Dental Tribune United Kingdom Edition

November 26 - December 3, 201224 United Kingdom EditionOpinion page 22DTß BOC LIFELINE® emergency resuscitation equipment. Saving minutes, saves lives. BOC Healthcare can assist your dental practice with the provision of emergency resuscitation equipment. For further information or to place an order contact BOC Healthcare: Tel 0161 930 6010, Email bochealthcare-uk@boc.com LIFELINE oxygen kit • Lightweight oxygen cylinder • Built in regulator • Next working day refills* • Variety of oxygen masks * Depending on location Automated External Defibrillators (AEDs) • Simple and easy to use • Rescue Ready technology • Seven year warranty • Four year battery guarantee BOC Healthcare can assist your dental practice with the provision of emergency resuscitation equipment. • Lightweight oxygen cylinder BOC Healthcare can assist your dental practice with the provision of emergency resuscitation equipment. extensive and expensive treat- ment, such as resecting roots and teeth from larger bridges to keep the restoration going for longer in an elderly pa- tient. Often we know that it’s a compromise – it’s fairly ob- vious what we’re waiting for! With an aging population and life expectancy ever-increas- ing, compromises that we may have once made in a 65 year old we may now have to make in an 85 year old instead. With patients on average living a lot longer than in the past, I do find myself increas- ingly dealing with patients in their 70s who ask me if it’s worthwhile spending money on a complex and risky endo- dontic procedure when it may be cheaper and easier just to have the tooth out instead. This poses something of a di- lemma. If the patient were in their 50s say, you could out- line with some degree of cer- tainty the advantages and dis- advantages of having a fully restored natural tooth for the next 20 years, as compared with a large gap. To have this discussion with a 70-year-old however, it may be a case that they will have a gap for a few more years, or they may yet live another 30 or more! The oldest patient I’ve treated for root canal therapy is 100 and she certainly didn’t want her tooth out! Genetics This then brings me on to the question of genetics. Be- fore attempting herodontics to try and salvage a dodgy tooth, maybe we should ask the patient questions about their family background. Are their parents still alive? How old were their parents when they passed away? Though somewhat morbid, these sorts of questions may well help to gain a rough idea of life expectancy and whether to go for a compromise now and regret it later (in say 10 years’ time when the patient really is elderly), or to bite the bullet and do definitive treat- ment whilst the patient is fit enough to manage long pe- riods in the chair but also to heal clinically. When heroic procedures work, they can be fantastic; they can give a great feeling of satisfaction to the clinician and of course the patient ben- efits by retaining their tooth. But these things must be tak- en in careful consideration. Heroic procedures “beyond the normal call of duty” don’t always work, and if they fail, then sometimes the outcome will be worse than the initial complaint. For this reason we should always carefully weight up the risks, consider all the possible implications, and ask ourselves, very seri- ously, “what’s the worst that can happen?” DT About the author Dr Michael Sul- tan BDS MSc DFO FICD is a Special- ist in Endodontics and the Clinical Director of En- doCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He com- pleted his MSc in Endodontics in 1993 and worked as an in-house Endodon- tist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist reg- ister in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been in- volved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices. For further information please call Endo- Care on 020 7224 0999. Or visit www. endocare.co.uk ‘The oldest patient I’ve treated for root ca- nal therapy is 100 and she certainly didn’t want her tooth out!’