Dental Ethics Boston

I think to be a good doctor, you have to put the patient first. I think you need to be conservative but not overly conservative. I think you have to . . . when you're assessing a patient for dental carries or decay, you need to determine if the patient has a low decay rate or a high decay rate, meaning are the susceptible to decay? Their teeth technically may have a little catch on it that somebody would turn into a live restoration or an inlay when it's a totally unnecessary treatment. Another thing we see a lot that makes me unhappy, is I see a lot of dentists talking patients into ripping out perfectly good amalgams, mercury fillings, when there's no need to. The less time a tooth is traumatized and treated, the better off the tooth is going to be. Generally speaking, an amalgam restoration could probably outlast a bonded, a composite, by 4 times. If they're out of the cosmetic zone, then there's no need to take these restorations out. On the other hand if they're leaking, discoloring the tooth, or preventing cosmetic issues, then that' a good reason to either remove them or crown them, knowing well that that's what the patient wants. We don't use the mantra that mercury is a health hazard and you have to take it all out at once, because once you take the restoration out, you volatilize the mercury, that's more of a hazard than leaving in an inert form that's totally safe. We tend to have a conservative approach with that. We haven't used mercury in over 20 years, but some of those fillings have been in for 20 or 30 years and they're bulletproof. You don't look for maybe a little crack on the edge and say it's marginated, it's got to come out; you assess everybody on an individual basis. Do they come in regularly? How do they take care of their teeth? Do they have low decay rate? Then you make a proper assessment, and then you discuss it with the patient. Sometimes there will be a stick or a little, small cavity on the tooth. If the patient comes in regularly, I'll say to the patient, "If you come in regularly, we watch it. You can do this now or you can wait a little bit, see if it gets worse or you can do it then." I leave the judgment up to the patient. Then I may coach the patient and say, "If it was me, I may want to do that because this could get worse." If I've been following them for 4 or 5 years and it's staying the same, it may be just an anatomical catch because the way the little groove comes down, a little stain in it; it never turns into a decay. The one thing that I abhor that I would never do is unnecessary treatment just for the sake of doing a procedure, or putting an inlay in when a little, teeny composite restoration would do, or doing a crown when a small composite filling would do because there's a crack. You have to sleep at night. That's how I practice.