How Do Dentists Decide What Treatment To Provide For Their Patients?

How do dentists decide what treatment to provide for their patients?

Yann and Gilly attended a meeting at the Royal College of Surgeons on Thursday 13th June, “Decision making in restorative dentistry” , which was a joint meeting between the Edinburgh Faculty of Dental Surgery and the European section of the Academy of Operative Dentistry.
It was really interesting, and we really want to share some of what we learned with you!
We began with looking at 10 photos of clinical cases such as chipped teeth or broken fillings. Each person could vote -live!-for their decision with a choice ranging from monitor, in other words keep an eye on it, to a porcelain or gold crown covering the entire surface of the tooth. We returned to this at the end of the day when all the data had been gathered and analysed.
A Dutch dentist Niek Opdam who has been in practice for around the same length of time as us, talked about how long things last. We also gather the figures for how long things last in our practice…..
David Ricketts from Dundee talked about decay. This is probably going to be the subject of a whole new blog! Decay is rising among young people of 12-20 years old and is becoming more difficult to diagnose. This is probably because the outer layer of the teeth is strong due to fluoride, but if decay makes even a tiny hole in the enamel it can balloon out very quickly into the underlying tooth material (dentine). So it is very important to pick this up, and to treat this decay as soon as possible.
A dentist from Portland, Oregon presented the American point of view. Amazingly, some American dentists do have a more restrained opinion and try to conserve teeth rather than putting veneers on them!
In the afternoon we reviewed our decision making with a team of experts and there was some heated debate. We were pleased to see that our thinking is in line with these experts, and I’ll try to summarise.
Old fillings don’t have to look perfect, and sometimes it is OK to monitor, and it’s often OK to repair. It is also important to try and keep the tooth alive and avoid damage to the pulp (nerve).
On the other hand we do want to prevent teeth falling to bits or cracking right through into the roots so in some situations we would decide to provide a new composite (white) filling or a porcelain onlay.  Among all the experts these were felt to be  very good treatment options.

Yann pointed out that it’s all very well to make decisions but it actually all depends on what the patient thinks and wants, and we have to make sure that they completely understand the situation.

At the end of the day we felt encouraged in our decision making.  We aim for minimal intervention in our treatments. Our patients know we try hard to explain things and get them involved in decisions about their teeth, and that’s exactly the way it should be.

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