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December 10, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 7:01 pm

Gravity is precise in nature, governed by laws and formulas; it does not respond to individual circumstances or objectives. It’s easy because it always works. Clinical dentistry, on the other hand, is science for sure, but an inexact science at best. Inexact science requires the skill of an artist to create a consistent and predictable result since it is not a matter of an equation, hence the “Art and Science of Dentistry.” This inexactness is something that dentists struggle with daily.

I am currently treating a patient who presented with a bunch of broken teeth. The patient is frustrated because these teeth have been “fixed” numerous times over the past few years. His previous dentist had tried to bond things here and there to keep the cost down for the patient but they just kept breaking. The patient, an engineer, said that he even tried giving the dentist suggestions to make things “stronger”. Those suggestions only led to more failure. Predictable dentistry often requires doing things that you would rather not do.

I recently heard an ad on the radio with a famous actor talking about colon cancer screening. He describes that having a colonoscopy after age 50 is huge in finding and treating early changes that lead to colon cancer. Most people don’t want to have a colonoscopy, but also don’t want to get colon cancer, so there is a dilemma. These actions have now become inconsistent with the desired outcome, much like the patient I just described. He doesn’t want to have a complete exam and map out a precise treatment plan that will ensure a more predictable result, but he wants to save his teeth.

We have come to a fork in the road. If you don’t want to get colon cancer you get screened and treat any early signs of problems to help avoid the cancer. If you want to risk getting colon cancer, you don’t get screened. If this dental patient doesn’t want to lose his teeth, he should get a complete exam and address the issues in a more logical and predictable manner. If he wants to risk losing teeth, he can keep putting band-aids on the teeth, but they may not hold up as he has already experienced.

Dentists often struggle with patients whose actions are inconsistent with what they want from dental treatment. It is important for dentists to listen to people to know what they want. A patient who says she doesn’t want to do a crown on a tooth has not said she would not do crown. She is saying she doesn’t want to do it, would rather not spend the money to do it, she won’t enjoy doing it, and she will want it to be over as quickly as possible. What does she want the outcome to be?

Too many disappointments have occurred because a dentist compromised treatment and the result was not what the patient expected. The dentist and the patient need to be very clear on compromise. The patient must understand that, if there is failure, it is most likely the result of the decision not to do the more ideal treatment. The dentist needs to thoroughly explain to the patient the risks and benefits of any treatment they are doing so that everyone is on the same page.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at You can view all previously written columns at

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