Wednesday, 6 August 2014

THE DILEMMAS IN EVERYDAY DENTISTRY- For the dentist and Patient.

Here, we discuss about commonly asked doubts/questions asked by patients while undergoing or considering dental treatments and also few common problems we encounter while performing   routine dental treatments. This is a sincere attempt to clear a few misconceptions.

Q- From the patient who feels cheated-                                                                                                                                    I went to the dentist because I had sensitivity in my tooth. They did a filling then I started having pain, then I went to another dentist who said that they have infected the nerve and I had to do a root canal treatment, the first dentist has cheated me.
A. When a patient comes to a dentist with cavity and sensitivity, the dentist hopes to be able to fill the cavity without the need for a root canal. Because most of the times even if the cavity is very deep the patient has only sensitivity, not pain.  
                                                                                                                                                                     To understand how a cavity affects the tooth, we need to have a basic understanding of its anatomy. A tooth is composed of several layers. Outermost layer is called the enamel.  Under the enamel is the dentin. Unlike the enamel, dentin contains nerve endings. Beneath the dentin is a vascular tissue called the dental pulp/nerve .When the cavity is in dentin the patient starts feeling sensitivity. When we start doing a filling, we actually drill out the decayed tooth material in enamel or dentin.  Unfortunately, a deep cavity in dentin increases the likelihood that the tooth will require a root canal .A lot of times patients force the doctor to do a permanent filling even if the doctor feels that the cavity is deep in dentin very close to nerve. The patient may be simply afraid of the procedure.  Here's the problem. If a deep cavity is filled, and there is no visible evidence that the pulp has been infected, the tooth might still need a root canal days, weeks, months, or even years later. The possible reason why this can happen is-The   bacteria may have entered the pulp/nerve via microscopic openings in the dentin surrounding it even before or during the procedure. This puts the dentist in a "catch-22" situation. If the dentist leaves the deep cavity alone, the tooth will definitely need a root canal when the cavity eventually reaches the pulp/nerve. If the dentist fills the cavity, the tooth may start giving pain either immediately or at a later point in the future. It is still better to fill the tooth, because there is also a good chance that the tooth will never need root canal or any other treatment. So we do take a chance and do a filling and inform the patient that if the tooth develops pain afterwards we need to look at RCT. Sometimes the filling works and sometimes it does not work.                                                                                                                                                                       In our practice also we have come across such situations .Now we have started to follow the STANDARD PROTOCOL described here to prevent any misunderstanding that can happen if the patient develops pain after a filling- In case of a cavity which we start out as a filling but realize that it is deeper and we feel that RCT is needed-Instead of taking a chance with a permanent filling we do only a temporary filling. And the patient is always free to take a second opinion regarding this.                                                                                                                                                                                                                                                                                                     Q- From the NRI Patient-I am a NRI from HongKong, U.K/U.S.A, I earn in dollars. If I come to you will you be charging more if I give my address as HK/U.S.A.?
No. For us you are a just a dental patient. The cost depends on the treatment required, not on your nationality. If you do not trust the doctors here, you have a choice. Unfortunately some NRIs (Not all, just some -with our due respect ) are stuck in a time wrap. They feel that they are entitled to get the best of the services at the lowest cost .And when the reality is different they accuse everyone of charging 3-4 times more only because they come from other countries. They fail to realize that India as a country has moved on to offer high quality services and Indians in general appreciate world class services. Good quality materials and equipment are mostly imported in dental field .They are expensive and we don't get to crib about their costs as the manufactures don't care about it.If you can not appreciate that fact that quality services don't come very cheap, you have a choice of not seeking treatment here.

Q-   Dr A charges only x amount for a fillings /RCT/crown. Why is it that Dr B charges more?
Dental treatments are not products sold in dental clinics.They are services offered by dentists.Private Dental clinics/dentists in India are completely self-regulated. They do not have any uniform regulations for the infrastructure .They do not abide by any standard specifications for the equipment/materials used during the treatment procedures. There is no authority monitoring the sterilization process or quality of materials used in any dental clinic. So if Dr A has spent very less on infrastructure, sterilization equipment and using cheaper materials then he can offer treatment at x amount. Someone who is spending more on equipment, using good quality materials and skilled staff will charge more. To give an example the  local dental x-ray machines cost about Rs 30000-40000 but they are known to emit residual radiation which is very dangerous to the patient . If you have to use a safer x-ray machine it will cost about 4-5 times more as compared to the local one.Same goes with lot of other materials.In effect safer and good quality dentistry will cost you more.
Also, Doctors who prefer to deliver hi- quality care to a limited number of patients in a day charge more than doctors who dilute the quality of care by taking in more people.Here we offer personalized treatments to a limited number of patients in a day.We are not into mass practice of dentistry. 
Q-Can you give me a cost estimate on the phone for my procedure?
A lot of times what the patient explains on the phone is completely opposite to what the doctor finds in the mouth during a clinical examination. It is better to arrive at a cost estimate after a thorough clinical examination and x-rays if required. Dental procedures require good expertise and state of the art setup. It is impossible for us to give the cost when clients ask for charges of dental procedures over the phone without bothering to check out the materials we use, the results we deliver. Hence it is always better to visit the clinic, consult the doctor and then commit to the treatment rather than shopping for the price.

Q- From Dentally Damaged-If I come with a single tooth infection will you treat my other teeth and ask me to pay for all these?
No. When a patient comes to us with a problem, we are merely giving an opinion based on clinical examination and diagnostic aids. The patient is absolutely under no obligation to start the treatment and pay us. In fact if the patient wants a second opinion he/she is free to go for it. In case the second doctor has a different opinion he is free to share it with us just with a phone call.                                                                                                                 As for the commencement of treatment with us is concerned,  typically this is the standard procedure that is followed.                                                                                                                              –--After arriving at a  detailed treatment plan a cost estimate is prepared. One copy of cost estimate will be given to the patient and the patient has to sign the second copy which will be kept in our records. So, Commencement of treatment is totally based on mutual consent of the procedures and cost.
A procedure like RCT  will require 3 stages of treatment.  Sometimes the patients come to us with severe pain or acute symptoms.It is more important for us to take care of the pain/problem rather than wasting time with standard protocol. In such a situation we may start the procedure first to offer relief to the patient and explain the procedure later. Unfortunately we live in a world where trust is the first causality in a doctor patient relationship.We strive hard to keep our relationship transparent with our patients.                                                                                -We advise any treatment be it extraction of wisdom tooth or RCT based on our diagnosis and clinical evidence.We are purely following science.The patient has the right to accept or reject it.If the patient does not understand why a particular treatment is advised, he/she can ask us for reasons.We are ready to explain the reasons for advising the treatment. The patients are free to take a second opinion regarding it.But if any other doctor disputes our diagnosis or treatment plan we are ready to have a debate/discussion about it with the doctor.It is required of our profession ethics.But if any other doctor/patient is suggesting/thinking that we have advised a particular treatment only because we want to make money from the patient even without discussing the reason for the treatment with us, it is wrong.We are sincere in our efforts to offer solutions for the problems of patients.Being open to any discussion keeps it transparent.                                                                                                                             About Post Treatment Problems and post-operative care
Q-What happens if I encounter problems during or after the treatment? What should I do?
All the patients undergoing treatment are given detailed instructions to be followed during the treatment .They are also explained about the possible problems that can occur. You will be attended to at the earliest if there is anything that needs attention. We advise the patients to follow up at least twice a year for post treatment recall and routine check up. If anybody has issues with any treatment taken they can meet us here. Ph- +91-0 98450 85230 ,080 266673439                                                                                                                                                                                                                                                               Q- How do you Identify your patients when they come back to you?                                     Every patient who comes here is registered and given a unique number.We always maintain digital and manual records of all the patients and the treatment we have done here.The patient needs to bring the reference number , we will be able to access all the treatment records.                                                                                                                    Q- Are there any guarantees on any treatment ? NO. While there can be warranty on products manufactured but not on any treatments. Some crowns do carry manufacturer warranty,but there can not be  any guarantee on any medical treatment. We put our sincere effort into every treatment  but the outcome and longevity depend on many factors including general medical health,hormonal status and  good maintenance from the patient. We can give a fair prognosis of said tooth depending on  our experience.Only quacks offer guaranty on medical treatments. Dentistry is not an exact science , therefore practitioners can not guarantee results.  

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