Tif Qureshi explains his ‘pausative’ dentistry concept and the importance of adopting a lifetime approach.
What does it mean to care for a patient over a lifetime? Are we, as dentists, treating a patient to make them happy and then saying goodbye? Or should we provide that patient with a stable, functional outcome to last for many years?
By applying ortho-restorative principles to treat mild and moderate crowding cases, as well as improving appearance, we are potentially also carrying out interceptive functional treatment that can maintain a patient’s long-term anterior guidance and a correct envelope of function.
The align, bleach and bond (ABB) approach provides the ability to reverse dental collapse and improve anterior guidance that, if left untreated, can lead to future problems. ABB is much more than aesthetic treatment. It is also functional and preventive and can change the way we approach all patients, not just cosmetic cases.
Being able to carry out Dahl build-ups is also important. When the Dahl technique is understood, it can be one of the most powerful tools in dentistry.
Monitor, retain or treat?
I believe patients often agree to treatment when they do not really understand the functional advantages.
Would it be more helpful if patients who decided to have aesthetic and cosmetic dentistry really understood the functional and potential lifetime benefits of those treatments?
Developing a long-term relationship and communicating with patients keeps them informed about what could happen to their teeth over time.
Understanding the occlusal and functional effect of continued tooth movement enables the patient to make an informed decision about intervention. I believe that it is crucial we talk to patients, present the facts and avoid rushing into treatment with veneers and crowns.
It is important to explain the slow minor positional, functional changes and educate the patient about what is happening in their mouths. I record the amount of dentine exposure and look very carefully at enamel chipping. I always explain that dentine is six to eight times softer than enamel and that it will stain more heavily.
Taking regular photographs of the patient is also important, even if no treatment is provided. Each time a patient presents, we can look at the images together to see the changes over time. I don’t think dentists are taught or conditioned to take photographs often enough.
I will also undertake a regular fremitus check, demonstrating the pressure of fremitus and helping the patient understand what it means to have a constricted envelope of function.
The key issue is that we explain that the change is gradual and progressive; we observe, we do not panic. We offer to monitor, retain or, of course, treat. Patients gain an appreciation that, over time, teeth keep moving, become more crowded, collide and discolour.
To view Tif’s case highlights following treatment of a patient over 17 years, as well as gaining access to hundreds of other courses, simply visit Dentistry CPD.
