When is ideal care inappropriate?

By David Rice, DDS, DrBicuspid.com clinical editor

January 15, 2020 -- Yes, I did just ask that. And yes, I know, you're either cheering because you've thought it and needed someone to say it, or you're steaming mad and wondering why in the world yours truly is the clinical director of DrBicuspid.com.

Either way, with 25 years of patient experiences behind me, I truly believe this is one of the more important clinical questions we can ask ourselves.

Please don't misunderstand me. I get ideal.

In fact, most days, I am all in on ideal. Phased or not, I love complete dental care, and I believe our patients deserve it. Also know this: I rarely factor patient finances into this equation. In today's dental practice, more than ever, we have ways of overcoming financial obstacles for most people.

So when should we switch gears?

Age extremes

David Rice, DDS
David Rice, DDS.

There are occasions when we have a patient in our chair who is just too young or too old for ideal.

On the young side, maybe we have a 15-year-old who just had root canal therapy on a posterior tooth that we would normally crown. Ideal is some type of core buildup with some type of full cuspal coverage.

On the old side, maybe we have a 98-year-old who just fractured the mesiobuccal cusp of an upper molar. Ideal is some type of indirect restoration depending on how much of the remaining tooth is actually tooth.

Health extremes

Self-explanatory in nature, there are seasons of life. Our goal is simply to buy time. When a patient has an upcoming surgery, yet has an urgent need. When a patient is terminal, doesn't have an issue that can blow up, yet does have a prosthetic need we can take a pass on.

Heroic extremes

Picture the patient who has big-time rampant decay and big-time periodontal disease. Add to that little interest in changing his or her ways and financial limitations. I told you I never say never. An idea might be to quadrant scale and root plane, manage decay, reassess, further treat, reassess, and prosthodontics.

Appropriate defined

Appropriate is pressing life's pause button. It's stepping back and asking, "If this were me, knowing everything that I know, what options would I want?"

If I'm 98 years old and fracture the terminal abutment to an existing RPD, would I want endo, post/core, and crown? Would I want to extract and be dentally crippled?

Or is there a compromise? Is there a compromise that, because of my personal situation, makes more sense than delivering ideal?

I'm not asking you to give up on ideal dentistry. I'm not asking you to deem someone too old or too sick or too far gone. I'm simply asking you this: When is ideal care not the best care we can deliver?

Hear some more of my thoughts below.




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