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Drill Down to Get Answers at the Dentist

Sept. 5, 2014
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By Bonnie Sheeren

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As an independent patient advocate, I always hope that clients will call me before they get into a medical tangle, instead of afterward. Being proactive allows me to research and help advise them to give the necessary information they will need to make the best possible choices, both for their health and for their finances.

Recently, a client called after reaching an impasse at her child’s dentist’s office. The dentist told her that her child needed seven cavities filled and that she would need to sign a vaguely worded consent form to authorize sedation. No attempt was made to explain the dentist’s decision on either account.

The mother, her intuition flaring, chose to leave the office and call me to research her options.  I determined four questions for her to consider as she searched for a second opinion, hopefully from a more patient-centered pediatric dentist:

1. How was the diagnosis made?

Which criteria did the pediatric dentist use to determine that there were seven cavities, or dental caries, to be treated?  This would be an excellent time to educate parents that there is an international system for evaluating treatment versus no treatment.  In fact, overtreatment and undertreatment can both be detrimental to one’s overall dental health.  A quick education on the international standards for the necessity of any procedure would be useful for parents.

2. Can you show me?

My client was never shown the cavities in question. All it would take would be a low-tech dental mirror, but higher-tech oral cameras are also available in some dental offices.  In addition, a thorough review of any X-rays taken can help put a parent’s mind at ease.

3. Was an in-depth family medical history considered?

As the field of dental genetics continues to expand, cutting-edge research has found that the cause of tooth decay can be 60% inherited and 40% environmental.  Knowing the patient’s family background could help both the dentist and the parent decide whether to take more aggressive action or a less intense “wait and see” plan.

4. What type of sedation is planned?

Exactly what method is the dentist planning to use?  My client was never told why sedation was necessary. Sedation options, such as nitrous oxide (laughing gas), oral sedatives, IV sedation and general anesthesia, vary greatly and carry certain risks. But my client was expected to sign a blanket consent form without knowing any of the specifics.

Pediatric dentists (as well as pediatricians) have an excellent opportunity to “teach, show, do” in order to instill a lifetime of responsibility and ownership of personal health. If sedation is being considered solely because of a patient’s anxiety, it may be constructive to consider other options that will put him or her at ease.

I was dismayed that my client’s pediatric dentist wasn’t more forthcoming, but I was glad she called me. Patient advocates love preventing bad health care scenarios and are always happy to assist. It’s what we do.