Not long ago, a patient was surprised to learn that many of the studies under way in our research clinics are funded by private companies. "Doesn’t the government develop all these new drugs?" he asked. No, it doesn’t, but I have since discovered that this misconception is widespread. A significant portion of the public, when pressed to think about the subject at all, seems to have the vague impression that drugs and medical devices are invented at the National Institutes of Health or the Centers for Disease Control and Prevention, or CDC, then somehow fall into the clutches of shadowy industry cartels.

I suppose one could make the case that we really don’t need to know anything about the product life cycle, or that a general lack of interest is a backhanded tribute to a system that is working well. But in this case, the dentist fills an essential role in making the process work. We need to understand that role, and the responsibility that comes with it.

Compare today’s operatory with the state of the art, say, 20 years ago. New materials and implants, new handpieces, new ergonomics, new drugs and a radically new view of infection control all make for better, safer, more predictable care. Dentistry long has been a fertile ground for innovation, and the trend continues unabated.

But where do these advances come from, and how do they get to the practitioner? My patient who gave credit to the government was partially correct, in that several arms of the federal government do sponsor much important basic research. The most prominent of these is the National Institute of Dental and Craniofacial Research, or NIDCR, which invests more than $342 million annually in basic biological, clinical and technological research related to dentistry. The CDC works in the area of prevention; the governmental departments of Defense and of Veterans Affairs also have a substantial interest in dentistry.

Private industry, too, conducts a great deal of high-quality research. Whereas the focus of this work is influenced by business considerations as well as by a quest for knowledge for its own sake, many of the fundamental breakthroughs in both basic and applied science originate in corporate laboratories.

Who, then, bridges the gaps separating scientific knowledge, new ideas and practical applications? The short answer is, of course, the manufacturers, with your help.

Every new idea, whether an "invention" or simply an evolutionary improvement, faces a long and arduous struggle before it sees the light of day. While obtaining a patent may be a major milestone in the process, it is only the beginning. The idea must be reduced to practice through years of clinical testing and engineering development to prove it safe, effective and practical. The new offering will need to compete with existing products while selling at a profit. Plenty of promising ideas fall by the wayside.

Then there is the matter of regulation. Most of the professional products we use must undergo scrutiny by the U.S. Food and Drug Administration, or FDA, before being approved or cleared for sale. Demonstrating safety and efficacy—the FDA’s sine qua non—may involve years of research. The ADA, before awarding its voluntary (but respected) Seal of Acceptance, requires yet another set of evidence. Want to sell outside the United States? Every nation sets its own criteria for acceptance, and the FDA’s blessing is no guarantee of a warm reception.

At last, the product arrives on the market and enters the most visible phase of its life. The company uses advertising and direct sales to educate the profession about the new offering, and, if all goes well, enough dentists adopt the product to make it profitable. There’s an almost audible sigh of relief as the new kid takes its place alongside established products.

Alas, even the most brilliant new offering starts to age as soon as it enters the operatory. Continual small improvements—frequently prompted by user comments—can keep a product fresh and competitive. Research and data-gathering efforts continue, both to ensure safety and to validate the product’s performance in established and new applications.

Nothing lasts forever, though, and eventually the inevitable decline sets in. Sometimes it’s a matter of technology: either the patent expires or better alternatives make the current product obsolete. It can be a matter of economics, when a product’s sales no longer justify keeping it on the books. Increasingly, products simply succumb to business consolidations: when one company acquires another, a "product line rationalization" often follows, and old, familiar products are withdrawn. Sooner or later, though, almost every product fades away, and a new one takes its place.

Thus, we see that bringing a new product to market is a lengthy, expensive, risky process, and that even a successful product for the dental profession has a limited life. The system works, but it works best when we take an active role.

If we want to see more and better products, products that meet our needs and embody the latest technology, we as practitioners must work together with manufacturers to reduce risk and lead time. Companies need better strategies to solicit, assimilate and capitalize on customer feedback. For our part, we should take the time to provide reasoned, constructive responses when we’re asked to rate existing and proposed products. It’s fine to be polite, but tell the truth: if there’s no way you’re going to pay more than $20 for a gadget, then say so—and explain why. If you think you have a good idea, communicate it to someone who can make it a reality. And, of course, don’t be blindly resistant to trying something new.

In any case, there are many ways you can make your opinions known to industry:

– Watch JADA’s "Dental Product Spotlight" section for a heads-up on products that have earned the ADA Seal of Acceptance. We’ll do our best to keep you abreast of interesting new developments.

– When a sales representative visits your office, ask questions and offer suggestions—the good reps will hear you and transmit your ideas up the line.

– At ADA and other meetings, visit the exhibits and use the opportunity to talk with representatives of the exhibitor’s product development staff. (Make sure the person with whom you’re speaking is in a position to work with you, though, and not just a "booth staffer" hired for the meeting; if you’re not sure, just ask.)

– When the occasion arises, participate in (legitimate) panels, committees, focus groups, surveys, and so on. Companies place considerable weight on this kind of structured input, so make your voice heard.

Technology is making for some amazing changes in dentistry. We and our patients will surely reap the benefits of these advances, but we can also do much to influence their direction. Just remember: there’s a lot more to a good product than a good idea.