Ethics — To Quadrant Dentistry or Not?

Paul Hsiao, DDS, MPH, JD

How is quadrant dentistry an ethical issue? Well, is it ethical to complete one filling at a time when there are also cavities on multiple teeth in the same quadrant? When recommending treatment plans, we should at least consider whether consolidating treatment into quadrants is feasible so we can be efficient with our and our patients’ time.

With quadrant dentistry, we are not traumatizing the patient’s tissues and muscles as often. Furthermore, many patients don’t have the luxury of taking multiple days off from work for themselves or for their kids in order to have procedures extended over a significant amount of time. For example, if the patient needed 12 fillings and the fillings were completed in 12 visits, there could be challenges with transportation, school and work, not to mention motivation to keep coming back.

Additionally, why give three nerve blocks over three visits when one visit and one nerve block can take care of the same three teeth? Aside from reduced trauma and trips to the office, consolidating treatment can result in fewer missed appointments because there is a higher probability of missed or broken appointments with more trips. Countless social media, practice management, phone calling, emails, postcards and software are aimed at decreasing no-show rates. If we can decrease the number of visits simply by performing quadrant dentistry, there’s potential for increased revenue because of less money and resources wasted in reminders. Moreover, fewer visits means setting up and breaking down the room fewer times. Resources spent on three visits could be condensed into one visit with less excess trash created from sterilization pouches, sharps, barriers, gowns, masks, suction tips, etc.

The ultimate ethical principle as a dental professional is to serve our patients and promote high standards. If a treatment plan includes multiple treatments in close proximity, discuss with the patient the pros and cons of having the treatment completed in one visit versus multiple visits. Multiple visits may be preferable for a variety of reasons (patient preference, length of treatment, medical condition, cost); however, patients will often appreciate the choice of consolidating treatment. We owe it to society to address carious lesions more quickly than addressing one filling a time and one month apart. The general public relies on us to perform to the best of our abilities, but we should also be efficient and effective with our time. CDA’s Code of Ethics section 5 states that “dentists have the obligation to advance their knowledge and keep their skills freshened by continuing education throughout their professional lives.” Therefore, quadrant dentistry seems like a logical choice for both the profession and the patients. n

Paul Hsiao, DDS, MPH, JD, is a general dentist practicing in Fresno, Calif. He served on the CDA Judicial Council.