Cast gold and informed consent

Over 40 years ago, a survey of 60 beauty pageant finalists between the ages of 15 and 17 concluded that when most of these young women asked their dentists for treatment advice related to cosmetics, the response was “it is not important” or “you look good enough.” Today these answers would be considered inappropriate and insensitive.

But has the pendulum swung too far toward cosmetically-driven dental treatment at the expense of function and longevity? Must these values be mutually exclusive? How much has the manufacturer influenced cosmetically-driven dental care? How much has cosmetic dental treatment resulted in unnecessary health care cost?

Parallel to these questions, has the profession’s previous lack of sensitivity toward the patient’s cosmetic preference played a role in current market trends? Has outdated educational philosophy decreased the use of traditional gold castings? Have cosmetic consequences virtually eliminated the use of cast gold in onlays?

These are just a few of the questions that a conscientious dentist, focused on the patient’s overall well-being, might consider. Today’s dental professional is required to take into account the best current evidence, integrate the patient’s preferences and values, and recommend treatment based on accurate diagnosis and prognosis-related issues. He or she must provide the patient with an informed basis for agreement on treatment, especially considering that many available choices are still experimental. The “latest and greatest” may simply be a product of marketing influence and not what is best for the patient.

Informed consent occurs when a patient, advised of the risks and benefits of each treatment alternative, intentionally authorizes a professional to act. Although this process may take additional time, it is an important investment in the patient/doctor relationship, outweighing the cost. A good clinician determines the best treatment option, based clinical expertise integrated with the patient’s needs and wants. This includes fulfillment of cosmetic desires as well as functional longevity, comfort, and biocompatibility. Achieving one of these criteria at the expense of the other, without the patient’s true, informed consent, clearly poses as an ethical breach in the doctor/patient relationship.

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