I agree with what Dr. Tony Ratliff writes in his article, "What exactly is a watch?" If a dentist is "watching" an area because of fear of rejection, lack of experience, or not wanting to do the dentistry that needs to be done, he or she is indeed doing the patient a disservice.
However, in my clinical experience, there are areas that legitimately can be observed and not treated if no changes are evident. Let me qualify that, however, by saying that these observable lesions probably are far fewer and much more specific than many dentists typically choose to "watch."
I`ve been in practice 23 years. I`ve been to the Pankey Institute and Boot Kamp with Walter Hailey. I`m a Fellow in the Academy of General Dentistry and a member of the American Academy of Cosmetic Dentistry. I`m familiar with the current trends in air abrasion, the use of a caries detector, bonded resin restorations, etc. I haven`t placed amalgam in nine years and I don`t "watch" amalgam that is breaking down.
All this is to say I have clinical experience and everybody`s clinical experience is unique to one`s belief systems and tempered by acceptance of scientific evidence, trust in the opinions of others, and one`s own observations.
Dr. Ratliff, in his five years of clinical experience, apparently believes that areas that are watched will only get worse or not improve. But my experience, probably once based inappropriately on some of the fears expressed in the article, nonetheless bears out the fact that some areas that are watched appropriately can remain stable for many years.
I once had a mentor tell me that "the best dentistry is no dentistry," but if that is not possible, then the best dentistry is the best you can do for the patient.
I have seen proximal radiolucencies on X-rays that do not appear to penetrate the enamel. But we all know that radiographic lesions usually are smaller than the actual lesion. Yet, I have seen small areas appear the same on X-ray 10 years later. That is, to date, treatment was not necessary. However, had I trusted that nothing should be watched, I`d have placed a restoration 10 years ago and might have been replacing it in the next few years.
Personally, I have a strained groove on the occlusal of my lower second molar that stains with a caries detector. Some would have us believe that air abrasion and restoration are called for. But this lesion has been observed for over 25 years! Sorry, but nobody`s filling that tooth without further evidence of disease.
The point is that some areas can be watched successfully, but you`ve got to know the patient`s history, document the change or lack of change, and be able to follow the patient over time, and inform the patient of your findings.
Robert D. Limoges, DMD, FAGD
Auburn, Maine
