The elegant and well-dressed woman sat uncomfortably in the dental office visitor’s chair. She must have been in her early to middle 60’s, but seemed to look a great deal younger. When she spoke her teeth showed straight and white in a face highlighted with animation, but there was obviously something disturbing her equilibrium.
“So what you are saying, Doctor, is that the last dentist I went to messed up my mouth”, she said, trying to keep any agitation out of her voice.
On the other side of the desk the dentist, dressed professionally in crisp striped shirt, tie and white consultation jacket, replied; “I would not say that. There was certainly nothing intentional, but it often happens that when seeing a familiar patient over a period of ten or twenty years, some things get overlooked. A dentist can come to think of a patient as having great eeth, and not see by\eyond to what can only be detected by an extremely thorough examination. In your case your old dentist, being also part of an older educational d\generation, may not have been as sensitized to some of the problems with gum disease that more recent graduates are.”
“But I think I’ve taken good care of my teeth. I bush twice a day and have for years. I watch my diet and stay away from soft drinks. Does this have anything to do with gum disease?”, she asked.
“Possibly not. Certainly you show little sign of decay on the crowns of your teeth, where the enamel covers. Other than the very conservative fillings that you had done when you were younger, your decay history is very mild. The crowns that you have were placed largely due to breakage of tooth structure after certain areas were worn flat and weakened with cracks. Good hygiene at home keeps common decay processes at bay. However, you are now encountering decay in areas of your teeth not protected by the enamel, AND lesions that need to be restored that are not caused by decay, but by grinding your teeth.. These involve areas were never meant to be exposed to the elements.”
“Still”, she replied, “How could this happen so subtly and now end up costing me thousands of dollars?”
It was clear that the woman wanted to know as much about her condition as he could tell her. She had always been proud of her smile and of her teeth which always attracted admiring comments from friends and suitors. Being widowed 5 years ago and maintaining a very active social life, her appearance had been of great consequence. Yet now, she was finding out that she did not have a major aspect of her appearance under control, that her mouth was unhealthy and shd didn’t even know it!
Her only recourse now seemed to be to try to understand the explanations of this obviously caring dentist, but whom she had known for only a short time. She came to him after moving into the area and receiving a mailer from his office. He described himself as a professor at a dental school in the area and a practitioner who cares about teaching patients about their mouth. Could she trust him? Should she seek a second opinion and subject herself to the possible attempts of another dentist to “win her over” to his practice? She trusted her old dentist for 20 years and yet he left her in a difficult position.
“The problems you are facing weren’t all that well known even thirty years ago. Periodontal disease can be mild and still lead to recession over the decades, and as soon as the root is exposed even a little, it is much more susceptible to decay at the edge where the enamel stops. And, the notches on the outside surfaces of many of your teeth at the gum line were for decades thought to be due to excessive tooth bushing. Your dentist may well have told you to use a softer brush. Now we know that these eroded areas are due to excessive forces applied to the teeth in sideways grinding movement. The teeth actually BEND, and the material breaks down there and makes a notch. They need to be filled if they are deep enough to threaten the pulp or significantly weaken the tooth, if they are sensitive or they are esthetically not pleasing. In your case they are not sensitive, but they are becoming noticeable in your smile, and deep enough in several instances where they should be filled to prevent further damage. And a night guard can be worn to prevent more problems that come from grinding your teeth.”
“Thank you, Doctor, for taking the time to explain this further. So, basically, as my gums recede I am getting some decay on the roots of my teeth, and as I grind the teeth there are notches forming on the outsides of the teeth that need fillings as well. I understand that more specific cleaning techniques at home can be of help, including flossing the plaque away from the areas of root decay, and possibly some form of intervention to keep my grinding from doing more damage. It all makes sense, even if it comes as a surprise!”
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