Recently, a patient was told by another dentist that she would have to have a tooth extracted because he saw a number of problems with the tooth. He wasn’t wrong. And he wasn’t right, either. The ‘standard of care’ for this tooth could of been argued that this tooth was very compromised and needed to be extracted. On the other hand, can we exceed the standard of care? Go beyond the average? Why not?
This patient asked me if the tooth could be saved. My response was this: This tooth requires the following procedures. 1) Removal of decay 2) Soft tissue repositioning 3) A new core (the tooth had a root canal previously) and 4) a bonded porcelain crown.
So I started to think of all the many steps in takes to do the above and how they are done. Let me list them here from start to finish:
1. A full medical and dental evaluation
2. The taking of a digital xray, specifically of this tooth
3) Discussion of the options available. Should we save this tooth or have it extracted?
4) Decision to save the tooth. Appointment to begin work. Is there a need for sedation?
5) Sedation appointment. Patient had taken medication the night before.
6) Additional medication given at the time of appointment.
7) We begin our work on this tooth and the surrounding gum.
9) Impressions, photos and bite registrations sent to laboratory.
9) Patient dismissed after a two hour appointment.
10 Patient returns and has porcelain crown bonded into position.
The cost to this patient was $2,500. So we ask ourselves, what is a tooth worth? Our teeth should outlive us and we are living longer. If we have a tooth extracted, it needs to be replaced. Replacing a tooth that has been extracted is always more costly than saving the tooth, whether the replacement restoration is a single implant or a bridge.
In today’s environment, we have many more opportunities to save a tooth with the greater access to new technologies. These new technologies do add to the cost of care, yet they also allow us to do work that were previously unavailable. The goal is to save our teeth because the alternatives are far less desirable.
What part of the above would we eliminate to control costs? If it is my mouth, none. If it is your mouth, you decide. Compromising increases the risk of losing the tooth. My view is simply this, do it well, without compromise, or do not do it at all.
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