2010 (April 01, 2010)

by Elliot Mechanic, DDS

A new decade and new challenges for the restorative dentist. We continue to pursue our quest for natural esthetics and minimally invasive dentistry to conserve tooth structure. This issue of Oral Health illustrates what is happening at the dawn of this new decade. The rules of the dental game are constantly changing and practitioners must adapt to the rapid changes taking place in our profession.

Recent years have seen several new materials introduced. With change comes controversy! Is lithium discilicate the future? Or is it feldspathic porcelain or zirconia? Or should we continue to stick with “old reliable” porcelain fused to metal restorations? With all that is available to us we must be judicious and evaluate the factors for our material choice:

1. The esthetic goals of the patient

2. The functional requirement of the restoration

3. The condition of the tooth being prepared

4. The color of the tooth being prepared

5. The location of the tooth (anterior vs. posterior)

6. Single unit of bridge

7. Cemented or bonded

8. Published success rates (University studies)

9. Previous experience with the material

10. The preference, skill and ability of the technician

In additition to new materials, new dental technologies have also been changing our profession:

1. Front desk computerization

2. Digital x-rays

3. Digital photography

4. Interactive patient education

5. Digital impression

6. CAD CAM restorations

Dental economics have also changed drastically. We are not living in the same world as just a few years ago. We must adapt to the different types and needs of our dental patients. People have different needs, philosophy and values. Not everyone sees the world the same way. That is what gives us individuality and makes us different.

Different types of dental patients visit our practices:

THE MAGIC PATIENT. Some patients will do anything that is recommended to them. They want the best, will cooperate and are willing to pay a fair fee for our services. If we think of our most successful cases we would often find that they were performed on “magic patients”.

THE AVERAGE PATIENT. This is our typical patient. They will restore their mouth gradually depending on their insurance and personal budget. With creative treatment planning and good communication we can achieve predictable long-lasting healthy results for these patients.

THE PATCH PATIENT. This patient is resistant to fixing anything properly as they view dental treatment as a nuisance and an unnecessary overpriced expense. They usually show up for emergency treatment and request overly huge composite resin or amalgam restorations or just want patches placed in their existing fillings. These patients generally do not follow our recommendations and when they do they are often overly demanding and have e extremely high expectations. They often do not take responsibility or appreciate their own dental disease. It would be much easier for dentists not to have to treat these patients as they tend to show up at our offices at the worst times and treating them often proves to be very frustrating . We ask ourselves, “Is this what I went to school for?” “Why am I taking courses to pursue excellence?” Many dentists today are faced with the economic need to treat these patients to keep schedules busy.

It is important to be well-documented, noting clearly in our charts the patient was presented with all options and chose to “patch”. Signed consent forms are advisable, as patients tend to blame us for their subsequent problems. It is always their previous dentists’ fault. None of us wants to be blamed and refered to as “my previous dentist.” When money gets tight patients get angry. We are judged to the norms of the profession. Our work can’t be substandard just because it was done as a quick emergency or for a reduced fee. “Beware of bargains when purchasing dental work or parachutes.”

The University of Toronto Advanced Esthetic Continuum is now in its third year. The program consisting of lectures and hands on training has been very well received. New courses are being added on a variety of subjects. All Canadian dentists are encouraged to register and be part of this program. For further information please visit www.cde.utoronto.ca or call 416-979-4902.

This esthetic issue of Oral Health contains a range of articles addressing many topics and facets of dentistry. I am pleased to welcome a host of new authors to our journal which this year contains contributions from Canadian authors. Canadians are the biggest secret in show business and dentistry! If anyone would like to contribute an article or has any comments or suggestions please contact me at Elliot@drmechanic.com

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