HOW ETHICAL IS YOUR NEW PATIENT EXAM?
The added benefits of a complete examination are that it cultivates trust and that it
communicates an authentic, genuine concern
for the health of patients. We are not selling
the patient a commodity; we educate and
escort patients on their journeys to health.
The Concept of Complete Dentistry promotes
an ethical dentist-patient relationship that
adheres to the American Dental Association
(ADA) principles of nonmaleficence,
beneficence, patient autonomy, justice, and
veracity, as well as to the Patient’s Bill of Rights.
These principles guide our profession in
providing the very highest patient care.
Nonmaleficence, or “do no harm,” is a natu-
ral expression of complete dentistry. The com-
plete exam affords the opportunity to identify
and communicate to patients every sign and
symptom of instability within the masticatory
system. By having a thorough understanding
of all problems adversely affecting patients’
oral health, we can offer solutions that will be
predictable, stable, and maintainable. The pri-
mary objective of any treatment plan is to
provide the best, most conservative solution
to patients’ problems.
Dentists have a deeply rooted desire to help
people. Society expects no less. This squarely
falls under the principle of beneficence, or “do
good.” The complete exam is the best opportunity to demonstrate our role as patient advocates
who listen, learn, and educate. We can use all
of our available knowledge and skills to help
each and every patient realize health. Adopting
an implication mindset allows us to develop the
best, most conservative treatment plan for pa-
tients. This is especially the case when evaluat-
ing patients with economic challenges.
Involving patients in their health-care journeys from the very beginning of the complete
examination and continuing throughout the
treatment planning process encourages patient
autonomy, or “self-governance.” Showing patients in their own mouths the difference between healthy versus unhealthy is a powerful
way to communicate dental problems and
engage patients. This exercise often leads pa-
tients to begin asking for solutions on the spot.
The codiagnosis and education that occur
during the complete exam also allow patients
to have meaningful participation in the treat-
ment planning process. Patients become in-
formed, which makes them capable of owning
their problems. Dentists are the welcome experts to help resolve those concerns.
Proper execution of complete examinations
on patients requires dedicated doctor time and
the support of a well-trained team. It requires
a commitment to further one’s knowledge base
and skill set. Various practice and personal circumstances may divert our professional attention from time to time. However, it should be
understood that our chosen profession carries
a calling from the ADA to “follow high ethical
standards, which have the benefit of the patient
as their primary goal.” 1 To fulfill this calling, the
complete examination is key for more than the
obvious reason of incomplete diagnosis and
missed patient education.
This leads me to the question, “Which patient
does not deserve an ideal treatment plan detailing
the pathway to a maintainable healthy mouth?”
With the spirit of justice, or “fairness,” let’s
look at the obvious answer: Every patient
deserves a complete examination. Every patient deserves to know all the problems that
affect his or her oral health. Every patient
deserves to know the most ideal plan to
achieve health. Patients from every walk of
life deserve to be treated fairly and without
prejudice—without exception. The ADA
states every patient has the right to know the
optimal treatment plan, as well as the right
to request alternative treatment options. 2
Poor economic climates paired with the
overwhelming presence of dental insurance
may motivate patients to seek out alternatives
to ideal treatments, but ethically the provider
must always offer and discuss the best option.
Dentists too often stumble into the trap of
examining, diagnosing, and treatment planning based on assumptions, thinking patients
only want treatment that insurance will cover,
or thinking that patients cannot afford treat-
ment because of the way they are dressed, the
car they drive, or the zip code in which they
live. Neither the patient, nor the dentist, nor
the profession benefit from such an
Instead, the practitioner can embrace the
idea of providing truly complete examinations.
Listening, engaging, and educating throughout exams culminates in trustful, informed
patients. The payoff is that trusting patients
are the ones who desire and accept
Within the implication mindset, treatment
needs are categorized into three categories:
immediate, deferrable, or elective/optional.
Immediate needs that are left untreated will
only progress into more complicated problems, which may require additional treatments, cost more, and cause undesirable
outcomes. For example, caries into dentin
will only worsen with time. Caught early
enough, a simple direct restoration will restore
a patient to health. But left untreated, the
decay will progress. In the future, a patient
may require a root canal and crown, or worse
yet—the tooth may not be restorable and need
extraction. Earlier treatment would have resulted in a better outcome.