The Pre-Terminal Dentition: Considering Dentures | PART 2

August 19, 2017 | by Dr Alex Fibishenko
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In Part 1 of this series I responded to a dentist’s dilemma about carrying out treatment requested by his young patient and committing her to dentures. It is not uncommon within our professional environment to face this or other similar situations that challenge our moral and ethical compasses. In this segment I explore how these might affect our professional conviction, …and whether this may be limited by an inexperience?

From a philosophical perspective, there are various elements to the dilemma at hand, the first being the removal of decayed teeth. This was not much of a dilemma for this particular dentist: he appears to be willing to remove decayed or diseased teeth for his patient, but there will be many others who will fight to save every tooth using available modern dental methodologies. Is there a right or wrong here?

The second part of the dilemma is the removal of teeth that may otherwise be healthy. There will be very few dentists who could rationalise removal of healthy teeth, but is this a question of their experience or inexperience? Is it a question of what they know or what they don’t know? On its face this dilemma would appear to be largely moral or ethical in its nature, but the question is also whether the clinician has adequate insight to look beyond the problems affecting individual teeth and to assess the overall situation, within the context of patient’s expectations, with treatment considerations that might in fact involve removal of healthy teeth.

Thirdly is the proposition of replacing the teeth with dentures, which have known issues and can impair the quality of life of individuals. Of the many areas in dentistry where I can, and do, keep an open mind, I have strong opinions on this because I see patients with dentures every day in my practice, and who would do whatever is within their means to get rid of them. So here I understand this dentist’s refusal to commit his patient to a life-time of issues, and also commit himself to a lifetime of trying to fix those issues, …”trying”!

The fourth part of this dilemma is dealing with what the patient might demand. As I pointed out in the prior article, our patient’s demands are often the result of a very limited understanding or insight. This patient only has insight and understanding of the problems that she has been having, and the failed attempts to address those problems. What she clearly lacks is an insight or understanding of the potential effects of dentures on her quality of life. So it is our job as their dentist to educate them about this, but in order to educate them about the alternatives such as dental implants, we must possess an insight and sound understanding of these alternatives first, …and so again, it becomes a question of experience …the fifth part of this dilemma.

Dental implants treatments such as All-On-4 and Zygomas offer normalisation of function, aesthetics and oral health. However when not done correctly, dental implants could only add to our patient’s cycle of dental problems. They are also difficult to undo, and often impossible to re-do. We should be mindful that these treatments require special skills and set-ups in order to be done in a way that will actually achieve the long term goals that we share with our patients. Done well, dental implants can have a tremendous positive impact on our patients everyday lives by allowing them to live their lives rather than focus on their dental problems or inacapacities with dentures.

I was touched by one other respondent’s story:

“I gave in to a 75 year old lady (and gave her dentures), after months of begging from her some 20 years ago. She did not eat solids after that. Died 6 months later. Have not done anything beyond my professional conviction since.”

I replied,

“Sad story John …I really feel for you to have to live with this guilt. Let this be a reminder to all of us that apart from eliminating all self esteem, dentures can be crippling for the young, let alone the elderly who are less able to adapt with age.”

Click to read a story about the opposite effect for a 75 year old treated with All-On-4

Dr. Alex Fibishenko


Oral Implantology & Reconstructive Dento-facial Surgery
Dental Surgeon in Self-Restricted Practice
Innovator of All-On-4 Plus ® & founder of All-On-4 Clinic

Dr Alex Fibishenko practices exclusively in Oral Implantology, Dento-Facial Surgery and Facial Aesthetics.

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