Assault by Dentistry
It is the purpose of dentistry to improve the oral health and comfort of our patients. In reality all dentists experience problems and complications. For those that say they do not, then perhaps they are not operating, not looking at their results, and/or they are prevaricating. Whereas problems may be “solved” immediately, complications are more serious, render harm to others, and necessitate additional treatment to resolve (if possible).
Complications occur in the short, medium, or long term. For example, a short-term complication is a cut blood vessel, a root canal filling that enters a nerve canal or the sinus, a devitalized pedicle graft, or an aspirated instrument. Medium-term complications include large restorations that devitalize pulp, fractured alveolar bone during an extraction that causes bone loss, implant osseointegration failure, and most postoperative infections. Long-term complications are insidious because the treating dentist is often not aware they occurred (because the complications become symptomatic many years later, the patient may have moved to another locale, and/or the patient desires to avoid the treating dentist). Here are examples of two common long-term complications:
- When an over-contoured crown is placed on an implant that impedes peri-implant hygiene, or when occlusal forces are not vertical, which leads to progressive peri-implantitis, vertical bone loss, and implant loss.
- When orthodontic (or Invisalign) tooth movement attempts to compensate for a skeletal growth deformity. Many malocclusions involve maxillary and/or mandibular growth deformities; e.g., moving teeth in a Class II mandibular deficiency without surgical advancement of the mandible is inherently unstable and often causes posterior dental attrition, breakage and loss of teeth, TMJ internal derangements, and promulgates upper airway and related systemic health issues.
As health care providers we make decisions for our patients, as well as offer treatment options for them. It is our job to direct patient care in the best interest of our patients. However, patients may want a “cheaper” or “shorter” treatment alternative. It behooves us to explain to our patients (including the technical-scientific stuff) that alternative care is just what it means…not the best, but compromised treatment that often risks complications. At what point have we rendered “care”, or a long-term festering patient assault?
This brief missive intends to stimulate introspection about how you practice, discuss treatment options with your patients, and how you follow-up after patient treatment. To excel we must be perpetual students, and have the humility to learn from and correct our mistakes. Continuing education is not just going to courses for credit but is continuously reviewing basic sciences, reevaluating ourselves, and frequent professional interaction with our peers. This is the heart of organized dentistry. I look forward to seeing you at the next CADS meeting!
By Dale M. Gallagher, DDS, PA
CADS President, 2018-2019