Third part of a series about educating patients on dentistry in just a few minutes
By Jannette Whisenhunt, RDH, PhD
This month, we are continuing our series on talking about "dentistry" when you really don't understand it yourself. As a new hygienist with no dental assisting experience, the restorative side of dentistry seems unfamiliar and can be very foreign to you. You can explain periodontal disease and gingivitis all day long, and you do this every day.
But, what happens when your next patient asks, "What are my options if I have to have this tooth extracted?" Your pulse goes up. You get nervous because you don't know enough about the options or the procedures to be able to explain it well. This is not a good place to be, and I want to help you feel more confident. So we will explain the options after an extraction in terms of answering these types of questions.
Sometimes, an extraction is inevitable and cannot be prevented, such as when a tooth splits down into the root, and it cannot be saved or repaired. So, what can be done to restore the function of the tooth that is now gone? You can give your patient an education by using the examples of the good, the better, or the best option.
When the function of the tooth is gone, the occlusion around the space will change position over time too. The opposing tooth will grow into the space below or above it, and adjacent teeth next to the space will fall forward and slant. This can cause problems with the bite and maybe even the TMJ joint. This is one of the best reasons a tooth should be replaced if extracted.
Good option-The good option to fill the space is to replace the missing tooth or teeth with a removable partial denture. It is not as stable, but it will chew food and will keep the opposing teeth from shifting. Usually, this is the least expensive option. It can last for years. If another tooth is lost, the replacement can be added to the partial for an additional cost.
The partial denture has to be removed and brushed twice a day, as well as kept in water at night. It should not be left in the mouth overnight because the normal tissue it sits on needs to "breathe" and be kept clean. A fungal infection can occur if the tissue is continuously covered.
Because the material is plastic, it may break and the patient cannot put as much chewing pressure on it or eat anything that is extremely hard. Also, when a tooth is extracted, some bone will be lost as well in that area, making the jaw bone thinner.
The procedure for a partial involves taking an impression and getting a color shade for the tooth on the first appointment. During the second appointment, the partial is fitted and adjusted. The clasps are tightened enough to hold it in, but loose enough to be able to insert and remove in the mouth each day. In the beginning, the partial may rub, causing a sore place on the gingiva, so it may have to be adjusted a few times until it feels comfortable.
Better option-If a person has the required teeth next to where a tooth was extracted, then they may be a good candidate for the better option of having a bridge procedure. A bridge is a three unit (or larger), lab-made replacement for the missing tooth with a crown on each side of the empty space and a crown in between where the space was.
The three units are fused together and are made of porcelain and metal. The two teeth on each side are trimmed down to a shorter, thinner version, and the lab-fabricated crowns are permanently cemented on these two teeth, and the fake (pontic) tooth in the center is over the space of the missing tooth.
The bridge can be brushed normally. Floss, though, is threaded under the fake tooth portion of the bridge. A bridge is a better option than a partial because it is permanent and does not go in and out at night like a partial. It is stronger so it can withstand normal chewing pressure and looks more like real teeth.
The bridge is more expensive than a partial, approximately the cost of three crowns together. The lab uses metal and porcelain, and it looks very natural with no clasps. It can last for 20 to 40 years when kept clean and well maintained.
The procedure takes two appointments with the trimming of the teeth, impression, and temporary bridge that is made and temporarily cemented. When the lab finishes the permanent bridge, it is adjusted and cemented into place. It is a very common replacement for missing teeth and is hard to tell from natural teeth when the patient smiles. There has to be healthy teeth that have a good foundation close to the empty space to hook the crowns onto for the bridge.
Of course, it is important that you do your homework and find out about the cost of a partial or a bridge when telling patients about their options. Consider investigating what patients' insurance covers. Always be honest with them in what the good, the bad, and the ugly can be about all of the options, which is a part of informed consent. Patients have to make the final choice for themselves, and we have to respect the choice they make. Have a great month and happy scaling! RDH
References
1. Bird DL, Robinson DS, Modern Dental Assisting, tenth edition, Elsevier Saunders.
2. Henderson D, Steffel VL. McCracken's Removable Partial Prosthodontics, 1973. 4th Ed.
Jannette Whisenhunt, RDH, BS, MEd, PhD, is the Department Chair of Dental Education at Forsyth Technical Community College in Winston-Salem, N.C. Dr. Whisenhunt has taught since 1987 in the dental hygiene and dental assisting curricula. She has a love for students and served as the state student advisor for nine years and has won the student Advisor of the Year award from ADHA in the past. Her teaching interests are in oral cancer, ethics, infection control, emergencies and orofacial anatomy. Dr. Whisenhunt also has a small continuing education business where she provides CE courses for dental practices and local associations. She can be reached at [email protected].
