Yesterday, I saw a patient for a 2nd opinion. She had a full mouth rehab with implants and was reportedly not happy with the result. I didn’t take any photos. This will be a short and sweet blog post. But, I hope it’s a story that resonates.
I met the patient and chatted with her. I engage in conversation with a patient like this for a couple of reasons. First, I want to get to know her (and her demeanor). Secondly, I’m also evaluating the cosmetics and phonetics of her dental treatment.
Eventually, we got to her complaint. She explained that she has implants on the upper and lower arches. The upper arch is a bar-retained denture. The lower is all fixed in three segments. She felt that the teeth are “too far forward.” Based on our initial conversation, I did not observe them to be proclined or protrusive. Her ability to speak was good. I did not notice any lisp or difficulty enunciating.
I asked what she had before.
Ten years, but I hardly ever wore them… just for smiling and pictures.
How long have you had your new teeth?
I did a cursory clinical examination. She told me the treating dentist was working on the lower front “temporary.” She had bridges in the posterior segments (that looked great) and a bridge in the anterior (canine to canine) that was PFM (porcelain fused to metal) and obviously significantly adjusted on the facial (through to metal on #27. She told me that she felt the lower front teeth were “still too far forward,” and the dentist had been adjusting them. She complained that she couldn’t bite off food. The adjustments had created an overjet / anterior open bite.
I observed lip support… from the front and in profile. It looked pretty good. But, if anything, there was a slight LACK of support rather than too much.
Overall, the work was quite nice. And, I told her so.
“Not only is this nice work, but I think you’re going in the wrong direction. If anything, your teeth are too far BACK.”
That’s what my dentist said!
“I agree with your dentist. I understand that you FEEL they stick out too much. But, I’ve looked at your facial and lip support. I’ve listened to your speech. It’s all pretty good. Your smile looks great! It looks very natural (my assistant nods and voices her agreement). But, I’d go the opposite direction. Bringing your lower teeth back to where they should be will give you a bite in the front. You told me you hardly ever wore your dentures. So, you’re used to not having teeth. You’ve had these teeth only two months. So, it feels strange to you. But, I can tell you with CONFIDENCE, and in my professional opinion, they are not sticking out too far. If anything, they’re not out far ENOUGH. That’s my story, and I’m sticking to it. (Yeah, I said that.)
My opinion is that you should work with your dentist, trust him, and give yourself TIME to adjust.”
And, that was that. I hope it works out! It’s not the first time I’ve pulled a dentist out from under the bus. Nor is it the second time. But, I think it is good for the profession. I don’t know who her dentist is, and he or she will never know about my visit with the patient. Sadly, I think there are some dentists out there who would see this as an opportunity to redo a case. I’ve been thrown under the bus by a colleague. To them I say, “Be very careful what you wish for!”Copyright protected by Digiprove © 2016 The Dental Warrior®
Very nice point.
Great story. This is the best way we can start teaching patients that when things don’t feel right, it is necessarily because the dentist did anything wrong!
You are right. Throwing another dentist under the bus is very unprofessional. However, there are some dentists who likes to do this.
Great job. That’s what a Second Opinion is for, to tell them your truth.
I’m glad to hear her dentist was doing a nice job. These are life changing procedures, which is what I love about dentistry!
Had a patient once that had buck teeth most of her life. When the temps were in place, she wanted the facials reduced considerably. We accomodated as much as possible then had to tell her that there was no reasonable solution to what she was wanting to accomplish.
1. We would had to Root Canal all her anterior teeth to prep back more aggressively.
2. Tooth fracture was likely
3. There would not have been sufficient porcelain to have long lasting strength.
She was a tough one! Mmmm hmm! She finally “compromised” and we cemented finals, after a lengthy consent form signing session.
Great blog Mike. This situation is an important crossroads of communication between doctor and patient that if not handled correctly, can open up a Pandora’s box of issues for everyone. Usually takes years of practice to get it right. Smarmy practitioners would see this as an opportunity for revenue, but oddly enough, when the previous dentist’s work and/or treatment proposals are disparaged, something of a paradox occurs. They do not, in all cases, see the new dentist as the “savior”, but rather start to feel badly about their decision to trust the first guy in the first place. That leads to questioning their ability to trust you as well. This is what makes it bad for the entire profession. It’s all about trust. Bad mouthing colleagues when all the facts are not known destroys what we are trying to establish in the first place.
Great points, Brian. Of course, if we do see problematic issues, we are obligated to make note of them. But, it can be done diplomatically without accusations, overt or implied. I agree with your paradox, which relates to my admonition, “be careful what you wish for.” You may not want to be the “savior.”
It pays to get a second opinion.
What a nice read. Thank you for sharing this wonderful story. If I was also in your position i would do exactly the same.
“That’s my story and I’m sticking to it” love it! You are right, some dentists would take advantage of this situation, lucky the patient got you instead 🙂