I feel treatment planning decisions often are the most challenging part of our job. They require our knowledge and experience and often compassion. The concepts of patient autonomy and beneficence are the foundation for making the right decisions with an individual. There are some teeth that clearly should be saved and some that clearly should not. The ones in between require us to be astute clinicians and insightful observers of our patients.
I had been out of dental school about six months and was doing part of my oral surgery rotation at the VA hospital in Long Beach. A veteran was presented who had three overdenture abutments on his lower jaw. (An overdenture abutment is a small stub of a tooth that can help support a denture.) One tooth had become infected and needed to be removed. I advised him of the situation and the procedure went very smoothly. When I turned back around to speak with him, there was a tear rolling down his cheek. This surprised me. I said to him “I’m sorry. Did that hurt? Are you okay?” He looked down at the ground and said, “Oh I’m fine but it’s just not every day you lose a third of your teeth.”
That stub of a root may have had an insignificant contribution to his chewing efficiency, but it was a big part of his emotional attachment to his teeth. That day was quite a lesson for me. There is something more than a periodontal ligament attaching us to our teeth. Since that day I have always made an effort to include the emotional component in treatment planning. For us to do our best in respecting patient autonomy beneficence as part of informed consent we must include this discussion too. It’s amazing to me sometimes where this goes. I love that my job is all about retaining what was naturally there and keeping the person whole.