Full mouth from the front, lips retracted. As a father, one of the most common questions I get from my two boys is “Why?” Why this, why that, why me, why now – and the list goes on. Sometimes it's frustrating to have this question thrown at you, but it does make you think about things you might never have questioned before. Asking “Why” has become one of the most interesting things for me in dentistry.

WHY makes me question what I'm doing and the way I'm doing it. It helps me gain insight for each particular patient's situation, something routinely overlooked in dentistry, and often in medicine as well.

A great example is this patient who recently came into my office with his crown off and asked if I could put it back on. He had no pain or sensitivity, and no immediate other concerns, he just didn't like being without a front tooth. As we talked about his past dental experiences I learned that he had been treated with orthodontics and had peg laterals that were restored post-ortho with crowns, one of which was currently off, again.

It turns out that this was the third time in less than a year this crown had come off and it had been redone once since it was completed three years ago. I could have simply continued the cycle and recemented the crown or I could change his expectation and ask why? Why did it come off again? Why was it redone? Why did it come off three times in the past year? Why do you want me to recement it if it's going to come off again?

I started off with the usually questions about habits and the patient reported that he doesn't eat anything sticky or hard and reports no habits such as chewing ice, biting nails, etc. When I asked him if he had any awareness of clenching or grinding his teeth, his response was common, “I don't think I do.”

As I looked around, I observed wear facets and hence, indications of clenching and grinding. Perhaps this is the answer to why he is losing his crown so often? Maybe not, but I just have to ask, “Why?”

I realize that patient's probably start to feel like I do when the litany begins from the boys. I usually just want to get something sorted out or understood and move on to the next thing to get it done; however, they want more, they want to know why. So do I. What WHY questions do you have as you think about this patient?

Jeff Lineberry DDS, www.jefflineberrydds.com


Commenter's Profile Image Paul Ganucheau
April 9th, 2012
My question is why is there so much wear on #'s 11 and 22? The incisal edge of 11 is really worn down. And it seems to me that there is a lot of wear on the facial surface of #22. Is he really constricted on the lower arch? Seems the lower anteriors are tipped lingually. Paul
Commenter's Profile Image Mike Weisbrod
April 9th, 2012
Why hasn't the other crown/veneer come off?
Commenter's Profile Image Jeff Lineberry
April 10th, 2012
Paul: You are thinking along the right lines when it comes to the wear, especially on the lower arch. I will share some photos on the next posting to help clarify how this is impacting things, but great "why" questions of why there is wear, arch restrictions, etc. Mike: Another great "why" question: yes, I asked that one too and yes, it has come off and been redone once, but has been intact since then. I will show more photos with the next posting to help gain some more insight. Thanks for the comments/questions.....