Tuesday, May 6, 2014

Really? AGAIN?

You see it on the schedule: pt CC is “loose bridge.” Immediately upon the assistant seating the patient, the pt states, “My bridge came loose and I need it recemented.” It’s the kiss of death! Does your stomach flip the moment you see it/hear it? I saw two of these men in the office in only a few weeks! #UGH

Patient #1 is a 78-year-old male who is fairly new to the practice. He reports that he’s had this bridge since the early 70s and denied any previous problems at his new patient interview, early in April.

Three weeks later, Patient #2, a 58-year-old male who has never been seen in my office shows up.

How often are you dealing with this? I can’t believe that I am the only person that absolutely wants to run into my private office and scream at the top of my lungs! Again, #UGH…

Really? #6 is fractured to the gingival line, #11 had endo/post, and the post and core are still retained in the bridge. Of course, the bridge is now in the patient’s hand.

Both patients look bewildered and confused when I begin to explain that it’s not as simple as just recementing the bridge. This is not an easy fix, the patient is overwhelmed, and the time allowed in the schedule is not on my side. This is, by far, one of the most frustrating experiences that I run into.

I find these cases to be a significant struggle. There is an obvious urgency for the patient and as soon as you combine patient urgency and substantial financial obligation, there is an immediate and (more than likely) negative emotional response from the patient (AKA The Perfect Storm!).

For Patient #1, I was able to take an impression and make an essix appliance using the patient’s existing bridge as a relatively inexpensive removable temporary. The patient wanted to discuss his options with his spouse. Unfortunately, Patient #2 refused any treatment after the basic fees were discussed, as he felt that he couldn’t cover the expenses.

How do you temporize? How are you handling these scenarios? Do you feel backed into treatment options that you wouldn’t normally recommend?

Colleen DeLacy, DDS, FAGD

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