440-646-1133 kogandmd@sbcglobal.net

It appears that my blog, which potentially generates zero readers (no offense taken there), is taking the route of going “quarterly.” That was never my intention, but (un)fortunately I have been extremely busy and haven’t had time to put my thoughts on digital paper. So, I wanted to write some quick thoughts before I start my day.

“It is more important for a physician to know what kind of patient has a disease than it is to know what kind of disease the patient has.”

— Sir William Osler

I have had a few topics on my mind lately, but one thing I want to focus on in particular is treatment planning in dentistry. While this may seem like a boring topic, I think it is extremely important for both the practitioner and the patient.

Obviously, I am not going to go into a diatribe regarding my own personal opinions of the data gathering and treatment planning process, but I will say that I believe this portion of the examination needs to be thorough, accurate, and thoughtful. Generally, it should be more than five minutes long (I truly believe it can take up to four hours to properly examine the dental structures and take any necessary records).

Last week I attended a casual study club meeting with three other colleagues. Each of us brings a unique perspective when it comes to case presentation and treatment philosophy. While one member of the group was presenting a case (pictures of teeth, gums, etc.), another colleague mentioned, “Isn’t it amazing how we don’t even look at the teeth anymore? The teeth are the last thing we look at.” He was exactly correct.

In the days of old, the restorative dentist simply checked your teeth. No cavities. No periodontal disease. No problem. “See you in six months.”

This is archaic.

To be blunt, the teeth and gums are part of the face. And this particular part of the face is responsible for all of your emoting capabilities. Kissing, smiling, laughing, eating, etc… you get the point. How can we not plan your mouth and smile in relation to your face?

Once we determine the aesthetic needs, if any, of a patient’s smile, we can then begin to formulate a plan. Of course, we must first know our patients circumstances, temperament, and objectives. Assuming this patient has assumed responsibility for their own health, trusts, and appreciates, we now have a definite path on which to plan for. Every patient has the right to be educated on an optimal plan for their oral health, regardless of their motivation and abilities today. I wholeheartedly believe this.

“If I accept you as you are, I make you worse; but if I treat you as though you are what you are capable of becoming, I help you become that.”

— Johann Wolfgang Von Goethe

Some doctors in my interdisciplinary team (specialists) tell me that patients need to be “ready to hear it.” Essentially they are saying that they (the patient) have experienced reactive-type dentistry for so long, that they need time to hear a complete plan for their entire mouth. I disagree with this notion, because I feel that it provides no benefit to the patient or myself. If we discuss a plan towards specific goals that has a definitive end point, we now have a clear and conscientious path to follow.

Personally, I like visualizing the end before I begin. It makes me more comfortable. It makes our relationship better. If that is a turn-off, then there are many practitioners who will schedule you with their hygienist and check your teeth alone for two minutes and probably reply with something like: “See you in six months.”

A handyman or an architect.

As dentists, we have decisions to make. It is very easy to be a handyman. People are used to this. Come in, scrape your teeth, and if something breaks, we will fix it. Oh, and if that breaks, we will blame the material or the laboratory and put in a “stronger” material (next blog entry – Maybe we should ask: “Why did this break?”).

I strive to be the architect. Let’s blueprint a plan to fix things, and fix things right. While we are at it, let’s do the very best we can do. The very best. Let’s replicate nature as best we can. Let’s try to fabricate custom restorations that are simply… beautiful.

This is restorative dentistry.

It is time to think like architects.

We are not handymen.