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Letters: 'Being flexible'

January 16, 2020

I am writing in response to the My View in the Dec. 10, 2019, ADA News, “Only You Are You,” by Dr. Stuart L. Segelnick. I agree with his concerns, but I would like to offer a reasonable treatment that might satisfy the patient without doing useless or expensive treatment. Too often, we are not willing to adjust our thinking and work out a reasonable compromise for our patients. It has been my experience during my 40-year career that being flexible while maintaining the dictum “do no harm” gives the patient a feeling of empowerment and confidence.

I have encountered a number of patients who insist on keeping hopeless lower, or sometimes upper front teeth. These teeth often have class 3 mobility with virtually no bone remaining. I have found that lingual splinting of the teeth from cuspid to cuspid with GlassSpan or similar products often gives years of function with minimal cost. While I never promise the longevity of the treatment, I have never had a patient who was dissatisfied. In addition, the fact that I am addressing their demands gives them confidence that I am listening to them.  

Of course, we scale and root plane the teeth before splinting but do no surgery.  There are times when a tooth is so loose or is infected that I have extracted it, shortened and sealed the root and “hung” it back on the splint. Often, these splints last five to 10 years and longer. While they may need some maintenance and repair along the way, patients are more than satisfied. If it comes to the point that extractions are required, the patient has established a relationship with me and is more understanding of the options going forward.

Again, I appreciate his larger point that educating patients in light of internet misinformation is often a hopeless task but applying innovative approaches to some of their demands has its place as well.

Henry Pinkney, D.D.S.
Farmington Hills, Michigan