PAGD Keystone Explorer Winter 2020

14 www.pagd.org So why did I just spend all this time trying to answer these questions? Well, the obvious answer is that it helps me decide what treatment plan we will now develop. If, for some reason, the patient still decides that he wants all of his remaining teeth removed; I would simply refuse to treat. Viewing the radiographs and photos, there simply is no way that I could justify extracting most of a patient’s teeth just because he is looking for an easy way out so that he can continue an extremely bad habit. I could not even justify referring him, nor do I even know anyone who would treat the patient in this way (but I would bet they exist.) The likely scenario would be that the patient really does not want his teeth removed. He just thinks that his teeth are so bad that they are not worth saving. It is our job to help him past that belief. We need to establish a treatment plan that removes any pain and caries as well as stabilizing the dentition. Let me say that in reviewing the photo and radiograph, there is a reversal of both the image and the radiograph as it appears that #9 was the tooth originally replaced. Also, panoramic radiographs are not ideal for treatment planning and we certainly do not have the ability to examine the patient, but I wonder if the lateral and the central incisors are truly hopeless. I might investigate that a bit further. If those teeth can be saved, I would consider root canals for long-term treatment objectives. I would next restore any caries along with prophylaxis/ periodontal treatment. Behavioral modifications are needed to reduce sugar exposure time on the teeth. I would consider temporary replacement of the partial denture to improve the appearance while the patient is able to change his habits. If the patient can exhibit, through subsequent periodic examination appointments, that he has indeed arrested the decay processes, then I would have him consider a more permanent fixed option. My choice of fixed option would probably be a multi-unit fixed partial denture versus an implant due to gingival esthetics caused by the lack of bone width and the high smile line. This is a great case with no singular way forward except that the patient must totally buy in to the need for saving his remaining teeth. I would proceed cautiously and deliberately. It took the patient eight years to arrive at this point. It will take some time to remedy the problem. “The likely scenario would be that the patient really does not want his teeth removed. He just thinks that his teeth are so bad that they are not worth saving. It is our job to help him past that belief. We need to establish a treatment plan that removes any pain and caries as well as stabilizing the dentition.” Q dentistry issues