Good day, Dr Burnett.
This is actually more of a thank You than a question.
Having transitioned to private practice the past 5months,I have advised at least 3 of my patients to remineralise areas especially associated with interproximal areas on premolars.I especially do this, because I have had personal experience using this method in 2009.
This week, however, a situation challenged me where I needed to explain to someone to weigh up drilling over arresting enamel caries, because they could not understand why I didn't want to drill.
In the end, I am glad I stuck by what I thought was right, eventhough, I must confess, reading stories recently about malpractice cases, have made me feel a bit insecure on this occasion :).
I'm not a naturally dynamic person, so everyday I pray for strength and wisdom.
Thank You for sharing Your knowledge and allowing me to learn as well.
All the best to You and Your extended team.
I'm sorry about the delay in getting my reply out.
First of all I want to congratulate you for offering the best dentistry to your patients. I'm really glad to hear from you.
You are correct in thinking you should protect yourself from legal repercussions. Especially so because there are some dentists who won't even understand what you are doing and might accuse you of leaving decay after treatment.
I am enclosing the following patient education device that should serve the purpose of educating your patients while also providing you with legal protection. You are welcome to copy, modify if you wish, and use it to supply that most important service, which is informed consent.
INFORMED CONSENT DISCUSSION FOR MONITORING DENTAL DECAY
Patient name:_______________________________ Diagnosis:_________________________________ Facts for consideration:
Initials ______ Typically, in adult teeth, decay progresses slowly often taking 6-8 years to penetrate the outer layer of enamel. Very often the decay will stop and a filling is not needed. However, about 15% of the population do develop many decayed teeth that may progress rapidly. ______ Filling teeth without ensuring that a person receives adequate fluoride, cleans the bacterial plaque off teeth, and avoids sugar between meals, will not prevent new decay from forming. Thus, the best course of action is to reduce those things that lead to decay and avoid fillings if possible. ______ Fillings have been shown to be of limited duration and lead to a repair/destruction cycle that can lead to tooth extraction. ______ It may be necessary to confirm that decay is no longer active and does not require a filling with a return monitoring visit. A monitoring visit may include bitewing x-rays, oral hygiene instruction, topical fluoride and/or chlorhexidine together with bacterial cultures. For some people it will be necessary to reduce the decay infection by rinsing with chlorhexidine. Benefits of Monitoring Decay Progression Include, But Are Not Limited to the Following: ______ Avoid a filling with associated risks which may include the discomfort of anesthetic shots and cost of the procedure. Other possible complications of fillings are short-term pain to hot and cold foods, tenderness to biting on a tooth or even toothache. The longer-term complications are replacement of fillings due to recurrent decay or staining or defective margins, fractured cusps leading to larger fillings or crowns, and root canal therapy. Large fillings also increase the risk of teeth splitting, leading to extraction. Risks of Monitoring Decay Progression Include, But Are Not Limited to the Following: ______ There are no known risks to monitoring the progress of dental decay if you return for evaluation within the time period specified by your dentist. There are risks associated with not following the planned monitoring schedule if it should become necessary to have a filling. Consequences of No Treatment Include, But Are Not Limited to the Following: ______ Lack of treatment, due to not following the planned monitoring schedule, could result in the decay progressing to a point which would require a larger filling to treat the tooth, possibly crowns, toothache, root canal treatment or tooth loss. Patient Declaration: I have read the above information and agree to have decay monitored in tooth/teeth # ______________________________ Signed __________________________________________ Date ______________
I hope this will be useful to you and your patients. You should be able to improve the formatting to make it easier and more effective.
Larry Burnett DDS