Well, Terry, we all know there are no magic bullets, no magical words that will make someone who doesn't care to come around and have that "dental conversion experience"! And in this case, part of the issue was that the periodontal condition was pretty good, no bone loss, etc, just decay under failing restorations.
I am seeing more and more people who have been restored comfortably for decades, to all of a sudden start having some decay issues, often caused by cough drops that the patient seems to need - probably triggered by some medications that they have been prescribed. Seems like the buccals of lower posteriors are the worst.
I understand demographics, but I also understand that people can surprise you, and sometimes you just have to give people a pathway out of their issues - a plan that is simple and understandable and sort of allows them to proceed at their own pace. This case, for instance, doing some nice provisionals and any endo, then crown lengthening if necessary, then your periodontal therapies, and then they could do the permanent restorations at their convenience- would be one way to attack the issue.
Bob Barkley always used the idea that "When your house is on fire, you don't call a carpenter!" and people understand that. We have to put out the fire, and that fire is a bacterial infection of your gums and teeth.
If someone doesn't care, it won't matter, but if they do care and have reason to hope, they can be helped, don't you think?
Obviously you have to get them out of pain first, but from a behavioral point of view, multiple, low cost and non-invasive appointments give them a chance to know and trust your office!
Rick
On Fri, Mar 22, 2013 at 10:35 AM, <terryfrey@relax2smile.com> wrote:
Rick & Jeff ... At times I've done presentations both these ways plus probably a few that I choose to forget. MY BIGGEST PROBLEM with most of my adult new patient is their periodontal health. If I can't get them to commit to getting that in order, I don't feel it necessary to be presenting much restorative. I will have my PCC/TC explain what we can do to address their chief complaint, if possible to "go around" the perio, but before we get into talking much in the way of cosmetic changes or restorative involving more than palliative treatment, we have to see that they are trying to get healthy. If they aren't, then I pursue a different tack.I find that treatment planning for me can be very difficult, because I start questioning each track that I start down.I'm looking for advice to handle this, but sometimes what I read doesn't appear to be applicable to my demographics. I know that people are people no matter where & I've found that education and financial level does not always correlate with acceptance of or value for dentistry.JMHO ... TerryJ Terry Frey, DDSAdvanced Dental Care623 N State St/PO Box 1008North Vernon, IN 47265(Ofc)812-346-6884(Cell)812-592-4057-------- Original Message --------
Subject: Re: [ACEsthetics] How would you handle these teeth?
From: Rick Coker <riccoker@gmail.com>
Date: Fri, March 22, 2013 10:22 am
To: "DMD Jeff L. Rodgers" <drrodgers@drrodgers.com>
Cc: Deb Shoemaker <drdebshoemaker@att.net>, Ace
<acesthetics@googlegroups.com>
You know, I have done that in the past, adopted a sort of objectivity attitude, but the last few years I have begun to think that this is a sort of abdication of my own accumulated experienced and what might in another universe be called wisdom. Call it the "Dutch Uncle" way of thinking, perhaps.I will lay out the things you mention briefly, but will suggest that if the patient was my wife or sister, there would only be two choices that I would entertain. I like Kent Smith's thinking here, to always have two choices, instead of the multiple ones that my disordered mind can come up with! (I truly believe I could devise approximately a hundred different treatment options for any single issue!). This forces me to make a value judgement as to what is best, what would really work, what I would want- that sort of thing.I just don't think we can afford uninvolvement, we have to have some skin in the game, some emotional investment in saying that : "Here's your problem, and here is how I would fix it if it was me". Not too much involvement, but just a bit.Rick--
On Fri, Mar 22, 2013 at 9:12 AM, Jeff Rodgers <drrodgers@drrodgers.com> wrote:
I would tell them the pros and cons of these 4 options….1. Do nothing2. Ext and partial denture (adding that I do not recommend)3. Endo, crown lengthening, buildups and crowns4. ImplantsThen ask them which way they want to go and I would go that way.Jeff
Jeff L. Rodgers, DMD, PCAtlanta, GA
On Mar 20, 2013, at 11:17 AM, Deb Shoemaker <drdebshoemaker@att.net> wrote:<18-20.jpg>I just removed gold crowns 18, 19 and a 40-year old decaying amalgam #20. The PAx shows what I have left. I have a few ideas on the final treatment options, but I want other opinions in case I am missing something. Any thoughts other than extract and place implants? Predictability and longevity of restoration is key here. Would any of you even try to save these teeth?Thanks,Deb--
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Dr. Rick Coker, DDS, FACE
Director, Academy of Comprehensive Esthetics
www.tyler-smiles.com, www.tylersleep.com
http://www.google.com/profiles/riccoker.
903-581-1777
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Dr. Rick Coker, DDS, FACE
Director, Academy of Comprehensive Esthetics
www.tyler-smiles.com, www.tylersleep.com
http://www.google.com/profiles/riccoker.
903-581-1777
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