By: Dr. Leslie S.T. Fang has dedicated much of his medical career to helping dentists keep their patients alive. He has been an invaluable resource to dentists for years, and in recognition of this dedication, he has become the most recent recipient of the P-I Brånemark Award for Lifetime Achievement in Dentistry. The award was created in 2015 to honor the late Prof. Brånemark and to recognize exceptional clinicians who have advanced dentistry for society’s general well-being. Previous recipients include Drs. Myron Nevins, Tiziano Testori, Istvan Urban, Michael Cohen, Jörg-Rudolf Strub, Massimo Simion and Maria Lopez Howell.
As dental procedures become increasingly complex, patients with various medical conditions are spending more time in the chair. If the dentists treating them don’t understand these conditions, which many don’t, the results could be tragic. That’s why Dr. Fang has spent so much time educating dentists about drug interactions and how to safely treat their patients.
Dr. Fang bridges the gap between the medical and dental fields, reaching dentists through in-person lectures, webinars, textbooks and the “Ultimate Cheat Sheets” (UCS) that he co-authored with periodontist Dr. Robert Fazio and Tracey Menhall. His connection to dentistry began during his days at Harvard Medical School, where he first met Dr. Fazio. The pair not only became friends, they decided they wanted to do something special after they graduated.
“I was in my second month of my internship at Mass General when Bob called and said I finally figured out what we’re going to do. We’re going to write a textbook, so we can bridge the information base you have on the medical side to what dental professionals need to know so we don’t harm our patients. I said that’s noble, but I’m up to my eyeballs. So the first chapter on high blood pressure took seven months to write, but once we got the format down we were able to write the next 34 chapters in six months.”
The textbook, called “Principles and Practice of Oral Medicine,” evolved into the popular “Oral Medicine Secrets,” and finally what Dr. Fang focuses on now, “The Ultimate Cheat Sheets,” a chairside guide for dentists that’s updated yearly. Using an algorithm, the information has been boiled down to exactly what dentists need to know to properly treat their patients.
And if that wasn’t enough, Dr. Fang’s contribution to dentistry goes beyond these written works and the critical information they provide. For example, he still lectures with dentists, was part of a popular interactive learning series on antibiotics in dentistry, advocates for safe dental sedation practices, and spent hours presenting free webinars during the COVID-19 pandemic.
A New Experience
Back in 2002, Dr. Fang partnered with endodontist Dr. Kit Weathers, becoming part of his interactive seminar. Dr. Weathers not only educated dentists about an endodontic file system during these meetings at his home in Georgia, but he also entertained them with magic. Dr. Fang began presenting lectures on antibiotic use in dentistry to help round out the seminar—and, with the help of Dr. Weathers, and endodontics and amateur magician, incorporated magic tricks that could be done chairside for patients, as well.
From that forum, they recorded what became a very successful didactic series, where Drs. Fang and Fazio addressed some of the most pressing issues with respect to the use of antibiotics, basically who and when to premedicate and with what.
They had a lot of fun creating the content, Dr. Fang said, and interacting with the dentists who came back to them with comments and questions.
“The antibiotic series continues to be an important part of our lectures. It represents the kind of information I want to present,” Dr. Fang said. “We approach what we do as how not to kill your patient, meaning you have to know what the medical issues are, understand them and the implications of medication, and adjust according to what your patients’ needs are.”
The Ultimate Cheat Sheets
After the second edition of the original textbook was published, Drs. Fang and Fazio, along with Dr. Steven Sonis, decided to move on to a Q&A format that would become “Oral Medicine Secrets.” They wanted to make the book incredibly practical and informative, and this just seemed like a better approach.
“We shifted the focus to, What do you do?,” Dr. Fang said. “What do you do when a patient walks in with a cardiac valve issue, for example? What is the premedication they need and what is the dose?”
While popular, the pair evolved the resource once again after receiving feedback from Tracey Menhall, an entrepreneur and CPA. Menhall saw them deliver a keynote in 2007, and loved how energetic and engaging they were on stage. She wanted more of that in their writing, versus the encyclopedia type style they had adopted. She suggested they make the book even more user-friendly, and to only present the absolutely critical information. So, they went to work whittling down sections as long as 43 pages to just one.
This was no easy task, so Menhall suggested they develop an algorithm to identify those critical pearls of information. The idea was for one side of the page to evaluate a medical problem and then, based on that information, detail how dentists should manage that patient differently from a medical standpoint on the other.
“It was very time consuming,” Dr. Fang said, “but once we got it set up and Tracey developed the algorithm, we looked at it and said wow, this really does look like a cheat sheet. It now has served as a chairside manual for dentists for more than 10 years.”
The manual covers just about every clinical situation dentists might face, with information presented in a color-coded, user-friendly format. UHC is updated yearly, and Menhall is still involved as a co-author.
Safe Sedation
Sedation dentistry also became a passion for Dr. Fang. He’s taught the medical aspects of sedation dentistry with Dr. Tony Feck for years, and it all started when he realized there was something missing in every dental textbook he had ever read—including his.
There’s always a line that reads “when a patient is deemed to be medically complicated, consider sedation.” The problem is, there’s no explanation of what that means or how to do it safely. Dr. Fang decided it was time to change that.
Not long after he brought this problem up to Dr. Fazio, he sat in on a seminar about dental sedation—and didn’t really like what he saw. Instead of teaching dentists how to safely sedate, the presenters only focused on what could go wrong. To him, it seemed like a forum to discourage dental sedation, and he made that opinion known. Dr. Fang eventually took over the course and changed its name to Sedation Solutions. The course, a collaboration with Dr. Anthony Feck, has since expanded to include pediatric patients and the elderly.
“It’s not complicated on the medical side; we do a lot of sedation and anesthesiologists know the nuances,” Dr. Fang said. “Its adaption into the dental office takes a little imagination. But over the last 20 years we’ve done well in making sedation safe and available.”
Uncertain Times
When the COVID-19 pandemic hit, Dr. Fang knew very early on that it would have a huge impact on dentistry, and that clinicians would need guidance. To provide it, he began presenting free webinars that covered all the latest and pertinent information, reaching 40,000 dentists from around the world.
Putting the content together wasn’t easy, but it was important. Dr. Fang studied the major medical journals and kept a close eye on the latest developments throughout the pandemic. The information was coming in “fast and furious,” and he had to sort though it to determine what was accurate and most relevant. He wanted to ensure dentists had the information they needed to make the best decisions for their practices.
“At that time,” he said, “the design was to make sure dental professionals knew all the things they needed to watch out for and to give them a frame of reference about the disease and what they needed to do to minimize risk to themselves, their families and the patients coming into the dental chair.”
Various dental forums invited him to lead webinars, including Seattle Study Club and DOCS Education. He also presented webinars to global audiences and answered questions specific to the issues in their countries.
Dr. Fang put together a total of 28 COVID-19 related webinars, recently presenting what he hopes was the last.
“I thought I was done with number 18 but then Delta came,” he said. “You just never know what the virus will do, but I think we’re pretty close to getting to the end of the information stream.
Bridging Two Worlds
Dr. Fang is active in the medical community, where his focus is on kidney disease and teaching medicine and nephrology to Harvard University medical students. He presents webinars for students, residents and staff, and said that part of what he does comes easily. What’s most challenging is determining what from that information is most important to dentists.
Dr. Fang has taught his fair share of both dentists and physicians, and said the two groups require a different approach. On the medical side, there are so many webinars, lectures and meetings available that it can be difficult to gain traction. Often, physicians must be convinced they need the information. Dentists, on the other hand, want the information. If you can teach it well, you’re going to draw a large audience. Dr. Fang is fortunate to have supporters on both sides, he said, who will attend his lectures no matter what he’s teaching.
“On the dental side,” he said, “I always see new names, and new names bring in more new names and then all of a sudden you wind up with a community as opposed to an audience.”
Choosing Collaborators
As the chair for the residency admissions program at Mass General Brigham hospital, a position he’s held for years, Dr. Fang has a big responsibility. The collaborative program gets between 5,000 and 6,000 applicants ever year, but only accepts 18. Many have superstar potential. So, for Dr. Fang, it all comes down to one question: Who would be the better roommate? This is the same question he asks when choosing dentists to work with.
“We need to select people who are not only talented, but who are good at working with others as a team,” Dr. Fang said. “The competency is there across the board, so you might as well work with people you really like to work with. For my lectures, I travel with people I enjoy teaching with because at the end of the day I’m going to enjoy a nice dinner with them.”
What's Next
Dr. Fang plans to work with Dental Education Studios to bring his teachings to an online format. He describes it as a TikTok version of the Ultimate Cheat Sheets with most lectures broken down into 10-minute modules. He’ll cover everything dentists deal with daily, emphasizing pharmacology, an area most dentists aren’t comfortable with.
Dr. Fang is also working on another book, this one focusing on dental therapeutics in medically compromised patients. It will be published in 2024.
“As dentists see more medically compromised patients, they need to think about what the dental evaluation and dental therapeutics will be like,” he said. “If people know the science behind why things are done from a medical standpoint, they can devise what to do from a dental standpoint to optimize care for the patient.”
