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A friend of mine recently asked me what makes a great dental practitioner? Upon reflection I thought that there are four great assets which would make a great dentist: communication skills, diagnostic acumen, treatment planning sensitivity and overall manual skills. All of these can be learnt. However, it seems some of us “learn” them better than others.

Communication, or rather lack of it, is one of the most common reasons for disputes between dental practitioners and their patients. The reasons for this are not always clear but it is an issue which each and everyone of us must be aware of.

In dental school we were taught “how to” but often not “why so”. In other words the learning process was based more on the technique than the individual on the receiving end of the treatment. Accordingly, upon graduation, and in order to succeed as a competent clinician, a new learning process needed to be undertaken so that we could adapt to the needs and wants of our patients. It was important to understand that listening to our patients’ chief complaint was central to the overall provision of treatment. If their wants are not addressed, then the chances of acceptance of the proposed treatment are reduced and a patient is lost. This would be like looking to buy a new pair of shoes and having the salesperson comment that what you really needed was a new suit before you can get the new shoes. What would your reaction be?

Obviously, there are many ways to manage any given dental/oral condition. There are many routes to an acceptable end point and it is really just a matter of figuring out which will be the best one for any particular individual. I guess you could call it personalized dentistry – no single treatment plan fits all sizes. However, all good treatment plans come from listening to the chief complaint, making the correct diagnosis and formulating a way to deal with the problem at hand. In doing this we will have listened to our patients and given them what they want. Provided that what the patient wants is not dangerous to their well-being, unethical or downright inappropriate treatment, then providing them with what they want is the first step to being able to provide them with what they need for their overall oral and general health. This sensitivity to our patients’ wants and needs is a cornerstone of patient centred or personalized management.

Finally, a “good pair of hands” goes a long way to providing high quality dentistry. I was shocked recently to see a case of a carious lesion extending subgingivally on the distal root of a lower right second molar left untreated to the point where the caries had extended into the pulp and the whole tooth was more or less now unrestorable simply because the practitioner felt the original position of the caries was too difficult to deal with. Whether the decision that the position of the caries was “too hard or not” is not the issue, it is the recognition of one’s limitations and what to do when these are exceeded is the real argument. In this case could the caries have been managed by another dentist/specialist with the skills/resources for the complex restorative procedure needed and thus prevent the ultimate demise of this tooth? Of course this is not a simple argument and I realize that cost of treatment and patient wants and needs must be taken into account. Nonetheless, in this case good communication, diagnostic acumen, treatment planning sensitivity and overall manual skills would have gone a long way to providing great personalized dental care.

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P Mark Bartold Editor