Success Of Dentistry – Treatment Planning - Restoring Excellence

Success Of Dentistry – Treatment Planning

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Jun 16
One of the great benefits of forums is that it allows us to be immersed in a sea of ideas, which I think drives forward our profession at a rate never before dreamed of.

It also allows us to comment on others work in ways that were never before possible.

Much discussion will be about what is considered the success of dentistry and what won’t be. Of course, we try to predict this using scientific experiments or studies, but often these provide the smallest snippet of information and aren’t always possible to extrapolate into practice.

However, beyond the limitations of science, there is a further factor that vastly influences success rates.

What you define as success of dentistry.

A frequent comment in dentistry is that patient’s cannot be relied upon to define the success of dentistry because they do not understand it. So we attempt to measure the success of dentistry through various standardised measures.

Longevity of the restoration.
Retention of the tooth.
Radiographic success.
Frequency of intervention.
Lowering population DMFS scores.

And so on.

The problem with many of these measures, is that they are profession focussed. And they often ignore that the end customer of dentistry is the patient, not the dentists. We could go back to our earlier argument that we know what is best for the population or the patient because of our skill and training, but then we delve into elitism. Elitism often starts out with supposed best intentions, but due to human nature, more often than not, ends up doing things that favour the elites themselves.

Further, we could argue that if such ideas are correct, then it should be applied to us as well.

Most dentists do not know automotive engineering. Perhaps they should only purchase cars approved by a particularly well know automotive engineer? Perhaps we should only be allowed to spend our money on things that are approved by a well respected group of financial planners? Perhaps we should have all our dinners checked by a group of dietary planners (despite the fact that the science of diet has turned on it’s head and everything that was right ten years ago is wrong now).

There are actually very few examples where elites consistently make the best choices for the population over the long term, unless they are held accountable by the population.

Which is why I think the patient’s values vastly influence success of dental treatment.

A patient that wants the least number of interventions, and the least total expense over a period of time may consider conservative restorative treatment a dissatisfying failure and a denture a success. They might even report such a dentist to a governing body and it could be an informed consent issue.

But by most dental measures, a denture would be a failure!

A patient that travels constantly may consider elective endodontics, with it’s very high success rate in vital cases, a success, and a deep direct restoration with pulp cap, that is far more conservative, but a higher risk of giving pain in an airport or on a plane, a failure.

But by many dental measures, elective endo may be an interventionist failure.

Thin labial veneers are the gold clinical standard for restoring aesthetics of anteriors. However for patient whose job allows absolutely no risk of temporaries dislodging, perhaps a minimal full coronal restoration is necessary to reduce this risk.

Whilst some of the scenarios I have proposed are more interventionist, similar examples could be in the reverse, like patients that wish the dentist had tried harder to explain the drawback of implants and the value of keeping their teeth.

There are any number of variations on this, but the key point is that success cannot be defined without respect to what the patient’s values. As shocking as it seems, some patient’s values are markedly different to yours or mine.

This is why I think that a crucial part of any treatment planning is learning what the patient values. What end result they want is? And while it is important to guide them, I think it also important to respect their choice to value things different to us.
Otherwise our treatment may be a dismal failure, whilst being considered a clinical success.

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About the Author

Dr Lincoln Harris has been completely focused on excellence and quality from the beginning of his career as a dentist. He established the first private dental practice in Bargara – Harris Dental Boutique in 2000. Since graduation he has trained extensively in Aesthetic Implant Techniques and Full Mouth Rehabilitation to attain immense skill and knowledge. With his vast dental knowledge Dr Harris coaches and trains dentists from all over the world on complex aesthetic dentistry, surgical techniques and business management. Dr Harris is the founder of RIPE. Restorative Implant Practice Excellence: Full Protocol group an international forum of over 70,000 members worldwide. The purpose of the group is to share information and excellence in the dental industry. He has also lectured in multiple cities throughout Australia, North America, Asia, Singapore, United Kingdom and Europe.