November 2015 - Prosthodontist in Johannesburg
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November 2015

Dr Gerald B Kaplan

You be a fly on the wall and listen in to a discussion that I had with a new patient this week.
Ellen (name changed) was in dispair. She had been troubling with a loose implant crown on an upper front tooth for over a month. She saw a dentist but he could not help. The problem was beyond him and he offered no practical advice.
Not knowing who to turn to for help, she Googled and found me on the Internet.
I set about dealing with this problem because it was a matter of urgency. She was very uncomfortable and self-conscious and needed prompt attention, which is now being dealt with. Her immediate problem was now my focus.

Having gotten the process in motion to deal with the upper front tooth, I then spent the next 30 minutes talking to her about how she would like her teeth to be going forward, even as far as 15 to 20 years from now?

She told me that her teeth are important for eating and smiling. She does not ever want to wear dentures.
The reality is that her mouth is greatly run down and in need of much advanced restorative dentistry and she was not aware of anything other than the failing implant on the front tooth! It was only after I asked her whether she would like me to make her aware of other dentistry that needed to be attended to that I proceeded to complete the comprehensive examination.. She said yes to my professional advice and that led us into a lengthy discussion as to how did she get into such a predicament?

Well let’s hear what she had to say…

She remembers seeing a dentist when she was in standard 9 and 17 years old. She presented with a large cavity on the lower molar tooth which was then filled. It was fine for a few years before the tooth started to break. The tooth started to become painful and the decay extended into the nerve of the tooth .The choice was now: a root treatment or extraction. A root treatment was chosen. With time the root treated tooth developed an abscess and became excruciatingly painful. This happened whilst the dentist was on holiday and it was difficult to get help. What unnecessary pain and suffering to endure especially at the wrong time. The abscess has to be drained and therefore the tooth was extracted.

The tooth was never replaced. No suggestion was made about a bridge or implant. The bite began to change with drifting and shifting of teeth. The wrinkles on her face started to increase.

With the passage of time she noticed all the other teeth starting to chip and break down. Spaces started to develop between the front teeth as well . Over the years she saw her dentist regularly and had extensive dental care which involved fillings and more root treatments .She was for ever having to be at the dentist for one problem or another.

Three years ago the crown on the upper front tooth came off. An x-ray of the tooth showed that the root had fractured. They attempted to save the tooth with a surgical procedure. That failed. The tooth was then extracted and replace with implant. And now the implant crown has failed!

This story of a downward spiralling cascade in dental health has spanned 25 years, slowly but surely. What a futile cost in time, effort and expense!

The starting point many years ago was a beautiful mouth in a young patient who was never shown effective plaque control nor properly taught by a dentist and also endured bad dentistry.

A small cavity becomes a big cavity; which becomes a root treatment; which becomes a failed root treatment and fractured tooth; and ultimately another tooth has been lost.

Is it not sad to see a dentist year in and year out and slowly suffer the consequences of poor dentistry done in an environment of inadequate plaque control and home care? But nobody told me they all say.

It is a lot more expensive to repair than to prevent.

The story is classic. I hear such a history time and again. I can only shake my head in despair .
Sad but true!