NMDA Journal Winter 2019-20

16 New Mexico Dental Journal, Winter 2020 Ask a young child who is losing their first set of teeth, “How much is a tooth worth?”The answer varies from less than one dollar to $10–20! As they anxiously await the visit from the tooth fairy, their expecta- tion becomes inflated. From this youthful experience, is their any trans positional perspective regarding the value of teeth from childhood to adult? The answer is somewhat equivocal and much of it has a psycho- social over tone. Most young adults are very attuned to their physical appearance and their smile occupies much of that self-identity. If a survey was taken asking the question, “What is a tooth worth?”The an- swer may be divided into the dentition that is seen and ‘the rest,’ with less emphasis on function and general well-being. It is assumed that the value of all teeth to the mature adult has an ap- preciated value, as measured by the number of fewer edentulous in- dividuals in the U.S population—the baby boomers—with potentially more disposable dollars, accompanied by an increased awareness of the value of a healthy dentition, both in terms of function, esthetics, comfort, and its impact on systemic health seem anxious to save their teeth. Extrapolating on information disseminated in the lay publica- tion—and the guidance and input from dentists and their team mem- bers—one becomes confused as to whether it is better to save teeth or remove them. Do they see more money in replacement and restor- ing implants? Moreover, from patient to patient, the psychological impact of be- coming partially or completely edentulous varies tremendously. So, when teeth are diagnosed as having a fair to guarded prognosis, or otherwise healthy teeth are recommended for extraction to facilitate a treatment plan, how do the practitioner and the patient evaluate the true cost to benefit ratio? What are the interpersonal dynamics be- tween doctor and patient that must take place to provide a workable treatment option? There is a financial incentive for the doctor to recommend extrac- tions with subsequent implant fixture placement, especially if the restorative dentist is also the surgeon. Often clinicians are fixated on one treatment modality and fail to consider other alternatives. Thus, the cost to benefit ratio will swing in favor of the implant option. When implants are placed, the restorative dentist does not have to be concerned with mobility of teeth, restoration of teeth for crowns and impressions of the preparations. Screw retained restorations minimize the potential for peri-implantitis. One might then conclude that the practitioner has a greater motivation to recommend implant fixture placement. Conversely, the patient may have had the tooth restored and has experienced a continuum of problems. For that patient that tooth has a marginal value, unless they can be educated to the ben- efits of tooth retention. So how does the patient value the worth of a tooth? Dentists have a moral and ethical responsibility to perform a comprehensive pre- treatment examination. Based on the diagnosis, treatment options are recommended. These algorithmic recommendations should be supported by evidence-based criteria. But herein lies the essence of the problem. At present, we do not seem to have this armamentarium in our clinical arsenal. The ADA and the component dental specialty organizations need to work more quickly with methodologists, using computer informatics, to provide clinicians with programs that allow for objective treatment alternatives, devoid of financial considerations, but include the best practice options for various levels of commit- ment. It is only after scientific based treatment plans are presented to the patient that the discussions between doctor and patient will vali- date the true value of what a tooth is worth? How Much is a ToothWorth? By Marc Appelbaum, DDS