Q: I have to have two dental implants (and some sort of build up) and one tooth removal in the lower right side of my mouth in a few weeks. I had a bridge for many years that needed to be removed because the back tooth it was attached to is bad. Bridge is no longer an option because there’s nothing to attach it to. So, here I am in need of this major work to the tune of $9,500. Ugh. Leaving a gaping spot in my mouth is not an option.
My question may seem silly to you, but I am petrified! I really feel like I want to be knocked out (an additional charge) but people assure me I’ll be fine with novocaine. After all that, my question is, what would you do?
A: This question came to me about two weeks ago. Feeling that a discussion was needed to give this patient an adequate answer, I reached out directly. It was too complicated and would be far too wordy to do it in print.
The patient and I spent quite a bit of time discussing this complicated treatment.
One point I want to make is that what I am trying to achieve with my column is to answer questions that you the patients may have in order to guide you toward what I feel is the proper treatment. Because so much has changed in my dental profession with so much emphasis on profit motive, I have desired to protect each and every one of you from being taken advantage of. I have tried to give you all questions to ask your dentist so that you the patient will be better prepared, have a better understanding of proposed treatment all with hopefully a better outcome. I have counseled you all on a regular basis to not just accept that “Doctor knows best.”
In the almost two years I have been answering questions from you all, I often have been sad and disappointed at times when treatment objectives did not seem ethical to me. My desire is to hold my profession and colleagues to the highest standard and keep that standard to what is considered reasonable and customary in the geographic area it is being practiced in. Rarely have I seen that to be the case.
I am stating this review of my objective because I am so proud and excited to tell you all that this patient, who was so carefully questioned by me, was being treated and continues to be by a health professional that truly makes me proud. Why, you may say. Well, I will tell you. The patient, D.P., went over with me in detail about the complicated treatment and what was explained. The doctor discussed the case for a very extended period of time, carefully reviewed the X-ray images and clearly and concisely went over all the possible treatment options. I know this because when I asked if this or that was explained, the answers (aside from the sedation question) were clear, concise and correct as far as I felt. The patient was given alternatives to treatment that had different financial implications as well as potential outcomes. Every option given to the patient was correct as far as I could tell.
This is so exciting to me because it is so rare that I see this kind of treatment. It is the kind of treatment I strived to provide during my practice years and spent similar time teaching others to do the same. D.P. is being treated by a fairly young dentist, approximately 8 to 10 years out of training, who obviously is very bright, very well trained, very ethical and in my eyes represents exactly what I want to see from my profession going forward. I am sorry to say that this type of practice is becoming harder and harder to find but I am thrilled to share with all of you that it does continue to exist. It may be hard to find a practice that is similar but they are out there. Just take your time in selecting a practitioner, ask polite and careful questions about each and every thought that you have. If the time is not taken to answer you or if you are made to feel uncomfortable, then “grab your hat” and seek another option for treatment.
I will say that regarding the anesthesia question, I advised D.P. to try and avoid general anesthesia. I feel that some type of premedication and possibly conscious sedation is a safer way to proceed. Submitting the patient to general anesthesia can be dangerous and is a variable that I would avoid. Only if the dentist has an anesthesia colleague present to administer the drugs and observe the patient carefully and continually, while the dental procedure is ongoing, would I agree to allow that degree of anesthesia to be administered. Simply put there has to be a dedicated anesthesia person present if D.P. is to be put to sleep.
Other than that, I advised that D.P. stay with this dentist, follow through with the treatment decided upon and above all, extoll the virtues of this dentist and this practice to all.
My other readers, be comfortable in knowing that the dentistry provided for D.P. is not out of the question for each and every one of you. Thank goodness!
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.