Informed consent in dentistry

THE most important service you can do for yourself as a dental patient is to be informed. Be aware of what your dentist is proposing for your treatment. Let us assume that he has told you that you need one ‘simple’ cavity filled. Which tooth is it? How can you prevent any similar cavities from forming? What type of filling is needed? How much will it cost? Ask plenty of questions if you are uncertain of what is going on, or what is about to happen to you. It is your tooth and your mouth, and you have every right to know what is going to happen!

Informed consent is a very important aspect of dental care today. Patient education about necessary treatment alternatives, or the ramifications of no treatment, should be accomplished at the diagnostic appointment (such as when you go for your routine tooth cleaning and checkup). Economics do sometimes dictate which option you must elect. For example, you might decide on amalgam (silver filling) rather than gold only. The amalgam may not be the best choice, but it will save the tooth until you can save enough money to select the better choice. Ask what your options and risks are in selecting a particular course of treatment.

Having a thorough understanding of your needs allows you to understand treatment plans before treatment is started. For every procedure, you need your dentist to inform you about treatment alternatives (advantages and disadvantages), cost, risk and ramifications of non-treatment.

If you have any doubts about the necessity of restorations, the experience or expertise of the dentist, or if there is anything else that bothers you do not hesitate to speak up. The dentist cannot read your mind. If the problem is one of confidence in the dentist, do not hesitate to change dentists or at least seek another opinion.

Now, let us assume that you have chosen a dentist, and you need restoration on your lower first bicuspid. Do you know which tooth this is? This could be very important information to know later. Why? What if you get a toothache on a vacation? If it is on the left side, you can tell any dentist that you recently had a filling on the lower left first bicuspid, and thus the toothache might be coming from that tooth. You need to be able to communicate with a new dentist who is not familiar with your dental history. It is also helpful to be able to communicate effectively with your regular dentist. In the beginning, a toothache is localised. Later the pain becomes diffused and it may become difficult to determine the source. If you are informed, you could be a great help in diagnosis. It’s also important to know how deep the filling was and whether pulp capping (sedative medication placed on exposed pulp) was necessary. You could be helping yourself out of an uncomfortable situation later.

In addition to the technical side, you should take into account the human aspect. A big question is: Can you communicate with your dentist? Find another dentist if the answer is a big ‘No!’

Finally, after you get home, you can examine the treatment done by your dentist. It is quite easy, provided the dentist placed a silver or gold filling. Does it feel as though the filling is hitting first when you bite down? If the answer is ‘yes’, go back and tell your dentist. He can ‘adjust the occlusion’ (fix the bite) by grinding down some of the dental restoration. What for tooth sensitivity or sharp pain, which also may indicate high restoration.

Next, you can purchase a mouth mirror from the dental aids section of your local pharmacy. It will look just like the one the dentist used except that it will probably be made of plastic rather than metal. There should be no ‘catch points’ restoration between the teeth when you floss. It should be smooth; thus, you can use your fingernail to test this and to make sure that you have no obvious open margins (spaces) between the tooth structure and filling material. An open margin can eventually lead to decay under restoration.

If there is a question of the quality of the service provided, first bring it to the attention of the dentist who provided that service. If you get no satisfaction, seek the advice of another dentist or your local dental society.

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