Cover Story: Does art improve dentistry?
Your artistic side may be good for your practice
By Eric K. Curtis, DDS, MAGD
Featured in AGD Impact, May 2007
Pg. 29

Posted on Monday, April 30, 2007

Leonard Shlain wrote in the preface to Art & Physics: Parallel Visions in Space, Time & Light that a surgeon “is both an artist and scientist. The craft demands a finely-honed sense of aesthetics: A maxim of the profession is if an operation does not ‘look’ beautiful it most likely will not function beautifully. Thus, surgeons need to rely heavily on their intuitive visual-spatial right-hemispheric mode. At the same time, our training is obviously scientific. Left-brain logic, reason, and abstract thinking are the stepping stones leading to the vast scientific literature’s arcane tenets.” Describing a surgeon’s need to “shuttle back and forth constantly between these two complementary functions,” Shlain pointed out that the word “technique” (and by extension, the words “technical” and “technology”) derives from Techne, the name of the Greek patron goddess for both practical knowledge and art.

Minnetonka, Minn., general dentist and painter Carol J. Austin, DDS, believes painting helps her as a dentist. One advantage is its calming effect. “My paintings are a strong part of who I am,” she says. “At the office, they provide me with my own feng shui. I’m relaxed and more comfortable, and I can do a better job.”

Dr. Austin also sees parallels between art and dentistry in terms of mental processes. “The concentration and endurance that artists must develop applies to dentistry,” she says. “Art exercises both sides of my brain. The right side allows images in, while the left side analyzes balance and color. The same sort of exercise is necessary for successful dentistry, where we face both technical and artistic demands. The right brain helps us communicate and look into patients’ eyes with empathy for their values and feelings. The left brain helps us organize and present our diagnosis and treatment plan. Dental treatment requires our full brain.”

Dental schools take an interest in applicants’ artistic endeavors. “During admissions interviews, we ask applicants questions related to manual dexterity,” says Frank J. Miranda, DDS, MEd, MBA, associate dean of alumni affairs at the University of Oklahoma College of Dentistry, who has participated on the college’s admissions committee. “We look for activities in their backgrounds that involve some degree of dexterity, such as guitar or piano—even origami. I don’t know if those are the people who will get better grades, but with all other factors being equal, we would give more weight to applicants who also show some history of enhanced hand-eye coordination.”

“We ask candidates if they ‘enjoy’ doing ‘artistic’ or ‘intricate’ hobbies,” says Kenneth L. Kalkwarf, DDS, MS, dean of the University of Texas Health Science Center at San Antonio Dental School and president of the American Dental Education Association. “The idea is, I guess, that if they don’t enjoy such things, they may not enjoy dentistry. However, I have not seen validation that such experiences can be correlated with performance in pre-clinical skills or excellence of clinical care. There are studies that show no correlation of the old chalk-carving assessment with performance in dental school.”

While dental schools once actively encouraged students to pursue training in the arts, administrators these days don’t perceive direct benefits for practice. “Is it intelligence, manual proficiency, or people skills that make dentists successful?” Dr. Miranda asks. “A complex set of factors must come together to produce good dental care. Just as the spatial relations part of the Dental Admissions Test doesn’t necessarily predict success in school, I don’t think any particular manual skill by itself translates into being a good dentist.”

Yet the feeling persists that an artistic bent must be good for practice. For accomplished watercolorist Mark D. Lemons, DDS, of Martinsville, Ind., studying art has been similar to learning the skill sets necessary for dentistry. “Art isn’t simply something you have in you,” he says. “It’s not a gift, but a learned process. For example, there are five elements of good design in painting—shape, color harmony, value, line, and texture. Mastering those elements is a long, hard evolution, but if you’re interested and persistent, you’ll improve.” Dr. Lemons’ sister and office manager, Cheryl Beard, believes her brother’s artistic eye also inspires confidence in patients. “Because Mark is an artist,” she says, “people feel they can trust his abilities as a dentist.” 

“Without seeing any research,” says Lawrenceville, N.J., clinician and educator Bruce W. Small, DMD, MAGD, “I would guess that the dentist who has artistic talent probably would have a better than average chance of being a better than average clinical dentist. This has nothing to do with genes. I would think that a dentist who takes the time to create a work of art, be it painting, sculpture, or the like, probably also takes the time to create better preps. Now I’ve seen the work of dentists who, if they had a week, couldn’t do it any better. But, generally speaking, the artist-dentist may be better at matching shades, creating better morphology, and just taking his or her time.”

Even if the value of artistic talent in clinicians may be up to interpretation by the dental education community, the public tends to perceive dentists as artistic. Russell Edson’s prose, “The Moonlighters,” which was published in the Winter 2007 issue of Mississippi Review, begins, “An artist, who moonlights as a dentist, squeezes some cobalt blue on his toothbrush and begins to brush his teeth….” Dentists might agree with that perception. Many dentists think of—and advertise—themselves as “smile artists.” Some especially creative ones also display their art outside the mouth. For example, Kenneth H. Fox, DDS, built towering concrete statues outside his Auburn, Calif., office. His 70-ton sculpture of a gold rush-era laborer has become an unofficial symbol of the community. Richard Schilling, DDS, of Loveland, Colo., published a how-to book, Watercolor Journeys: Create Your Own Travel Sketchbook (North Light Books, 2003), which includes a self-portrait he painted while treating a patient.

“I was an artist before I was a dentist,” says Dr. Austin, whose abstract acrylic paintings decorate the walls of her office. “In dental school I was good at lab work—my lab partners asked me to carve their pontics—and I really did well at carving all those wax teeth for the dental anatomy course. I later taught dental anatomy.”

Dr. Lemons, on the other hand, was a dentist before he was an artist. Working in watercolor, acrylics, and collage, he began painting after a 1997 fire destroyed his office. “At the time it seemed like a good stress release,” he says. “I just like creating. When you’re doing a restoration, you want it to be just right. It’s the same with painting—but in dentistry we have to work in a tiny area, so it’s fun to paint on a 22 x 30-inch blank sheet.”

Dr. Austin describes painting as a voyage of self-discovery. “Art helps me express from deep within that which no words can describe,” she says. “It led me to a strong emphasis on cosmetic dentistry in my practice, which makes me feel more creative and integrated as a person.”

“My patients often say, ‘I want you to paint me something,’” Dr. Lemons says. “I’ve sold several paintings out of my office.” Currently vice president of the Watercolor Society of Indiana, Dr. Lemons also aims to teach painting and become a signature member of the exclusive American Watercolor Society. “My goal,” he says, “is to have something meaningful to do when I retire.” 

Eric K. Curtis, DDS, MAGD, is an adjunct associate professor at the Arthur A. Dugoni School of Dentistry, University of the Pacific. He practices in Safford, Ariz., where he also dabbles in mosaics, stained glass, sculpture, watercolor, and drawing. He has illustrated two textbooks, Decision Making in Periodontology, by W.B. Hall (Mosby: 2nd ed., 1992; 3rd ed., 1997; 4th ed., 2002) and Decision Making in Dental Treatment Planning, by W.B. Hall, W.E. Roberts, and E. LaBarre (Mosby: 1st ed., 1993; 2nd ed., 1998). To comment on this article, send an e-mail to impact@agd.org.

Learning to see by learning to draw

A dentist’s experience at the tip of a pencil

Of course I’m visually oriented. Aren’t all dentists? We’re trained. Hand-eye coordination is our middle name. I thought I already lived for the details of sight, immersed each day in a crisp, narrow world of 2.5 magnification and confident in my command of shapes, shades, and contours. Then I took a drawing class and learned how to see.

While I’ve always liked to draw, I had not previously considered getting instruction. Yet sketching (something I do for amusement on the back of envelopes in airports and at church) also comes in handy at the office. I often draw anatomical diagrams to explain TMJ function and restorative options. So I was intrigued last summer when I read an online commentary suggesting that a course in drawing could help improve observation and visual thinking. The particular course the blogger recommended was “Drawing on the Right Side of the Brain.”

I realized my mother had given me a book of the same name years before—a New York Times^® Best Seller that I had dutifully shelved and forgotten. I leafed through the book (first published in 1979, then updated and re-released both in 1989 and 1999), which was written by California State University, Long Beach art professor Betty Edwards, PhD. In the book, Dr. Edwards writes, “Drawing is a curious process, so intertwined with seeing that the two can hardly be separated. Ability to draw depends on ability to see the way an artist sees, and this kind of seeing can marvelously enrich your life.” That key skill of drawing, she wrote—learning to see—lies at the heart of creativity. The Los Angeles Times called Drawing on the Right Side of the Brain “not only a book about drawing … [but] a book about living.” Figuring that continuing education ought to be just as important for the art of living as it is for the practice of dentistry, I signed up for a five-day workshop in Del Mar, Calif.

Dr. Edwards is retired now, and her son, Manhattan artist Brian Bomeisler, directs the workshop. But Dr. Edwards, still vigorous at 80, came to the Del Mar class on several days to discuss the students’ work. “The process is so interesting,” she said. “I still get a thrill from seeing people learn.”

My fellow students, who had flown in from around the country, as well as from Paris and Tokyo, ranged in age from their 20s to their 60s. They included an anesthesiologist, a lawyer, a research chemist, an architectural student, and several IBM® employees. A few were veteran amateur artists and one was an art teacher. Everyone was nervous.

Laconic and unruffled, Bomeisler speaks in a quiet, clear, deliberate, slow voice. Many of the words for creative thinking, he pointed out, are related to seeing. For instance, “insight” means seeing the light, “foresight” is seeing beforehand, and even the root of “intuition” means “to look at.” Bomeisler explained that learning to see, and learning to draw what you see, is akin to learning to read and write. In fact, he declared, if you can learn to write your name, you can learn to draw. It’s not a matter of talent so much as practice. Reading and writing involve a mastery of phonics and spelling, whereas students must learn five basic perceptual skills to see and draw. The first is the ability to perceive edges, practiced through contour drawing. Second is the ability to perceive spaces, especially the “negative” space around an object. Third is the perception of two kinds of relationships: angles and proportions. Fourth is the perception of lights and shadows. Fifth is the perception of the whole—Bomeisler used a 1970s word, “gestalt”—which happens as the first four skills come together.

These five skills, Bomeisler believes, are useful not only for drawing but for analyzing all kinds of situations. To solve any sort of problem, for example, first consider the edges—that is, define the problem and estimate its boundaries. Second, consider negative spaces, or the elements that surround the problem: Where does the problem fit? What is the context? In The Social Life of Information, John Seely Brown and Paul Duguid describe the value of negative space when they write, “[A] central focus inevitably pushes aside all the fuzzy stuff that lies around the edges—context, background, history, common knowledge, social resources. But the stuff around the edges is not as irrelevant as it may seem. It provides valuable balance and perspective. It holds alternatives, offers breadth of vision, and indicates choice. It helps clarify purpose and support meaning.”

Third, consider relationships and proportions of the problem: What is constant and what is changeable? Fourth, consider the lights and shadows: What is plainly visible and what are the subtle or unseen ramifications? Finally, consider the gestalt, or complexity of the problem: What is included in the unique set of qualities that makes the problem what it is?

Bomeisler told the story of a psychiatrist working with several severely withdrawn patients who were not progressing. The psychiatrist began to draw the patients, studying each carefully and talking about his observations, such as saying, “You have a very interesting chin.” Many of the patients eventually responded to treatment. He later asked them why. Were they flattered that he would draw them? The psychiatrist concluded that his patients felt he was finally trying to understand them by really seeing them.

Each of the five days of the workshop concentrates on a particular skill. On the first day, Bomeisler asked us to conduct a pretest by drawing a self-portrait. I sketched myself squinting into a small mirror. I decorated my picture with some shading and crosshatching, but the result didn’t look much like me. Bomeisler explained that most people’s drawing skills are arrested at the fourth grade. Indeed, some of the other students in the class had literally drawn stick figures. Children learn to draw symbols as shortcuts for reality, Bomeisler said, then they become frustrated, and typically, they eventually stop drawing. At the same time, they tend to stop seeing details. People’s powers of observation become rusty, as School of the Art Institute of Chicago professor James Elkins described in How to Use Your Eyes. He wrote, “Our eyes are too good for us. They show us so much that we can’t take it all in, so we shut out most of the world, and try to look at things as briskly and efficiently as possible.”

In an exercise to sharpen our skill at perceiving edges, the class spent the afternoon copying a Picasso sketch—upside down, so as to avoid substituting symbols (what we think, for example, a nose ought to look like) for detailed observation (what the nose really shows). The second day we studied negative spaces, first drawing our own hand—hands are the hardest thing to draw—and then devoted an entire, painstaking afternoon to rendering a chair by drawing the spaces around it. Bomeisler encouraged us to drop into a state of relaxed concentration, a sort of self-hypnosis. “Did you feel a mental shift?” he asked. “Were you relaxed? Did noises and other distractions drop away?”

The third day we went outside for a plein-air exercise in observing angles and proportions. The assignment was tightly defined. Pick a modest composition, perhaps a door frame, a window, some stairs, or a tree. Choose a “basic unit”—the length of a step, the width of a lamp shade—to use as the reference point for other features in the picture. Sight in the door frame, the window—that is, eyeball the angles, look for the vanishing point, capture the perspective. I pulled up a deck chair and labored over a sketch of a palm tree’s shadows rippling across the hotel pool.

The fourth day, we practiced using lights and shadows by each drawing a profile portrait of another student. We set a ground, rubbing a graphite stick on the paper and smearing it with a Kleenex®, to establish a middle tone from which to emphasize lighter and darker values. My model was a woman named Stace, and I worked self-consciously, aware of her discomfort under my gaze. Stace was polite about the result.

On the fifth day, Bomeisler arranged black backdrops and spotlights around the room, as if for 20 tiny photo shoots. We positioned ourselves beside a light and each spent the hours struggling to capture a likeness of our own face. I tried to watch myself closely and carefully, surprised at how little I really knew about the components of my countenance. Using the width of my eye as the basic unit of comparison, I blocked out proportions for ears, nose, chin, lips, and forehead. At afternoon’s end, mildly pleased with the collection of pencil strokes and shadings I had amassed, I stepped back to take in my progress. Oh. Well. I gulped, choking on my gestalt. While I had gotten the nose right, it wasn’t enough to save the semblance. My eyes seemed too wide and clumsy, and my chin was too long. Ouch. The drawing had emerged as a caricature, and even then, it didn’t look much like me.

I was disappointed. I went home and thought about the course. I practiced explaining the concepts to my wife. On several Saturday afternoons I pulled out a few pencils and my Strathmore drawing pad (“This paper can be erased forever, and it still holds its tooth”) and worked through a few more self-portraits in the mirror. Rembrandt, of course, did loads of self-portraits, because they were good practice and he didn’t have to pay his model.

The practice sessions were relaxing. “Drawing is not magic,” Bomeisler’s velvet voice told my brain. “It’s a process. Accept the information you see. Don’t try to draw in what should be there.” As I concentrated on rendering small curves, folds, wrinkles, miniscule shadows, I lost track of time. On the second Saturday I was startled to see my face emerge on the paper.

Dr. Edwards’ critics argue that right brain/left-brain theories of creativity and performance are outmoded. Others say that realistic art only minimally engages the imagination. Some also worry that compressing drawing instruction into a short course encourages a mindset of instant gratification. One artist I consulted estimates that learning to draw takes a year of “practice, patience, perseverance, and passion.” In three months, my own succeeding drawings didn’t necessarily get better. In fact, some got worse. Students employing Drawing on the Right Side of the Brain techniques go—sometimes dramatically—from nothing to something, but the skills they absorb don’t turn them into Michelangelo.

Still, armed with this modest training (OK, it was 40 intense hours) in applying the formal framework of the five perceptual skills that Dr. Edwards and Brian Bomeisler teach, and willing to accept a few modest conditions—including some unbroken time, a patch of patience (read: tolerance for mistakes), and concentration—I became better able to resist visual clichés and symbols and rely on close observation to draw with increased accuracy. I learned to enjoy the process of looking and then expressing what I see, without words, at the tip of my pencil.

Another former student, Tony Schwartz, wrote about the course for New York Magazine in 1989: “Edwards assured us that learning to draw realistically would increase our self-confidence and give us great pleasure by itself. But in addition, it would prove a means to a broader end. By learning how to consciously shift into the artist’s mode of seeing, we would also gain a rich, new, visual language. Not only would we discover tools to express ourselves beyond words, we’d be better equipped to comprehend the complexity of the world around us.” Finally, Edwards said, “the capacity to see differently and more deeply is critical to creativity and thus would give us more access to creative powers.”

I don’t know if I’m more creative these days, but I’m definitely more aware. I look at details, including those of my patients’ mouths and faces, more carefully. I mentally sketch everything I see now, observing a shape’s edges, the space around it, its angles and proportions, and the lights and shadows playing off its surface and splashing around it—then pulling back my inner camera for a broader, “total” view. I find that close observation makes plain things interesting. I understand what the painter John Constable meant when he declared, “I never saw an ugly thing in my life: for let the form of an object be what it may, light, shade and perspective will always make it beautiful.”

The educator John Gardner said that life is the art of drawing without an eraser. Drawing, I have realized, is the art of living…with an eraser close by.