We dentists and our teams go to great lengths to try and provide comprehensive preventative care to all of our patients. What that means is that we offer treatment for all of the problems that we diagnose or see. If we find a concern, we offer our patients the solutions available to fix that concern. Sometimes we have simple solutions for simple problems. For example, a tooth with a small carious lesion (that’s nerd talk for a cavity) will usually be treatment planned for a tooth colored filling. Other times, things can be more complex. A patient in pain with multiple missing and broken teeth, temporal mandibular disorder (jaw joint pain or TMD), and gum disease has a lot more options to ponder. We do our best to explain all of the options and then let our patients tell us where to get started. After all, it’s your mouth and your teeth that you have to eat, smile, and live with the rest of your life.
Often, we have patients come in and request that we only treat what is necessary or what their insurance will pay for. Many times, we can estimate what insurance will cover and then let our patients decide what they want to use their benefits for. As far as only treating what is “necessary,” well, that can get a little more confusing. Maybe the following loose guidelines will help.
Pain – I think that it goes without saying that any pain, whether from tooth or gums, is necessary treatment. Most dentists will also recommend preventative treatment to keep you from getting into pain in the first place. A tooth with three cracks and an old, broken down silver‐mercury filling is eventually going to fail you. Preventative treatment helps to keep it from breaking at the wrong place or time.
Periodontitis – Rarely does anyone come into our office and ask us to treat their gum disease right away. Why? The truth is that gum disease is rarely painful (except for the periodic infections that some people get) and most people do not even know they have it. The problem is that periodontitis causes you to lose the bone that holds your teeth in place. If left untreated, your teeth will eventually start to get loose and fall out. If that isn’t bad enough, gum disease is also a constant low grade infection that can contribute to a host of other health problems including diabetes and heart disease. If you want to keep your teeth the rest of your life, then I’d say gum treatments, brushing, flossing, and regular dental cleanings should be considered necessary.
Missing Teeth – Okay, nobody has ever died from losing a tooth and not replacing it. Therefore, I cannot tell you that replacing every missing tooth is absolutely necessary. Many people get by just fine without replacing teeth lost to gum disease or decay. What I can tell you is that there comes a time when enough teeth are lost that you begin to lose the ability to eat, smile, and live the way you would like. In my opinion, that is when replacing teeth becomes “necessary.”
Infection and Decay – Any infection, including the cavities in your teeth caused by bacteria, should be addressed as necessary and urgent treatment. Then again, it’s only necessary if you want to keep your teeth and stay out of pain.
Airway, Sleep Apnea, TMD, and Orthodontics – Most people consider braces to be an elective procedure to straighten out some crooked teeth. Sometimes that is the case, but often those crooked teeth are causing or contributing to other health problems. Without going into a lot of boring research, let’s agree that a well positioned bite is usually necessary. I know that’s like telling your three year old, “…because I said so,” but I’m out of room for today. I’ll try to expand on this subject down the road.
May you all have a safe and happy New Year. Until 2009, keep smiling.
‐Comments can be sent to Drs. Parrish at ParrishDental@aol.com.