Is No Dentistry the Best Dentistry?

“Don’t just do something, stand there!”

-White Rabbit, Alice in Wonderland (1951)

I was reminded last week of something one of my clinical instructors from Dublin Dental School used to say. (How long ago?… well…let’s just say I had a lot less grey hair back then!!) When listing treatment options for any dental issue, he would always start his list with “First, do nothing!”

Sometimes in dentistry (and in life) we’re all too keen to act; the “Don’t just stand there… DO something!” effect. This case nicely illustrates the need to remember that doing nothing can sometimes be the wisest option.

I originally saw this gentleman about four years ago. He’d been living/working overseas extensively since, so I hadn’t seen him again until last week. While examining him, I came across this:

Photo of tooth in 2013

Picture taken of dark area in 2013. Looks like it might need a filling to me…

I’ve circled the two interesting areas on the tooth. The green circle shows a slightly darkened area in the middle of the biting surface. This looks slightly suspicious, but it’s debatable if it’s enough to justify touching it. The red circled area is much more obvious, and my first reaction was that this might need to be filled. On the X-ray I took, nothing much showed up however.

So then I looked back through his notes,  and I found another photo of the same tooth, taken back in 2009.

Photo of tooth in 2009

4 years previous, and it looked the same then…

It’s slightly out of focus, but it still shows the same dark areas fairly clearly. And comparing this picture to the first one, it’s immediately obvious the dark areas haven’t increased in the last four years at all. So this damage has clearly stopped progressing. Can I still justify filling this? I don’t think so.

So having this older photo basically changed my decision. This shows the value of having an intra-oral digital camera. If something is a 50:50 call, you can photograph it and compare with what you’re seeing six months (or 4 years!) later.

Using our intra-oral camera to show patients what we're seeing!

Using our intra-oral camera to show patients what we’re seeing!

I don’t want to end up watching something gradually fail either, so maybe I’ll look at this again in six months and decide I need to intervene after all, but the more information I have, the better the decisions I can make.

If you become aware of a dark spot on your tooth however, do get it checked out. It may not need treatment, but if does need attention you definitely don’t want to “do nothing”!

Karl Cassidy - Dublin DentistWritten by .
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