By: Savanah Craig
Treatment planning is one of the most difficult parts of my job as a new dentist. Often, I am meeting a patient for the first time and trying to access the problems that need to be addressed and learn about their desires all in an hour-long appointment.
Patients’ wants and desires are complex. Trying to determine a plan for their smile that not only addresses disease but also meets their esthetic and functional expectations is really a challenge.
Dentistry is unique in that if you showed 5 dentists the same panoramic radiograph, you would probably get 5 different treatment plans. If oral disease is being controlled, there is no wrong answer for how to proceed with a treatment plan.
Some dentists are more conservative with their approach to treatment planning than others.
Aesthetics over Function
Some dental offices focus on aesthetics over function.
As a patient, it is important to communicate with your dentist about what your expectations are for your smile. However, I don’t think a lot of patients fully grasp what it is they are looking for when they make a new patient exam and are seeking compressive care.
Respecting Patient Autonomy
In my hometown, it wasn’t uncommon for people to choose to have full mouth extractions and dentures fabricated when they retired. They knew that they would lose their dental benefits when they retired, so why not eliminate the problem by eliminating their teeth?
Most, however, didn’t realize that while dentures may be easier to care for than teeth, they do not function the same as teeth. While their dentists shared the risks of bone resorption over time, many didn’t understand what that would actually look and feel like as time went on.
If you are a dentist practicing in a more affluent area, perhaps you are shaking your head at the dentists who removed restorable teeth in patients as young as 55.
Yet, these dentists were respecting patient autonomy and meeting the patient’s goals and expectations. With proper informed consent, this was an appropriate treatment plan for those who wished to be edentulated.
Cost is another issue when it comes to treatment planning. Who wouldn’t want their dentures retained and supported by implants? But not every patient can afford overdentures.
It is not uncommon for patients to have ‘sticker shock’ when treatment plans are presented. Personally, having honest conversations about money with my patients is not something I am comfortable with, but in time I will need to be.
It can be helpful to give patients’ an estimated range for treatment costs so that expectations can be set accordingly.
Take Time to Think Before Treatment Planning
I know that there is still a lot to learn about treatment planning and in time I will get there.
My best advice for new dentists is that it is okay to pause and think about a treatment plan before discussing it with the patient.
Focus your new patient exam on really gathering all of the necessary information to make a decision with your patient.
Understand where they are coming from, what their problems are, and what their goals might be. It’s okay to say “I’d like some time to think about your case so that I can provide you with the best options.
Would you mind if we schedule a short appointment for you to come back so that we can have a conversation about your treatment?” In my short experience, patients seem to appreciate the honesty and appreciate that I’m not rushing to make a decision about their care.
Photo by Ylanite Koppens