So day before yesterday I had this middle aged lady in my clinic with discomfort and pain in the upper right quadrant. I could see no frank pathology in that region, except a metal ceramic crown with the second molar which she had got placed some eight months back. After removing some local deposits from that region I could locate the pain to the area between the first and the second molar. There was some food lodgment there and I suspected a proximal decay with the first molar because there was some discoloration and roughness. I went ahead with a radiograph but the tooth appeared intact with no radiolucency, I was still in two thoughts; both the first and the second molar were slightly tender, but neither could I see any periapical pathology nor I could see a decay. I removed the food that was sitting in between the two teeth but could not find a lot to curette. I scheduled the patient for my endodontist, to finalize, take a call and start any RC/Re-RC. Since even he could not pin point any lesion and we could locate a frank tenderness with the second molar we planned to remove the crown. Underneath the crown, we found a temporary restoration which was dissolved and replaced by food in the entire proximal aspect where the wall was missing and should have ideally been built up before the crown was planned. Fortunately, there was no decay with the first molar, just some discoloration, and slight enamel wear. The patient was instantly relieved and I was sad because she had told me previously that she had got her treatment done from a much-known practitioner in town, and she had paid a handsome amount for the treatment.
What do we achieve by placing the crowns over the temporary restoration and sometimes even cotton, and how much money or time do we save like this? Why don’t we check the margins and contacts right? Why do we hesitate to get the work repeated from the lab if required? I guess by all this more than anything we instill the idea in the patients head that crowns are always associated with problems and do not come for more than a year or two! Lately, I have been reading a lot about the amount that should be charged by the dentist because of the material charges, machine charges, education charges that we invest and so on and so forth! It’s good to calculate, and it’s good to compare that we charge much less when compared to the west I won’t say anything against that. But people lets justify what we charge! Charge if you can deliver the right work! Cutting your expenditure by treatments like this? Where you relieve the patients of pain and let them linger with some problems or the other till endless times just to save a few pennies or a few minutes of yours is something unacceptable! The only way to increase our value is by delivering the right work I guess!
(p.s: how to deliver more in lesser charges! Well I have something to say on that as well; do wait for my next blog post for it)
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