I have been a practicing dentist in Midtown Manhattan for over twenty five years. I have noticed that many new patients are over whelmed by their dental problems and don't know where to start and how they will be able to afford their entire proposed treatment. Plan...

New patients do often new patients present with multiple problems that need addressing and have finances that limit their ability to afford their best treatment plan. Sometimes they have dental insurance which is a help, but only cover $1500/year of the treatments and may only cover 50-80% of the fees for the procedures needed. Patients can be in a real bind; they want to carry out the proposed treatment plan but can't do it all in one year.

This is a situation where staged treatment planning is helpful. Say for example, that a patient need gum treatments, two root canals, two posts and two crowns. Also, they desire teeth whitening (not covered by dental insurance).and may want some simple bonding to enhance their smile. The problem is their insurance only covers $1500 / year and they can only afford $1500 out of pocket for now.

An ideal treatment plan is proposed, but it will need to be completed in stages over two to three years, mostly for financial reasons. In stage one the patient will have gum treatments and any needed root canals. Good antimicrobial temporaries will be placed in teeth having root canal (IRM cement or miracle mix cement). At this point the patient has probably spent their dental budget for the first year.

The next year, If no other emergencies have interfered, Stage Two is started; Posts and (or) Cores are place in the root canaled teeth and good long term temporary crowns might be place over the cores to protect the teeth from breaking. Also Stage two would be a good time to finish bleaching and perform any simple bonding that might be needed to improve the patients smile. Since this work is done in the second year, their dental insurance will contribute another $1500.

In the third year, the patient will have the needed crowns completed; using another $1500 of their dental insurance benefit and the rest will be paid by them "out of pocket". Although the treatment plan took three years to accomplish, a financially strapped patient usually benefits by not putting off the work and loosing teeth needlessly!

It must be pointed out that for stage treatment to work properly, a patient must commit to coming in twice a year for recall and exams and must report any tooth problems that crop up between dental visits. If a patient goes "AWOL"(takes an unplanned vacation from seeing the dentist), these staged treatments don't always work out well. For example, teeth having had root canal and not properly sealed are at risk for decay or infection and make it more likely that an extraction or a retreament of the root canal will be needed. Also, without their final restorations, root canaled teeth are more fragile than normal teeth and can break or crack in half. If this does occur the tooth in question may need to be extracted.

Staged treatment plans, although not completely risk free, are often a good option for a patient with a complicated treatment plan and limited financial resources. Also. they are often used for patients requiring multiple interdisciplinary procedures, such as implant cases, requiring extractions, bone grafting, implant placement and implant restoration

I hope this article has been informative and if the reader has any questions about it feel free to email me at drspindel@lspindeldds.com