This is one of the most useful time-management tools that I use in day-to-day practice. By asking these questions before each task it allows me to focus on the most important task at any one time.

I thought that I would transfer this tool into a way of reviewing dental implant and periodontic procedures.


• Do: BPE regularly. Despite all the scientific arguments about this procedure, I find it an essential screening tool that provides me with more than enough information to determine if further diagnosis and treatment is necessary. It is a quick and easy procedure to perform once fully understood.

• Dump: Full-mouth bleeding scores. I believe it is a waste of time that tells me nothing.

• Delegate: Most of your non-surgical therapy from hand to ultrasonic instrumentation. It is more efficient and cost effective and, in my opinion, clinically more effective.

• Defer: Bleeding point scores until you have performed the initial treatment phase. Bleeding points may be of use at recall appointments when there are some non-responding sites where they may tell us something about disease activity. Or maybe they don’t.

Dental implants

• Do: Thorough diagnosis, case selection and treatment planning. The procedure to actually place dental implants is relatively straightforward once everything else is in place.

• Dump: Some of Branemark’s original protocol. In its time it was forward looking and brilliant. However, I am convinced that some of the protocols, although still relevant to a degree, must be reviewed and dental implant clinical procedures developed to fit with the current thoughts. Despite this thought, it is a wise idea to remember to avoid throwing the baby out with the bathwater.

• Delegate: Pre-operative and post-operative maintenance therapy to the practice hygienist/therapist. Before performing extensive restorative care, the preventive therapies must be well established in the patient’s daily routines and they must be encouraged to attend for regular post-operative follow-up appointments.

• Defer: Doing dental implants until you have attended a suitable training programme run by experienced clinicians. Do not run before you can walk.

The four Ds is easy to remember and use. It may now be considered both a time-management tool and a mechanism for education and information recall.