It is trendy, in dental circles, to talk about the biological cost, in supplement to the financial cost, when discussing treatment planning.
The biologic cost is fraught with misconceptions and has to some extent, been used as a way to try and protect patients from dentistry that is very badly performed. As invasiveness of a procedure is increased, our responsibility to plan more carefully, inform more carefully, and carry out the treatment more meticulously, increases.
Any incompetence with an invasive procedure obviously can cause the patient significant morbidity.
However, a further cost that is rarely discussed is the distress cost.
For the vast majority of people, dentistry is a distressing procedure. The mouth is a very personal part of the body that normally only our lover or spouse is allowed to touch. To have surgery done in such a personal and sensitive part of the body is not surprisingly, quite emotional and unpleasant for most.
So a further factor that should be considered when treatment planning is not just the financial and biological cost, but also the distress cost.
Some procedures are minimally invasive, but fail quite a lot more quickly, requiring the patient to get them redone again and again. Now for some patients, the distress cost of having procedures done frequently is fine.
However, for others, the cost is very high. And in this situation, the patient would prefer something that is longer lasting, perhaps even if it is more invasive, to keep repair cycles less frequent.
And examples of this may be porcelain veneers compared to edge bonding in some cases. Or Extraction rather than doing root canal therapy, crown lengthening and post core crown. Or doing a crown rather than a five surface composite.
The number of visits, how soon it will need redoing, and the amount of maintenance necessary are all things that come under the distress cost. A discussion with the patient about these facts should be weighed when deciding dental treatment.
We should also remember that costs are a modifier of dental treatments, never the goal itself.
Our goal is never to be minimally invasive. Or cheap. Or long lasting. The goal should be things like nice smile, function, pain relief and comfort. Our plan then is modified to make it less invasive, or less expensive, or less distressing. However we never focus on modifiers as our primary goal.
For instance "my goal is to make dentistry cheap...oh, and possibly that you are satisfied with the appearance" does not make sense.
So don't just focus on financial or biological costs.
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