I have been baffled for some time how angry people can get about treatment planning.
The amount of emotion that can get involved, for a body part that many people live just as long lives without, seems mildly disproportionate.
Large forums give us the unique ability to see how hundreds of different eyes see something and not surprisingly, the same presentation can be seen very differently by different dentists.
What I've come to understand is that treatment planning is not a cold scientific thing backed by evidence based studies (although it frequently is claimed to be).
In general, every dentist has foundational values through which they view treatment planning.
I should be at pains to point out that this is not bad. Or good. It just is. To some extent, different dentists with different values are very important as each patient also has a set of values and dentists and patients only work well together if they are similar.
Since these values are not really scientific, they resemble the way political values are discussed. With escalating emotion as our values become more extreme.
Like young people everywhere, we often graduate dental school what you might call slightly to the left of centre.
The dental lefty
Is what I call the dental communist. They worship the proletariat tooth, the common tooth. The humble worker tooth should be left untouched. Not being made to be better than other teeth through any sort of intervention. The end goal of treatment is minimal intervention above all else.
The dental righty
Is what I call the dental fascist. They worship the creation of a master tooth. Strong intervention is necessary to make a perfect set of teeth, that is better than other teeth. The end goal of treatment is a text book set of teeth regardless of the patient wishes or consequences.
Like any political spectrum, as the left and right get more and more extreme, they start to look more and more similar and enter the realm of totalitarian dentistry, in which both groups are identical in outlook, but diametrically opposed in treatment.
The Totalitarian dentist
is characterised by having such a strong viewpoint that they really only think one single treatment plan is suitable. After much argument about all the options, they end up doing the same treatment on every patient. There is no variation to suit individual patients, circumstances, budgets, values, time frames, disease risk.
An example of each end of the extreme spectrum would be someone that either does every treatment with composite or alternatively, turns everything into a full mouth ceramic rehab.
The totalitarian dentist also tends to spend a lot of time telling other people that there treatment is very wrong in the strongest possible terms without regard for the country, training, population, experience and so on of the dentist and patient concerned.
I graduated as a lefty knowing dentist intervention caused most dental problems. I did some courses the made me swing the other way. And then I have oscillated backwards and forwards as my career went on, trying to stick more to the centre where possible.
So what does all this mean?
It means that you are as likely to have a reasonable discussion with someone who strongly criticises your treatment planning as you are having a good discussion about politics on facebook with someone that disagrees with you.
What are your thoughts?
