Healthy Smile: “I Need A Lot of Work”

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

Missing and broken teeth appeared before me when I met this new patient. The main concern for this gentleman was the appearance of his teeth. A front tooth cracked at the gum line, leaving a large gap. Adjacent to this tooth was two broken teeth. My patient came to the appointment with his wife and valued her opinion. In general, he was nervous and concerned. I do not know if this behavior is typical for him due to living with Covid in our world for the past year.

In general, he wanted to look, feel and eat better. The lower teeth are in much better shape, which means that I can limit my approach to the upper teeth. I began with my usual questions about what type of treatment he was seeking. A question like that does not preclude me from discussing various options but still helps me narrow down the suggestions.

Being in his eighties, he took a denture out of the picture. I have stated before that a drastic change from teeth to no teeth is a true challenge as we age. Learning to eat with a denture after decades of having teeth is a challenge and, for many of us, impossible.

I was glad to hear that he wanted to keep teeth because I know that the result is more predictable than a complete denture. A partial denture would be a challenge, and he may or may not get used to that type of tooth replacement. Fixing all of his teeth with permanent remedies would be the easiest for him to adapt to the new teeth.

Aside from the broken teeth, I observed spaces between many teeth. The spaces result from missing teeth which translates into decreased chewing function and overuse of the remaining teeth. If there is any hope of avoiding a complete denture, I must fill the gaps before the teeth that are present break into pieces. To replace missing teeth is not difficult for me. I could use bridges or implants and create a full complement of teeth. There is only one problem, though. My patient’s remaining upper and lower teeth do not touch each other. The teeth position is such that when the patient closes his mouth, all the teeth miss each other. I can not fix anything without knowing where the teeth should be in relation to his jaws.

The problem that I have just described is complicated, and the details are beyond the scope of this column. The fix, though, is not that challenging. I made the patient a plastic bite determiner for him to wear. After a few days, his jaw will align, and I will create teeth at the correct position in his mouth. If I do not perform this diagnostic step, the work would be impossible at best or disastrous at worst. The treatment would be a waste of time and energy for everyone involved. The steps involved with the procedure are straightforward and will guide me throughout treatment.

Some treatments are simple, and others are more complicated. When you seek dental care, make sure that you find someone who can analyze and diagnose those cases with hidden problems.

If you are looking for a new practice or want a second opinion, please call us at 440-892-1810. We can set up a visit for you to share your concerns with me. I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com