Table 2 Key challenges and outcomes in Case 1
From: Craniofacial fibrous dysplasia: a challenge for general dental practitioners
Challenge | Reasons | Outcomes |
|---|---|---|
Patient's attitude to treatment and lack of engagement | Lack of appropriate information at the outset: Patient being told that nothing could be done and he had to accept the appearance and difficulty in chewing, resulted in non-compliance, poor behaviour and engagement | Supportive discussion, dialogue to improve understanding about his role and how he could help address his concerns |
Patient's expectations | Refused to accept that a fixed prosthesis would be difficult | Phased treatment plan highlighting the importance of sequenced treatment to mitigate risks |
Multiple risk factors – stress, smoking and unstable periodontal disease | Lack of understanding and awareness of the effect of risk factors on his oral health although he understood his CFD well but not the oral aspects | Behavioural change and engagement into the process with excellent compliance once patient gained understanding of the treatment process; drastic change noted after fitting of the denture |
CFD and the associated challenges with predictability of treatment options | Mixed activity of CFD with increased risk of bleeding; challenges with fixed tooth replacement options | Multiple discussions with patient-centred planning to engage patient in the decision making while ensuring realism |
Multiple impacted teeth | Influenced the choice of treatment options | Careful and pragmatic planning with no issues encountered |
Osseointegration of dental implants | Lack of bone and fibrous stroma complicating osseointegration; poor evidence base on treatment outcomes | Successful outcome of implant treatment with risk-assessed planning approach using his interim denture to achieve the aesthetics |
CFD, craniofacial fibrous dysplasia. This case of a young patient highlights the impact of lack of appropriate information given at the outset about oral health can have a domino effect on management, behaviour and attitude to care. The successful outcome achieved emphasises the role of clear communication in such cases to manage expectations overcoming the behavioural challenges while maintaining realism. The importance of phasing in multidisciplinary treatment is also highlighted, as it enables careful, stepwise management of each contributing condition, managing risks and stabilising them before proceeding to the next. The improved patient attitude, expectations and compliance early in the journey was fundamental to balancing the surgical risks associated with implant provision in this patient with unknown CFD status. | ||
