This week’s schedule was literally cleared for my dad’s long overdue full mouth reconstruction. I’ll eventually post a case presentation, as it’s a “doozie!” I spent four full days treating only my dad. But, I did squeeze in some emergencies with existing patients.
Another local dentist, who is also a friend, contacted me about seeing one of his patients for a second opinion. Here is the story:
The patient has been seeing a dentist on his plan for some time. Dentist #1 retreats a root canal on an upper lateral, and it fails. It needs to be extracted. Patient loses confidence in dentist #1 and seeks out a cosmetically-oriented dentist on the web. He finds dentist #2 (my friend). Dentist #2 treats with a 3-unit bridge.
The patient then decided to go back to dentist #1 for his next prophy, since that dentist is on his plan. Dentist #1 sees new bridge and tells patient the lingual margins are “wide open.” Patient is upset and contacts dentist #2 about it. Naturally, this upsets dentist #2. Patient doesn’t know who to believe. So, dentist #2 asks me to take a look and give my honest assessment. His own x-rays (sent to me) show the margins to be closed. He will replace the bridge if I discover any issues he could not find. He honestly wants to do right by the patient. But, he’s understandably upset that the other dentist threw him under the bus.
I fit the patient in during my dad’s marathon dental session. I had already seen the x-rays. And, clinical examination revealed intact, sealed margins. I did note the lingual margins were supragingival, making the whiter porcelain contrast with the darker root structure.
The patient then told me that his cousin, a dentist in the Philippines, said that the porcelain should go all the way to the gum line. I explained that supragingival margins preserve natural tooth structure and are healthier for the gums. But, the margins are in no way “open.” They are sealed tight. Unfortunately, my explanations seemed to be falling on deaf ears. “But, my cousin said….” I finally had to say, “I respectfully disagree with your cousin. Furthermore, to redo this bridge for no good reason will actually potentially cause more problems by increasing the chances of needing more root canal treatment.”
The conversation was friendly, and the patient was very nice. But, I didn’t have the feeling that my effort was a “win.” Nevertheless, I felt good doing it, and I would hope another dentist would do the same for me. Sadly, this isn’t the first time I’ve blogged about our profession’s propensity for dental fratricide.
I called my friend that evening, and told him how it went. He’s scheduled to see the patient again next week. We’ll see how it goes, and I’ll update this post accordingly.
Chime in with comments and your own stories below!
UPDATE #1: Further communication with Dentist #2 reveals that he spoke with Dentist #1. Dentist #1 said that he would have suggested to the patient to contact the state Board of Dentistry about these “open margins.” But, since he knew Dentist #2 was a “famous cosmetic dentist,” he did Dentist #2 a “favor” by telling the patient to go back to Dentist #2 (instead of calling the board).