By Dr. Lawrence Spindel DDS

Patients often come into the NYU School of Dentistry, where I teach with “emergency dental procedures”… They often have a particular symptom that is bothering them. The students often want to address the symptom immediately, but often they are required, in non emergency situations, to first do a comprehensive exam and treatment plan. 

It is not usual for these new patients at the school to initially express a resistance to taking a full set of radiographs and submitting to a full work up by that student. Quite often their student dentist will also want to immediately care for the tooth that’s bothering them, but although many patients come to our school to take care of the one problem that is bothering them, it’s very important that our student dentists understand the need for the performance of a complete patient assessment prior to performing the non emergency dental treatments.  Many problems that patients have are not terribly symptomatic, at least until that time when their conditions worsens and they are forced to seek “emergency care”. For this reason and others, most of our emergency treatments are palliative in nature and not definitive care.

Obviously, if a patient is experiencing an acute infection or a tooth that is causing significant pain, something should be done for them to alleviate their “acute” problem, but once they receive emergency treatment, it’s the dentist primary responsibility to evaluate their patient’s entire clinical situation.  As general dentist, we should always assess our patient’s overall condition and come up with a treatment plan, or multiple different plans that might be appropriate alternatives. This is principal that our students need to embrace, even when their patients maybe initially resistant.

A patient may say, “I am here to address this one tooth that’s bothering me and nothing else for now, but on the occasion that I’m in attendance, as the supervision, charge with the responsibility, for overseeing their student’s treatment, I engage the reluctant patient and explain that often dental problems are initially not overly bothersome but can be serious enough that they need to be addressed as well. Also, dental treatments can be expensive and patients should be aware of their overall problems before committing funds to treating just one tooth. Many patients actually have multiple problems that may influence the types of treatment that will ultimately be chosen. Teeth that have infections and/or large carious lesions may need multiple costly procedures to remedy and if multiple teeth are similarly involved, a patient needs to become aware of the extent of their problems, before deciding on expensive treatments to save just one tooth. After all patients have multiple choices to make, and options when they’re deciding which teeth should be saved and which should be extracted.

Once I explain this to patients, most tend to relax, especially after I point out that no one can force them to have any particular proposed treatment.  Still it is our duty to perform a comprehensive examination to determine the extent of their problems,  so that they can make an informed decision, concerning their subsequent treatment. Since no one can “force” them to have treatment, the “worst”case scenario is that our school may not provide the particular treatment they desire, (because in our opinion, it’s not in their best interest and we try to “do no harm” to our patients), but they’ll still be free to seek a second or third opinion elsewhere.