Today, I would like to touch on a topic that every dentist deals with every day: patient autonomy and how we achieve it. I know there are a lot of sincere efforts by dentists all over the country to give the patient all of the information necessary to make a good decision based on the patient’s personal situation (finances, past experiences, personal preferences, etc.). However, nearly every practice in the country has patients that come to the realization that what their dentist secretly thinks is best, is in fact best.
Go into any community in America today and you can find a practice that only provides bridges and another that only does implants for single-tooth edentulous areas. You can find a practice that only provides posterior composites and another that only does posterior amalgams. How can we say we are giving the patient options when this is happening?
I am not saying it is the dentists’ fault at all. For one, go look at the research comparing those things. You will find that when dealing with long-term survival of anything in the mouth, the data is scarce and not definitive. Hence you can find whatever answer you are looking for. Another factor that must be considered when determining what is best for a patient is what the doctor is good at. A patient may feel that amalgams are just awful and leak mercury, but having a dentist who has never done a posterior IP composite is a recipe for disaster. Maybe the patient thinks composites leak too much BPA and want their children to only have amalgam. That might be tough job for a doc that hasn’t touched the stuff since dental school.
I want to share a case I ran across. I am stuck wondering what is best for this patient. There is irreversible pulpitis with normal PDL and normal probing on #3. We scheduled for RCT, opened it up and found a large distal crack.
Did I do the right thing? What would you do? What do you say to the patient to ensure patient autonomy in a situation like this?
Bryan Bauer, DDS, FAGD