The patient is four. He was fabulous at his first restorative dental appointment. At the next he is screaming. His. Head. Off. Dr. Stacey Simmons doesn't want to be "that dentist." So, she does what she needs to do to make sure little Johnny gets his restorative filling taken care of and is set up for success at his future dental appointments. Well, what would you do?
HE WAS FOUR and did absolutely fabulously at his first restorative dental appointment. So, we scheduled his next one—an occlusal resin filling on T.
He came in all smiles and sat in the chair. I gave a local and he screamed. His. Head. Off.
Whoa! What happened?
Tears, wiggling around everywhere, hands flailing, and I’m looking at my assistant, thinking, "?!@*#!!"
Since the hard part was over (or so I assumed), I sat the little guy up and let him gather himself while I did a couple of hygiene exams. Then, I tried—keyword here is tried—to commence with that darn occlusal resin. No go. I maybe removed two seconds worth of tooth structure and then it all fell to pieces. It was an absolute no go on this simple filling. He was either going to hurt me, himself, or create a worse situation overall.
Frustrated that I couldn’t finish something that would have taken me literally five minutes to do, I placed a small temp and told Dad the little guy needed to be referred.
My question is this: at what point do we throw in the towel, so to speak, when we are in a situation where we need to stop, back up, and have a chat with the patient in the consult room to either change the treatment plan or refer to our specialist colleagues down the road?
Could I have pushed to get the filling done, and had Dad and my assistant hold the patient down? Yeah, possibly, but I didn’t want to be that dentist to set the stage for a horrific childhood dental experience that might lead to anxiety into adulthood. I’m not a pediatric dentist. And, while I don’t like making it inconvenient for my patients to get dental work done (the closest pediatric dentist is an hour away), I would rather put this kiddo in the hands of someone who can manage the situation and set him up for success for subsequent dental appointments.
The same goes for any discipline in dentistry—endo, perio, oral surgery, etc. Knowing your limitations and being able to respect a situation for what it is (or could be) adds to your credibility as a health-care provider and ultimately becomes a win-win for everyone. Yes, it was a simple occlusal filling, but if it was only about the filling, the patient would have gotten all of his work done! Teeth are attached to patients with variable needs and challenges, and it is indeed somewhat humbling to inform a patient that you can’t perform the work or that the treatment plan needs to change. Patients may not like or understand it at the time, but you have to remember that they are in your care and you are ultimately responsible for the outcome.
You may be thinking, “I live in a rural area, and the option to refer is not as easy as it is for other dentists.” While I am totally sympathetic to that (because I live in a rural setting too!), there is still the option to refer or change course.
On more than one occasion, I have called upon my specialist friends for a weekend emergency or some quick advice. It’s more than appreciated, and I’m grateful that I’ve cultivated those kinds of professional relationships that I’m able to access without reserve.
So, the next time little Johnny comes to my office, I hope that he can see me, smile, and have an experience that sends him out the door, still smiling. Or when Mrs. Jones walks in and says the root canal she had done was even complicated for the specialist, I can smile and be glad that she got the best dental care she deserved. And that's what it's all about.
Stacey L. Simmons, DDS
Editorial Director, Breakthrough Clinical