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Volume 35 , Issue 1
January/February 2015

Page 7

Editorial: Recognizing Our Limitations

Marc Nevins, DMD, MMSc

PMID: 25895172

As dentists, we are charged with providing compassionate care as we help our patients attain and maintain functional and esthetic oral health. We are licensed by our individual states, provinces, or countries to provide dental care for patients without specific limitations to certain procedures or area of expertise. When dental school graduates obtain their licenses to practice, it is not like young drivers getting their temporary drivers permits; there are no specific limitations on which procedures can be performed or certain levels of complexity in comparison to an experienced clinician or dental specialist.

In today’s dental environment, the delineations among specialists are becoming increasingly blurred as clinicians expand their repertoire. Likewise, the super-generalist has evolved to the point at which he or she provides complete care to patients as a single practitioner. The expanse of continuing-education courses that include surgery, orthodontics, periodontics, endodontics, and dental implants allows for readily available exposure to new techniques. How do we determine in our own practices how to expand our ability to care for our patients while we strive for excellence?

These thoughts crossed my mind as I received a patient referral for a maxillary second molar dental implant surgical placement. According to the patient, the referral was from a local colleague who had surgically explored the site and informed the patient that he would not place the implant and, instead, referred the patient to me. He told the patient that although he does simple and somewhat complex placements, I specialize in more complex care and can successfully place implants in more advanced cases. My colleague’s “self-intervention” prevented the patient from experiencing complications that could result from inadequate implant placement or failure and, hence, “did no harm.” Upon examination, I determined the case could be handled with a combination of guided surgery and internal sinus elevation.

I have tremendous respect for the specialist who made this referral. His ultimate goal was to provide the best care for the patient. It is a privilege to be trusted to provide dental care and we must respect this. The competitive environment and the business of dentistry push us to explore our clinical limits. In addition, our egos challenge us to determine our own limits.

I think every dentist is capable of learning new technologies and procedures but must take the education process beyond the initial exposure at a lecture or even a 2-day course. Developing expertise in a new procedure or subspecialty of dentistry is an ongoing learning experience that can take months or years. It is this continual learning process that makes the practice of dentistry such an interesting profession in which our daily work can always feel “new” and does not have to be done the same way we were taught 10, 20, or 30 years ago.

We are always challenged in our work, whether it is adopting new technology or expanding our individual scope of practice to determine what to offer to our patients and which procedures to perform ourselves and which to refer to a more experienced clinician or specialist. I challenge each of us to do no harm, continue to expand our expertise, and to understand our individual limitations with the goals of excellence in patient care.

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