Dental Error Issue? – What do you think? Advice? (teeth, hurts, pain)

[TinNJ]

Sorry for the long post, but I think the details are important. I recently had some dental work done due to some serious pain I was experiencing in my upper left jaw. It started as a dull ache that quickly ramped up to extremely painful searing pain in my upper and lower teeth, the jaw joint, temple and sinuses. This pain would come and go, but was unbearable about 5 minutes after eating anything. I went to my dentist who I have been using for over 10 years and he recommended a gold crown and root-canal ($3K) that DID NOT ultimately solve the problem and now he has recommended some more costly work (another $3K on a different tooth). In looking carefully how he approached this I think he made a major mistake in his original diagnosis and I could use some advice on how to approach this. I really hate to get into it with the dentist, but he has not come forward to admit any culpability in this case...and this pisses me off. If you have some constructive ideas...especially if you are a dentist or legal expert in this area....please give me your thoughts. Here are the details...

VISIT 1:
After I reported the initial pain, the dentist did a cursory examination of the teeth on the left side of my mouth. He did a quick squirt of some cold air some water on lower teeth with no response. He did a quick “bite test” using some rolled up rubber sheeting...with no response. No cracking on any tooth was evident. He took five x-rays of my upper and lower teeth on the left side...still nothing evident. Upon physical manipulation he says that my back upper molar needed a crown and that, based on his anecdotal experience as a child, was probably causing all my pain. He recommended a gold crown. I said OK...if you are sure that is the problem...go ahead. He started the crowning process and put in a temp crown.

VISIT 2:
The pain never fully subsides and the dentist puts in the gold crown (one week later) with temporary cement “in case I needed a root canal”. After about one week the pain was still there and very serious. I went in to see him with my wife and he did a panoramic x-ray and suggests “he thinks he sees” an area of infection below the tooth he targeted. After inspecting my jaw he said that TMJ may also be the problem. This time he did a localized hot test on each tooth on my left side as well as a bite stick test on each tooth. No tooth exhibited instant pain, BUT after 5 minutes the pain did return. Of course, we still have no idea exactly which tooth is the culprit. He schedules a root canal for the next day on the crowned tooth.

VISIT 3:
The root canal was performed and a temporary crown was applied again. After about a week the pain was still there and has gotten worse.

VISIT 4:
This time the dentist did an Electric Pulp Test on each suspect tooth after calling me back in saying that is the definitive test. All my teeth were fine EXPECT for the tooth IN FRONT of the one he originally said was bad and he did the root canal and crown on. Needless to say I was pissed. If the Electric Pulp Test is THE definitive test to determine which tooth has a bad nerve and causing my pain...WHY DIDN’T HE USE THIS TEST DURING MY FIRST VISIT??? The dentist offered to “handle my pain” right there (i.e. start a new root canal...which I immediately saw as a “hard sell” tactic), but I said no thank you and expressed my dissatisfaction with his testing procedure realizing he did the wrong tooth and left. (FYI, the tooth he actually did was never on any treatment plan so I am even suspicious if it ever needed a crown.) I am very sure that he believes that he did nothing wrong in how he targeted the first tooth. Now that I realize what should have been done, I vehemently disagree.

Now I need another $3K procedure on the correct tooth. The new tooth he tested was shown to have a dying nerve and became very pressure sensitive, but has actually stopped hurting over the last week because the nerve is toast...but... there still is the danger it may abscess...requiring removal of the tooth....which the worst possible outcome. I really think my dentist blew it on this one and I should not have to pay for the crown and root canal on the original tooth, but he has not even followed up with me to see what I want to do. I think, he thinks that he has me over a barrel because of this potential for losing the second tooth (another reason for me to be pissed off). If he is ready to play hard-ball on this one...well, so am I. He has made no effort to address this problem since and I can use some advice on how to approach this...especially if you have dental or legal experience. I really think I have a case, but I want to be sure I approach him on this in the correct way.

Was my dentist's initial testing procedures in fact correct and adequate for finding the actual tooth causing my pain? Shouldn't he have employed ALL the tests he ultimately used (tooth-specific cold, hot and pulp tests) BEFORE he targeted the problem tooth?

Is my assumption that not performing the root canal and crown on the actual correct problem tooth can lead to serious complications? Or, now that the pain has subsided can I just let the nerve die without problem?

Do you think my dentist should charge me for work on the original tooth, which was not tested correctly and did not ultimately solve my pain problem? If not, how do you think I should approach him about this?

Thank you in advance to anyone who will offer constructive advice on my problem.

TinNJ

[TinNJ]

Note to Self: Don't post such a long thread...if you really want people to read it and respond.

Although the details are important in this particular situation, I did try to come back and edit my post down, as well as "tone it down a bit", but found no "edit" option as in other forums. I think a resolution would be helpful to others facing a similar situation. Again, any informed responses would be greatly appreciated. Thanks.

[drsmiley06]

Don't worry about posting such a long thread, guys like myself who are clinicians don't mind reading stories like this. First of all, no one test is definitive, asking any endodontist. There are a series of tests used (hot, cold, percussion, palpation, electric pulp test) to determine a diagnosis. Sometimes I'll see patients that come in that have pain in a general area and it's our job to narrow the symptoms done and find out which tooth it is. A crown really won't solve any sensitivity or pain issues, usually that's an internal problem or an apical problem. And if he was uncertain he should've just referred to an endodontist and it would've been easier and alot less cost effective and less time consuming. Granted, it is sometimes tough to figure out which tooth it is and sometimes the patient can't even tell you which tooth is bothering them, but nothing wrong with bringing another person into the scene to help out. As for the costs, seems rather high and I would go back and negiotiate something with him since your pain was resolved with what he did. Hope this helps

[TinNJ]

drsmiley06...thank you for the response. I'm afraid the issue here is the fact that the pain only subsided after the second tooth, that was identified - finally through a proper testing regimen - as the actual culprit... died. Only on the second tooth did my dentist use the electric pulp test which he could dial up to 10 without sensation.

Although I am no longer feeling the pain - for now, that is - once that it has died don't I need a second root canal and probably a crown to save the second tooth and avoid further complications?

Assuming I need to spend another $2.5K - $3K to treat the correct tooth (for a total of ~$6K...including testing) our negotiations will probably get heated. This hurts after using the same dentist for over 10 years. I really don't want to lodge a formal complaint with the dental board...but I very well might have to. Thanks again for your response!!