For too many people, comprehensive dental care means restoring every tooth in your patient's mouth. All you have to do is look at some of the Facebook dental groups to see dentists brag about how good their dentistry is, because they choose to spin down 28 teeth. Rarely is there mention as to why that extent of care was performed.
The medical model is the same for all patient treatment. Gather data, develop a diagnosis and then treat to the diagnosis. While there is just one diagnosis, there can be several treatment options.
For me, comprehensive dental care starts with visiting with my patient and developing a relationship. I want to get to know them and them to know me, our team and our practice. Many years ago, I heard Dr. Pankey talk about how we should not treat strangers. I live that to this day and creating many friendships is one of the many blessings dentistry has given me.
As our conversation turns to dentistry, I ask my patient, “What are your concerns, what has brought you in today?” Now it is my turn to be attentive and be an active listener.
Though we are now using digital records, I still do like to make notes in front of the patient sitting knee to knee, eye to eye. I want them to see that I am paying attention to what they have to say. At times, I will add a question to clarify, nod my head and encourage more conversation.
Before I start a clinical exam and gather records, I share what I plan to do. I hold up seven fingers and tell them there are seven things of which I want to make you aware. If there has been anything that they have mentioned during our conversation, we highlight their concerns during that part of our exam/screening.
“First we will do an oral cancer screening. As I sit here, I am looking at your face and making sure nothing seems abnormal. We will also look at your lips, cheek, roof of your mouth, floor of your mouth and tongue. We will look at the top and bottom of your tongue, as well as the sides, and pull your tongue out to see the back of your throat. We will also do this each time you come in for a hygiene appointment. It is not likely we will find anything, but we will always look.” I like to let patients know the details of what we plan to do.
“Second, gum disease.” I point to my second finger. “We will look at and evaluate your gums. What we do to get your gums healthy and keep them healthy is the basis for helping you to keep your teeth for the rest of your life.”
“Third, tooth disease. Both visually and with photography we will look at your teeth and the existing dentistry to see if there are any concerns. Is there decay? Is anything broken or failing? Is the shape and structure of the tooth or restoration doing the job in which it was designed?” That last question often stimulates a question from my patient. I love questions from patients, it tells me they are engaged in the process.
“Fourth, functional disease.” At this time, I extend the fingers of both hands and create a “wrist-ulator” using my fingers to mimic teeth functioning. “When teeth function, they create forces. How are these forces managed by the teeth, the gums, the bone, the muscles and the joint? In health all of these are working in harmony. When our body does not work as we were designed, things break down. Our hope is to catch breakdown as early as possible, so the amount of dentistry needed to correct the problem becomes as little as possible.”
“Fifth is cosmetics. The truth is if the gums are healthy and the teeth are healthy and the functioning system is working as designed, whether your teeth are red, yellow, black or green, your teeth should last for a long time. However, most people want some shade of white. We can review this in more detail when we review your photos together.” Again, this comment had stimulated questions.
“Sixth. We asked questions that relate to sleep and airway. We now know that the position of teeth and arch form, the bone position of your jaws, can affect your ability to get air into your lungs to breath, during both hours awake and asleep. If we see signs that are obstructing airway and your ability to breath well, we will discuss things that can help.” These statements also pique curiosity and generate questions.
“Seventh and most important, we want you to feel that you have made the right choice in trusting our office for your dental care. All of us are here to help you any way we can. If there is a problem after hours our cell phones are on the business card and our answering machine.”
I believe that this approach will help many dentists young and old to develop a trust relationship with their patient. It has for me.
While yes, I can show patient cases where many teeth needed restoration, those cases are becoming fewer today as we have many other treatment options to help us provide comprehensive care and preserve tooth structure.
In my opinion, comprehensive dental care means evaluating all the systems; airway, esthetics, function, structure, biology. Isn’t it wonderful when a comprehensive exam just reveals healthy systems and there is just a need for maintenance? My job is to help my patients remain stable for many years to come. While many patients over the years have trusted me to regain a level of dental health, I believe my job is to help them maintain their health for their lifetime. I am a believer of less is more, I like keeping original equipment in good working order.
All the best on your journey.
Carl E. Steinberg, D.D.S., M.A.G.D., L.L.S.R. (www.DentistryinPhiladelphia.com ) is a contributor to Spear Digest.