The Fine Line Between Ethics and Experience: A Reflection from the Operatory

 


A Moment Before the Lecture

    A few years ago, I was preparing to deliver an afternoon lecture at a professional gathering of dental specialists. Just before the session began, a young endodontist approached me, holding her phone with an IOPA image displayed. She looked a little unsettled but curious and asked if she could share a quick case with me.

The Dilemma of Doing Right 

    She recounted a recent experience from her clinic: A patient had walked in, requesting a replacement for a crown that had been placed nearly a decade earlier. The patient was asymptomatic, with no pain or swelling, and just wanted a better-looking or perhaps better-fitting crown. As part of routine protocol, an X-ray was taken, which revealed something she hadn’t expected – the root canal filling done ten years ago was clearly underfilled.

Ethically, she did what she had been trained to do. She explained the situation to the patient, informing him that the previous root canal, although functional all these years, wasn’t ideal from a clinical standpoint. She suggested a re-treatment of the root canal before placing a new crown, and the patient, trusting her professional judgment, agreed.

The Patient’s Perspective 

    She proceeded with the retreatment. In the first visit, she removed the gutta-percha and performed biomechanical preparation. The procedure went smoothly, and she sent the patient home. But the next day, he returned, furious and in visible discomfort. He had developed severe pain and noticeable swelling on the side of his face. He demanded to know why a previously trouble-free tooth had suddenly become a source of agony. He shouted, accused, and questioned her competence.

Understandably so. From the patient’s perspective, there was no problem to begin with. He came for a crown replacement and ended up with pain, swelling, and frustration. The young dentist was shattered. Although she managed to calm him down, complete the treatment, and ultimately resolve the situation, she was left with a dissatisfied patient and a deeply unsettled mind.

The Emotional Toll of Ethics

    She asked me then, as an experienced person in this field: “What would you have done differently?”

    And let me tell you, I didn’t have a clear answer. Ethically, she did everything right. As clinicians, it is our duty to inform the patient of the clinical reality and offer the best treatment plan. But ethics and experience often find themselves on different ends of the scale.

What Would I Have Done? 

    I reflected, and perhaps, had I been in her place, I might have chosen to simply advise the prosthodontist to go ahead with the crown replacement, after obtaining an informed consent from the patient about the root canal being underfilled and the possibility of needing retreatment in the future. Was that the safer path? Or the lazier one? Or the more empathetic one?

A Room Divided 

    This isn’t about right or wrong. It’s about weighing the risks, understanding the patient’s perspective, and sometimes, balancing the science with the art of medicine. During the lecture that followed, I raised this very case for discussion, and the room was divided. Some agreed with her decision. Others leaned towards mine. Many remained in the grey zone – exactly where this profession often places us.

 Ethics, Experience, and the Grey Zone

    Ironically, the same dilemma surfaced for me again recently. I found myself pausing, recalling that young dentist’s story. And it struck me: Every case, every patient, every decision is not just about clinical precision. It’s about judgment, timing, communication, and sometimes, grace.

    As we grow in our careers, we realize that our textbook knowledge forms the spine of our profession, but our experience, empathy, and reflection become its soul. Ethical lines aren’t always clearly marked. We draw them as we walk, often erasing and redrawing them based on what we learn, who we meet, and how we feel.

A Question Worth Asking 

So, I write this today not with an answer, but with a question:

Where do we draw our ethical lines? And when we do, are we brave enough to question them again?

I invite my colleagues, young and experienced alike, to share their thoughts. Because in our collective reflection lies the path to collective wisdom.

SSP

Comments

Post a Comment

Popular posts from this blog

Are We Cooking the Pulp in Its Own Juices... and Cracking It in the Process?

Image
As dental professionals, we constantly strive to restore health and function to our patients’ teeth. But have we ever paused to consider what’s really happening beneath the surface when we prepare teeth for fillings or crowns? When we drill, we're not just shaping the tooth — we're creating heat and friction that could be silently damaging the very pulp that keeps the tooth alive. The Silent Dangers: Microcracks and Overheating It’s well-known that dental drills, even when water-cooled, can raise pulp temperature by 3–10°C during routine procedures (Zach & Cohen, 1965). That might not sound like much, but it’s enough to tip the balance and cause irreversible pulp damage . And don’t forget the microcracks — those invisible fractures in the enamel and dentin that can undermine a tooth’s strength. Studies have shown that these cracks can weaken the tooth over time, making it more susceptible to fractures (Shetty et al., 2016). Are we really helping by drilling and p...
Read more

The Dental Chair That Has Seen It All

Image
As I sat and thought about that chair — not a throne, not a recliner, not some sculpted ergonomic marvel — just a chair, worn by years and softened by lives — I found myself transported. Not to one moment, but to all of them. Every chair I’ve known since dental school... they’ve all blended into this one memory. In 25 years, there have been many: cracked vinyl, shining leather, metal bases, sleek arms. But they’ve all shared the same sacred duty — to hold stories. And I, more than a dentist, have been their quiet co-witness. I remember the very first one — in the clinical halls of my college. It seemed monstrous then. I walked toward it with gloves too big, and confidence too small. That chair saw my first patient — a classmate, nervous and trusting. It also bore the weight of my embarrassment when I couldn’t find the right angle for a mirror, or when my cotton roll flew into the air. It was there through the crucible of clinical exams — the invigilators peering over shoulders, my hear...
Read more