Many people mistakenly believe that dentistry is a specialized field, but in reality, dentistry, like Western medicine, is further subdivided into different specialties based on the area of treatment. In this article, we will explore how complex dental problems can be solved through " interdisciplinary dental treatment " based on a special case of an elderly person losing teeth provided by a reader.
Mr. Yang, who had no appetite
Mr. Yang's (pseudonym) father had been troubled by the problem of eating without teeth for a long time and had recently consulted a clinic about the issue of tooth loss in the elderly. Mr. Yang, 68 years old this year, loves food. Before retiring, he often traveled around the world for decades due to his work, tasting all kinds of delicacies. Enjoying food is one of the great pleasures of his life.
However, since retiring, perhaps due to declining physical function, his teeth have gradually loosened and become frequently painful. As a result, Mr. Yang has been unable to chew many foods and has had to switch to liquid foods that are plain in appearance and taste. Mr. Yang, who loves food, initially got angry about this, but over time, he stopped getting angry. However, he became depressed, self-destructive, and felt that life was meaningless, which caused his children great distress.
Mr. Yang said that his family had all advised his father to see a dentist as soon as possible to see if there was any way to save his teeth. However, his father refused, believing that losing teeth as one gets older is a normal part of life and that dentists couldn't help him; he thought seeing a dentist was just a waste of money and time. The dutiful Mr. Yang didn't give up. A year ago, he took his father to the dental emergency room for a simple examination and pain relief treatment, but ultimately, the problem of his inability to chew was not resolved.
Is there no cure for tooth loss in the elderly?
Like Mr. Yang, many elderly people face the problem of tooth loss, but is it necessarily incurable? Dr. Chan Sze-yan, who is also the Medical Executive Director of the Dental Centre, and her specialist colleagues, including Prosthodontist Dr. Tse Chi-man, Periodontist Dr. Chow Wai-wai, and Oral and Maxillofacial Surgeon Dr. Lee Chi-ying, will analyze the above cases from a professional medical perspective.
From left: Dr. Zhou Huihui, Periodontist; Dr. Xie Zhimin, Prosthodontist; Dr. Li Zhiying, Oral and Maxillofacial Surgeon; and Dr. Chen Sixin, Medical Director of the Dental Centre.
Dr. Chen Sixin stated that if Mr. Yang wanted a diagnosis that reflected the latest situation, he should undergo a more comprehensive 360-degree oral scan. However, based solely on the diagnostic records provided by the reader, Mr. Yang's condition is indeed quite complex. Many of his teeth have begun to fall out one by one due to periodontal disease, and the remaining teeth are loose, decayed, and even several teeth have decayed to the point that they are hidden in the jawbone.
Mr. Yang suffers from several dental problems, including periodontal disease, cavities, and severe bone atrophy. He also has several other health conditions, such as diabetes that is difficult to control, and osteoporosis that requires regular bone injections. All of these conditions make any dental treatment more difficult.
However, Dr. Chen emphasized that Mr. Yang is not necessarily beyond help. Because handling such a complex case involves knowledge from different dental specialties, the patient could consider interdisciplinary dental treatment. This means that the attending dentist familiar with the patient's condition will develop a comprehensive treatment plan, which will then be handled collaboratively by general practitioners and specialists with different areas of expertise. The attending dentist will coordinate with restorative dentists, periodontists, and oral and maxillofacial surgeons as needed to systematically address different dental issues according to the treatment plan, and will adjust the treatment plan as needed based on the patient's condition and requirements.
Photos provided by readers
Photos provided by readers
What is "interdisciplinary dental treatment"?
In Hong Kong, not many people may have heard of " multi-disciplinary dental treatment," but in recent years it has become a relatively mature treatment model in places like the UK and the US, known as " Multi-Disciplinary Dentistry."
The underlying idea is based on the fact that dentistry itself is divided into different specialties, and dentists in each specialty have accumulated extensive clinical experience and are experts in their respective fields. If a patient's problem involves more than one specialty, collaboration among dental experts from different specialties may be more effective in eliminating the root cause of the problem.
Different specialties of dentistry
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Specific treatment process of "interdisciplinary dental treatment"
Dr. Chen pointed out that, taking Mr. Yang's case as an example, after the attending dentist formulates an initial treatment plan, it will be handed over to the prosthodontist for further detailed evaluation. Based on the treatment needs, it will be determined which tooth can be retained as a support for the future denture, and which necrotic tooth needs to be extracted to avoid affecting other teeth.
Afterwards, the periodontist will take over to thoroughly remove periodontal bacteria and stabilize the patient's oral condition. This is because if periodontal disease and cavities are ignored and dentures are made directly, the remaining teeth will not be able to provide stable support, ultimately rendering the dentures useless.
In addition, because Mr. Yang has been receiving bone injections for a long time, any oral wounds or trauma could lead to bone atrophy and tissue necrosis. Therefore, it may be necessary for an oral and maxillofacial specialist to extract the necrotic teeth. Finally, a prosthodontic dentist will custom-make the most suitable denture for the patient.
Example of a dental team division of labor in "interdisciplinary dental treatment"
Dentures are not the only solution
Dr. Xie, a specialist in prosthodontics, added that in addition to dentures, Mr. Yang can also choose dental implants. He explained that doctors will recommend different options based on the patient's physical and oral condition, and will also decide which teeth may need to be extracted early to avoid affecting the durability and aesthetics of the future dentures.
Based on past experience, many elderly people are worried about their health and do not want to undergo too many invasive surgeries. Doctors mostly tend to use more conservative methods, such as making removable dentures (dentures that can be removed and put on by the patient) instead of implanting teeth in multiple locations. This approach is also more economical.
Removable dentures
If possible, some teeth, despite their fragile structure, can be preserved through root canal treatment (commonly known as root canal treatment ) and magnetic inlay to support and fix removable dentures, making the patient more comfortable when wearing dentures. Furthermore, this method preserves the tooth root, which reduces alveolar bone resorption, making it simpler and faster if the patient wants to have implants in multiple locations in the future.
Magnetic inlay device for fixing dentures
Periodontal disease treatment is indispensable
As mentioned above, periodontal disease treatment is an indispensable part of the entire treatment. Patients must first remove periodontal bacteria from their mouths in order to create a healthy oral environment and create favorable conditions for the subsequent fitting of dentures.
Dr. Zhou, a periodontist, points out that in cases of severe periodontitis, dentists generally try their best to salvage the remaining teeth so they can provide strong support for future dentures. The dentist first performs a deep cleaning to remove tartar and periodontal bacteria that have accumulated over the years from the tooth roots, and then teaches patients self-care and cleaning techniques. If the patient's health permits, the dentist may also perform minor procedures such as tissue repair and bone/gum regeneration on loose teeth to make them more stable.
However, she cautioned that since periodontal disease is a chronic condition, treatment cannot be completed overnight. Even after treatment, it is necessary to have follow-up appointments every few months to stabilize the condition.
As mentioned above, periodontal disease treatment is an indispensable part of the entire treatment. Patients must first remove periodontal bacteria from their mouths in order to create a healthy oral environment and create favorable conditions for the subsequent fitting of dentures.
Dr. Zhou, a periodontist, points out that in cases of severe periodontitis, dentists generally try their best to salvage the remaining teeth so they can provide strong support for future dentures. The dentist first performs a deep cleaning to remove tartar and periodontal bacteria that have accumulated over the years from the tooth roots, and then teaches patients self-care and cleaning techniques. If the patient's health permits, the dentist may also perform minor procedures such as tissue repair and bone/gum regeneration on loose teeth to make them more stable.
However, she cautioned that since periodontal disease is a chronic condition, treatment cannot be completed overnight. Even after treatment, it is necessary to have follow-up appointments every few months to stabilize the condition.
When is it necessary to have an oral and maxillofacial specialist intervene to extract a tooth?
In the entire multidisciplinary dental team, oral and maxillofacial specialists are responsible for extracting necrotic teeth. However, Dr. Li, an oral and maxillofacial surgeon, said that it is not only they who can extract teeth, because general practitioners are also capable of extracting teeth, depending on the situation.
She pointed out that because Mr. Yang's case was quite unique, requiring bone injections, there was a higher risk of complications such as bone atrophy during the tooth extraction procedure. As a precaution, many patients request that similar situations be handled by oral and maxillofacial specialists, as they specialize in large and complex surgeries and are capable of handling unexpected situations.
Team members cannot act independently.
Dr. Chen Szu-hsin emphasized that the key to " interdisciplinary dental treatment " is that members of the dental team can communicate closely and regularly about the patient's condition to ensure that the treatment of different parts is completed in an orderly manner according to the time and method set in the treatment plan. If medical conditions arise during the treatment process, the team members may need to discuss whether the treatment plan needs to be revised in order to achieve the original expected treatment results as much as possible.
Conversely, if dentists in different specialties work independently and ignore the treatments of other team members, it may result in duplicate treatments or make it difficult for the dentist handling the next step to complete the original plan.
"Interdisciplinary dental treatment" may not be suitable for every patient.
However, not every patient is suitable for " multidisciplinary dental treatment." Dr. Chen pointed out that if a patient does not have many special medical conditions and their oral health is not bad, it is often not necessary for all specialists to be involved. For example, as mentioned above, tooth extractions and dentures can be handled by the patient's family dentist if the situation permits, and then the periodontist can be consulted to complete the entire treatment.
Simple cases should be handled with simple methods, which will save time and money. Moreover, whether to perform partial or full treatment depends on the patient's individual needs and financial ability, and the dentist will ultimately respect the patient's wishes when formulating a treatment plan.
How can patients determine if they are suitable for "interdisciplinary dental treatment"?
To determine if they are suitable for or need " interdisciplinary dental treatment," dentist Dr. Chan Sze-yan suggests consulting with a trusted family dentist. Generally, some local private hospitals and dental day clinics have more comprehensive dental specialties and the necessary equipment and experience to provide related treatments.
With sufficient experience in collaboration, independent family dental clinics can also work with other specialist dental clinics through referrals to complete treatments. Patients can check the list of registered dentists uploaded to the Dental Council website at any time to verify a dentist's professional qualifications.
The key to the success or failure of treatment
Because the entire treatment involves multiple different procedures, and patients need to wait for their oral health to recover after completing certain procedures, it may ultimately take up to six months to complete. Dr. Chen reminds patients that before deciding to undergo treatment, they must be fully prepared psychologically and have a firm determination to complete it, so as not to give up halfway and suffer losses. After completing the treatment, patients also need to maintain good oral hygiene and care for their teeth, otherwise the chance of relapse will be greatly increased.
After reviewing the analyses of the dentists, Mr. Yang and his father regained their hope of regaining their chewing ability and enjoying food. After discussing with their family, they decided to seek a second medical opinion to see how to solve their current troubling dental problems.
If you have any questions, please consult your trusted family dentist.
Source: Parenting Kingdom