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What do you do when the dentist does not acknowledge decay under a restoration he just placed?

The dentist diagnoses interproximal decay found on x rays. Treatment is completed but when x rays are taken again the decay was not completely removed. When the dentist sees the x rays he says it is fine. What role as a hygienist do I have to say something to the dentist? Should the patient be told? Can I document in the chart I noticed decay but the dentist said it was fine?



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13 Answers

That is a tricky situation. I have never had this happen to me and don’t really know what I would do. If it was brought to the dentist’s attention and he said it is fine I would probably just document what happened and let it go. If the patient comes back later and has an issue with the tooth you can say you accurately documented the incident and therefore covered yourself. Its the dentist that may have it come back to bite him, not you.

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First, make sure it’s decay and not a base that was placed or just contrast differential on x-Ray. If you take x-Ray at tracer and it’s changed then you’ll know for certain. Be very certain of what you’re seeing. Also, is this something you see frequently? If so, you need to document like crazy!

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Legally, in Michigan anyway, a dental hygienist cannot diagnose decay. Therefore, I do not suggest that you tell the patient about the decay. Ethically, I would speak with the dentist about this situation. It is all in how you approach the dentist and how you express your concern. Your boss should be receptive if handled properly. If not, you may need to reevaluate whether or not you can work for a dentist who breaks his or her Hippocratic oath to “Do no harm.” I hope this helps.

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I see nothing wrong in approaching the dentist about your concern. This is a learning opportunity for you. If it isn’t decay he can explain what you are seeing and if it is, he just might thank you for the heads up. Some dentists appreciate our skills and expertise. Additionally, they don’t mind you inquiring about dentistry. My DDS loves when he can “teach” me about dentistry. This is a learning opportunity for you. I would ask away. Sure we can’t diagnose but we can always learn and for that your DDS should applaud you and support you and tell you what the heck you are seeing in the radiograph.

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That makes me crazy! I document that I noticed and dr said it was fine. CYA, my friend.

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With Snickers on this…document, document, document. Next time the patient comes in, you might say you notice some recurrent caries on that tooth.

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We can’t diagnose. Find other employment.

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I agree with everyone else. Since we can’t diagnose you can’t do too much but I would try to bring it up to your employer somehow. This is definitely a tricky situation. Has this ever happened before?

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I would also say be sure it’s not something other than decay….the dentist is probably better at interpreting radiographs then you are! Don’t jump to conclusions…I’ve done this in the past and been wrong….just document and make sure things aren’t changing in the next radiograph!!!!

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In new york I cannot diagnose decay so I will not say anything.

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We don’t diagnose, which includes writing what we believe to be decay…It could be a liner, a shadow, cervical burnout, only your DDS knows, b/c he/she was just in there… privately, not in front of the patient, ask your DDS what it is, b/c you want to be better at reading x rays,not diagnosing.. see how it shakes out.

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Although you can not diagnose you may know that it is decay. Ask your DDS in private about what you are seeing. Ask him how to deal with this situation in the future.

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I am having the same issue! How did this turn out for you did you talk to him? What did you say? I’m not sure how to even approach this with my Dr.

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