When I examine a new patient for the first visit, I always bring them into the conference room, rather than the dental chair. I want to hear that patient’s story face-to-face. Why is that patient in my office and what is it he or she is looking for? If a previous practitioner made a mistake handling that patient, I want to know so that I do not make the same mistake. Of course, I also want to quiz the patient on medical and dental history. Lastly, I provide the patient with a short lesson on dentistry and dental care in general. I haven’t looked in the patient’s mouth, so the patient knows that I am providing them with general education. Already they can see that I am different than other dentists. It is evident that I care about them and that they are not just a piece of meat to whom I can sell an expensive case.
In fact–in complex cases–I consider the first visit nothing more than a fact-finding mission; a “getting-to-know-you” visit. The patient will have a full series of X-Rays, upper and lower impressions, intra-oral photographs and charting. I might share some obvious findings and point out some problem areas to the patient. But it is not my goal to do complex treatment planning off the top of my head. In fact, I don’t even want to do the general exam until I have studied the results of all the diagnostic tests. Therefore, I have some homework to do.
After the patient has left, I examine the X-Rays, models, photographs and charting carefully. I write down everything I found that is wrong on a separate sheet of paper. I will use this paper –my “cheat sheet”–to look at areas closely when I do the oral exam on the next visit. I will already know what to look for when I do the exam. At this point I also have some idea of what treatments might be required to correct the dental abnormalities. Often, it is clear that orthodontics is necessary to correct problems and achieve an ideal result. Sometimes orthodontics needs to be combined with restorative dentistry to achieve an ideal result.
What approach will yield the best result? Which approach offers the least invasive treatment? Which treatment would you do for yourself if you had that condition? These are the questions I ponder when trying to determine what treatment might be best for a particular patient.
Well, I’m not an orthodontist, so I cannot answer orthodontic questions without some help of an orthodontist. I have always sought out the best orthodontists in my area to work with, and I establish a great relationship with my chosen orthodontic mentor. In New York I worked with a very fine orthodontist in Scarsdale, Dr. Brian Finn. I knew I could count on his advice, as he was only interested in doing right by his patients. Now that I am in Arizona I am working with Dr. Shawn Bader, who shares the same ideal. (I would love to introduce the two of them!). Dr. Bader is doing some amazing things in the field of orthodontics that are on the cutting edge. In addition to helping me with my patients, I am now his patient. That fact speaks volumes! I have the utmost confidence in my orthodontic buddy’s competence, caring and skill.
Whenever I have stumbled across a case that requires an orthodontic consult, I have always arranged to meet with my orthodontist mentor—usually over lunch—to discuss the patient. I show him my models and X-Rays. I want to know what can be done, and then I will present the orthodontic information at my next consultation with the patient. Every patient I have examined this way is impressed that I took the time to consult with an orthodontist on his or her behalf. The patient already has a preliminary idea of what might be involved in orthodontic treatment when he or she schedules a consultation appointment with the orthodontist. I want the patient to have all the information before any decision on treatment is made. The patient will return after the orthodontic consult to discuss and finalize a treatment plan.
My orthodontist buddies in New York and in Arizona both tell me that few general practitioners take the time to meet with them about individual cases. I am truly shocked. Don’t they want to know? I am keenly aware of what my limitations are. I know very little about orthodontics, but I am an expert in full coverage restorative dentistry. Every treatment modality has limitations and may or may not be suitable to achieve the most ideal result for the patient. It is my observation that too often doctors become specialists in a particular type of treatment—sometimes it is implants, sometimes bonding, sometimes crown and bridgework etc. It is easy to fall into a trap where every case is evaluated in terms of that one specialty; where the answer to every restorative problem lies within that specialty. That answer might not be best for the patient. It is critically important that treatment modalities are not extended beyond their limitations or failure will result.
While I would like to “do a case” for obvious reasons, I most want to do right by my patient. I only care about accomplishing the best outcome.
When it comes to treatment involving orthodontics, four scenarios are possible:
Orthodontics Alone: Sometimes orthodontics by itself is the best treatment.
Full Coverage Restorative Dentistry Alone: Full coverage restorative dentistry can often substitute for orthodontics by changing the architecture and tooth position in an arch.
Orthodontics and Full Coverage Restorative Dentistry: Sometimes orthodontics and restorative dentistry are required to achieve an ideal result.
No Treatment: Never forget that the patient may opt for no treatment. That is a choice too. Perhaps the patient is not physically fit enough to sit through treatment, or has to postpone treatment for financial reasons.