Growing up in a small neighborhood in Trinidad, Dr Jason Warner found himself initially drawn to dentistry following his childhood orthodontic experience. Local dental school, followed by a stint in Manchester, England to earn his master’s degree, were all steps on the path toward home, where he opened his endodontics practice 12 years ago. Warner shared his local view of dentistry and the challenges and opportunities of practicing on an island, while also looking to the future both of the industry and his new study club.
Q What first motivated you to study dentistry, and specifically endodontics? Is that still a motivator—if not, what drives you now?
From the ages of 11-16 I wore braces and thus spent a lot of time at the orthodontist office. My interest in dentistry initially sparked during that time. Around the age of 16 I was required to select my preferred subjects for what is known as A Level examinations in Trinidad, and with my interest in dentistry I opted to do sciences. Typically, once you choose this route, it will normally lead to either the medical or dental profession in Trinidad. With my experience as an orthodontic patient and since I had no real interest in medicine, dentistry became the natural route for me, although I was naïve about the profession.
My first clinical experience in dental school was performing a root canal. As time progressed, I performed root canals more than any other procedure and grew to enjoy it. One of my clinical instructors always joked I would become an endodontist. When I graduated dental school in 2006, there was only one practicing endodontist—who happened to be my lecturer at dental school. I decided then that I did not enjoy all aspects of dentistry, and aside from being marketable in a competitive field, I wanted to do something I enjoyed.
My motivation for dentistry has since changed. One of my main objectives for my practice is customer satisfaction, so I am constantly trying to find ways—whether practice management or new technologies or procedures—to keep my customers happy. This is what keeps me going the most.
QWhere did you go to college and dental school? If you left the area for school, what brought you back to Trinidad and Tobago?
Education in Trinidad is aligned with the UK system, so our high schools (ages 11-18 or 7 years duration) are also known as college. Our main University in Trinidad and Tobago is known as the University of the West Indies (UWI), which has branches in other Caribbean islands. UWI has a medical and a dental school in Trinidad. I opted to go to dental school in Trinidad, which I entered right after high school at the age of 18. Our program is a 5-year program with a mandatory 1-year Internship.
I did my master’s degree in endodontics in Manchester, England. I always wanted to return home to start my own practice because of the great business opportunity—I also had obligations to the university where I returned to lecture for six years.
Q Trinidad and Tobago are richly multicultural—English is widely spoken, but what kind of communication challenges do you face with patients, if any? How do you clearly relay treatment information?
Despite the cultural influences, English is our native tongue. There are rarely any communication challenges. When there are any, it is usually from foreigners who speak no English at all. These people usually come with someone who can translate for them.
(Editor’s Note: Cultural influences include Native Caribbean, Indian, African, Portuguese, Spanish, Chinese, Arab, and French.)
Q Has anyone deeply influenced who you are, what you believe in, and what you’re committed to in your work and life?
My parents have been my main influencers in life. They both had pretty humble upbringings and have worked very hard for what they’ve achieved mostly to ensure that my sister and I had opportunities they never had. They have taught me to value and appreciate what I have. I hope to emulate them with my own family—I have two daughters now and wish to be there for them as my parents were for me.
Q Let’s talk about starting your study club. What were your continuing education opportunities prior to SSC?
Locally, we have a body called the Dental Association of Trinidad and Tobago. They are primarily responsible for hosting continuing education events. They have been quiet in recent years but have become quite active again.
I personally travel to the U.S. at least 2-3 times per year for continuing education. It has taken me to many different states. I go to the American Associations of Endodontists conferences and have completed continuing education in CBCT. More recently I’ve taken up an interest in dental implants, which has led me to actively pursue CE programs in this field as well. Apart from this, I have done CE online from U.S. based providers.
Q Since you’re starting your first study club year, what are you expecting?
I honestly have great expectations. I am glad that I attended the Directors Summit this year. My interactions with other directors increased my enthusiasm and reaffirmed my decision to go with Seattle Study Club. I think my group will enjoy the first year and word will spread about the great program we provide.
Q Describe current marketplace challenges in Trinidad and Tobago. How do you think these conditions or constraints affect your club members’ practices?
We have a few challenges in Trinidad and Tobago. The first is market saturation. Every year the local dental school graduates on average 25-30 dentists, most of whom enter practice in Trinidad. This does not take into consideration graduates from outside schools. It is becoming increasingly difficult for new graduates to find jobs, and as a result many choose to open their own practices soon after. So we are faced with an increased amount of dentists and by extension an increased number of dental offices, within a limited space in a difficult economic climate.
Another issue we have in Trinidad is advertising. Our most recent dental regulations are dated 1982 and prohibit dentists from advertising. This is especially limiting in the age of social media, as we are unable to utilize these platforms to raise awareness and thus improve marketability.
In addition, dental insurance plans need significant improvement. Most have not factored in the increased cost of materials, equipment and new technologies, and have continued to offer the same coverage. If the yearly limit were to be higher, more people would have incentive to complete dental treatment and also do more complex procedures. Such adjustments could greatly improve access to dental care.
Q Are all areas of expertise and any necessary materials and labs available on Trinidad and Tobago, or do you and any of your club members have to refer to and/or rely on resources available elsewhere? If so, how does that impact a practice?
I can say that although we do not have recognized specialty boards in Trinidad, we do have most specialties available. I know other club members prefer to use dental labs in the U.S., as do I, for some of their cases. For instance, I utilize a lab in the U.S. to fabricate my implant surgical guides. This service is not available in Trinidad. I find this tends to drive up costs—due to shipping and customs duties—and we are often limited in how much we can charge the customer, so the profit margin can become negligible.
We have many local dental supply companies in Trinidad that distribute a vast range of brands. However, some brands/companies are not available in Trinidad, so we must source them from the U.S. or sometimes even Latin America, Europe or other countries. The major impactor again is the cost of shipping and customs duties. Items not readily available locally can be a problem.
Q Think of a unique situation or case you’ve encountered—how do you envision similar future situations being handled and resolved differently when you can rely on your network of club members?
I can’t think of any one specific scenario, per se, but I would like to know how to better manage cases where there is loss of inter-occlusal height. I’ve had a discussion on a particular case with a prosthodontist who is a member of my group, but the patient never went through with the treatment plan. I think that once I can rely on my network of members, the discussions and ideas will increase as will my knowledge of the case. This could possibly help me in motivating my patients toward more complex treatment. We’ve opted to form a WhatsApp™ chat group and Facebook® members page where we can easily access each other to post questions on any cases or issues we may be having. Hopefully this accessibility will facilitate better communication and ease of treatment planning.
Q Concerning the future of endodontics in general, and specifically on Trinidad and Tobago: What gives you a sense of hope? What makes you concerned or worried?
I’m not too worried about endodontics as a profession. When I see the great work done by bodies such as the American Association of Endodontists to educate patients and dentists on the safety and importance of endodontics and the role of the endodontist in saving teeth, I know our profession will always have protection and support. Even with the recent trend toward implants and the advent of biological dentistry, I still believe we should try all means possible to save the natural tooth, and I think most people feel the same.
In Trinidad, the concept of a dentist specializing in root canals is still largely unheard of. I think this is mainly due to the lack of patient education by their general dentists. It is a hindrance in that many patients will question their GDP and ask why they can’t perform the root canal themselves—the end result often being that the patient does not take the referral advice. We also lack major public awareness programs. I think awareness will very slowly increase due to patients’ own need for information. However, we do face the problem of misinformation from sources like the Netflix® movie The Root Cause. I have tried to quell this by placing the AAE position statements in my offices and addressing it thorough my office newsletter.
I think there will be more specialists in the country at some point, and hopefully once awareness raises, more people will be inclined to seek the service of an endodontist in a market that isn’t oversaturated.
Q What are you looking forward to?
At the moment I work six days a week. I’m really looking forward to working only about four days so I can relax, find more time for my hobbies, and spend time with my family.