'Is there anything wrong with my teeth and gums?' The challenges of the dental examination and care planning

Abstract

Patients attend dental professionals with the aim of improving the quality of their lives; they want to be healthier or healthy. This may range from the relief of physical pain, discomfort, or reduced function, to managing the emotional distress of dissatisfaction with appearance. Health, according to the World Health Organisation, is 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', and oral health therefore becomes an essential component of this definition. To meet these aims, dental practitioners should be concerned with the desires and expectations of their patients, as well as their clinical needs. To achieve this, a wide range of knowledge and skills must be employed to first make a diagnosis, then by making clinical decisions to arrive at a care plan that is appropriate for each individual patient and yet remains within the scope of practice as determined by the General Dental Council. Each stage of the interaction between provider and patient - examination care planning, and disease management - presents physical, clinical and ethical challenges. Further, having established the status of the soft and hard tissues, decisions must be made as to whether it is appropriate to leave the patient with some level of disease process or impairment of function rather than attempt to eliminate it entirely. Enhancements, the ever-increasing demand for cosmetic dentistry, and the tension that is created between the desire of the patient and the clinical, moral and ethical obligations of the practitioner, challenge the dentist not to transition from being a professional into the world of commercialism. This article addresses these challenges.