PROGNOSIS

All patients will be directed to this page and will be referred to it from time to time.  It is essential to realize that all treatments have a statistical possibility of an expected outcome as well as an outcome that is less than expected or even undesirable.  This is referred to as the Prognosis.  There is no getting around this statistic, however, we can certainly improve it in your favour.

Following are some common prognoses and what you need to know about them:

• Sensitive teeth following a restorative procedure.  When you have a filling, crown or bridge placed, there is a certain amount of trauma to the nerves (pulp) of the teeth involved.  The deeper the decay or existing filling, the greater the chance of nerve inflammation and sensitivity.  If the situation progresses to a toothache, a root canal procedure may be required on the affected tooth.  Consider that this might need to be done through a recently crowned or filled tooth.   The worse the existing shape of the individual tooth prior to treatment, the less the prognosis may be.
• Tooth or cusp fracture.  This is very common and is due to continued loading of the individual cusps (the pointed parts of the teeth).  The bigger the existing filling and/or decay, the greater the chance of fracture.  Occasionally, a tooth may fracture in such a way that it is unrestorable (unfixable) and will require extraction.
• Root fracture and subsequent tooth loss.  In the event that a tooth has been root canal treated, it may not be as strong as the original tooth.  With constant wear and tear, a root canalled tooth is more likely to fracture under repeated loading.  A tooth is no different than a simple 'beam' and is susceptible to stress fractures due to excess or constant loading.  A simple analogy is  when you bend a coat hanger repeatedly until it breaks.  This is fatigue fracture.  Also, the older a tooth is, the more likely it will be to fracture. 
• Recurrent decay or gum disease.  Despite our best efforts, decay or gum disease can return.  There are many reasons for this.
• Prosthetic Failure.  The more complex a prosthesis becomes, the less load it will be able to withstand.  Simply the fewer teeth you have supporting a bridge and the longer the span of the bridge, the less load it will be able to withstand.  The same goes for the condition of the abutment teeth.  Whenever root canalled teeth are used to support a bridge, the more likely they are to fail.
• Dry socket.  This follows an extraction whereby the blood fails to clot in the formed socket.  Onset occurs with 2-4 days of the extraction.   You will be aware of this by the dull throbing pain that is not alleviated by pain medication.   Please contact the office as we can provide a specialized packing in the socket to alleviate the discomfort. 

Please consider that any treatments we recommend for you are calculated to improve the long term prognosis of your dental health.  We would advise against treatments that have a poorer prognosis than other treatments.  How can your prognosis be improved?  Consider the following:

• Treatments should be done in a timely fashion.  The longer you leave decay or any other condition to progress, the worse the condition becomes.  As far as teeth are concerned, the more tooth structure you are left with, the better off the tooth remains.
• A maintenance schedule should be followed.  If you neglect professional care and/or neglect proper recommended home care (flossing, brushing, etc), the more chance you will have of gum disease, tooth decay and other problems occurring.  We urge you to keep your regular appointments so that we can discover problems before they advance further.
• Basic health recommendations should be followed.  Smokers and uncontrolled diabetics will be more prone to dental disease.  You should follow the advice of your physician and make sure that you take your recommended medications.
• Grinding and clenching habits should be controlled.  The more you grind and stress your teeth, the more likely they are to break or crack.  If you grind on a root canalled tooth, it also will be more likely to fracture.  If you are  a grinder/clencher, make sure you check out the site for Temporomandibular Disorder (TMD).  If recommended, you should be wearing your brux (grinding, night) guard as suggested. 
• Treatments selected.  Not all materials are the same.  Some materials used to fill or fix teeth have a statistically higher incidence of post operative sensitivity or pulp death than others.  We prefer machinable ceramics to conventional ceramics, gold, metal ceramics or composite for this reason.  Also, when implants are used to replace missing teeth, they have a better long-term prognosis than when fixed bridges are used.  We prefer not to prepare (file down) the adjacent teeth for a bridge.  Also, when fewer teeth are used to support a bridge, there is more stress on the abutment teeth.  As a general rule, the bigger the bridge the less the prognosis.  Implant retained teeth allow all teeth to support their own load, hence a better prognosis.

IMPORTANT:  Did you know that under the DENTIST'S ACT,  we are not allowed to guarantee our treatments?  Nonetheless, we will give you our very best and stand behind our treatments.  Making your treatments last as long as possible is not only our professional responsibility but a matter of pride to us.  Naturally, we cannot stand behind our treatments in the event that you do not follow our treatment recommendations, fail to complete treatment, do not show up for your regularly scheduled visits and fail to follow our maintenance recommendations, i.e. daily home care program.  Another example of this is when it is recommended that you wear a grinding/brux guard in order to reduce stress on the teeth during sleep.  By not having one or wearing it as required, you greatly increase the chances of tooth or ceramic fracture as well as root sensitivities, notching and recession.

One of our biggest challenges in dentistry today is the longevity of our patients!  Two generations ago, we used to consider crowns as a lifetime treatment.  This was simply based on the fact that many people did not get crowns or bridges until their fifties and were then only expected to live to their late sixties.  Today is a totally different ball of wax.  With vast reductions in heart and lung disease during the sixties years, we are now performing treatments during the patient's seventies realizing that  making it last the patient's lifetime is still going to be a major challenge!  Today, people not only expect to be active into their eighties but expect to enjoy life with the same degree of gusto.  Consider that enjoyment of food is a huge part of life.  Today's cuisine is as much geared to the actual taste as well as to the texture of the food. To really enjoy your food to the max, you need to be able to chew it, regardless of the texture and consistency and you must not cover the sensitive taste buds in the palate of your mouth with a denture.  In the event that you do have some form of denture or removable appliance, consider replacing them with implants.

Prognosis will always be a part of all treatments.   We will advise you based on the preferred treatments so that your prognosis for any treatment is kept as ideal as possible.  Let us know if you have any questions or concerns about your treatment.