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.
Bridge from #6 – 8 looks good to me.
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.”
Zoomed in on same photo as above. Would you call this margin “wide open?”
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).
Copyright protected by Digiprove © 2013 The Dental Warrior®
Another excellent blog! As a dental rep, I hear this almost daily how Dr. A doesn’t do this as well as Dr. B that I am speaking with…and yet Dr. A is using the most current techniques, has invested thousands in CE and is among the top practices in the area. Is there some jealousy? Is there room for more than one way to successfully complete the same procedure?
You have inspired me once again Mike….the subject is VERY valid in our profession and I hope some people reading this recognize that they too may be doing the same thing to other dentists. If there is a problem, it may be best to tell the patient you will get back to them after ‘evaluating’ and for courtesy and professionalism call the dentist and discuss your findings. Sometimes we all want and need a second chance to do our best.
Smile!
Warren Bobinski
Success in Dentistry and Life
The Everything Dental Guy.
Thank you for your wisdom. This is the professional and ethical thing to do as you suggested and is in our Ethical Code.
“You have inspired me once again Mike….the subject is VERY valid in our profession and I hope some people reading this recognize that they too may be doing the same thing to other dentists. If there is a problem, it may be best to tell the patient you will get back to them after ‘evaluating’ and for courtesy and professionalism call the dentist and discuss your findings. Sometimes we all want and need a second chance to do our best.
Smile!
Warren Bobinski”
When DDS’s/DMD’s “through the Doctor under the bus”, we are not only
acting unethically but placing our patient is such a terrible position.
This is not unlike divorced parents making disparaging remarks to their children. Warren’s comments and suggestions are Spot On!
We need to uplift our profession. We have enough MD’s/DO’s, Nurses and public thinking that we are not Doctors or Surgeons. Let’s not contribute to their incorrect thinking but correct it with ethical behavior.
This is a serious problem.
I have a client right now going through something similar. He’s a GP dentist doing implants and IV sedation and he’s marketing to the public, not relying on referrals. Had a patient who came in, had implants done for their lower denture, and then she went back to her “in network” the doc — who diagnosed all kinds of issues.
The case was truly beautiful, and the “in network” didn’t even do implants, yet qualified himself as able to diagnose problems.
Fast forward to last week, the board called and wanted my client to submit to binding arbitration on the matter after a panel of dentists inspected his work. This panel is comprised of all specialists who dislike my client for doing implants and sedation and not relying on the “traditional referral system” to stay in business.
You are a credit to the profession my friend!
Great post. While being honest, I sometimes have difficulty throwing fellow dentists under the bus as I just don’t know the circumstances under which a particular procedure was performed. I’m currently waiting on a patient to heal sufficiently following my hard tissue crown lengthening because former dentist placed poor margins so subgingivally the tissue was beet red. She asked whether he’d done anything wrong and I replied honestly “I’m not sure the condition of your gums when he placed these crowns. Sometimes when crowns are placed it’s better to first do the surgery we’re going to do on you now.”
Have to be honest, your follow-up regarding contacting the board pissed me right off. It’s pathetic to be that guy. Every dentist has failures. This case wasn’t even close to a failure to me. I prefer margins high and dry whenever possible. Far more hygienic to me.
I’ve been thrown under the bus more than once – by Florida dentists. It goes like this. I have been treating a patient for several years with a recall interval of three months. They start “snow birding” and spend more and more time in Florida instead of New Jersey. They slip off the wagon and the 3-month interval grows to 6 or 8 or even 9 months. Quite predictably, the patient’s perio condition declines and they end up with a perio abscess when they are in Florida. Of course, they find a dentist who sees them on an emergency basis. During the visit, the dentist asks, “Didn’t your dentist tell you about your gum disease?” After 8 or 10 years on the 3-month recall with no problems, the patient forgot WHY they were coming in so often and makes no connection between their lack of care and “new” gum disease that the lousy dentist in New Jersey “never mentioned.”
Hi Sam,
I always chuckle at this NY / NJ vs. Florida dentist rivalry. Down here, snowbird patients often brag about their dentist “up north,” who is INVARIABLY on the faculty of NYU. Apparently every dentist in that area is on the faculty, and that single credential is proof-positive that their dentist is a DENTAL-GOD. 😉 Seriously… it’s a huge joke down here among dentists. We ALL hear about these NYU dentists. Hilarious.
Anyway, I enjoy telling these folks (who believe dentists up there are so much better) that 90% of the dentists here are from NY / NJ! Hahahahaha! I mean, come on…. Boca Raton is the 6th borough of NYC!
But, you are right about patients’ selective memories. “Oh no…. my dentist never said that.” Bullshit. It’s their way of really saying, “Yeah, I know about that, but I don’t want to do anything about it. I just want to use an easy excuse to refuse treatment by suggesting my (NYU faculty) dentist is smarter than you.”
I assume the dentist in the Phillipines only does PFM bridges, and yes, you pretty much put the margins subgingival ‘cuz they’re ugly if you don’t. I’ll bet he’s never done an Emax bridge like this. I’ve seen some Filipino dentistry that I wasn’t exactly wild about…..
Hi John,
While in the Navy (Pacific side, which was once referred to as the “Filipino Navy” due to the large numbers of Filipinos enlisted), I saw a TON of Filipino dentistry. I wasn’t exactly wild about it, either. 😉
Good blog, Mike! It’s so tempting to make the other guy look bad, thinking that
it makes you look better. I think it’s just dental human nature. However, it does
bring us all down together. We all need to work hard at being a united dental
“team”, instead of paranoid, back-stabbing dentists locked up in our little worlds.
Once again… great post Mike.
It made me really think what it is that makes some people throw others under the bus….we all have done it, specially with the siblings. I got my older brother in trouble a few times and vise versa when we were kids. We laugh about it now, but as adults why do some people still do it? I looked up the phrase and this is what I found:
“To throw someone under the bus” is defined as meaning “to sacrifice; to treat as a scapegoat; to betray, utter betrayal, the sudden, brutal sacrifice of a stalwart and loyal teammate for a temporary and often minor advantage.”
To me it is a sign of weakness, not being confidant and eventually they will not be trusted by their colleagues any longer and will find themselves in the same situation.
It doesn’t solve anything and besides, the patients are not dumb and can see right through them.
What to do? The exact opposite! Always compliment on the good things. The bad stuff, we don’t know the circumstances and worst case scenario, pick up the phone and call the doctor if need to. Who knows, may be you can lead them in the right direction or motivate them to do better.
Finally, Nothing good can ever come out of the criticism. and that goes for all three parties!
What to do? The exact opposite! Always compliment on the good things.
Great point. And, I do this regularly. I always try to find something good in every patient’s mouth. “Wow, the dentist that did this did a great job.”
Here’s the thing… by complimenting the other dentist, you are complimenting the patient. The reverse is true, too. By criticizing the other dentist, you are criticizing the patient’s ability to choose a good dentist. And, if the patient isn’t capable of choosing a good dentist, then he (or she) may think he’s failed AGAIN by choosing you!
These stories are always hard for me to read. I like to think it is the excpetion rather than the rule yet I hear more and more similar stories. Even if the margin were open do we really need to involve the board or make threats right off? Who knows what happened and perhaps it was just a one time error? Let ye without sin cast the first stone! Clearly a phone call of concern to the other dentist would be the way to go in a first encounter such as this, would it not? But that fact that these margins are clearly sealed just shows the pathetic depths that some people will fall to. I actually pity dentists/people like this that feel so threatened, it must be a difficult life for them? I recently heard of a case where the dentist claimed he had never once had an open margin himself…pllllleaaaseee! If you do this long enough we all have our days when things don’t go as planned.
Great points, Ken. All so very true.
It is disappointing that dentist #2 was so quick to criticize the work of dentist #1. Based on the X-rays and photos you posted, the work looks beautiful and well done. We as dentists have to be so careful with what we say to our patients. Sometimes you see a patient with sub-par dental work and think to yourself how you could have done so much better. Then you start treating the patient and you can barely get your handpiece past the lateral incisors due to their limited mouth opening, and the patient is moving around all over the place. Better keep your mouth shut except to compliment other people’s work. There is a saying: “criticism is an indirect form of self-boasting”.
Thanks for your comments, Alyce. I always try to find SOMETHING to compliment in every patient’s mouth.
This is so interesting! I hear that even at dental school faculty can have conflicts over students’ work because they have different opinions/standards/philosophies- whatever you’d like to call it. The patient sought out dentist #2 because he was unhappy with dentist #1’s work in the first place- what do dentists think about their patients seeking another dentist’s advice?
Thanks for chiming in, Yesle. Many dentists are very insecure.
GREAT BLOG! Its sad that some feel that they have to find something negative about someone else to try to make themselves “look good” However, the exact opposite occurs, making everyone look bad. IMO this is one of the main reasons PTs are Dentist shopping, B/C we have lost their trust and want to harp one the negative.
Im not sure how anything could have been said about an open margin. That bridge is beautiful and well made. That PT should be very thankful/appreciative of the work he/she received.
Thanks, Kamran. I agree 100%.
I always like to complement the nice work that I see other dentist’s have done in patient’s under my treatment, (especially if it ws done by my father!)
I think the problem, for me, is that the complimenting of others can become a humbling experience; the unspoken thought in my mind is, (sometimes), ‘I hope my (e.g.) esthetic margins are just as nice!”
Hi Mark,
I think complimenting the previous dentist’s work establishes you as at least an equal (if not an authority). It’s good form. It compliments the patient. And, it makes you look good in their eyes… they’ve picked a good dentist before, and they’ve picked another good dentist now.