In the first row of photos, note that the occlusion teeth bite was over-closed due to a prior history of an eating disorder, now controlled, and a current teeth grinding habit.
An Oral Surgery consultation with panoramic x-ray (second row) was performed prior to treatment to evaluate opening the dental bite.
The third row shows x-rays taken after the Endodontist completed eight root canals on the first day on tooth #’s: 6 – 11 and 14, 15. This was accomplished with just enough dental sedation to keep the patient comfortable but he was awake the whole time.
The fourth row shows the dental laboratory processed 11 teeth temporary dental bridge and the cast gold post and cores – with Kaitlyn loops – for the root canal treated teeth.
The fifth row shows the cast gold post and cores cemented.
The sixth row shows the lab-processed temporary bridge in place after the oral surgeon extracted tooth #’s: 3 – 5 and 12, crown lengthening gum surgery was performed on tooth #’s: 6 – 11, and a distal wedge gum surgery was performed on #15. The patient was not nervous or anxious during these dental procedures either. He did not feel helpless due to appropriate behavior modification during his office visit. He just felt emotionally comfortable during his smile makeover.
The patient will have a final porcelain metal teeth bridge made after the gums heal. Dental implants may also be placed in the upper right posterior. A bite plate is also necessary to try to mitigate the force of tooth grinding. Referral for pharmacological management of anxiety is also worthwhile. Before and after pictures. Image #1 of 2.
Image #2 of 2.
This patient had been wearing a very old, broken temporary dental bridge; she had been recementing it herself daily for years. The after photo shows a new dental laboratory processed provisional teeth bridge placed later that same day.
We successfully controlled this patient’s dental fear phobia through emotionally supportive behaviors that gave her control over us.
This dental anxiety patient was successfully managed with behavior modification and nitrous oxide gas. She was a bright and successful businesswoman who had difficulty giving up control so we let her maintain it. She successfully overcame her fear of dentistry by learning she was not helpless when under the care of a dentist.
This dental treatment took only one day from 9 am to 5 pm. The dental laboratory technicians and specialists including the Endodontist, Oral Surgeon and Periodontist were scheduled for specific times throughout the day. This dental fear phobia patient was kept comfortable throughout the day with nitrous oxide conscious dental sedation.
Dental sedation was provided with nitrous oxide – laughing gas – to achieve a comfortable state of conscious sedation. These before and after pictures document how much dentistry can be performed when a dental phobia patient is emotionally and physically comfortable. This dental treatment took 15 weeks only because of the time needed for healing of the gums otherwise it could have all be completed in one or two weeks.
This case is now over ten years old. The patient moved to Florida but flies up every three months for her regular dental prophylaxis and examination. She frequently brings morning bagels for the staff; she is no longer afraid of dentistry.
The patient learned to see his teeth as jewelry and became comfortable with the dental treatment; his dental anxiety disappeared. He did not experience tooth pain in the office. Temporary provisional dental crowns caps were placed during four days of dental treatment. More dental work remains for completion.
The decision to fabricate a removable immediate partial denture, rather than a fixed lab processed temporary teeth bridge, was determined by the particular periodontal weakness of tooth #28. The patient was informed that the immediate prosthesis was to be used during healing and that the four remaining teeth abutments, particularly #28, might be subsequently extracted.
She appreciated becoming involved in her dental treatment and this reduced her being scared of the dentistry. A little nitrous oxide conscious dental sedation also helped. People who are comforted emotionally can usually be treated with low levels of nitrous oxide.
Dental treatment included porcelain fused to metal dental crown & bridge, root canal therapy on all teeth abutments, a root tip extractions, and facial cosmetic dental bonding on both upper lateral incisor teeth. The upper anterior root canal and dental crowns were first completed to show her how pretty her teeth could look and that it could be accomplished quickly and without tooth pain. The Oral Surgeon completed teeth extractions of the hopeless teeth at one time and initiated early to allow time for healing before final teeth preparation and impressions for teeth bridge work – dental crowns. Root canal was performed on the posterior teeth abutments before their preparation – drilling – for bridgework. The patient experienced minimal post-operative tooth pain. Controlling teeth pain with prophylactic endodontics root canal is ironically one method how to help dental phobia patients overcome their anxiety. No mouth pain means comfortable patients.