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Diagnosing surgeon

Dentistry is procedure based. Generally speaking, we do all kinds of procedures to fix problems with the teeth, gums and jaws. That’s what dental school trained us to do. With the exception of some newer “medical model” treatments, most dentists spend their days doing fillings, crowns, root canals, extractions, placing implants, making removable prostheses and doing periodontal therapy. These procedures typically have a starting point and end point (except dentures in dental school…those never really end) that is easily denoted.

That isn’t to say that dentists aren’t diagnosticians. We become expert at recognizing all kinds of pathologies of the teeth, gums, jaws and muscles. In order to treat our patients effectively (usually using procedures at which we become more and more proficient), we need to effectively diagnose their problems and communicate to them what we’ve found and their options to treat (or not treat) as the case dictates. Most dental offices are one stop shopping unless the dentist chooses to refer procedures out to specialists.

Broken armOur colleagues in the medical industry operate differently. In many cases the physician that diagnoses the problem doesn’t actually treat the problem. If I fall off a ladder and break my arm it’s likely that an ER doc is going to assign a differential diagnosis to the problem and order a radiograph that’s read by a radiologist, who diagnoses the fracture. At that point, it’s likely that I would be referred to an orthopedic surgeon to treat the broken arm.

What you don’t see very often in this multidisciplinary track of care is the patient being concerned that there is “overtreatment” going on. For one thing, it’s often very problem based. I wouldn’t have shown up in the ER if my arm wasn’t bent in a funny direction. For another thing, there are several clinicians that are coming to an agreement about the care you’re going to receive. That’s a big difference from what typically happens in dentistry. Not that we don’t refer to specialists, but it’s pretty rare that a patient’s diagnosis and treatment plan is put together with that many brains.

Some patients, especially ones that don’t know you very well, may believe that you are treating problems that they don’t have. A big cavity can remain painless until the pulp is involved. Sometimes even after the tooth is abscessed the patient doesn’t feel pain. Gum disease is almost always painless. Often the patients don’t realize they have a problem even though it’s obvious to you as a clinician. I find this to be one of the less fun parts of being a dentist. I’ve got to be the guy to deliver unexpected news in a way that doesn’t seem like I’m hoping to cover my boat payment. And it’s always a boat payment, right?

Spear Online education posted a video that I found helpful. It’s entitled “Managing Fear When Presenting Findings to Your Patients.” I related to a lot that he discussed. One thing I walked away with is that presenting findings is a lot different than presenting a treatment plan. That may seem obvious to you, but sometimes I get hung up in that. When I’ve got two hygiene checks per hour and I’m doing a bunch of time consuming restorative dentistry at the same time, I often don’t separate the two.

“A treatment plan scares people away.”

Dr. Frank Spear

I need to remember to share the findings of my exam. A few months ago I moved my microscopes from my treatment operatories to my hygiene operatories (I only have two scopes). Each one of the microscopes has an HD camera that’s connected to monitors in the operatory. I do all of my hygiene and new patient exams through the microscope. This has been the greatest tool I’ve ever used to explain conditions to patients without automatically moving to a treatment plan. Also, I get a lot less of the “boat payment” comments now, too. I’m still just beginning with this technique. I think my patients have a much better understanding of their condition than I’ve ever been able to offer. Another pleasant surprise…treatment acceptance is way up!

I just need to remember that my exams are not just a way to create a treatment plan for a patient but a chance to explain the conditions that I’m seeing to the patient. It’s about diagnosis and education. The treatment plan will come from that discussion.

Questions or comments? Please leave them in the comments section below or email me at  If you’re a dental peep you owe it to yourself to listen to my dental podcast. It’s called The DentalHacks Podcast and it’s made with 50% unicorn tears and 50% sweat from Chuck Norris’s brow.D

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  1. Very important advice to keep in mind – I personally believe educating your patients is just as important as treating them for what they have. If they don’t understand what caused the problem in the first place, they may be doomed to repeat it. Thanks for sharing your insight on this!

  2. Hi!

    Thank you for this great article. Every time I visit the dentist I really do believe that they always try to give me more treatment than I really need. I had this believe from day one.
    Online education is available but not always suitable for specific needs (in my case).

    Have a great day!

  3. You wouldn’t think it’d be hard to convince people they have dental problems from where I sit. We get phone calls of people everyday who have already self diagnosed and decided they know exactly what they need! Try explaining to them they are wrong… Fun.

  4. No truer words have been said. This is really a big issue. Most patients often think that we “overdiagnose” them when in truth, they need the treatment. Maybe if we sent them to 3 “specialists”, they wouldn’t be so suspicious, eh? All kidding aside though, thanks for highlighting this issue. The internet itself doesn’t help so much. Everyone thinks they’re “experts”. Anyway, we observed this trend a few years ago and took proactive steps to mitigate it focusing on patient education. And it’s been paying off, seeing as most of them trust us.

  5. Indeed a very good article. I think a lot of dentists who have been in the field for so long often times begin to lose sense of how important it is to educate and connect with patients even if it means just simply listening to their concerns.

  6. I bet it’s not easy to tell a patient they have to spend x amount of money on a filling when their tooth doesn’t even ache. Tough job but grateful for all that dentists do!

  7. “Boat payment”… aaah, why do we get such a bad rap? Dedicating more time to patient education does solve this dilemma, based on my experience as well. This meaningful contact provides the opportunity to develop trust and helps patients feel we have their best interests at heart. Thanks for the great article Alan! Will be checking out the podcast for sure.

  8. As a fellow dentist, I cannot express my joy at seeing this blog. Atleast someone is out there who is talking about what we do and how we do it. This is fantastic and more of us should really follow your example and take to blogging. As a community dentists are growing now and so is dental science. It is unimaginable how far we have come simply pulling out teeth. There are today different branches of dentistry specialising in a certain dental procedure such as implant denstistry or Dental bonding. This brings us close to our peers in the medical industry.

  9. Dentists do have a responsibility to educate their patients. It’s not just about treating conditions – it’s about keeping the patient comfortable. The more they know, the more comfortable they are.

  10. Very informative! Trying to bridge that gap in understanding between a dentist and a patient is no small task. To much of the whats involved is taken for granted by the patient. For best results understanding should be mutual I think.

  11. Thanks for sharing! I’ve let my nieces watch a cartoon together (regarding how to properly brush their teeth and they got very excited to brush their teeth correctly, but only for few days. Is there any brushing game or device that our kids can use to motivate them brush their teeth? I heard from a friend that there will be new product, called Brushie, which will be released this March. Before its launch to the market, she actually worked as a tester for the product. Surprisingly, she found it very engaging and fun! I will surely try out this product but if you guys have other suggestions, I am open to it because our kids are just so crazy about sweets and they don’t even want to brush their teeth. :(