Planning treatment

There are three levels of treatment planning. The first is planning for you as a person, secondly planning for your mouth as a whole, and thirdly the tooth or gum showing a particular problem. If all considerations coincide treatment planning is straightforward, but if there is a conflict, a compromise solution must be found or just do nothing at this time.

For example a very broken down tooth, or loose tooth, may not be worth saving, but you desperately want to keep it. So in effect you are asking for treatment which is unlikely to work. We know that many people need to arrive at a point of psychological acceptance before losing teeth and we will try to help you keep it as long as possible, but this means we have to explain the risks and consequences.

Sometimes, in an effort to achieve an optimum result, temporary intermediate stages have to be passed through with problems to be overcome and accepted. It is surprising how many people gloss over these difficulties when they focus on the end result and become irritated by the stages they must go through. We need to make these clear and usually give written details.

Financial constraints often limit what can be achieved and loss of a tooth may be accepted to maintain the health of the mouth.

In cases of severe gum disease, where a person is unable to maintain good oral hygiene, perhaps because of a physical problem, we may suggest loss of several or many teeth to protect their general health.

Treatment planning can become very complex when we have to consider the effects of medical, physical, and psychological conditions developing in a person who has maintained good oral health before their condition developed.

Before plans can be finalised we may require more information and additional tests performed. We cannot believe the Government expects an NHS dentist to provide the time and tests that we do for a patient charge of £16 (the dentist receives £20 to £25 for this), when the full range of tests cost us over £250 to carry out. Of course an NHS patient never receives this level of care, unless their treatment is in a dental hospital under the care of a consultant.

The quality of treatment can be severely compromised without proper assessment and planning. Savings on treatment costs by missing out the planning stage can be very costly in the long term.

Tests to provide information for the planning process

Screening tests (Part of a normal exam)

During the examination periodontal screening is carried out to give an indication of gum problems.

A Diagnodent laser is used to detect otherwise invisible decay, or assess the activity of visible decay.

Additional tests(Usually require an additional visit, but if time permits are included in the exam)

Where there are grounds to do so, digital radiographs (x-rays) are used to give images of bone and teeth. This helps us decide whether and what type of treatment is required.

Saliva tests give information about your body's ability to cope with modern diets. Problems with saliva content can push someone on a diet with a small refined carbohydrate component to develop dental decay, or could stop you reaching a stable point where no new decay is being formed. The results indicate whether we need to explain additional preventive strategies. Changes in saliva can take place as a result of illness and when taking certain medication. If these are not present it could indicate your genetic makeup is causing this.

Transillumination (shining a strong light through teeth) helps us detect cracks which may be causing pain or sensitivity.

Use of intra-oral camera to magnify teeth, fillings, cracks so that an assessment can be made.

Electronic pulp testing of teeth is a painless way of deciding whether a tooth is still alive.

Taking impressions for study models, so that your bite can be carefully assessed before deciding on crowns, bridges, implants and others.

Tests carried out elsewhere

Where a full mouth x-ray is required we make arrangements for this.

Should we detect changes in soft tissue or find unusual bone formations we refer you to the hospital for additional tests.