Why It Is Called a Big, Complex, and Difficult Case
I practice in lower Westchester, where many people come from all over the world for “the best.” They want to live in the best places, send their kids to the best schools, shop at the best malls, and so on. Naturally, they want the best dentist—not a glitzy environment, but someone competent and caring.
For those people, their teeth are already “fixed” and generally in good shape. Many people assume that beautiful models or wealthy individuals constantly visit cosmetic dental practices to fix their teeth. The opposite is often true. Their dental work was usually completed long ago. As a result, much of my job is simply to “babysit” their teeth, which is perfectly fine with me.
A second need—though for a much smaller segment of the population—is what we call big, complex, and difficult cases. These cases require many skills to “resurrect” teeth from the brink of extraction and dentures. In some sense, I become a “dental hero” for these patients. I don’t think I would have developed this level of passion for dentistry without serving this group.
Still, the number of patients who actually need big cases and complete the full treatment is extremely small. Someone once estimated it to be around 3% of those who need the work. The reasons are many: lack of trust, fear of pain, cost, difficulty finding the right dentist, and not knowing what modern dentistry can offer.
To follow through with a big, complex, and difficult case, the dentist must be able to utilize all of their skills at their fingertips.
Often, a dentist may dislike or avoid certain procedures and favor one type of treatment. When specialists are involved, things can be done very well—and that is why specialists exist. In dentistry, there are five main specialties:
Endodontists (root canals)
Prosthodontists (crowns and bridges)
Orthodontists (braces)
Pedodontists (children)
Oral surgeons (extractions and bone grafting)
For example, in Minnesota there are only seven prosthodontists. In New York, we have so many that some practices have two.
However, in reality, involving many specialists often complicates the process rather than simplifying it. Imagine five busy dentists trying to coordinate treatment for one patient. Splitting fees among multiple providers increases the financial burden, scheduling becomes difficult, and the list of obstacles grows. No wonder so few patients complete treatment.