Levels of Care

1. Introduction
2. Level One
3. Level Two
4. Level Three
5. Routine Prevention and Maintenance

Introduction

This section explains the timing of dental services.  For example, level one care is provided before level two care.  A motivated patient with complex dental requirements may elect to proceed from level one through completion of level three.  Alternatively, completing three levels of care is irrelevant for a patient who just needs a replacement denture.  Some patients choose to take more than one calendar year to complete applicable levels.

This section also explains the amount or extent of available dental services.  For example, just level one care would be completed if only basic dental service was desired.  Yet another patient may want to get any or all that contemporary dentistry could offer.  Then this patient would complete treatment suggested through level three.

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Level One

The objective is to arrest bacterial diseases.  Microorganisms (bacteria) cause gum (periodontal) disease, caries (decay), and abscessed teeth (infected nerves).  Reduction of bacteria and illumination of location for bacterial inhabitation is essential for prevention of tooth loss. 

What is done to achieve this level of health:

1. Review patient needs and desires.

2. Undertake the comprehensive exam.

3. Agree to the nature and extent of beginning dental treatment.

4. Remove hopeless teeth.

5. Deliver root canal therapy where it makes sense.

6. Remove plaque and tartar build up.

7. Polish surfaces of teeth subject to harmful stress distribution.

8. Restore decayed and damaged teeth at least transitionally.

9. Discuss possible progress to level two care.

10. Build temporary crowns, bridges, dentures and partials consistent with progression to level two care.

11. Commit to routine prevention and maintenance.

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Level Two

The objective is initiation of the process to rebuild structure and function.  Also esthetic concerns are addressed.

A full complement of front and back teeth are necessary for proper digestion, speech, dental stability, social interaction and personal confidence.  Front teeth function to tear and shred food.  Back teeth function to grind and chew food food.  Moreover, front teeth should protect back teeth.

When teeth are lost or damaged there is greater susceptibility to gum disease, occlusal disease and more tooth destruction.  But the ideal number of teeth function best if only they are in a balanced position relative to one another.  A balanced position helps eliminate harmful tooth-to-tooth contact stress. 

What is done to achieve this level:

1. Review of patient needs and desires.

2. Review and evaluation of treatment and objectives of level one care.

3. Assessment of current and ideal dental esthetic condition.

4. Assessment of current and ideal number, position, shape, character, composition, size and color of teeth.

5. Assessment of the current and ideal condition and position of the temporomandibular joint and associated muscles.

6. Assessment of the dynamic functional relation between teeth and temporomandibular joint.

7. Assessment of parafunctional activity.

8. Agree to the nature and extent of the upcoming treatment.

9. Consultation and treatment with dental specialists including but not limited to oral surgery, periodontics, endodontics and orthodontics.

10. Treat unhealthy jaw muscles or jaw joints.

11. Enhance color with bleaching.

12. Build prototype or transitional restorations and prosthesis if necessary.

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Level Three

The objective is to optimize form, function, esthetics and long-term stability.  Biocompatibility of dental materials may be addressed.  The effects of macro and micro nutrition on dental health may be addressed.

What is done to achieve this level:

1. Finalize treatment with specialists.

2. Create permanent restorations.

3. Create permanent prosthesis.

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Routine Prevention and Maintenance

The key to retaining teeth is patient’s home oral hygiene.

NOTE:  The attainment of level three is the objective for all patients.

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