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Cosmetic Dentist Advisor: Are These Teet Worth Saving?

July 25, 2011
Dr. Mark Wilhelm tells dentists why they owe patients a truthful assessment of their treatment options.

by Mark Wilhelm, DMD, MSD

If you are a cosmetic dentist like me, you’ve had patients come to you for treatment, tell you they want your expert opinion, and then turn a deaf ear to the truth if it’s not what they want to hear. Your job is not necessarily to convince them of what’s right. Rather, you owe them a truthful assessment of their options. The final choice of what to do is up to them.Consider a new patient who has not been to a dentist for 10 years. The main reason for the absence of routine maintenance is fear, and you offer some sedation options that give the patient some hope. Let’s say his name is Bill. The real reason Bill called you is that a front tooth is turning black and it bothers him. After a general introductory interview, you perform an exam and discover that there is significant bone loss and caries on many teeth, including the roots. Bill has told you that he’s not keen about having dentures and he wants to get a better smile and t back to good oral health.From a diagnostic position, you know a few things. Bill is susceptible to periodontal disease and, at age 52, you don’t expect to see bone loss. He is a non-smoker and has poor POH. We know that his prognosis is poor and that the cure for his problem is to remove the teeth. He is at high risk for caries and your restorations will do little to prevent future decay. If you attempt to restore the teeth, they will almost certainly end up structurally compromised and susceptible to fracture. What should you do?Bill doesn’t want to hear about tooth loss and may, in fact, refuse to accept the diagnosis because of preconceived ideas about what he wants and expects from you. But he needs to hear the truth! Bill will experience more rapid bone loss from the perio, and infection will become more likely. The caries will continue, and within 10 years, he will have systematically had his teeth removed. If he waits, his experience will be disappointing, and in 10 years he will still need dentures. If he has the teeth removed today, he can get some dental implants, lose less bone, have a better smile, and get on with his life. While Bill’s immediate goal may be to restore his teeth and fix his smile, he needs to understand the long-term consequences of his request and the other options available to him. Remember that Bill wants a nicer smile and improved dental health. The goal of this visit is to help him understand the difference between his “wishes” and his “health.” Document his options and let him choose.
Mark Wilhelm, DMD, MSD, has been in private practice in St. Paul, Minn., since 1990, where he is focused on cosmetic and sedation dentistry advanced restorative procedures, and dental implants. After graduating from the University of Illinois, Dr. Wilhelm received his doctorate of dental medicine in 1985 from Southern Illinois University School of Dental Medicine. He continued his education to achieve a masters of science dentistry, and completed specialty certificates in prosthodontics and maxillofacial prosthetics at Indiana University. Dr. Wilhelm is an author, consultant, mentor, and frequent speaker to dentists and the public on techniques that enhance oral health. He presents many seminars on implant dentistry and advanced restorative procedures to family and cosmetic dentists in the Minnesota area. Visit his website at