The staircase of a tooth: a restorative philosophy for a new era
Time to shift the clinical journey, says Ben Atkins.
It is time, says Dr Ben Atkins, Past President of the Oral Health Foundation, to champion ethically staged treatment, show all dental health team members that prevention is not only safe, but sustainable, profitable and rewarding – and time to build partnerships that communicate clearly, train effectively and empower clinicians to act with confidence.
In a blog post for the General Dental Council, Dr Atkins says: “Dentistry is changing. For years, the conversation has centred on techniques, materials, and aesthetic revolutions. But the real transformation isn’t just about what we do—it’s about where we place our focus, and whether we act on what we should do versus what we realistically could do.”
Dr Atkins says that for decades, he has explained prevention to patients using a simple metaphor: the staircase of a tooth. “Imagine a tooth born at the top of a staircase. Every intervention – no matter how precise – moves it one step down. Our role? To keep that tooth as close to the top as possible.
“Yes, restorations can be beautiful. The anatomy, occlusion and morphology may be textbook-perfect. But biology is relentless; every filling will eventually need replacing, often with something more complex.
“Traditionally, dentistry has thrived at the bottom of the staircase – specialists, aesthetic practitioners, advanced restorative experts. The complicated work is celebrated. Yet for 30 years, I’ve worked in the healing space, striving to push teeth back up the stairs.”
Dr Atkins recalls: “When I qualified, failure meant extraction. Today, failure is preventable intervention—a filling that could have been avoided if early decay or gingival inflammation had been recognised as signs of imbalance in the oral biome. Our challenge is to push failure up the stairs. To redefine ourselves not only as fixers, but as protectors.”
He concludes with a call to action: “This philosophy must be embedded across systems, teams, and patient conversations.
- Champion ethically staged treatment.
- Show all dental health team members that prevention is not only safe, but sustainable, profitable, and rewarding.
- Build partnerships that communicate clearly, train effectively, and empower clinicians to act with confidence.
“Because the future of dentistry does not lie at the bottom of the staircase. It lies at the top. Let’s climb.”