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Grey areas in restorative dentistry: Part 3. clinical decision making and care planning

From Volume 52, Issue 1, January 2025 | Pages 67-72

Authors

Robert L Caplin

BDS, MSc, DGDP (RCS Eng), Dip Teach Ed (King's), Retired Senior Teaching Fellow, Faculty of Dentistry and Oral and Craniofacial Sciences, King's College London; General Dental Practitioner, London

Articles by Robert L Caplin

Email Robert L Caplin

Abstract

Much of clinical dentistry is subjective rather than objective, and every dental practitioner must make decisions about how to manage the various clinical and ethical challenges that patients present. These clinical decisions are ultimately idiosyncratic and are, therefore, the reason that there can be wide variation between dentists as to how each would manage a particular situation. There is a need to balance the demands of the patient with the ethical requirements of the profession and the moral position of the practitioner.

CPD/Clinical Relevance: Whereas some aspects of dentistry are supported by science and the evidence base, many are not, especially in the realm of clinical decision making.

Article

When a patient attends either for a routine examination or as an emergency, it is essential to have a standard protocol so that an effective and appropriate care plan can be drawn up. This will involve listening, observing, questioning, examining, making a provisional diagnosis, testing, reviewing the test results, revisiting the provisional diagnosis and then, with all of the gathered information, producing a care plan that meets the needs and wants of the person that has come for care.

The care plan will be based on what outcome is agreed between the patient and the practitioner. Sometimes it will be just the management of a single issue, whereas at other times, it may be bringing the mouth to a state of good oral health. It is time well spent in discussing with the patient their hopes and aspirations for their dental care because it can avoid misunderstandings, disappointment, and perhaps legal redress, later on in the treatment and post-treatment phase: ‘disappointment lives in the gap between expectation and reality’.

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