Why do we Inform before we perform?



Yesterday, as is common most days, I looked at my schedule and  one of my  patients had a "lost filling".  I wondered what the state of his tooth would be. Sometimes a tooth that has lost a filling can be simply refilled, sometime not. If there is extensive tooth structure missing sometimes the appropriate treatment is a crown instead of a filling. This can happen for one of several reasons. The original filling may have been a "compromised" treatment because when it had been placed the tooth structure was already compromised. Often when this filling falls out it takes a little bit of additional tooth structure with it. Another scenario is that the filling came out and the remaining tooth structure has recurrent decay and after all the decay is removed their tooth has insufficient tooth to safely refill. A third possibility (a quite common one) is that the patient actually hasn't lost a filling but instead has lost part of the tooth adjacent to a filling. In all of these situations, my patients tooth maybe in what I call the "crown zone", ie :having insufficient tooth to safely allow for a simple filling. Instead a crown is the most appropriate treatment.

Needless to say a patient who came in for a filling but ends up needing a crown ( or even a root canal, core and crown) may become upset and even get angry. Angry people sometimes look for someone to blame.  It seems possible for them to blame a number of possible people.  "My previous dentist was bad" is a common retort. Another culprit is their parents, "who didn't take proper care of my teeth when I was young". Worse yet they may accuse me of "breaking their tooth or exaggerating their problem.

Bottom line: when a patient's treatment doesn't go as they expected they can become upset. Thats why we dentists are trained to "inform before we perform" especially when the outcome of  a proposed procedure is in doubt. Things go much better when we explain what we might find before we touch a patients tooth with a drill. This gives them advanced warning and allows them a little time to process this information before we start drilling.  If I suspect that a tooth may not be a candidate for refiling I let my patient know before I administer a local anesthesia. Most accept what I say, but I allow some patients to opt out of my proposed treatment and seek a second opinion. This early exit is OK with me because I really do not want to treat a patient who is not on board with what I am saying and needs a second opinion.

Another option that I advise a patient is that if for some reason I believe their tooth should have a crown and not another permanent filling I will place an interim filling until they decide what to do. Most times they eventually do allow me to crown their tooth, but occasionally they go elsewhere and find a dentist to perform a treatment more to their liking ( a large filling or a less expensive crown).

Although I do not enjoy it when a patient doesn't accept my recommendations, I have learned to not take it personally. Most times its best in the long run for all if when a patient doesn't "buy into" what I am saying, that they seek a second opinion.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2017/10/why-do-we-inform-before-we-perform.html - http://lspindelnycdds.blogspot.com/

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