You have been employed in a periodontal specialty office for the past eight years and have been doing regular maintenance cleanings for Mrs. Higa for the past three years every three month
You have been employed in a periodontal specialty office for the past eight years and have been doing regular maintenance cleanings for Mrs. Higa for the past three years every three months. Mrs. Higa misses her three-month recall and returns in six months instead. She tells you that she had pain during and after her last cleaning in the upper left last molar and asks you to avoid cleaning the upper left last molar because she wants to avoid any possible discomfort after the cleaning. Topical anesthetic is ineffective, and the patient refuses local anesthesia and does not want a radiograph of the area taken. The tooth supports a bridge and has a 5-mm pocket with furcation involvement. You know that Mrs. Higa needs to keep this tooth, and it has a good prognosis if it is regularly debrided. The main element in this scenario is to ensure that Mrs. Higa has a clear understanding of the nature of her periodontal status and the nature of disease progression.
Does Mrs. Higa need to be reinformed about her oral health status and the periodontal disease? Is the patient aware that discomfort after or during treatment sometimes occurs and can sometimes be alleviated by informing the operator? How do we reconcile the difference between a patients choice of treatment and your preferred treatment plan? What are the ethical options in this situation? What would you do?
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