Delivering bad news.....
I had quite a stressful day today. We had two new patients booked in this afternoon, both female, aged 34 and 55. Both had recently had examinations and already had long-term NHS Dentists.
The younger patient, let’s call her Patient A, was concerned about her gums and felt she had some tooth movement, particularly around her front teeth.
Her own Dentist had always dismissed this and just encouraged her to keep brushing twice a day. No perio advice or treatment had been suggested. She admitted she smoked and although she knew it wasn’t good for her health, she never felt the need to quit as she was not aware of just how significant the link between smoking and perio disease was. She had decided to see us for a second opinion. As soon as I started talking to her, prior to the examination, my heart sank. I thought to myself, “Oh my God, how are we going to tell her it’s this bad.” It was blatant to me that she had advanced perio disease. From talking to her, I think she thought that we would agree that she has been quite neglected but a few visits with the Hygienist would have her right as rain.
To cut a long story short, after a few x-rays and tears, the Dentist broke it to this poor lady that she required extractions UR3 to UL2. Now just imagine- she had been seeing her Dentist every 6 months since she was a child and trusted him with her oral health. As far as she was aware, yes her gums weren’t in great shape but generally her oral health was fine. And now we had just presented her with a treatment plan consisting of 5 extractions, a partial denture and a course of intense periodontal therapy at the age of 34.
Going through the treatment plan post-consult in my office was difficult as the patient was understandably very upset, angry and confused as to why the perio disease had become this advanced and not been acknowledged. I found this situation very difficult, as I too felt nothing but anger and hurt on behalf of this poor lady, also pure shock as to why her oral health had been so badly neglected. Despite my feelings, I had to stay strong and professional and help this patient as much as I could. I offered her a supportive hug and reassured her that once we had treated the active disease, we should be able to keep her gums stable and healthy with regular 3 month maintenance visits with our Hygienist and prevent further tooth loss. Although she was still upset and shocked at the diagnosis, I think she was also relieved at knowing that we could at least prevent her from losing any more teeth. I dread to think what would have eventually happened for her if she had chosen not to seek another opinion.
Patient B was similar in the fact that she had suffered from perio for a long time, however she was starting to lose teeth and felt that now was the time to take action. She was particularly interested in fixed options such as bridgework and dental implants to give her back her teeth if at all possible. Her own Dentist however had assured her that “everybody loses their teeth eventually” and that he thought it was “unnecessary” her seeking advice from a cosmetic dentist when he can just make her some dentures. I couldn’t believe what I was hearing. After a Consultation with one of our Dentists, it turns out that we are able to restore her mouth with implants and give her what she actually wants- a healthy, well-functioning mouth. Providing she commits to hygiene maintenance and gives up smoking that is, which she is prepared to do. Patient B left the practice feeling inspired and relieved that it isn’t in her destiny to end up with no teeth and full dentures!
I still feel frustrated that there are patients being neglected and uninformed about their oral health, in both NHS and private practice, but at least there are dental practices out there that are willing to combat this and (just about) save the day!
