When I teach other dentists at the LD Pankey Advanced Dental Institute in Miami, we frequently discuss the frustration we experience in trying to create value for a higher quality of care that is long lasting, less costly and in the patient's best interest. This is the kind of thing some dentists talk about when their clients aren't around!

upper teeth and bridge by jottendds

My frequent response is that, of course, it's frustrating.

Patients can't know about the quality of their care and make informed decisions unless they have some point of reference. If they can't know the differences, how can they have choice? Frankly, as ill advised as it is (more about that later), the most frequent point of reference is when they have a problem. In a world of quick fix, insurance-based care and "Extreme Makeover" mentality, the message and value of careful, deliberate, and accurate patient-centered care is easily lost. So how do you know what level of care you're receiving? Are YOU choosing the level or is the dentist?

Let's try to bring this to light with a quick example. Ruth (name changed to protect the innocent) came to us because some dentistry she had done in the last few years didn't ever seem completely comfortable.

Actually, Ruth was much more perceptive than most people who have very similar circumstances. It's a good thing she was. Take a look at the picture above and the same teeth in this picture.

upper left bridge by jottendds

This is what is commonly called a bridge and consists of porcelain and metal crowns tied together to replace a missing tooth. Looks pretty good, right? You wouldn't know anything was wrong by looking and she had no pain.

Now look at this picture --yes, it's kinda gross-- of the teeth and gum tissue underneath after we removed the bridge.

bridge removed by jottendds

Looks good right? I really shouldn't even joke about this because the sad fact is that the red bloody gum tissue and the discolored mushy teeth are problems so bad that she may lose a tooth. At best, it will take a tremendous effort to fix this. She may lose one tooth (then we may not be able to do another bridge) and minimally we have to do gum and bone surgery around all three teeth, rebuild the core of each then replace the bridge with a new more precise one.

The point here is that this damage was probably unnecessary. Unfortunately, we see this kind of thing all the time. This bridge was less than three years old. We shoot for 20-30 years! Worse, this patient now has to pay MORE for me to fix a more complicated problem than she once had because of the apparent poor quality of the care she received. When I asked about the planning that went into this bridge, it was clear from Ruth's response that there was little or none. And when I asked why she chose the dentist who did the work, the reasons were that he was listed as a provider on their insurance and they knew him, two common but in my opinion very low importance reasons.

So, if you are someone who wants a better outcome, what do you do? How do you know what to ask for? First, like most successful outcomes, it starts with good planning. To me that means a skilled, dedicated practitioner with the documented training to prove it and a comprehensive evaluation process like the one represented in this link on our web site that thoroughly involves you in the decision-making process. These are the essentials for you to have real ownership, choice and control what happens to you.

Here's one aspect of that process that illustrates my point. Have you ever had crowns, bridges, cosmetic dentistry, veneers, dentures, implants, orthodontics, or bite problems? If so have you ever seen a device that looks like the one in the picture shown here?

articulator by jottendds

If you said no, you're certainly not alone. This is a three-dimensional jaw-movement analysis device called an articulator. On it are models of a person's mouth for analysis. Doesn't it make sense that if we were to do any of the dentistry described above it would be helpful -- to me, mandatory -- that we would place these models on this device for analysis, planning and fabrication? You wouldn't build a house without a blueprint, would you? Unfortunately, over 95% of the patients we see that have had these procedures have never seen this device used before -- and they'd know if it was. It wasn't in Ruth's case either, most likely contributing to this premature failure.

Our passion is to help people become healthier. One way is to make you a better consumer. Your responsibility is to take an active role in your care and ask questions--especially the tough ones -- to be sure you're getting the care you think you're getting. By the way, pain is a terrible indicator of dental disease as only about 10% of all dental disease is painful.

If you want to know more about any aspect of dentistry give us a call (843-6404) or visit our informative web site. We're always happy to answer your questions whether you are a patient of ours or not. We'll help you be an informed consumer making informed choices. Until next time, be well.