The Benefits of being a Treatment Co-ordinator at Absolute Dental, Kingsbridge

It was my pleasure recently to act as treatment co-ordinator and nurse for a new patient to the practice. He and his family had moved to Devon from London in an attempt to alleviate his sons asthma. The patient is male, 44 years of age, a saxophone player who suffers from asthma. This patient originally presented at Absolute Dental due to a broken tooth in the upper left quadrant. On examination it was clear that although the UL8 required immediate restoration, there was no carries present, and also that the patient had a severely worn dentition.

During his consultation with Rhodri John we found out that he was aware of bruxing in the past, approximately 15 years ago which was associated with the stress of a high powered city job. Since ‘retiring’ to a more stress free lifestyle the tell tale symptoms and signs have ceased. As this was investigated more we found out that the patient’s diet was also quite acidic (including fruit juice, cordial and white wine). The patient also suffered with indigestion and possible acid reflux (probably stress induced) although the patient had never sought a medical diagnosis or treatment for this. At this appointment the options for restoring the worn dentition were only briefly discussed and only the UL8 was repaired, as this was the patients primary need.

When the patient returned to us for a scheduled New Patient Consultation we were able to take a more detailed history from the patient and discuss his “wants” in more detail. Our previous discussion with the patient had caused him to consider the possibilities for his worn upper dentition. His grinding was discussed in more detail and the patient revealed that although he had experienced pain in his TMJ on waking previously, he had not been aware of it for some time, nor had he been told that he was grinding at night for some time. Our options had been full mouth rehabilitation involving extensive crown work, which would mean removal of more
of the natural tooth surface, which had already been compromised by the patients
grinding/erosion; composite build ups on the upper 3-3 to give the patient anterior occlusion only, allowing the posterior teeth to over-erupt into occlusion (Dahl principle) or to leave the patient and carry out no treatment.

Because we had seen and treated this patient previously, we had already begun to build a rapport with the patient and his confidence and trust in us was growing. This meant that although the patient had decided to dismiss the idea of having the teeth crowned, he had decided that he wanted to improve their appearance and wanted to discuss the composite build ups further. The patient was amazed that until moving to Devon and visiting Absolute, the only options for improving the function and appearance of these anterior teeth had been invasive and non-reversible treatment. The patient said that he was willing to try the composite build
ups, and understood that if he couldn’t cope with the anterior only bite, the whole procedure could be reversed.

Our radiographs at this initial consultation showed some areas of bone loss, most noticeably in the lower left molar region where there was some furcation involvement. It was believed that this bone loss was consistent with past periodontal disease, but likely exacerbated by the patients previous bruxism; the patient may need to see our periodontal specialist for bone regeneration therapy in the future. The radiographs were shown to the patient and discussed in some depth so that the patient could see that his grinding habits were not only affecting the appearance of his teeth, but also the supporting structures.

Once again, the patient was grateful for our explanation as he had never understood this before. Picture 1 shows the patients dentition at his initial appointment.

This patient was now ready to make a positive decision on the treatment and chose to have the composite veneers placed, after a course of home whitening and routine periodontal therapy. Impressions were taken for the whitening trays and study models were cast and articulated. Our dental laboratory made diagnostic wax ups which were used to help in the treatment planning and help the patient to visualise the final result.

Once the patient had achieved the shade he was happy with through the whitening we saw him to begin the composite veneers. This took place during a 2 and a half hour appointment where, without local anaesthetic, the patients upper incisors and canines were transformed from their worn flattened appearance into teeth that looked so natural healthy that the patient was quite literally lost for words. Layers of composite were built up gradually replacing dentine and enamel, adding translucency at the incisal edge for a more natural appearance, starting with the
upper right canine and incisors first (picture 2).

At this stage the effect is already staggering, and as the dental nurse assisting in this procedure, I am already aware at how much of an impact the final result will have on the patient. More shades of composite are combined, like an artist mixing their palate for a painting, as the left side is completed; and then it’s time for the reveal.....

Now, I know how good they look and how clever the dentist is to have worked freehand to transform these worn teeth into the natural looking composite veneers that the patient now has, but there is always a moment when you wonder if the patient appreciates the complexity as
much as the dental team. As I hand the patient the mirror he simply beams widely and says “Wow – they look amazing!” And do you know what – he was right (picture 3).

This patient is by no means out of the woods yet, only time will tell if he can tolerate his occlusion in this transition period, or if he is indeed still grinding his teeth, in which case these composite veneers might need adjusting, but what is clear at this stage is that this patient wanted a solution to his worn dentition that was non invasive and gave him his confidence back – and we’ve helped him to achieve that.

In the post treatment video testimonial that I took from this patient he described the treatment as comfortable and relaxing (so much so that he nearly nodded off at one point), and that he was grateful to have been offered this treatment for the first time and had the treatment explained and delivered to him in such a competent and professional manner.

I love cases like this; I feel proud to work with such a talented dentist like Rhod and to help a patient in such a dramatic way and I look forward to monitoring his progress closely over the coming months.

Diane