A 2009 Gallup poll, as quoted in the September 2011 issue of the Journal of the American Dental Association, asked respondents to rate the honesty and ethical standards of different professions. Dentists received only a 57% rating of “very high or high,” ranking lower than that of physicians, pharmacists and nurses. This number fell below the 2006 rating of 62%.
Similarly, an article was published in an issue of Reader’s Digest in which the writer assessed “the consistency and fairness of American dentistry” by visiting 50 randomly selected general practices in 28 states. He brought with him a copy of his full mouth series and informed the dentists that he had no cosmetic concerns, and was simply hoping to maintain good oral health. Prior to venturing out, he was examined by a panel of dentists who determined that he needed two teeth restored with crowns, which they advised should not exceed $1,500. To his dismay, he received treatment plans ranging from $500 to $29,850. He reported that only nine out of the 50 dentists wished to consult the periodontist that completed his recent periodontal surgery. Only 21 performed the ADA-recommended oral cancer screening, while only 14 completed the ADA-recommended periodontal screening. While dentistry is not always an exact science, how does an article with these findings speak to our profession?
If ten dentists are put in a room to discuss a case, it is more than likely that 10 different treatment recommendations will result. Some may take a more conservative approach to dentistry, while others prefer to treat for prevention and restore anything that could be problematic in the future. How can we explain these differences to our patients? With “free second opinions” becoming a regular tagline on many dental advertisements, how can we help patients realize that different approaches to dentistry do not indicate misdiagnosis or wrongful intent?
Although we cannot control the ethical boundaries of all dentists representing our profession, we can work to prevent misunderstanding during the diagnosis and treatment-planning phases. We must ensure that we conduct our appointments under the highest standards and include oral cancer screenings, periodontal and dental examinations, and review of all medical and dental history. Understanding how these details can affect existing pathology or treatment options and discussing this with the patient is essential to improved patient understanding.
It is important to consider any possible treatment options and communicate how different circumstances make one approach a more suitable option than another. Medical and dental history, caries risk assessment, finances and the attitude of the patient towards treatment should all be taken into consideration when comparing treatment alternatives. There will always be a “most ideal” treatment plan, but this will often undergo modifications to fit our patient’s specific needs and desires. Aside from addressing their chief complaint, it is our responsibility to first learn what our patient’s goals are. What changes might they like to see over the next year? What about the next five years? Keep in mind that a patient’s situation can change over time. Be sure to maintain this communication at follow-up appointments and review their overall goals and wishes for their oral health care. This is important because without their input, can we ever truly meet their needs?
Our patients rely on us to not only evaluate their dentition, but their overall health, and make recommendations with their best interests in mind. Although it is true that time is money in the world of dentistry, we cannot treat patients the way they deserve without taking the time to have conversations with them. Gauge their dental knowledge. Learn about their background. Your patients may surprise you with how much they already know about their oral health. Encourage them to review the information that was discussed during the appointment, and to bring a list of questions to their next visit. By doing so, you take the initiative to ensure their better understanding and thus create a more open, transparent relationship.
~Alexandra Pierre-Bez, Midwestern-AZ ’17, associate, Council on Professional Issues
The May issue of ASDA News features an article on “Creative diagnosis in dentistry.” Click here to read the article and gain insight on how the profession is working to increase accountability and trust within dentistry.