Person thinks the tooth can heal by itself so he dont want treatment but comes anyway

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

maybe123

New Member
7+ Year Member
Joined
Jan 3, 2015
Messages
5
Reaction score
0
A person comes in with severe caries on his 8s and he have read on the internet that it can be healed by itself. He suffers great pain but don't want me to extract the teeth, what should I do?

Members don't see this ad.
 
Obviously if the caries has reached the dentin, the tooth needs to be operated on. You need to explain to the patient that at this point, it is irreversible. However, the patient always has the right to refuse treatment, regardless of how stupid that decision is. It is going to come down to your communication skills. You need to make the patient want treatment.
 
  • Like
Reactions: 1 user
There really isn't much you can do. Patients have autonomy and they'll make their own decisions. You need to document the conversation you had with presented treatment (and choosing nothing is an option), then you need to tell the patient exactly what happens with every choice. Usually with a patient like yours, I'll explain pain, infection, and possibility of death. But it's important to communicate the risks/benefits to any procedure.

ie - decay to pulp (you need RCT/bu/PFM - $$$, but you keep your tooth, or extraction - cheap, but no more tooth, or doing nothing - super cheap, but risk of pain/infection and possible death). But sadly, this conversation does a little better in private practice over dental school.
 
Members don't see this ad :)
A person comes in with severe caries on his 8s and he have read on the internet that it can be healed by itself. He suffers great pain but don't want me to extract the teeth, what should I do?

If he doesn't want them out then the pain isn't great enough. Not much you can do about that. Document the patient's refusal for treatment well. If the teeth have reversible pulpitis you could attempt a filling and see what happens. I haven't met anyone yet who wants to have a RCT done on a third molar but I suppose they're out there.
 
quantify for him the maximum rate that he could remineralize teeth vs advancement of carious lesions. As others have said describe how lesions advance once in dentin and how topical "remineralization" attempts will not help. Teach him the difference between remineralizing enamel vs not being able to replace it once it's lost. Finally, depending on radiographs and symptoms, explain to him that the pulp may be infected and why no degree of good hygiene etc can help that. If you've done a good job of explaining all these things and he refuses then what more could be done? At the end of the day it's his body & his decision.
 
I've been in this same situation many times.

All I do is just acknowledge what they are saying (that remineralization can IN SOME SPECIFIC INSTANCES occur - patients tend to think that it can occur in all clinical situations often, hence the confusion) and then go on to show them either their radiographs of the tooth/teeth in question and/or intra-oral pictures of their tooth/teeth in question and explain why it won't work in their advanced state of decay.

I then explain their options - in the situation you describe where the teeth in question are wisdom teeth, those options would be to leave them as is, IGNORING THE ACTIVE INFECTION present (stressing the words "active infection" usually grabs the attention of any patient) and having their pain persist, or having their wisdom teeth extracted.

If at that point, they still choose to believe that they can remineralize their advanced decay, I will then politely explain to them that my treatment philosophy which is based on both proven science and years of clinical experience and there beliefs are different enough that they won't find themselves comfortable in my practice and give them the names of a few other dentists in the area for them to get other clinical opinions from. I then thank them for coming in and let them know that the door will be open if they choose to come back after seeking opinions elsewhere

There are some patients for whom you will never be able to see eye to eye with, and that's fine
 
Top