case in progress

The fellow shown above walked into my office assuming that I would have to remove all his teeth and insert full dentures. He had been drinking soda all day, every day for the last five years and when he presented, these teeth were soft, brown, and CLEAN. They were clean because the patient had recognized a year ago that he was going to lose his teeth unless he started brushing them. Therefore, he began a serious effort to clean his teeth and had been doing so two or three times each day for the last year.

He did not, however, realize that his sugar habit was the thing that was causing the teeth to continue to rot out. See my page on dental decay to see why this was so!

The image on the right shows what his top front teeth looked like after five visits. This kind of dentistry is not unusual, or especially expensive. None of the teeth have had crowns placed on them, although the treatment plan calls for crowns to be placed eventually, in a few years as the patient can afford them.

The first visit involved an exam, a full series of x-rays and a cleaning. It also involved counseling on the role of sugar in causing this patient's condition. It should be noted that after this visit, the patient DID stop his sugar habits, and the decay stopped dead in its tracks! Over the course of the patient's treatment, even the active decay stopped progressing and began to harden on its own. At this time the patient and I decided to pursue a slow, two stage process in which we would begin with basic repair of the top front teeth and proceed sextant by sextant (a sextant is one sixth of the teeth; The top front six teeth are one sextant, the top right back teeth are a second sextant, and so fourth around the mouth). Finally, after basic repair was complete, we would begin the process of placing more durable and better looking crowns on the most heavily restored teeth. This would take some time depending on the patient's ability to pay for the work. His dental insurance would cover about a thousand dollars a year, and he felt he could afford to pay about an equal amount each year toward the work.

The most expensive work performed so far involves the repair of the two central teeth. They were both so badly damaged, that the nerves in them would never have survived simple repairs with fillings (as was done with the four teeth adjacent to the two central ones). Root canals were first done on these two central teeth. Since the nerves in both of these teeth were alive when the root canals were done, the procedures were accomplished in one visit (the second visit in his first series).

On the third visit, the two central teeth were repaired with posts and cores. The titanium posts are cemented into the treated root canal spaces and stick out of the roots to hold the cores in place. The cores were made out of tooth colored restorative (composite) to look like the tooth structure they replace. The reason that the central teeth in the image on the right above seem to have a grayish cast is because there is very little natural tooth structure left above the gum line and you can see the shadows of the metal posts under the translucent filling material used to build the cores. This defect will eventually be corrected by the placement of porcelain crowns over the posts and cores.

The fourth visit was spent repairing the two teeth to the immediate right of the central teeth, and the fifth visit was spent repairing the two teeth to their left.

The patient took a long break to replenish his money supply and returned in a little under a year to continue the work. During that time he had stopped drinking regular soda and had substituted diet soda in its place. He had also stopped using sugar except at mealtimes. His hygiene was very good and he brushed his teeth twice daily with a fluoride toothpaste. By the time he returned to the office for his second round of work, surprisingly, the decay had hardened up and was no longer active. This is a process called ebronation. In the absence of sugar, decay not only stops, but it begins to recalcify due to the calcium in the saliva. Thus, even though the non-repaired teeth still looked terrible, they were no longer in danger of becoming worse, and in fact, were in much better shape than they had been when the patient first appeared in my office. Note that the finished image above was taken a year after the initial series of visits were completed. You are actually looking at restorations that are about a year old.

This year, we repaired all the remaining back teeth with ordinary white fillings. Next year we will proceed to phase one treatment of the lower teeth.