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Letters: Patient-centered diagnosis

December 09, 2013

I read Dr. Jeffrey Camm's editorial, "Creative Diagnosis" (Oct. 21 ADA News) with mixed feelings.

In my 30 years of practicing general dentistry I have also seen many examples of what I would consider overtreatment. But I always need to caution myself that we each have different education backgrounds and different experiences. I have always said if you have 10 dentists in a room and you ask them for a diagnosis, you will get 10 different answers—and they will all be right.

I consider myself very conservative when prescribing treatment. But sometimes that has backfired on me. Most notably, I do not routinely do a full series of X-rays on a patient until they are in their mid-20s. That included my son. Unfortunately when we finally did the full series we discovered untreatable internal resorption on No. 7. The tooth will require extraction and an implant in an otherwise perfect mouth.

Also I need to comment that until I got digital X-rays and wore high power magnification I was overlooking a lot of pathology. My hygienist, who also wears telescopes, and I often joke that we are putting ourselves out of business. We are treating small decay before it gets large enough to cause real damage (and therefore more expensive treatment). I still take into consideration the patient's hygiene and overall health before deciding on treatment but if a dentist without that technology looked at some of what I call decay, I am sure they could question my motives.

I also treat 5 and 6mm periodontal pockets with scaling and root planing and Arestin therapy. Some would argue that these pockets do not require treatment but I have discovered that with this very conservative treatment, good oral hygiene and frequent recare appointments, more extensive periodontal therapy can be avoided.

I do agree with Dr. Camm that there is much decay in primary teeth that I do not think should be treated. Several things need to be considered including how long the tooth will be in the mouth, the cooperation of the child, the hygiene, the diet, etc. Obviously we don't want the child to be in pain and we don't want him/her to lose the tooth too soon. But each dentist needs to make that professional judgment themselves based on their own experience and the patient sitting in his/her chair.

The examples Dr. Camm gave were extreme but I doubt this happens very often. Yes, some of our colleagues base their treatment on their own bottom line, but most of us are doing what we believe is best for our patients.

Kim S. Haskell, D.D.S.
Upper Marlboro, Md.