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Creating a Treatment Plan

Creating a Treatment Plan


Full mouth reconstruction is a process of combining two or more dental treatments to restore the health, balance, and functionality of a patient's smile. Because no two patients' needs are exactly the same, extensive planning and preparation is essential. This always involves an in-depth consultation to determine the patient's needs and goals, deciding on the type and number of prosthodontics needed, and scheduling the phases of treatment.

Though we all know that healthy teeth and gums are important, it can be easy to take a healthy smile for granted. But when one or more teeth are lost, or the gums and teeth become compromised by trauma or decay, quality of life can take a rapid downturn as functions like chewing and speaking become inefficient and painful.

Fortunately, modern dentistry is capable of restoring smiles suffering with virtually any degree of compromise. Innovations like dental implants are a milestone treatment that make restorations like dentures as stable as your original teeth. Meanwhile, advancements in the quality and appearance of dental porcelain have made other restorations like crowns and dental bridges incredibly strong and indistinguishable from your original teeth. Modern dental practices can restore both excellent health and flattering aesthetics to practically any smile.

Whether you are beginning to experience pain and other complications as a result of a compromised smile, or if you have been suffering with oral health issues for a long time, it is never too soon to speak with your dentist about planning a full mouth reconstruction. This process cannot rebuild your smile overnight, but with careful planning and patience, you can expect to eventually achieve a smile that is balanced, attractive, and free of disease and decay. Starting a new chapter of healthy smiles in your life begins with choosing an excellent dentist.

Enlisting an Expert

If you have a healthy smile that has suddenly been compromised by injury or trauma, there is a good chance that you regularly see a trusted dentist for checkups, and he or she can either help plan a full mouth reconstruction, or refer you to another doctor who specializes in comprehensive restorative procedures. On the other hand, if you have been suffering for a long time with gum disease, missing teeth, and other conditions, you may not have an established relationship with a dentist.

Today, the Internet has made it incredibly easy to compare doctors in your area without ever leaving your home. When selecting a dentist, Colgate's Oral Care Center suggests that patients consider the dentist's location and office hours, cost, personal comfort, professional qualifications, emergency care, and state licensing boards.

Search for doctors who provide full mouth reconstruction either entirely by themselves or in cooperation with other area specialists. Take time to read testimonials and look through their before and after photos of full mouth reconstruction patients. If you have friends or family members who have undergone a full mouth reconstruction or other less comprehensive restorative procedures, ask for recommendations.

Once you have chosen a dentist and scheduled a consultation, make certain that the doctor listens to your goals, patiently answers all of your questions, and takes plenty of time to conduct a thorough assessment of your oral health.

The Consultation: Specifying Your Needs and Goals

Most of the time, I feel that there is only one best course of treatment for a patient, and that is arrived at only after a really thorough examination and evaluation involving a lot of listening.

I find that during most full mouth reconstruction consultations, patients already know about half of the treatments they will need. They know they will need something to replace missing teeth, or they know their gums are swollen and painful, and will likely require some medication or periodontal treatment. Over the course of about an hour and a half, we talk, perform an evaluation of the state of the patient's oral health, collect x-rays, and sometimes take computerized tomography (CT) scans.

I find that during most full mouth reconstruction consultations, patients already know about half of the treatments they will need

Your dentist must take care to evaluate the whole picture and understand what led to the current conditions. Some contributing factors may not be so obvious, such as teeth grinding or acid reflux.
Some important questions that must be answered during this consultation include:

  • Has the jaw bone experienced any atrophy as a result of tooth loss or other conditions?
  • Are malocclusion, dental wear, or other factors disrupting the balance of the bite, placing undue strain on the muscles and tendons that govern the movement of the jaw? This can be indicative of temporomandibular joint (TMJ) disorder, and can have a major influence on your course of treatment.
  • Is gum disease affecting the patient? Are gum grafting, antibiotics, or other treatments necessary?
  • Are there any suspect lesions or other signs of adverse oral health conditions?
  • Does the patient have any health issues such as diabetes or autoimmune disease affecting oral health?
  • Will referrals be necessary to address all pending health issues?

It is also very important to determine any changes in lifestyle or diet necessary to facilitate a successful full mouth reconstruction. I counsel my patients about smoking. By now, everyone is well aware of the many health hazards of smoking, and it becomes an issue when we're doing complex reconstruction with dental implants.

According to the American College of Surgeons, smoking interferes with every phase of wound healing. It decreases your cells' ability to fight infection and bacteria. It also increases your risk of breathing problems, such as pneumonia. Post-surgical complications can be reduced by 20 to 30 percent in patients who quit smoking four weeks before their procedure.

A diet that involves large amounts of sugar also requires special measures. The University of Rochester Medical Center states that sticky candy and sweets, starchy foods, and carbonated soft drinks are the worst foods for your teeth. If the patient does not want to cut out sugary foods such as energy drinks, I tell them to have a drink of water afterwards to clean away the sugar, and to take extra care in brushing and flossing daily.

I often recommend home fluoride treatments, vitamins, and other simple ways to generally facilitate improved oral health in preparation for the treatment, and to maintain the results of the treatment after it is completed.

Scope of Treatment

Once all of the patient's oral health needs have been identified, I can begin determining which treatments will meet those needs, and the order in which they should be performed.

A full mouth reconstruction can require a simple treatment scope, or a plan combining several extensive treatments. A successful full mouth reconstruction must begin at the foundation of the smile: the jaw and the gums. Treatments often used to restore the jaw and gums include:

  • Bone Grafting: If a patient has been missing teeth for an extended period of time, the jaw bone may have begun to atrophy, or shrink. In the absence of tooth roots, the body will begin to resorb the bone cells surrounding the tooth socket. In order to support the restorations needed to replace the missing tooth and rebuild the bite, the dentist may recommend a bone graft This involves transplanting either donor tissue or the patient's own bone tissue (usually harvested from the hip) to restore lost bone mass.
  • Tooth Extraction: Teeth that are too decayed to be salvaged through a root canal or cavity treatment must be extracted in order to set the stage for full mouth reconstruction.
  • Root Planing and Scaling: Plaque bacteria can accumulate below the gum line on the tooth roots, endangering the health of the tooth, jaw, and gums. Root planing and scaling is a process of removing bacteria from the tooth roots, and smoothing rough dental surfaces below the gum line to make the teeth less prone to bacteria accumulation.
  • Gum grafting: Advanced gum disease can cause the gums to recede, compromising the foundation of your smile and exposing tooth roots. Gum grafting is a process of replacing recessed gum tissue, sometimes with tissue harvested from the roof of the mouth.
  • Antibiotics: If the gums have become inflamed as a result of infection, antibiotics can help the body fight the infection and restore the health of the gums.

Most full mouth reconstruction procedures require some treatment of the teeth. If the jaw and gums are healthy, or if they have been fully restored during an earlier phase of full mouth reconstruction, your dentist and any necessary specialists can move forward with dental restoration. These treatments can include:

  • Tooth-colored Fillings: Composite resin fillings can restore teeth following cavity treatment. If a patient had one or more silver amalgam fillings placed in the past, he or she may have experienced some chipping or cracking around the fillings. In this case, the patient may only require new composite fillings, which can replace the metal fillings while concealing the chips and cracks, providing renewed support.
  • Root Canal Therapy: If tooth decay has advanced beyond the outer surface of a tooth and reached the pulp (the blood vessels and nerve endings in the center of the tooth), the healthy outer structure can be salvaged with root canal therapy. This procedure involves removing the infected pulp from within the tooth and roots, replacing it with an inert substance, sealing the tooth, and usually restoring it with a crown.
  • Crowns and Bridges: Crowns and bridges are custom replacement teeth. Crowns are most often used to cover a tooth following treatment for decay or trauma, while bridges (also called partial dentures) replace missing teeth. They can be created from a variety of materials that provide both a natural appearance and exceptional durability. Crowns and bridges can draw support from existing teeth or dental implants.
  • Dental Implants: Dental implants are small titanium posts that are surgically implanted in the jaw to replace tooth roots and provide support for your restorations. Implants virtually eliminate the risk of restorations slipping, and halt the atrophy of the jaw bone that can occur in the absence of tooth roots.
  • Dentures: Dentures are designed to replace an entire dental arch on the upper jaw, lower jaw, or both. They can be held in place with a mild adhesive, or designed to attach to dental implants.

Depending upon the patient's goals, cosmetic treatments may be included in a full mouth reconstruction. Often, by addressing the practical needs of the smile, you can't help but experience a cosmetic upgrade. However, some patients choose to undergo cosmetic treatments as part of full mouth reconstruction in order to better accentuate the aesthetic value of their smile. These can include:

  • Teeth Whitening: Specially formulated whitening solutions can eliminate deep dental stains caused by dark-colored foods and drinks, tobacco, genetics, and other factors.
  • Porcelain Veneers: These thin porcelain shells attach to the front surfaces of teeth to conceal minor imperfections like chips, cracks, inconsistent shaping, and slight misalignment. In some cases, veneers can actually create small changes in the way the teeth meet, improving the balance of the bite.

Providing the patient with excellent functionality and aesthetics can require a careful review of the patient's lifestyle to ensure long-lasting results. Bruce J. Wilderman, D.D.S. is a cosmetic and restorative dentist practicing in the Philadelphia area. Dr. Wilderman explains:

"I always want to know if a patient is the kind of person who is committed to long-term whitening maintenance. If not, we have to carefully choose the shade of our final restorations. If they are committed to long-term maintenance, we can choose a lighter shade. I often ask the patient how good they are with taking their daily medications. Are they diligent about taking meds that must be taken three to four times daily? If they have trouble with that, they probably won't do their whitening maintenance on a regular schedule. We want the shade we pick for our restorations to blend with the natural teeth over the long term."

Phasing Full Mouth Reconstruction Treatments

The phases of full mouth reconstruction begin with your initial consultation and diagnosis, followed by periodontal treatments, dental restoration, and aftercare. Several treatments associated with full mouth reconstruction require multiple visits and healing time:

  • Bone grafts can require 3 months or more to heal.
  • Gum grafts can take one to two weeks to heal.
  • Antibiotic treatment can take about two weeks.
  • Dental implants require at least two surgeries, with three to six months of healing time in between.
  • Dentures, crowns, bridges, and porcelain veneers usually require at least two appointments over the course of two to three weeks.

Aftercare can be ongoing. For example, if you grind your teeth, you may be prescribed an orthotic, or splint, that will act as a buffer that will prevent damage to your teeth or your restorations.

Sedation: Helping You through Lengthy Treatments

According to the American Dental Association, the use of sedation dentistry, whether it is local anesthesia, sedation, or general anesthesia, is an integral part of dentistry. Some treatments involved in your full mouth reconstruction may require lengthy sessions in the dentist's chair. This is especially true of bone grafting and dental implant surgery involving placement of multiple implants.

If you have conditions such as arthritis that make it uncomfortable to sit for long periods of time, or suffer with extreme sensitivity to dental treatment or anxiety, you may want to ask your dentist about administering sedation during lengthy treatments. Today, most dental offices offer nitrous oxide, oral conscious sedation, and IV sedation options.

Budgeting for Full Mouth Reconstruction

Because of the practical nature of many of the treatments involved in this procedure, your insurance policy may cover most of the cost of your full mouth reconstruction, if not the entire cost. Unfortunately, most insurance companies consider extremely beneficial treatments such as dental implants to be elective, and will not provide coverage for this phase of treatment.

Before beginning dental procedures, such as dental implants, Delta Dental suggests that all patients ask their dentist for a pre-treatment estimate. This way, patients know beforehand what their dental plan will cover, and what costs they are responsible for. A pre-treatment estimate is a free service that dentists can provide.

While dental implants do require what many consider to be a substantial investment, it is important to consider the benefits they provide, such as being able to eat, speak, and laugh without worrying that your dentures or other restorations will slip out of place. Meanwhile, because dental implants preserve jaw bone mass, you can save yourself the time and expense of returning to the dentist to have dentures refitted as the dimensions of your mouth change.

If any part of your full mouth reconstruction treatment plan is not covered by insurance, most practices work with third-party financing companies, or offer their own financing options.

Stopping the Stop-gaps: Helping Thomas Achieve a Complete, Healthy Smile

My patient Thomas had been suffering with broken teeth, advanced tooth decay, and restorations that had become worn, damaged, and unsightly over time.

"I knew I had to do something," he said. "I just wasn't sure I wanted to go the full extent. But as I started looking into my options, I realized that just addressing one problem at a time would be like putting a band-aid on it. I'm 72, and when you get to this point in your life, you don't know if you want to invest the money in extensive dental treatment. But the fact is that I wish I had done it sooner. Leading up to my treatment, I probably put more emphasis on the cost than I should have. The benefits I'm experiencing far outweigh the cost."

For many years, Thomas had been visiting a dentist who was using old techniques and technology

For many years, Thomas had been visiting a dentist who was using old techniques and technology, and he was interested in finding out how a modern approach might help him to finally achieve a comfortable, fully functional smile. During our initial consultation, I conducted a full examination of his oral health, and provided him with suggestions on how we could help him rebuild his smile.

"I'm the kind of person who really wants to know about the process," Thomas said. "I'm not going to just sit there and say, yeah, okay, I don't care. Dr. Kelley explained the procedures in full detail, and it helped me to have confidence in the treatment. That was important to me."

Together, we determined a phased treatment plan that spanned about three months. This included a root canal, replacements for his metal fillings, and new dental crowns. Two years later, Thomas says his full mouth reconstruction treatment continues to provide benefits.

"My bite just feels right," Thomas said. "I'm not self-conscious about how my smile looks. It just gives me peace of mind knowing that I have a good smile, and I don't have to worry about piecing out treatments anymore."

Relief, Rejuvenation, and Renewed Self-confidence: Plan on It

A full mouth reconstruction can make a tremendous difference in your health as well as your self-esteem. However, the success of this comprehensive treatment depends greatly upon your cooperation with your dentist in planning a scope of treatment that addresses all your oral health needs while fitting your schedule and your budget.

By taking ample time to choose an excellent dentist, arriving at your consultation prepared to discuss your restorative and aesthetic goals, and committing to a scope of treatment that makes no compromises in the interest of time or expense, you can experience life-changing benefits. If you are suffering with a compromised state of oral health that you feel is hopeless, I encourage you to research dentists in your area and schedule a consultation. Achieving a healthy and beautiful smile may be a more realistic goal than you think.

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