What’s Under The Old Crown?

One of the most complex pieces of treatment planning occurs when I have to replace old restorative dentistry. The challenge comes from the uncertainty around the actual condition of the tooth. Knowing what the tooth looks like under the old restoration is a critical piece of information in determining what treatment is needed. On the dentist’s side of the equation we are clear that the final treatment plan will emerge once the old restoration has been removed and we can now see the exact clinical situation to be remedied. As clear as we are about this, we struggle when trying to explain this to the patient.

I was presented with just this situation last week. Over the years I have learned that playing the role of the all knowing expert has not served me well with patients. Instead I have found that “talking my think” is an incredible way to interact with other people. It takes all of the stress off of my shoulders, allows me to be authentic with patients, and has eliminated a large amount of frustration and failed expectations part way into treatment. With the use of photographs and radiographs I allow patients to see what I can see, and then explain what my concerns are.

” We found decay around the edge of your old crown during your exam today. Unfortunately due to the metal under your old crowns, I can not see the extent of the decay on the xrays we took today. The place to start is by removing your old crown, we may find that we have caught the decay early and can simply replace it. It is also possible that the decay has advanced and this tooth will need additional treatment or may not be able to be saved. Once I have your crown off, you and I can stop and discuss how to move forward.”

My experience is that patients can manage the uncertainty. What is challenging for patients is the fear that treatment will be performed without them being involved in the process, they want to know that choice remains with them, that they have control over their care, and that whatever the outcome is, there are options and a solution will be available. I also find that patients want to know that at the end of each appointment they will be able to eat and smile, will they have discomfort and will they still have at least a temporary in the space. Simply said they do want to understand what their experience will be like. I assure my patients that whatever we find, I will support them in understanding their options, the risks and benefits of the different options, and in getting the treatment complete. This approach has saved me a lot of sleepless nights over the years.