Is dentistry fairly straightforward?

[PAthrowaway]

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In medicine, differentials can be confounding. I'm under the impression dentistry is fairly straight forward for the most part. Has this been your experience?

 

[Muggsy Bogues]

Dentistry can be regarded in some capacity as a field of surgical procedures. And regardless of the type or severity of the surgery, surgical procedures are pretty much "see problem, fix problem".

But no dentistry is not entirely straightforward. There is a level of treatment planning that extends beyond the actual procedures. It's not theoretical physics but it can be quite involved and on par with or exceed many medical subspecialties.

 

[Screwtape]

Dentistry is definitely less straightforward than I thought it was going to be before I started dental school. Lots of grey area with treatment plans and when to treat. But overall I'd say dentistry is fairly straightforward and usually the stakes are relatively low compared to the heavy hitting medical specialities.

 

[Soleus715]

The way I see it is that if you present one patient to 100 dentists, you will very likely see many different treatment plans come out as a result. (even without accounting for greed/corporate influence)
There are conservative/risky options for many different dental problems but definitely not as complicated as having to deal with the rest of the body

 

[distressstudent]

There are many viable solutions to the same problem. So in that sense it isn't straight forward at all.

 

[fogorvostan]

I was always told that a patient can go to 10 different dentists and get 11 different treatment options, so in that sense, I would say that it isn't necessarily.

 

[Utdarsenal]

As someone mentioned, it's definitely not as straight-forward as I thought it was going to be. It all depends on the case and how far you're willing to go to provide a solution. This is an example of something that occurred to me in dental school

Patient had mobility on a tooth (#21), with a huge vertical bone defect that reached almost to the apex. This is where the periodontists (two different periodontists) started debating on what the ideal periodontal treatment would be- so, they mostly agreed it'd be an extraction. They could've let it remain there (patient never even realized she had the defect till we told her), they could've done a bone graft and seen if they regained bone level, etc.. but they went with the path they thought would have the best long-term prognosis.

Now, with a missing tooth this is where Prosthodontists come into play - To fill in that missing tooth space there are several options - a bridge (would mean you grind down the two adjacent teeth), a removable partial (grabs on to other teeth to fill in the space), or an implant (which we decided to go with - after further evaluation from the periodontists).

The bridge would've been done quickly and we'd be saying goodbye to the patient in an extremely short amount of time- but decided to go with an implant which would take over half a year to finally be able to restore.. the treatment ended up becoming an autogenous bone graft from the anterior mandible (we got the maxillofacial surgeons involved now)....

Anyways to sum it up, the bone graft failed, the patient was tired of going back for so many appointments, and is still currently toothless in that spot.

Things can definitely not go according to plan.

 

[SansaStarkMD]

Worst case... abscess, infection, and death. Don't think this ever happens in 2016. Worst case... pull tooth?

 

[PAthrowaway]

As someone mentioned, it's definitely not as straight-forward as I thought it was going to be. It all depends on the case and how far you're willing to go to provide a solution. This is an example of something that occurred to me in dental school

Patient had mobility on a tooth (#21), with a huge vertical bone defect that reached almost to the apex. This is where the periodontists (two different periodontists) started debating on what the ideal periodontal treatment would be- so, they mostly agreed it'd be an extraction. They could've let it remain there (patient never even realized she had the defect till we told her), they could've done a bone graft and seen if they regained bone level, etc.. but they went with the path they thought would have the best long-term prognosis.

Now, with a missing tooth this is where Prosthodontists come into play - To fill in that missing tooth space there are several options - a bridge (would mean you grind down the two adjacent teeth), a removable partial (grabs on to other teeth to fill in the space), or an implant (which we decided to go with - after further evaluation from the periodontists).

The bridge would've been done quickly and we'd be saying goodbye to the patient in an extremely short amount of time- but decided to go with an implant which would take over half a year to finally be able to restore.. the treatment ended up becoming an autogenous bone graft from the anterior mandible (we got the maxillofacial surgeons involved now)....

Anyways to sum it up, the bone graft failed, the patient was tired of going back for so many appointments, and is still currently toothless in that spot.

Things can definitely not go according to plan.

Interesting case. But for a general practitioner dentist, once they found out this person had a vertical bone defect would they just refer the patient to a specialist (periodontist)?

 

[Screwtape]

Interesting case. But for a general practitioner dentist, once they found out this person had a vertical bone defect would they just refer the patient to a specialist (periodontist)?

Depends on the general practitioner. I bet most, including myself would extract, bone graft immediately post-exo, then place implant a few months later dependent on healing, then restore at some point. Unless pt was a smoker. Then extract and bridge. RPD last choice, I'd rather do nothing if single tooth and removable only option. But many routes this could go, all dealt with effectively by a well trained GP. Of course I don't know the whole situation but based off of limited facts this is my take.