What Should You Consider When Writing for a Dental Publication?

Francis Crick, BSc, PhD, The Astonishing Hypothesis(1994)

Effective writing in dentistry is difficult, yet highly rewarding. Successful writing of scientific information, whether in dentistry or other clinical/scientific disciplines, requires the execution of various talents and skills. "Good scientific research begins with an original idea that is put into practice by means of a robust methodology."¹

Yet equally important in written communications in dentistry is having a thorough command of the English language. Proper use of grammar, punctuation, syntax, and vocabulary is necessary for effective writing.

My experience as an investigator and author has been in the area of the laboratory and clinical investigation of biomaterials and devices. Publications in this realm, like that of science in general, are often complex and involve considerable detail, making this material often hard to read. While this fact challenges the reader's understanding and comprehension, poor writing can present an additional barrier to effective communication.

Good writing in dentistry involves both a depth of technical knowledge and experience and a command of more "classical" disciplines of knowledge and education, such as language, grammar, rhetoric, and logic. All of these factors influence the psychology and rhetorical interpretive mechanisms by which readers process and derive meaning from written text and are especially relevant to effective technical and medical writing.²

While many basic concepts of good scientific writing have been articulated in the literature, dental authors can utilize the following four principles to greatly improve their writing and communicating in dentistry:

Collaboration is critical. Given the breath and complexity of knowledge and research in dentistry, collaboration between researchers and investigators has become a necessity. Having mentors early in one's career and serving as a mentor later in one's career promotes good research and writing.

Be an exhaustive reader of the literature. Extensive reading within an investigator's chosen area of the dental literature provides not only the intellect to understand, process, and analyze the state of the art, but also enhances and continually improves one's writing quality.

"Scientific writing requires practice."³ In truth, good scientific writing in dentistry can only be achieved with considerable and continuous practice and constructive criticism.

Tell a story. In addition to communicating a good idea or hypothesis, a robust methodology, clear and interesting findings, a sound interpretation of those findings, and solid, well-founded conclusions, research and scientific writing must "tell a story."⁴

In scientific writing, writers often fail to appreciate readers' mechanisms of information processing and underestimate the difficulties and ambiguities inherent in the reading process. Good scientific writing should match and support the psychology and logic of how readers process written information in order to derive meaning and value from the text. Good writing in dentistry is a highly valuable and vitally important practice.

When embarking on a dental writing project, there are a number of questions and suggestions one may consider that can help advance the scholarly effort, from formulation to journal submission. Before starting, considerations might include: Will the topic be worthy of interest, make a difference, and advance science? Is the topic appropriate to the intended journal and audience? Does the content apply to most situations and most populations? Most importantly, writers must ask themselves if they have the time and persistance to do the research, writing, and revisions.

Another set of questions can be asked when actually writing the scientifc report: Does the article title stimulate interest, and does the title include "keywords"? Is the abstract a concise summary of the main purpose, results, and conclusions? Does the introduction establish the background for the hypothesis with what is already known, and does it state the purpose or research question? Are the methods designed to answer the research question? Do they explain what was done and are they in enough detail so that the reader has sufficient information to evaluate the results? Do the results follow the methods and do they present factual unbiased findings in the text, tables, or figures? Does the discussion then follow from the results? Does it support/not support the hypothesis? Does it compare the findings to what others have done? Does the discussion consider the limitations of findings/opinions or potential bias of this scholarly effort? Are the conclusions derived from the results and written so that the findings matter to the reader? Finally, are the citations accurate and current, and do they follow the journal's format?

In general, writers shouldrefrain from slang, hackneyed, overused words/phrases; write short sentences; and use concise words, such as "clarify" instead of "elucidate." Writers should know the intended audience and write to them. It is often said that easy-to-read writing depends on revising, rewriting, revising, and rewriting. Also, it is a good practice to have an experienced writer study the near-finished work for organization, clarity, and syntax. Lastly, before submitting a document for possible publication, make sure it conforms to the journal's instructions to authors.

"The dental assistant took an x-ray that showed the patient needed a root canal." "There were interproximal cavities on the bitewings." "All the caries were (or was) removed." "Silver diamine fluoride arrested all the carious lesions." "There was buccal cervical caries on both laterals." "After a prophy, the tooth was prepped for a crown."

Poorly written sentences such as these can cause bruxism in former English majors who ventured on to dental schools. Just where did the dental assistant who "took" that x-ray go with it? And besides, we know that the patient already had a root canal-many of them, in fact! In reality, the assistant recorded a periapical radiograph of a premolar that showed alterations suggesting endodontic therapy might be indicated.

"Interproximal" is a space between teeth, so how can dental caries develop in space? Approximal tooth surfaces can develop decalcification and caries lesions, which appear as radiolucent changes on radiographs, but the bitewing radiographs themselves do not have caries lesions on them. Moreover, caries is not a physical material that can be removed. Carious tooth substance is eliminated in an infected tooth in the debridement stage of wound healing during the restoration process. Caries lesions infect teeth and are commonly called tooth decay. There is no such thing as a carious lesion. The lesion is not carious; the tooth is carious.

Contrary to common usage, there are two "m's" in "diammine," and microbiological studies from TRAC Research in Utah have shown that caries infections are actually "intercepted," "abated," or "attenuated," not "arrested."⁵ And while it has become acceptable in lectures and print to assign "buccal" surfaces to anterior teeth, this is technically inaccurate because no incisor or canine tooth actually apposes musculus buccinator. Also, it is better to write "lateral incisors" rather than "laterals." Terms such as "prophy," "prepped," and "laterals" may be reasonable lunch time verbal banter among dental colleagues or as unedited comments in patient record progress notes, but such jargon degrades scientific writing.

Unfortunately, the history of dentistry and writing in dentistry are two largely neglected topics in professional dentistry education. Without the luck of serious mentoring by concerned teachers, how is a student of dentistry to learn how to effectively write a case report, clinical technique article, research paper, editorial, or any other written communication in the dental profession?

A teacher of mine advised me that you do not need to be a researcher to write for publication in dentistry. "When you find something that you think you can make better, make it better and document each step along the way." Communicate in writing what you have achieved in that quest, and augment the writing with high-quality photographs, tables, charts, etc.

Here are some considerations when writing for dentistry:

With apologies to Lewis Carroll, have something meaningful to say and say it meaningfully.

Write it simply, as if you are talking. Keep it precise and concise. Speak your sentences out loud after they are written, and let your ear hear your writing voice. Theodor Seuss Geisel (aka "Dr. Ted from the West") wrote it perfectly: "So the writer who breeds more words than he needs, is making a chore for the reader who reads."

Writing isn't difficult. Rewriting is profoundly difficult, always necessary, and most rewarding. Rarely are first sentences the best that one can do.

One of dentistry's great scientists, Dr. Ralph Phillips, advised me to consider having a co-author to aid in a work. He said if the piece is good and well received, there is joy in sharing the glory. If not, there is someone to blame.

Publications have "author guidelines." Follow them!

Steven R. Jefferies, MS, DDS, PhD
Guest Researcher, Department of Applied Materials Science, Uppsala University, Uppsala, Sweden

Norman Tinanoff, DDS, MS
Professor, Division of Pediatric Dentistry, School of Dentistry, University of Maryland, Baltimore, Maryland

Theodore P. Croll, DDS
Clinic Director, Cavity Busters Doylestown, Doylestown, Pennsylvania; Adjunct Professor, Pediatric Dentistry, University of Texas Health Science Center at San Antonio (Dental School); Clinical Professor, Pediatric Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio

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Boucher CO. Writing as a means for learning. J Prosthet Dent. 1972;27(2):229-234.

Croll TP. Preparation of a dental case history report for publication. J Am Dent Assoc. 1981;102(1):59-61.

Warren JA Jr. Coming to terms with terminology. Operative Dentistry. 1998;23:105-107.

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