Case study: a first appointment after ten years away

The concern

The patient had not been examined in a decade following a painful extraction, and made the appointment only because a back tooth had begun to ache. They arrived expecting to be told off and to lose several teeth.

What we found

Less than feared, which is usually the case. Generalised staining and hardened deposits, gum inflammation throughout, two teeth with decay, and the painful molar with a cracked cusp that was restorable rather than hopeless. No teeth required removal.

The sequence, and why it mattered

• Visit one: conversation, photographs, scan and x-rays only — no treatment at all
• Visit two: the painful tooth stabilised first, so the reason they came was resolved early
• Visits three and four: hygiene therapy in two halves, then the two fillings
• A review at three months to check gum response before any discussion of appearance

The outcome

Comfortable, stable and back on six-monthly hygiene visits. Cosmetic work was raised by the patient, not by me, at the review — and by then it was a conversation between two people who already knew each other.

Details anonymised. This is an account of one patient's care, not a prediction of anyone else's findings.