One Chipped Tooth....4 Different Treatment Plans?

     I am frequently asked by random folks, who know that my field is Dentistry, to comment on their dental problem and proposed treatment solutions. I'm not sure why, but can only guess that it's because I'm honest and direct (?). Lord knows, I have presented enough treatment plans, and spoken to enough patients over decades, about their oral health, and treatment options. While I don't diagnose their oral health conditions or issues, and I don't create the treatment plans or options, I facilitate, explain, empathize, and work on solutions. Because, ultimately, if you walked into a dental office with an issue, you likely walked out with a diagnosis and proposed treatment plan. Somehow, though, in many cases, the blame for the treatment option or treatment recommendations, and their costs, gets placed on the dentist. Honest to God, I have heard this so many times I can barely keep count of them all.

     While the dentist gave you options and discussed alternatives, risks, and benefits of proposed treatment for the chipped tooth (that's Informed Consent), you may have gone to get a second opinion and gotten a whole different treatment option and set of fees. As a result, you are confused and somewhat angry. How could one dentist's opinion and recommendation be so different from another? Why are they so far apart in fees, too?? How do I decide what dentist was "right" and what dentist was "wrong" with what they were recommending I do to get the tooth fixed?? Here is where I usually say, "well, if you went to four different dentists, you may end up with four different treatment plans....and they may all be based on the dentist's sound philosophies and experiences". This is usually followed by a shocked look and a "What??? WHY?????? How do I know which treatment plan to go with????" So, let's talk this out for a minute so you can see this from a three dimensional point of view: not just the one.....

      First, you need to know, that dentists did not cause the issue with your tooth. They are not to blame here. If you chipped a tooth (let's say, a molar in the back of your mouth), and went to four different dentists, you may very well get four different treatment options and four different sets of fees. Dentists have faults, but being the cause of your dental issue is not fair, and its not accurate. Please don't get angry with them for the condition your teeth are in before you walked into their offices. Now that this has been established, let's look at why you might (realistically and appropriately) get four different treatment plans handed to you to fix one chipped tooth.

     It all depends on the professional philosophy and experience level of the dentist. It's that simple. One dentist might take a very conservative approach in believing that smoothing off the chip is sufficient to buy you some time before proceeding on with, say, a filling. One might take a slightly less conservative approach and recommend a filling be placed; maybe even a silver amalgam filling, in that molar, since that dentist might have total faith in silver fillings still. The third dentist may believe in a proactive approach and say that a filling is a temporary measure, like patching a flat tire, and why patch something that could choose to break again, when you can crown the tooth and get 40 more years out of it. The fourth dentist might take a more proactive and prophylactic approach and state that since the nerve is now close to being exposed, that having a root canal done prior to having a crown made, may help to ensure that the nerve of the tooth may not "come alive" after it is crowned, necessitating a root canal through the crown. There you have it: four different recommendations for one chipped tooth and they may all be quite feasible in their own ways. It depends on the philosophy and experience of the dentist.

     Yes, it is subjective and No, there is not one set of standardized, required guidelines, per say, for that tooth. And, No, the dentists are not to blame for these philosophical differences. Somehow, though, dentists DO get blamed. They get blamed if the tooth is smoothed off because your funds were tight, and two weeks later the tooth decides to break off again, and now you are in pain. They do get blamed if they fill the tooth, because the crown was not financially feasible at that time, and the tooth is sensitive for days. They also get blamed if they crown that tooth, and the tooth hurts and the nerve decides to "come alive" 3 weeks later. They do, also, get blamed, when they perform that root canal and crowning of the tooth, and it ate into your paid sick leave and savings account balance. So, when folks ask me about their treatment plans, this is what I tell them. At that time, they get a better understanding of how different treatment plans does not mean automatic negative opinions should be formed. They shouldn't. It means there are options based on a number of different factors, that will carry with them different prognoses for your tooth. Choose carefully and find out all you can and for heaven's sakes, don't blame your dentist because you're upset.

     Philosophical differences might also be the reason why one child may be found to have 4 cavities in one practice, but told they have 10 in another. Before you go thinking that one dentist has no clue while the other is honest, you need to find out more information. It may very well be the case where the child does indeed have 10 teeth that possess caries(decay) in very small amounts in 6 teeth but more noticeably present in 4. The dentist may not want to fill all 10 of them until they are bigger. The dentist may even recommend home fluoride treatments daily to possibly help those teeth get stronger. Meanwhile, the philosophy of the second dentist might be: decay is decay is decay, and if its present, we need to remove it. However, the immediate thought is...4 cavities versus 10?? How could one dentist be so different than the other? Ask questions, my friends. Become more knowledgeable about the how, why and what aspects of dentistry. Know all the facts first, and take accountability for the condition the teeth were in before walking through the door to the office. Don't place blame without knowing all the facts, and understand that different doctors (cardiologists, endocrinologists, ob/gyn's, etc. ) have different philosophies regarding a patient's treatment options. That doesn't immediately make them wrong or otherwise. It means they have had experiences that have shaped those philosophies, and you need to choose with a FULL set of information and an OPEN mind first and foremost. Fair is fair, here.

     So, that's today's soliloquy. Just keep these things in mind, is all I'm asking. For now.


Thanks for stopping by, and remember...you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY want to keep. Nothing more. That's it.
Dr. Driscoll