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Feel like I have a complicated case – should I try and tell it all to my dentist, or should I just be quiet and let him decide what needs to be done?

  • Thread starter Thread starter Annie364
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Annie364

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I have found a dentist I really like who will also be doing my implant. I’ve seen him for the implant consultation and the extraction, and he’s going to be my general dentist now too, so I have a new patient check coming up very soon.

I feel like I have so much that potentially needs doing, and a lot of things are dependent on other things in terms of timing, so if we choose to do one thing then the other thing should be delayed or changed which will affect something else etc. This is a list of everything I can think of:
  • I need one implant where he extracted a tooth for me at UL7 – my first ever implant. At a different appointment in 3 months or so, he will check the bone on CBCT for an implant
  • I need 3 overlays or crowns where I had root canals in 2021 - UR5, UR6, LR7. He knows about these
  • I have a large gap at LR6 from 2006, and it was said an implant could be possible. The gap does affect my eating due to the size of the gap now, and the neighbouring teeth are starting to tip inwards. If we want to do the implant there, first we’d have to wait until after the UL7 implant to check I can tolerate implants OK as it’s my first time with the implant at UL7
  • The UR6 tooth above the large gap at LR6 has extruded downwards, causing the root to be showing
  • If we decide to implant at LR6, to get the correct bite with UR6 we’d need to make a non-extruded crown for UR6 and cut into UR6 and reduce its height. But if it ends up that we can’t implant at LR6 then it would be a pity to cut into UR6 and reduce its height needlessly if it reduces the lifespan of the tooth
  • UR6 had a large longstanding abscess for over a decade before the 2021 root canal, and though it looks healed now, there is still pain and it would be good to check it on CBCT. There is small chance the dentist might recommend removal and implant or other treatment
  • A misaligned tooth at UL5 is being pushed inwards, so if we want to push it back outwards and backwards into the space along with UL6, we’d need to do it before putting in the titanium implant post at UL7. But then we’d need to delay the UL7 implant, and LL7 might extrude upwards more in that time (see below) and maybe for the bone it’s better to implant 3-4 months after extraction rather than waiting too long
  • LL7 has been extruding upwards since the root canal on the opposing UL7 caused UL7 to be half-height, so I have a plastic guard to wear at night to try and stop LL7 moving upwards more while I wait for the implant at UL7. I heard the dentist speak about the possibility of a retainer as he wrote up my notes after doing my extraction and when I'd asked him to be my general dentist too. I don't know if that is for upper or lower
  • Another misaligned tooth at LL5 is pushed inwards just like the one directly above it. Although it’s on the other side to the potential implant on LR6, it still makes more sense to realign LL5 first before putting in the implant at LR6 I would guess (if it’s a good idea to realign it)
I feel like it’s a lot, and if the dentist didn’t consider all of it before starting work and just does first things first, then there could be problems caused by not realising what later work would be needed. I think my new dentist is really good, but I’m wondering if he won’t realise all the stuff that potentially needs doing and how interdependent it all is before he makes the treatment plan.

I’m wondering how I should be when I see him. I don’t want to make a bad impression by saying too much, or offend him by sounding like I’m trying to do his job for him. Also I want to do what he recommends should be done, and I don’t want to seem like I’m requesting work which actually is not a good idea to get.

How much if any of the above points should I say, or is it better to just keep quiet and see what he says I need done? I’d mention the pain at UR6 of course.

Thanks very much.
 
The treatment planning is what you're really paying him for, the actual treatment is relatively easy in comparison :-)

He should be able to give you an estimate of what he plans doing and the order in which he plans on doing it. You can take it from there if you want to discuss things with him further.

Given the amount of (expensive) treatment you're looking at buying here, it's not unreasonable for him to spend a decent amount of time going over the treatment plan with you.
 
Thank you Gordon, that is so helpful, I didn't realise that the treatment planning is what I'm really paying for!

So shall I just come in and stay quiet apart from mentioning the pain at UR6, and then see what he says, but then if he doesn't mention it, ask about the misaligned UR5/LR5, possible implant at LR6, and CBCT/maybe treatment for UR6? And then don't mention the ins and outs of timing/planning and just see what treatment plan he comes up with for me, and then discuss it at another date with him if I still have questions?
 
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Hopefully he'll ask you questions and initiate a discussion with you as to what you actually want out of this treatment plan. It should really be a two way process, not just him dictating to you what is going to happen.
 
Thanks ever so much Gordon, it's so helpful to talk about it with you. You're right he will hopefully be asking me questions and it should be a two way process. I did get a good impression of him from the two times I saw him, so I hope he will do that.

The appointment is tomorrow. He knows I need 3 crowns and 1 implant, and at the extraction appointment I said I'd like him to be my general dentist and he agreed, and then I made this appointment which is tomorrow.

Should I actually say at the very start of the appointment, I'd like you take a look at my whole mouth and see what you think needs doing and give me a treatment plan? Otherwise he might just think I only need 3 crowns + 1 implant and not consider anything else.
 
Should I actually say at the very start of the appointment, I'd like you take a look at my whole mouth and see what you think needs doing and give me a treatment plan?
Yes, I suspect he's mentally been doing this anyway, but no harm in setting it straight with him from the start.
 
Thanks so much Gordon, I read your reply on the train up, it was really helpful and prepared me for seeing him. You are right, he said he was planning to take a look at everything and discuss it with me, and he asked me what I was thinking might need doing as well.

It went very well, and the outcome was:

- although he's not an orthodontist, he was able to tell me it would be quite a difficult path to align the UR5, with 2 years of wearing the materials to move it, and it could be that the orthodontist would say he can't. So I've decided to not go ahead with it as I can eat perfectly fine and he said it's unlikely to move more or if it did it would be very gradual and we could do something about it then. It's visible recessed in a bit in when I smile but I'm OK with that vs the amount of work it'd take. Overall I'm glad I asked about it and thought it through now.

- I need the overlays/crowns on the 3 root canalled teeth ASAP, and there's be work to get the bite correct with them which he will do. Also he said it's appropriate to reduce the extruded UR6 to the same height as the others, regardless of whether I get the implant at LR6.

- we will CBCT scan both UL7 and LR6 in a couple of months to check if they are suitable for implants, and he will tell me then how difficult (or not) they might be. Because LR6 was removed in 2006 it might need a lot of grafting, so it might or might not be worth it, depending on how I feel about the gap.

- he has referred me to the root canal specialist to re-scan the old abscess at UR6 and see if anything should be done. This will be done before any crown on UR6 in case it changes the plan.

- I didn't get to ask him about retainers, but perhaps when he mentioned it before, it was about the temporary one I have to stop LL7 extruding while I wait for an implant. I'll ask when I see him next.

We've now booked an appointment for the first overlay/crown as I said I'd like to go ahead with what he suggests. I don't know if I should be given a treatment plan as well for the above, or if it's enough that he's explained it to me verbally?
 
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Thanks for the update, it sounds like you've got a good plan worked out.

If you want a written plan then ask for one, it's not compulsory (actually it is for NHS patients!) but it's easy enough to print one out if you want one. (When I'm the patient, I don't usually bother).
 
Thanks so much Gordon, it's good to know I don't necessarily need one.
 
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