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Is this a case of
over-treatment by Dr. Knell, or is it a difference of
opinion about appropriate alternative treatments?
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Due to the lack of
research in this area, dentists must make decisions
based on their clinical training, experience, and judgment
– more art than science.
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A dentist's philosophy
could range from, "I crown everything" to "if
in doubt, prevent, wait, and reassess."
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What seems to be lacking
is the acknowledgment that uncertainty will always be
a part of our clinical practice because our knowledge,
materials, techniques, and abilities are imperfect,
and the oral cavity is a hostile environment in a constant
state of entropy.
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"Trust by the
public that serving their true dental needs with appropriate
quality care is the heart of the patient-dentist relationship."
In regards to our case, however, it is less clear as
to how we define our patents' true dental needs.
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How should the dentist
providing the emergency care in this case respond to
the patient's inquiry , and should the question of economic
motive be discussed with Dr. Knell?
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Don't concern yourself
with this situation. Take care of the emergencies and
don't worry about over treatment
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Explain to the patient
that you don't have all the diagnostic materials to
make that judgment and can't answer the question
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Explain to the patient
that you don't have all the diagnostic materials to
make that judgment and can't answer the question
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When emergency patients
request definitive treatment recommendations in the
absence of adequate diagnostic information, the dentist
is justified in treating the emergency and informing
the primary dentist of the patient's comments.
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What does the research
tell us about this treatment decision?
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"The dentist should
consider the characteristics and requirements of each
case in selecting the material(s) and technique(s) to
be utilized."
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Recommends that educators
and policy makers, "support research to identify
and eliminate unnecessary or inappropriate dental services,"
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"support a research
program that includes clinical research, evaluation
and dissemination of new scientific and clinical findings,
and research on outcomes, health services, and behavior
related to oral health," and "extend its research
program, when feasible, to the basic sciences and to
the transformation of new scientific knowledge into
clinically useful applications,"
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that dental educators
work with public and private organizations to "make
use of scientific evidence, outcomes research, and formal
consensus processes in devising practice guidelines
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