Patient compliance is not in our control

By Joseph J. Massad, DDS

Welcome back. This month is meant to be a reality check for the dentists who truly work hard to give their patients the best possible care, and then they find out that one of their proudest accomplishments is failing.

The patient presented here was a high school classmate of mine who came to me during some hard times in need of full-mouth extractions and a denture. He dreaded losing all his teeth and wearing complete dentures.

I believe all my readers would do the best they could and go above and beyond to help out someone like this. After extractions and complete dentures were delivered, adjusted, and realigned, all was great six months later. My classmate/patient was very appreciative, and he got back on his feet by finding a fine management position, and within two years he became the departmental head.

FIG. 2 -- Healed Tissue

Wouldn't you say that's a great story? I had suggested at the start of treatment that implants should be considered. Within three years he returned and asked for something more like natural teeth that would be fixed and less dependent on occasional use of adhesives. I agreed to do a complete workup, and I planned implants in such a way that we stayed within his budget and still made the best available restoration.

I discussed on numerous occasions that impeccable hygiene was the No. 1 factor keeping me from going with a fixed prosthesis instead of an implant-assisted restoration that was easier to clean and repair. But I gave in to his requests, and even reduced my fee to half for old times' sake. I believe the first figure will tell you the rest of the story. Oh, wait! Did I disclose that after the fix was delivered, he bit down on a bottle cap and cracked three teeth?

So, after all the time spent on repairing and refitting, he ended up with grunge mouth. I was pretty upset with my former classmate; however, I needed him to take the responsibility of getting his tissues cleaned up and avert the loss of any of the implants. I read him the riot act, and a week later his tissues appeared miraculously cleared up.

Proven hygiene methods allow patients to maintain dental health. His regimen included using an oscillating-rotating pulsating power (Oral-B SmartSeries 5000) with two different brush heads twice daily for two minutes, toothpaste formulated with stabilized stannous fluoride and sodium hexametaphosphate (Crest Pro-Health Clinical Gum Protection Toothpaste), and a mouth rinse containing cetylpyridinium chloride 0.07% (Crest Pro-Health Multi Protection Rinse) twice daily for one minute.

You can see the results comparing the two figures after one week of this oral hygiene regimen. With this one patient, we were able to get the inflammation under control before it was too late; however, many noncompliant patients may not be so lucky.

I hope this case will help you. Again, I hope my pleasure in dentistry will also be yours.

Dr. Joseph Massad may be reached at (918) 749-5600 or [email protected].
To see Dr. Massad's video tips, visit www.DentalLibrary.com