Again and again, I see, read and hear treatment discussions between dentists. Some study models-perhaps some photos or x-rays are shared at a study club, online or at the end of a course.
- “What do you think we should do?”
- “Do you think ortho would help this be ideal??”
- “Should I refer the patient to a _________ (name the specialist)?”
This goes on for a while. The models are held together and scrupulously examined.
- “We need to mount the case…”
- “We need to get a wax up.”
- “What is the patients diet like? Do they floss a lot? They probably dont…”
This goes on & on. The models are passed, exchanged…re-examined. At some point I would hope that it gets asked-or I might interject-“What does the patient want? What are their goals?”
We may be met with blank stares or “What do you mean?”
Well they dont want__________. You can fill in the blank. Braces, surgery, to spend a lot of money. The patient is turning down or placing barriers to a ˜dental destination that has not even been clarified. The dentists begin looking at procedures and processes when they are not even sure what the end point is The patient may not even be aware of what is possible. Without goals, the dentists do not know how to proceed. It becomes somewhat the blind leading the blind. Everyone gets frustrated.
When treatment planning begins without an outcome or goal in mind, it becomes inefficient at best. It can be a lot closer to blind guesswork. It does not need to be though. Looking at what can sometimes be a daunting or intimidating clinical presentation, we need introduce some ˜knows, some goals. This begins by trying to better understand the patient and also by helping the patient understand and realize what is possible.
Shared by Dr. Frank Spear, these can be organized into 4 basic groups: Esthetics, Function, Structure & Biology. I would also add pain & budget. Pain almost always comes first as an emergent treatment. Budget can show up at many different times during the process. Certainly always at the end, but budget can also be a guiding factor early on in case planning. Without a goal or outcome, a budget can also just be a price tag that is attached to nothing but a monetary amount without consideration of what it means to the patient.
Esthetics: Are looks important to the patient? In which way? Color? Shape? Display? Gum tissue? Arrangement/straight./crooked/canted? Or-maybe they dont care about looks at all. Lets move on to the next area then.
Function: Now dont go dental! Ask about their expectations of what they expect to eat. My favorite examples are always corn on the cob & steak. They are taxing meals. A patient on a ˜limited budget may want dentures but are they aware of the limitations? Will their functional goals dictate either saving teeth or bringing in implants? Slowly, the processes begin to present themselves as more obvious options, driven by the purpose.
Structure: Are things broken? Are they going to break? That seems obvious-but also structure can be looked at as the foundation upon which the esthetics and function can be built. That may include bone or tissue grafting. It may include implants. It may be teeth upon which the chewing or smiling goals are accomplished. Again-driven by the patient goals-the purpose that we clarify together
Biology: That is the disease stuff. The stuff we always talk about The place we always start treatment planning from. While I am not saying dont address disease, I am suggesting to not let it monopolize your focus too early in treatment or case planning. Believe it or not, when you have goals that we examined above, the biology/disease will largely take care of itself as a process of the treatment plan to help us achieve the purposes or goals of the treatment plan. If not, we can always treatment plan to address disease.
The days of treating for textbooks or podium perfection is passing. But please dont get me wrong-it is not that we cannot and will not still achieve those levels of care. A time has come for that care & outcome to be driven by the patient and their goals-their purpose. We are here to be facilitators in explaining what is possible, the benefits & considerations of care and the process with which patient can achieve it. This can be best summed up in a phrase a friend and mentor, Dr. Gary DeWood shared with me “Based on your goals, as i understand them, what I would recommend is….”
A clarifying perspective is that the purpose IS the treatment plan. The technical steps, the referrals, the crowns, the implants, the wax ups, the diagnostics…the process simply becomes a way to help us achieve it.
I hope that that helps you as much as it did me in my own treatment planning journey. I hope for you that this is where possible begins.
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