You know the old conundrum: "If a tree falls in the forest, does it make a sound?" Personally, I’ve never had any trouble with this one: of course it makes a sound. Just ask the squirrel that lives next door.

Philosophers argue that there is no sound unless there’s someone to hear it. Although I wouldn’t go that far, I do think the analogy has something to say about the importance of communicating what we learn. A scientific discovery or practical innovation, whatever its potential value, remains profoundly incomplete until somebody knows about it.

JADA, like its fellow journals, does its best to publish articles that are timely, credible and relevant. We are entirely dependent on our authors—volunteers all—to provide that content, and we are fortunate to have had a steady flow of fine contributions on a wide range of topics. Still, I’m concerned that a vital source of ideas and insight is not as well represented as it might be. I refer to the practicing dentist, from whose close connection with real, live patients come observations and innovations that are often useful and occasionally groundbreaking.

Consider Dr. Frederick S. McKay, who opened his Colorado Springs general practice in 1901. He soon noticed that many of his patients had conspicuous dark mottling on their teeth. Curiously, these same patients seemed to exhibit an abnormally low level of caries. Struck by the coincidence, he began analyzing his records and confirmed that, indeed, the "Colorado brown stain" (what we now call fluorosis) was clearly correlated with low levels of dental caries, and, moreover, was probably associated with the public water supply. He published this finding (in JADA,¹ as it happens) in 1928. Dr. McKay’s articles stimulated discussion and experimentation, which soon led to the identification of fluoride as the common etiologic agent.

From this beginning came the idea of using fluoride to prevent caries. It took years of research before a safe and effective dosage was worked out, and much debate before public water supplies were fluoridated, but the end result has been a dramatic reduction in the incidence of caries among American children. The link might never have been discovered if this one dentist had not made it his business to think about what he saw in his practice, and to publish the results for others to read.

In this era of "big science," the value of practice-based reports like Dr. McKay’s is often overlooked. The fact is, though, that quantum leaps in dental care are at least as likely to arise from direct patient contact as from laboratory research. Procedures are invented, developed and perfected by creative individuals in their own offices. Important diseases and public health trends are first spotted by "ordinary" clinicians. Yet, because most of us work in solo or small group practices, there is a great risk that good ideas will be lost unless we as individuals take the initiative to make them known.

JADA has always encouraged contributions from practitioners. While practice-based articles are welcome in any category, they often fit best into one of these four:

– Clinical practice is the natural place for many clinical papers, including case reports and literature reviews. If you have encountered an unusual case or pattern of cases, or if you have reached an informed opinion based on the prior literature, this may be where you can share it with your colleagues.

– Cosmetic dentistry articles focus in depth on a single technique, typically illustrated with numerous high-quality photographs. Whether you developed a technique yourself, or learned it from others, an extended discussion can be a valuable contribution. In addition to clinical pictures, data such as success rates, cost or level of patient satisfaction add greatly to the value of these papers.

– Practice management addresses the business of dentistry (management, economics, staffing, insurance, etc). Well-received articles have included critical comparisons of management systems, concepts for improving some aspect of practice management and reviews of a legal issue. Data and references are welcome but not always necessary.

– Clinical Directions, a JADA feature introduced in 1999, offers tips for the practitioner, based on personal experiences of other practitioners. These reports are brief (one or two pages) and to the point; photographs may be included if they help illustrate your message.

Quantum leaps in dental care are at least as likely to arise from direct patient contact as from laboratory research.

Unlike those of us in the academic world, from whom the "publish or perish" mentality squeezes a regular flow of printed words, practitioners who take the trouble to write papers usually do so out of conviction that they have something worth saying. As a peer-reviewed journal, JADA owes its readers high standards for publication. We do our best, though, to apply standards that are appropriate in the context of individual submissions; our expectations of a case report, for example, are much different from those of an epidemiologic study. A few requirements apply to everything we print: conclusions supported by evidence or logic (not just opinion), acknowledgment of sources and contributors, open disclosure of potential conflicts of interest, and protection of the patient.

I realize that the peer review process, in which you expose your best ideas to criticism by experts, is uncomfortable for part-time authors. At least some negative feedback is par for the course—though we don’t tolerate unreasoned critiques—and almost every manuscript needs to be revised at least once before it is finally accepted. But if you persist, and your article goes out to 140,000 readers, there’s nothing to match the confidence of knowing that it has survived the scrutiny of knowledgeable reviewers and the ministrations of professional editors.

JADA is important, but journal articles are certainly not the only way to communicate ideas. For example, continuing education courses provide a great venue not only for learning from a lecturer, but also for comparing notes with your colleagues. Participate actively by asking questions, even those that the speaker may find difficult to answer. Be sure that what you hear passes the test of "clinical plausibility"; if it doesn’t, probe (politely) until you understand why.

Opportunities abound to give talks, lectures and continuing dental education courses. If you have a knack for taking clinical photographs and thinking on your feet, consider putting your cases together and talking about them. Most of us start out a bit "podium shy," but the local dental society is normally a welcoming audience. Depending on their reactions, you may want to take your message to larger groups. And consider teaching part-time at a dental school, if there is one near you. Working with students and residents one or two days a month can be a wonderful experience. You get to pass on your experience to the next generation of dentists, and, in return, your thinking is kept sharp and current.

By my estimate, about 100 trees fall in the forest every month to produce the paper for this Journal; and thanks to our authors, they make quite a sound indeed. If you have something to say about the practice of dentistry, you could do worse than to say it here. Whatever you do, though, don’t let your good ideas languish for lack of communication. You never know where they might lead.