New BBC show - Britian's Worst Teeth

[wa-loaf]

http://www.bbcamerica.com/content/317/index.jsp

This has got Dr Jeff's name all over it.

Britain’s Worst Teeth follows four twenty-somethings with some of the worst teeth in Britain. Their teeth are so bad they affect every aspect of their lives. They are in pain and are embarrassed to go out. They find eating and speaking difficult, and not surprisingly, they find it difficult to attract partners.

There is an epidemic of poor teeth in Britain. 1 in 5 people never visit the dentist. 1 in 10 is terrified of the dentist chair. Sugar consumption, eating disorders, and bad diet make Britain’s global reputation for being a nation of terrible teeth completely justified.

All might not be lost. Three of Britain’s top dentists have agreed to take on these four cases and see if they can do anything to save their terrible teeth.

 

[wa-loaf]

Let them eat cake ..

I think that's how they got there in the first place.

 

[drjeff]

http://www.bbcamerica.com/content/317/index.jsp

This has got Dr Jeff's name all over it.

Actually I do enjoy watching shows like this and "Extreme Makeover." It's actually in general a very good conversation starter between myself and my patients that can leed to me doing some of these "cosmetic cases" which while professionally fun for me to do, typically end up creating alot of subsequent headaches because often the patients will develop an unrealistic expectation of what can be done (read as what they see when they look in the mirror doesn't match their favorite celeb's pic in People Magazine -- and most of that is do to the airbrushed photo factor, which I can't control )

The biggest issue I do have though with shows like these, is that typically you're taking someone from a lower socio-economic level, and then gvivng them a complete and very costly makeover. The problem then is that all that dental work needs regular and sometimes costly maintenance since I'd highly doubt that mnay of those patients ultimately will continue to give up those bad habits that got them to their original level of disrepair. So while the TV network initially footed the big $$, or the "celeb doc du jour" did a freebie(in return for the free national TV name dropping plugs), whose going to cover the cost of the follow up care for the next X number or years?? Or worse off, whose going to pair for the work to be replaced in 15-20 years when it reaches the end of it's functional lifespan?? That's where I have issues with these types of programs.

 

[wa-loaf]

Actually I do enjoy watching shows like this and "Extreme Makeover." It's actually in general a very good conversation starter between myself and my patients that can leed to me doing some of these "cosmetic cases" which while professionally fun for me to do, typically end up creating alot of subsequent headaches because often the patients will develop an unrealistic expectation of what can be done (read as what they see when they look in the mirror doesn't match their favorite celeb's pic in People Magazine -- and most of that is do to the airbrushed photo factor, which I can't control )

The biggest issue I do have though with shows like these, is that typically you're taking someone from a lower socio-economic level, and then gvivng them a complete and very costly makeover. The problem then is that all that dental work needs regular and sometimes costly maintenance since I'd highly doubt that mnay of those patients ultimately will continue to give up those bad habits that got them to their original level of disrepair. So while the TV network initially footed the big $$, or the "celeb doc du jour" did a freebie(in return for the free national TV name dropping plugs), whose going to cover the cost of the follow up care for the next X number or years?? Or worse off, whose going to pair for the work to be replaced in 15-20 years when it reaches the end of it's functional lifespan?? That's where I have issues with these types of programs.

What would you normally do with that kind of patient? Pull them and give them dentures?

 

[thetrailboss]

When is Marc going to be on the show? :wink:

 

[drjeff]

What would you normally do with that kind of patient? Pull them and give them dentures?

It would depend on ALOT of variables. First and foremost has to be what they could afford both now and then asuming normal conditions (employment, etc) later.

Then after that it would get down to a situation where I'd have to take into account what got them to that state of dis-repair(and not just I never had braces), but what their diet is(a determinant of future decay risk), what their hygiene is like (a determinant of what their future periodontal(gum) disease risk is, and from a functional standpoint, how their bite is with respect to postion of their upper and lower jaw bones and their jaw joints(TMJ) "comfortable" position. Once all that's been figured out and I feel relatively comfortable that they'll be able to take care of what I'm talking about AND from 1st a functional standpoint and secondly from an esthetic standpoint(hey before it can look good it has to work) that everything will work, then the process would start.

I can say from many full mouth re-builds that "disaster cases" typically involve about 3 or 4 months of consult/planning visits with not just myself, but usually the orthodontist, the periodontist(gum specialist), the oral surgeon and possibly the root canal specialist too. These cases often to get them done right, the way that you'd want them done will often usually take a couple of years from start to finish (especially if braces are needed) to get them right, and most made for TV makeover programs don't like that kind of timeframe for filming

 

[wa-loaf]

So watched it tonight. First chick had a real sugar problem. They made her change her diet and gave her brushing lessons. They looked pretty bad, but couldn't have been all that rough since they cleaned her up and gave her veneers. Second chick had her teeth worn down from bulimia which she had kicked, so she just got veneers. The second crew a brother and sister who had a dentist phobia and the worst teeth. The brother managed to get in and had a bunch of teeth pulled under sedation and then they just gave him a partial bridge. The sister never overcame her fear and still has rotten teeth.

Overall pretty realistic outcomes and no crazy implants and what not.

 

[drjeff]

Overall pretty realistic outcomes and no crazy implants and what not.

Actually that's what bothered me a bit, since in many of those case scenarios they showed last night, implants are now essentially the standard of care, but the problem with them and made for TV makeovers like this is that implants typically take a solid 6+ months from start to finish, and once again, most TV producers don't like that timeframe

And BTW, the "starting point" of all those patients, while "ugly" is very similar to what I see come walking through the door in my practice atleast a couple of times a month Definately one of the "joys" of practicing dentistry in a rural environment

 

[Marc]

When is Marc going to be on the show? :wink:

Heeey!!! You take that back!




I don't live on that smelly island. Ok, it's only smelly because of the breath. And the Scots. But it's acceptable because of Single Malt.

 

[wa-loaf]

Actually that's what bothered me a bit, since in many of those case scenarios they showed last night, implants are now essentially the standard of care, but the problem with them and made for TV makeovers like this is that implants typically take a solid 6+ months from start to finish, and once again, most TV producers don't like that timeframe

I'm a little confused now, because I thought you were kinda against doing lots of work the people won't be able to take care of. It seems the first girl didn't need any teeth replaced and her roots were good so building them up with veneers was cool. Kinda the same deal with the second chick as long as she stays away from the sugar.

The last two, they were a freakin mess and obviously can't even be bothered to brush their teeth, so why bother with the effort of doing implants anyway. I can't believe they couldn't have sedated that chick somehow to get her work done? Not even a Valium or something? Oh, and those chunks of tartar . . . uke:

 

[drjeff]

I'm a little confused now, because I thought you were kinda against doing lots of work the people won't be able to take care of. It seems the first girl didn't need any teeth replaced and her roots were good so building them up with veneers was cool. Kinda the same deal with the second chick as long as she stays away from the sugar.

The last two, they were a freakin mess and obviously can't even be bothered to brush their teeth, so why bother with the effort of doing implants anyway. I can't believe they couldn't have sedated that chick somehow to get her work done? Not even a Valium or something? Oh, and those chunks of tartar . . . uke:

Implants are kind of "hygiene proof" in that they can't decay, and under most circumstances are essentially immune to bone loss(gum disease), so they actually become a very attractive option in many questionable patients. Plus, their longevity under most conditions is longer than a restoration on a tooth(once again you can't decay an implant, vs. that girl who had all the veneers done who could very easily "decay out" her tooth structure under those veneers if she reverts back to the original diet).

The brother sister super dental phobics, well they'd realistically be best dealt with by taking them into an actual operating room, and completely knocking them out via general anesthesia, and doing what could be done/removing what needs to be removed, and then they could be restored in the office without anesthesia using some type of denture. In the US, you'd be looking at probably a bill for the operating room that starts at 5 grand, and maybe as much as 10 grand, and that would be before any dental work gets done Not quite sure how that would work in the British healthcare system though.

As for those chunks of tartar, well as gross as it sounds, there's alot of us in this profession (both dentists and hygienists) who find a very perverse sense of enjoyment in seeing how big a chunk we can remove intact in cases like those

 

[wa-loaf]

Implants are kind of "hygiene proof" in that they can't decay, and under most circumstances are essentially immune to bone loss(gum disease), so they actually become a very attractive option in many questionable patients. Plus, their longevity under most conditions is longer than a restoration on a tooth(once again you can't decay an implant, vs. that girl who had all the veneers done who could very easily "decay out" her tooth structure under those veneers if she reverts back to the original diet).

I see. I thought they always tried to save the root if possible.

The brother sister super dental phobics, well they'd realistically be best dealt with by taking them into an actual operating room, and completely knocking them out via general anesthesia, and doing what could be done/removing what needs to be removed, and then they could be restored in the office without anesthesia using some type of denture. In the US, you'd be looking at probably a bill for the operating room that starts at 5 grand, and maybe as much as 10 grand, and that would be before any dental work gets done Not quite sure how that would work in the British healthcare system though.

It sounded like there was a 2 year wait there to get into that kind of surgery.

As for those chunks of tartar, well as gross as it sounds, there's alot of us in this profession (both dentists and hygienists) who find a very perverse sense of enjoyment in seeing how big a chunk we can remove intact in cases like those

I had no idea it could build up that much. :-o I have had a couple occasions in my life where I went 5-6 years without seeing a dentist. The hygenist had to work a little extra to clean my teeth, but nothing crazy and I didn't even have any cavities.


Unrelated to this, my 12 yr old cousin recently killed his two front teeth in a collision during a lacross game. They gave him a root canal and he has been instructed to never drink soda, coffee, or red wine (when he's older)! That seems pretty unrealistic for kid who's just hitting his teens. Why wouldn't they do implants at this point?

 

[drjeff]

I see. I thought they always tried to save the root if possible.

In the past, that was definately the case, however nowadays what we see happening in the mouth, is that if there's at all a question about the long term stability/survival of that root and the bone that it's in, then very often the implant will be the better long term restoration

It sounded like there was a 2 year wait there to get into that kind of surgery.

Depending on your insurance in this country, well a year or so wait can be the case here too. Cash patients though where no insurance company pre-authorizations/denials/run arounds would very likely be in and taken care of within 2 months tops.

I had no idea it could build up that much. :-o I have had a couple occasions in my life where I went 5-6 years without seeing a dentist. The hygenist had to work a little extra to clean my teeth, but nothing crazy and I didn't even have any cavities.

My "best" one was during my residency, there was a special needs patient, who had such extensive tartar build-up on all of his teeth that without either x-rays or removal of the tartar it was actually impossible to tell how many/few teeth he had It literally looked like a 1/2" diameter tartar color sausage from 1 corner of his mouth to the other both top and bottom uke: Ended up knocking off my own personal record tartar chunk on that case that measured out at 2.5cm x 1cm x 0.7cm!

Unrelated to this, my 12 yr old cousin recently killed his two front teeth in a collision during a lacross game. They gave him a root canal and he has been instructed to never drink soda, coffee, or red wine (when he's older)! That seems pretty unrealistic for kid who's just hitting his teens. Why wouldn't they do implants at this point?

The diet factor is that even with those teeth restored, he's still at a significant risk for decay and/or staining. No implants now is simply because he's still growing, and the way an implant locks into the bone, the implant would not move as his jaw grows(basically his jaw would grow around the implant), where as a natural tooth moves with the bone as he grows, so from an esthetic standpoint(kind of important with front teeth ) while an implant might look great at age 12, when he's 18 or 20 and fully done growing, the implant postition and/or gum line could be way off, and then removing and replacing an implant involves some serious potential esthetic complications.

In scenarios like that, what we as dentists will try and do, is get him into atleast his 20's with those restored teeth, and then when those restorations reach the end of their functional lifespan and need replacement, well its bring on some titanium and put those implants in!

 

[GrilledSteezeSandwich]

The massive chunk of tarter is gross...wow...and I'm uber concerned because my upper canines aren't sharp from grinding and my lower front teeth have shifted 1/10 of a millimeter even with a permanent retainer...sheesh...no girl is going to make out with any of these dudes..yuck//.