An Educated Diagnosis and Appropriate Dental Treatment Plan

In my previous article, I shared with you a very impactful personal experience regarding my healthcare. I was afraid that I had truly lost a measure of health and might need to change my daily health and exercise regimen. These not only double as my hobbies and social activity but also very closely correlates to my happiness.

 

I was also afraid that I might have some chronic pain for the rest of my life. I know, compared to so many other ailments or injuries, it seems so small, but it’s all relative, right? The first physical therapist that treated me completed a quick cursory exam after a brief conversation regarding my history. After her equally quick assessment, she put me in in what seemed to be a typical or common category and the treatment plan seemed almost like a recipe, regardless of variations of signs and symptoms.

There is no doubt that her intentions to help me were genuine and that the plan might have been appropriate if the diagnosis was correct. Moreover, the inappropriate treatment plan probably works for some people and might have resulted in some benefit for me at some point. However, it wasn’t a correct diagnosis and I actually got worse over a two-month time period in which I did everything I was told. It was actually exacerbating the symptoms. I wanted to be better. I was getting worse.

The stomatognathic system is no different. Have you ever had a patient with pain that seemed to get worse with biting or temperature or both?  The iced coffee in the morning with the gluten-free bagel has brought happiness and joy to the beginning of a new day for that patient for years. The thought of giving that up seemed almost depressing. Equally as concerning, some days eating softer foods produced discomfort, too. The chronic discomfort with episodic exacerbations had previously led to a lot of dentistry covering teeth. Not only did the symptoms continue, they became more consistent and intense. The new restorations required many adjustments for comfort and spaces seemed to be growing between the new front teeth. 

The teeth started to look flat, eating got harder and the pain got worse. Did something change? Was it just bad luck? Was the diagnosis correct? Was there actually a diagnosis? Was the treatment plan incorrect or incomplete for the correct diagnosis? Was the treatment plan appropriate for the wrong diagnosis? It is a complicated system in a complicated body.

Compare a dentist who did great in dental school, repairs teeth every day, has very good technical skills and has a genuine intent to help every patient with the first physical therapist that I saw. This dental patient needs and deserves to see a dentist comparable to my current physical therapist. What key components will give her the same experience?

1. Listening to the story and history with intention

• Hear about contributing factors, lifestyle, habits and values that will help determine an appropriate customized treatment plan.

2. A comprehensive exam that examines the entire system in which we work (not just the teeth) 

• How are the joints and muscles working with the teeth as a unit?  

3. Form a working diagnosis

• A system to make sure that all components of the exam will be rationally placed into a category that will help guide you through a systematic evaluation.  You can put into words a diagnosis for the teeth, the muscles, the joints and periodontium.

4. A systematic way to evaluate every patient 

• A process that you can predictably trust.  A starting point for every patient to minimize confusion and begin to unveil the compromises that led to the current condition or that will jeopardize future treatment. 

5. Treat appropriately

• A way to create a stable environment to evaluate the signs and symptoms (the body’s response) to that environment. You can observe if the signs and symptoms change when placed in a harmonious environment (physiologic occlusion and/or protected).  One of three things will happen to the signs and symptoms:
  • They will get better
  • They will get worse
  • They will stay the same
• Wouldn’t you like to know this before beginning irreversible treatment?

6. Assess and re-assess during treatment for necessary “course corrections”

• You have proven to yourself and your patient that you can create sustainable comfort. If not, you have a new working diagnosis or your new educated best guess, based on your initial hypothesis and now coupled with your new knowledge.

A deeper understanding of the system than most had in school
An exam that comprehensively evaluates that system
A systematic approach to diagnose the system
A way to test a very educated guess

To whom am I referring? You or my physical therapist? Aren’t we lucky that it’s both? For many dentists, it can sound like everything has to do with the joints, muscles and occlusion. And for a lot of physical therapists, it can sound like it everything has to do with the extension of the spine. It’s about understanding the system at a deeper level and identifying what is appropriate for each patient. The similarities continue:

Their gift:	Your gift:
is NOT only about derangement	is Not just about joints
is NOT just extension	is Not just about muscles
is NOT just about repeated end range movements	is Not just about cuspid rise
does NOT ignore biopsychosocial influences	does Not ignore other philosophies
is NOT just about the spine	is Not just about occlusion and sleep

 

It’s uncomfortable to some people because it’s different. It’s intimidating because it’s more than we learned in school. It’s challenging because it requires change. It’s rewarding because people like me can have a proper diagnosis, a proper treatment plan and appropriate treatment for who I am and where I am in my life.

(Click the link for more articles by Dr. Kevin Kwiecien. You can also see more on dental treatment planning here.)

Kevin Kwiecien, D.M.D., M.S., Spear Faculty and Contributing Author