Mixing up the treatment plan

Nov 28, 2010

Editor's note: Dr. Doniger's column, Dental Diaries, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

I know that when we see a new patient, we should start with the foundation and work from there. You can't build a house on quicksand, and you certainly cannot restore a mouth to function with a sad periodontium.

But when a patient comes to you with an aesthetically unpleasing mesial decay on her lateral incisor as one of the many restorations that need to be cared for, what do you do first?

Patients do have to own their own problems, and understand the reasons why they arrived at our offices with the conditions they exhibit. They have to realize that if we don't take care of their foundation, the houses will collapse. They also have to acknowledge their role in maintaining the foundation to ensure longevity of their new restorations. But, sometimes we have to bend the rules just a little to accommodate the rare occasion when the patient is right.

One recent Saturday (yes, I do work on Saturday and I love it -- the patients are so appreciative that we are available!), we had a new patient. This woman -- who happens to be my granddaughter's babysitter -- was very nervous and brought her entire family to the office for moral support.

She had been to many dentists over the course of the past five years, and each time she wanted to have her front tooth fixed, they recommended a larger, more productive treatment program, downplaying the wants of this woman. She finally gave up and stopped going to the dentist because "no one listened to her."

She had mentioned this particular lateral to me when she made the appointment. We discussed the fact that she rarely smiles and how she has wanted that particular tooth fixed for a long time. She knows she has other issues, but she wanted this one in particular fixed.

I had promised her that I would evaluate her entire mouth and see what the radiographs told about the offending tooth. I told her I was first going to evaluate that tooth. We discussed that I would only work on that tooth if it was restorable, and she would decide if she wanted to return for the remainder of her work. After evaluating the radiographs (and doing a mental triage of her entire treatment), we discussed moving ahead with treatment on the tooth. Since it was not endodontically challenged, I knew we would be able to make her happy and potentially a less nervous, more reliable patient.

Upon completion of the restoration, we gave her the mirror. She was near tears. She said, "This is all I wanted for such a long time and no one would do it." Yes, she has other restorative needs. But she is happy and will now be a happy referring patient. After all, we did what she asked for: We restored her tooth, painlessly, just as she asked.

Arguably, we cannot do this on all patients. Some patients' needs far usurp the ability to do a minor restorative before major scaling and root planing or extractions. But on the rare occasion when you can make a patient's day, especially a patient who hasn't been listened to by her previous dentists, it is a good thing.

We are in the business of restoring dentition to form and function. Occasionally, on the road to completing this business, it is heartwarming to make patients happy with something as easy as listening to them and being able to fulfill their requests. That Saturday was one of our days. And I am confident the patient will return for the completion of all of her dentistry. Now everyone is happy!

Sheri Doniger, D.D.S., practices clinical dentistry in Lincolnwood, IL. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefit company, and has written for several dental publications. Most recently, she was the editor of Woman Dentist Journal and Woman Dentist eJournal. You can reach her at [email protected].

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