How ethical is your new patient exam?

Every patient enters a dental practice with the goal of having a maintainable, healthy mouth. But what do “maintainable” and “healthy” mean? As a profession, it may be possible that our standards for “maintainable” and “healthy” fall short. Are we, as dentists, fully and consistently evaluating our patients’ overall health? Are we understanding our patients’ unique desires and needs? Are we recommending appropriate treatments? Are we delivering the high level of care we think we are?

Defining the components of a “complete exam” can help us understand why giving honest answers to these questions is difficult. Let’s challenge our mindsets regarding a complete examination. In the end, we may find ourselves asking, “Can a 15-minute new patient exam be ethical?”

Undoubtedly, everyone in our profession can agree that a new patient exam should determine the presence of oral pathology, periodontal disease, caries, missing teeth, and esthetic concerns. These are things all patients expect, and they are things we are meticulously taught in dental school. Patients and members of our profession readily accept that, without intervention, almost every dental problem is progressive. Therefore, a new patient exam must identify all active factors contributing to the breakdown of oral health or function.

Other systems in the body have proven to affect oral health, and vice versa. To be complete by today’s standards, our clinical assessments must evaluate the airway, temporomandibular joints, muscles of mastication, occlusion, function/parafunction, nutrition, and other areas. These components are not thoroughly taught in dental school, nor are they commonly understood by patients, but they are crucial to patients’ overall and long-term health. We must appreciate that these dynamic systems are functionally interrelated. Disorder or deterioration in any one of the aforementioned areas will eventually affect other parts of the masticatory system. Patients, therefore, cannot achieve and maintain healthy mouths if we fail to diagnose instability in these interconnected systems. It is impossible to offer appropriate treatment recommendations and develop predictable treatment plans if the total system is not fully evaluated.