Correspondence workspace

Dear Marcus,

Thank you for attending Sydney Dental Specialists today. This letter summarises what we found and what we have planned, so you have everything in writing.

The crown on your lower right back tooth (47) was placed some years ago and the edge of it has broken down, allowing bacteria underneath. You are not in pain, which is good news, but leaving it will allow the decay to progress.

Our plan is to remove the old crown under Valium sedation so we can see exactly how much decay is present, clean it thoroughly, and fit a temporary crown on the same day. About two weeks later we will bond a new monolithic zirconia crown — a single-piece ceramic crown chosen because it is very strong and resists the effects of grinding.

We also recommend a night guard for your lower jaw to protect the new crown and your remaining teeth. The full plan comes to $8,320, and your enclosed plan sets out each step and fee.

Please remember that you must not drive after sedation. I have also written to your specialist team regarding your transplant medication.

Kind regards,

Dr. Prashant — Specialist Prosthodontist

Dear Helen,

Thank you for referring Marcus for assessment of suspected recurrent caries beneath the crown on 47. He attended today and I am pleased to summarise my findings.

He was asymptomatic. TMJ opening was normal with no tenderness and the masticatory muscles were unremarkable. Oral hygiene was adequate with minor lower anterior calculus and inflamed lingual gingivae. Occlusion is Class I with approximately 10% generalised wear, marked grinding facets on 14 and 24 and an edge-to-edge anterior relationship. BPE was not recorded on this visit.

The crown on 47 is an ageing metal-ceramic restoration with a marginal ledge, an open margin and cement washout, with suspected recurrent caries beneath. The crown on 46 is more recent; a possible distal marginal defect was noted and I will confirm this radiographically.

I have recommended removal of the crown on 47 under Valium sedation with caries removal, a core build-up if indicated and a provisional crown, followed by a definitive monolithic zirconia crown over two visits. A lower occlusal splint has been recommended and may be fabricated in your practice if preferred. Implant replacement of the missing 27 will be deferred until the dentition has stabilised.

Marcus is aware of the 3–5% risk of pulpal necrosis following preparation. Given his kidney transplant history I will coordinate sedation and antibiotic cover with his transplant unit.

Thank you again for your kind referral. I will keep you updated at each stage.

Kind regards,

Dr. Prashant — Specialist Prosthodontist