Dentists, please help! I'm a hygienist with a question...?

I'm a dental hygienist. We have a patient in our office who is a teenager, but has the mental capacity of a 3 year old. He has a severe underbite, and because of it has ground down all of his mandibular anterior teeth. Our doctor placed crowns, and the patient has repeatedly broken them off. She (the dr) recently re-placed the crowns, and the pt has since RIPPED them off and flushed them down the toilet.


What would you do? We're at a loss. The crowns aren't working for him... The family doesn't have a lot of money, so ortho and surgery are not an option... What are your suggestions?


Thanks in advance for the help...


(Also, are there any other websites for questions like this that are not Yahoo Answers? Maybe this question would be better suited for a dental site...)

Dentists, please help! I'm a hygienist with a question...?
There is nothing more to do except make the patient comfortable. Someone like this with an incapacity to understand treatment should not be receiving crowns, ortho, or surgery.


You should do the minimum treatment necessary. Eventually she will lose her teeth and will have to function without them. I certainly wouldn't be trying to make dentures.
Reply:um im no dentist im only 15 sorry, but maybe you should try explaining to him that if you keep them in till like the next time that you want to see him he gets a treat like candy(obviously sugar-free) and see if he does that and tell him not to actually rip them out cuz he wont get candy - make sure that the sees you frequently so that he doesnt forget about your candy, if he does rip them out and he comes back and is expecting candy, just say try again and put the crowns in and tell him that this time he can get candy if he doesnt rip them form his mouth and dispose of them.
Reply:Due to his mental capacity and his severe under-bite, nothing would probably be the best option. I feel he can adjust fine since these are anterior teeth only.





Anything removable will be a problem, and if he broke porcelain crowns, a bridge would be the same problem.





I would leave it alone, and just make sure his existing teeth and gums are healthy.
Reply:This is not actually a dental question, it is for mental health workers who deal with these types of issues. However, the answer lies with the caregivers, not you. This patient should be restrained and or supervised to keep him from behaving in a self-destructive manner.





We place helmets on the heads of children and adults who bang their heads, so it is obvious that a face mask to prevent this patient from pulling out his teeth is required. He can damage his future health with this type of behavior. If his family does not have money, almost all States have provision's for these types of conditions, especially when it is a child.





Have the parents call the local center for children with disabilities, they will have the information for the proper face guard. If you feel the parents are not following through, call the authorities yourself to report the lack of supervision. Allowing this to continue will be bordering on neglect and it is easily corrected.





Good luck!!! AND thanks for caring!!!!
Reply:as a dentist,my suggestion wud be...nothing.don't harass ur patients wit artificial stuff in his mouth.jus let him be n he'll manage jus fine..
Reply:as you say the pt is mentally compromised and doesnt cope up with the prosthesis , it is better not to force it as it might increase the aggressiveness of the pt ... after creating a good rapo with the pt , check up in regular intervals to evalute the hygeine , caries succeptibility should be done , its better to prevent than to struggle later in these pts . as in for the anterior teeth , if any sensitivity is there then an anti sensitivity paste or rinse is the best we could do .