This is my first foray into blog writing, so I apologise to all readers if I have not followed blogging etiquette or fallen short in any way.
I have been thinking about writing this for a long time mainly because this blog can act as a means of imparting my knowledge and my opinion (which is based on education and experience) to anyone that is seeking it, with regards to my field of focus : healthcare particularly oral health and dental care. I hope that the information might at least in some small way increase awareness of measures to prevent disease as well as provide a basis for informed decision making when contemplating treatment and procedures.
I thought for a while about the topic for this first post and I decided on : The Dental Consult and Examination.
I chose this topic because I believe that throughout all branches of health care, this is the single most important appointment of all the appointments that a patient might have with a health care provider : it is the appointment where, from the healthcare provider's perspective, a diagnosis is reached. Correct diagnosis is the foundation of successful professional intervention - it does not matter how technically correctly the procedure (such as a filling or tooth extraction in the case of dentists), is carried out , if it is based on an incorrect diagnosis, it is likely to fail. Similarly, from a patient's perspective, it should be the most important appointment because this is where you learn about your state of health, where you get to ask as many questions as possible to evaluate risk against benefits of various options and, obtain fee and timeframe estimates. The consult and examination, almost always, also happens to be the cheapest interaction a patient is likely to have with any health care provider - it therefore provides very good value for the time and money spent.
Sadly, many patients seem quite happy to forego this very important interaction with their healthcare provider (in my experience of dentistry, anyway), often requesting telephonic quotes for procedures ('fillings', 'cleanings', 'extractions') rather than requesting costs for an examination and/or discussion. I often answer the telephone at my practice, and even after all these years, I still struggle to convey the value of a dedicated consult and examination to many patients. The matter of telephonic quotations is a topic on it's own, and I will not digress.
Every healthcare provider will chose his or her own approach to the examination and consult based on their experience, preferences and scope of practice. Below is the 'programme' summary that I provide to my dental patients at the time of the appointment being scheduled, so that he or she has an idea of what to expect :
Your Dental Consult
A consultation appointment is the most important interaction you have with your health care provider whether that is a dentist, doctor or other health practitioner.
The success of health management has its foundation in a correct diagnosis. To arrive at a correct diagnosis, a practitioner needs information. This information is obtained by talking and, very importantly, listening to you the patient. Various histories are taken and reviewed, an examination takes place and tests and investigations are carried out. All the data collected is reviewed and a diagnosis and treatment options are arrived at. A discussion is then had with the patient who decides how he or she wants to proceed.
As a patient, you should ask questions. Never agree to treatment from a position of doubt or ignorance – you must be happy and understand all aspects of the plan such as risks, benefits, alternative choices and costs (time and money). It is perfectly acceptable, and in fact recommended, that you seek a second opinion or take time to make your decision. Unless it is advanced states of infection, pain or trauma related, with dentistry, there is usually freedom to take some time to sit in the comfort of your home and think about how you want to proceed.
From the patient’s perspective, the consult is important as it is an opportunity to:
Internally – Examine gum, cheek, palate, floor of mouth, tongue, throat, teeth.
The dentist is looking for signs of anomalies – lumps, ulcers, decay, gum disease, crooked teeth, fractures, loose teeth, plaque, bleeding, pus. Each tooth and its surrounding gum is assessed and details recorded.
When carrying out an examination a dentist will use touch, pressure, eyesight and instruments (there are instances where sound and smell can also be used). Sometimes separate consults are necessary for specific disorders such as crooked teeth or gum disease.
3. Record collection
Photographs – you see what the dentist sees. They are good for planning and discussing your case with you.
Impressions for models of your teeth – these create a 3 Dimensional replica of your teeth. Again they help with planning and discussion but can also be used to create mock-ups of what your treatment result could look like.
X-rays – very valuable. Shows us areas not visible to the naked eye – the supporting bone, the pulp, depth of certain cavities. Usually small x-rays are taken in the surgery. Depending on your needs, a full set could be up to 12 x-rays. Sometimes a larger x-ray, taken from outside the mouth is required (for example to assess wisdom teeth or your TMJ’s). These may require you to visit a radiologist. X-rays are 2 dimensional representations of 3 dimensional teeth so they have some limitations but are still more than adequate for everyday dentistry. In instances where more detailed x-ray information is required, a CT scan which is a 3-Dimensional x-ray can be requested from a radiologist.
Additional fees usually apply for records over and above your consultation fees.
A discussion with you around findings – problems, implications, causes, future prevention, treatment choices, risks, benefits, costs, answering your questions.
Sometimes the dentist, like you, may need to think about what he should be advising as an approach to your care, and he may request you return for a chat at a subsequent visit. Usually no fee is levied for that additional visit.
Food for thought......
Often it is expected that a consult includes a scale (‘check-up and clean’). However, as can be seen from the above, a thorough consult requires time. If your oral health is relatively straight forward, there usually is enough time for that clean. However, if you have complex oral health issues, there should never be an attempt to ‘squeeze-in’ a cleaning with the consult. A consult is an investment in your health and is educational and informative. A scale is a procedure and should not be prioritised if is at the cost of long term gains – wouldn’t it be better if you were first made to understand how you can avoid needing that clean in future? Give a man a fish…. Or teach a man to fish?
Thank you for reading this attempt at blogging. For my next topic I hope to provide my ' two cents worth' by attempting to provide insight to what might be the most commonly asked question by dental patients : ' why does dental treatment cost so much? '.
P.S : We have a Comprehensive Examination Offer at Dr Fill Dental
Pranesh has been a dentist for over 15 years. He is the owner of Dr. Fill Dental in Point Cook, Victoria, Australia where he combines technology with experience for best patient outcomes. He has also authored the book EAT TALK SMILE - A Guide to Oral Health and Dentistry for the Patient.