To Drill, Or Not To Drill…

Tough call!

One of my favorite patients was in the other day and we had a little situation come up that prompted some deeper thinking and I thought I’d get it out there.

DD is one of my patients that least comfortably lends himself to being a dental patient.

The joke used to be that we had to have a bucket under the headrest, because as soon as the chair went back he would start sweating profusely.

Where’s the ShamWOW when you need it.

He didn’t need to be a dental phobic for the purpose of the discussion, but it adds an interesting twist.

I have done a fair amount of work on DD over the years (he might say it’s been an unfair) and we needed to touch up a filling that we did several years ago. After I repaired the filling I went to adjust his bite. Once I got the tooth balanced in with the rest of his teeth to where it hit as much as the neighboring teeth without bumping extra when he slid his jaw around I decided to look at his bite in general.

Enter the dilemma of the day.

DD is asymptomatic. No headaches, neck aches, breaking teeth, grinding or gnashing his teeth at night, clicking or popping of his TMJ or jaw locking or not opening too far. None of my most common things that people with bite imbalances frequently report with are present with DD.

However, when I check his bite it’s off by as much as any patient I’ve examined. He’s got a big slide once he hits his teeth in the back left, way before he hits anything else.

Now, we’re all a little more mature than just saying, “If it ain’t broke, don’t fix it,” right?
That is a cowards way of viewing things. Benign neglect, ‘playing ostrich’ is attractive because it doesn’t take any time or cost any money but that’s about it.

The cornerstone of minimally invasive dentistry is trying to prevent problems and fixing them early once they are identified. This situation seems to fit the criteria for going in and equilibrating proactively, before he becomes symptomatic. So, how did we decide to let things go and revisit things in a few months?

You can reference my last blog that states that it’s my job to impart the necessary knowledge upon my patients allowing them to make the informed decision that they feel is right for them. Fairly simple, right? Hell, even the lawyers can’t complain!

Reenter the fact that DD is one my most reluctant dental patients with fairly sensitive teeth in his defense. Maybe this was the tipping item for me. Maybe it was more important for us to let him feel empowered and in control, which are the pillars or overcoming dental phobia for most, than to strongly recommend preventive.

DD and I have been through a lot of dental stuff together. He trusts me fairly implicitly, to the extent that if I told him that we should go ahead with this now he would likely have reluctantly agreed that it was the right thing to do.

I’m curious what outsiders might have to say in this matter. Let’s say it’s for your 21 year old son and you want to respect their ability to make an adult decision, but at the same time you want them to be vaccinated from potential problems down the road. I mean, you did expose them to lots of vaccines as children which was invasive.

I’d love to hear thoughts on this one.

Things like this are why I say communication is the biggest art form in dentistry.

Next time I’ll be back with a nice case of clinical dental arts with some pictures.



Dillon Family Dentistry, 1084 East Lancaster Ave Rosemont PA 19010, Phone Number: 610-228-0329