Elective
Vs. Mandatory Dentistry
Dentistry has experienced a major change in
the past 30 to 40 years. Before that time, patients sought
dental care because something in their mouth was painful
or broken. The problem was obvious to them, and they could
tell the dentist what treatment they wanted to have completed.
Many restorative options in dentistry available then are
unacceptable by today's esthetic standards. Most of today's
complex procedures in oral surgery, orthodontics, periodontics
and prosthodontics were not available. Even routine orthodontic
therapy was a rarity.
Today, dental treatment options have increased
significantly. New esthetic procedures are readily available
to and considered highly desirable by knowledgeable patients.
However, it is very difficult for patients to know whether
suggested treatment is mandatory or elective. Many speakers
in practice administration have used the terms "need
dentistry" and "want dentistry" to describe
these two categories. The negative Reader's Digest article
on dentistry of a few years ago demonstrated the high level
of frustration that a patient feels when one dentist gives
him or her a treatment plan very different in cost and content
from a plan suggested by another dentist. As an example,
a patient might be told by one dentist that he or she "needs" 16
veneers, and by another dentist that he or she does not need
any treatment. These situations are extremely confusing for
the patient - and, in the long run, bad for the profession.
It appears to me that dentistry requires a
new method of presenting treatment plans to patients, one
that clearly differentiates between mandatory and elective
care. This article describes such a method and how it can
be implemented.
Distinguishing mandatory
from elective dentistry
Oral conditions requiring therapy usually are
evident to knowledgeable dentists. Examples of such conditions
are frank dental caries, the need for endodontic treatment
or tooth extraction, oral soft-tissue lesions and overt periodontal
diseases. Elective oral care is equally easily identified.
Examples are tooth whitening, some types of orthodontic therapy,
replacement of amalgam restorations with tooth-colored restorations,
some implants and replacements of functionally acceptable
but esthetically impaired anterior crowns.
The challenge comes in explaining the difference
in therapy to patients, who do not know what distinguishes
mandatory treatment from elective treatment. Although dentists
have adjusted somewhat to the increased number of elective
treatments in dentistry, many patients still are completely
confused. How can the profession better educate patients?
• Educating
patients about elective dentistry
• Paying
for oral therapy, mandatory and elective
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