1990s and 2000s saw rapid development in aesthetic and digital dentistry. Porcelain veneers evolved from fragile, handcrafted restorations to reliable, beautiful lithium disilicate (e.max) ceramics, while zirconia replaced metal for crowns and bridges. Yet James warns against overuse of monolithic zirconia, which, although strong, can damage opposing teeth, due to it’s abrasiveness and lack of “forgiveness”. It also lacks the artistry of traditional layered ceramics. He predicts a return to more biocompatible, tooth-friendly materials.

James confirmed that he  embraces some digital advances but fears that AI, robotics, and full-digitisation risk eroding the craft and artistry of dentistry. He continues to favour traditional methods—manual impressions, stone models, and close collaboration with technicians—believing true excellence comes from hands-on skill and communication.

Turning to ethics, James laments a troubling shift: dentistry becoming a business rather than a caring profession. He cited examples of overtreatment, overdiagnosis, and young dentists taking on complex cases after minimal training. Root causes include inadequate understanding, fear of litigation, and the Dunning–Kruger effect, where limited knowledge breeds false confidence. He urged humility, continuous learning, and a return to conservative, patient-centred care.

James went on to discuss honesty and accountability, insisting that dentists must admit and learn from mistakes. Patients, he argued, respect transparency and genuine apologies far more than denial or concealment. Through personal stories, he demonstrated  how openness and integrity strengthen trust and long-term relationships.

He warned against “red flag” patients—those with unrealistic expectations or difficult personalities—and emphasised the importance of recognising one’s own limits, referring complex cases, and seeking peer support. 

Study clubs and collegial discussion are invaluable for growth and sound judgment.

James then concluded with a critique of corporate dentistry, driven by hedge funds and profit targets that pressure dentists to overtreat, contrasting this with the true purpose of the profession: to care for people, not just teeth. Trust, must be earned through empathy, consistency, and time.

A story of a fearful patient overcoming trauma underlined the power of compassion in rebuilding confidence and trust. James values these human connections as deeply as any technical achievement, noting that dentists often provide more continuity and personal support than doctors.

Looking back, he expressed pride not only in the quality of his clinical work but, above all, in the relationships and trust built with patients over decades. 

As he nears the end of his career, he reaffirmed his belief that The Heart of dentistry lies in Craftsmanship, integrity, and the Privilege of caring for others.