The recent BDA's British Dental Conference and Exhibition in Glasgow was a great success in many ways and was testament to the continuing importance of gathering together to network, as the current idiom has it, or to just plain chat and swap knowledge as the older parlance describes it.

The opening session provided the accustomed format of a keynote speaker from outside dentistry presenting on the way in which we might learn lessons from other worlds and apply them to our lives and practices. Previous celebrities have included Michael Portillo, Betty Boothroyd and Roger Black and this year was the turn of Charan Gill MBE, a Glasgow born and bred Asian entrepreneur also known as the 'curry king' for his ownership of a chain of Indian restaurants.

Charan charted how he had begun in business from fairly humble beginnings and how he had gradually grown his empire. Strikingly, he explained that his technique involved a heavy reliance on gut instinct and of 'heart over head' in terms of taking risks and seizing opportunities. Speaking without notes he acknowledged that business plans, balance sheets and paperwork in general had their uses and their place in the scheme of things, but emphasised nevertheless how intuition was at the forefront of everything he did and to which he attributed his success. Described by those asking questions and by general acclaim as an inspirational speaker as well as being a local hero, the audience quite rightly clapped and cheered the spirit as well as the substance of that which they had just witnessed.

A remarkable contrast

As I listened to the next two presentations by Susie Sanderson, Chair, BDA Executive Board and Margie Taylor, Chief Dental Officer, Scotland I was struck by a remarkable contrast. Both were excellent speakers and both described in detail the matter of their subject areas; the positive developments of the BDA and progress in oral health in Scotland respectively. No, the contrast was exactly that; the detail. Whereas Charan had specifically eschewed the particular and the small print, in essence the evidence, in favour of the instinct, both of these speakers provided the very sound evidence-base for all their plans, thoughts, actions and achievements. And the audience, quite rightly, clapped and approved their important work.

It occurred to me that in dentistry we are completely hidebound by the need for evidence to guide and dictate our every decision and move. So that, while we admire and acknowledge the value of the entrepreneurial spirit and perhaps hanker after the freedom, creativity and excitement that it conjures up, we then revert to the rather more humdrum reality of what providing dental care seems to require of us. In some part this is due to the duty we owe to patients in providing advice and treatment that has a basis of predictable outcome and that most importantly does no harm. Whereas, arguably, the entrepreneur has only her or himself to consider at least in the immediate future, our consideration has to be divided between ourselves, our teams and those for whom we care. On one level it is perhaps less self-absorbed and yet on another is it too restricting?

Doubtless, it is about balancing when the gut feeling should rule and when the detailed evidence should prevail. There are occasions when we all go with our instincts. At the VT interview when deciding on a practice, choosing to respond or not to a particular classified advert for a job, plumping for the purchase of premises or an established practice which just 'feels right' for reasons that it would be impossible to list. House purchases fall into the same category; how often do we say 'I don't know what it was about the place but it just felt right'?

However, the extent to which this instinct can be applied in the face of scientific evidence is a far more difficult dilemma to manage. It lurks in the underlying caution about technique or practice usually born of years of clinical experience which finds expression in 'well it works in my hands' or 'I've done it this way for years and it's never let me or my patients down'. Does this instinct then get in the way of progress, preventing us from adopting what logic and science tell us is a better way or an improved technique, or like Charan Gill should we be guided by it?

Whoever settled on the expression 'the art and science' of dentistry (and I will now probably have a deluge of emails informing me of who it was) was a wise person indeed. Considering that it was coined many years before the technology and complexity of modern life had impinged on decision making it has a remarkable and lasting resonance probably because it is fundamental and goes to the heart of what we do. And there is that concept again, heart. Heart over head. Part of the art of dentistry has to be the ability to balance the two elements of fact and, if not exactly fiction then the somewhat ethereal, the un-pin-downable. And perhaps, just perhaps, that is what makes it from time to time a very satisfying profession to practise.