Watch it vs. Treat it.
Let's talk about the difference between being conservative with treatment and being disregardful. It is important that we distinguish between actively tracking a problem with a set end-point (conservatively treating once a specific threshold has been reached) vs. arbitrarily looking at a tooth and not treating it because it is "not big enough yet". The first description matches that of the modern prudent dentist, whom has a clear idea of when the treatment should begin, based primarily on objective findings (e.g. cavity depth shown on X-ray or visible findings) mitigated only by risk levels determined by etiological factors (e.g. home care - brushing/flossing, sugar intake frequency). The problem with the ill-defined "not big enough yet" dentist is the lack of parameters to determine when treatment will begin. Those parameters should be put in place and understood mutually by dentist and patient to prevent catastrophic tooth breakdown and/or infection and/or worsening of the condition (particularly in the case of periodontal disease).
Let's address periodontal disease for a moment. Historically, general dental practices have had a difficult time explaining this disease (severe gum disease) because of the complexity of the disease and the problem that it develops very gradually. If this is a new patient, it is part of our comprehensive assessment to determine the risk levels for 1. periodontal (gum) health 2. caries (cavities) risk 3. bruxism functional (grinding) risk 4. cosmetic assessment. Every exam includes a head and neck cancer screening. When an existing patient has a cleaning we check those probing depths at least once a year to reevaluate their depth. When a patient begins having 5 or 6mm pockets in an area, we don't just watch it. We address it while it is still manageable. Thirty years ago, these patients might have had to wait until they had several sites of 6mm with bleeding and pus to receive any treatment at which time they would be referred to the periodontist for gum surgery. Now, we scale those areas under local anesthetic, and we have been having incredible success with localized laser treatment to these areas, which heals quickly and eliminates the ulcerated and infected pockets.
So, whether it is watching a cavity grow bigger or gum pockets get deeper or TMJD become more severe or teeth shift further out of alignment, there are interventions that are frequently cheaper, less painful, and more effective when the problems are treated while the problems are still small. I tell my staff if we are going to watch something we must have a specific criteria that determines when we will move on and recommend treatment. Otherwise, "watch it..." really means “WATCH IT GET WORSE".
We have a little saying that "watch it" is not a complete sentence. The full sentence is "watch[ing] it get worse".
Please note: there are cavities that are so small that they can be remineralized with a high fluoride toothpaste. Likewise, patients can stabilize and learn to maintain a 5mm pocket. Some clicking of the TMJ is harmless and (if painless) is still only a low risk factor.
The point of this entry is not to say that every tiny thing must have some immediate treatment, but rather to say that treatment often offers the best hope of minimally-invasive, successful, comfortable care. Furthermore, this blog entry is suggesting that it is in a patient's best interest to know if we are "watching a spot," when will we know it's time to decide to treat. Not treating small cavities and early periodontal disease is not always the most conservative form of treatment, since more advanced stages of these diseases often require more advanced forms of therapy.
Let's talk about the difference between being conservative with treatment and being disregardful. It is important that we distinguish between actively tracking a problem with a set end-point (conservatively treating once a specific threshold has been reached) vs. arbitrarily looking at a tooth and not treating it because it is "not big enough yet". The first description matches that of the modern prudent dentist, whom has a clear idea of when the treatment should begin, based primarily on objective findings (e.g. cavity depth shown on X-ray or visible findings) mitigated only by risk levels determined by etiological factors (e.g. home care - brushing/flossing, sugar intake frequency). The problem with the ill-defined "not big enough yet" dentist is the lack of parameters to determine when treatment will begin. Those parameters should be put in place and understood mutually by dentist and patient to prevent catastrophic tooth breakdown and/or infection and/or worsening of the condition (particularly in the case of periodontal disease).
Let's address periodontal disease for a moment. Historically, general dental practices have had a difficult time explaining this disease (severe gum disease) because of the complexity of the disease and the problem that it develops very gradually. If this is a new patient, it is part of our comprehensive assessment to determine the risk levels for 1. periodontal (gum) health 2. caries (cavities) risk 3. bruxism functional (grinding) risk 4. cosmetic assessment. Every exam includes a head and neck cancer screening. When an existing patient has a cleaning we check those probing depths at least once a year to reevaluate their depth. When a patient begins having 5 or 6mm pockets in an area, we don't just watch it. We address it while it is still manageable. Thirty years ago, these patients might have had to wait until they had several sites of 6mm with bleeding and pus to receive any treatment at which time they would be referred to the periodontist for gum surgery. Now, we scale those areas under local anesthetic, and we have been having incredible success with localized laser treatment to these areas, which heals quickly and eliminates the ulcerated and infected pockets.
So, whether it is watching a cavity grow bigger or gum pockets get deeper or TMJD become more severe or teeth shift further out of alignment, there are interventions that are frequently cheaper, less painful, and more effective when the problems are treated while the problems are still small. I tell my staff if we are going to watch something we must have a specific criteria that determines when we will move on and recommend treatment. Otherwise, "watch it..." really means “WATCH IT GET WORSE".
We have a little saying that "watch it" is not a complete sentence. The full sentence is "watch[ing] it get worse".
Please note: there are cavities that are so small that they can be remineralized with a high fluoride toothpaste. Likewise, patients can stabilize and learn to maintain a 5mm pocket. Some clicking of the TMJ is harmless and (if painless) is still only a low risk factor.
The point of this entry is not to say that every tiny thing must have some immediate treatment, but rather to say that treatment often offers the best hope of minimally-invasive, successful, comfortable care. Furthermore, this blog entry is suggesting that it is in a patient's best interest to know if we are "watching a spot," when will we know it's time to decide to treat. Not treating small cavities and early periodontal disease is not always the most conservative form of treatment, since more advanced stages of these diseases often require more advanced forms of therapy.
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