Practice philosophy

Aug. 1, 2004
Amalgam or composite? CR or NM? PFM or porcelain? Insurance or no insurance? Pick your poison! Regardless of what type of dentistry you practice, you have a choice.

Matt Bynum, DDS

Amalgam or composite? CR or NM? PFM or porcelain? Insurance or no insurance? Pick your poison! Regardless of what type of dentistry you practice, you have a choice. Be it right or wrong, you have a choice! But who is to say whether you are right or wrong? How can you be wrong in your very own opinion? If you believe your way is the best way, then do it! Do it with passion and do it with vigor. Do not stray or waiver from your philosophy. After all, no matter what you think, you are right!

I recently sat in front of a committee and was judged for my belief and philosophy by a group of my supposed peers who, in turn, passed judgment based on their individual beliefs and philosophies. How can this be? A ruling should be based on fact and legality, shouldn't it? Instead, I sat before a group of individuals who had been practicing nearly 100 years when totaled. One dentist made it very clear that there was nothing wrong with the "old way." Another stated that long-term provisionalization would have been rendered best. Rather than get angry, I sat in awe of the fact that dentistry and progress are passing them by. It was sad that they seemed to be missing the train of progress to enhance their patients quality of care.

Every week, I hear patients say that their previous dentist did something wrong or did not meet their expectations. There's nothing wrong with that, is there? But what just slays me time and time again is the philosophy itself. How can they be so far apart and so wrong in the information gathered to support their philosophy?

For instance, there exists in our profession a very divisive line between proactive and reactive stance on treatment. We can take action to correct a current and existing problem, or we can wait until something happens before treating. We can treat definitively or we can "watch" it. Hello! Watch what? Is it right to sit and watch the decay increase with time? Is it right to watch the fracture continue to split until it hits the nerve? Are you kidding?

I used to do caries-inhibition research in dental school, and I would use controlled environments to reverse incipient lesions and remineralize tooth structure. It worked in the lab and I was sure it would work in vivo. I was wrong! Teeth and decay do not work the same in the mouth as they do on the bench! I did my share of "watching" as I was taught by instructor after instructor in dental school. What I found was that the next time I saw that patient, the lesion and decay were full-blown. I quickly changed my philosophy from being reactive and treating when something presented itself, to proactive where I found ways to help prevent what I saw happening.

The one pet peeve I have in dentistry is when new patients come to my office and say their previous dentist said they "needed" to do this or fix that. These same patients then would tell me that they did not "want" to do any of what they were told they "needed." This is the "want" vs. "need" philosophy. The fact is, people do not have to do anything! They simply do not "need" to do anything but eat and breathe and, depending on what they want the outcome to be, they do not even have to do that!

I explain this philosophy by telling the story of my great grandfather, Raymond Bynum. He lived to be about 93 years old and was very instrumental in my not liking removable prosthodontics. You see, he had full dentures. The interesting thing with him was that while he had a full set of dentures to walk and talk with, he would remove them to eat. I watched that man eat corn on the cob, steak, pizza, and anything else without the use of his dentures! He was told he "needed" them, but he proved to me that he did not! The same goes for my patients. I am there to recommend treatment, but my patients have the ultimate say about whether they want to do it or not.

This crosses the lines of elective dentistry. Why is cosmetic dentistry and smile enhancement degraded by so many of our colleagues? Is it aggressive to perform? Yes, if you are modifying virgin teeth to obtain an end result. Does it have to be done? Yes, if the patient "wants" to have his or her smile enhanced. But the choice is theirs! The treating dentist is not "bad" because he or she is helping patients to attain their goals and patients are not bad for "wanting" it. You can elect not to offer this treatment, but don't say that another dentist who does it is wrong. It just might be that you are wrong for not offering to improve the smile of someone who so rightfully wants it improved.

Philosophies are vast and varied. Find one and follow one. If it doesn't seem to be working, change it! You deserve to be happy, and so do your patients. What is your current philosophy? Do you even have one?

Dr. Matt Bynum lectures internationally on aesthetic and reconstructive dentistry, practice management, motivation, and team building. He is a clinical instructor and featured speaker at the Las Vegas Institute for Advanced Dental Studies and is co-director and co-founder of the "Achieving Extreme Success" lecture series. Dr. Bynum maintains a full-time private practice in Simpsonville, S.C. Reach him at (864) 297-5585 or [email protected].

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