Putting the Patient First

Kathleen Safford has been a patient of UCSF Dental Center since 1990. In 2022, she moved to the care of Dr. Melissa Tuft, who had recently joined UCSF Dentistry.

“I chose her based on her career in private practice,” Ms. Safford said. “I thought it was great for the patients and also the students to get the benefit of all her experience.”

After routine X-rays, Dr. Tuft discovered extensive decay under a crown on one of Ms. Safford’s teeth. The usual procedure would be to extract the tooth and implant a replacement.

Dr. Tuft carefully reviewed Ms. Safford’s dental record, which was integrated with UCSF Health, and learned the patient had just begun treatment for osteoporosis. Patients taking bisphosphonates are recommended to avoid invasive dental procedures due to the risk of osteonecrosis of the bone. To proceed with the extraction while she was on the medication posed a great risk to the patient. Not taking the medication during the extraction and implantation could delay osteoporosis treatment for nine months or longer, which would leave the patient vulnerable to advancing disease.

Considering the patient’s circumstances and committed to achieving the best possible outcome for her, Dr. Tuft decided that she would do everything possible to save the tooth.

Ms. Safford understood that oral surgery was not recommended for patients with osteoporosis. She was greatly relieved when Dr. Tuft presented her plan.

“She was willing to give it a try, which I think we both thought was going to be an exercise in futility given what she saw on the X-ray,” Ms. Safford said. “She did a great job. She took care of the decay and replaced the crown. Not having to delay treatment was a great relief. I was elated.”

Dr. Tuft said that the successful outcome was far from certain, but if the attempt didn’t work as hoped, they could still do the extraction. Her calculation was that it was better to make the effort and try to spare the patient the anxiety about her other health issues. In this case, the additional time and care paid off.

“Dr. Tuft is a true role model for patient-centered care,” Ms. Safford said. “She had empathy, which made all the difference for me. I will always be grateful for her.”