In these uncertain times it must be emphasised that what we say must have a singular clear meaning, with no implications.
With no innuendo.
With no uncertainty.
I’ve heard about some real clangers being used when discussing dental services and shutdowns and lockdowns….
According to the NSW State Government a person is permitted to leave home for medical reasons.
Dentistry is a medical reason.
The Dental Council of NSW says this:
“the provision of care should always be aimed at achieving an optimum outcome. In this assessment, you should also evaluate whether delaying treatment may lead to an unfavourable result”
“you must always exercise professional judgement when determining the clinical care/treatment that is being proposed/delivered to each of your patients and consider whether it is appropriate to undertake the care/treatment at this time”
“While adhering to infection control standards, keeping abreast of the latest government developments, and undertaking a risk assessment for each and every patient.”
I believe the key wording is the use of the term “essential care” and determining whether “delaying treatment may lead to an unfavourable result”.
What is an unfavourable result?
Is the spread of decay unfavourable?
Is having a larger deeper cavity unfavourable?
Is having chronic infection in the oral cavity unfavourable?
Is having the blood that pumps through a patient’s infected gums travelling throughout the rest of the patient’s body unfavourable?
Is halitosis due to plaque and tartar build up unfavourable?
Is leaving an unprotected crack on a molar that could fracture vertically unfavourable?
What is essential?
More importantly, what is “necessary” dental treatment?
You would think that any dental treatment that reduces or eliminated the chance of an unfavourable result would be considered ESSENTIAL and NECESSARY.
But are teeth necessary?
After all, a dentist friend of mine believes that teeth are not really necessary… he says that’s what blenders are for.
And he’s correct. You could always blend your food to a puree to avoid having to chew it.
What if you said this?
What if you started telling your patients that you were cancelling or rescheduling their appointment because their treatment was not urgent?
Or was not essential?
What would the patient think?
Would the patient then start to wonder how much of their previous treatment was “not urgent” or “not essential”?
What is the use of these terms with relation to restorative dentistry, periodontal health, endodontic treatment, preventive dentistry, orthodontic treatment going to do to restore confidence in our profession and its professional judgement?
I heard of one dental office where they told their patient that because that patient attended regularly for check-ups and hygiene visits, it was going to be ok for that patient to defer their upcoming visit.
Because they were a regular attender?
Which implies that really this patient’s regular visits are unimportant in the scheme of things…
And it infers that maybe in the future this patient need not attend as regularly as the dentist is insisting…. After all, if they can delay their hygiene visit this one time, why can’t they delay it more often and for longer every time?
But it’s not just dentists…
Last year my local hospital told me that they weren’t booking colonoscopies during lockdown because the hospital wasn’t doing any elective surgeries…
Who decided that having a colonoscopy was elective surgery?
Who in their right mind wakes up in the morning and elects to have a colonoscopy because they have nothing better to do that day?
In the USA…
In the USA any [medical] procedure that through its delay is considered to cause permanent damage or loss of body tissue is considered to be an essential treatment that the government cannot legislate against it happening.
A new interim policy issued by the American Dental Association (ADA) in Chicago on August 10, 2020 stated that dentistry is an “essential health care service,” reaffirming that oral health has long been recognized as an integral part of overall health.
“Whether it’s the current pandemic, a future epidemic or a natural disaster in a particular area, this policy recognizes the need for people to be able to continue to access the full range of dental services,” said ADA President Chad P. Gehani, D.D.S. “Oral health is integral to overall health — staying well depends on having access to health care, which includes dental treatment.”
Dr. Gehani added that regular dental visits are important because treatment, as well as prevention of dental disease, helps keep people healthy. “Beyond teeth and gums, the mouth also serves as a window to the rest of the body and can show signs of infection, nutritional deficiencies and systemic diseases,” he said.
The policy includes the following:
- Oral health is an integral component of systemic health.
- Dentistry is an essential health care service because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health.
- The term “Essential Dental Care” be defined as any care that prevents and eliminates infection, preserves the structure and function of teeth as well as orofacial hard and soft tissues. Orofacial generally refers to the mouth, jaws and face.
- Essential dental care should continue to be delivered during global pandemics or other disaster situations.
- Government agencies such as the Department of Homeland Security and the Federal Emergency Management Agency have acknowledged dentistry as an essential service needed to maintain the health of Americans so they can sustain their health and livelihoods and live resiliently during the COVID-19 pandemic response.
I agree whole heartedly with the US ADA in believing that dentistry IS AN ESSENTIAL SERVICE needed to maintain the health of the population so they can sustain their health and livelihoods and live resiliently during the COVID-19 pandemic response.
As such, it is each dentist’s responsibility, as emphasised by the Dental Council of NSW, to “evaluate whether delaying treatment may lead to an unfavourable result.”
Remember, what goes on inside the oral cavity is not like cleaning up the garage. You just can’t close the garage door and come back in a month, and everything is still the same.
It’s a hostile environment inside the oral cavity. Things do get worse in there with time.
In most cases delaying dental treatment leads to a result that is less favourable than if we had begun that treatment sooner.
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