I retired yesterday, and while I will no longer treat any patients, I hope to support both dentists and the public through some reflections on my years in practice.
Last month this patient reminded me of how I'd looked after her when she was anxious and unhappy with her previous dentist who had fitted some veneers. She then told me how I wouldn't replace the veneers until she cleaned her teeth better and had some outstanding work carried out.
These are her BWs from 1997. Below are my comprehensive notes of the period and an indication of how the majority of our record keeping. We had to keep them to a minimum; otherwise, the record card would explode.
There is far much to discuss, but the root filling LL6 had a fractured instrument was poor, but lasted longer than the root filling I did in the ll5. It is strange how variable the outcomes are for root fillings despite their radiographic appearance.
I was never confident enough to make a crown on the ll6. I repaired it with Dyract in 2002, as you can see here. She is not concerned with the appearance. In fact, none of the teeth since 1997 have failed apart from both lower second premolars.
below are her recent digital BWs with many original amalgam fillings from 1997.
Finally, I sent off for permission to replace the veneers. This is the current appearance in 2020. I removed the offending cosmetic restorations and did not attempt temporaries. Two weeks later she returned for the fitting but decided she liked the appearance as they were. She still has the veneers at home.
I saw this patient under the NHS, if you look how long she was booked in for and my notes, you can see how different it is today. If you had a few of these NHS patients in your chair, what would you do? Give them some cash, and ask them to go elsewhere?
In retrospect, avoid any RCT where you intended to get near the apical foramen? Simply extract may have been better, as seems the new norm in NHS dentistry. If I hadn't gained her confidence back then, I doubt if she would have any molar teeth now. As for the person who placed the veneers, they gave the profession a bad name.
After a while, when using an ultrasonic scaler, my mind drifts off. Sometimes I even wonder what I am doing, and why? In March 2016 Mrs Collins isolated premolar supporting her CoCr -/p was M2 and bleeding. Desperate measures were required, so I sent her a YouTube video form the excellent group Perio Courses. In July 2020 she still has no bleeding, no mobility, and a lower denture she likes-even more unusual. She was the tipping point for my teeth4life APP.