Form, Function and Meaning in Dentistry

What are the form, function, and meaning of an innovation in dentistry?

In his remarkable book, Diffusion of Innovations, icon of the Diffusion field Everett Rogers explains these three qualities that every object, process and procedure has.

Form is the directly observable physical appearance and substance of an innovation.

Function is the contribution made by an innovation to the way of life of members of a social system.

Meaning is the subjective and frequently unconscious perception of an innovation by members of a social system.

*****

We can examine form, function and meaning in dentistry. Being technical sorts of people, we dentists blather on and on about form. Every dental website I've ever seen has lists of procedures performed in the practice. Usually with some bragging about how well they're done, but that's another story. And in our dental offices we go on and on about what we can do for a patient. The form.

What rarely gets asked is, what is the function of a procedure or restoration; what is the contribution made to a patient's life?

And meaning? In dentistry, I've almost never heard meaning discussed at all.

So let's look at that.

*****

Consider a worn-out old amalgam restoration. It's breaking down; leaking to the point of decay. The plan is to replace it with an adhesive composite resin restoration. We assume that the best methods are to be used, including self-etching primers and superb technique, all phases of the prep and restoration to be done in a surgical operating microscope...

Well. The form can be said to be a specific material, placed in a specific manner, that replicates the natural tooth contour, keeps it sealed and has excellent wear resistance.

The function is to allow a tooth to still be used for chewing, speaking, and to have total comfort.

The meaning, though. Ah, the meaning can vary tremendously. Consider these--
-"Thanks, doctor! I couldn't stand how that ugly black old filling showed when I smile."
-"What? Two hundred dollars to fill a tooth? What are you putting in there, diamonds?"
-"I'm so glad you stopped this tooth from hurting when I chew. No one could ever figure it out at the other office. You're the best!"
-"You guys are always so funny. I do get nervous, so thanks for making my dental visits so pleasant."

*****

Now let's consider two very similar X-rays. In this first one, below, that dark area around the middle tooth means a root canal infection. And this particular infection is silent. It doesn't hurt the patient at all. There are no signs or symptoms. That happens sometimes. So. What might be the meaning here when we inform the patient that they have a dental infection, and they need a root canal treatment?
-"Oh, doc, I'm glad you caught this one before it got painful. My Great Root Canal Tsunami of '09 is something I never want to go through again!"
-"Nine hundred dollars for a root canal? Are you nuts? I don't have any pain! Forget it. See you in six months."
-(This next patient is scheduled for hip replacement surgery in a month--)
"Doctor! We gotta get this infection treated before my surgery!"
"Don't worry, Mrs. Haywire. Although I don't have any openings for a bit, I'll come in early for you, before my first patient, and treat this issue. I know you like early appointments, so 7:00 AM shouldn't be a problem!"
"I'd do five in the morning if you wanted! Oh that's so nice of you, doctor. You're the best."
"You've been a patient in our practice since long before I started, Mrs. Haywire. You're royalty."

In this next film, we see a similar dark halo around the root of that middle tooth. But in this case, our patient is in agony. Severe, unrelenting, intractable pain. Pretty much the only common meaning is this:
-"Can you get (gasp) me out of (gasp) pain?"
And then, a little while later,
"How'd you do that, doc? All the pain is gone. I can never thank you enough."

*****

Treatment of periodontitis--gum disease--is a little bit different, since it's a process, or procedure, not a physical object. Still, a wide variety of meanings can be found here.
-"You want to scrape my gums? Are you nuts?"
-"We caught it before there was bone loss? I've heard about that. My Aunt Ermengarde lost half her teeth from bone loss. Can we start the scalings today?"
-"Will my gums stop bleeding once we're done treatment? They bled on a first date once, and it was, like, grody to the max!"

*****

One more. Dental implants.
-"I want an implant, not a bridge. No one is gonna cut down my other teeth to put in a bridge! Plus I want to be able to floss; connecting teeth together freaks me out."
-"Three thousand dollars for a tooth? Bugger that. I've got a trip to Aruba to plan."
-"No. Sorry. You're not going to put a spike in my jaw. That freaks me out."
-"Doc! I can't thank you enough for giving me back my front tooth. I'm still not completely over the trauma of the car accident. I still have nightmares about it. But this makes me feel better. I can smile again. I think it's going to be a little easier now."

*****

Meaning in dentistry. We dentists would be well advised to mull a lot more on the meaning that our diagnoses and treatments have for our patients.

Comments

[Tom Bentley]

Rick, this is a great essay (and should be seen elsewhere). Nice work around the concepts of perspective and interpretation. But it does remind me I need some dental work, sigh...

[Ablakeney]

Wanting implants instead of a bridge is understandable. As you said, having connected teeth you cannot floss between would be difficult, and would not be as comfortable or easy to take care of as implants. Do you know how long implants last and how often they need to be replaced? http://www.ottawadentureclinics.net/implant_dentures.html