It
happened again this week. A patient come into me upset that a bridge
that someone else had done had failed. It was actually a longer story
than that. She had surgery done at the hospital. She “warned” the
anesthesiologist to be careful, that he or she could damage the fixed
bridgework in her mouth. And sure enough, it was damaged beyond repair.
Was this the fault of the anesthesiologist? I can tell you that it is nearly impossible for an anesthesiologist to damage stable dental work. If the anesthesiologist had an opportunity to see the patient well before the surgery, he could have referred the patient to a dentist before administering anesthesia. But we often don’t have that luxury.
Here’s
what I can tell you. When I saw the patient, only one tooth met on the
affected side. The one tooth meeting was taking 700% more force than it
should be taking.
Why?
The jaws did not line up properly. The lower jaw was much smaller than
the upper jaw, so much smaller that the front eight teeth did not touch
each other.
What
does one do? When we see this problem in younger people, we send that
patient to the orthodontist and the oral and maxillofacial surgeon.
Together, these two specialists can correct for the jaw deformity and
align the teeth correctly. That can eliminate the problem that this
patient now has later in life.
What will we do for this patient? We will rebuild some crowns and add some dental implants to better distribute the load. She’ll have five contacts where she now has one. And that should go a long way toward improved stability. Perfect? No. But this design should give her an improved opportunity for better function as well as a more stable result.
Lee N. Sheldon, DMD
Dr. Lee Sheldon does dental implant and periodontal therapy in Melbourne. His new book, The Ultimate Mouth Manual, may be found at all book outlets (also downloadable for free here).