More than any other, the dilemmas presented by the wear patient cause confusion and fear in dentists. Understanding the wear patient is the first step in successful treatment of these patients.
What makes managing the worn dentition so difficult? Fear of failure: Dentists don't want to do anything that's not going to work. You don't want the patient angry with you if treatments fail.
Number of teeth needing treatment: In severe wear cases, you almost have to treat every tooth, which in turn creates a huge financial consideration for the patient. Additionally, it may not be apparent how to do the case in segments, making it more manageable for the patient.
Complexity: Wear cases tend to bring up a lot of uncertainty because some dentists aren't exactly sure what to do. “Should I or shouldn't I open up the bite?” “Should I or shouldn't I crown lengthen the teeth?”
Inadequate tooth structure to restore: What do you do if you prep the tooth, and there's no tooth left?
No space for the restoration: You may have to open the patient's bite, but this is not always the case.
Need to alter vertical dimension.
A few items that contribute to the fear factor:
- Fractured porcelain
- Fractured preps
- Fractured implants
- Fractured solder joints
The biggest reason of all: The unknown. Treating someone when the outcome is uncertain is really unsettling.