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Basic Rule 6: Consult, Consult, Consult

Posted By Stephanie Wilhelm, Wednesday, November 21, 2018

 Basic Rule 6: Consult, Consult, Consult

 When we first started examining patients in dental school one of the first items to be filled out on the examination form was the section titled “chief complaint”. It seemed like a silly item at the time especially since we were going to do all the treatment anyway, were we not? Well, needless to say as time has passed I have, just as you have no doubt, come to learn that this is probably the most important item to explore and answer when we first meet our new client. Actually, we now refer to this not as the chief complaint but as the chief concern. This, along with knowing why the new patient left their previous oral care provider, must be identified before we proceed.

A patient’s chief concern will become the chief complaint if we do not address it first.

Another important point to be made before I discuss Basic Rule 6 is the 5 stages of convalescence. The 5 stages are as follows:

1. why me?
2. anger
3. depression
4. bargaining
5. acceptance

We all go through these different stages at different rates when we are faced with a difficult challenge.1 For example, if we are advised that we have a terminal illness some of us will go straight to stage 5 and apply professional advise accordingly, whereas some might go to stage 4 and seek alternative, non proven remedies.2 On the other hand, some of us might get stuck in stage 2 and find blame for our condition. Most of us go through these stages in our routine daily lives as well. A good example of this is a leaky roof. How many of us call the roofing company when that first drop of water on the kitchen floor is noted and order a new roof on the spot. Not many I would guess. Over the years I have had my share of roofing problems and I can assure you that I did a whole lot of bargaining (patching). This brings me to my point. We all have a practice full of patients that are usually mulling in one of the stages, usually bargaining. Such questions as “do I really need this?” or statements such as “I’ll wait until it breaks” concerning obvious necessary major restorative treatment are down right frustrating for the conscientious practitioner. Nevertheless, patience is a virtue and must be employed when dealing with patients especially when it comes to consideration of complete oral rehabilitation.3 We must help our patients go through the 5 stages at their own pace and offer appropriate support so that they can make the best choice for themselves. Patients that choose the treatment plan that is right for them are more likely to be satisfied with the final result. In a paper by Fitzpatrick it was concluded that completely edentulous patients were satisfied with their prosthetic outcome with or without implant support if they choose the prosthesis design.4 Getting to know our patients is thus of critical importance and working as a team with them to help them to decide what path they will take on their dental journey is prudent to say the least.5 This brings us to Basic Rule 6: Consult, Consult, Consult.

I don’t know about you but I find that the more time I spend consulting with a new or existing patient the less problems I have.6,7 This is because the patients are making the decisions, not us.8 Provided that the decided course of treatment does not compromise our core values then all we become in caring out the treatment is the operators. If there are any snags long the way the patient is working with us to move forward once again as quickly as possible. The pressure is off and dentistry remains fun. We just have to make sure that we do the job right by following all the Basic Rules.

I consult as often as the patient wants. I keep the consultation visits to under an hour. Usually all that is required is just one consult appointment. It’s probably because I have set in my mind that I am not in any hurry that it only takes one consultation. Having stated this, occasionally I might see the patient three or four times. It doesn’t matter since once the treatment has been decided upon and commenced we will more than make up our production costs. I also try to listen as actively and intently as possible. When Dr. Bill Dorfman was asked the following question in an interview (dentaltown.com, August 2005): “When a dentist … performs a bad makeover, where do you find they go wrong most often?” he responded: “I think that most often the dentists don’t listen to what their patients want …”. I agree. Please do not forget that with each consultation we also thoroughly document what transpired.  

Finding out the patient’s major concern, facilitating the decision making process, and being patient as our client moves toward acceptance of their oral rehabilitation needs and plan harmonizes and optimizes the treatment journey. This is done by consulting. Consult, Consult, Consult. It will be the best time ever spent in our offices, guaranteed!

Further Suggested Reading and References:

1. Jensen BO, Petersson K. The illness experiences of patients after a first time myocardial infarction. Patient Educ Couns. 2003;51:123-31.

2. Stoller EP, Gilbert GH, Pyle MA, Duncan RP. Coping with tooth pain: a qualitative study of lay management strategies and professional consultation. Spec Care Dentist 2001;21:208-15.

3. White BA, Maupome G. Making clinical decisions for dental care: concepts to consider. Spec Care Dentist. 2003;23:168-72.

4. Fitzpatrick B. Standard of care for the edentulous mandible: a systematic review. J Prosthet Dent 2006;95:71-8.

5. Holman AR, Brumer S, Ware WH, Pasta DJ. The impact of interpersonal support on patient satisfaction with orthognathic surgery. Oral Maxillofac Surg 1995;53:1289-97.

6. Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.

7. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior. Community Dent Oral Epidemiol 2003;31:368-77.

8. Bailey LJ, Haltiwanger LH, Blakey GH, Proffit WR. Who seeks surgical-orthodontic treatment: a current review. Int J Adult Orthodon Orthognath Surg. 2001;16:280-92.

 

 

Tags:  Basic Rules  Consultation  Racich 

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ADI Advocates to World Leaders and Civil Society during UN General Assembly Events

Posted By Stephanie Wilhelm, Tuesday, September 25, 2018

September 24 marks the start of a series of events when over 130 Heads of State and Government together with senior officials and parliamentarians gather in New York during the 73rd United Nations General Assembly (#UNGA). On Thursday, 27 September, the UN will hold a one-day comprehensive review of the progress achieved in the prevention and control of non-communicable diseases (NCDs), which will be the third high-level meeting of the #UNGA on the issue.  The comprehensive review, also known as High Level Meeting 3 (#HLM3) will be attended by over 55 world leaders seeking to achieve Sustainable Development Goal 3.4 to reduce premature mortality by NCDs by over one third by 2030. NCDs account for seven times more deaths than infectious diseases and millions of people worldwide suffer disabilities resulting from NCDs.

 

Oral health is very frequently overlooked by governments as they fail to recognize that oral diseases are some of the most prevalent NCDs on the planet. 3.5 billion people suffer untreated oral diseases from which the indirect costs, such as time away from school and work, amount to more than US$140 billion per year, ranking the indirect costs of oral diseases among the top 10 causes of death.  There is a clear social gradient to the inequalities in oral health, and the social determinants for oral diseases are common to many other NCDs. Treatments for these NCDs and other conditions, for example cancer, will be compromised though poor nutrition consequent to poor oral function. Choking to death and inhalational pneumonia also are rooted in poor oral function and a compromised dentition.

 

Around the HLM, many side events are to be held and are both organized and attended by representatives of governments and NGOs. ADI as the only direct membership advocacy group for oral health in Special Consultative Status with the UN Economic and Social Council will be represented at many of these events. ADI’s positioning is for all Member States to recognize oral diseases as:

(1)   major social, economic and developmental burdens on society and national development

(2)   an indicator of common risk factors predisposing to other NCDs

(3)   largely preventable through tough actions

a.      against added and non-intrinsic sugars in all forms, including taxes on sugar-sweetened beverages

b.      against the use of all forms of tobacco

c.       including access to

i.      clean water for use in daily oral hygiene practices

ii.      appropriate availability and use of fluoride agents such as toothpaste and drinking water.

Key events and their sponsoring organizers to be attended by ADI’s representatives include:

           

·         NCD Alliance: Civil Society Advocacy Briefing

·         The Access Challenge: Forum on Non-Communicable Diseases

·         UN Development Program: Curse or Cure? Leaving No One Behind in an Age of Technological Revolution

·         American Heart Association and others: Time to Disrupt the Health Care System

·         Government of Uruguay and WHO: Non-Communicable Diseases (NCDs): Time to Deliver Combatting - NCDs is Political Choice

·         NCD Alliance: No turning back - Charting opportunities to invigorate and intensify the NCD response

·         Global Alliance for Chronic Disease:  Implementation Science - protecting national investments for NCD scale up?

·         New York University: Oral Health and NCDs: Accelerating Integrated Global Progress

 

Contact:

Dr. David C. Alexander

Vice President International Affairs

Academy of Dentistry International

   +1 732 484 0582

 DAGlobalHealth

Tags:  fluoride  NCD  NGO  safe water  sugars  United Nations 

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2018 Student Servant Leadership Awards

Posted By Administration, Tuesday, September 18, 2018

The 2018 Student Servant Leadership Awards have been posted.

Click here to see the award winners.

This post has not been tagged.

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Advocacy for Oral Health and Sustainability at the United Nations – Academy of Dentistry International takes a Unique Role

Posted By Stephanie Wilhelm, Tuesday, August 14, 2018
Updated: Wednesday, August 15, 2018

Press Release

Academy of Dentistry International

Immediate Release

Advocacy for Oral Health and Sustainability at the United Nations – Academy of Dentistry International takes a Unique Role

New York, August 14, 2018. The Academy of Dentistry International (ADI) was granted Special Consultative Status to the Economic and Social Council of the United Nations (ECOSOC) on 24 July 2018. This consultative status is unique for an oral health-related membership organization and as such, enables a loud and direct voice for global oral health to be heard at the highest levels of the United Nations’ member states, the UN Secretariat and Agencies.

As an NGO with Special Consultative Status, the Academy will submit statements and provide advice on matters related to its areas of competence –

·         Promotion of oral health as a critical element of general health;

·         Role of oral health in the achievement of the UN’s Agenda for 2030 – the Sustainable Development Goals; and

·         Social responsibility and volunteerism of the dental profession.

This unique status is granted at a pivotal time for oral diseases when over half the world’s population have no access to even basic and essential dental care. The ‘Global Burden of Disease Studies’ funded by The Gates Foundation report that untreated dental decay in permanent teeth is the single most prevalent disease on the planet, severe chronic periodontal (gum and underlying bone) disease the sixth most prevalent and untreated decay in deciduous (‘milk’) teeth the 12th most prevalent. According to the World Health Organization (WHO) 60% to 90% of children worldwide have dental caries. Unfortunately, oral diseases affect the most vulnerable individuals, children, elderly and members of racial and ethnic minorities. The economic burden of these preventable diseases is severe. The indirect costs, such as time away from school and work, amount to more than US$140 billion per year, ranking the indirect costs of oral diseases among the top 10 causes of death. The World Oral Health Report (published by WHO) concluded that oral disease is still a major public health problem in high-income countries and the burden of oral diseases is growing in many low- and middle-income countries. Oral diseases are linked to diabetes, heart disease and stroke, and pre-term low birthweight babies among other conditions. Common risk factors for many of these diseases include sugar, tobacco, alcohol, lack of hygiene, unsafe water, and lack of injury prevention. There is a clear social gradient to the inequalities and disparities in oral health, and  the social determinants for oral diseases are common to many other Non-Communicable Diseases.

In the build-up for this unique role the Academy, together with many other civil society organizations, has submitted statements to the forthcoming High-level Meeting on Non-Communicable Diseases to be attended by heads of State and Government during the 73rd session of the UN General Assembly in September 2018.

The Academy’s mission is brought to life through the service of its members in volunteer work and oral health projects serving communities in need. The ADI spearheads social responsibility among the oral health community supporting its members and others to design and deliver health programs, and to provide advice on oral health to governments and other NGOs worldwide with focus on the under-privileged and under-served. Through a number of its members, the Academy has close working relationships with the WHO Global Oral Health Programme. The President of ADI, Dr. Gerhard Seeberger, a dentist from Cagliari, Italy, views this new status as a major game-changer for the reductions in oral diseases and their harmful effects on general health and quality of life.

“As oral health professionals we need to talk less among ourselves, and truly reach out to Governments and other NGOs within the health sector and beyond, to work together to make health and improved well-being  a reality for all peoples. Special Consultative Status brings the call for essential oral health and disease prevention closer toward achievement of the SDGs and the UN’s 2030 Agenda - Transforming our World.”

      

The designated representative to the UN on behalf of the Academy of Dentistry International is the Academy’s Vice President for International Affairs, Dr. David Alexander a  specialist in dental public health and the study of oral diseases. In describing the goals for the Academy with ECOSOC, Dr. Alexander added:

“We are strong supporters of the Sustainable Development Goals and put significant focus on a broad number of the goals which together will not only help prevent oral diseases but promote health and well-being in general. Currently the Academy is the only voice for oral health within ECOSOC and we hope others will join us and align around common goals for the betterment of mankind. It’s time to stop the needless suffering from these preventable diseases.”

About the Academy of Dentistry International

The Academy of Dentistry International is a global network of over 3000 oral and other healthcare professionals in more than 80 countries around the globe dedicated to the improvement in the oral health and quality of life for citizens of every nation. As an international honor society, ADI supports and undertakes service projects for the health and welfare of the underprivileged, underserved people of the world and advocates for the 2030 Agenda – Transforming our World: the Sustainable Development Goals, rather than the needs and personal interests of members. See www.adint.org

 

Media Contacts:

Mr. Fred Herbst (Germany) Chair, Public Relations, ADI                                                                                            

ChairPublicRelations@adint.org                                            

+49 172 6900469                                                                       

 Dr. David Alexander (USA) V-P International Affairs, ADI

david@appoloniaglobalhealth.com

+1 732 484 0582

Central Office

Academy of Dentistry International

3813 Gordon Creek Drive

Hicksville, OH 43526  USA

info@adint.org

+1 419 542 0101

Tags:  ECOSOC  SDG's  UN  United Nations 

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Rule 5: 6 E’s

Posted By Stephanie Wilhelm, Wednesday, July 25, 2018
The Basic Rules of.....

Basic Rule 5: 6 E's

When I first started to read about Dr. Earl Pound’s removable prosthodontic technique what immediately became apparent was how organized he was with his patient care. His organizational skills were such that he made removable prosthodontics a predictable procedure or at least as predictable as one could make such a discipline. He did this by having multiple steps and appointments with each one obviously being a precursor to the next but also involving the patient in the process along the way. This had the effect of doing two things. Firstly, the patient was apart of the process and could put their input in as required or desired. If they were agreeing with each step along the way then a successful outcome for treatment was more or less assured. What a relief to know we are on the right track, isn’t it! Secondly, and most important, if the patient was not satisfied with the process no matter what the cause, the services could then be terminated. Wow. Imagine, your half way threw treatment and you leave on pleasant terms. Why was this possible? Because before treatment commenced he followed the 4 E rule (I have added two more “E”‘s to make it the 6 E rule).
 
The E’s are:
1. Evaluate
2. Educate
3. Empower (my “E”)
4. Estimate
5/ 6. Enter or Exit (Pound had Eliminate)
 
The process of the E’s means that we are thorough with our patient interviews, case work-up, and case treatment planning and execution. By making the patient an equal partner in the process, ie. co-discovering, with us we are working towards a common goal like a team.2-4 We are up front with our patients with regards to treatment options, treatment length of time, costs, and efficacy. There are no surprises. And we expect to get renumerated at each appointment, just as Dr. Pound did. Dr. Pound received a fee at each appointment so that if services were terminated he was not out of pocket, the patient paid for what was done to that point, and the patient left the practice knowing full well that the pre-treatment contract had been honoured. Pretty smart. This concept can be applied to 21st century dentistry be it comprehensive fixed or removable prosthodontics, or just the routine everyday basics.

In my practice I follow the 6E’s. We thoroughly evaluate. There are no exceptions to this rule. Then we educate. Remember Basic Rule 2. Empowering of the patient results whereby they become a participant in their own care. Furthermore, this education process is not only about our diagnosis, treatment options, and empowering but also about fees and termination of services. We make each step of the way sequential and progressive such that records and treatment to date can be picked-up and continued at another practice of choice if in the unlikely event that “E” #6 (exit) occurs. We insure also that our fees have been looked after as well to this point.

A good example of our approach to comprehensive oral rehabilitation is the common way we provisionalize. In generalized moderate wear, erosive cases we frequently directly bond with hybrid composite; we like to call this the “prototype phase”. We do our thorough examination and evaluation followed by a thorough education of etiology, risk factors, treatment options, and efficacy. Costs are estimated and agreed too. We then perform our diagnostic provisional “prototype” phase (i.e. we have entered (“E” #5) into the treatment phase; in this example we bond establishing form, function, and vertical dimension re-establishment (Figures 1-3).

Figure 1

Figure 2

Figure 3

Figures 1-3: Composite bonding done in one appointment reestablishing form and function to the stomatognathic system.

This can usually be done in maximum one appointment per arch. At this point we have accomplished the first 5 E’s and have been renumerated. We can then proceed to the definitive restorative phase with the material of choice (gold or porcelain) at our leisure (ie. reenter (“E” #5) the relationship again) or services can be terminated depending on the circumstances (ie. exit (“E” #6) the relationship). Therefore, treatment has been predictable and stress free.

The 6 E’s offer another vehicle to optimize patient communication and interaction. The 6 E’s also just make good business sense. As oral healthcare providers we dance a fine line between professionalism and business. Nevertheless, a high regard for professionalism coupled with business acumen will ensure that we keep the busyness that us top professionals deserve.

Further Suggested Reading and References:
1. Pound E. Personalized denture procedures: dentist manual. Anaheim: Denar Corp.; 1973.
2. Roth SR. ProSpective volume one. Reclaiming the passion of dentistry. Seattle: ProSynergy Press; 1993.
3. Roth SR. ProSpective volume two. Defining the mission of dentistry. Seattle: ProSynergy Press; 1995.
4. Roth SR. ProSpective volume three. Advancing the profession of dentistry. Seattle: ProSynergy Press; 1996.

Tags:  Basic Rules  Racich  Rehabilitation  Treatment 

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India Chapter presenting Global Conclave Oct 6-8, 2018

Posted By Stephanie Wilhelm, Wednesday, June 13, 2018

The ADI India Chapter has organized a huge program of speakers presenting a wide range of CE! Please come and join ADI in Lucknow! Topics include Zirconia Implants, CAD-CAM, Regeneration and Esthetic Dentistry as well as Volunteerism and the Global Burden of Oral Disease on whole body health. Please plan to attend!

View full size flyer HERE

Registration is through the India Chapter at www.adiindia.net (This link takes you to another website.)

 

Tags:  CAD-CAM  CE  Estehtic  Inda  Lucknow  Regeneration  zirconia 

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Rule 4: What Could Go Wrong?

Posted By Stephanie Wilhelm, Friday, April 13, 2018

The Basic Rules of …..

Basic Rule 4: What Could Go Wrong?

 

When we really stop and think about it, what could go wrong with our oral rehabilitations and why? The answer I break down into three main areas: diet, hygiene, and parafunction. All three of these etiologies are patient preventable only. We act as the facilitators of dental education and patient oral care. That is why excellent communication and rapport are essential before embarking on a major undertaking such as an oral rehabilitation. Let’s now take a look at these three etiologies.

Dr. John Kois has championed the concept of risk factors and assessment for restorative and prosthetic dentistry. This is a profound concept and one that must be completely assessed before treatment commences. Dr. Kois discusses risk assessment in the areas of esthetics, occlusion, and periodontics for example. I agree with his approach.1-3  When we look at risk factors especially post treatment with an eye to their effect on oral rehabilitation longevity we can readily appreciate that a non-compliant patient will doom our efforts. I can attest to this. The saying “good judgment comes from a lot of experience and a lot of experience comes from a lot of bad judgment” I am sure we have all learned the hard way. In fact, a patient that refuses to participate in effective personal and professional oral hygiene care will undoubtedly have future problems or compromises with their oral health. Root caries, periodontal issues, and esthetics (eg. staining) to mention a few. The patient has to be advised pre-treatment on a lifetime of maintenance requirements. This is documented in their file and the patient is to be reminded of this if they are found to be waning.

Diet is another source for failure. Specifically, sweet intake. The patient needs to be educated on the relationship between sweets and caries and the significance of the frequency verses the volume of consumption. The patient also needs to appreciate that sweets are more than just chocolate and candies. There are many sources of sweets that the patient might not realize that are damaging, such as fruits or sports beverages (sweet/ food breakdown product “acid” attacks or acidic substances).4,5 Age and the associated decline in salivary flow also require explanation. Strategies to offset lifestyle decisions can then be formulated. Protection with daily fluoride rinses or stimulation of salivary flow with sugarless gum or lozenges could be introduced. Once again, this is documented in the patient’s file and they are to be reminded of this if they are found to be waning.

The third and most significant reason for oral rehabilitative failure is parafunction, better described as bruxism.6 We have known for quite some time that a patient’s teeth are never to be together unless they are chewing or swallowing.7 A patient’s teeth might touch for a split second when they chew or they might touch when they swallow (my teeth do not touch when I swallow). We all have patients that ask how long their new restorations will last or what kind of guarantee I will give them. My standard response is “I will guarantee the work for the rest of their life but only on one condition - as soon as their teeth touch once, the guarantee is off.” This of course is unrealistic and somewhat of a sarcastic response but it nevertheless gets the patients attention and drives this point home. Keep your teeth apart! Isn’t this the first thing we tell TMD (temporomandibular disorder) patients to do? Oral rehabilitative patients are no different. For those patients that brux at night or who just want to protect their investment while they sleep, it is a simple task to fabricate a full coverage hard acrylic maxillary orthotic. It’s that simple.8

Diet, hygiene, and bruxism. Make the patient aware of these three vices and we are well on our way to a successful post-treatment scenario.9 Failure to properly educate and monitor these three etiologies will be your undoing.

Further Suggested Reading and References:

1. Kois Center. https://www.koiscenter.com/  info@koiscenter.com

2. Kois JC. The restorative-periodontal interface: biological parameters. Periodontol 2000 1996;11:29-38.

3. Malament KA, Socransky SS. Survival of Dicor glass ceramic dental restorations over 14 years: part 1. Survival of Dicor complete coverage restorations and effect of internal surface acid etching, tooth position, gender, and age. J Prosthet Dent 1999;81:23-32.

4. Coombes JS. Sports drinks and dental erosion. Am J Dent 2005;18:101-4.

5. Lussi A, Hellwig E, Zero D, Jaeggi T. Erosive tooth wear: diagnosis, risk factors and prevention. Am J Dent 2006;19:319-25.

6. The glossary of prosthodontic terms. J Prosthet Dent 2017;117 (5S):e1-e105

7. Lundeen H, Gibbs C. Jaw movements and forces during chewing and swallowing and their clinical significance. In: Advances in occlusion. Boston: John Wright PSG, 1982. p. 2-32.

8. Racich MJ. The basic rules of occlusion. Markham: Palmeri Publishing; 2012.

9. Racich MJ. The basic rules of being a dental patient. Markham: Palmeri Publishing; 2016. 

Tags:  Basic Rules  Racich  Treatment 

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ADI Foundation co-sponsors "International Volunteer Project Workshop: Exploring Challenges & Developing Best Practices

Posted By Stephanie Wilhelm, Wednesday, March 21, 2018

The ADI Foundation is proud to co-sponsor the ADA Foundation's International Volunteer Project Workshop: Exploring Challenges and Developing Best Practices

This one-day workshop is designed for groups and institutions that are already involved in planning, directing, or implementing international volunteer dental projects dedicated to either the provision of care or training. The workshop will include presentations by keynote speakers Dr. Francis G. Serio and Dr. David Frost, followed by breakout groups that will discuss the myriad challenges of these projects and develop best practices.

May 11, 2018

For more details: www.adint.org/event/IntlBestPractices2018

 

Tags:  ADA  Best Practices  Volunteerism 

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Dental Asia Jan/Feb issue features ADI's "Global Burden of Oral Disease" symposium.

Posted By Stephanie Wilhelm, Wednesday, March 14, 2018
Dental Asia Jan/Feb 2018 issue featured an article on the ADI's "Global Burden of Oral Disease" Symposium. Click the link to read the article on the right page. Dental Asia Jan/Feb 2018

Tags:  Dental Asia  Global Burden 

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Rule 3: 3 Reasons for Treatment

Posted By Stephanie Wilhelm, Tuesday, December 5, 2017

Basic Rule 3: 3 Reasons for Treatment

People seek dental treatment for three main reasons: appearance, comfort, and function. Dr. Earl Pound spoke and wrote about this concept decades ago and in today’s supercharged world of cosmetic dentistry these words still hold as true now as they did back then.1 Dr. Pound was a removable prosthodontist who realized that the main reason that people sought out his services was for appearance, however, he also realized that the patients would never be happy with their appearance unless they were comfortable and functioning satisfactorily. We see this often in our practices. A good example is a procedure such as anterior veneers. Let’s say for example that a patient has some cervical temperature sensitivity after cementation of some freshly placed maxillary central incisor conservative laminates. Chances are that the patient will inspect their new restorations to possibly find a minuscule amount of root exposed on one of the teeth. A minor discomfort issue might then escalate to an appearance concern. On the other hand, let’s imagine that one of the new veneers is contoured incorrectly in the incisal one-third such that phonetics (ie. function) is altered. They are unable to say “F” as they did before. The patient might once again inspect their new restoration closely and once again an appearance concern might ensue. It is of critical importance therefore to listen to patients’ chief concerns and although cosmetic or esthetic priorities quite frequently top the list, the prudent practitioner must identify discomfort and dysfunction considerations first.

Discomfort concerns are either of an acute or chronic nature. The dental profession has become very proficient over the last century in handling patient acute pain situations. Prompt, efficient care is important and we can thereby move forward with our treatment in a timely and sequential manner after we address the acute concern.  Chronic pain is another matter. It’s as if the average practitioner runs for the hills when confronted with a patient or patients with conditions such as long term TMD (temporomandibular disorders). Interdisciplinary care is widely preached and encouraged by academics and leading clinicians but sadly this aspect of it is commonly ignored. More frequently the sexier and more lucrative cosmetic dental disciplines get the limelight unfortunately.2 There are many fine, contemporary textbooks available that cover the topic of patient discomfort, that are easy to read and allow immediate clinical application.3,4 Please avail yourself of this literature or refer your patient to other health care providers in a timely fashion in order to provide optimal care and service for your patients in an evidence-based manner.

Dysfunction is multifaceted and it also needs to be definitively addressed as well before moving forward with oral rehabilitative treatment, comprehensive or not. Dysfunction can be psychologic, physiologic, anatomic, behavioral, or pathologic. We have to identify which one it is and either structure a program to deal with it or refer to another medical or dental health care provider. If the dysfunction is related say, to bruxism, then patient education and appropriate follow-up (ie. evaluation, differential diagnosis, and preliminary treatment plan) is indicated. For bruxism as an example, the patient would be educated on diurnal bruxism (ie. “keep your teeth apart”) and for sleep-time they would be advised that bruxism is now considered a sleep movement disorder.5 The later would be managed with a sleep-time only orthotic use and referral to a sleep clinic for assessment would be offered.6 Oral rehabilitation could then proceed following The Basic Rules of ...

Appearance dentistry is driving the dental industry today with unprecedented demand for cosmetic services. I hope that I don’t have to remind you that esthetic and cosmetic dentistry are not one and the same. Cosmetic dentistry can’t always be made esthetic but esthetic dentistry can always be made cosmetic. Cosmetic is defined as “superficial measures to make something appear better”, whereas esthetic is defined as “pertaining to a sense of the beautiful”.7 It’s esthetic dentistry then that will make our patients happy with their appearance more times than not. There are many books available to help clinicians understand and practice smile design and facially generated treatment planning that is highly esthetic (and cosmetic if the patient so chooses). 8-14 This essay series will address esthetic dentistry in detail as we go through The Basic Rules.

 Three Main Reasons for Treatment:  Three Main Reasons for
Restorative/Prosthodontic Failure:
  • Appearance
  • Function
  • Comfort
  • Diet
  • Hygiene
  • Parafunction

Knowing the three main reasons why patients come to our office is an essential overall concept to understand, but defining what could go wrong with our oral rehabilitations and why, is mandatory. The answer I break down into three main areas:  diet, hygiene, and parafunction. All three of these etiologies can be prevented only by the patient. Poor dietary choices, bad hygiene, and relentless bruxism are three vices to make our patients aware of and if we can, then we are well on our way to a successful post-treatment scenario. We act as the facilitators of dental education and patient oral care. Failure to properly educate and monitor these three etiologies will be our undoing. That is why excellent communication and rapport are essential before embarking on a major undertaking such as an oral rehabilitation. 

Dr. Pound was right about appearance, function, and comfort. Dr. Pound also developed and enhanced a total body approach, not just the teeth and smile, to his patient care experience by discussing with patients general health guidelines many of which are standard today. He discussed with his patients the importance of exercise, diet, vitamin and antioxidant protocols. When his patients came to him with one of the reasons for treatment, he dealt not only with their chief concern, but he also gave them a whole lot more and never forgot that the patient would never be happy with their appearance unless they were comfortable and functioning satisfactorily.

Further Suggested Reading and References:

1. Pound E. Lost – fine arts in the fallacy of the ridges. J Prosthet Dent 1954;4:6-16.
2. Roblee RD. Interdisciplinary dentofacial therapy: a comprehensive approach to optimal patient care. Chicago: Quintessence; 1994.
3. McNeill C. Science and practice of occlusion. Chicago: Quintessence; 1997.
4. Okeson JP. Orofacial pain: guidelines for assessment, diagnosis, and management. Chicago: Quintessence; 1996. 
5. Blanchet P, Rompre P, Lavigne GJ, Lamarche C. Oral dyskinesia: a clinical overview. Int J Prosthodont 2005;18:10-9.
6. Racich MJ. Predictable fabrication and delivery technique for full-coverage hard acrylic non-sleep-apnea dental orthotics. J Can Dent Assoc 2006;72:233-6. 
7. Flexner SB, ed. The Random House dictionary of the English language. 2nd ed. New York: Random House; 1987. 
8. Magne P, Belser U. Bonded porcelain restorations in the anterior dentition. A biomimetic approach. Chicago: Quintessence; 2002.
9. Chiche GJ, Aoshima H. Smile design: a guide for clinician, ceramist and patient. Chicago: Quintessence; 2004.
10. Fradeani M. Esthetic rehabilitation in fixed prosthodontics. Vol. 1 & 2. Esthetic analysis; Prosthetic treatment. Chicago: Quintessence; 2004, 2008.
11. Racich MJ. The basic rules of oral rehabilitation. Markham: Palmeri Publishing; 2010.

12. Racich MJ. The basic rules of occlusion. Markham: Palmeri Publishing; 2012.

13. Racich MJ. The basic rules of facially generated treatment planning. Markham: Palmeri Publishing; 2013.

14. Racich MJ. The basic rules of being a dental patient. Markham: Palmeri Publishing; 2016.

 

Tags:  Basic Rules  Racich  Treatment 

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