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Prevention is better than cure

11 July 2014
Foresight beats hindsight every time, as this case demonstrates...

A new patient attended a practice, having recently moved into the area. He had started a new business locally (a health, fitness and leisure club) and he asked the dentist if something could be done about the appearance of his anterior teeth.

The upper incisors were heavily filled with composites, with a number of these restorations being chipped or fractured, while the lower incisal edges were also heavily worn and chipped.

The dentist suggested 10 porcelain crowns (six upper and four lower) which were duly prepared and fitted. The patient was delighted with the appearance, but within three weeks he returned with two of the crowns fractured. Although these were replaced free of charge, one crown fractured for a second time and three other crowns subsequently fractured.

On further investigation it came to light that not only did the patient own the health and fitness centre, he was also a qualified fitness instructor whose specialist field was weight training. When lifting heavy weights he would clench his teeth in an edge-to-edge position to brace his lower jaw. Once this was recognised, a soft splint was constructed for the patient to wear when weight training and the problem did not recur

Learning point:
Establishing the cause of failure after the event is never as satisfactory as predicting the possibility ahead of time. The outcome may be similar, but the responsibility is diminished by providing a suitable warning or even eliminated by suitable intervention.
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