dental dam?

MoneySeeker1

pramsay13 said:

If you feel strange about things being put in your mouth you should maybe be asking before booking if there are any changes to normal procedures during this time.

It's not up to the patient to do that. It's the responsibility of the practice to tell them if things (any things) are going to be different to normal - in advance.

They had told me about all their protective gear stuff for themselves and about waiting outside to be called in and being made to wear a paper mask for my few seconds dash from main door to surgery and then again for few seconds dash back again and I'd thought that I could just about manage about one minute in total of being forced to wear a paper mask.

I hadnt been told I would be made to leave handbag/coat/etc at reception and I should have been. Thankfully, other people had told me that and so I didn't land up in awkward situation of being made to leave my money away from my sight - as I'd already known to take the precaution of that small close-fitting body bag with it in underneath loose top that I was wearing as part of my clothes.

No-one is likely to ask "Are you proposing to deal with medical procedures from my pov in a different way to normal - and, if so, how?" You just go in expecting the medical treatment to be as normal - because you know you would have been told in advance if it wasn't going to be (ie as it's obviously them that would know and them that should tell you).

MoneySeeker1

Silvercar - there may be an element of personal perception as to how different people view different procedures. So it may be your personal thing that you prefer it. I didnt know what my personal perception would be and, in common with many people, I did not like it/came over panicky. Whilst we know logically a dentist wouldn't stuff it down our throats and suffocate us - try telling our emotions that....as they don't know that...

Different people also expect a different degree of bodily control and agency. I'm in the increasingly large (now very large) proportion of people that make our own decisions on medical matters - we've read about thalidomide, vaccine reactions, vaginal mesh, etc and been horrified for the people concerned. So we expect to know - and we expect to make our own decisions about any medical procedure and give our "informed consent".

brook2jack2

it is it is interesting that you equate rubber dam with thalidomide, vaginal mesh, etc when all of these are medical procedures with Substantial risks and possible benefits which turned out not to be whereas placing a rubber dam Which has been about for well over a hundred years is universally agreed to be gold standard procedure Involving no risk , at the moment is mandatory , protecting the patients air away, reducing aerosol and bacterial load , increasing success rates of fillings etc and protecting staff and next patient.

Like every dental procedure the only problems with it are , for some people, patient acceptance, cost , time and it's a skill the dentist has to be trained and and use.

MoneySeeker1

This is indeed the thing - "patient acceptance" to use your phrase. The whole dental practice is there for the patient - for that reason and for only that reason. Without us patients - it wouldnt be there in the first place. It's there to serve us and according to our choices.

Our body our choice - same as with abortions for instance (our body our choice).

That was THE valuable lesson of the 20th century - that we personally ourselves should be the ones making all of our decisions - what way we get our income, what way we dress, what beliefs (or otherwise) we hold, what way we eat, etc, etc and one of our choices is "what way we do (or don't) deal with health issues". WE decide.

Emmia

Also, the examples cited are things which are permanent - the effects of thalidomide, vaginal mesh are not really undoable.  A dental dam is used during a procedure and then removed.

Undervalued

MoneySeeker1 said:

This is indeed the thing - "patient acceptance" to use your phrase. The whole dental practice is there for the patient - for that reason and for only that reason. Without us patients - it wouldnt be there in the first place. It's there to serve us and according to our choices.

Our body our choice - same as with abortions for instance (our body our choice).

That was THE valuable lesson of the 20th century - that we personally ourselves should be the ones making all of our decisions - what way we get our income, what way we dress, what beliefs (or otherwise) we hold, what way we eat, etc, etc and one of our choices is "what way we do (or don't) deal with health issues". WE decide.

I largely agree. 

However, the dentist does of course have the right / duty to refuse to provide the treatment if he doesn't consider it to be in the patient's best interest. Or, if doing it in a certain way exposes either party to an unacceptable increase in risk.

Question for Brooke.....

What happens in your practice with a patient that can't or won't tolerate the use of a dental dam? Do you refuse treatment or do you do the best you can without (which seems to be what the OP's dentist ended up doing)?

Undervalued

brook2jack2 said:

it is it is interesting that you equate rubber dam with thalidomide, vaginal mesh, etc when all of these are medical procedures with Substantial risks and possible benefits which turned out not to be whereas placing a rubber dam Which has been about for well over a hundred years is universally agreed to be gold standard procedure Involving no risk , at the moment is mandatory , protecting the patients air away, reducing aerosol and bacterial load , increasing success rates of fillings etc and protecting staff and next patient.

Like every dental procedure the only problems with it are , for some people, patient acceptance, cost , time and it's a skill the dentist has to be trained and and use.

I can't see how it can be "no risk" if it induces a panic attack or similar?

Also if "mandatory" at the moment are you saying that the dentist was breaking the rules in carrying out the treatment without?

brook2jack2

Because of the risks to patients if carrying out eg root treatment without rubber dam eg inhaling a small instrument , because patient refusing is no medical legal defense and so can still sue, our medical defense says we should refuse treatment if patient refuses rubber dam in ordinary times. 

In normal circumstances , a filling is less cut and dried but there is no doubt rubber dam improves outcomes for the patient. 

If a patient can not tolerate rubber dam then no root treatment and certain other fillings , you may need to use a material that's less durable .

However in covid times because rubberdam cuts the aerosol down by over 95% so making it safer for staff and just as importantly the next patient in the surgery (after an hours fallow time and disinfection ) , and anyone coming in contact with the patient after the procedure as much,much less aerosol is created , in our practice we would refuse treatment. Our operating procedures are laid down by the chief dental officers and to provide aerosol treatment we must abide by this , and to protect other staff and patients , as well as myself even if I were not compelled I would make this part of my conditions of treatment as the scientific evidence for protection is overwhelming along with the improvement in outcome for the patient. 

brook2jack2

This is one of the protocols for dentistry in covid times , just for Wales. There are many,many other documents dentists have to follow , each slightly different in each country.
if you check page 41 you will see rubber dam is a requirement , as it is in every country where you are allowed to undertake aerosol treatment. https://bda.org/advice/Coronavirus/Documents/Wales-sops-for-agps-on-non-covid-19-patients.pdf

thepurplepixie

MoneySeeker1 said:

This is indeed the thing - "patient acceptance" to use your phrase. The whole dental practice is there for the patient - for that reason and for only that reason. Without us patients - it wouldnt be there in the first place. It's there to serve us and according to our choices.

Our body our choice - same as with abortions for instance (our body our choice).

That was THE valuable lesson of the 20th century - that we personally ourselves should be the ones making all of our decisions - what way we get our income, what way we dress, what beliefs (or otherwise) we hold, what way we eat, etc, etc and one of our choices is "what way we do (or don't) deal with health issues". WE decide.

You sound very arrogant, it isn't all about you, the dentist and his nurse are entitled to safe procedures as are other patients.  Are you so happy if you get Covid because a previous patient refused safe treatment?  I think the dentist would have been in the right if he'd told you he couldn't treat you if you refused safety measures.  Maybe brook2jack2 could tell us if the dentist could/should do that.