MEDICAL HISTORY

 I recently had a patient return to my office after 12 years. At that time he needed and was treated for a deep periodontal cleaning.  Shortly thereafter he moved. Now in his late 50’s he returns to my office.  He has had HIV for some time, but he was diagnosed with a Stage 4 bone cancer which seems to be in remission.  

DENTAL CONDITION

However his dental condition has deteriorated considerably.  He has several missing posterior teeth on the upper left, plus he’s missing all of his lower posterior teeth.  He has much decay on his front teeth, both upper and lower.  One of his upper lateral incisors was so bad that he broke it off at the gum line and it needed to be extracted.So, what am I to do with this patient?

TREATMENT

One choice is to recommend full mouth dentures.  This may be the practical choice, but he has had a difficult time with a treatment partial denture made a couple of years ago that he didn’t wear at all.The patient has indicated that he would like to save the teeth that he has if possible.  So, the idea is to save the teeth and then see if that is something that he can afford.  Implants are not a great idea at this time because the full treatment plan has not been worked out.  Once presented, the patient has a choice of proceeding with that or going the complete denture route.  

His treatment will include a deep cleaning which needs to be performed first, then caries control for the extensive decay on his natural teeth.  He has some crowns that have decay around them and will have to be replaced.The prognosis for most of his decayed natural teeth is fair to good.  I want to avoid placing crowns on the natural teeth as this will greatly increase the fee at the beginning, and the stability of his health is not certain.  The best bet is to proceed along quickly to at least get the decay under control.The other problem is of course financial.  The patient is not yet aware of the total cost of this approach.  So the treatment has to be done sequentially but with the great decay, time is of the essence.  At any time the patient can opt into complete dentures, so I don’t want to get into the more expensive treatments (crowns and root canals) until we are certain we can get a good stable result.  This is certainly not a clear cut treatment plan and will be adjusted as significant changes occur.