NOt to belabor a point here, but let me discuss the way I practiced dentistry for 2 decades, then the way I do now.

1982-2002. Patient calls for an appointment, usually in pain, we schedule them that day, see them, deal with their pain, try to reappoint for a "cleaning" Repeat the above, year after year, with my patients using my services as they needed, or felt they needed.

2002-present. Patient calls for an appointment. Either they are a new patient or they are an existing patient. We ask what prompted the phone call. Patient responds, either they have a problem they want fixed, or they want to schedule for a cleaning an xrays, etc. If they are a new patient with an acute problem, we try to schedule them for a comprehensive examination, full mouth of radiographs, check every tooth, every area of their gums, their bite, their soft tissue for oral cancer, etc. We also provide palliative treatment for the problem they called in for. If it is an established patient, we obviously schedule for whatever necessary work they need which we have documented in their charts since they will have been through a comprehensive exam within the last 2 years. If they are a patient of record, but have been out of treatment for 2 years, we schedule them as a new patient in order to know exactly what we are dealing with.

By doing this, we systematically diagnose each and every issue in their mouth and develop a plan to solve their problems. I find that my old way of treatment gave the patient the quick fix but in no way did we have any idea what the big picture was as we were only treating the immediate problem, (putting out the fire).

My comprehensive examination is scheduled for 1 1/2 hours where the staff and I carefully go over the case item by item, prioritize, and discuss with the patient the "battle plan" for their treatment. If thie patient doesn't follow through, I still see them, I take care of them as best I can, I do not try to hustle them for treatment, I don't beg and coax and leap through fire hoops to get them to accept treatment. I am merely there to help. Most follow through, some don't. I am not frustrated because I have done my best and the rest is up to my patient.

my plan:


1 Treat the disease. Bacterial issues of the gums first, decay second. If we can get the cavities fixed with simple fillings we go ahead. Otherwise we frequently go through and " put out fires" by removing decay and placing temporary fillings. at no time do I jump ahead and do "secondary" dentistry, (Crowns, bridges, implants partials etc) until we have done the primary disease removal first.

2 treat the rest of the case as per a co-decision based on the patient's wants, needs and desires, at the speed that they dictate. (ie some people want everything done in one visit. We will sedate them, do 4-5 hour case, then 2 weeks later place the crowns, bridges, etc as per the wishes of the patient. Other people want us to only max out their dental insurance on a year by year basis which I am happy to do,provided the patient realise that this decision is theirs and may create need for mor expensive dentisty as a result of delay.)

3 We aggressively treat periodontal disease ( gums) and push hard for patients to follow through with this treatment as it is the one area that at some point all we can do is forstall the inevitable, loss of the teeth. U find most patients over 35 have some manefestation of gum disease when they present, Smokers nearly a hundred percent.


Now a point about dental hygienists: In America, most dental hygienists have 3-4 years of college and the difficulty in getting accepted into the DH program creates a situation where only the cream of the crop become registered dental hygienists. A couple states are the exception where they have a different criteria ( much less education) In the use of Ultrasonic scalers, piezo scalers, abrasive polishing systems and the use of hand instruments for the removal of calculus form the teeth, the dental hygienist has much more education than the dentist. I do not clean teeth, I never have, now will I ever. I know 25 years ago it was normal for dentists to provide this treatment, but that has pretty much gone the way of the horse and buggy. Every patient is scheduled for one hour with my dental hygienist. Any less time and it is doubtful that a patient is given a thorough cleaning. In the presence of disease, the treatment can and does take several appointments and require local anesthesia.

I am only relating this so we have a level playing field to discuss from if you would like. I am not going to criticise anyone's dentist, nor will I support the profession as being without charletans and rogues that are out to cheat you out of money. By and large, though, most pentists I know want to take good care of their patients, make a good living, and pay for their investment.

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