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Doing What’s Right, While Doing Good

By: Dr. John “Jay” Owen, IV

Tooth #30 (MO) has been prepped to receive a composite restoration, checked off and deemed restorable.  Composite is layered into the mesial box at the perfect angle and cured to allow optimal integration between the tooth and the bonding agent, as well as to ensure perfect depth of cure and minimize leakage associated with the restoration.  The pulpal floor on the occlusal aspect is filled, the marginal ridge given ideal anatomy, and care is taken to place a distinct central groove and accessory anatomy allowing perfect food deflection during mastication.  After curing, the restoration is polished and sent for grading. 

Next on the list - #10ML.  An ideal preparation was completed with retentive features and an esthetic bevel placed so the composite will blend right in.  My loupes were removed to rest my eyes and admire my work, only instead of relief, panic set in.  Sitting, looking me dead in the eyes, was a test tooth – I had completed my work on my personal dentoform tooth and not the required and specially marked test tooth.  My immediate thought was, “…this is ridiculous…,” then, accompanied by tachycardia, came the rush of self-preservation thoughts: “I can just re-prep the test tooth and no one will know.”  Instead, I decided to confront the professor, admit my mistake, and take the failing grade on my mock boards.  Failing was not only going to mean loss of a passing grade, but also several clinic sessions to make up the failed work.  In the end, I made the correct decision: I was able to accept my mistake, free my mind of burden, and I even learned something during the process.

What would you do in this case?  Have you ever prepped or extracted the wrong tooth? Damaged an adjacent tooth?  Seated a crown without optimal margins because the cement will “close the space”?  Started a treatment without a proper or complete diagnosis?  When these ethical situations arise, it is hard to make the correct decision and tell the patient what we have done because, “…they will never really know.”  As dentists, or in my case, dental student, we work in a profession that has been established based on trust.  Patients do not understand the complexity of the dental procedures and cannot see the results, but rely on us to do the correct thing – both ethically and professionally.  It is important that we, as a profession, continue to operate in an ethical fashion and build the relationship of trust with long time and new patients.  We need to remember that rapport based in trust will be far more beneficial than not redoing a restoration or providing a free fix for the damaged adjacent tooth, even in those procedures that run over into lunch or a date with the wife.  

In the current state of affairs and changes in society norms, ethics has taken on a new connotation and is not based on common belief, but rather based on situational circumstances.  It is our job to maintain unity in thought and practice about what is professionally ethical so future dentists, like my classmates and me, can enjoy the world of dentistry as those who came before us.  Even if the proper and ethical decision comes with a loss to our financial bottom line, our personal coffers will be filled.  This year is a great time to clean our slates and work as a family to better the profession we all pledged to protect.


Virginia Dental Journal, Volume 90, Number 2 - April-June 2013