The Harsh Realities of Communication in Interdisciplinary Teams and What It Means for You as a Dental Patient

At one point or another, you’ve likely encountered some kind of health issue that required more than one doctor to diagnose and treat. Maybe you went to your primary care provider with a health concern, only to be referred to a specialist (or variety of specialists) after describing your symptoms. Or maybe you’ve undergone cancer treatment with an entire team of doctors working in tandem. Regardless of your specific situation, you probably have some experience needing to communicate with multiple providers to coordinate your care, including care for your teeth.

You know, then, that communication in interdisciplinary teams is rarely smooth sailing. It’s no secret that our healthcare system is flawed, and doctors—like everyone else—are human! That means we, too, sometimes struggle with clear communication and unfortunately drop the ball from time to time. 

But where I see patients making a big mistake is entrusting 100% of their care to their provider. Without a doubt, we doctors play a crucial role in caring for your health, and it is largely our responsibility to coordinate your diagnosis and treatment. But even when we do everything right, it’s still not a good idea to take a hands-off approach to your health! Understanding what’s going on with your body, and what’s being done to care for it, is vital to ensuring you receive the care you both want and deserve.

There’s no better way to make a point than with real-world examples, so let’s take a look at a tooth story from my own practice that demonstrates just how important it is to stay informed, advocate for yourself, and take on an active role in your own care.

The Role of the Dental Patient in Interdisciplinary Team Communication

The star of today’s tooth story is a wonderful woman in her sixties who came to my office for help with her lower left molar, what we call tooth #19. She had previously had a dental bridge that covered that and two other teeth, but over time, decay had formed underneath it. By the time she showed up at my practice, the cavity on #19 had grown deep enough to reach the inside of her tooth, so she needed a root canal to be able to save it.

It’s difficult for a patient to see, but for an endodontist like me, it’s clear even from the radiographs above that her tooth had gone necrotic. That means the pulp tissue inside of her tooth had died due to bacteria that had entered through the cavity. Now, try taking a look at the 3D imaging from my CBCT:

See that enormous dark shadow underneath tooth #19? That’s called a periapical lesion or radiolucency—bone loss that occurs as an immune response to infection. If it wasn’t certain before, it was certain now: This patient needed a root canal, stat!

With a clear diagnosis in hand, I proceeded with her root canal treatment, and everything went smooth as butter. The patient was thrilled—as was I! So, I sent her home, thinking I wouldn’t see her again until her one-year follow-up, when I would check to see how the tooth was healing. 

Little did I know, I would be seeing her again much sooner than expected, and it would highlight just how important communication in interdisciplinary teams is to your dental health!

Kept Out of the Loop

Only six months later, the same patient was back in my chair—but this time with a new concern. She told me that her dental implant on tooth #18 had fallen out, and that her dentist wanted me to check on the root canal I had done.

Wait… what?!? She was supposed to get an implant on #18? No one had mentioned that to me!

If I had known that was the plan, I would have recommended waiting at least six to twelve months for proper healing before moving forward with any bone grafting or implant placement. This situation is a perfect example of what can go wrong when there’s a drop in communication within interdisciplinary teams.

After speaking with the patient a little more, I found out that after her root canal, she had seen her general dentist, who removed tooth #17, placed a bone graft, and inserted an implant—all in one visit. Now, she was back in my office, without the implant, and her 3D imaging looked like this:

Not only had tooth #19 not properly healed, but the bone loss had gotten worse! At this point, my concerns extended beyond the root canal. No matter what the dentist thought, there was something more going on here, and we needed to find out what it was ASAP. So, I sent the patient’s images to the oral maxillofacial radiologist to see if I could find out more and better understand how to proceed with treatment.

The Truth is (Partially) Revealed

The oral maxillofacial radiologist determined that the patient had osteomyelitis, which is severe inflammation of the bone or bone marrow that must be treated with medication and/or surgery. That poor patient! But what did that say about my role in the situation?

More likely than not, the osteomyelitis diagnosis meant that the root canal I performed on tooth #19 had nothing to do with the patient’s implant failure. Why? For one thing, implants don’t inherently fail when put in next to a lesion. They just need more time and special care to be successful. So even if my root canal had failed and the lesion hadn’t healed, that wouldn’t automatically lead to problems with the implant.

But for another thing, I’ve personally seen cases quite similar to this one that had perfectly happy endings. Here are some examples:

Lessons Learned About Communication in Interdisciplinary Dental Teams

At the end of the day, we’ll never really know why the patient’s implant fell out. But what we can be certain about is that the entire situation could have been avoided had there been good communication within our interdisciplinary dental team. So let’s talk about not only what we, as the patient’s dental team, could have done better, but also what YOU can do as a patient to ensure something like this never happens to you!

Lesson #1: The referring dentist should have informed me of the implant.

As we’ve already discussed, the referring dentist should have let me know they intended to put in an implant on tooth #18 when they sent the patient to my office for an evaluation of tooth #19. Treatment plans cannot and should not be made in a vacuum! That’s why doctors routinely ask which medications you’re taking before prescribing new ones. Everything in your body is connected, so treatment for one part of the body must be done in consideration of treatments for other parts of the body, and that includes different teeth!

Lesson #2: I should have taken 3D imaging earlier in the process and shared it with the referring dentist.

One misstep I myself made was that I didn’t take 3D imaging until after I had already committed the patient to root canal treatment. That’s because at the time, I believed that it was best to save my use of CBCT for when the patient was already prepared for treatment. After all, society (insurance companies in particular) has created the mindset that we need to keep costs down as low as possible!

As you saw earlier, 3D imaging can help us see much more of the picture than traditional x-rays. So had I taken images earlier—and then shared them with the referring dentist—both of us would have been in the loop on all of the details of the patient’s situation and therefore could have created a more appropriate treatment plan. That’s why these days, I actually take a CBCT as part of my consultation appointment. Teeth are an important part of your overall health, and they should be treated as such no matter what insurance companies say!

Lesson #3: Dentists should keep patients in the loop, too!

I know I work hard to make sure my patients are well-informed on their condition and treatment plan, but I can only speak for myself. Unfortunately, dentists sometimes either don’t realize they should (or don’t believe it’s important to) explain what’s going on to the patient, and I believe that was the case for this tooth story. It’s clear the patient didn’t understand the importance of telling me about the implant—otherwise I’m sure she would have mentioned it! 

Lesson #4: You, as a patient, should take on an active role in your care.

While I certainly don’t put the full responsibility of care on my patients, this tooth story shows us that there IS a benefit to taking on a more active role in caring for your dental health. When it comes to communication in interdisciplinary teams, you as a patient have a role to play—for better or worse!

So, what can you do to help facilitate that communication? 

First, make sure you stay informed. While ideally your providers will help you understand what’s going on, that’s unfortunately not always the case. Ultimately, it’s up to you to ask questions and get clarification when needed.

Second, don’t ever blindly trust your providers! Always make sure you know what’s going on and why. That way, should you need to see a specialist, you can fill them in on any missing details and help facilitate communication between all members of your dental team. Trust applies to your treatment plan, too! If, after receiving your diagnosis and treatment plan, something doesn’t feel right, don’t be afraid to ask questions or even seek a second opinion. The more informed you are, the better you’ll be able to advocate for yourself.

Finally, make sure you follow your provider’s instructions and treatment plan, as they’re a crucial part of the healing process. Yes, your provider is responsible for the actual treatment, but if you don’t follow post-op instructions or miss follow-up appointments, any poor outcomes that result from it are at least partially on you! 

So, do yourself a favor and don’t take a back seat in your care. YOU have the power to take control of your health, and it’s easier than you think! Be in the driver’s seat at your next dental visit by enrolling in Tooth Wisdom: The Empowered Patient’s Guide to Oral Health—my self-paced online course designed just for you. Whether you’re looking for a trusted dentist, want to get out of pain, or simply want to take better care of your teeth, this course will give you the knowledge you need to make informed decisions and become your own best advocate at the dentist’s office.

– Sonia