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Professional Courtesy: The Pursuit of Perfection by Dr. Thomas Giacobbi

Professional Courtesy: The Pursuit of Perfection


by Thomas Giacobbi, DDS, FAGD, editorial director


Many dentists are self-described perfectionists, but dentistry is not a perfect pursuit.

Most people are familiar with the “good/fast/cheap” triangle, in which you can pick only two sides of the triangle because the third will always be left out. In the context of perfection, I’d add another triangle for dentists—patient/procedure/provider—but in this case, all three sides would be required to achieve perfection. For example, a patient who’s easy to numb needing an occlusal composite on a day you’re feeling great with plenty of time to work.

However, many of our days can be filled with the pursuit of perfection against the challenges posed by difficult patients, challenging procedures and a stress level that challenges your patience.

Sometimes dentists let perfection become an obsession and it only leads to an increase in poor outcomes. A perfectionist will become more critical of every small detail, which in turn will erode their self-confidence and result in more errors.

To be clear, I am not suggesting that the best defense against being a perfectionist is to accept poor outcomes or do sloppy work! I think it’s more important to understand the limitations of each situation and that the three factors for success—patient, procedure and provider—are equal partners. When you face a procedure that has not gone to plan, ask yourself what could be done differently if you did it again—if you could have used a different approach or a different material or had more time … the list goes on. Then do it again.

Whether you call it a warranty or something else, standing behind your work is the best form of quality control. A simple example: If you did a filling and it falls out in two years (and you expected it to last five), then you do it again for free. Determining why it failed will be a valuable lesson that improves your dentistry moving forward. If something is likely to fail beyond your control (you attempt herodontics), then great communication skills with your patients will prevent future disappointment. If the communication of your expectations does not happen at the start, you’ll be in for a valuable lesson in the future.

One of the best examples I can give of the failure to warranty a restoration is the new patient I saw with sensitivity after a simple Class II restoration from their previous dentist.

The previous dentist adjusted it a bit and essentially told the patient to just give it time. The reality is that the bond between composite and tooth was contaminated and the filling needed to be redone. I removed the filling, placed an interim restoration to allow the tooth to calm down, and then restored when it felt better. When I explain this to patients, I tell them that I would do the same procedure if I had placed the initial filling myself. (In reality, I rarely have to do this because once you have to fix one of these, you pay very close attention to your bonding protocols.)

Every time we meet a patient and assess their dental needs, we must answer these questions:

  • Can I manage the patient and their expectations?
  • Do I have the materials and knowledge to deliver the necessary treatment?
  • Do I have the skills and confidence to be successful with this patient?
Of course, the answers to these questions are not always yes or no. The gray areas in between are opportunities for us to be creative and to find new solutions. Dentists are the teachers of all things dental, but our patients provide endless opportunities to learn.

Do you have a case to share that illustrates your clinical creativity? Can you share a lesson you learned the hard way? Please share your thoughts in the comments below. And if you’d like to reach me by email, send your messages to tom@dentaltown.com.



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