Treatment Planning Dental Patients with Compromised Health


A 70 year old female came in a week ago.   She has had good dental care for many years up until only the last couple of years.

When she came to see me, her crown had fallen off her first premolar (the tooth just behind the canine). After inspecting the crown, I saw a much bigger problem because the tooth structure was sitting inside the crown and there was no tooth structure left above the gum line to recement the crown.

Before providing her the options for treating this tooth I noticed she had difficulty breathing. She said that she has been diagnosed with COPD, and her doctor said that the average life expectancy for such a case is about 4 years…not very long in my opinion.

This tooth is in the smile zone and something needs to be done for her. The first order of business is to have the tooth extracted.

The most often recommended treatment is to have a dental implant placed and, a few months later when the implant is fully osteointegrated (fused to the bone) to have a permanent crown cemented. This procedure is predictable and lasts a long time. The entire procedure is more costly than most dental procedures but is the best way to go.

Dental bridges work well but the teeth on either side of the space need to be crowned to support the missing tooth. The price tag on this is similar or a little less, usually, than the implant procedure. The patient doesn’t have to wait as long as the implant procedure, so this can be accomplished rather quickly (just need the gum tissue to heal at the extraction site).

A third choice is to have a removable tooth fabricated. This is known as a flipper or a removable partial denture. This can be fabricated as a temporary solution until the implant is ready to be restored, or it can give the patient more time until the patient is ready to move on one of the more recommended solutions (implant or bridge).

For this patient, money is an issue, and she is also concerned with her medical problem. Something removable, possibly as the final solution to this dental problem, may be just the perfect way to restore her mouth.