The following is a guest post by Mark Wilhelm, DMD MSD. If you are interested in guest posting for Dental Heroes, please sign up here .
Mark Wilhelm, DMD MSD
There are many cosmetic dentists who believe that diagnosing a patient must begin with a close examination of test results and x-rays.
It Starts with “Hello”
With over 20 years of experience to call upon, I beg to differ. While many situations will require clinical research, you might be surprised at how much it’s possible to tell from your first “Hello” with a patient.
Simple Case Study
I recently had a patient visit me to get a second opinion. She was 63 years old and had a lot of dentistry already completed. She had an issue with her front teeth. At a previous provider she was told that she needed a full-mouth reconstruction and went into the details as to what was proposed. After listening I asked her these five basic questions regarding function:
1. Are you able to chew bagels or other tough foods?
2. Are you able to chew gum?
3. Do you sleep restfully?
4. Do you feel as though you have one bite when you close (or more than one place to bite)?
5. Have you noticed any wear, flattening or changes in your teeth in the last five years?
These weren’t trick questions but rather basic ones that could give me any evidence of functional concerns or breakdown. From the five questions I asked her and from what I could see from my position in the consult room, my opinion was that she did not need a lot of dentistry.
Now note that I had not even moved from my seat and already had a good idea of what, if any, problems she had. She brought copies of x-rays and I did eventually get a clinical look at her teeth, but the bottom line is that I did not need an articulator or the study casts that she brought with her. How could I do this? It’s simple. She was 63 years old and told me that she was able to chew and eat just fine, did not have any pain and did not exhibit any appreciable clinical wear on her teeth. This all meant that her chewing system was working fine. It didn’t need fixing! Next I was able to address her needs with her front teeth. Simple treatment for a trusting patient.
This diagnosis began at hello and concluded with an investigation. After she agreed to proceed, I could use the study casts to do the diagnostic wax-up and coordinate it with facial measurements to plan the treatment and the provisional restorations. But my determination that her occlusion was functioning acceptably meant that I did not need to change her bite.
Take a different patient referred by his family dentist because he had a problem with his front teeth. He was also in his sixties and he thought that he just needed to have some crowns on his front teeth and he would be on his way. Well, at our first “hello” I determined that his occlusion was not functioning acceptably and after asking some questions and looking at his mouth I confirmed this. His problem with his front teeth developed because he had a problem in his occlusion with his back teeth. He did need a full-mouth reconstruction, or close to it.
Please note that these are significant conclusions confidently made without an articulator or study casts or anything other than experience and careful observation. Treatment, on the other hand, requires instrumentation and the knowledge that goes with using it. Knowing when to use what will mean the difference between success and failure, and will potentially save you from doing a lot of unnecessary dentistry and still possibly succumbing to failure.
What do you think? Can you reliably make an initial diagnosis pre-examination as Dr. Wilhelm suggests?