Where to start dental treatment

In the last couple of weeks I have had several patients come in who were in very bad dental condition.  They have broken teeth, gum disease , missing teeth, and one was in pain.  These patients have been avoiding the dentist, either because of fear or because of financial problems.  So, now they have appeared, at my office, and fixing their mouths might be overwhelming.

So where do we start?  I always like to start with handling the emergencies.  This could be because of pain or because of a cosmetic emergency.  For tooth pain, the choices are having a root canal orextracting the tooth or teeth, and then having an implant, fixed bridge or a removable partial denture to replace the tooth or teeth.   If any other dental work is required, we will sometimes make a temporary treatment partial denture, especially if the missing tooth is in the cosmetic zone.

After the tooth emergencies are handled, I like to move on to checking the gums and making sure they are in good order.  A simple cleaning (prophylaxis) is performed, or the patient may need to have a deep cleaning.  It is also possible that gum surgery at a periodontist is indicated.  In that instance, I do like to move on to examining the teeth.

On the tooth side, there may be decay or broken teeth that need to be addressed.  I like to do fillings to control the decay first, then move on to any crowns that need to be done.  If the patient needs a root canal, that would need to be performed before a crown is placed on that tooth.

Once the gums and teeth are stable, then the patient can move on to any orthodontic treatment, implant treatment, removable denture treatment or cosmetic treatment.  This phase takes some sharp planning to get the desired result.  You don’t want to expend time, effort and money and have to do something else.

Once you have everything healthy, functioning well and cosmetic, it’s time to maintain all of the benefits received.  Great home care is paramount.  Appropriate intervals for dental cleanings or periodonatal maintenance is very important.  Some people need to wear bite guards if they grind their teeth which will help to save both the enamel as well as all of the dental work received.  I have noticed that patients who floss regularly, wear their bite guards (when appropriate) and have their cleanings at the recommended intervals are VERY stable compared to the rest of my patient base.  If does take some commitment!