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Show Your Work: Don’t Slight Senior Care! by Dr. Joe Whitehouse

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Categories: Orthodontics; Prosthodontics; Restorative Dentistry;
Show Your Work: Don’t Slight Senior Care! 

by Dr. Joe Whitehouse

In my 46 years of practicing, I have learned too many dentists treat older patients with indifference related to how they look. Many of these elderly patients came to me sharing their frustration with their former dentists for not taking their physical oral characteristics seriously.

The case I am sharing is emblematic of situations where the patient’s goals were ignored to the extent that her daughter, after seeing my marketing material, brought her mother to see me with the hope that I could render care that was appropriate for her condition. Her mother, Margery, had been getting dental hygiene care for years with the smile you see here. Margery was never asked about her dental goals, which were to:

  1. Preserve as many teeth as possible.
  2. Improve her smile.
  3. Have a healthy mouth.
Is that what you see here? Margery inferred her dentist was just waiting to make her full dentures. There was, in my opinion, a complete breakdown in communication. Once Margery and her daughter were interviewed, it became obvious to me that Margery wanted a course of action that would meet the aforementioned goals. A course of action was presented to both of them:
  1. Control caries.
  2. Orthodontics. (I asked if the patient would be willing to wear braces.)
  3. Open her bite.
  4. Eliminate partials.
  5. Place veneers/crowns for a pleasing smile.
I wasn’t concerned about presenting a fee that would enable the care to be rendered. In my experience, dentists worry about presenting a big fee that will be rejected, therefore robbing many patients of making an informed decision. Too often a patient presenting with a certain look often causes a projection on the part of a dentist to tone down the treatment plan to fi t the dentist’s view of what the patient can afford.

Here, the patient accepted the treatment plan and fee because I provided a treatment plan that fit the patient’s goal and quoted the fee straightforwardly. After two years, we started the case when the patient was ready.

Case study

As you can see from Figs 1–7, the case was in 100% overbite and caries were present. The periodontium was totally sound. Clinically, there was no way to restore the case without CAMBRA, so that was implemented. Margery understood the importance of maintaining her investment. Orthodontic brackets were placed on the maxillary arch for two months of activation and two months of retention. The lower arch was restored for a foundation with a bridge on the right side.


 Show Your Work: Don’t Slight Senior Care!
Fig. 1
Show Your Work: Don’t Slight Senior Care!
Fig. 2
Show Your Work: Don’t Slight Senior Care!
Fig. 3
Show Your Work: Don’t Slight Senior Care!
Fig. 4
Show Your Work: Don’t Slight Senior Care!
Fig. 5
Show Your Work: Don’t Slight Senior Care!
Fig. 6
Show Your Work: Don’t Slight Senior Care!
Fig. 7

I opened her bite by holding the arch open distal to #11 (Fig. 8) while making a bite impression on the right side. Then with the patient biting on that right impression, the left side got the same bite registration impression (Fig. 9). This allowed the lower right one-half arch to be prepared as seen in Fig. 10.

Show Your Work: Don’t Slight Senior Care!
Fig. 8
Show Your Work: Don’t Slight Senior Care!
Fig. 9
Show Your Work: Don’t Slight Senior Care!
Fig. 10

I made a unilateral impression of the right side after teeth #25–#30 were prepped. Then, teeth #20–#24 were prepped. With the first bite on the right side inserted, the left bite was taken. The lab then had a full-arch impression of the prepped teeth along with the two bites to the opened bite. The lower restorations were placed.

The lower arch had been installed (Fig. 11) with the completed upper arch ortho (Fig. 12). It was now ready for preparation. A bridge on each side was prepared, thus eliminating both partial dentures. The same bite regimen was used to stabilize the arch so the upper right side could be prepped. When that was completed, the same kind of bite was used to register the prepped upper right, and the upper left was then prepped.

Show Your Work: Don’t Slight Senior Care!
Fig. 11
Show Your Work: Don’t Slight Senior Care!
Fig. 12

To be clear: The confirmed bite opening was preserved by holding that arch open to what the lab built for the lower arch and the upper arch was prepped and impressed one side at a time. The lab got a bite that supported each side per the required opening of the bite, along with a full-arch impression of the prepped teeth.

The upper anterior four crowns were built with extended lingual metal to couple with the lower anteriors because of the remaining overjet after the ortho (Figs. 13 and 14).

Show Your Work: Don’t Slight Senior Care!
Fig. 13
Show Your Work: Don’t Slight Senior Care!
Fig. 14

Upon placement of the upper arch, the patient, in anticipation, had her hair coiffured and was really ready for her makeover’s completion. As seen in Figs. 15–17, she was not the same person that showed up to my office originally. I always wondered what her dentist thought when she returned to his office.


  Show Your Work: Don’t Slight Senior Care!
Fig. 15
Show Your Work: Don’t Slight Senior Care!
Fig. 16
Show Your Work: Don’t Slight Senior Care!
Fig. 17
Show your work in Dentaltown!

If you’ve got a case you think might be a great study for Show Your Work, email editor Sam Mittelsteadt: sam@farranmedia.com. Be sure to include a sentence that sums up why the case is so special to you, to help us review and select the best contenders for publication.



Author Bio
Dr. Joe Whitehouse Dr. Joe Whitehouse graduated from the University of Iowa Dental School in 1970. During his career, Whitehouse brought three other practices into his own and adopted a totally minimally invasive approach to dental care. He was a co-founder of the World Congress of Minimally Invasive Dentistry, serving as president for two terms.
Whitehouse also earned a master’s degree in counseling, enabling him to treat many fearful/apprehensive patients without drugs. He has written about dealing with fearful patients and authored articles on minimally invasive dentistry and clinical issues dentists face.
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