Informed patients are the most conscientious patients. And nothing goes further in educating patients than close-up images of what’s actually going on in their mouths, particularly when there’s a problem they are not even aware of.
I’ve found that one of the most effective tools to help explain diagnoses and the rationale for treatment is the SoproCARE diagnostic camera with its 3 distinct imaging modes. In addition to the DAYLIGHT mode for traditional intraoral captures, the SoproCARE has a CARIO mode that clearly reveals caries in bright red. Furthermore, the PERIO mode delivers a light wavelength that fluoresces plaque, calculus, and inflammation differently from healthy tissue. This is sure to be especially useful for justifying nonsurgical treatment under the new CDT code D4346 for moderate-to-severe gingivitis.
Patient Presentation
A young male patient came in on a Monday for a consult because the mesial/buccal cusp on tooth No. 2 had completely broken off. He mentioned in the first few minutes that he had just lost his job and had no insurance.
I pulled out the SoproCARE to get a close look, and in addition to the missing cusp, tooth No. 2 had an existing amalgam as well as cracks running through the outside enamel. Furthermore, the PERIO mode revealed some serious hygiene issues with the presence of plaque and calculus buildup as well as inflammation.
With the help of the magnified close-ups of his tooth, I explained to the patient that the best treatment would be a crown after thorough cleaning and scaling. However, knowing that wasn’t in his budget at the moment, I proposed an interim solution. He said he had to think about it and left after the consult.
Treatment
Very soon after he walked out of the office, he called and said those images had convinced him that he needed to do something, so we appointed him for the next day to do the suggested procedures.
After anesthesia, I removed the amalgam, under which there was residual decay. I captured an image with the SoproCARE to show him the decay, along with the large crack, and to explain why a crown would eventually be necessary. He could, however, buy some time until he could afford the treatment, and he agreed.
After removing the caries, I cleaned up the local periodontal issues with a curette—by no means a comprehensive cleaning, but enough to make it obvious to the patient that the tooth looked much better after debris was removed.
Then I placed the composite buildup as a provisional measure, keeping it slightly out of occlusion to reduce the risk of any undue stress on the tooth while waiting to place a crown. The patient understood that if he improved his hygiene and “laid off” the buildup, he could maximize its useful life. He has scheduled a future appointment for a thorough full-mouth prophy and hopefully will make the direct buildup last until he can afford the full crown.
The SoproCARE allowed the patient to visualize and understand his situation and the need for treatment if he wants to save the tooth. And not surprisingly, this happens all the time. A picture truly is worth 1,000 words.
