What happens if you don't remove all the plaque and have regular examinations

Yesterday I received a phone call from a patient saying that she bit into something soft and her upper left "eye tooth" broke off at the gum-line. There was no pain, but she was embarrassed to smile and was worried about what would have to be done to give her a tooth so that she could smile and function in a social setting. Why did this happen? She had gotten busy and neglected to appear for a hygiene visit for about 4 years. During that time (a stressful time for her) she developed extensive tooth decay on about 6 teeth. A few of these will need to have root canal treatment because the decay has eaten it's way into the nerves of those teeth. The tooth that I looked at today may not need the root canal treatment. ... but the decay was so extensive, it had eaten into the tooth like a beaver chews into a tree, that the tooth could no longer support itself and it fractured. It was very tricky to restore, and it challenged me and forced me to be creative, but after about 1 1/2 hours I was finished repairing the tooth. This was a temporary repair and the options for final treatment are rather complex. This patient will need extraction and implant replacement of the tooth, extraction and a bridge, or root canal treatment followed by gum surgery and a crown. Had she been more consistent with her dental hygiene appointments I would have been able to catch the decay sooner and avoid this unfortunate situation. It seems from my experience that if we go longer than 2 years between x-rays that it is possible for tooth decay that may have been too small to be detected at first, to grow into a full blown area of tooth decay on the tooth. It's good to have x-rays taken at least every 2 years to catch decay before root canal treatment is needed. Dr. Marty Frankel 416-770-8526 drmartyfrankel@rogers.com