Wednesday, May 23, 2012

Full-Mouth Rehab

A couple of things before I get started. This weekend we had NO games. I really was confused when I woke up on Saturday. You mean I have no athletic thing at all today? It was just weird.

Oh, before I forget, I put two videos on YouTube this week. These are the videos I made for my lecture. I am going to put them on my Speaker Packet DVD. I think they turned out okay. I have had 40 views in two days. One is my schpeal on my lecture and the other is a before-and-after teaser. Tell me what you think.

And the last thing before I talk about teeth. My son turns 13 next week. I am having a hard time with this. I didn't have a problem turning 40, but in five years, he will be out of the house. This is the time I remember the most from when I was a kid. I recollect a ton of stuff from middle school and high school. I think about him in 15 years and wonder what he is going to remember. A lot of stuff happened in my life at that age that made me the way I am right now. I wonder what it is going to be for him. Will I be part of that?

I heard today that a mother of one of our patients, 45 years old, died in her sleep. Dang. I know heaven is real and I know I am going there, but I really like where I am at right now (God is up there just laughing at that last statement). And I have a TWO-year-old. Life, for me, is going so fast. I can't stop it. All those times I wanted to speed things up, all those times I couldn't wait until the next stage, I take it all back. I have pictures of my kids when they were three and four years old and now they are going to be 12 and 13. Stop this crazy thing!!!

Now, let’s talk teeth. I saw a patient on Friday for the first time on an emergency. She is 45 and had a full mouth rehab done 5 years ago. Her cosmetic dentist was in Winter Park (but has now moved to another state), which is the high-brow part of Orlando. She told me that she spent $42,000 on her mouth five years ago.

She came to me on Friday to have an all-porcelain molar recemented. I looked at this thing and critiqued this dentist’s work. Now, I didn't know the circumstances, but the prep was this little thing and there was about 4mm of porcelain on this tooth. So, this dentist opened up this woman's bite. When I asked the patient about it, she said, "Yes, she wanted me to show more teeth."

She smiled and yes, she showed A LOT of teeth. These were teeth that were whiter than B1 (to all the non dentists out there, B-1 is the lightest natural shade; to go lighter than that, you have refrigerator shades). I noticed she had a repaired chip on #9 and I asked her about it. She started lamenting about it and about how she didn't know there was going to be so much up keep.

See, five years ago she had money. She was living in a fairly exclusive neighborhood, going to a high-brow, high-end dentist. Now she is divorced, living with her parents, and doesn't have the kind of money to keep pouring into this already expensive work. I told her that the problem with this kind of work is that you are married to it. Exasperated, she said, "I know that now."

She asked about failures and if they happen. I told her that the best dentist in the world (Frank Spear) says that he gets a 5% failure rate in five years. That means that if you are the best dentist in the world and you are doing a 24-unit case, you are planning on two failing within five years. Now, how many people do we tell this?

I have done one full-mouth, all-porcelain case, and only because the patient insisted. About four years later, she decided to try a jaw breaker. Jaw breaker vs. all-porcelain crowns. And the winner is… jaw breaker. She broke two of the units. I replaced both with PFMs. Luckily, she hasn't chipped anything in the anteriors.

I do plenty of veneers and never even consider them failing. I am not very good at telling patients that these could fail. Let’s say I do a 10-veneer case. There is a good chance that one of them is going to fail within five years. Here is my thing: I am not having any of my veneers fail, so… I am not saying that I am better than Frank Spear; I am just saying I am on a good run.

But I need to warn folks of the drawbacks of porcelain. Now I tell them, "You have to know that you now have fine china on your teeth. Treat them that way." Then I tell them that the best dentist in the world has a 5% failure rate. I tell them that while I have not had too many failures, we should count on some sort of minimum setback. But back to this patient. She was 40 years old and decided that things were going great in her life and it was a good time to drop $42,000 on her teeth. That was a great day for the patient and the dentist. But little did they both know what the future held. Now that things are not the same in her life, she can't afford any setbacks. Again, I know we don't want to think of the failures. But I think it is in our best interest to be up-front with these patients. If we are not, then they are blindsided and then bitter.

Are you warning your patients about the drawbacks of large cases? Are you afraid to tell them because they might have second thoughts? (This is where I usually fall.) If you do, how do you tell them without talking them out of it? Do you have any patients like the one I saw?

Have a great Wednesday, john

1 comment:

Dr. Andy said...


Very nice videos. What stands out the most is not your dentistry but your passion.



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