Future in Prosthodontics

I have to relate a funny story that happened the other day in the clinic. It was actually two days ago. I thought I should write it down before I forget the funny details of the experience. Anyway, I was schedule to see one of my patients for a 24 hour denture check. To better appreciate the story I'll provide a little background; I received this patient about 1 year ago next month from a graduating senior. As part of his treatment plan with her she elected to extract her remaining upper teeth and replace them with a complete denture. She was missing a couple of teeth on the lower and we suggested to make a lower partial denture to help support the upper. She didn't want to do that. I got everything ready to go by making her an interim denture that she would be able to wear during the healing process immediately after the extractions. I informed her that I placed her denture teeth slightly forward to cover up her lower teeth a little more due to their crowded nature. Immediately after her extractions I inserted her interim denture and saw her the next day. I was sure to explain to her multiple times that there would be a huge learning curve going from natural teeth to denture teeth, especially with interim dentures. She actually handled the interim denture process very well. I saw her as often as she needed to be seen to make adjustments to the denture to make them as comfortable as possible during her 6 month healing period. She at first thought her teeth looked different, but after a while she liked them. The healing time passed and it was then time to fabricate a final denture. Making a denture requires multiple visits. She missed several visits along the way for different reason, but eventually we were able to get all the visits in she needed. One of the visits required what is called an anterior try-in. During this visit I place the anterior teeth onto a denture base and try-it in the patient's mouth. At this visit the patient has the opportunity to personalize/adjust what she likes or dislikes regarding the dentures appearance. I told her that this time I set her teeth a little differently, not as forward. She told me that she liked it and "it looked more natrual." I made sure that things were the way that she liked them. She insisted that they were fine. I finished up the dentures and finally inserted them after a couple more canceled appointments. She loved them. They fit very nicely and looked really good. My instructor thought they looked very nice as well. She went home very happy, so it appeared. As I mentioned above we like to see denture patients 24 hours later to make sure they fit ok. She missed her next appointment so I saw her 48 hours later. I was pretty excited to see her, due the past experiences I've had; she seemed pretty pleased. I greeted her in the loby and as we walked in the clinic I asked how she was doing. She said "Not so good." I then asked her what was going on? She said, "Well, everyone says that I look like I don't have any teeth!" I asked her what she thought and she said "I don't know, I can't really tell, I just don't want people to think that about me." We sat down in the operatory and I began to try and find out exactly what the problem was. She informed me the "everyone" was her daughter. Her daughter said "Mom, you look different." Then she told me her what she first told me when I asked her how she was. Then she told me that her grandaughter told her that her teeth looked small. I said "Ok, lets have a look and see." I examined her appearance and her soft tissue profile looked pretty good. I could notice that her lip wasn't as full as when the interims were in, but she still looked pretty good. I tried to explain that maybe her family noticed the difference between the interim and the finals and they might get used to it. She then said "Well, my interims look more natural than these do. I don't want to look like I don't have any teeth." I explained the process why we did the dentures the way we did and then explained that if she wasn't happy with the way they look now then I would do my best to correct the problem until she was happy. I started to explain the different options we might have to correct the perseption. One option might be to thicken the plastic above the teeth, another might be to make a new denture. When I mentioned that option she wigged out even more. She said, "I've been driving all the way here for almost a year now. I'm not doing that again. I just won't." I said Ok lets look at the thickening option first then. I grabbed some soft wax and placed a thin layer abover her teeth and had her place the denture back into her mouth and then look at herself in the mirror. She looked and proceded to tell me, "I'm not the expert, I don't know how to fix it, I just don't want people to look at me like that." I tried to explain again that I wanted to help her and the different options she might have. She looked at her wax adjusted denture and didn't comment. She just got more upset and repeated the previous complaints again. This time she kept trying to get out of the chair and started telling that she just wanted to leave. I tried one more time to explain that I was there to help her and I was tring and I would do all that I can to help her. Then she threw up the arm rest grabbed her purse and stormed out of the clinic. I was blown away. I was somewhat at a loss.

Morals of the story:
When making a denture invite the patient to bring someone along who they respect their opion (daughter in this case, she broke the success of this case)
Explain to the patient that other might see a difference in their appearance when they receive a new denture
There is a good chance that if something else is going on in a patient's life you might be the scape goat for them to release their anxiety