It’s been a while since I’ve written! Busy with life and uninspired.
Today I saw an emergency patient for a dentist-friend who is out of town. She’s a new patient for my friend. A veneer (on #9) that was done in another office (before my friend) just two months ago, came out. The office that placed it was what I call a “McDentist”…. a local multi-location corporate office that turns over staff regularly, including the dentists. But, hey…. these McDentists take any and all dental plans. Their waiting rooms are full, so “they must be good,” right? 
So, they’re always busy, churning patients through the chairs. Quality and attention to detail? Bah! Churn and burn, baby!
It tooth #9 (a single central veneer case), and she’s leaving on an overseas trip Sunday.
Houston, we have a problem.
Here’s the thing… The veneer was done just two months ago (again, not by my friend and colleague). The FIRST time it came out was the DAY AFTER it was placed. Something is VERY wrong, if that happens. She went back. They recemented it. It came out again. She went back. Rinse and repeat. She finally gave up and called my friend (who has seen her husband as a patient for quite some time).
This was the FIFTH time it came out. After I cleaned out a THICK layer of cement (shouldn’t be that way), I was not surprised that it didn’t fit well at all. The tooth preparation? I’ll just say I wasn’t impressed. 
The restoration needs to be re-done.
Here goes somethin’!
I used all my tricks and rebonded it. I sandblasted all the cement off the porcelain. I re-etched it with Hydrofluoric Acid (Ultradent). Applied Silane (Interface by Apex Dental Products), Scotchbond Universal (3M), and Calibra (Caulk). Hopefully, it will hold up long enough for her to return from the islands and until my friend can do a new veneer for her. I didn’t take any photos.
You get what you get.
It’s frustrating for those of us (dentists) who work HARD to do our BEST for each and every patient… spending TIME with those patients… treating them like we would our own family… to see these “McDentals” treating patients like shit and making money hand-over-fist by doing huge volumes of treatment. They can afford to lose some patients who are unhappy with treatment or figure out the treatment was low quality. Most of their patients don’t know (any better) or are unaware of the problems until it’s too late. I recently wrote about the “Scourge of Corporate Dentistry.”
After many years in this profession, I can conclude that TODAY, the cultural trend is… the VAST majority of people (dental patients) TRULY do not care about quality. Sure, they pay LIP SERVICE to the notion of caring about quality. But, they really care about “cheap,” and they care about whether the dental office is “on their (crappy) plan.” SOME of them EVENTUALLY figure it out, after they’ve been treated like shit repeatedly. Or… their veneer falls out FIVE TIMES in a 2-month period. Some never figure it out, or perhaps they figure there’s no difference wherever they go.
Well… there IS a difference. Some patients DO get it. But, many… too many… don’t. Or, they learn the hard way.
“The bitterness of poor quality remains long after the sweetness of low price is forgotten” – Benjamin Franklin
You can’t provide nor receive the best dentistry (or service) on an HMO / PPO plan. You just can’t. The same goes for a corporate chain McDentist, where the non-dentist office manager directs treatment and high volume and production numbers reign supreme.
“But, it can happen in a private office, too!”
I have already heard this argument. While it’s theoretically true, I’m just not seeing it. In my 30 years of practice, when I get these problem cases, it’s ALWAYS from one of these clinics. Always.
What’s sad and, frankly perplexing to me, is that these McDentists don’t care, either. How does one get to that place, mentally?
</rant>
Hi Mike! SO GLAD that McDentists are going to be practicing out of Walgreens now! That’ll definitely increase the number of disgruntled patients that’ll filter out to private care offices.
Reply
Ha! Yeah… it could ultimately benefit us!
Hope you are well, my brotha! 🙂
Reply
Mounting student loan and scarce availability of job are two driving factors for people to end up in corporate. I’ve seen bad dentistry from private office too, I think if one is gonna do bad dentistry it doesn’t really matter where he/she is. I doubt if the mcdentist you described would’ve left the corporate and open a private office he/she will suddenly start practice properly…corporate does have more pressure and driving force to influence one’s dentistry but ultimately it’s up to the individual to participate in the bad act.
Reply
Absolutely. It’s possible and it is up to the individual dentist. But, there is IMMENSE pressure to produce at the McDentist. Ask anyone who has worked in one. That all said… the crazy cases I see…. are virtually always from a mill (or from overseas).
Reply
Exactly right! Most patients don’t care about their teeth…even those who can well afford it. They think there is one standard we all meet. They do not know until it’s too late. Corporate ethical standard is “buyer beware”. Let the marketplace make the distinction…the worse they are the better we are. Hopefully not too many will be hurt.
Reply
I hear ya… and agree.
Reply
Everything you said bout cooperate dentistry is true and unfortunately it is growing like a cancer. My son is a dentist in AZ and the state is probably 90% corporate.
The question is what is to be done, just sit back and bitch and write protest articles?
I have been in private practice for close to 40 years and I am sure as hell glad I am not just starting out in practice in this dental swamp environment.
Again what can be done to correct, limit, contain the spread of this type of dentistry that will drive our profession back to the days of the barber chair.
Reply
I don’t consider this a “protest article.” I’m just pointing out what I think is the obvious (facts). It’s recognizing reality. As one who believes STRONGLY in the Free Market, I think the market place will sort it all out. There will be a two-tiered system. Consumers are FREE to CHOOSE. There will always be those who do not value quality dentistry and are willing to “get what they get” for the perceived lower costs. There will also be a (small) market for those patients who DO value quality dentistry and are willing to pay for it.
In some ways… we can be thankful for corporate dentists driving these patients to us. 😀
The only fools among dentists are those who THINK they can serve both masters.
But, yeah… I’m also a big advocate for our Constitutional Rights, including Free Speech. So, my blog is my “bully pulpit.” 😀 Those who don’t like it, don’t have to click on it. But, given the numbers of visits I get each month… it’s resonating with a significant number of dentists. 😀
Reply
90% agree with you. But, when I hear stories of Fee For Service dentists covering up their mistakes with patch work, I cringe. Since the patient paid cash money, you do not want to give the impression you work is failing because you’re selling them on the lowest cost option instead of treatment planning appropriately.
I think you can do quality dentistry with PPO plans you just need to have your earning potential humble.
Reply
You’re so right. Most patients don’t care about their dental health until it’s too late. Sad, but true! that’s definitely the culture trend.
Reply
Interesting read
Reply
Hi, Mike–
Notice you focused on meticulous use of a variety of MATERIALS in the re-bonding sequence.
One thing not mentioned, though, is the setting for the bonding: i.e. PURE air, PURE water spray. Often, these are contaminated, particularly with oil. And, if you don’t pay attention to this, much bonding is doomed to premature failure.
And what of traumatic occlusion? Partly a potential factor, but if bonding’s decent, whole veneers won’t just pop loose, they’ll chip.
Meanwhile, what does the profession DO about the McDentist situation? Not seeing much.
Reply
Hi Bill! Long time, no see! Hope you are well.
While I’m aware of the contaminated air issue, I have not seen it in my office. I admit I don’t have one of those special pure air nozzle thingies. So far, so good. 🙂
I don’t recall the occlusal situation with this patient. And, she was a one-timer for me (her new dentist was out of town). But, yeah… occlusion is a factor, too, in many cases.
I don’t see any solutions for “McDentist” other than letting the free market sort it all out.
Reply
Wouldn’t be surprised if it came out the 6th time if not for your hard work. It’s sad to see patients suffering just because they made a bad choice earlier and now the hardworking guy has to put twice the efforts. But that’s what good dentists do. Kudos to you Mike!
Reply
Thanks, Dr. Dan! It’s still in there, as far as I know!
Reply