Playing Sherlock Holmes

By Carol Waldman November 18, 2013

Today brings another beautiful day and another fascinating patient. As I have stated before, all my patients are unique, but this particular patient was special.

This patient had a full set of porcelain veneers and crowns on all of his front teeth, top and bottom and they had been there for a few years, but they were showing significant signs of breakdown: wearing down of porcelain, cracks and chips. Not to mention, mild symptoms of jaw joint compression.

At the initial assessment, I knew that any future cosmetic treatment completed for this patient would be compromised. It was important to treat the foundation first. Failure to do so would result in further stressing and potential breakage of his porcelain restorations.

Why: This is where playing detective and knowing how to read the clues comes into play. This patient?s primary problem was not the wear to his teeth, this was just a sign or ?clue? of the problem. With my extensive training I was able to read the clues and determine that his primary problem is his bite or ?occlusion? as we dentists call it. In this case, his upper front teeth were hitting hard against his lower front teeth. This often happens when the lower jaw is a little too large to fit inside the upper jaw. This results in the lower front teeth and jaw being held back by the upper front teeth, and from protruding to the position it should be in, and then the front teeth ?rub too hard together?. It is this rubbing and friction that causes the teeth to be worn down, crack and chip.

So, I expressed to this patient, the only way to truly correct his bite problem is to first reposition the front teeth so that they don?t ?rub together? any more. This can be simply done by using the Invisalign System of invisible clear orthodontic aligners. Once this is accomplished, then replacement of the broken crowns and veneers can be simply performed, and they should last for many years to come. As an additional bonus the patient will benefit from the lower jaw (mandible) finally being allowed to reposition itself into a far more comfortable position and eliminate any muscle tension or joint issues he has been feeling!!

You see, all dentists should be like Sherlock Holmes. Playing detective to determine the real issues, and making the necessary recommendations to our patients to solve their problems and not just disguise them!