Excellence in dentistry.  I feel like this is an every day pursuit of mine.  At the same time, it is elusive.  Excellence in dentistry comes from many different parts of the whole and is the sum total of those parts.  For example, a patient comes in with a fractured central incisor (‘your front tooth’) and we take the time to get the very best restoration to match the adjacent teeth and function in the bite (chewing).  You might thing that getting a good result brings us to that goal of excellence.  It doesn’t.  Excellent dentistry goes way beyond that final result.  Were the proper records taken prior to treatment? Was the cause of the fracture discussed? Is the gum at the same height as the adjacent central incisor?  Was the patient comfortable throughout the different appointments.  Was the nerve of the tooth tested and are we assured that it is healthy?  Was everything properly explained to the patient and were the patient’s questions fully explained?  If the patients wanted whiter teeth, did we discuss bleaching or whitening the teeth prior to doing the crown?  Did the tooth fracture because of too much pressure from an edge to edge bite, and is Invisalign indicated.

Today we have many tools available to us.  Digital X-rays that reduce radiation by more than 75%.  Invisalign to straighten teeth and improve the bite. Lasers to adjust the gum to the heights that we want or remove inflamed tissue.  Sedation Dentistry to make our patients more comfortable during treatment. Improved materials that provide more natural aesthetics and greater durability.  All these technologies, materials and techniques help us pursue excellence but they also raise the bar to achieving excellence.  Before we had these newer technologies in dentistry, life was easier. Not necessarily better, but certainly easier. A patient had a cavity and the dentist would fill it with a ‘beautiful’ silver/amalgam restoration.  The bigger the better.  I think the only person that liked the way this big gray wad of metal looked was the dentist.  But for the time that silver amalgam was the main material, that wad of metal was all it took to achieve excellence.  Today we have new and improved.  And it really is new and improved.  But getting to excellence today is more challenging.  The criteria for excellence has expanded. Today it is easier to get the gum more even with the adjacent tooth with the laser.  Therefore, if there is a one millimeter difference in gum height and it was not treated, did we achieve excellence given that a laser can help us get there fairly easily?  I think not.  Achieving excellence is dentistry requires the commitment of the dentist and staff to a level of care that is almost unachievable.  ‘Good enough’ just isn’t enough.  Cosmetic dentistry opens us up to many more challenges.  Of course excellence in care was achieved years ago.  The difference is that now there are many more criteria that we look at to truly define what excellence is and when it has been accomplished.

A friend and colleague of mine is an excellent orthodontist.  He doesn’t like to compromise and, in fact, doesn’t compromise.  His treatment plans are always fully developed and cover soup to nuts, A to Z.  I once asked him if he could alter a proposed treatment plan when a patient had asked me to speak with him. When I spoke with him to possibly alter a very complex treatment plan his response was clear.  If he started to compromise, where does it end?  Where is the excellence?  Are we faced with accepting less and calling that excellence?  As Yogi Berra might say, accepting less is accepting less.  If it is something less, then it is not excellence.

It is called ‘the pursuit of excellence’ for a reason.  Pursuing excellence in dentistry means striving towards that elusive goal of perfection.  It is a worthy journey, bringing all the different aspects that dentistry has to offer today so that our patients benefit.

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