Drs. Kinzer, Rouse Take ‘Worn Dentition’ Into the FutureBy Michael Ferraresi on September 11, 2019 | comments
One of Spear’s original campus seminars, “Treating the Worn Dentition,” has a new look and updated curriculum to help dentists understand the often-complex etiologies of tooth wear.
Beginning Dec. 5-6, the seminar will be led exclusively by Resident Faculty members Drs. Greggory Kinzer and Jeff Rouse — accomplished clinicians and longtime educators who collaborated with Dr. Frank Spear to refine the material in recent years. The seminar is designed to teach dentists how the etiology of tooth wear is key to the prognosis of treatment, to identify patterns of wear created by different etiologies and treatment plan for more consistently predictable patient outcomes.
Dr. Spear’s final “Worn Dentition” session will be Oct. 24-25 in Boston, though he will continue to teach other campus seminars, serve as Resident Faculty and contribute to the development of content across the Spear learning ecosystem.
While “Worn Dentition” loses the presence of one of dentistry’s most respected teachers and clinicians, the curriculum is stronger than ever with the introduction of airway as a possible etiology of wear. Dr. Spear said the session will advance considerably under the direction of Drs. Kinzer and Rouse as the dental community continues to explore how airway impacts wear.
“They’re going to bring in some current knowledge base and concepts that, frankly, I don’t have,” said Dr. Spear, who has practiced with Dr. Kinzer in Seattle for more than 21 years, and worked intimately with Dr. Rouse more recently on the integration of newer content into the seminar.
Drs. Kinzer and Rouse worked diligently to ensure that Dr. Spear’s foundational lessons will remain deeply embedded in the seminar curriculum, while casting the seminar forward for future generations of dentists.
“We saw the need to reinvent the seminar with new material and fresh blood … and I feel really positive about the future because our faculty truly is on the cutting edge,” Dr. Spear said. “It’s very fulfilling.”
Wear cases have the potential to leave dentists to hesitate in treatment planning, or experience anxiety about restorative materials potentially breaking. Many dentists, being unclear on the etiologies of wear, can do patients a disservice by making them wait longer — often resulting in more complex, costly treatment.
Dr. Spear credited Drs. Kinzer and Rouse for their diligence in refining “Worn Dentition” materials to provide seminar attendees with clear, actionable steps to address clinical challenges like bruxism, erosion and reflux — which can lead to acid-related wear — in the context of Spear’s foundational treatment planning principles.
“The single biggest change is the knowledge base around etiologies of wear, with airway being part of that,” Dr. Spear said. “But even our knowledge base around erosion has changed a lot.”
“Our style of treatment planning has stayed consistent,” he added, “except for the fact that issues like airway could lead you down a different treatment plan pathway than we would have followed 10 or 15 years ago.”
Essential lessons for everyday wear challenges
Dr. Kinzer began teaching “Worn Dentition” with Dr. Spear in Seattle nearly 14 years ago, prior to the inception of Spear Education.
The fellow faculty members would teach groups of 12 dentists at a time in a three-day workshop they’d host at a local hotel. Today, the two-day seminar is one of Spear’s most popular and well-reviewed, with more than 200 dentists in attendance in the state-of-the-art auditorium at the Spear Campus in Scottsdale, Arizona.
“Worn Dentition” enables dentists to treat a whole new base of patients, including high-risk patients that demonstrate a clear potential for destroying the final restorations. Fear of the severe wear case failing can also cause dentists to refer potentially lucrative cases, or sometimes rely too heavily on restorative materials to correct issues that may soon resurface because the root issue was never resolved.
Dr. Kinzer said it was bittersweet to see Dr. Spear, his longtime partner, step away from the seminar. But he added that the development of airway components to the curriculum make the material more comprehensive. Attendees learn phasing methods for complex cases and take home a manual that can be used in their practices to operationally walk through cases like those introduced in the seminar by Drs. Kinzer and Rouse.
The “feeling of failure” that many dentists experience with wear cases provides a fear factor that is quite common in the industry, Dr. Kinzer added.
But the changes to seminar curriculum, with added emphasis on airway as an etiology, help dentists understand potential root causes that directly impact treatment options like occlusal appliances.
“What most dentists were taught about why people grind their teeth is not true anymore,” said Dr. Kinzer, one of Spear’s original faculty members who has taught alongside Dr. Spear at various workshops and seminars since 1998.
“It’s amazing, the change that’s happened in the thought process from an etiologic standpoint,” Dr. Kinzer said. “Given the literature we have out there, the literature that’s being done, and based on our clinical experience — airway answers the questions better than anything else right now.”
Learning to ‘sequence your way through’ treatment
Dr. Rouse joined Spear in 2017 after he and Dr. Kinzer co-developed the “Seattle Protocol” to recognize, control and direct resolution of airway distress in a restorative dental practice.
To do so, Dr. Rouse — who practiced as a general practitioner in his native Texas for 14 years, and as a prosthodontist for 15 years — traveled from San Antonio to Seattle every other week for two years to immerse himself in cases with Dr. Kinzer.
He said the experience began to shape the vision for what would eventually become the updated “Worn Dentition” curricula, which includes material grounded in Dr. Spear’s facially generated treatment planning concepts but incorporates new content based on recent airway findings.
Dr. Rouse joked that he barely muttered 10 words to Dr. Spear at various trainings he’d attended before formally meeting him in 2015 and pitching airway concepts for Spear curricula. But the two hit it off, and over the past two years, Spear faculty have drawn from Dr. Rouse's experience to integrate airway findings into applicable lessons.
He is also the first to admit that “it’s not all airway” all the time. It is one key etiology of wear, however.
Dr. Rouse said it’s gratifying to have advanced to the point in his career where he could work intimately with some of the top dentists in the world to shape continuing education materials that shift how dentists address patient needs, and even develop the potential to recognize dental symptoms that indicate more serious health problems, like apnea, before the patient visits a physician.
“In the past, we used to say, ‘my patient bruxes, my patient has reflux,’ but we never went further to ask why,” said Dr. Rouse, who is recognized as a pioneer in the field of airway prosthodontics — the impact that a compromised airway has on the stomatognathic system.
“Our vision in the past was that the problem was the bruxism, or the problem was the reflux,” he said. “But really the problem is that they have a dysfunctional airway, which is causing these problems to happen.”
The longer dentists let a problem go, the more complex and time-consuming the dentistry becomes for both clinician and patient. Theoretically, the added wait time can increase the patient's risk of losing teeth and experiencing greater pain.
Dr. Rouse said while clinicians like Drs. Spear or Kinzer, for example, have spent decades shaping their skills — “Worn Dentition” distills some of their most impactful lessons into a format that dentists of all skill levels can absorb and apply at home.
“That’s the most important part — learning a foundation by which to evaluate a patient, and how to present to a patient and sequence your way through it,” Dr. Rouse said.