When we talk about delivering comprehensive dentistry there are many steps in arriving at a diagnosis. A comprehensive diagnosis not automatically connected to the delivery of extensive or expensive dentistry. We like to begin our initial examination by taking time to try to get to know our client as a person – what are their likes and dislikes?, what kind of life are they living at the moment?, what are their goals in our office?, does our emotional intelligence suggest that we can work well together? Do we feel that there is a good possibility that we can build a relationship of trust and respect? In many cases this will take quite some time but we can usually tell if the “chemistry” is good rather quickly. There is no point in wasting your client’s time or your time if you cannot get along in the long run.
Before we begin our examination process we like to ask two questions. “After our discussion so far, are you comfortable allowing us to thoroughly evaluate your oral health?” If we do not get a yes to this there is no point in going further. If you do get a yes, the manner of the response will tell you something about the person if your emotional intelligence is working. The second question is; “Are you comfortable with me telling the truth as I see it about everything I see”? You may be surprised by some of the answers you get to this question. Many people fear the worst or do not really want to hear about or admit the level of neglect in their oral health. If the client does not want to ‘take ownership of the problem” that is a strong negative red flag in our office. If the client does not own the problem there is nothing we can ”fix” that the client cannot destroy. How often have we heard, “Doc, your filling broke” when the patient arrives with a 10 year old restoration with a broken cusp from chewing ice.
As you can see our diagnosis begins long before we are worried about teeth and gums. We want a 30,000 foot view of the person attached to the teeth, we want to know who referred them and why. Once we have permission and we believe we are the proper office and now is the proper time, we proceed with our exam (See: Back to Basics – What Constitutes a Comprehensive Exam). Once we have the data in hand it is time to diagnose.
You can use our system (See: Back to Basics – Diagnosis), Frank Spear’s system, the Pankey Institute approach or others. Be consistent. Review all the complete stomatognathic system, evaluate all the data, and look at the big picture as well as one tooth at a time. Forget about money, insurance, time or fear. Think about what the data is telling you – from the moment you first met this person until now. You data may be telling you that this case needs multiple disciplines to reach your patient’s goals. However, the family has two kids in college. It is appropriate to discuss the totality of the case with this person but also morally right to discuss how to put the person in a “holding pattern” until the time is right for them to move ahead with comprehensive treatment that they can afford. We owe our clients the very best that we can deliver in our diagnosis. It is up to them to determine the outcomes that are suitable for them at this moment in time. Remember, if you always tell the truth you do not have to waste time trying to remember what you said.