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Sorry in advance for this long post, but I hope you'll understand after reading it and give me your feedback.
After going to the same dentist for about 25 years, I unfortunately went to someone different at the end of 2016 for a new crown on tooth #18 due to it breaking. It was obvious from day one that I received substandard dental work and a poor-quality crown. I won't go into the details of that horrible experience, but it appears now that my fears were well-founded. I've since moved to another part of the state, and recently went to two dentists in this area:
Dentist #1: I finally got into him mid December 2021 for a full comprehensive exam. Instead of talking to him directly, I had to tell my concerns to his young assistant, who may or may not relay to him properly. I put on my paperwork and/or expressed verbally that:
1. I've always been worried about that #18 crown for many reasons, including that maybe it's from China and I'm having an allergic reaction to it and/or bad cement because I've had a burning sensation. Among other things, I also said that it never felt right and always seemed too high or maybe it doesn't fit with the top tooth properly.
2. My tongue started to tingle, the roof of my mouth felt irritated, I got a sour taste in my mouth and my lips felt dry/parched after I started taking Ibandronate for four months in 2021 for osteoporosis.
3. Since I moved here, I've been dealing with significant stress, I'm being exposed to second-hand smoke and other*environmental things in the building that I've been living, and I was diagnosed with eczema for the first time ever.
I was shocked that the first thing the dentist said without first looking in my mouth was that I have great teeth and good dental work. While it was nice to hear that he felt I have great teeth, I didn't understand how he could determine that I have good dental work without first examining my mouth in general and that tooth specifically. His exam consisted of periodontal probing of my gums and he checked my jaw joints.
His findings/comments were as follows, and I was given a Treatment Plan with the costs when I checked out:
1. It's red around that #18 crown and if it still is after my teeth are cleaned, then we'll know, but I don't know exactly what he meant. When he said the crown is white, I think he meant that he can't see through it with x-rays because it's metal. When he asked, I said it wasn't painful when the tooth broke, it just felt like some of it was missing and it wasn't sensitive to hot or cold.
2. When I said my teeth have shifted because it's not tight between that #18 crown and the tooth next to it, he said it has nothing to do with the crown, but he never said why that's happening or how to stop it.
3. The inside and roof of my mouth look good and dry mouth can make your mouth sour, but he didn't say if I have that or how to resolve it if I do.
4. I have some decay coming on #31, and he'd do a new white filling to replace my old silver filling that I've had for decades.
5. I may have to come back for another cleaning since it's been so long, but his assistant previously said that she'd seen so much worse, which wasn't a surprise because I have great at home care.
6. I have some gingivitis, which is why my gums are swollen, but once my teeth are cleaned, it will fix that. He suggested that I get a Waterpik and electric toothbrush. He measured mostly 2- 3 mm with his periodontal probe but said I had a couple 4-5 mm.
7. The bones in my mouth are good.
8. He used gel and a tool to hear my joints when I opened and closed my mouth and said they're good.
9. There are four teeth (3, 4, 13, 14) that have some recession at the gum line, and he'd fix them with a resin composite filling.
I left feeling frustrated because I still had many of the same concerns about #18. My first thought was dentists protect dentists, and I'd never go back there after my cleaning that was already scheduled.
I then went to his hygienist the following week. She was by far the absolute worst that I've ever been to, and their equipment seemed old. The hygienist was older and extremely sloppy. It was very uncomfortable how she put the suction thing in my mouth, and many times water was dripping down my face. She hurt me when she obviously hit a nerve on the top left side of my mouth, and I almost jumped out of the chair. I had to stop her when she was cleaning around the #18 crown so I could pull out a little piece of black something that went under my tongue. She said "tartar", but I believe it was cement from that ill-fitting crown. After she finished, I noticed that there was still a lot of stain left. She said I can have a second cleaning, which I've never had to do before. She also did a horrible job flossing, if you can even call it that, and my teeth felt rough in so many areas because she didn't polish them. They then tried to charge me $132 for the cleaning instead of the $115 that I was quoted, even though I expressed my disappointment. Granted, I hadn't had my teeth cleaned since the end of 2016 versus my typical every six months to a year because dentists where I lived before said to go back to the one who originally did that crown for a resolution. I then had over a year of my life wiped out starting in early 2019 due to cancer. In 2020 COVID happened, and I also moved the end of the year. When I tried to get into dentists here in 2021, they either weren't taking new patients or it took months to get in. I went a few years without having my teeth cleaned one other time (during the 2008 Great Recession when I lost my job), but my hygienist had them sparkly clean like always when I went back to her.
Just when I thought it couldn't get any worse, the #18 crown fell off two days later on a holiday. I was eating a soft piece of bread, and this was the first time that I'd eaten on that side since I went to her. When I called, the dentist said to breathe in through my mouth to see if I had sensitivity. When I said a little but it's not terrible, he said if the tooth isn't sensitive at all, to be careful and don't eat anything hard. However, since I had a little sensitivity, he suggested I go to the office so he could put a temporary on until they come back from their week off during the holidays, but other dental offices were shocked that he had me go in and said some sensitivity is normal at first. He said this is the safest route, especially since it was going to be over a week before they were back, and a day or so would be okay, but not the course of a week. I reluctantly did as he suggested, and I was appalled when I got there and he said he wasn't going to clean out the decay that was under that crown until I come back and when he has an assistant. I was there for less than an hour, and he said it was going to be an astonishing $400.00, but he didn't charge me that day. He said his girls would call the day that they return from vacation to give me a price for the new crown and to schedule. Then, no later than three days after he put this temporary on, my lips felt gritty like sand was glued to them and other weird things were happening.
I became more and more bothered that he never looked at that crown specifically or addressed my concerns and that his hygienist was so extremely rough that it was apparent she loosened it. If this dentist and his hygienist had done their jobs properly, this never would have happened, but I accepted that I'd need to pay for another exam with a different dentist so I could get a new crown. While I've always believed this was an inferior crown and/or cement, it's not right that I have to pay for another crown and a hefty after-hours visit due to their negligence, as well as deal with the added stress this caused me. I also found it suspicious that they never called to schedule the new crown, and I didn't follow up because I felt very uncomfortable going back there. I once again began trying to find a reputable and honest dentist, which has been very difficult.
Sixteen days after the #18 crown fell off, I received a very unprofessional/shoddy statement that didn't make sense and parts are handwritten. I always pay my bills, but I've been having a difficult time paying someone for their negligence.
I then received a second statement the middle of February. Instead of describing the services rendered like statements generally do, the description just has "Previous Balance" with the wrong date. I guess they couldn't remember what they hand wrote before.
About 10 days after receiving that statement, I went to their office to discuss my dissatisfaction and to get my x-rays and chart notes. The lady at the front desk said I owed for the after hours visit and handed me the cost for the crown and build up. This also included an additional $230.00 for Gingivectomy or Gingivoplast, which I've never heard of. She said it's a laser that he uses around the crown to get a good margin. She subsequently emailed the x-rays of my initial visit but refused to give me the chart notes until she talked to him. They were finally emailed four days later, but it was obvious that they changed their notes based on things that I said to the front desk lady, and much of these notes contained lies (like the hygienist polished my teeth).
Dentist #2: I eventually got into this guy the middle of February. He's in his mid 30's so he hasn't been practicing long. When I scheduled the full comprehensive exam, I was told it's $200, which includes all x-rays, pano x-rays, bitewings and a CT scan if one is needed. They were going to charge the same whether I gave them my x-rays or not so I expected them to take their own. I was disturbed when the assistant initially was just going to do bitewing and panoramic x-rays instead of the normal full set. She said they normally don't do this on the first visit but couldn't explain how he'll know everything that's going on in my mouth without them. His assistant was very contradictory and later said they do it initially if people are having issues.
After he did his exam, he said that I needed to come back for a 30-minute consultation to discuss his findings. His assistant said they schedule a consultation later because he'll study everything and it's a nice presentation. These are my notes of what he said during the exam:
1. I have some bone loss, but he didn't show me on the x-rays.
2. I only need a permanent crown and have some gum issues but nothing urgent.
3. While my gums measured mostly 2's and 3's, I have a couple deeper pockets of 4's and 5's. I felt he was aggressive and hurt me when he used his probe and then said I have periodontal/periodontitis disease. I could tell where he was going so I said I just need another regular cleaning. He said regular and deep cleanings are two different things.
4. Everything looks normal, but I'm not sure if he meant in general because my next note under that has "crown and bite adjusted and will be fine."
5. He has to take off the temporary crown to evaluate. His assistant later said he would have seen decay and there were no cavities.
6. There's some inflammation around the gums on #18. Cement was around the temporary, which was irritating my gums. He showed me some of it on his tool, and it appeared pink like my gums. I only recall him scraping the cement off on the tongue side and maybe between the teeth but not the other side.
7. I have light staining, tartar/calculus, plaque (even though I'd recently had my teeth cleaned at Dentist #1).
8. He used a tool to check my jaw joints, but I felt he pressed on my face by my ear unusually hard. When he asked if I heard that clicking noise and do I normally, I said that I usually don't.
9. His assistant later said everything looks good, but I need to get the lower left (#18 crown) finished.
I was troubled that the permanent crown was going to be delayed even longer so after reviewing my notes and thinking about it for a long time in my car, I went back inside to say that I don't understand why I couldn't get the Treatment Plan and schedule to have the crown done. There was a TV screen now in the lobby and apparently they just gave a seminar on implants, which apparently is his focus, and they do these seminars monthly.
When I went to the presentation two weeks later, the dentist came in with a different assistant than the first time. He showed me x-rays and pictures on a monitor, but there were times he seemed to change the lighting on some. Below were his comments during this visit:
1. He noticed something peculiar on my lower front teeth, an abnormal finding that's suspicious and maybe a cyst (in writing it has abnormal, large radiolucent lesion in the anterior mandible). The only way possible to know is for more imaging or to go to an oral surgeon and have a 3D CT scan so he can look at and send to radiologist/pathology and either pursue anything with surgery or monitor it. He can send directly to a surgeon or have an image there and send it to a radiologist, but it's simpler and he'd probably recommend going to a surgeon in case I need a biopsy. He said their costs are similar for the CT scan ($450), but I was told when I was given my initial quote that it's included if one is needed. His finding could be something bad, but oral cancer is not likely.
When I said I'm a fanatic about flossing and brushing my teeth, I don't smoke or have any other risk factors other than I've been suffering from second-hand smoke since I moved here, he said this has nothing to do with dental hygiene, it's not an infection, and anything can develop in your jawbone and could affect the whole body. It's down below the roots of my front teeth, and handed me a referral to a surgeon to determine if we do treatment or just keep an eye on it. It's suspicious because it's shaded there and it all should be light, not dark and light. When it's dark, meaning a space, it's either a hole or a defect in the bone. He thinks I should have a surgeon look at it, and if it looks normal, then okay. He's not worried about me losing my front teeth, but if that permanent retainer that I've had for decades was taken off, my teeth would move.
2. Periodontal charting shows some deeper pockets, and he said something about bone loss. It's 2-3 mm when healthy. When bacteria sits too long, it's gingivitis. If it sits a while longer, then it's periodontitis, and those pockets can be 4, 5, 6, so when there's 4-5 mm pockets, that's not normal when he looks at an x-ray. He pointed to a picture that he says shows tartar buildup where bacteria hardened on the root of a tooth. It's not an advanced stage, and I only have mild bone loss. We do have bone loss throughout life, but when there's bone loss and deeper pockets, then it's an active case of periodontal disease. He started to say if there's no bleeding...and I missed the rest of what he said (but my gums don't bleed). I don't have a significant amount*of bone loss, but if there's 4-5 mm pockets, it will get worse. They can prevent it from getting worse and one way is deep cleaning those areas. The goal is to get the 4-5's to go down to 3's, but once bone loss happens and you have periodontal disease, the roots are more exposed than before. I'd need the deep cleanings the rest of my life, and he called it periodontal maintenance. It's different than a normal cleaning and a little more involved and they smooth the root surface. A regular cleaning is a prophy where it's just the enamel and is done mostly when there's normal, healthy gums and no lost bone, but once there's bone loss, bacteria and things can stick easier on the root surface. With this process, the roots need to be planed and smoothed. They recommend it every three months so four times a year with the hygienist, and I really need to be working at flossing and brushing at home and maybe use a Waterpik. I don't have a severe case, but he doesn't want it to get worse and make sure I don't lose more bone. They'd deep clean two teeth on the upper right and two on the upper left and the rest would be a regular cleaning.
He'd also give a prescription that will help. I'm still flabbergasted by this because of how I am with my at home care.
3. There's red inflammation around the #18 temporary crown. That could be caused by gum disease, but that's not his suspicion. When a crown and margin is too close to the bone, you have chronic inflammation where it's tender, and this could be what is happening. Maybe that crown is too close to the bone, and if decay is too close to the bone, it could cause tissue to look like it does. If that's the case, he'd look at the tissue, take the temporary off and it could be my bite is off. He said something about a root canal and a fracture, but I was stressed so I didn't catch what he said. He wouldn't want to put a new crown on when that inflammation is going on because I'd be unhappy. If that crown is too close to the bone, maybe I'd need surgery or a root canal. I didn't think about it until later but that crown fell off so it can't be too close to the bone now. When I told him that he said during his exam that cement was causing the irritation and he removed some and it feels better, he said that's on the tongue side. He wants to get everything looking good, take the temporary off, remove any decay or fillings to make sure there's no decay under or a fracture. He likes to take off any restoration if another dentist did it because you can't see through an x-ray once cemented and he then said something about seal and core build up. As long as I'm feeling comfortable with his new temporary, he'll send the impression to the lab, and the crown will be back in three weeks. I was more upset after reading his Treatment Plan because it says this tooth has had problems for several years and it's possible I'd need a root canal, crown lengthening or the tooth can't be saved, but I'd think he could tell by the x-ray.
4. I have some recession that could have been caused by braces (which I had decades ago). He'd recommend a night guard if I'm clenching, but this isn't his biggest priority. I don't understand how a night guard helps with recession, and I don't clench my teeth.
The grand total of his presentation is a whopping $4,020, but $655 of that is the hygiene total and I think that's $655 x four times a year. That doesn't include a surgeon or if anything really needs to be done other than a crown on that #18 tooth.
He later said the first step, even before doing the crown on #18, is to have the surgeon look at the lower front because there's a lesion on the x-ray that's as clear as day. When I questioned this because he made several contradictory statements before, he said this needs to be done because it could be oral cancer and something serious. When I said I'm very concerned about delaying the #18 crown any longer, he said he can set up the crown for that tooth.
BTW - when I went to this stupid presentation and before seeing the dentist, I asked the front desk to email my x-rays and chart notes. The Office Manager said she can send the x-rays, but she needs to talk to the dentist about the chart notes. I never received either so I went back last Friday (11 days later). A young girl said she was the only one there, but she called the OM to check. She was given the okay to email the x-rays but said the OM needs to talk to the dentist when she returns on Tuesday about my chart notes. It makes me very suspicious when dental offices have a problem giving me my chart notes. After I go to any other doctor or medical facility, I always ask for and receive the office visit notes, x-rays or whatever was related to that visit, but dental offices are always the only ones that won't freely give that information, at least in this area.
In summary, how can two different dentists say these two totally different things about the same mouth?
1. Dentist #1 says that I have no bone loss, and Dentist #2 says I have mild bone loss. (I do have osteoporosis in my hip.)
2. Both say that I have a couple deeper 4-5 mm pockets. However, Dentist #1 says I have gingivitis and a regular cleaning will clear that up, although they recommended a second cleaning since his hygienist failed to do her job properly the first time. Dentist #2 says I have periodontal disease that needs the very expensive deep cleaning for the rest of my life.
3. Dentist #1 doesn't say anything about oral cancer, but Dentist #2 scares me to death and says that I need a very expensive CT scan and I need to go to an oral surgeon.
4. Dentist #1 says that decay was under the #18 crown that fell off, but he did see the tooth without the crown.
Dentist #2 said he'd have to evaluate after the temporary is off. but I'm baffled why he couldn't tell from the x-ray because a temporary isn't metal.
5. Dentist #1 didn't indicate that I'd need a possible root canal or that I could lose my tooth on #18, but Dentist #2 said both are possible.
6. Dentist #1 said that I have decay coming on #31, but Dentist #2 doesn't mention any decay on it.
7. Dentist #1 said that I have some recession and he'd do a resin composite (filling) on those teeth. Dentist #2 says I have recession without stating which teeth and recommended a $1,000 occlusal guard.
8. Both dentists say there's irritation around that #18 tooth, but neither gave a concrete explanation as to what's causing it.
My view of dentists was severely tarnished after going to the dentist in 2016, but I don't know if I'll ever trust another dentist again after these two here. I'm having a very difficult time trying to figure out what to do or who to believe. I wouldn't go back to Dentist #1 because it's obvious they caused this already ill-fitting crown to fall off, but it also seems Dentist #2 is trying to pay for his dental school.
What do you think about this nightmare situation and what would you do?* This is costing me a fortune, and meanwhile the issues with the #18 crown are still not resolved and need to be ASAP before I do end up needing a root canal or worse. Should I pay for a third dentist and hope I'll receive an honest evaluation or should I go back to Dentist #2 or do something else? My gut told me not to go back to the dentist in 2016, but I did because I didn't want to pay for another dentist or delay the new crown, and that decision was a big mistake.
Thank you in advance for any words of wisdom and feedback.
Last edited by LFJourney; 03-14-2022 at 05:54 PM..
You need to take some very deep breathes and calm down. I couldn't read your entire post, but it seems to me that it would be worth the time and trouble for you to just go back and consult the dentist you saw for 25 years. You must have liked/trusted him for you to keep seeing him for that long.
Meanwhile, you need to learn some techniques for dealing with your anxiety. High blood pressure can lead to any number of poor health outcomes - some even worse than what you are dealing with your teeth. Go to your GP for a once over and ask if she can recommend someone who will help you deal with your anxiety.
You need to take some very deep breathes and calm down. I couldn't read your entire post, but it seems to me that it would be worth the time and trouble for you to just go back and consult the dentist you saw for 25 years. You must have liked/trusted him for you to keep seeing him for that long.
Meanwhile, you need to learn some techniques for dealing with your anxiety. High blood pressure can lead to any number of poor health outcomes - some even worse than what you are dealing with your teeth. Go to your GP for a once over and ask if she can recommend someone who will help you deal with your anxiety.
Agree. There's more going on here than perceived, possibly imagined, trouble with your teeth OP. You seem to be hyper focused on this. Not good for anyone.
If I were you I'd just get the #18 fixed since it's bothering you right now. The other problems may or may not be significant enough to sink money into, who knows, but why bother for the time being if it's not causing your decline in QOL?? I agree there are many shady dental practices out there (only thinking about $$$).
I'd find another dentist that someone you knows recommends as a good dentist. I'd visit an oncologist and tell him your dentist said you might have cancer of the mouth and let him diagnose you, get the scans and let him tell you one way or the other. I'm not sure how old you are but at 75 I had problems in the last 5 years with three molars on the left side, two top and one bottom and just had them pulled. Two of the problems happened after my first deep cleaning in 7 years. I'll never have a deep cleaning again. I use the water pic and it is the best treatment for gums. When I was much younger I was told I had gum disease and my teeth were loose. I couldn't afford a periodontist and I bought the water pic instead and my gum disease and loose tooth went away. I have a bunch of crowns and had root canals for all of them. I didn't know you could get a crown without a root canal. As you get older a cleaning can't make your teeth that white.
If I were you I'd just get the #18 fixed since it's bothering you right now. The other problems may or may not be significant enough to sink money into, who knows, but why bother for the time being if it's not causing your decline in QOL?? I agree there are many shady dental practices out there (only thinking about $$$).
I agree about #18.
Regarding the possible cancer, health insurance might cover that since it's a medical issue that happens to to be in the mouth.
Where in Florida do you live? I've lived in Melbourne and now Miami and have had a couple good dentists I can recommend.
I'm currently living in SW Florida so Melbourne and Miami won't work, but I appreciate the offer. Another problem with this situation is that I really don't like this area and wish I'd never moved here so I'll have to try and find yet another dentist when I move again.
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