“As a dentist, what is the most severe dental problem you have ever seen? What is the most severe one out there?"
Kate from Pennsylvania
Hi there Kate,
You know, this is typically the kind of question that I never answer, because, to be honest, this is information that gets abused. Usually, people will want to know how bad something can get so that they can justify not going to the dentist to get their bad teeth taken care of, or that they don’t need to change on their set in stone morning oral hygiene routine. What’s more, often people will use information like this to justify not going to the dentist at regular intervals for their check up, so usually I just don’t speak on matters of severity, or how bad things can get.
But this has got to be my 200th letter of this kind. I do not know why people are so obsessed with morbid and disturbing imagery and problems, but here you go, here are some of the worst things that I know of or have seen in my professional career.
First off, it is necessary to distinguish: what branch of dentistry are we talking about? A severe orthodontic problem will look very different from a severe oral surgical issue, and even more different from a hygiene related disaster, although the latter is the one you encounter the most often as a regular dentist. Also, are we talking about self inflicted problems, or congenital ones, as these two are also a completely different bag altogether.
From the self inflicted, hygiene related disasters, the worst I know of is periodontitis that can become so severe that teeth start to become lost, caries are everywhere, the teeth are completely dead and discolored from the bacteria raging in the mouth, and the situation can become so severe that even parasites can start living in the mouth. Gums can swell to where they actually cover teeth, and plaque and tartar are usually abundant in these situations. From congenital issues that patients have no control over, I would probably say that cleidocranial dysplasia is the scariest thing. It is when there are abundances of teeth that grow all over the oral cavity, with teeth bursting out of strange places, often with no roots, but connected to a giant tooth stub below the gumline. This condition is truly a nightmare, much more so for the patient, but also for the dentist. Usually, this kind of problem comes with many other kinds of defects and issues as well, making it even harder to treat or deal with. Usually, this condition does not affect intellectual development, making the situation a tad bit worse, because the child has average intelligence and can fully understand what is going on, and why they are different from everyone else, not the best thing for a child to experience.