Yesterday I spent close to an hour with a new patient consultation. She was referred to me by my family’s pediatrician. This patient is in the midst of extensive dental treatment by another dentist. She is very nervous about dental treatment and had it done under IV sedation. At this point, 10 teeth have provisional / temp crowns. All of them are posterior teeth, some in each quadrant. During treatment, tooth #3 was determined to need root canal therapy during her long appointment, and so it was done by the dentist right then.
The dentist also told her that the teeth in the upper left quadrant would need crown lengthening surgery before final crowns could be placed. This has not been done, yet. But, the dentist wants to do it himself at another visit. Nothing wrong with that.
Immediately after her first big visit (multiple preps and root canal), the patient noticed a discharge from her nose on the right side. It went from clear to rusty colored. The dentist put her on antibiotics and it cleared up. But, then the dentist informed the patient that the tooth with the new root canal would need to be extracted.
Between the root canal, the nose drainage, the need for extraction of #3, and the crown lengthening, the patient was losing confidence in the dentist. So, she asked her pediatrician for a referral, and she ends up in my office.
I took a look. The temps aren’t the prettiest I’ve seen, but they’re not the worst, either. They’re adequate. Soft tissues look pretty good. Nice and pink. No pain or swelling anywhere.
Patient allows me to take a few x-rays. It’s obvious she’s had a lot of work in the past – multiple root canals, posts, pins, fillings, etc.
The main thing that stands out, though is the root canal therapy on #3. There’s a problem there, for sure.
So, patient is in tears wondering if the dentist is “trying to make up more work.” She’s already paid a significant amount of money. What do you do or say?
I explained to her that like medical treatment, dental treatment can have complications and “hurdles.” And, with complex “big cases” like hers, it’s all the more likely. Things don’t always go exactly as planned. And, sometimes we have to make decisions during treatment. I explained that there is an issue with the root canal.
One canal is “over-filled.” And, with root canal treatment, this is one of the possible complications. Any dentist who does enough of them will have every complication occur. The good news is that there is always something that can be done. I’d suggest you speak with the dentist about the possibility of referral to an endodontist to evaluate if it can be retreated. The alternative is to extract and place an implant. Implant placement may include sinus augmentation to create more bone for the implant.
I also said that based on my limited information, crown lengthening surgery may well be indicated for the upper left quadrant. But, if she wanted to be certain, a consultation with a periodontist may help with that decision.
Ultimately, I suggested that she try to work it out with the dentist with open communication. Starting over with a new dentist may not be practical or necessary (not to mention financially burdensome). If I was to take over this case, it would be $15,000 – $20,000. But, I’d rather she go back and finish with the other dentist. I’m not going to lie to a patient to “protect” another dentist. I’ll tell her the root canal is an issue, and here’s why. But, I’m not going to play on her fears and limited information to gain favor or financial reward, either.
Could the dentist have done better? Possibly. I wasn’t there. Could he have communicated better? Yeah… probably. She didn’t seem to know about the overextended gutta percha in #3. She just knew that he didn’t like the result and wanted to extract the tooth.
A few years ago, a dentist threw me under the bus, and it resulted in a claim that was settled by my malpractice insurance company. It was an easily resolvable situation. But, unfortunately, I never got a chance to address the issue.
I spent a good hour with this patient (and only charged her for a few x-rays). She felt better after our visit. And, I believe she’ll work it out with her dentist. He’ll never know what I did. Putting out fires like this is good for patients, and it’s good for the profession. Sometimes going to bat for a fellow dentist is part of being a Dental Warrior.