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A clinician’s failure to investigate TSL adequately, which can lead to an incorrect diagnosis and inappropriate treatment (especially where such treatment is unnecessarily interventive), is the most common problem encountered. A clinician’s ability to withstand such challenges will rely, in part, on the extent to which the clinical records can demonstrate each of the stages in the diagnostic and treatment process. Excluding tooth tissue loss through trauma, caries, or interventive procedures, TSL can arise from three main factors, either alone or – as often occurs – in combination. These are erosion, attrition, and abrasion.
The ten-point checklist below serves to highlight key questions and areas to consider when diagnosing and treating TSL. Use it to assess and improve the quality of your own clinical records the next time you are treating a patient who has presented with TSL. Remember also that TSL may not be static – a review appointment following initial assessment and treatment is an ideal opportunity to build on whatever information you have gathered previously, and this may also lead you to explore additional or alternative aetiological factors or different treatment approaches.
Any failure to recognise or manage TSL in an appropriate fashion, which then results in the condition deteriorating unnecessarily, can leave a clinician open to criticism. Where TSL has been present for some time, and is not progressing, it is sufficient in most cases to record the fact that it has been recognised and pointed out to the patient, and is being kept under observation. On the other hand, proceeding too hastily – or with insufficient prior assessment and investigation – with extensive restorative treatment, can be difficult to justify and defend if this treatment subsequently proves to be unsuccessful.