I want to do it my way?


Some times when I treatment plan it doesn't always go "my way".  Let me explain what I mean. Usually I start by discussing any dental problems I find and I start by offering optimal treatment plans. "Optimal plans" tend to be courses of treatment that should have the most predictable outcome that will most likely stand the test of time, without causing additional problems.  After explaining the  "best approaches" I observe my patients reaction. If my patient objects to my plans I may offer another "second best" option, but always point out any disadvantages with electing to go forward with it.

Often a patient will suggest their own idea for a possible treatment. Sometimes their idea is feasible, but sometimes it is not appropriate for the situation. For example if a tooth is too badly compromised to be restored then I can't in good conscience go along with "saving it", even if my patient is pushing hard for this option. Sometimes their choice may work for a while but can lead to problems. For example a tooth that is already "overfilled and has recurrent decay can often hold a even larger filling, but restoring with another filling may increase the likelihood of a future fracture. Some fractured teeth end up being restorable but some may require extraction. Before I agree to place what I consider to be an overly large filling in a tooth I always warn my patient that this will place the tooth at a greater risk of fracture and if this does happen they may lose the tooth. I a patient understands this then placing a large filling is a possibility but they need to understand and accept the risk (informed consent).

This is probably obvious, but sometimes dentists, in their eagerness to please, neglect to fully inform our patients of all the attendant risks. This is bad because when and if something bad happens to the tooth, our patient may say "Why didn't you warn me?" For this reason, even though it may temporarily upset my patient , I try to full inform them before choosing a less than optimal treatment, even if that is what they say they want.

Another recent development are online sites offering do it yourself dentistry. The other day one of my patients surprised me. I had recommended making a night guard because she was cracking her teeth and I suspected she was grinding her teeth at night. She had returned for her six month recall and we had an existing pre-certification that had approved this plan.  When I brought it up to her, she proudly explained she had one already. When I looked puzzled she explained she made it herself by sending models that she had to an internet site.  This could be ok, but online night guards usually are not adjusted for a proper occlusion and may actual cause problems such as unintended tooth movement.

I guess "Amazon dentistry" may be a recent trend. Pts can use internet sites to provide do it your self "Invisalign like" tray assisted tooth movement, other sites provide night guards, and many items meant to be provided by dentists are offered in a "grey market" on Amazon. While these may provide do it your self dentistry, are they  as safe as using your local dentist to provide more carefully supervised treatments.... I don't think so.








from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/10/you-want-to-do-it-your-way.html - http://lspindelnycdds.blogspot.com/

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