A patient comes into your office with a denture that is 5 years old and says, “My insurance will pay for a new denture every 5 years, so I’m here for my new denture.” You have rent and payroll due, and it’s been a slow month. You check the fit of the denture and it is satisfactory. The patient acknowledges no problem eating anything and thinks they look great. He only wants new dentures because the insurance will pay for them. He also has an old denture as a spare. The insurance company will pay only for needed treatment. However, the patient feels he is entitled to his new dentures since he pays all his premiums on time. What are you going to do?

You have just started a new job as an associate in an established, high-quality office. The employer/owner dentist has diagnosed four quadrants of scaling and root planning for the patient you are seeing. On checking the periodontal condition, you find no pocketing >4 mm with only slight supragingival calculus on the lingual of teeth #23 to #26. What are you going to say to the patient and to your boss, the employer/owner dentist?

The very next day you see another patient as the associate dentist. A tooth has been diagnosed by the employer/owner dentist to need a buildup and crown. On examination you find that a two-surface amalgam restoration, in your opinion, would function just as well. Your education loan payment is due and you really need this job. You are paid on a weekly production basis. What are you going to do?

A patient had a crown placed on #14. Two years later she comes in for a maintenance visit. The periodontal condition is within normal limits except between #14 and #15, where there is a 5 mm pocket and the tissue bleeds easily on probing. The patient states that she always gets food trapped between the two teeth ever since the crown was placed. Tooth #15 only needs an occlusal restoration. On examination, the contact between #14 and #15 is not ideal. In fact, it is open. What are you going to do? Extend the restoration on #15 to the mesial to tighten the contact even though there is no decay, or remake the crown on #14 (if so, at no charge or for some sort of fee)?

A patient comes into your office with limited funds available for dentistry. He wants to do what is best. Tooth #18 has an old crown with slight marginal caries. Tooth #20 has a small occlusal amalgam with no caries. Tooth #19 is nonrestorable. You recommend the extraction of #19. After talking with the patient, the patient says he can afford some treatment with a payment plan. Would you restore #18 and #20, and place an implant for #19, which would cost more because his insurance does not cover implant-related services, but would be ideal? Or would you make a bridge from #18 to #20, for which the insurance company would cover a portion of the payment but would be less than ideal?

Dr. Drillem is a provider in several insurance plans within a preferred provider organization (PPO), which include Save Teeth Dental Pl/>