EDITORIAL - February 25, 2020

I am professor of Periodontology at the University of Pisa. I am also honorary Professor in Periodontology at the University of Hong Kong and University College of London and what is more I have had the honour to serve the European Federation of Periodontology as its President.

And I have been hating dentistry for a significant portion of my life.

In my young years, charged with ambition, I had always thought that the job one chooses should, in some way or another, have to leave a trace for the generations to come. Yet dentistry, or at least the desire of becoming a dentist, seemed a sort of „minor“ ambition. However, coming from a family of dentists I gave the dental faculty entrance exam a go. I passed, I entered and off I went – results: 2 years being miserable.

Now, 20 years down the road, I am desperately in love with my job. But what is it that make us love what we do?  

In fact, think about it for a moment, what is it that motivates you?

It seems that motivation lies on the 3 basic principles: mastery – autonomy – purpose. And in these principles lies, I believe, an explanation why dentistry is such an amazing job… according to dentists, that is.

Why Dentistry?

Dentistry is all about creating one’s own mastery. We've all started from our hands trembling. Then, little by little, confidence came along. Finally, after years of experience, problems are welcomed with a very practical approach and in one way or another the act of moving the hands becomes one of the greatest joys. Very often, the bi-directional relationship between brain-hands and hands-brain is what makes the act of doing and the joy of making in dentistry so incredibly pleasant.

Irrespective of how fundamentally connected and interwoven medicine and dentistry as vocations are, one specific reason makes the greatest difference between the two. Due to the type of work-setting (own dental practice) and the widespread diffusion of the pathologies we treat, a dentist does not have to wait two decades before being in a position of making one's own decisions. Already at 24 years of age one can take their own (diagnostic, planning, treatment) decisions and apply them in their work, daily with any (and every) possible consequence. Basically, all of us are our own Department's chairman, even at a young age. This ticks autonomy on our 3-point checklist, and autonomy for sure is at the base of our happiness at work. Autonomy is crucial when considering job satisfaction. Literature, even dental one, has indicated that the jobs with less autonomy are associated with less satisfaction and higher stress levels (and also higher plaque scores!) than the ones with higher degrees of autonomy.

Bearing this in mind, we need to move on to the last and the most delicate part: the purpose... and the question is - why do we do what we do?

When I was just a kid of 25ish year-old (literally few years ago), in a sequence of absurd events that deserve an editorial of their own, I changed my entire life (house, work, nation) in a matter of 48 hours and started a 3-year specialty in Periodontology. Then my journey to find my purpose began.

Why Perio?

I discovered Perio and its wonder: the only discipline in Dentistry that moved away from being an art in a forceful attempt of being a Science. The measurements that we take in fact allow us to create infinite possibilities and most importantly to move away from biased opinions, with a detached outlook on facts

Periodontology is all about biology - you cannot do Perio if you don’t know biology. But in fact, you cannot do Perio if you don’t train your hands well either. Perio is one of the finest and most delicate disciplines when it comes to manual dexterity and techniques. It is a discipline in which you might study the behaviour of some specific pathogen or cells one minute, and moments later being covered in blood, trying to reconstruct lost tissues.

Yet, it is not only about biology and fine surgical technique. When you are doing Perio you are not doing just something that is oral cavity-related. No, no: you need to interact with an entire human being, a Persona. Understanding the habits and patient’s motivation become as important as the precision in suturing. In the armamentarium of a good periodontal surgeon the capability to support a patient in giving up smoking, reducing plaque and gingival bleeding scores has the same dignity of being capable of placing a membrane... actually it is the essential prerequisite. And do allow me to ask you a question - would you ever change your behaviour if the suggestion comes from somebody that you don’t like? Somebody that you might not find yourself at ease with or rather someone that you do not appreciate? Call me out as biased, but I tend to limit my exposure to the people I don’t like… and when in the role of a patient myself, I tend to do the same. This is the reason why to be a good periodontist, you need to have the capability to interact, empathize and connect with another human being. You cannot be a good periodontist if you are not genuinely interested in the persona that is sitting opposite of you. In a nutshell, you cannot be a good periodontist if you don’t love people.

But Periodontology also presumes moving into the realm of medicine, as treating Periodontitis determines important benefits for the overall health and quality of life. Thus, understanding hormone metabolism or vascular physiology are now also important aspects that, I believe, are required to be known by a good periodontist.

In fact, Perio really did save my life: but this is a story for another time... 

Why Academia?

I believe that in academia you are never alone, or bored. In one single day you: move from trying to put precise sutures on a precious flap to rushing to submit an email with the final proofs of a manuscript that you have worked on for months (which the journal, first playing really hard to accept, now wants in 2 milliseconds); rushing from a lecture given to a bunch of very annoyed 23 year olds wondering why a grown up gets so excited about gums to see the morning patient who is still bleeding 2 hours after (damn sutures!); switching from a strategic discussion with the department director to replying more emails regarding that one review you were supposed to send last week; running back home in the evening hours so after dinner you can happily spend the rest of the night making lecture slides at the computer, facing the disbelief of your partner

All this rushing, all this passion about work, all of this... is the purpose… And I believe that the main purpose of an academic is to advance and share knowledge, and this never ends.

It is never the finding, the outcome, the result that bears the most relevance, they are in fact of minuscule importance.

It is really the process of doing it, of being in it that makes sense.

The purpose is not the goal, the purpose is the journey. And we look forward to having you with us on this one.



K. Kavafis

When you set out for Ithaka
ask that your way be long,
full of adventure, full of instruction.

The Laistrygonians and the Cyclops,
angry Poseidon - do not fear them:
such as these you will never find
as long as your thought is lofty, as long as a rare
emotion touch your spirit and your body.

The Laistrygonians and the Cyclops,
angry Poseidon - you will not meet them
unless you carry them in your soul,
unless your soul raise them up before you.

Ask that your way be long.

At many a Summer dawn to enter
with what gratitude, what joy -
ports seen for the first time;
to stop at Phoenician trading centres,
and to buy good merchandise,
mother of pearl and coral, amber and ebony,
and sensuous perfumes of every kind,
sensuous perfumes as lavishly as you can;
to visit many Egyptian cities,
to gather stores of knowledge from the learned.

Have Ithaka always in your mind.
Your arrival there is what you are destined for.

But don't in the least hurry the journey.

Better it last for years,
so that when you reach the island you are old,
rich with all you have gained on the way,
not expecting Ithaka to give you wealth.

Ithaka gave you a splendid journey.
Without her you would not have set out.

She hasn't anything else to give you.
And if you find her poor, Ithaka hasn't deceived you.

So wise you have become, of such experience,
that already you'll have understood what these Ithakas mean.