Dental Treatment Plans, and Why They Vary (Second Opinions)
Remember playing the game “Telephone”? The story that starts out is usually quite different than the one at the end. It’s hard for people to remember the details and sequence of an event over time, particularly if they don’t quite understand the material. We see it quite a bit in dentistry because procedures are laced with acronyms, the vocabulary is unfamiliar, and the insurance coding system is cryptic. Add to that the ominous nature of dentistry, with its unwarranted reputation for discomfort, bad tastes and compromising positions that have been a source for jokes. It’s no wonder that people get confused when comparing the options presented by various providers.
The Continuum of Change
To understand treatment plans for dental care, it is best to first understand the continuum of change that has occurred in this profession. Early in the practice of dentistry, providers just fixed a problem so that painful teeth were removed and holes in teeth were patched. If teeth were a nuisance or money tight, they were all pulled and dentures placed. When the health care community entered the era of preventing disease, providers sought to examine teeth early and promote good home care to prevent decay and gum disease from ruining teeth and bone. But they all drew the line for prevention in different places, depending on their view of urgency for the problems and their patients’ interpretation of insurance coverage. They adopted the posture that all teeth should be saved and, if some were already missing, dental implants or bridgework should restore those areas. Today, dentistry has a new component because people want esthetic options like white, straight teeth and improved breath, to improve their appearance. They are also much more discerning in the level of care that is available.
From this brief synopsis of history, it may be easy to see how dentists who graduated at different times might have different perspectives on patient care. For example, assume a tooth that has been filled breaks in half close to the nerve and it hurts. One dentist may immediately place a silver filling because it is a strong material that cannot be seen in the back of the mouth. Another may place an esthetically-pleasing tooth-colored one, and still another would suggest a crown to improve the long-term, structural integrity. Someone else would use temporary filling material to buy some time and see if the nerve remains healthy because if the nerve gets infected, the choices change to a root canal, removal, or dental implant. Each treatment has a different cost and takes a different length of time. So which one is the “right” treatment? It depends on the dentist’s perspective for proper dental care, modeled when attending dental school. No matter what, they have always been considered authorities on proper treatment and are used to stating a viable solution, without question, based on their perception of the patients’ interest in health or a pleasing smile. It’s been the most efficient way to get the job done! But that’s changing…
What to Expect…and Avoid
One thing is for sure. A conscientious dentist will provide a comprehensive treatment plan of options with a thorough discussion of the priorities and prognoses. This cannot be accomplished in 5-10 minutes during a visual exam. The office presentation must include diagnostic tools like pictures and models, website graphics, and x-rays. Someone from the office should explain the purpose for the materials recommended and the payment plans that are available. The patient should have choices because people evaluate information differently when considering a purchase, just as they do when purchasing a car or entertainment system. Dentistry has evolved to this point. Over the years, I’ve seen new patients come to my practice fearful and confused by treatment that had been performed without choices offered. I’ll highlight some common observations:
- Patients were encouraged to keep, and even restore, diseased teeth that impacted their overall health. Some teeth simply cannot be fixed and result in a chronic, ongoing infection when they are retained.
- Patients had problems “patched” throughout their entire mouth, rather than fixed with restorations that would provide years of good service. Would you patch a tire a dozen times and expect it to perform optimally on the highway?
- Offices offered to “whiten” teeth on the first or second visit when crowns are present. The material for crowns doesn’t change color so it creates dark, unnatural teeth that are expensive to replace.
- Offices focused on cosmetic improvements as a higher priority than fixing broken fillings and mouth pain.
- Patients were assured that insurance would cover most of the cost of treatment, and then it didn’t.
- There was no discussion of financial arrangements prior to commencing treatment.
- Patients did not have a complete set of x-rays or dental charting prior to the development of a treatment plan. It is impossible to determine the health of the bone, or the presence of decay under fillings, without these materials.
- Offices fixed teeth prior to treating gum disease with a thorough cleaning.
- Patients experienced recurring pain after each dental visit.
What Can Be Done?
Expect the dentist to involve you in treatment decisions, and ask questions until you’re satisfied if they don’t. But don’t expect to dictate treatment to a passive dentist, the recipe for faulty decisions, because you don’t have enough training to make worthwhile decisions. Try to ascertain where the dentist rests along that continuum of change that was presented earlier. If they focus on treatment that is only covered by insurance, they are allowing an antiquated system to evaluate your need for treatment. If they are willing to patch problems rather than placing a complete crown, they are providing short-term solutions that may jeopardize the long-term health of the teeth. Worse yet, if they want to fix a tooth that is surrounded by unhealthy bone or mal-positioned in the jaw, you will continually spend money on a sub-standard tooth that will eventually need removal. Finally, if a dentist hasn’t kept up with progress, they may not be able to offer you as many options or have the talents to create custom-designed indirect fillings that fix a specific problem.
It is very important for you to cover the following three key points. First, you must understand the condition of your entire mouth, not just one or two teeth that may bother you. Second, consider all options that are available with an open mind. Options should involve steps to not only correct, but also to improve, your dental health. When you compare different treatment plans by price alone, you use an incorrect tool. Third, consider the consequences of avoiding treatment. Dental problems don’t go away – they just get worse, and often more costly!
Two-way communication is the key to understanding a dentist’s philosophy about your dental care. Successful treatment decisions are based on long-term thinking and attention to detail during the planning and implementation phase of treatment. Then, the rest is up to you! Keep up your home care regimen and regular check-ups, and quality care lasts much longer than you’d expect.
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Find out more about Dental Treatment Plans, visit Dr. Anil K Agarwal‘s website http://www.wintersetdental.com/
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