Is orthodontic consent fully informed?

May 1, 2004
Sometimes restorative care is better for your patients.

By Josh Bernstein, DDS

Due diligence is required of all dentists reviewing risks, benefits, and alternatives of recommended treatment. As new dental treatments gain widespread acceptance, it is incumbent upon each dentist to offer patients these options — whether they are available in each practice or by referral.

Not long ago, if a patient lost a tooth, options were limited to doing nothing, getting a removable partial denture, or getting a fixed bridge. When implants became a successful alternative, informed consent discussions included implants. Before Invisalign, orthodontic consultations were limited to discussing more traditional approaches.

Until recently, patients with orthodontic problems were offered only orthodontic solutions. Properly trained restorative dentists now can treat successfully many conditions previously approached only from an orthodontic perspective. In postgraduate programs such as those offered at the Las Vegas Institute for Advanced Dental Studies, dentists are trained in advanced orthodontic techniques, but are not limited to orthodontic treatment. In many cases, this is an advantage to the patient who otherwise would endure years of braces only to require restorative care in the end — restorative care that could have solved the orthodontic problem in the first place. In other cases, when fully informed, the patient may choose restorative dentistry over orthodontics.

Diastemas, crowding, over bites, over jets, inadequate vertical dimension, TMD, and other manifestations of malocclusion are being treated restoratively in a relatively short period of time compared with orthodontics. Another advantage is that restorative dentists are generally more attentive than orthodontists with regard to adjusting pathologic occlusal interferencees after treatment.

Orthodontic cases now may be treated without the discomfort and embarrassment that accompany wearing braces and without the time and inconvenience involved with Invisalign. Patients must be informed when alternatives exist that do not require them to wear uncomfortable, unsightly, or time-intensive appliances.

Adhesives now rival the biological bond of enamel to dentin, and porcelains now rival the strength and appearance of enamel. Because select dentists are properly trained to restoratively treat traditionally orthodontic cases, the time has come to offer restorative treatment as a viable alternative to orthodontics.

Often, there is more than one treatment option. When a restorative dentist consults a patient who presents an orthodontic problem, the restorative dentist must present orthodontic treatment as an option. Similarly, orthodontists must inform patients of the restorative option to orthodontics to satisfy informed consent requirements. This will foster greater communication among restorative dentists, orthodontists, and patients, which will benefit patients.

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