No matter what our focus is in dentistry, it always pays to, on occasion, take a step back to refocus on what we are doing, why we are doing it, and what the results of our efforts will be. We strive to do the right thing, but for whom?
We’re all familiar with the Golden Rule—do unto others as you would have them do unto you. It’s certainly an honorable way to live our lives. However, there is also the Platinum Rule, which is less well known and invoked not nearly as often—treat others the way they would like to be treated if you were them.
We want to treat people with respect and, in our position as dentist, offer the best treatment possible for our patients. To do that, we need to understand and utilize the Platinum Rule principles. It is our role not to provide what we would want for us but what the patient wants, within our professional and ethical standards, of course.
This involves first needing to really communicate with our patients as the recipients of our care. We need to be aware of the vast spectrum of each patient’s needs: the psychological, the financial, what the patient is really seeking, and how much of an impact our treatment has on the patient’s life.
Evidence-Based Dentistry Vs Value-Based Dentistry
“Evidence-based” is one of today’s big buzzword phrases, whether in medicine or dentistry. How does it affect our decisions for our patients? The “evidence” is the result of scientific research. It might be the compilation of tens, hundreds, or thousands of studies of patients. The data from these studies gives us the general guidelines for patient treatment.
The issue with the results of all this data is that it gives us what the average outcome will be for the average patient in the average circumstance. However, it does not help us address the unique needs of the patient in our dental chair. Evidence-based care is vital to the growth of dentistry and all healing professions, but it does not tell us what the best treatment is for the individual patient we are seeing right now.
Possibly a better and focused approach is to practice value-based dentistry. First, learn from your patients what values they find important, not what we find important for ourselves. Is it their appearance, eating better or more healthily, socializing more, or maybe just being pain free? Your patient values a combination of these factors and probably a few more like self-esteem or employability. It is very important to find out what these values are, for that will make the outcome better for you, your patient, and the profession.
The value we as dentists provide is a balance between the quality of care and the cost of that care, and not just the financial cost. Did we provide the care the patient wanted? Did we give the service the patient desired? Was the patient able to afford the care given? Did we manage the risks involved in the treatment decisions made? The cost of treatment is not just financial. It also is the time to complete the care, time off work, and accessibility of care. Did we provide the best outcome possible given the patient’s needs and wants?
Patients often ask “What should I do?” The answer should be based on the Platinum Rule. It is not what I would like done if I were the patient, which is the Golden Rule, but more importantly, what is best for the patient based on their unique situation and all the factors previously mentioned.
That’s the Platinum Rule. Treat others the way they want to be treated, not the way you want them to be treated. Time, effort, finances, and desired outcomes that the patient wants are what is most important, not necessarily the latest technology or use of the highest-cost cutting-edge equipment.
This is the most important conversation to have with the patient, not what the newest technology is and how great the benefits of that technology are.
Applying Value-Based Dentistry
Applying this value-based system to your potential denture patients is the perfect example of seeking a better overall outcome. Options include traditional dentures requiring four or five visits, which may be moderately expensive for some and intrusive for others due to the number of appointments.
Are teeth to be removed? Immediate dentures may not be the desired choice, but the patient may be in pain now and not want to wait to get their dentures. Digital dentures are available now. With the dentist’s learning curve, an extra visit or two, and usually increased cost factors, digital dentures may not be the ideal choice either.
Is there enough evidence-based research to justify digital dentures for all patients? Are the materials proven to last long enough to meet the standard of care without issues of chemical leaching over time of compounds now found to be toxic?
Another option is the denture that can be fabricated in a single visit of about an hour, or two hours if immediate-load implants are to be used. The Larell One Step Dentureoften can be a reasonable choice for the patient.
Less chair time, pleasing aesthetics, lower cost, and improved function are the value-based attributes needed to be discussed with and understood by the patient. Again, it isn’t what we want. It’s what the patient wants.
There are those who will always opt for the best treatment they can get no matter the cost. There are those who will opt for an outcome that meets their needs at financial, time, and effort costs that are acceptable to them. Maybe they want the latest technology, even though they may not really see the difference.
Studies of all-on-four fixed bridge systems are a perfect example. There is no question that this technique provides a high-level result, comfortably combining aesthetics and function. But when analyzed, seven or eight out of 10 patients who come in for a consultation don’t proceed with treatment. Mostly this is due to the cost.
If they do proceed, maybe an implant-retained denture is the desired result, considering how all the factors, including financial cost, balance with function and aesthetics.
There is no one right answer, and it is incumbent upon us as providers to really find out what our patients want, what they can afford, if they can handle the procedures, and which outcomes they would be happy with.
It is our professional obligation to present to patients all of the risks, benefits, and alternatives for treatment and agree on a treatment plan that is right for them in all aspects, not just what is right for us and what we think the best outcome should be.
I truly believe we should have at our disposal all the options available to the patient that we can provide. If that isn’t possible, then we should be able to point the patient in the right direction to the right provider who can give the patient what they want.
Our decision should be based on this value-based system. Less important is what equipment we have purchased and now have to justify through the costs and time involved in acquiring and using those systems.
The one-visit denture, the traditional multi-visit denture, and the digital denture all have their place in current dentistry. Consider what is involved in each technique, how long have they been on the market, if the outcomes are comparable, and if they provide a standard of care going into the future.
The number of patients needing dentures is increasing. As the population ages, the number of patients requiring dentures will continue to increase, even though more people will be retaining their teeth. We may need to spend a little more time with them to really understand what fits their value system, explaining not only the risk/benefit/alternative analysis but also each patient’s own determinants of financial and psychological costs. The true worth of the care we provide is a combination of all of these value and cost factors.
Once we really understand our patients and their value system and not ours, we are really applying the Platinum Rule—treat patients the way they would like to be treated, not the way we would like to treat them. We will have outcomes that are better for all, including you the provider, the patient, and the profession. We must remember we are not here just for ourselves. We are here for the people we serve.
Dr. Wallace has led an impressive career in the dental industry as a practicing oral and maxillofacial surgeon, medical consultant, and founder and CEO of the Larell One Step Denture. He has been published in many journals including Dentistry Today, WebMD, and Dentaltown. He has played a major role in expanding the use of one-hour dentures to the dental profession as well as to many national and international philanthropic organizations. He has lectured extensively on denture and dental implant topics. He can be reached at larry@larell.com.
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