Dental train wreck
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- Photos courtesy of Mark Dreyer - www.rxroots.com
From: Mark Dreyer
Sent: Thursday, January 05, 2006 2:17 PM
Subject: [roots] George Burns reincarnated
Not only does he look just like him, he is even funny like Burns was.
He was in my waiting room, filling out the tablet PC, and says in a
really loud voice "You know I could die before I finish this!"
Anyhow, he's seriously medically compromised including an aortic
aneurism as well as a urinary catheter. He is very very frail looking.
Talk about a referral source dumping someone on your doorstep without a
tx plan. How would ya'll handle this dental train wreck? I'm inclined
to think that for someone like this, one tooth at a time patchwork would
be the way to go rather than insisting on a comprehensive tx plan.
I'm not sure he could tolerate any massive reconstructive tx plan.
I want to help, but I sure don't want a medical emergency in my chair
either - - Mark
A call to his physician before anything.
Status of Aortic Aenurism ?
Is he too unhealthy for them to treat it with a Stent or whatever ?
Is the pt. responsible for himself or is someone with him that
makes the decisions ?
Dr. , pt / helper says ok to treat
Is he hurting ?
How much treatment does he want ?
1 tooth at a time would probably be ok.
If he wanted extensive treatment ?
I would have his Dr and my anesthesiologist check him
If they said ok, then according to how long they wanted to IV Sedate
or General Anesthesia,
How much can he afford?
All ok above, treat all necessary 1 visit RCís, stop all decay with
extractions if necessary in 1 long appt. under Sedation / GA.
If he survives that, all the Crown and Bridge he wishes probably on
We do Cerec 1 visit crowns, so maybe some of that could be done at the
1 or more visits under Sedation / General Anesthesia.
This would be in an outpatient Surgical Center ready to treat any
emergency with lots of physicians, nurses, and equipment prepared
ahead of time.
Just some quick thoughts. I am sure there is more to consider.
Really just saying hello. - Danny
I don't see a problem with carrying out your treatment one tooth at a
time, but I would still feel better with a comprehensive PLAN.
Obviously, your plan is going to start with what is hurting, broken,
or decayed. Once you accomplish that, the rest is kind of up to him.
The flip side of patchwork dentistry is that as this guy's health
continues to fail, he is going to be less and less able to tolerate
treatment. Better in my mind to go ahead and work towards getting
him as healthy as possible.- Catherine Mincy
Thanks, Catherine. Believe it or not, every single one of those
teeth with caries responded vital, and he has no hx of symptoms.
Of course that doesn't mean endo won't be needed. I plan to consult
with his MD to verify that he is stable enough to be treated in an
outpatient facility. - Mark
Yikes! I'd say some caries control with g.i. build-ups and monitor,
as long as things test vital, and health permits, - Kendel