advice regarding bad experience with dentist

[uniwelder]

My wife went to the dentist two weeks ago for a regular checkup and cleaning.  At the end, the dentist (I'll call him #1, he opened the business ~12 years ago, we've been customers since that time, and he's the guy we almost always see) notes that one of her fillings should be replaced, sooner rather than later, but not an emergency.  He recommends scheduling at her conveniences so my wife asks for the next available opening. 

This past Wednesday Thursday, she arrives and there is a dentist she has never met before (call him #2, we found out today he's been working there less than a year) that says he'll be doing the procedure.  She goes along with it, but notices he is having trouble drilling and comments he went deeper than originally planned, right by the nerve.  He does the filling, but afterward and for the next few days, my wife says it aches and doesn't subside. 

She called the office this morning to ask if dentist #1 can take a look at it.  She is told by the receptionist (puts her on hold to discuss with dentist #1) that my wife needs to be evaluated by dentist #2 that did the work.  My wife doesn't like dentist #2 and tells the receptionist she does not want to deal with him, but the receptionist insists dentist #1 will not meet with her.  She went ahead and set up an appointment for this Wednesday to have it looked at by dentist #2.  Supposedly, there will be no additional drilling, and it will only consist of x-rays and inspection. 

We're pretty frustrated, particularly because she was told the filling wasn't in bad shape.  She certainly would have waited if she knew they would schedule her with someone else new to the field.  She is only going back to the same guy because she's in pain and we doubt we'll find another dental office that can take her in the next couple of days.

My question is---
1) Is this normal?  Dentist #1 doesn't want to evaluate work done by dentist #2. 
2) Is the aching likely due to some mishap of dentist #2 or something else?
3) Is there usually any charge for these types of follow up visits?
4) If there are follow up corrections to be made, what does that entail?

[Metalcat]

My wife went to the dentist two weeks ago for a regular checkup and cleaning.  At the end, the dentist (I'll call him #1, he opened the business ~12 years ago, we've been customers since that time, and he's the guy we almost always see) notes that one of her fillings should be replaced, sooner rather than later, but not an emergency.  He recommends scheduling at her conveniences so my wife asks for the next available opening. 

This past Wednesday Thursday, she arrives and there is a dentist she has never met before (call him #2, we found out today he's been working there less than a year) that says he'll be doing the procedure.  She goes along with it, but notices he is having trouble drilling and comments he went deeper than originally planned, right by the nerve.  He does the filling, but afterward and for the next few days, my wife says it aches and doesn't subside. 

She called the office this morning to ask if dentist #1 can take a look at it.  She is told by the receptionist (puts her on hold to discuss with dentist #1) that my wife needs to be evaluated by dentist #2 that did the work.  My wife doesn't like dentist #2 and tells the receptionist she does not want to deal with him, but the receptionist insists dentist #1 will not meet with her.  She went ahead and set up an appointment for this Wednesday to have it looked at by dentist #2.  Supposedly, there will be no additional drilling, and it will only consist of x-rays and inspection. 

We're pretty frustrated, particularly because she was told the filling wasn't in bad shape.  She certainly would have waited if she knew they would schedule her with someone else new to the field.  She is only going back to the same guy because she's in pain and we doubt we'll find another dental office that can take her in the next couple of days.

My question is---
1) Is this normal?  Dentist #1 doesn't want to evaluate work done by dentist #2. 

this is NOT normal, especially if dentist #1 is the owner
2) Is the aching likely due to some mishap of dentist #2 or something else?
No, it's very common after replacing fillings, X-rays don't show well what's happening under fillings and there can be surprises
3) Is there usually any charge for these types of follow up visits?
there shouldn't be
4) If there are follow up corrections to be made, what does that entail?
If the cavity or crack or whatever was deep enough, the nerve might be in trouble and it could need a root canal, again, this is not uncommon and not doing the filling in the first place would not have prevented it, it just sped up the problem to drill into a tooth that's already in trouble

Source of my replies: I've been a business consultant for doctors and dentists for years and have taught many, many dentists how to manage exactly this kind of situation, which they are generally absolutely BALLSACKS at managing in a productive way because dentists are famously bad at managing conflict.

FTR she should NEVER have been surprised by the work being done by a different dentist. This is not okay and not normal. Patients have the right to choose their providers and should know who will be doing the work before they agree to the appointment.

That said, research has shown that new grad dentists are actually generally technically better than more experienced dentists. Technical skills actually tends to drop off after around 3-5 years, but clinical judgement improves over time.

So technically, having a diagnosis and plan from an experienced dentist and then technical work done by a less experienced one wouldn't necessarily be a bad deal.

[uniwelder]

My question is---
1) Is this normal?  Dentist #1 doesn't want to evaluate work done by dentist #2. 
this is NOT normal, especially if dentist #1 is the owner
2) Is the aching likely due to some mishap of dentist #2 or something else?
No, it's very common after replacing fillings, X-rays don't show well what's happening under fillings and there can be surprises
3) Is there usually any charge for these types of follow up visits?
there shouldn't be
4) If there are follow up corrections to be made, what does that entail?
If the cavity or crack or whatever was deep enough, the nerve might be in trouble and it could need a root canal, again, this is not uncommon and not doing the filling in the first place would bot have prevented it, it just sped up the problem

Source of my replies: I've been a business consultant for doctors and dentists for years and have taught many, many dentists how to manage exactly this kind of situation, which they are generally absolutely BALLSACKS at managing in a productive way because dentists are famously bad at managing conflict.

FTR she should NEVER have been surprised by the work being done by a different dentist. This is not okay and not normal. Patients have the right to choose their providers and should know who will be doing the work before they agree to the appointment.

That said, research has shown that new grad dentists are actually generally technically better than more experienced dentists. Technical skills actually tends to drop off after around 3-5 years, but clinical judgement improves over time.

So technically, having a diagnosis and plan from an experienced dentist and then technical work done by a less experienced one wouldn't be a bad deal.

Thank you for the thorough reply.  I wonder though, since you're in Canada, does this still apply to the US?  I'm thinking mostly about the part of passing off work to another dentist without being informed ahead of time.

What would do you if you were my wife?

[Metalcat]

My question is---
1) Is this normal?  Dentist #1 doesn't want to evaluate work done by dentist #2. 
this is NOT normal, especially if dentist #1 is the owner
2) Is the aching likely due to some mishap of dentist #2 or something else?
No, it's very common after replacing fillings, X-rays don't show well what's happening under fillings and there can be surprises
3) Is there usually any charge for these types of follow up visits?
there shouldn't be
4) If there are follow up corrections to be made, what does that entail?
If the cavity or crack or whatever was deep enough, the nerve might be in trouble and it could need a root canal, again, this is not uncommon and not doing the filling in the first place would bot have prevented it, it just sped up the problem

Source of my replies: I've been a business consultant for doctors and dentists for years and have taught many, many dentists how to manage exactly this kind of situation, which they are generally absolutely BALLSACKS at managing in a productive way because dentists are famously bad at managing conflict.

FTR she should NEVER have been surprised by the work being done by a different dentist. This is not okay and not normal. Patients have the right to choose their providers and should know who will be doing the work before they agree to the appointment.

That said, research has shown that new grad dentists are actually generally technically better than more experienced dentists. Technical skills actually tends to drop off after around 3-5 years, but clinical judgement improves over time.

So technically, having a diagnosis and plan from an experienced dentist and then technical work done by a less experienced one wouldn't be a bad deal.

Thank you for the thorough reply.  I wonder though, since you're in Canada, does this still apply to the US?  I'm thinking mostly about the part of passing off work to another dentist without being informed ahead of time.

What would do you if you were my wife?

Dentists are private industry just like US dentists and the ethics are similar. There could be a liability insurance issue, but I doubt it, dentists handle each other's cases all the time.

If I were your wife I would not agree to see a dentist who didn't make me feel comfortable. I would insist that the owner see me under threat of transferring the family to another dentist. A patient or a family leaving a practice is a major loss to the owner because they make money for years off of people in hygiene, they don't make much off of their associate dentists.

I also wouldn't take what a receptionist says too seriously, they aren't medical experts and sometimes get their wires crossed. Your wife can demand an appointment with the owner, a phone call, or an email to discuss the case. Dental receptionists are trained primarily as gatekeepers, so sometimes it takes a bit of pushing to get past them. But don't assume that what they say is actually the direct will of the owner, she may be taking her gatekeeping further than she should without realizing she's violating ethics.

Also, putting things in writing and asking that they be added to the chart is helpful because it radically increases the dentist and the owner's liability.

I would also suggest your wife have the receptionist add to the chart that she never gets booked with any dentist other than the owner, and that she confirm this every time she books or gets a reminder call. This may limit her appointment time options, but it's not unreasonable at all.

Dentists are a dime a dozen, there's no reason for patients not to be able to demand reasonable, ethical accommodations from them.

But really, I think this is quite possibly more a case of a receptionist being overzealous than an actual policy of the owner refusing to see her.

Dentist #1 may have said something like "Dentist #2 should really see her because it's his work" and then that may have gotten amplified. If on insistence Dentist #1 truly refuses to provide care for your wife and forces her to only see a dentist she isn't comfortable with, I personally wouldn't want to be a patient at that clinic.

[FLBiker]

I don't think seeing different dentists in the same office is so unusual.  It's happened to me a number of times in both the US and in Canada (for post cleaning exams).  And I'm not totally surprised by the pushback from dentist 1 re: checking the work of dentist 2.  I could see how, politically, they wouldn't want to get into situations where they would be forced to be critical or correct each other's work.  I'm not saying that's right, but it wouldn't surprise me if it were common.

We had a similar experience in Tampa, and the other dentist didn't want to get involved.  That said, the dentist who screwed up wasn't sprung on us in that situation -- they were someone who had worked on my wife's teeth before.  The issue we had was with a bad wisdom tooth extraction.  It all ended up healing OK, but it required a couple of follow up visits and undue pain.  I'm 99% sure that my wife was not charged for the follow up, but it was several years ago so I'm not sure.

[Metalcat]

I don't think seeing different dentists in the same office is so unusual.  It's happened to me a number of times in both the US and in Canada (for post cleaning exams).  And I'm not totally surprised by the pushback from dentist 1 re: checking the work of dentist 2.  I could see how, politically, they wouldn't want to get into situations where they would be forced to be critical or correct each other's work.  I'm not saying that's right, but it wouldn't surprise me if it were common.

We had a similar experience in Tampa, and the other dentist didn't want to get involved.  That said, the dentist who screwed up wasn't sprung on us in that situation -- they were someone who had worked on my wife's teeth before.  The issue we had was with a bad wisdom tooth extraction.  It all ended up healing OK, but it required a couple of follow up visits and undue pain.  I'm 99% sure that my wife was not charged for the follow up, but it was several years ago so I'm not sure.

It's not unusual to see other dentists, especially for check ups, but it is unusual to think you are booking with one and then end up seeing someone you have never met do the work.

People generally expect to have a say over who touches them.

[uniwelder]

Update--- My wife got a call this morning that dentist #1 has asked to see her today.  She was told they'll still keep her on for the appointment tomorrow with dentist #2.  This is step in the right direction and perhaps tomorrow's appointment will get changed.

I would also suggest your wife have the receptionist add to the chart that she never gets booked with any dentist other than the owner, and that she confirm this every time she books or gets a reminder call. This may limit her appointment time options, but it's not unreasonable at all.

Dentists are a dime a dozen, there's no reason for patients not to be able to demand reasonable, ethical accommodations from them.

But really, I think this is quite possibly more a case of a receptionist being overzealous than an actual policy of the owner refusing to see her.

Dentist #1 may have said something like "Dentist #2 should really see her because it's his work" and then that may have gotten amplified. If on insistence Dentist #1 truly refuses to provide care for your wife and forces her to only see a dentist she isn't comfortable with, I personally wouldn't want to be a patient at that clinic.

I assumed dentists were in short supply like all other medical professionals, but I certainly could be wrong.  We do live in a rural area, which may skew things.  Its incredibly difficult (either they don't take new clients or wait time is 3+ months) to book appointments with a new doctor, let alone one we're already familiar with.  We'll see how things go today before we start asking around for a new dental office.

Also noted about insisting and confirming only the preferred dentist/doctor do the work.

[Metalcat]

Update--- My wife got a call this morning that dentist #1 has asked to see her today.  She was told they'll still keep her on for the appointment tomorrow with dentist #2.  This is step in the right direction and perhaps tomorrow's appointment will get changed.

I would also suggest your wife have the receptionist add to the chart that she never gets booked with any dentist other than the owner, and that she confirm this every time she books or gets a reminder call. This may limit her appointment time options, but it's not unreasonable at all.

Dentists are a dime a dozen, there's no reason for patients not to be able to demand reasonable, ethical accommodations from them.

But really, I think this is quite possibly more a case of a receptionist being overzealous than an actual policy of the owner refusing to see her.

Dentist #1 may have said something like "Dentist #2 should really see her because it's his work" and then that may have gotten amplified. If on insistence Dentist #1 truly refuses to provide care for your wife and forces her to only see a dentist she isn't comfortable with, I personally wouldn't want to be a patient at that clinic.

I assumed dentists were in short supply like all other medical professionals, but I certainly could be wrong.  We do live in a rural area, which may skew things.  Its incredibly difficult (either they don't take new clients or wait time is 3+ months) to book appointments with a new doctor, let alone one we're already familiar with.  We'll see how things go today before we start asking around for a new dental office.

Also noted about insisting and confirming only the preferred dentist/doctor do the work.

IDK about where you live but we have an absolutely massive oversupply of dentists in virtually every urban area of Canada.

Even in rural Canada, it would take me up to a decade to get a family doctor where I am right now, but I could see a dentist tomorrow.

[merula]

I'm not sure how rare it is to book an appointment with one dentist and end up seeing a different one. That's happened to me a couple of times, although only one was an awful experience that made me leave the practice. (New dentist told me I should make my child sleep with their mouths closed.... somehow? They did need their tonsils out later, but that was not mentioned by this dentist, who only said that mouth-breathers always need braces as though it was causative.)

My mom was a dental hygienist, and with the stories she brought home from work I can absolutely confirm that dentists aren't good at conflict management. Another part of that is that the office managers tend to be power-mad and overbearing, and dentists love them for it because it saves them the work of managing conflict in their own businesses. It's entirely possible that the office manager answered the phone (it's sometimes a hybrid role or the manager covers for breaks), or that the office manager told the receptionist to be a jerk about it.

[GilesMM]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

[uniwelder]

My wife came back from her appointment with dentist #1. 

He apologized for not explaining the procedure and the risk of complication, said he couldn't defend or scrutinize the actions of dentist #2, took x-rays and inspected, cancelled the appointment tomorrow with dentist #2, and set up a referral appointment with an endodontist for tomorrow afternoon. 

I guess this is his way of passing on the problem to someone else?  Any thoughts?  This sounds like it's likely to be the most expensive tooth filling we've paid for.  My last one was 20 years ago and my wife has never had one done in the US for the last 12 years she's been here.  Definitely a further push for getting more of our medical care done in Mexico, particularly since it sounds like this could have waited until our next trip down there anyway.

edited to add--- The endodontist office called.  Consultation will be about $300 and the root canal will be about $1,400.  If she weren't in pain right now, we could definitely have just gone to Mexico for this.

[Metalcat]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

That would be nice if it were true. Dental work actually varies pretty dramatically. I worked in that world for years and there are many dentists I wouldn't go to.

[Metalcat]

My wife came back from her appointment with dentist #1. 

He apologized for not explaining the procedure and the risk of complication, said he couldn't defend or scrutinize the actions of dentist #2, took x-rays and inspected, cancelled the appointment tomorrow with dentist #2, and set up a referral appointment with an endodontist for tomorrow afternoon. 

I guess this is his way of passing on the problem to someone else?  Any thoughts?  This sounds like it's likely to be the most expensive tooth filling we've paid for.  My last one was 20 years ago and my wife has never had one done in the US for the last 12 years she's been here.  Definitely a further push for getting more of our medical care done in Mexico, particularly since it sounds like this could have waited until our next trip down there anyway.

Again, it sounds like the situation under the filling was worse than expected based on just the X-ray. It's not at all uncommon, it's also not uncommon for dentists to be shit at explaining risks of treatment.

This is literally what I trained dentists and staff on: how to explain basic shit to patients and handle the fallout when shit happens. They very seriously lack these skills.

Anyhoo, yes, it's likely to be expensive, but as I said before, not doing a filling on a tooth like that doesn't prevent this from happening, it just makes it more unpredictable when/how it will cause problems.

It doesn't sound to me like anyone did anything wrong except communicate poorly, which is exactly why dentists get sued, and exactly why they used to pay me to teach them how to prevent this.

[jrhampt]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

That would be nice if it were true. Dental work actually varies pretty dramatically. I worked in that world for years and there are many dentists I wouldn't go to.

Yeah, I second this.  I had a dentist a few years ago that couldn't fit a crown right after multiple tries, so I finally had to give up and go elsewhere to someone who got it right the first time.

[Metalcat]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

That would be nice if it were true. Dental work actually varies pretty dramatically. I worked in that world for years and there are many dentists I wouldn't go to.

Yeah, I second this.  I had a dentist a few years ago that couldn't fit a crown right after multiple tries, so I finally had to give up and go elsewhere to someone who got it right the first time.

And that's a case where the patient can actually tell something is wrong.

My two front teeth are porcelain because I was hit in the face in a basketball game as a kid. My original crowns looked great and lasted 20+ years but they were actually done fucking horribly and never fit properly. I don't get cavities so it wasn't a problem, had I been prone to cavities, I would have lost both teeth within a few years.

I had them replaced recently by the top dentist in the region, utter psycho perfectionist and they're literally flawless, but they've hurt like hell since and I now need braces to fix the position of one of the teeth because it shifted for absolutely no understandable reason.

That's the thing with dentistry, the patients can't actually tell when the work is good or bad a lot of the time, and certainly have no idea why.

But dentists aren't comfortable explaining any of this to patients...or really explaining much for that matter. They're absolute shit at it, which leaves patients in pain and confused and convinced that someone did something wrong.

[Kris]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

That would be nice if it were true. Dental work actually varies pretty dramatically. I worked in that world for years and there are many dentists I wouldn't go to.

Yeah, I second this.  I had a dentist a few years ago that couldn't fit a crown right after multiple tries, so I finally had to give up and go elsewhere to someone who got it right the first time.

Thirded. I might have thought dentists were interchangeable back in the days when I only ever had routine fillings and cleanings. Definitely not anymore. I have a very good one now, and you will pry him out of my cold, dead hands.

[economista]

Just chiming in to say that I've experienced this exact same thing in the US. I have a dentist who've I've been going to since 2011. I had an old filling that needed to be replaced a year ago and I asked the hygienist for the next available appointment, assuming it would be with him. She scheduled me for the next available at the office, which was with another dentist he had recently brought on board. That dentist did the filling replacement and he did notify me while he did the filling that the cavity was deeper than he had imagined under the old filling, and the cavity was actually white, so hard to see. He got super close to the nerve and put in a liner material to try and help prevent the need for a root canal. A few days later the aching had not gone away and then my daughter popped me in the chin with her head and made my teeth slam together. It caused a hairline crack in the tooth going into the root and it hurt like nothing else.

The next day I was in so much pain I was almost delirious so I called the dentist's emergency number and got a same day emergency appointment. It turned out that dentist was the same one who did my filling a few days earlier! I had to have a root canal and crown and it was like $1500. He said I probably should have had a crown from the beginning but he was trying to save me from that by just using the liner and doing the filling instead. It just didn't work out.

[Metalcat]

Just chiming in to say that I've experienced this exact same thing in the US. I have a dentist who've I've been going to since 2011. I had an old filling that needed to be replaced a year ago and I asked the hygienist for the next available appointment, assuming it would be with him. She scheduled me for the next available at the office, which was with another dentist he had recently brought on board. That dentist did the filling replacement and he did notify me while he did the filling that the cavity was deeper than he had imagined under the old filling, and the cavity was actually white, so hard to see. He got super close to the nerve and put in a liner material to try and help prevent the need for a root canal. A few days later the aching had not gone away and then my daughter popped me in the chin with her head and made my teeth slam together. It caused a hairline crack in the tooth going into the root and it hurt like nothing else.

The next day I was in so much pain I was almost delirious so I called the dentist's emergency number and got a same day emergency appointment. It turned out that dentist was the same one who did my filling a few days earlier! I had to have a root canal and crown and it was like $1500. He said I probably should have had a crown from the beginning but he was trying to save me from that by just using the liner and doing the filling instead. It just didn't work out.

Yeah, this is a case where I could totally understand being booked with a different dentist. If you ask for the soonest possible appointment, they're likely going to book you with whoever has time, but they're supposed to tell you who they're booking you with.

The only time they don't generally give a heads up when you're going to see a different dentist is for checkups. You book with a specific hygienist, but you pretty much get whoever is available for a checkup unless you specify that you want to only have checkups with a specific dentist.

But no one should ever, ever be surprised by who they are booked with to actually get work done. That's part of the informed consent process, knowing who will be working on you.

[uniwelder]

Another update--- My wife just returned from the endodontist.

They did a repeat of the same x-rays sent from the dentist yesterday and the endodontist inspected and talked to my wife for about 5-10 minutes.  He said there is an infection at the tooth and a root canal will be necessary, plus recommended dentist #1 put a crown on the tooth in the next few weeks afterward.  My wife asked how the infection would have occurred since she had no problems until after the filling was done, and he simply answered that it happens sometimes, and when pressed, would not elaborate.  He recommended taking some pain killers until the procedure next week and left the room.  The assistant then came in to wrap things up and noted that no antibiotic was prescribed for the infection, so she said she'll get back in touch with my wife about that.

During conversation, my wife found out the endodontist's wife actually works at dentist #1's office.  Overall, she is pretty pissed off at this entire experience for a few reasons---
1) Endodontist won't elaborate about possible cause of infection.
2) Endodontist forgot about prescribing an antibiotic if an infection is really the problem.  When dentist #1 did the inspection yesterday, he told my wife he was confident there was no infection at the tooth.
3) Conflict of interest regarding dentist/endodontist relationship.
4) Brief in and out visit and being annoyed by patient asking questions.

Assuming there really is an infection, is the dentist not responsible for paying for this procedure?  I have no experience in this area at all.  My wife is currently looking up flights for Mexico to just get it taken of there.  Medical care in the US has constantly been a huge frustration for her.  I'm simply used to it because I don't know any better.

[zygote]

I think Malcat mentioned it briefly upthread, but unfortunately this does just happen sometimes. It's not necessarily caused by the filling procedure, or a mark of the dentist's skill.

My dentist has always told me whenever he does a filling (or redoes an old one) that you never know 100% what's going on from X-rays, and unexpected things can be uncovered once you drill into the tooth. The cavity can be deeper than it seemed from the images (which could be what Dentist #2 was originally trying to say), there can be a hairline crack at the edge of an old filling letting stuff in, and/or there can be an infection already brewing.

My guess is that the infection was developing behind the original filling the whole time, and redoing the filling just brought the info to light faster. She probably would have needed this root canal in the near future regardless. If you're in pain, something is definitely wrong, but not being in pain before doesn't mean something wasn't wrong, if that makes sense. You can have an infection and feel fine until suddenly you don't. The dentist and endodontist just apparently suck at communicating this possibility with their patients.

I doubt the dentist will cover any of this, you'll likely have to pay up. It's not really the fault of the work itself, just the way things can go with cavities and fillings. (According to my dentist at least, obviously I am not one.)

That said, if your wife feels uncomfortable with the bedside manner of the endodontist or the possibility of a conflict of interest, she is 100% entitled to get a second opinion from another independent endodontist she finds herself.

Anyway, thanks to this thread for motivating me to call my dentist about my own filling I got a month ago that is mildly sensitive when I floss. That always happens at first while the nerve is irritated, but it's been long enough it should have gone away by now. Hopefully I just need to get the filling reshaped and I don't need a root canal myself!

[uniwelder]

I don't think I read anywhere in the thread mentioning infection as a complication, only that damage might be deeper than can be seen in the x-ray.  Is that the same thing?  Honest question, as my medical knowledge is very poor. 

Yes, it has been mentioned that a root canal was probably going to need happen at some point, but this went from a casual preventative measure to emergency, and from our perspective, it seems to have been initiated by our dentist.  If we knew how this could have turned out, my wife would have just gotten it done in Mexico on our next trip.

She could go to another endodontist and pay an additional $300 consultation for probably the same end result.  I don't think anyone (dentist #1, endodontist, wife) is disputing whether or not a root canal is necessary.  What really gets me is that dentist #1 says there is no infection and the endodontist says there is, but hasn't actually prescribed an antibiotic at this point.  Shouldn't an antibiotic treatment be initiated before the root canal procedure if there is an infection?

[Metalcat]

Another update--- My wife just returned from the endodontist.

They did a repeat of the same x-rays sent from the dentist yesterday and the endodontist inspected and talked to my wife for about 5-10 minutes.  He said there is an infection at the tooth and a root canal will be necessary, plus recommended dentist #1 put a crown on the tooth in the next few weeks afterward.  My wife asked how the infection would have occurred since she had no problems until after the filling was done, and he simply answered that it happens sometimes, and when pressed, would not elaborate.  He recommended taking some pain killers until the procedure next week and left the room.  The assistant then came in to wrap things up and noted that no antibiotic was prescribed for the infection, so she said she'll get back in touch with my wife about that.

During conversation, my wife found out the endodontist's wife actually works at dentist #1's office.  Overall, she is pretty pissed off at this entire experience for a few reasons---
1) Endodontist won't elaborate about possible cause of infection.
2) Endodontist forgot about prescribing an antibiotic if an infection is really the problem.  When dentist #1 did the inspection yesterday, he told my wife he was confident there was no infection at the tooth.
3) Conflict of interest regarding dentist/endodontist relationship.
4) Brief in and out visit and being annoyed by patient asking questions.

Assuming there really is an infection, is the dentist not responsible for paying for this procedure?  I have no experience in this area at all.  My wife is currently looking up flights for Mexico to just get it taken of there.  Medical care in the US has constantly been a huge frustration for her.  I'm simply used to it because I don't know any better.

Ugh...dentists are so shit at explaining things.

Okay, so the reason they recommend replacing a filling is because bacteria have infiltrated between the filling at the tooth. It's impossible to say from the X-ray how far down it's gotten.

If the bacteria are already close to the nerve, then the tooth was doomed to need a root canal anyway. Doing the filling didn't cause the infection, it just sped up the process of the nerve getting pissed off. Remember, fillings are surgery if a tooth nerve is already infiltrated with bacteria, drilling into it is only going to piss it off more and cause pain.

Sometimes if you remove the bulk of the bacteria and put an antibacterial lining, the nerve can recover, sometimes it can't. In this case it didn't.

Every dentist involved has handled this properly and no one has done anything wrong except be fucking terrible at explaining truly basic concepts that they should all really be prepared to explain.

But again, I used to charge a lot of money to teach these people how to explain things in understandable terms.

Anyhoo, is your wife Mexican? If so then yeah, she can probably easily navigate the local Mexican dental system.

If she isn't, then I cannot state strongly enough how much I would never, ever, ever engage in the Mexican dental tourism industry.

Most Mexican dental tourism clinics are not owned by Mexican dentists, the bulk of Los Algondones clinics are owned by Irish tourism companies. And the dentists who work there aren't necessarily okay with the practices of those companies.

So yes, local dentistry in Mexico tends to be quite good, but there is an issue that a lot of Mexican dentists will charge Americans a hell of a lot more than they charge Mexicans. That's why I ask if she's Mexican, because if she is, then yeah, makes sense.

[Metalcat]

I don't think I read anywhere in the thread mentioning infection as a complication, only that damage might be deeper than can be seen in the x-ray.  Is that the same thing?  Honest question, as my medical knowledge is very poor. 

Yes, it has been mentioned that a root canal was probably going to need happen at some point, but this went from a casual preventative measure to emergency, and from our perspective, it seems to have been initiated by our dentist.  If we knew how this could have turned out, my wife would have just gotten it done in Mexico on our next trip.

She could go to another endodontist and pay an additional $300 consultation for probably the same end result.  I don't think anyone (dentist #1, endodontist, wife) is disputing whether or not a root canal is necessary.  What really gets me is that dentist #1 says there is no infection and the endodontist says there is, but hasn't actually prescribed an antibiotic at this point.  Shouldn't an antibiotic treatment be initiated before the root canal procedure if there is an infection?

Cavities ARE infections.

So if a filling needs to be replaced, it's because there's already infection in the tooth.

There are two reasons to replace an existing filling: new decay or fracture or both. Fractures also allow bacteria into the tooth, so whether it starts as a cavity or a fracture, infection gets into the tooth.

It's just a question of whether it it is within the hard tooth structure, which can be cut out and replaced with filling, or whether it gets all the way into the nerve, which can die and abscess.

All fillings will breakdown and allow infiltration eventually and X-rays don't show this very well because fillings are opaque on X-ray. So it's a judgement call when to replace fillings and sometimes the infection underneath is worse than expected, especially if there are unseen fractures, which also don't show up on x-rays.

[uniwelder]

Another update--- My wife just returned from the endodontist.

They did a repeat of the same x-rays sent from the dentist yesterday and the endodontist inspected and talked to my wife for about 5-10 minutes.  He said there is an infection at the tooth and a root canal will be necessary, plus recommended dentist #1 put a crown on the tooth in the next few weeks afterward.  My wife asked how the infection would have occurred since she had no problems until after the filling was done, and he simply answered that it happens sometimes, and when pressed, would not elaborate.  He recommended taking some pain killers until the procedure next week and left the room.  The assistant then came in to wrap things up and noted that no antibiotic was prescribed for the infection, so she said she'll get back in touch with my wife about that.

During conversation, my wife found out the endodontist's wife actually works at dentist #1's office.  Overall, she is pretty pissed off at this entire experience for a few reasons---
1) Endodontist won't elaborate about possible cause of infection.
2) Endodontist forgot about prescribing an antibiotic if an infection is really the problem.  When dentist #1 did the inspection yesterday, he told my wife he was confident there was no infection at the tooth.
3) Conflict of interest regarding dentist/endodontist relationship.
4) Brief in and out visit and being annoyed by patient asking questions.

Assuming there really is an infection, is the dentist not responsible for paying for this procedure?  I have no experience in this area at all.  My wife is currently looking up flights for Mexico to just get it taken of there.  Medical care in the US has constantly been a huge frustration for her.  I'm simply used to it because I don't know any better.

Ugh...dentists are so shit at explaining things.

Okay, so the reason they recommend replacing a filling is because bacteria have infiltrated between the filling at the tooth. It's impossible to say from the X-ray how far down it's gotten.

If the bacteria are already close to the nerve, then the tooth was doomed to need a root canal anyway. Doing the filling didn't cause the infection, it just sped up the process of the nerve getting pissed off. Remember, fillings are surgery if a tooth nerve is already infiltrated with bacteria, drilling into it is only going to piss it off more and cause pain.

Sometimes if you remove the bulk of the bacteria and put an antibacterial lining, the nerve can recover, sometimes it can't. In this case it didn't.

Every dentist involved has handled this properly and no one has done anything wrong except be fucking terrible at explaining truly basic concepts that they should all really be prepared to explain.

But again, I used to charge a lot of money to teach these people how to explain things in understandable terms.

Anyhoo, is your wife Mexican? If so then yeah, she can probably easily navigate the local Mexican dental system.

If she isn't, then I cannot state strongly enough how much I would never, ever, ever engage in the Mexican dental tourism industry.

Most Mexican dental tourism clinics are not owned by Mexican dentists, the bulk of Los Algondones clinics are owned by Irish tourism companies. And the dentists who work there aren't necessarily okay with the practices of those companies.

So yes, local dentistry in Mexico tends to be quite good, but there is an issue that a lot of Mexican dentists will charge Americans a hell of a lot more than they charge Mexicans. That's why I ask if she's Mexican, because if she is, then yeah, makes sense.

Thank you.  This is really helping me understand the situation.  I read this to my wife.  She is Mexican and has lived in the US for the past 12 years.  In Mexico, she says what would have happened when she went for the filling to be replaced would have been--

1) x-rays, general checkup, drilling of tooth
2) if it looks deep/complicated, the dentist would have informed her that it looks complicated and a new filling may not work out
3) apply an antibiotic to the tooth and seal it temporarily
4) have her scheduled to see a specialist for root canal the next day

She's having a lot of trouble understanding why the dentist would complete the filling, knowing there is a decent chance it would fester.  Now that the new filling has to be drilled out, removing even more natural tooth material, doesn't that cause more potential problems, hence the recommendation of the crown which might not have been needed if there was less drilling?

Also, why didn't the endodontist prescribe an antibiotic?  The assistant noted that there should have been one prescribed.

[Metalcat]

Another update--- My wife just returned from the endodontist.

They did a repeat of the same x-rays sent from the dentist yesterday and the endodontist inspected and talked to my wife for about 5-10 minutes.  He said there is an infection at the tooth and a root canal will be necessary, plus recommended dentist #1 put a crown on the tooth in the next few weeks afterward.  My wife asked how the infection would have occurred since she had no problems until after the filling was done, and he simply answered that it happens sometimes, and when pressed, would not elaborate.  He recommended taking some pain killers until the procedure next week and left the room.  The assistant then came in to wrap things up and noted that no antibiotic was prescribed for the infection, so she said she'll get back in touch with my wife about that.

During conversation, my wife found out the endodontist's wife actually works at dentist #1's office.  Overall, she is pretty pissed off at this entire experience for a few reasons---
1) Endodontist won't elaborate about possible cause of infection.
2) Endodontist forgot about prescribing an antibiotic if an infection is really the problem.  When dentist #1 did the inspection yesterday, he told my wife he was confident there was no infection at the tooth.
3) Conflict of interest regarding dentist/endodontist relationship.
4) Brief in and out visit and being annoyed by patient asking questions.

Assuming there really is an infection, is the dentist not responsible for paying for this procedure?  I have no experience in this area at all.  My wife is currently looking up flights for Mexico to just get it taken of there.  Medical care in the US has constantly been a huge frustration for her.  I'm simply used to it because I don't know any better.

Ugh...dentists are so shit at explaining things.

Okay, so the reason they recommend replacing a filling is because bacteria have infiltrated between the filling at the tooth. It's impossible to say from the X-ray how far down it's gotten.

If the bacteria are already close to the nerve, then the tooth was doomed to need a root canal anyway. Doing the filling didn't cause the infection, it just sped up the process of the nerve getting pissed off. Remember, fillings are surgery if a tooth nerve is already infiltrated with bacteria, drilling into it is only going to piss it off more and cause pain.

Sometimes if you remove the bulk of the bacteria and put an antibacterial lining, the nerve can recover, sometimes it can't. In this case it didn't.

Every dentist involved has handled this properly and no one has done anything wrong except be fucking terrible at explaining truly basic concepts that they should all really be prepared to explain.

But again, I used to charge a lot of money to teach these people how to explain things in understandable terms.

Anyhoo, is your wife Mexican? If so then yeah, she can probably easily navigate the local Mexican dental system.

If she isn't, then I cannot state strongly enough how much I would never, ever, ever engage in the Mexican dental tourism industry.

Most Mexican dental tourism clinics are not owned by Mexican dentists, the bulk of Los Algondones clinics are owned by Irish tourism companies. And the dentists who work there aren't necessarily okay with the practices of those companies.

So yes, local dentistry in Mexico tends to be quite good, but there is an issue that a lot of Mexican dentists will charge Americans a hell of a lot more than they charge Mexicans. That's why I ask if she's Mexican, because if she is, then yeah, makes sense.

Thank you.  This is really helping me understand the situation.  I read this to my wife.  She is Mexican and has lived in the US for the past 12 years.  In Mexico, she says what would have happened when she went for the filling to be replaced would have been--

1) x-rays, general checkup, drilling of tooth
2) if it looks deep/complicated, the dentist would have informed her that it looks complicated and a new filling may not work out
3) apply an antibiotic to the tooth and seal it temporarily
4) have her scheduled to see a specialist for root canal the next day

She's having a lot of trouble understanding why the dentist would complete the filling, knowing there is a decent chance it would fester.  Now that the new filling has to be drilled out, removing even more natural tooth material, doesn't that cause more potential problems, hence the recommendation of the crown which might not have been needed if there was less drilling?

Also, why didn't the endodontist prescribe an antibiotic?  The assistant noted that there should have been one prescribed.

Sometimes antibiotics are needed, sometimes they aren't.

As for the sequence she's describing, yeah, that's one option, but it's not *the* sequence.

The filling doesn't need to be drilled out to do a root canal, the hole for a root canal is always the same size whether it's through tooth, filling, or a crown. It's not wrong to finish a filling instead of placing a temporary, it's really unpredictable if a deep filling will go sideways or not.

A temp filling is more done when the nerve gets perforated and bleeds a lot. The range of "this is deep but will probably be fine" to "this is deep and should be sent tomorrow for a root canal" is pretty broad, and surprisingly unpredictable.

No dentist would automatically send someone for an root canal consult just because a filling was really deep. But yes, they should explain this.

But if the dentist told her it was deeper than expected and he put a liner of some sort, that WAS the dentist explaining what I have explained. Dentists are just REALLY BAD at understanding that patients don't get the significance of what they say.

It sounds like her dentist(s) back in Mexico were better at explaining things.

I know that the dentists here in Canada I've worked with and the ones I've known who were trained in the US are fucking atrocious at it. Like really, embarrassingly bad at explaining things.

Most doctors are actually terrible at this, but the general public understands more about the rest of their body than they do about teeth, so the MDs get away with it. The dentists don't realize how little the public understands so they *think* they're explaining things when they describe what they see, not realizing that the average person has ZERO fucking clue what a cavity even is, or gum pockets, or whatever other nonsense words they use that people nod and agree to but meanwhile no one has a clue what they've actually agreed to.

ETA: the average MD doesn't understand the basics of dentistry and dentists know this, so it blows my mind that they can't grasp that the general public can't make reasonable sense of what they say.

[MathematicalCycler]

Uniwelder, I have no information to add, only empathy to share. I too, had work done by a new dentist, and the two fillings ended up needing root canals. I was not in pain before the fillings, but afterward, waiting the two months for the root canals, was the worst pain I have ever experienced. Its a terrible situation to be in. Even if my dentist was not bad (and malcatīs helpful explanations are helping me better understand his perspective and decisions), his office was terrible and didnīt return calls, share sufficient information, and deal with the billing or emergency situations in a timely manner. It is really hard when you are not in pain, and then after the dental encounter are suffering, needing more procedures, and facing steep expenses. A great endodontist helped me out, but it was a horrible few months. I hope your wife gets relief and solutions soon!

[Metalcat]

Uniwelder, I have no information to add, only empathy to share. I too, had work done by a new dentist, and the two fillings ended up needing root canals. I was not in pain before the fillings, but afterward, waiting the two months for the root canals, was the worst pain I have ever experienced. Its a terrible situation to be in. Even if my dentist was not bad (and malcatīs helpful explanations are helping me better understand his perspective and decisions), his office was terrible and didnīt return calls, share sufficient information, and deal with the billing or emergency situations in a timely manner. It is really hard when you are not in pain, and then after the dental encounter are suffering, needing more procedures, and facing steep expenses. A great endodontist helped me out, but it was a horrible few months. I hope your wife gets relief and solutions soon!

My case was similar. I was in hit in the face when I was 11 and never ever had a problem with my front tooth except that it was a shade darker than it's neighbours.

Well, I was a very poor university student when a dentist insisted the tooth was dead and needed a root canal.

Cue an entire year of excruciating pain, 4 root canals, temporary crowns constantly falling off while I was eating (happened on a date more than once), and an oral surgery, none of which I could afford, and none of which was explained properly to me.

Countless tears and meltdowns, working full time and doing full time school trying to scrape together enough money to even pay for an endodontist.

There's a solid reason I have so much disdain for the horribly incompetent communication and conflict management skills of dentists.

[uniwelder]

Update-- Sorry, I forgot about this for a while. 

My wife goes to the dentist this week to finish up with the crown.  She already got the root canal complete, and went back to dentist #1 for the first visit prep for crown.

There was some previous discussion about antibiotics and infection.  It ends up the endotontist did indeed forget to prescribe an antibiotic.  Just as the office was closing, 45 minutes after my posting where I complain about her experience, they gave her a call to say they put a prescription for Amoxycillin through to her pharmacy.  About 3 days after taking the antibiotic, her tooth pain subsided almost completely.  The root canal took place just as the antibiotics course was finished and she has been feeling fine since then.

All in, this will cost $4,000, plus aggravation.  It's been a learning experience, that's for sure.  Lots of great information from you all here, especially @Metalcat.  In the future, my wife is determined to use dentist #1 only for regular visits and get anything requiring fillings or more done on her trips to Mexico.  We're luckily at a point where she can just hang out there for a month with friends and family.

[tj]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

That would be nice if it were true. Dental work actually varies pretty dramatically. I worked in that world for years and there are many dentists I wouldn't go to.

How have you learned to evaluate their skills?

[Metalcat]

Dentists are fairly interchangeable in my experience.  They have different chairside manners, but all can fill a cavity, do a root canal, fit a crown, etc.  This is basic dental school stuff not oral surgery.  And it makes sense for the dentist who did the work to do the followup.

That would be nice if it were true. Dental work actually varies pretty dramatically. I worked in that world for years and there are many dentists I wouldn't go to.

How have you learned to evaluate their skills?

It helps to be a medical professional who can read X-rays, but really, the lab techs are the folks who know who does good work and who does shit work, and they often love to gossip.

If you're ever in a new area, call a dental lab and ask who they recommend.