Good Fundamentals Key to Dental Treatment

March 30, 2020

 I regularly see patients for second opinions. Almost invariably, the patient has been presented with an exotic plan of treatment – complex and filled with all of the latest trends in dental restorative procedures. But on inspection of their mouth, I notice that basics have been overlooked.


What about the wear on certain teeth? It’s often a symptom of a change in their bite. What about deteriorating fillings – usually in hard to get at places, that haven’t been included in the plan? What about the identification of key teeth – the teeth most critical to the maintenance of function and cosmetics? What about just a thorough professional clean and some coaching around the patient’s home care?


These are all fundamentals. And they are often ignored.


If you have dental problems, my theory is simple.

  1. Get the fundamentals right first: this is about ensuring stability moving forward.

  2. Once you are stable, if you desire more exotic treatments, you can build these on top of the fundamentals that you have developed in the first phase of treatment. If you are satisfied with the fundamentals – GREAT! You are now dentally stable – go and enjoy life.

So what is wrong with doing dentistry this way? Firstly, getting the fundamentals right takes time and effort. If your problems have arisen over a period of 20 years, then I don’t believe these kinds of issues can be resolved in 3 weeks. Often there will be some new learning of how your body is responding to these changes as well as new learnings on how to treat your body to create the healing and stability you desire. Healing takes time. Remember – we are aiming for a stable, durable result.


It can be tempting to get a quick fix. The problem with quick fixes in dentistry is that not only is money expended – often significant amounts of money. And the key issue is that these quick fixes are often irreversible.


If you engage in a quick fix – and lots of healthy tooth is cut away (as in the case of crowns) – you may have dug yourself into a hole. In time, some of your problems may/will return and you have debilitated teeth because lots of tooth structure has been cut away by the quick fix. If this happens, the cost of the solution escalates dramatically – sometimes to the point that almost no amount of money is going to overcome uncertainties and give you back your own teeth.


Yes – I understand that dental implants are an option. Please understand that dental implants are not your own teeth, they have their own set of problems and short-comings, have a very long treatment program and they are frightfully expensive. If money is not a limitation to you – you may consider them – but I would still caution you about some aggressive implant treatment modalities. In my practice, dental implants are a last resort - not a go-to treatment.


So what do good dental fundamentals look like?

  1. Tooth colour that the patient is happy with

  2. Absence of disease in either the hard tissues (teeth and bone of the jaws) or soft tissues (gum and lining of the mouth)

  3. Sufficient functional capacity to satisfy the patient requirements around being able to chew their food as well as being able to function socially

  4. Comfort

  5. Dental Stability – year on year minimal deterioration of the dental system as a consequence of dentistry that is durable, repairable and maintainable.

Obviously, your dentistry should be minimally invasive, well-executed and have an element of long term strategy about it. This kind of planned care ensures that in time, if you do have mishaps, there will be a recovery option that is a feature of the dental restorative strategy that you have embarked on. Very often, the more fundamental treatments have more straightforward recovery options in case of a mishap.

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