Dental treatment planning:
When a patient sees a dentist for a problem, there is often more than one solution or approach to solve their issue. How to approach dental issues and which treatment goals to pursue is achieved during a part of the visit which we call ‘treatment planning’. In this article, we will discuss some of the main factors and considerations a savvy dentist should take into account when they are creating a treatment plan.
Per the guidelines of medical ethics, patients must be informed of all their treatment options and understand what the pros and cons are for each approach; this is the essence of informed consent. Some practitioners may feel comfortable with one type of approach based on their specialty or their practice model. However, this must never be the basis upon which the decision for patients’ treatment plan is made. Furthermore, the interests and niche of the office must be set aside. The best interests of the patient, in both the short- and long-term aspects of care, must take the highest priority. Thus, we take this opportunity to remind every reader that the best advocate for the patient is the doctor — not any other person or factor. If the doctor does not use their knowledge and expertise alone, without any other persuasions, the patient has not been served. The following are key factors to consider and comprise the bases for sound dental treatment planning:
- Identifying the root cause of the illness: Dental vs. Systemic origin
It is integral to diagnose the cause of a dental problem. A lack of proper oral hygiene is the most common cause of oral health issues. Unfortunately, the consequences of inadequate dentistry will follow the person for rest of their life. Ultimately, no dental treatment will last “forever.” Over time, small cavities become big cavities. Small fillings need to be replaced every several years. Each time a filling is redone it will roughly double in size. If a filling is initially placed during their adolescent years, by the time the person is in their 40s’ it will likely need a root canal treatment and to be restored with a crown. Recurrent decay under crowns, tooth loss, and implant loss are reality. The fact of the matter is that the best dentistry is preventive dentistry, because healthy teeth are stable and repaired teeth are not. Moreover, extracting teeth has even graver consequences for periodontal health. Conditions such as dry mouth are devastating to teeth and gingival health. Diabetes, as well as the side effects of large numbers of medications, such as blood pressure, antidepressants and mood stabilizers, are small sample of drugs which can induce dry mouth. Simply trying to refill a tooth over and over is like playing “catch up.” Dentists should not be just ‘tooth mechanics.’ Bad bites and lack of orthodontic treatment are additional causes of injury to teeth and untimely tooth loss. Quite often, people see orthodontic treatment as a cosmetic treatment. In fact, orthodontic treatment is establishing a stable bite system which results in stable and durable teeth and a healthy jaw joint; A beautiful smile is only a small contribution of orthodontic treatment.
- Short-term vs. long-term objectives of dental treatment:
Ideally, treatment must be divided into different phases. The first phase of treatment addresses pain management and infection control. Usually, dental pain is a manifestation of an infection or inflammation. Abscesses, cavities, and gingivitis are various types of oral infections. Infection control is an imperative part of the short-term set of treatment objectives. Long-term treatment objectives include definitive care, such as: straightening teeth, restoring structurally weak teeth (i.e. placing crowns) and replacing missing teeth. Dental fillings serve as a bridge between short- and long-term objectives. Quite often, dentists will complete treatment on one tooth while disregarding a patient’s comprehensive oral health status. This is not the right approach to effective oral health treatment and must be avoided. A dentist must advise patients to treat the mouth in its entirety, not as one individual tooth at a time.
- Private vs. insurance payment for dental treatment:
Oftentimes, budgeting and method of payment becomes a factor in dental treatment planning, decision making and treatment options. A patient may feel that dental insurance plans are the financial basis for their treatment. However, it is fact that no insurance plan examines their members’ mouths to determine how much and what type of dentistry each member needs. Dental insurance companies provide a certain budget to everyone in the plan regardless of how much dentistry an individual may need. What happens if an individual needs a whole lot more than the next person in the plan? Insurance companies basically don’t care. By the way, dental insurance plans’ annual benefit amounts have not increased much for the past thirty years. Employers negotiate with dental insurance companies to determine what amount of annual treatment levels to purchase for their employees. One will see that relying solely on insurance companies and their dental plans may often be a mirage for a rightfully treated mouth. In light of this, who pays for individuals’ dental treatment should not be a determinant for which dental treatments is rendered. Thus, treatment planning around dental insurance budgets could have poor and unsatisfying results for both dentists and patients alike.
- To see the whole mouth as a system vs. number of individual teeth:
Not accounting for the effect(s) of one tooth on the overall function of how teeth work together is very shortsighted. I often use the following example with my patients: Every single tooth in the mouth is like a member of a symphony orchestra. Members of a symphony can only play a piece when they all play in unison. They must play the notes together with great coordination otherwise it would be noise, not music. Back teeth are as important as front teeth. Top teeth are as important as bottom teeth. Back teeth may not be in view, but without them the front teeth will not last long. Likewise, front teeth cannot perform the functions of the back teeth. Ultimately, sound dental treatment must cover all teeth.
- Age of the patient
Thanks to medical and public health advancements, people are living longer and longer. Therefore, people need their teeth longer because they live longer. Dental treatment plans must reflect types of treatment that will serve people longer than ever. Dentists and patients must share the vision of solid long-lasting dentistry. Patchwork and ‘one-tooth dentistry’ will not serve this long-living population.
In conclusion, I would like to remind dentists and patients that treatment planning can be one of the most difficult parts of dentistry at times. We must agree that long-term goals and effects of dentistry have to be kept in mind when it comes to making treatment decisions. The knowledge and skill of the dentist, trust between the dentist and patient, patient perception of great dentistry, understanding the cause and effect of all teeth on overall health, means of payment for treatment and long-term effects of dental treatment must converge to find the balance and harmony to drive treatment success.