The porcelain crown which had been placed over the lower left second molar fourteen years back, in a city based Dental Clinic had admirably served its purpose.
However, of late the porcelain crown had come out of its base as the patient was flossing the inter-dental spaces between first molar and second molar and second molar and third molar. The patient had been methodically scrupulous in maintaining her oral hygiene.
As a 54 year old business woman her job was to interact with customers and convince them of the quality of watches in the shop which had a varying range of price-line.
She was conscious of the fact that her breath should always ‘smell good’ as halitosis of the mouth would discourage the clients from engaging in face to face financial transactions.
The Dental Surgeon surveyed the porcelain crown which the patient had tucked in her hand bag and taken out.
The status of the porcelain crown was good. The sulfaces-occlusal, mesial, distal, bucal and lingual-were all clear of plaque or food debris. The porcelain had remained intact despite the load of mastication it had taken over the years.
The patient said earnestly that since the porcelain crown had been out she had a weird smell and taste in her mouth. She wanted to have the crown fitted back into the void, left by the dismantled crown.
The Dental Surgeon (DS) cleared off the previous carboxylate cement from the hollow of the porcelain crown using the high speed drill with its jet of water to cool the crown. The cement provides the much needed tightening around the cut tooth and helps to retain the crown in place.
The DS was about to place the crown on the site to see if the bite with the upper molars was okay. His eyes fell on the base of the tooth which had been providing the support to the tooth. There was no portion of the enamel or dentine left. Instead, around the margins of the gums the two roots had opened up.
Their canals had reddish points indicative of the root –canal treatment that had been carried out more than a decade ago. The patient said, “I have also been having pain in the same tooth when I chew food.” The DS addressing her concern said, “There is no sufficient base on your second molar to provide a retentive seat to the porcelain crown. Furthermore the roots are denuded. The gums are inflamed.
They also bleed upon slight probing. There is also a degree or two of mobility associated with your roots.
I wish to convey to you that even after insertion of freshly prepared cement to place the porcelain crown back into its original position there is a possibility that the porcelain crown will not hold”.
The patient did not like the site of the roots and the accompanying redness of the gums around the roots. She said, “Doctor, please try to cement the crown as best as you can.”
The porcelain crown was re-fitted into the stumps of the roots.
For the sake of any future need for a new restoration it was decided to take a peri-apical view of the area. Needless to say both roots at their ends showed gross resorption of the alveolar bone that normally supports the tooth structure. No amount of conservation of the roots would help to restore the health of the roots.
The patient, as per the differential diagnosis, came back after eight days to the Dental Surgeon. She was carrying the crown as on ‘integument’. She agreed to have the infected roots of the molar removed under local anesthesia. The roots came out nice and easy with no resistance whatsoever, offered by the underlying bone.
The patient is now awaiting the complete healing of the socket site. She said, “I want to replace the gap with a removable partial denture which is clipped in. It I get used to this contraption it will save me the expenditure which I may have to incur in case I have to go for fixed crown and bridgewook.”
A mouth later a removable prosthesis consisting of the second molar with two stainless steel clasps grasping the anterior and posterior molars was put in place. The patient seems quite comfortable with the denture.
Son: “Pop, what’s the capital of Uruguay?”
Father: “I don’t know, son.”
Son: “Where was Mwalimu Nyerere born?.”
Father: “I don’t know.”
Son: “What is a polygon?”
Mother: “Don’t bother your Father!”
Father: “Let him ask questions. How else is he going to learn?”
In the trilogue above, the son would have been better off seeking answers to his quessions from somebody with an educational base. An ignoramus cannot provide a reply to a question posed by his own child if he has no academic background.
The patient in the Dental Clinc at least made it certain that her dental problem was tackled with appropriate expertise of the Dental Surgeon. There is no room for flippancy in health matters.
Dr. K. S. Gupta is a private Dental Practitioner available at Kgupta firstname.lastname@example.org.