Herodontics

Herodontics

In every dental career, there comes a moment when you’re standing at the edge of reason, staring down a bombed-out bicuspid with 2 mm of coronal tooth structure and a patient who says, “Can’t you just fill it?” Welcome to the world of Herodontics. It’s that gray zone between smart dentistry and clinical masochism, where ideal treatment plans meet financial reality, patient desperation, or your own sense of challenge. It’s where you save the unsavable, or try to, and sometimes get rewarded, other times burned.

Across decades of experience and hundreds of cases shared on Dentaltown, a picture emerges: herodontics is part necessity, part art, part self-delusion. Sometimes it’s all we can offer when the patient can’t afford more. Sometimes it’s a test of our skills and materials. Often, it’s a gamble we make with our back, reputation, and peace of mind on the line.

Many Townies admit: we’ve all been there. The 90-year-old with root decay to the bone, the recovering meth user with newfound motivation, the broke 20-something saving for a better future. We bond, sculpt, isolate, polish, and pray. Some of these restorations last far longer than expected. Others fail immediately, leaving us explaining, apologizing, or worse, defending ourselves.

Case selection and communication are everything. The clinicians who sleep well at night aren’t necessarily the ones with perfect outcomes, but the ones who documented expectations, explained prognosis, and secured informed consent. “This is a plumber’s-rate emergency fix, not a miracle,” is a line worth repeating.

Material debates rage, RMGI vs composite, Equia Forte vs packable, MTA vs Biodentine, but the real battleground is risk. Not just the biological risk to the tooth, but also emotional, legal, and physical risks to the provider. Multiple posters expressed regret about years of bending over backward for ungrateful patients, only to be blamed when things went south, despite the disclaimers and consent forms.

Yet, there’s an undeniable heroism in some cases. A boy’s apexogenesis delayed long enough to allow root development. A disheveled young man restored to confidence and employment. A priest with nothing but Delta Dental, slowly rebuilt with a mix of compassion, compromise, and composite.

The wisdom is not in never doing herodontics, it’s in knowing when and how. Are you buying time? Managing expectations? Can the patient tolerate failure? Will you?

In public health, some Townies say they “herodont all day” because there’s no other choice. But in private practice, as one post put it: “Just because you can doesn’t mean you should.” There are no awards for the most heroic RCT on a mobile root tip. No one throws you a parade for deep subgingival composites on a noncompliant patient.

The real lesson is self-preservation. Your time, body, and reputation are finite. Herodontics is fine, as long as it’s a choice, not a compulsion. Do it when the story, the patient, and the prognosis make sense. But know when to say no. Sometimes the bravest dentistry is extraction, a referral, or walking away.

As one Townie said: “Teeth can’t talk. People can. And they’ll say the worst things.” Document well, communicate better, and pick your battles. Herodontics isn’t dead, but it’s aging. And sometimes, letting go is the most heroic thing you can do.


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Sally Gross, Member Services Specialist
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Email: sally@farranmedia.com
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