<p>D2 has started a new job in a new city and is seeing a new dentist. She didn’t have dental insurance in grad school, and didn’t see a dentist during that time. She had no sensitivity/pain, and is a religious flosser. But she wasn’t surprised to learn that she needed treatment for a few cavities. She found a dentist online whose reviews were good (a situation that is about to change). </p>
<p>She picked him because she could walk to his office from her job, and she didn’t want to have to take too much time off from work. Since August, she has had these complications: two temporary crowns that have fallen off repeatedly, pain under the temporary crowns where previously there was no pain, and, this morning, a permanent crown that has been in for several weeks that fell off when she was flossing. He did a root canal before putting on the crown that fell off today, which surprised me - my own dentist refers root canals to endodontists, which I thought was standard practice. I don’t understand how she could have needed a root canal on a tooth that had no sensitivity or pain. She also had to remind one of his assistants to put an apron on her before doing an xray - then had to remind her to take off the apron 15 minutes later. </p>
<p>She’s an adult, but I’m posting this because I know we have dentists who read the forum, and also because some others here may have input. She doesn’t want to be the new employee who is always taking time off for appointments, so she’s actually going to see this dentist once more to have the last permanent crown put on. Then she’s requesting her records and going elsewhere. I’m curious - could this simply be bad luck, does she have weird teeth (no dentist ever had trouble treating her previously), or is the guy probably a bad dentist?</p>
<p>Without an independent 2nd opinion, it’s hard to say if this dentist is incompetent in his diagnoses. Temporaries can fall off, but I wouldn’t expect a permanent crown to do so. If all she had were a few cavities, were they so large that she required crowns?</p>
<p>As far as doing root canals, general dentists can do them. DH is a dentist and he only refers out more complicated root canals.</p>
<p>I would have her ask co-workers for referrals to dentists instead of checking online reviews.</p>
<p>Good idea on asking for referrals, shellfell. I think she’s learned that she should have done that in the first place! And thank you for the clarification on referrals for root canals.</p>
<p>She’s discouraged to be out $2,300 so far and feel as if he’s made her teeth worse instead of better. But I don’t see how he can stay in business if everyone has such a difficult time in his office. </p>
<p>Without knowing your kid’s actual dental health, I’m wary of a lot of dental work because I know - from talking to dentists - that some engage in selling more services than necessary. We had this happen to us at a well respected practice and I talked to two dentists who left there because they couldn’t put up with the sales pressure. An example, the person who was my dentist moved and over the next few visits I found my fillings being replaced and then crowns being suggested as necessary. So I tracked down the old dentist - it had been a few years - and without saying a thing went for an exam. When it was over, I asked him about the issues I’d been told were necessary and he told me that was why he left, etc. I then found another dentist from another practice who told me the same thing about where he used to work. (FYI, I needed a crown nearly 2 decades later.) I’m not accusing “dentists” as a group but it’s been explained to me that financial pressures are high and there’s a temptation to take advantage. And we have a lot of dentists in this area.</p>
<p>In terms of quality of work, my wife had an issue with a crown. It was really the lab’s fault; crowns are made by labs - or specialized contractors who do this - and it wasn’t exactly right. So that it could have come off at any time. My brother, who is an MD, has a crown that has never fit right. It’s more art than science. </p>
<p>That said, I’d suggest your kid have another dentist look at her teeth. Blind, like I did, just to see what another dentist says is right or wrong. First exams are usually very inexpensive and if she likes this other person, then …</p>
<p>Just another person here who has had my long-time dentist do root canals. The first couple I had done over 15 years ago, he referred out; but the last couple, he has done. I’m just so glad it has turned into a one-appointment visit, as opposed to two or three.</p>
<p>And he is NOT the kind of dentist who tries to oversell stuff. After reading so many stories here on CC about those kinds, I’m so glad we have him. Now if I could only convince him not to retire in the next five years.</p>
<p>Thanks for responding, @Lergnom - I’ve had many of the same concerns about seeing new dentists. I’m not accusing the entire profession, either, but I recall those same CC threads and have heard the same reports from friends IRL. I like and respect my own dentist very much, but even he pushes whitening more than I think is appropriate. He actually does Cerec crowns, which require only one visit, and I wish that had been an option for my d. Good advice about the second opinion.</p>
<p>and thanks @teriwtt for confirming shellfell’s comment about general dentists doing root canals. It isn’t common practice here, but I’m glad to know it’s acceptable. @ucbalumnus, I haven’t had a chance to discuss those questions with my d, but I will when she checks back in. She’s at the dentist today, since he has Saturday hours. I hope to hear good news later.</p>
<p>I had a lot dental work done right after graduating from college too for ‘deferred maintenance’. The first dentist I visited gave me an evaluation that mentioned maybe 10 cavities and a root canal with a crown. Because of an insurance snafu, I had to go to another dentist who said I had about 20 cavities and needed a root canal. I asked about different evaluations and they gave me some mumbo-jumbo about some cavities just needed to be polished out or something like that. I don’t think it really matters what dentist tells you up front because once they get in your mouth they start finding other stuff to pad your bill. Sorry, but I don’t totally trust dentists because I think too many of them are money grubs who are in a cottage industry operating pretty much unsupervised by regulators and other dentists who will rat them out. The dentists who usually get caught and charged with crimes seem to be the ones who get caught ripping off Medicaid and other government programs doing stuff like yanking healthy teeth to sell dentures.</p>
<p>Get a second dentist involved for a mouth exam!</p>
<p>“In terms of quality of work, my wife had an issue with a crown. It was really the lab’s fault; crowns are made by labs - or specialized contractors who do this - and it wasn’t exactly right”</p>
<p>This is only partially correct. Some practices own digital milling equipment and make crowns on site without the need for temps. </p>
<p>“Is d dealing with incompetent dentist?”
Even a DDS who has actually examined D with xrays would be reluctant to flat out say some other DDS is incompetent as we live in a rather litigious society and DDSs would rather be in their office as opposed to being deposed and/or on witness stand fending off some defamation lawsuit. Hopefully friends, coworkers can help and then it comes down to trust.</p>
<p>Random thoughts</p>
<p>Dental pain (as opposed to sensitivity) is often a late symptom, not an early warning sign. A person can need a root canal on a tooth that is painless</p>
<p>There’s a reason that temporary crowns (temp) are called temporary. DDS uses lets call it “glue” that is weak and allows DDS to easily pop off and continue. When a crown is needed typically all of a tooth’s external protective coating is removed. The temp is placed as a protection until final crown is placed…Sometimes temps pop off from eating, brushing, flossing, etc. Some people can have no discomfort to increased sensitivity if temp comes off, it varies. </p>
<p>General DDSs do do root canals, some refer. It’s like wisdom teeth, some general DDSs do take out wisdom teeth, some refer. It’s a matter of what DDS likes to do and can do well.</p>
<p>As to term "permanent” crown. how long a crown lasts can tilt from the care the crown gets after placement (patient related (brushing, flossing, etc)) to the quality of care in placement of crown (DDS related). A newly placed “permanent” crown coming off several weeks during flossing may be just one of those things and other than inconvenient to D, no big thing. If it continues to come off, it could tilt to a quality of care issue. </p>
<p>
</p>
<p>labs do typically make crowns for DDS but they are only making crowns based on instructions and materials they received from DDS. Although labs do make mistakes, the materials/instructions that dentists send to labs could be flawed which could result in a crown that should not be placed into patient’s mouth. I suppose it’s easier for DDS to point blame at lab as opposed to pointing finger at him/herself.</p>
<p>
That milling equipment is very,very expensive and fee will reflect patient’s cost</p>
<p>I had 3 or 4 new crowns done when I lived abroad because it was covered 100%. They were all painless. It is 2 years later and they are still perfect. Two years ago D1 started going to a very expensive dentist referred by people at work. The dentist told her she had a lot of cavities and needed one root canal. She was surprised because she was going for her dental care every 6 months. The root canal was done so poorly she was having a lot of pain. She ended up going to our dentist (very efficient dental group. They fixed her root canal and told her she didn’t have any cavities to be taken care of. It has been a year now and D1’s teeth are perfectly fine.</p>
<p>I’ve had some excellent dentists, and still managed to dislodge many termporary crowns. </p>
<p>I’ve had one root canal done by a general dentist (simple) – but the others (molars) were referred out to an endodontist with the personality of a slug (but that is a different story). </p>
<p>It won’t help her now, but my strategy before I moved here was to have an appointment for a checkup shortly before I moved with my very good dentist, and then an appointment with a new dentist shortly after moving. When the new dentist recommended thousands of dollars of work that needed to be done soon, I called my prior dentist and he advised me to find another dentist. I did, and have been very happy with that practice for more than 25 years.</p>
<p>I have a phenomenal dentist, and she refers out root canals if necessary - but she does simple ones. She had to do one on me a couple years ago, and no, I did not have any pain. She explained the reason, which I have since forgotten - but I trust her completely, so I am sure it was necessary. </p>
<p>I know it’s hard to find a dentist (or doctor, for that matter) in a strange city. My D is in Chicago, and she had to do a lot of checking around to find doctors and a dentist. She has changed PC, derm, and gyn - happy now, but it is sometimes a try-it-and-see thing. It is rough when there is a lot of money involved, especially when you are not sure if it was well spent. </p>
<p>Considering that new dentists have a lot of dental school debt, plus whatever startup costs there are for setting up a new practice (space, equipment, etc.) or buying out an existing practice from a retiring dentist, it does not seem surprising that some will oversell. Perhaps an older dentist (who has long since paid off the dental school debt) in an older office (with all of the equipment paid for and not-too-high rental costs) may have a lower chance of being financially pressured to oversell services.</p>
<p>Thanks to all of you for taking the time to respond - I truly appreciate it. Interesting to know that general dentists often do root canals, since that hasn’t been my family’s experience. But good to know that a general dentist is qualified to do it. There haven’t been complications from the root canal (fingers crossed).</p>
<p>My d had an emergency appointment with another dentist in the practice this morning. He reattached the permanent crown, decided that the tooth with the temporary crown needed a root canal, and referred her to an endodontist for it; he also gave her a prescription pain reliever, because she hasn’t been able to sleep well due to pain. </p>
<p>Perhaps all this was bad luck, but since three of the four cavities the original dentist treated resulted in the need for followup treatment, and since my d is now in considerable discomfort (and was in NO discomfort before first seeing this guy), she’s moving on to another practice. She shouldn’t have let a convenient location and good online reviews dictate such an important choice, and I’m sure she won’t do that again.</p>
<p>DD is very careful with regards to dental care. She was particularly careful while in the Peace Corps. She had a cleaning once a year but that was it. When she was completong her service, she had an extensive dental exam there. She was told she had a number of cavities and could,either get them fixed before returning home, or,they would give her a voucher for her own dentist to do the work here.</p>
<p>The dentist was well educated, in Europe, I think.</p>
<p>She chose the voucher, thank goodness. Turns out, she had NO cavities…at all. Not even a small one. </p>
<p>She kept dental coverage with her health insurance just in case there was an issue. There hasn’t been. She will self insure for her regular checkups…dental coverage isn’t what it used to be…and the costs equal the two check ups a year…or more.</p>
<p>I have terrible teeth, but I didn’t have any root canals until I was in my late 40s. My dentist does them himself, but he doesn’t pull teeth. I’ve never had a crown fall off.</p>
<p>Dentists are a tough category. We have gone to a conservative family dentist as far as treatment I think, recently my oldest D went to a dentist in her new city who wanted to fill 14 cavities! After some negotiation, she had 4 filled. She had regular twice a year checkups before that here at home. I have had some suspicions about our dentist, as my H (who has terrible teeth) has had numerous crowns, a few have come out, some have needed to be replaced sooner than should be necessary. I had my first crown by him last year and was not happy with the result, so I switched dentists. My new dentist wanted to fill a couple of things, and when I switched my other 2 kids to her, she wanted to do a few fillings on them too. Still haven’t convinced H to switch, even though he had to have another crown replaced this fall. It is hard to know which approach is best.</p>
<p>My dentist has her own milling equipment. The crowns she has done (I have very bad teeth) for me have been awesome. They let me watch the machine in action one day which was fascinating. In my case, the crowns were considerably cheaper than at my previous dentist (who was definitely a bit of a pushy “upseller” trying to make me buy unnecessary procedures I didn’t need).</p>
<p>All my root canals have been done by the dentist.</p>
<p>Falling off crowns and pain from a crown does sound like a not very good dentist.</p>
</p>