It is important 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.
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. At Steveston Smiles, Drs. Doug and Michele Nielsen proudly stand behind their work. As a regular active recall patient who is up to date with your oral care, dental check-ups and cleanings you will benefit from their continued goal to strive for excellence. If a filling needs to be redone due to fracture, material defect or even decay within the first 2 years, we will repair it at no charge. If a crown fails due to fracture, material defect or decay and needs to be replaced within 5 years, we will replace it for you no charge. Exceptions to this policy, compromised treatment plans and poor prognosis treatments will be clearly stated before any work is started.
If you However, 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 not wearing it as required, you greatly increase the chances of tooth or ceramic fracture as well as root sensitivities, notching, and recession.
The 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 nerve(s) (also known as pulp) of the tooth/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. Most teeth that fracture can be restored with a crown; however, occasionally a tooth may fracture in such a way that it is not restorable (unfixable), and will consequently 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. Essentially, the top of the tooth is hallowed to access the canals. The older a tooth is, the more likely it will be to fracture. Having a crown placed on the tooth with increase its prognosis.
Recurrent decay or gum disease. Despite our best efforts, decay or gum disease can return. There are many reasons for this.
Prosthetic (crown/bridge/veneer) 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 supporting teeth. Whenever root canalled teeth are used to support a bridge, the more likely they are to fail.
Please consider that any treatments we recommend for you are 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 greater chance you will have of gum disease, tooth decay, and other problems. 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 will be more likely to fracture. If you are a grinder/clencher, make sure you check out the site. If recommended, you should be wearing your brux (grinding or night) guard as suggested.
Implants. When implants are used to replace missing teeth, they have a better long-term prognosis as opposed to fixed bridges. We prefer not to prepare the adjacent teeth for a bridge. 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.
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.