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Medical Forum / General / Dentistry / April 2005An argument for denturity?
So, my buddy the general dentist sees a new, emergency patient. Guy has a toothache, gets tooth pulled. Is told he has visible caries, prob. has other dental problems and needs comprehensive exam. Guy says, OK, and he wants partials too, but is going to see a specialist to get them made. My friend says fine and schedules x-ray and exam appointment, figures patient will have other needs addressed and then prosthetics. Guy shows up two weeks later with upper and lower acrylic partials, not well made but he’s attempting to get used to them. X-rays show extensive caries on virtually every one of the teeth he has left. He needs to have at least one of the teeth pulled. Dentures were made in a same-day clinic, cheaper by maybe 20% off usual cost. No exam, no x-rays. Patient doesn’t know anything’s wrong. Yet. My buddy’s trying to decide whether to confront the dentist, call the state or advise the patient to go to Peer Review. Isn’t this where I read that a dentist cannot provide substandard care, even if the patient consents to it? Sounds like they treated without fully diagnosing the problem. That is never a good idea. If other teeth need out, the sh*t is going to hit the fan at some point, tell your friend to be sure he isn't in the splatter zone. I'd send them back to the place they were treated and let them confront the person who left them in this state. As a wise man once said, you get what you pay for, and sometimes you don't. This patient didn't. T > So, my buddy the general dentist sees a new, emergency patient. Guy has a > toothache, gets tooth pulled. Is told he has visible caries, prob. has [quoted text clipped - 21 lines] > Isn't this where I read that a dentist cannot provide substandard care, > even if the patient consents to it? > Sounds like they treated without fully diagnosing the problem. > [quoted text clipped - 35 lines] > go >> to Peer Review. Upper and lower acrylic partials are "interim partial dentures". I agree the guy should have had x-rays and an exam, but are you sure no exam was done? An interim partial denture is a perfectly acceptable provisional appliance used on patients with treatment in progress...as long as it was explained to the patient that they were "provisional". I think it's best for your buddy to talk to the other dentist and find out exactly what he had planned for the patient. There's simply not enough info here to determine that the other dentist did anything wrong. > Upper and lower acrylic partials are "interim partial dentures". I agree > the guy should have had x-rays and an exam, but are you sure no exam was [quoted text clipped - 5 lines] > exactly what he had planned for the patient. There's simply not enough info > here to determine that the other dentist did anything wrong. I guess they don't have many same day denture places where you are. Where I am, acrylic partials are often what they consider the entry level models. Kind of like the pinto of the denture world. They usually try to talk you into upgrading...perhaps chrome wheels, curb feelers, vinyl top...or even jumping up to the next model...but while you and I would consider such dentures as a temporary solution...these places often do not. T >> Upper and lower acrylic partials are "interim partial dentures". I agree >> the guy should have had x-rays and an exam, but are you sure no exam was [quoted text clipped - 15 lines] > jumping up to the next model...but while you and I would consider such > dentures as a temporary solution...these places often do not. So what's the big deal? It filled a need at the time it was done. It's up to the new dentist to inform the patient what is still wrong with his mouth, and how to proceed from here. At that point, if the patient feels that he was mislead into thinking that these were a form of "final" treatment, then it's up to the patient to file a complaint with the other dentist, the local peer review board, or via a lawsuit. Why should the new dentist file a complaint when the patient may be perfectly content with his "interim partial dentures"? The peer review may investigate, and find that the patient signed consent forms and was aware that these were "provisional". I'm no fan of dentists who undermine other dentists without at least conferring with the other dentist first. That's sneaky, underhanded, and extremely unprofessional IMO. > So what's the big deal? It filled a need at the time it was done. It's up > to the new dentist to inform the patient what is still wrong with his mouth, [quoted text clipped - 11 lines] > conferring with the other dentist first. That's sneaky, underhanded, and > extremely unprofessional IMO. Maybe I read it wrong...but it sounds to me that the new dentures were found to be obsolete within a couple of weeks. I've seen cases like these first hand...these denture places don't extract teeth, so they'll place a denture around whatever is in there....no matter how hopeless the prognosis for what remains. This is fine if the patient is aware they have received a temporary solution to their problems, but this is a detail often left out. I don't think the new dentist should make the complain, but it seems like someone should. Personally, I'd want to distance myself from the situation. T Those are very good points and it's not like my friend (the new dentist) is in a total snit, I think he's gonna go talk to dentist #1. At least one of the clasped teeth, might be more, needed extraction at the time of denture fabrication - ain't there something wrong ith that? I'm with NOYB (ok, what's that stand For????). 25 years on mediation & peer review and rule #1 - which I learned from my dad - is ALWAYS call the providing dentist first. Isn't that what you'd want? Chances are good there's a story here and dentist #1 will make things right if that's what's needed. There's a couple DDS's around here have made a secondary career outta badmouthing other people's work. One of our guys was beat with the malpractice hammer for years over a case that finally went to trial. I was one of the consultants - a total, total waste of everybody's time; "Phantom Bite" case. He won, but all the gray hair will never grow out. All because some Largemouth B*assh*le dentist inappropriately jumped all over his work. Little tough to be objective when one of his patients shows up in Mediation.... But we do it. Peer Review is a great service, great committee if I do say so myself. 'Course it was better years ago before the lawyers got involved..... Oh yeah, I want to add that - in my opinion - it is too narrow a perspective to label acrylic RPD's as always "interim" or "temporary". Yes, of course they often are as they're a part of ongoing treatment that anticipates a different, "final" prosthesis. But there are scenarios with healthy tissues and abutments where they are a better idea than a cast framework pros. Yes, greater strength/potentially more hygienic design/better vertical stops with Co-Cr, but sometimes this is not germaine. Pt. has the mandibular 7's as abutments. Do I really want to lock those two teeth to the denture with rests (which transmit most of the force) guide planes and 1/2 round cast clasps and reciprocal arms? It's not going to be a primarily (or even close) tooth-supported prostheses no matter what I do. Sure, I can knock off the rests and use wrought arms with a Co-Cr too. And I would do this because.....? Oh yeah, I can charge a lot more! Just my chicken scratchin's (apologies to the owner of this charming phrase) Charlie >Just my chicken scratchin's (apologies to the owner of this charming >phrase) > >Charlie Am about to do a case with 17, 21, 22 as a transitional. Bet I can keep the guy out of a full for quite a while. Cast frame ? No Way ! not on this case. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I'm with NOYB (ok, what's that stand For????). 25 years on mediation & > peer review and rule #1 - which I learned from my dad - is ALWAYS call the [quoted text clipped - 16 lines] > so myself. 'Course it was better years ago before the lawyers got > involved..... I am really confused by your response. Have you had any opportunity to see the kind of work some of these same day denture places turn out? I have told more than one patient who came from such places that the only solution for their "new" denture was to go to the river and give it a good toss. I see your experiences with someone questioning the work of your friend has shaped your opinion, and admit that my experience with some of these instant denture places have shaped mine. I agree with the fact the person who provided the work that is felt to be questionable should be contacted by your friend or the patient, but a two week old denture clasping on teeth that need to be removed and placed without a complete exam seems like a problem no matter what type of light you want to shine on it, and I would have no reservation telling that to a patient. Even if the denture is a temporary prosthesis, why build it around clearly failing teeth and why was it placed without an exam? I cannot envision a scenario where a dentist could explain that one away. Sorry for the rant, this is just a sore subject with me. I am not a fan of the mindset we should never question another dentist's work. I am well aware that there are many situations where it is hard to understand what may have occurred and led to certain decisions, but I also know a month of explanations isn't going to make sense of some situations. This case falls into the latter category in my mind. T Hey Tony Sorry, I got carried away ranting in the opposite direction. I'm not saying dentist #1 didn't do something wrong. I'm inclined to think he did, but I don't have all the facts. I was just trying to make a case for giving the dentist his day in court before the patient runs off to one of the (heavily-advertising-ambulance-chasing-knuckleheads) tort law firms. Here's my intuitive scorecard from my years in Peer Review: patients 45% (poor dental work), dentists 45% (problem only existed in patient's mind), nobody's fault (these things happen) 10%. I've got RPDs out there sitting on rotten roots that need extracting. It's a different scenario perhaps 'cause the patients are long-term, medically compromised nursing home residents. Some of these poor folks cannot tolerate the endo much less the extractions. Anyway, my point is that another dentist looking in one of these mouths and judging using the customary dental yardsticks might think Charlie is one ignorant or uncaring DDS-SOB. I don't like bad dentures no matter who makes them. We have a couple same- day joints here in upstate NY and I don't think much of them. > Hey Tony > [quoted text clipped - 4 lines] > for giving the dentist his day in court before the patient runs off to one > of the (heavily-advertising-ambulance-chasing-knuckleheads) tort law firms. I agree with this, and despite my rant...what is with all the ranting!!!...I am not one to jump all over someone else's work. My first course of action is to explain, in the least inflammatory manner possible, what problems I might see and suggest the patient go back and discuss the matter with the prior dentist. Then I'll usually go in my office, shut the door and wonder how the f**k some of my colleagues got their dental license and how they can peddle some of the crap they send into the world...then I go back out and put on my happy face again. > Here's my intuitive scorecard from my years in Peer Review: patients 45% > (poor dental work), dentists 45% (problem only existed in patient's mind), > nobody's fault (these things happen) 10%. I think your numbers sound about right. > I've got RPDs out there sitting on rotten roots that need extracting. It's > a different scenario perhaps 'cause the patients are long-term, medically [quoted text clipped - 3 lines] > customary dental yardsticks might think Charlie is one ignorant or uncaring > DDS-SOB. Those are cases that anyone who is being fair or reasonable will understand. I am talking more about cases where a patient has a denture that looks like it was made for someone else because it fits so poorly, or a month old fixed bridge permanently cemented with margins so open you can hear the ocean when you hold your ear close by, or a permanently cemented anterior crown that is so grossly overcontoured and poorly shaded that it looks like someone jammed a chiclet on the tooth. These are all things I have seen, and I am sure we all have stories of such horrors. T > I have told >more than one patient who came from such places that the only solution for >their "new" denture was to go to the river and give it a good toss. What ?! You didn't offer to turn it into a fishing lure for them ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Scoff away unbelievers, but a 3- or 4- clasp RPD makes a great pike lure. >Scoff away unbelievers, but a 3- or 4- clasp RPD makes a great pike lure. The most expensive 'spoon' you will ever use ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I'm with NOYB (ok, what's that stand For????). If I tell you, you'll think I'm being a smart a.s. None Of Your Business. NOYB. sheeeeesh...........I shoulda figured that out >I'm no fan of dentists who undermine other dentists without at least >conferring with the other dentist first. That's sneaky, underhanded, and >extremely unprofessional IMO. A-greed. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >> Upper and lower acrylic partials are "interim partial dentures". I agree > >> the guy should have had x-rays and an exam, but are you sure no exam was [quoted text clipped - 27 lines] > investigate, and find that the patient signed consent forms and was aware > that these were "provisional". Show me those forms haha Were they written in plain English and could you read them without using a microscope? > I'm no fan of dentists who undermine other dentists without at least > conferring with the other dentist first. Yeah you should conspire first and get your stories straight lol That's sneaky, underhanded, and > extremely unprofessional IMO. >> >> Upper and lower acrylic partials are "interim partial dentures". I > agree [quoted text clipped - 50 lines] > > Yeah you should conspire first and get your stories straight lol When the sharks are circling, it's best to stick together. You guys have brought out the worst in people...so don't blame us for the hatred we feel towards your side. I would hate to be a lawyer if I needed any form of medical care. I'd be afraid that someone might be spitting in my IV drip. > >> >> Upper and lower acrylic partials are "interim partial dentures". I > > agree [quoted text clipped - 54 lines] > brought out the worst in people...so don't blame us for the hatred we feel > towards your side. The differnce betwee lawyers and dentists is that lawyers take your money/time wheras a bad dentist with a bad product can take your health. Take my money but leave me my health. > I would hate to be a lawyer if I needed any form of medical care. I'd be > afraid that someone might be spitting in my IV drip. Is that what happened to Johnnie Cocharin? He was supposedly ok and then...By the way, they are still running commercials with him in it. |
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