The Hardest Part of Being Your Dentist Is Probably Not What You Think

Is it the long clinical days, hunched over, working in a dark hole, performing procedures where fractions of a millimeter make all the difference? Or managing anxious, scared patients who would rather be anywhere else but there? Or maybe even the gory side: extractions, blood, spit, bad breath, infections, and generally being elbow-deep in people’s mouths all day? (That’s actually one of my favorites 🙂) Some might even guess it’s the money side—student debt, dealing with insurance companies, and managing to keep the schedule full. 

The truth, at least for me, is that after I’ve looked at your X-rays, examined the tissue around a problem tooth, learned about your history, and obtained a clear clinical picture, there’s a moment when I find myself holding three or four different options in my head at once and trying to figure out which one is right for you.

That internal tug-of-war—more than the physical strain of hunched shoulders, the constant “I hate the dentist” refrains, or the clinical complexity of a difficult case—is truly the most demanding aspect of this profession. My objective is to ensure that the individual sitting in my chair receives the result they deserve. Yet, in this line of work, determining what is truly optimal is a moving target that remains remarkably difficult to hit.

When we complete extensive treatment, my goal is to have that be the last time you have to make an investment like that in your mouth. Plain and simple. But that sometimes requires a level of care that is unreachable, either emotionally or financially. 

Now what?

The Myth of the “Best” Option

In school, answers felt cleaner. If decay reaches a certain depth, you do this kind of procedure. If a tooth fractures a certain way, you treat it this way. The textbook version of dentistry is tidy.

The real world isn’t tidy. Every patient is different. Every option is a tradeoff. 

The phrase best treatment assumes there’s a winner. Most of the time, there are several reasonable paths, each with a different profile of risk, cost, and longevity. You are paying me to help you navigate those complex paths. 

What I’m Weighing

Here’s what’s running through my head when I sit down at night, after the kids are asleep, to study a case and develop a treatment plan.

• Risk vs. benefit: Every procedure carries some risk, no matter how minor. At times, the more aggressive option will provide a more predictable outcome but could lead to other issues down the line. And so much of the outcome depends on the patient – how consistently they care for their teeth and keep up with maintenance long after they leave the chair. 
• Longevity: A filling, an inlay, a crown, an implant—they age differently. Some buy you ten reliable years; others can run twenty-five if conditions are right. Knowing how long a restoration is likely to last in your mouth and with your habits changes the algorithm.
• Cost: Money matters, and pretending it doesn’t is a disservice. The “ideal” plan that requires nine appointments and an out-of-pocket figure you can’t comfortably afford isn’t ideal. It’s a pipe dream. The right plan is one you can actually finish. And yes, good dentistry is going to be an investment. But it shouldn’t force you into a financial predicament. That said, early intervention is ALWAYS less costly. 
• Invasiveness: How much healthy tooth structure do we have to remove? Once enamel is gone, it’s gone forever. Sometimes, the conservative option is correct even if it’s not the most complete thing on paper. Sometimes, it’s a band-aid that buys us time safely. And sometimes, it isn’t. With nearly two decades of combined experience informing those decisions, knowing the difference is judgment, not a formula.
• Your habits: If you grind, certain materials won’t survive. If you don’t floss, restorations will fail faster. If you smoke or vape, healing changes. If you battle depression, maybe you’re prone to times when you don’t go through your at-home care routine and compromise your treatment and investment. I have to plan for the patient who’s sitting in my chair, not the patient in the educational pamphlet.
• Your ability to change those habits: This is where it gets genuinely difficult. Do I plan for the optimistic version of you? Or the you over the last twenty years? There’s no clean answer. I have to read the room.

Why Your Life Matters as Much as Your X-rays

I think a lot of patients assume dentistry is an exact science—that the right answer is hidden in the X-rays if I just look hard enough. It isn’t. Two people can have nearly identical X-rays and need very different treatment plans. There’s an old saying in dentistry: “Ask ten dentists, get eleven opinions.”

The patient who travels constantly for work, can’t always get back for a follow-up (or refuses to do so), and clenches at night, needs planning through that lens. The patient who has a low-stress schedule and has had pristine oral hygiene since they were sixteen is a different world. Similar imaging, two very different plans.

That’s why getting to know patients as people is so important. It provides the framework to operate in. 

How We Decide 

When someone has delayed comprehensive treatment and needs my help in a big way, their usual flow through my office starts with the initial consultation, which we call the best checkup ever. (I wrote about it in an earlier blog: “Best Checkup Ever”) 

During that visit, I collect your information via records, like X-rays, digital scans, and CBCT scans. And I get to know you—who you are, what your priorities are, and what your expectations are. Then I sit with all that information, wrestle with it, and ultimately lay out options.

One week later, we meet again and take a tour of what is and what could be. Although there are many ways to go about things, I will recommend what I think fits you best. When you walk out of a treatment consult with me, I want you to understand four things. That’s why I list all of them in plain English and share them with you in an easy-to-follow outline:

• What we found in your mouth.
• Why I’m leaning toward a particular option for you specifically.
• What would change my recommendation if circumstances changed.
• What happens if we do nothing—at least for now.

That last one is important. Sometimes, “Let’s keep an eye on it” is the right thing to do, despite what “experts” may say. I’m over experts. 

Living with the Uncertainty

Here’s the part of being a provider that doesn’t get talked about much: I don’t get certainty in this line of business. I make the best decision I can with the information I have, and then I live with the outcome. It’s kind of like being a parent.

Sometimes, a patient comes back two years later, and the conservative restoration I chose is holding beautifully. Then I feel great. But sometimes, a piece of work fails earlier than I expected, and I spiral in self-doubt as I reconsider the most basic aspects of my decision-making trees. 

I’m sharing this not to shake your confidence in your dentist. (Is that what’s happening? I hope it’s the opposite.) I could make processes easier by defaulting to the most conservative thing. Or by always recommending the most thorough thing. Or always recommending whatever insurance most easily approves. It’s tempting. Defaults are simpler. 

But defaults aren’t optimized for you.

What This Means for Your Next Visit

The next time you sit down with your provider to discuss your treatment options, you should walk away feeling that they’ve given your case specific consideration. One of the gifts of working in a private office (which is a dwindling phenomenon), free from quotas and pencil-pusher pressures, is that we’re able to take that one-on-one approach with our patients. I know them by name. I know their families, hobbies, worries, and concerns. And I take all of that into account. I think about how much they understand their current condition and possible options, then my team and I put together educational videos to watch with the patient during their treatment consult visit. We want them to have the background knowledge needed for a true shared decision making process. 

When I say, “This is what I would do,” I mean it. I’ve put a lot of thought into that statement. And I respect the privilege and weight of the trust placed in me. I do not take it lightly. 

There is no version of this work where you, or I, get to be certain. But I can offer you honest deliberation and a real conversation.

That’s what we aim for at Semidey Dental, every time.

Whether you’re just up the road or coming from Weston, Davie, or Fort Lauderdale, we’d be glad to welcome you into the kind of care that starts with a real conversation. When you’re ready, we’re here.

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