- Dr. David Alfaro
Do I really need an exam?
Our dental clinic is on the main floor of a 110 year old house which is beautiful and welcoming, but it does not have a traditional dental office floor plan. In our space, this means that I don't have a private office. I work on a computer in the corner of the reception area like I am on permanent “time out”. As such, I get to overhear the incoming calls and I often listen to our receptionist explaining to potential patients that they need a comprehensive dental examination if they want any treatment at our practice. Then come the questions......
"But why do I need an exam? I just want a cleaning."
"Well, I just had an exam in Calgary"
"I just want one tooth looked at"
These are all understandable questions, and ones that we get almost every day, so I wanted to explain a bit about why we are so insistent on a proper dental checkup before any treatment is provided.
First and foremost, when someone visits the office, it is imperative that we review their medical history and take a good look at what is going on, so it makes sense that an exam be required...even if it is for someone who wants to only come in for a dental cleaning.
But why a complete exam?
We do insist that people have a complete dental examination at their first appointment, which includes: discussing their health and dental history and their main dental concerns/goals, an evaluation of the head and neck (checking for swelling, pain, tender lymph nodes), evaluation of the jaw joints and chewing muscles (TMD/TMJ), evaluation of the soft tissues of the mouth, tongue, lips and throat (oral cancer screening), and then finally, assessment of their teeth/bite and gums. Dental radiographs (x-rays) are prescribed accordingly and then the findings and diagnoses are reviewed with the patient, and treatment options outlined. This is not just a quick peek!
It is all part of a system.
There are various reasons why we have a firm policy of a complete examination before any treatment is completed, with the main reason being that the bite is a complex outcome of joint function, muscle function, emotional state, anatomy, dental health and previous dental care. Every treatment we perform can change the balance of things, so we need a thorough examination before we intervene, even if it is just to fix up one tooth.
As you can see, the last thing I do is take a look at the person’s main concern; I do not want to get tunnel vision and focus on the one thing and miss potential contributing factors or other problems. Everything is connected!
The other reasons are unfortunately medico-legal. We are in an era where complaints to the College of Dental Surgeons of BC are on the rise and if you analyse the outcomes of these investigations, regardless of the nature of the initial concerns, a common finding is that the dental office performed treatment without having complete records (periodontal charting, odontograms, radiographs, informed consent etc). At our practice, we enter everything into the patient charts, including emails, phone, and in person conversations. It is very time consuming, but is a reality of being a healthcare provider today.
Who would complain to the college anyways?
Unless the dentist really did something wrong, why would somebody take it to the college, right? Well, although we are health professionals, dental offices are also in the service industry and we are in an era of the Yelp reviewer. No matter what industry you are in, I bet you can recall someone getting upset about a minor issue. Dental offices are not immune to these outbursts, but fortunately, it is few and far between.
Then there is also the rare fraudster. Just like there are people jumping into traffic to catch an unsuspecting driver without a dashcam, there are people looking to scam their way into a bunch of discounted or free dental work. As a specialist I saw it a couple of times a year when practicing in Vancouver; people would coming in for a "second opinion" on work they had completed somewhere else hoping for me to find problems.
At our office, we are more concerned with patient care than with the few bad apples out there and find that we do our job best when we do not cut corners. Most patients are happy after the complete examination process, and often comment that they have a better understanding of their options and are more relaxed and more comfortable with their decisions than if they just had one thing assessed. I definitely feel like I am providing responsible health care when I have taken the proper time to evaluate and explain things to the patient. Who would not want that from their dental office anyways?
Thanks for reading!
Dr. Dave
