During my presentation last Friday I showed the group a radiograph with a class two lesion and asked them to choose “Fill it or Watch It?” It’s a fun exercise to experience the thought process behind clinical treatment recommendations. After the program, taking the escalator down to the lobby, Dr. Gary DeWood and I were reflecting on the program and he made a comment that stopped me in my tracks. “ I hate when dentists say they are “watching” something. What are we “watching” it do? I don’t want my physician “watching” my heart disease.” I realized how something I have been saying for more than two decades must sound so peculiar to my patients, and doesn’t fit with my philosophy of practice at all. What would I think as a patient when the dentist or hygienist tells me I have a “small cavity, but we are just going to watch it”? I can think of a whole list of things that would go through my head, and most of them do not reflect positively on us as a practice.
As I thought about it I realized that when I use the word “watch” I always discuss the findings with the patient and make recommendations. The difference in the recommendations is they don’t fit a billable procedure code. 
Many of these recommendations are designed to create an alteration in patient behavior, things like home care, nutrition or simply being observant of a cause. In addition I am hopeful that with intervention on the patient’s behalf at home the finding may not need “in office” treatment in the future. It also struck me that all of these “watched” findings get noted in the patient’s record with a recommendation to follow-up diagnostically at a future appointment.
In the future I will be sharing with my patient’s that their exam revealed “x” and my recommendation is to implement some conservative approaches they can take at home to “manage” what we discovered. At future appointments we will be monitoring and assessing the effectiveness and can make additional recommendations if needed. I want the language we use to be congruent with the fact that we are proactive, conservative and individualized in our approach to patient’s health, so “watching” is a thing of the past.
Hi Lee Ann,
You make an excellent point! We must change the way we communicate with our patients and help them understand the preventive measures they may want to consider in their overall care. However, article like this one in the NY Times yesterday (http://well.blogs.nytimes.com/2011/11/28/are-dentists-overtreating-your-teeth/?ref=health) just make us all look bad.
It seems like the profession is being attacked constantly at this time. Just wrong if you ask me.
Thanks for all you do!
John
I enjoy every one of your post, thank you.
100% agree with you.
Hi Lee
Just had a conversation with our hygienist about the word watch. What we do is tell the patient that we will monitor certain areas such as furcations, recession and reevaluate them at their next visit. I agree with you and we usually don’t watch decay.
We think the word monitor and reassess have better connotations.
Hi Lee, I read this post at around 3PM today. It’s now 11PM and I have been thinking about why dentists watch disease, for a few hours. I have created quite a list and very few items have anything to do with teeth. It’s interesting how you post coincided with that NY Times article that came out this week. The spin the reporter took was another article that painted the entire profession through a very suspicious lens.
Your question can be answered in many ways…the simplest one would be to go back and ask each individual dentist to “Know Thyself.”
There is one thing that I would like to say as far a having a basic philosophy about prevention or early detection for medical as well as dental procedures: Signs precede symptoms by sometimes fifteen years. This goes for diabetes…skin cancer…perio disease etc.
Barry
Lee,
I continue to be surprised that dental teams watch progressive gingival recession with minimal inflammation and pocketing and fail to realize that their patients are experiencing progressive bone loss. Gingival recession is a bit of a misnomer as it suggests a minor occurrence. Gingival recession is really BONE RECESSION!!! followed by gingival adaptation, often with no pocketing. Lack of pocketing does not equal health and stability in these cases. When the gingival adaptation keeps up with the bone loss there is no pocketing, including on proximal surfaces. These patients are at risk to lose teeth over time. The absence of obvious inflammation is also not diagnostic, though a closer evaluation often identifies at least mild gingivitis. There is a strong genetic predisposition to most bone and gingival recession in the form of thin bone and minimal keratinized attached gingiva. The thin bone has more to do with the volume of alveolar bone and the eruption pattern of the tooth most of the time than any other anatomical influence, including orthodontics done carefully. Please share this with any one is might be interested. Thanks. Mike