Don’t Fall off the Ladder

Good morning!  We’re in month three of being open for business now and things are picking up!  I’m glad to say that it’s harder to find time to write these blog posts, but I do look forward to keeping them going.  I hope you find them informative.  In this monthly blog post, I’ll be explaining my common analogy of dentistry being like the rungs on a ladder.  You may think that it’s an odd analogy, or that I’ve fallen off my own ladder, but keep reading and you’ll understand.

First off, let’s just do away with the myth that any tooth restored by a dentist is ever as “good as new.”  God-given healthy teeth, with enamel, dentin, vital nerves, and healthy periodontal attachments are unparalleled in their ability to last our lifetimes.  However, not everyone has currently healthy teeth and gums.  That’s where dentists like myself step in to intervene.  No filling, crown, root canal, bridge, implant, etc is better than a perfectly healthy natural tooth.  But those options are better than a tooth with decay, or a missing tooth, a tooth with gum disease.  So we treat only teeth that need treatment and restore them to the best of our abilities within the limitations of man-made materials.  There are inherent limitations to all our restorative materials, but that may be a topic for another blog post.

So, why do I say dentistry is like a ladder?  It has to do with the ‘death spiral’ of teeth.  Fillings never get smaller, only bigger as they wear out or need replacement.  Once a tooth has a crown, it never goes back to not having at least that.  Same thing with a root canal.  And eventually, if enough failures occur and we live long enough, that tooth could fail entirely and need to be extracted.  So picture that ‘death spiral’ instead as rungs on the ladder.   A perfectly healthy tooth is the ground.   A small filling is 1 step up the ladder.  A larger filling is rung 2.  A really big filling is rung 3.  A crown is rung 4, add a root canal is rung 5.  How many rungs are on your ladder for a given tooth?  I don’t know, it depends on lots of factors.  What I do tell my patients is that the very top rung of the ladder, the one marked “Do Not Stand Here,” is the implant.  We don’t have another step up from here.  So, if an implant fails (and yes, implants can fail, anyone telling you otherwise is selling you something), what happens then?  Well, just like reaching for another rung up the ladder that doesn’t exist, nothing good follows.  It’s not a simple matter to remove a failed implant and replace it with another one.  It’s possible, but we’re really pushing the envelope at that point.  That is why I tell patients not to skip steps on the ladder.   If a tooth needs a filling, do a filling.   If we can catch it early and do a small filling, that’s way better than a large one.  If a tooth is salvageable with a root canal and crown and has a good prognosis, I’ll typically recommend that approach versus the extraction and implant route.  

Ultimately, I want all my patients to have healthy mouths and beautiful smiles for their entire lifetime, whether that be 75 years or 120 years.  None of us has a visible expiration date (wouldn’t that make planning much simpler?).  Because of that, I treatment plan conservatively.  Don’t needlessly skip steps on the ladder.  If a patient eventually ends up with an implant, that’s fine, they are a wonderfully successful, functional, and esthetic option.    But if I put an implant in a patient at 20 years old, versus an implant in a patient at 75 years old, which implant has the better chance of lasting that patient’s lifetime?  

Don’t fall off the ladder!