In carpentry, the first rule every beginner is taught is: MEASURE TWICE, CUT ONCE! Similarly, dentistry requires the same attention to detail. If one follows my preceding three dental “Commandments“, the prognosis for their teeth can be pretty solid long-term.
For most dental patients, I recommend that they have needed dental work accomplished in as few steps as possible–Do it once; do it the right way the first time in order to avoid multiple procedures. For example, if a tooth needs a crown (Commandment #3), then I may be able to patch it with a filling, but will have to treat the tooth again in the future to protect it with a crown. Treating a tooth twice means twice the risk of injury to the nerve in the root canal of the tooth–since every time a tooth is damaged, infected or restored (“filled”), the nerve inside the tooth is injured/inflamed and must heal. That can happen only so many times before the tooth is irreparably damaged and gives up the ghost–leading to extraction.
Fig. 1 Check out the “new” roof. Sometimes the patch doesn’t “quite” match the original.
I advise my patients that the amount of dental care they need will be directly proportional to the amount of dental work they needed (or should have had…) while in their teenage years. Every 20 years or so, they will need to have the dental work updated or replaced–just like those “20-year” shingles on a roof. Now, I can hear all the nay-sayers out there saying, “Ha! Well my dentist did a great job–my fillings have been there for almost 30 years.” To that, I say, “Please refer back to previously discussed Commandment #1 and Commandment #2, because nothing lasts forever and to maximize long-term predictability of dental care, one must be preemptive in its maintenance.
Figure 2–Before photos (2006)
Though the patched roof in Fig. 1 may not match or look as good as the original (it may be part of a long-term replacement plan by the owner), it should function well until the rest of the project can be completed. For the patient in Fig. 2 and 3, I created a phased treatment plan so that all the procedures needed for his extreme dental makeover (and thus the expenses!) were accomplished over a 7 year period to permit numerous travel opportunities for him and his wife and necessary delays to allow for orthodontic therapy, sinus augmentation and implant healing time. The important part was that he completed his goals on HIS time schedule; got the cosmetic and functional result he desired and each tooth was only restored once!
Fig. 3 Smile complete (2012)
The only time that a “phased” approach to care doesn’t make sense is when one or more teeth must be touched multiple times unnecessarily. It’s not a mandate, but merely advice to avoid increasing the risk of complications. Remember: Commandment #4 really means that the more times a tooth is touched, the more likely one is to lose the tooth! So, if you are in need of extensive dental care, ask your dentist if the option of a phased approach to care would be best for you. If your dentist cannot answer that question to your satisfaction, give my office a call and schedule a consultation appointment to discuss your needs–I’ll do my best to provide sound advice.
Either way: Do it once; do it the right way–the first time.
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Next time: Commandment #5–The “Apartment Building Theory”
Dr. Bobbitt's Dental Pearls 