Karun Dewan
16, Jun 2020

“I want all my teeth pulled out and replaced with a denture”

The Art of Prosthetic Dentistry & Patient Expectations.

By Karun Dewan Consultant in Restorative Dentistry, Specialist in Prosthodontics Endodontics& Periodontics.

Teeth can become a major headache from when they either first start to be an embarrassment due to how they look or the repeated dental pain although episodic and intermittent to start with, the dental pain is all too common to remind them: “I’m so sick of failing teeth, dental problems, pain, abscesses. My life would be easier if I just had all my teeth pulled and got dentures”.

If you are one of those people who have started to think Life will be better If you just pull all your teeth and your worry will disappear then THINK TWICE!

I hear this statement so often in my daily practice. Tooth decay is one of the main causes of toothache and is due to bacteria in your mouth. These bacteria thrive on the starches and sugars in foods you eat, gradually forming a sticky, colourless layer of plaque over your tooth surfaces. Unfortunately, the bacteria in plaque produce acid that will gradually erode the hard tooth enamel covering your tooth surfaces. Eventually this results in a cavity. One of the first signs of tooth decay is noticing your tooth feels a bit more sensitive whenever you eat something hot or cold or anything very sweet.

Typically, much is spoken about the decline in dental caries among the younger population and the long-term effects that this decline may have on the profession. Yet there is a tendency to ignore our aging population with its often extensively restored dentitions. The management of restorative failure is becoming an ever-increasing challenge to the profession compounded with the ever-increasing problems of tooth wear. Anxiety, which can be either primarily of dental origin (e.g., lost teeth or restorations) or of psychogenic origin but aggravated by dental treatment is one another huge factor that makes people frustrated and further alienate themselves for reaching out for the right help and the right time by the right person.

I have also heard plenty of times: “ I had all my teeth pulled and got dentures.  I thought that would solve my dental problems.  Now, the dentures don’t fit right, they hurt, I can’t eat and most of the time I go around without teeth because these plastic things just don’t work for me”.

Removable dentures construction what I believe falls under the art of prosthetic dentistry. The artistry is to not just to replace the lost hard and soft tissues but very importantly, getting the patient bite correct from vertical, horizontal and when dentures are in function such as when chewing food. To ensure that the dentures are supported well over the tissues, are stable and are retentive are key three areas where successful outcome could be reached even though dentures will never be able to replace the lost teeth that were fixed to your jaw bone via periodontal ligament fibres. There is reduced masticatory function due to severance of proprioception following tooth loss, and if the patient has poor neuromuscular adaptability, no matter how well technically the dentures are made, they will fail eventually from the patient perspective.

The relevance of patients’ expectations for health outcomes has received increasing attention in recent years. Expectations play an important role in both physical (Di Blasi et al., 2001; Mondloch et al., 2001) and mental health (Constantino et al., 2011; Rief et al., 2015; Kube et al., 2017).

Managing Patient Expectations via Effective patient communication can go a long way to increase satisfaction with treatment outcomes, ensuring the patient knows what to expect at every stage of the process. Not only does this benefit the practice reputation, but it can also streamline the workflow and reduce the potential for prosthesis and restoration remakes. Patient expectations in dentistry have grown over the years as the importance of a good smile has become more apparent. Patients are also more informed with greater access to clinical information and are more aware of the options available to them. For the dental professional this can be encouraging in many ways as patients are more engaged and motivated in their treatment and are more receptive to their treatment plan. However, there are challenges with this too; patient expectations can be misaligned with reality and so careful management of these, from the very first appointment, is imperative. Further still, regular and free-flowing communication with patients and the dental team throughout the treatment journey can ensure that all parties are satisfied with the outcome.

The dentist must balance the patient’s view of the end result with the materials and techniques available to achieve this, as well as your ability to reach it in light of the patient’s anatomical structure, complexity of case, your skills set and training. It can be a delicate conversation to be had with a patient if their expectations are not achievable. Openness and honesty from the start can promote trust and increase the chance of satisfaction with the final results.  The key to success is to set expectations from the start, invest in good communication, be transparent, define and discuss your goals early, learn how to say no when necessary, know your own limitations and learn from your mistake.

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