Do I Really Need That?
A Discussion Of Treatment Options People Often Consider At The Dentist Office And How To Make The Right Decision For Yourself
We hope that discussions with your dentist evoke a sense of trust and respect. Unfortunately, we often meet people who have had treatment discussions with their dentist that have made them feel like they were getting “sold.” Why do different dentists recommend different treatment options? How do you know which decisions to make, which treatment to accept, and which treatment to decline or delay at the dentist office?
The first thing to understand regarding treatment discussions with your dentist is that dentists are in a tough position. Most dental diseases and problems don’t actually cause symptoms or pain until they are REALLY big problems to deal with. So, we are often in a position of telling people they have problems they didn’t know about and asking them to get treatment they don’t want in a place that makes them fearful and anxious. Some professionals respond by trying to minimize problems, some respond by over explaining situations, but the answer is we all ultimately try our best to offer a version of informed consent to a patient.
So what is informed consent? This is the process where we try to help you understand the problem at hand (ex: cavity, cracked tooth, signs of grinding, etc) then we offer solutions. Of the solutions, we give the risks, benefits, and alternatives to treatment along with the consequences of no treatment. For many people, this is too much information to take in, and for others it isn’t enough. Often, people want to know what the dentist would suggest or do if it was them. We often do try to answer that question as best as we can, but each person weighs decisions with different factors in mind. Some people want treatment that will fix the root of the problem, some want to simply keep the problem from getting worse, some want treatment that will be acceptable for years but as cheap as possible, some want treatment that will last a lifetime if taken care of properly, some want things done as quickly as possible, and others have all the time in the world. All of these factors are purely individual. So, as dentists, we try to collect as much information about you as possible. This is so that when we consider the treatment options available, which may be A LOT to choose from, we can present options that best fit that person’s individual wants/needs.
So, let’s get down to an example.
Crowns vs fillings and patchwork
There are many factors that go into the decision of whether to crown or simply put a filling in a tooth. In general, if less then 30% of the natural tooth remains, if cusps of the tooth are broken/missing, or if the tooth has cracks, it could benefit from a crown! Teeth with a cavity under an old filling that isn’t too big and teeth that have never had dental work before are often great candidates for a filling. The decision gets complicated though when patients ask for options that are cheaper or want to delay needed treatment because of cost. Sometimes we can buy time in these situations by putting a large filling in a tooth that really needs a crown, but there’s no guarantee the tooth won’t break or get worse by taking that option, so is it really an option? Sometimes we can buy time by placing anti-cavity medications like SDF to stop cavities in their tracks, but this only works for limited time and only in certain situations. Fillings have, on average, a relatively short lifespan as well, whereas ceramics like crowns or even ceramic fillings (called onlays and inlays) have much longer and predictable lifespans. Not to mention, within these treatment decisions is the concept of what type of materials are used. Do you prefer metal or no metal? Tooth colored, gold or something else? Do you prefer BPA free materials or no? These ceramic options are more expensive and take a bit more appointment time though and often require a digital scan or physical impression. Sometimes people consider pulling a tooth and then getting an implant replacement rather than trying to crown it. This decision depends on the long-term prognosis of the tooth, someone’s willingness to wait to have the final tooth, additional expense, and the concept that if the implant fails there isn’t a great replacement option. So, all of this information summed together means that dental treatment decisions that seem very straightforward are actually often very complex. Compound this with patient emotions from receiving unwanted news about their dental condition and dentist emotions regarding having to deliver that information, and it becomes a REALLY complex decision-making process.
What can you do as a patient to make sure the treatment option(s) you’ve been given is/are the best ones for YOU?
Emphasize your unique motivating factors: Do you want the option that is plain and simple the cheapest? Do you want something that will last the longest? Do you want something that is the most esthetic possible? Do you want whatever can get completed in the fewest number of appointments, the shortest length appointments or something else? What is your risk tolerance for if a treatment fails? Do you prefer certain types of materials or prefer simply to avoid certain materials? Do you prefer to decline treatment altogether with the understands of the risks of no treatment? If you have no preferences on options above, ask your dentist his/her treatment philosophy: watch and wait to intervene until the problem is bigger; fix early while the problem is small; get to the root of the problem; etc.
Ultimately, the responsibility to properly inform you of your treatment options is your dentists’, and the responsibility to make an autonomous decision is yours. Ask questions and know what is most important to you. You don’t need to know all of the treatment options available. Afterall, you haven’t earned your doctorate in dentistry. What you do need to know is what you want out of the treatment you receive in terms of cost, time, longevity, function, esthetics, and your dentist can present your options from there.
