Diagnosis, consultation and treatment planning in Dentistry

Today I observed a consultation from start to finish. The consultation was with a woman who, as a child, had a maxillary lateral incisor extracted and ultimately the orthodontist moved all the posterior teeth forward in order to close the space. At the time she was told that putting in an implant would be too complicated and so the patient just underwent the treatment without the implant. 8 years later she presents to this office unhappy with her smile and the positioning of her teeth. She said that her teeth were pushed too far back and that when she smiled her teeth didn’t look nice to her. She found out about Dr. Dorfman’s practice online and she was presented with a diagnosis and a few different treatment options.

Since she had the teeth moved in and forward to fill the space of the laterals, the maxilla was constricted. In order to compensate for this, her mandibular teeth shifted inwards and therefore looked like they were pushed in. She has less than 1 mm of an over-jet. She was told that doing veneers would be a good option to cosmetically move her smile outwards but they would be unable to fix the over-jet. The patient was concerned because one of her friends had veneers done and she wasn’t happy with the result. The next option for this patient was to have braces and undergo orthodontic treatment for 2 years to re-open the space and then to have an implant placed to restore #7. The patient had ortho once and was not at all thrilled about this option. She then asked if she could have a surgery. This was also an option for her and a consult would of course be necessary with the oral surgeon. The patient also asked about invisalign. She was informed that in her case invisalign could be used to fix the maxillary teeth but fixing the mandibular teeth with invisalign is more difficult because of the nature of the bone and the inclination of the teeth. The patient seemed to want a quick fix in order to improve her smile. She will bring her x-rays for an additional consult.  

A very important thing I learned earlier in the day was a way to communicate with the patient about dental terminology in “English.” It is difficult to explain conditions and procedures to the patient using dental terms such as pulp, dentin, amalgam, tubules, etc. When explaining to the patient that an amalgam restoration could conduct heat and cold and cause sensitivity to a tooth in the absence of a liner, especially in deep fillings, it was surprising how easily I forgot that the patient had no idea what all of these terms meant. It is our job to educate them. The correct way to explain all of this is to say, “Metal fillings conduct heat and cold, so in order to protect the tooth you need to put something between the tooth and the filling that doesn’t conduct; and this is what a liner does.” It seemed so simple once it was explained but I didn’t realize how confusing it can be for the patient to try to understand all of this without a background in dentistry.

H.A., New York University College of Dentistry, Patient 5

Categorised in: Dental Student Experiences

This post was written by Interns