I Have Not Seen a Dentist in Years. Where Do I Start? A Washington, DC Guide

Practice clinician: Gerald M. Marlin, DMD, MSD, prosthodontist, Elite Prosthetic Dentistry, Friendship Heights, Washington, DC. Last updated October 30, 2026.

Returning to dental care after five, ten or twenty years is one of the most common ways a comprehensive case begins, and one of the hardest first steps for the patient to take. The difficulty is rarely the dentistry. It is not knowing what you will be told, what it will involve, and where to go. This guide explains how a mouth with many problems becomes a plan with a few phases, what the first visit does, what is addressed first and what can wait, and how to choose where to go back.

The Situation Is More Common Than You Think

Patients return after years away for ordinary reasons. A painful or embarrassing experience earlier in life. A move, a divorce, a demanding decade of work or family. Dental coverage that lapsed. A dentist who retired. Fear that compounded each year it was avoided. By the time they return, something has usually forced the question: a tooth has broken, a crown has come off, a front tooth has darkened, chewing has become selective, or a family member has said something. Many of these patients are successful in every other area of their lives and are embarrassed to be in this one. The embarrassment is the main obstacle, and it is misplaced. A prosthodontic practice sees this situation constantly.

What the First Visit Does

The first visit establishes the facts. It is not a treatment visit and it does not require a decision.

• A complete examination of every tooth, the gums, the bite, the jaw joints and the soft tissues.
• Imaging. X-rays, and for most returning patients a CBCT scan, which shows bone levels, infections, cracked roots and the condition under old restorations that a visual examination cannot see.
• Records. Photographs and impressions or a digital scan, so that the bite and the teeth can be studied outside the mouth.
• A conversation about what has happened, what hurts, what worries you most, and what you want at the end: comfortable chewing, a presentable smile, no more emergencies, or all three.
• Immediate relief if something is infected or painful, which is handled before any planning begins.

You leave with findings, usually with a second visit scheduled to review a plan built from them.

How Many Problems Become a Few Phases

A mouth that has gone without care often has a long list of findings: decay under several crowns, a few teeth beyond saving, gum disease, worn or shifted teeth, a bite that no longer meets evenly. The list is overwhelming only when it is treated as a list. A prosthodontic plan sorts it into an order that is the same for nearly every comprehensive case:

1. Stabilize. Pain, infection and active disease are treated first: emergency care, gum treatment, extraction of hopeless teeth, root canal treatment where a tooth can be kept. Nothing durable is built on an unstable foundation.
2. Decide the design. With the mouth stable, the end result is designed before any permanent work: which teeth stay, which are replaced and how, where the bite will sit, what the teeth will look like. Mounted models and a diagnostic wax-up make this visible. This is the step most often skipped in piecemeal care, and it is the one that decides whether the result lasts.
3. Build the foundation. Grafting where implants need bone, crown lengthening where crowns need structure, implant placement, orthodontic movement where it helps.
4. Restore. Provisional restorations first, worn and adjusted until the bite and the appearance are right, then the final crowns, bridges or prostheses from the practice’s on-site laboratory.
5. Maintain. A schedule for cleaning, examination and protection of the result, which is where the next twenty years are decided.

Within that order, the plan is paced to the patient. Stable problems can wait a season or a year. Phases can be matched to insurance years and budgets. What cannot be rearranged is the order itself: design before building, foundation before restoration.

What Can Wait, and What Cannot

Cannot wait: infection, a cracked tooth that is still restorable, a loose tooth with treatable bone loss, active gum disease. Each gets worse and more expensive with time, and some close the door on options.

Can usually wait: an old crown that is intact but unattractive, a missing back tooth that has been missing for years without the neighbors shifting, worn teeth that are not sensitive and not fracturing, cosmetic concerns. These are planned, not ignored, but they are scheduled rather than rushed.

The evaluation puts each finding in one of these two groups with the reason stated, so that the first phase is as small as it responsibly can be.

Fear, Sedation and Long Visits

Many returning patients stayed away because of fear, and some because of a specific experience with a specific procedure. Both are addressed directly. The examination itself usually needs no sedation and most patients find it easier than they expected. For treatment, the practice offers nitrous oxide, oral sedation and intravenous sedation administered by a certified registered nurse anesthetist. Sedation also makes it possible to consolidate long treatment steps into fewer visits, which matters to patients who want the work done without it taking over their calendar. Our pages on sedation dentistry and dental anxiety cover the options.

Where to Go Back

If you expect your mouth is mostly healthy and needs cleaning and small repairs, a general dentist is the right place to start, and the practice will say so if that is what the examination finds. If several teeth are broken or missing, crowns are failing together, teeth are loose, or the bite has changed, a prosthodontist’s comprehensive evaluation gives you one plan for all of it instead of a series of separate repairs made over time without an overall design. The difference is explained in our guide on choosing a prosthodontist for full mouth reconstruction. If you are not sure which situation you are in, the examination answers the question, and the practice coordinates with a general dentist for ongoing routine care afterward.

How Elite Prosthetic Dentistry Approaches Returning Patients

Dr. Gerald M. Marlin examines, images and records the mouth before proposing anything, and the plan that follows states what is urgent, what can wait, what the end result will be and the phases that get there. The practice treats both the problem-solving patient and the patient who wants aging dentistry replaced before it fails; many returning patients are both. Crowns, bridges and prostheses are made in the on-site laboratory, implants are placed and restored in the same office, and the written plan includes fees before anything begins. Patients come to us for both comprehensive reconstruction and proactive replacement of aging dentistry, and the returning patient is usually somewhere on that spectrum.

When Another Setting Fits Better

A patient whose examination shows a healthy mouth with routine needs is directed to a general dentist, with the findings sent along. A patient with severe, generalized gum disease may need a periodontist’s treatment before any restorative plan. A patient whose anxiety requires general anesthesia for even routine care may be better served in a hospital-based setting for the surgical phase.

Documented Cases

• A patient whose teeth were neglected and broken down as he avoided dental appointments, rebuilt with a comprehensive full mouth reconstruction.
• Loose, failing crowns, hidden decay and abscesses: one hopeless tooth removed, strategic teeth saved, both arches rebuilt.
• Severely broken-down upper and lower teeth salvaged from gum and bone disease.
• Both arches rebuilt after years of neglect and heavy grinding.

More cases are organized in the full mouth reconstruction success story hub.

Related Decision Guides

• Keep your teeth or replace them? Selective implants vs. full-arch extraction
• How to choose a prosthodontist for full mouth reconstruction
• What determines the cost of implants and reconstruction, and how to compare two quotes
• Understanding your dental treatment plan
• Comprehensive dental treatment on a demanding schedule

Take the First Step

The first visit is an examination and a conversation. Request an appointment or call (202) 244-2101. If it has been a long time, say so when you call; it changes nothing about how you will be treated, and it helps the team plan enough time.