One of the most common concerns raised by patients in my practice is ‘How do I keep my teeth into old age and avoid dentures?’ This patient concern has been the major contributing factor in the development of my restorative dental care. As a dentist, the best way I can help you keep your teeth for life is: Avoid cutting away your teeth unnecessarily! It is simple – but it requires a significant change in mindset.
Most importantly, every medical/dental intervention carries three different COSTS: An emotional cost associated with undergoing a procedure; a financial cost associated with the procedure and lastly, the cost that is most often overlooked – the biological cost of the procedure. Most interventions involve some loss of your tissues -an irreplaceable loss. Therefore the biologic cost of dental care has the potential to carry the highest price you will pay.
Secondly, people often ask ‘how long will this restoration last?’ Good question. But a more pertinent question may be: ‘how much tooth are you cutting away, and is the restoration repairable?’ Some restorations, such as conventional ceramic crowns, carry a high biologic cost (i.e. a lot of sound tooth is cut away needlessly) as well as being impossible or very difficult to repair. They may last somewhat longer, but when they fail, the tooth is at risk of being lost. Composite resin crowns (large fillings) have an undeservedly poor reputation. If fillings and composite resin crowns are placed with care and skill, they have the potential to last some decades. And if they do develop problems, they can be effectively repaired without having to undo the whole restoration. This lowers the biologic cost of the restoration, not only at the initial placement but also as the restoration is maintained over time. We’re living longer than ever before, in an age where everything is becoming disposable. It is time that we instituted more repairability – dental care is an excellent candidate for this kind of thinking.
Finally, a little strategy goes a very long way. If you want to keep your teeth for life, you need a strategy to deliver teeth for life. A fundamental strategy is to start all treatment with the simplest, lowest biologic cost interventions and persevere with the least aggressive strategies for as many restorative cycles as possible. Only move onto a more aggressive strategy once you have exhausted simple ones. This has the effect of delaying higher biologic cost interventions and not only is this more conservative of your finite tooth structure, but it also has a relatively lower financial cost (when you compare ‘apples to apples’). Higher biologic cost treatments early in a patient’s dental lifecycle accelerate the loss of tooth structure and accelerate the rate at which future treatment cycles become increasingly aggressive and expensive.
As patients being treated with this approach age, sometimes we will engage in managed tooth loss. As patients’ get older, ‘the ravages of time’ may present themselves. Prioritising the importance of teeth as well as discussing the prognosis of certain teeth is beneficial.
By patients understanding the relative importance of teeth, they can conserve funds for the teeth that are important to their function and cosmetics without the need to needlessly waste money on teeth that are a relatively ‘poor bet’.
Each patient needs to have their own unique plan around this – one that they understand and are comfortable with. It’s not good to lose teeth, so at least know which teeth you want to pursue and which teeth you can spare. Sometimes, it is in these instances, where a key tooth is lost as a consequence of being unsalvageable or a ‘poor bet’, that the funds saved from simply extracting non-critical teeth in the past, can be re-invested into an implant crown to replace the key tooth.