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Medical Forum / General / Dentistry / June 2005Dentist wants to replace all my fillings
Hello all, I recently began seeing a new dentist. My main reason for seeing him is that one of my molars is bothering me. The pain was sporadic and transitory in the past, but now the tooth is botherimg me almost constantly. I had already mentioned this problem to my former dentist at least twice over the last five years, and he kind of just "brushed it off" (i.e., he ignored me and did nothing). So I felt it necessary to find a new dentist. My new dentist performed a very thorough exam, the most thorough dental exam that I had ever had in my entire life. He found a number of problems, one of which is that almost all of my amalgam fillings are leaking. He determined this by visually looking at them-- except for a suspicious radioleucency in one tooth, all the x-rays were normal. None of these other amalgam fillings are currently bothering me. However, this dentist's rationale seems to be that these fillings probably have decay forming under them; therefore, the fillings should be replaced as a pre-emptive action to protect the teeth. I was told that if I decline to have this done, I will probably need multiple root canals at some point. I should probably add that all but one of these fillings are about 30 years old. One thing that troubles me is that my new dentist didn't seem to be in any hurry to deal with the tooth that is bothering me. I thought that he would want to deal with the problem immediately. Instead, it seems that he is focused on fixing every little problem that he can find, rather than dealing with the crises first to get them out of the way. Of course, that's just my subjective assessment, which may not necessarily be a fair one. Even so, I don't think it's unreasonable of me to expect a dentist to focus his attention on a tooth that is causing me discomfort, and to take prompt action to deal with the problem. Everything else can be dealt with later. Now, back to the fillings... My dentist proposes to replace my amalgam fillings with resin-bonded composite fillings. These will be "temporary fillings" that will only last 1.5 to 2.5 years (3 years max.). Does that sound right? I wasn't aware that white fillings have such a short life. The reason for the temporary fillings is because he really wants to put crowns (seven full, two partial) on my teeth. However, he also thinks that I need full braces. So the reason for not putting the crowns on now is that the braces would probably cause the crowns to break off. Another reason is because I cannot really afford all of the extensive treatment that he is proposing. So the idea is that this will buy me some time and give me a chance to research my options, and hopefully my financial situation will improve in the next year or so. Even the stop-gap measures proposed will be quite a hit financially. Curious as to what it will cost (and not wanting to be too shocked when it comes time to pay), I asked for a rough estimate. It looks like it is going to set me back by about $3800. Wow! These have got to be the most expensive fillings that I have ever had in my entire life. And what's even worse is that they're apparently not all that durable. For that price, I would almost expect that these fillings would make my teeth as strong as a beaver's, and last for at least 50 years. (Yeah, I know that's not realistic, but I am allowed to dream, am I not?) :-) Well, this post is getting quite long, so I'd better stop now. Your thoughtful comments would be greatly appreciated. My new dentist is unlike all the other dentists I've ever been to, and while he seems like a caring dentist and a very nice guy, it is hard for me to shake this nagging feeling I have that there's something not quite right here. Harry I'd get another opinion. Anytime you get such an extensive plan, which will undoubtedly cost quite a bit of money, you owe it to yourself to get another opinion. I am a bit bothered by the comment that your existing fillings "probably have decay forming under them". Either they do or they don't, they should find out BEFORE treating. T > Hello all, > [quoted text clipped - 65 lines] > > Harry > I'd get another opinion. > [quoted text clipped - 4 lines] > have decay forming under them". Either they do or they don't, they should > find out BEFORE treating. Hi Tony, You're right; getting another opinion would be wise, especially in a situation like this. Regarding my existing fillings, my dentist seems to be operating using this rationale: X-rays aren't very good at detecting decay under fillings. Therefore, to know for sure you have to remove the fillings so you can see what's underneath them. Well, that does seem like one way to know for certain whether there is decay under my fillings. The problem, though, as I see it, is that one will end up destroying quite a few perfectly good fillings this way. And once the filling is removed it has to be replaced with something, and the material he is proposing to use is much less durable than the original fillings. And he won't replace them with silver/mercury amalgam fillings because he does not use them at all in his practice. I was told that gold is the only metal he uses. Thank you for your advice and comments. Harry > Hi Tony, > [quoted text clipped - 18 lines] > > Harry I may be a bit too conservative in my approach to care, but while it is true that removing the filling will provide a definitive answer to the question of whether there is decay underneath, it is a rather costly (for you), and invasive method of getting the answer. If the teeth are symptom free, and there is no radiographic sign of pathology, I am of the let sleeping dogs lie school of thinking. I would talk to friends and ask them for a recommendation for a good, honest dentist (not to imply the new guy isn't honest) and go for another opinion. You'll feel better. It is always a bit disconcerting when you go somewhere new and you suddenly need a huge amount of treatment. It could be that you DO need all this work, or it could mean the new guy is very aggressive in his approach to care. Based on the information you have provided thus far, I'd keep one hand over my wallet in this new place! Good luck to you. T Ask the dentist how his physician checks his heart. Does he open his chest at every physical?  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >> I'd get another opinion. >> [quoted text clipped - 28 lines] > > Harry > Regarding my existing fillings, my dentist seems to be operating using > this rationale: X-rays aren't very good at detecting decay under > fillings. Therefore, to know for sure you have to remove the fillings > so you can see what's underneath them. Hi, I agree with that. Most old amalgam have some decay. But through x-ray you cannot detect. But I would not remove them firsthand. I would also check how active caries is in this very patient. When there is much caries it is propable that decay is also under the filling. But in good looking teeth, no plaque it is rather unlikely. But I have to admit that I often did not guess right since in systematic amalgam removel you look under every filling. And there is not necessarily discomfort shown by the patient. JK SignatureDr. Jochen Kulow |email: jochen.kulowNOSPAM Zahnarzt/Dentist | (at)dentalmail.de |remove NOSPAM |PGP: http://wwwkeys.de.pgp.net |HP: http://www.dr-kulow.de --------------------PGP-Fingerprint------------------- DAA3 468E 10FB 463D AE5C A135 6D6B 9250 7746 6FC7 ------------------------------------------------------ > Hello all, > [quoted text clipped - 65 lines] > > Harry From your description, I'd go with my gut--which is to run! He could be totally right, but I'd need a very detailed, comprehensible reason for ignoring your primary complaint, and proposing extensive treatment that by his own definition is temporary for repairing fillings that "may" be leaking. Steve SignatureCut the nonsense to reply >> Hello all, >> [quoted text clipped - 73 lines] > >Steve I wonder if the new dentist showed the OP the "three slides"? .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > >> Hello all, > >> [quoted text clipped - 4 lines] > >> this nagging feeling I have that there's something not quite right > >> here. > > From your description, I'd go with my gut--which is to run! He could > >be totally right, but I'd need a very detailed, comprehensible reason [quoted text clipped - 10 lines] > > I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. OK, I'll bite: <rustle, rustle, shift toward DrSteve:> ... And just what 'three slides' would we be speaking of here? And while we are on this subject, apart from visual inspection, passing the DiagnoDent on the margins and the BiteWings, I don't see how one can be so sure these things really are leaking. If the caries are on the same level with the fillings (which must be quite large), there won't be any signs on the B/W's: Only if the caries gets underneath them, and who wants to let things go till that stage? I often must make a decision based on what has happened in similar situations in the past. It is not a sure thing, as Tony B has implied. Thanks SP Thanks SP SignatureFinally: take out the TRASHH I forget the name of the practice management guru who sells you three slides and you are just supposed to show the three slides to each patient and ask which mouth they would like to like. His idea is that you make enough money on the one patient who bites the bait to make up for the 30 patients who get disgusted and walk out the door. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> >> Hello all, [quoted text clipped - 39 lines] > Thanks > SP > I forget the name of the practice management guru who sells you three slides > and you are just supposed to show the three slides to each patient and ask > which mouth they would like to like. His idea is that you make enough money > on the one patient who bites the bait to make up for the 30 patients who get > disgusted and walk out the door. You can do this with your own intra oral camera: just show them a pic of your fillings in their mouths and then show them a pic one of their teeth that needs treatment. One of these days I'm gonna have to git me one o' those do-dads . Thanks All-Tempa-Cheers SP SignatureFinally: take out the TRASHH Dick Barnes? SignatureRoy rem NADA to reply |I forget the name of the practice management guru who sells you three slides | and you are just supposed to show the three slides to each patient and ask [quoted text clipped - 44 lines] | > Thanks | > SP >Dick Barnes? Yes!! .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>Dick Barnes? > [quoted text clipped - 4 lines] > >I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. I hear he's a real dick. <hehe> -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >>Dick Barnes? > > [quoted text clipped - 11 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com Bigus Dickus? SP SignatureFinally: take out the TRASHH > From your description, I'd go with my gut--which is to run! He could > be totally right, but I'd need a very detailed, comprehensible reason > for ignoring your primary complaint, and proposing extensive treatment > that by his own definition is temporary for repairing fillings that > "may" be leaking. Hi Steve, Thanks for your reply. Yes, it does seem that ignoring one's gut feelings about something is usually not a smart thing to do. A friend of mine once told me that whenever she ignores her intuition, she always regrets it later. My dentist did give me a very detailed treatment plan. However, nothing that he provided me with has convinced me that these problems require immediate attention (aside from the tooth that I wanted him to fix). Almost all of the problems that he is calling attention to have been there for years, apparently. Other dentists have undoubtedly noticed these problems, and some even made casual comments about them, but none of them ever indicated that these were urgent problems requiring immediate attention. BTW, just to give you a little clearer picture (to the degree that it's possible through this medium), none of my teeth show any visible evidence of severe decay or anything like that. In fact, every dentist I've ever been to has made basically the same comment when examining my teeth: "You obviously take very good care of your teeth." Anyway, I just thought I'd mention that because I am sure you've seen stuff so bad it would probably give most people the "heebie jeebies." My situation is nothing like that, in case anyone is wondering. Harry Hi Harry, I am not a dentist but as a person who has had problems with my teeth do to other medical problems destroying the teeth. I read what you said about your appt and I can tell you this, if I went into my dentist with a problem that was causing pain or even discomfort and he went through all the problems he is assuming is wrong and does not address or tend to your immediate needs that brought you there, I would run not walk to another dr. This to me sounds like the dentist is more interested in the money in the bank then in your condition UM MOM Susan >> From your description, I'd go with my gut--which is to run! He could >> be totally right, but I'd need a very detailed, comprehensible reason [quoted text clipped - 28 lines] > > Harry >if I went into my dentist with >a problem that was causing pain or even discomfort and he went through all >the problems he is assuming is wrong and does not address or tend to your >immediate needs that brought you there, I would run not walk to another dr. There you have it again "run *don't* walk..". -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >> From your description, I'd go with my gut--which is to run! He could >>be totally right, but I'd need a very detailed, comprehensible reason [quoted text clipped - 14 lines] > fix). Almost all of the problems that he is calling attention to have > been there for years, apparently. You don't know that, I don't know that--and you can bet this new dentist doesn't know that either. Steve Other dentists have undoubtedly > noticed these problems, and some even made casual comments about them, > but none of them ever indicated that these were urgent problems [quoted text clipped - 10 lines] > > Harry SignatureCut the nonsense to reply >> From your description, I'd go with my gut--which is to run! > [quoted text clipped - 4 lines] >of mine once told me that whenever she ignores her intuition, she >always regrets it later Same here. RUN don't walk away from this dentist. Find someone else. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Even so, I don't think it's unreasonable of >me to expect a dentist to focus his attention on a tooth that is >causing me discomfort, and to take prompt action to deal with the >problem. Everything else can be dealt with later. Absolutely true. We call it primary care. Take care of what is bothering the patient first !!! >Now, back to the fillings... > >My dentist proposes to replace my amalgam fillings with resin-bonded >composite fillings. These will be "temporary fillings" that will only >last 1.5 to 2.5 years (3 years max.). Does that sound right? I wasn't >aware that white fillings have such a short life. WoW Get a third opinion. IOW run ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Will we EVER get that fourth, fifth or sixth opinion from Joel. Gail > WoW > > Get a third opinion. > > IOW run ! Or maybe Jan or I should take a crash course in dentistry. We need all the help we can get. Of course, my effort would simply be a crash. We need to expand beyond amalgams and mercury. Gail >My dentist proposes to replace my amalgam fillings with resin-bonded >composite fillings. These will be "temporary fillings" that will only >last 1.5 to 2.5 years (3 years max.). Does that sound right? I wasn't >aware that white fillings have such a short life. I would NOT do this, I had a dentist tell me almost the same, and drilled out the old, and replaced it with the "newer" composite crap, and boy, do I regret it! I didn't have any pain, no sensitivity or anything like that, but with the composite stuff, I had both, it was pure hell for weeks, couldn't bite down on hard food, and in the end, I had to go back 4 times for him to redo the fillings over & over again, adding some stuff which supposedly helped the sensitivity issues, but it still is there, and it took a few tries for him to grind down the tooth so that when I eat I wouldn't feel pain. For that chunk of change, I would get a 2nd or even a 3rd opinion. >For that chunk of change, I would get a 2nd or even a 3rd opinion. Good advice. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Hi, I just remembered something that I thought I should also mention. When I went for my follow-up consultation, the dentist's assistant told me that it would NOT be a good idea to just fix the tooth that is bothering me. She said that the adjacent teeth should also be treated because they are touching that tooth, and the bacteria from the bad tooth could infect those teeth as well. So if the bad tooth needs a crown, they would want to put a crown on the teeth that are next to it as well. What do you think of this? If you went to a dentist (without revealing that you are also a dentist) and you were told this, what would you say? Harry <harry_lewis@yahoo.com> .................. > What do you think of this? If you went to a dentist (without revealing > that you are also a dentist) and you were told this, what would you > say? > > Harry What I would say would be inappropriate to post in this group, due to the language I would use. Let's just leave it at this - the asst. doesn't know what she is talking about. Get a second opinion. carabelli ><harry_lewis@yahoo.com> .................. > [quoted text clipped - 9 lines] > >carabelli IOW, ass-sistant bullsh*t ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Hi, > [quoted text clipped - 13 lines] > >Harry Kindly help us out and lose this dentist now! .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Wow - I just love all the 'run don't walk' responses without even seeing any of the teeth/fillings in question...you guys have indicted, tried, and hung this guys dentists without seeing one radiograph or picture! > >Hi, > > [quoted text clipped - 20 lines] > > I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. We have been in the field long enough to know when someone is being fed a marketing scheme. Replacement of all amalgam fillings because they *might* have caries under them?????? Gold on every tooth in the head??????? Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Wow - I just love all the 'run don't walk' responses without even seeing > any [quoted text clipped - 27 lines] >> I am writing on a Tablet-PC,so forgive me if the PC misreads my > handwriting. How can you know they don't need replacement without ever seeing them? > We have been in the field long enough to know when someone is being fed a > marketing scheme. [quoted text clipped - 47 lines] > >> I am writing on a Tablet-PC,so forgive me if the PC misreads my > > handwriting. > How can you know they don't need replacement without ever seeing them? I don't know that. But the patient's account of his consultation is making my nose bleed. Steve >>We have been in the field long enough to know when someone is being fed a >>marketing scheme. [quoted text clipped - 58 lines] >>> >>>handwriting. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > How can you know they don't need replacement without ever seeing them? > > I don't know that. But the patient's account of his consultation is > making my nose bleed. > > Steve LOL...thanks for the laugh!! I agree! T > > > How can you know they don't need replacement without ever seeing them? > > [quoted text clipped - 8 lines] > > T <sigh....> OK, this one, too, went a thousand miles over my haid... Why is your nose bleeding? SP SignatureFinally: take out the TRASHH > How can you know they don't need replacement without ever seeing them? Well, this was posted earlier in the thread "When I went for my follow-up consultation, the dentist's assistant told me that it would NOT be a good idea to just fix the tooth that is bothering me. She said that the adjacent teeth should also be treated because they are touching that tooth, and the bacteria from the bad tooth could infect those teeth as well." carabelli Yes, the hygienist is full of it, but what matters is the dentists diagnosis..she was probably trying to verify, although using an unsound reason, the dentists recommendation that the fillings be replaced. > > How can you know they don't need replacement without ever seeing them? > > [quoted text clipped - 7 lines] > > carabelli >> How can you know they don't need replacement without ever seeing them? >> [quoted text clipped - 7 lines] > >carabelli Yeah, what he said. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > > How can you know they don't need replacement without ever seeing them? > > [quoted text clipped - 7 lines] > > carabelli I actually have been told by a Manggement consultant that I should replace all the Am's in a quadrant when I find one that is defective. Reason: They were all done at the same time, so they all get worn down at the same time. I said, 'Thanks'.... SP SignatureFinally: take out the TRASHH Key words: "*might* have caries" >How can you know they don't need replacement without ever seeing them? > [quoted text clipped - 9 lines] >> ~+--~+--~+--~+--~+-- >> Stephen [What's a Temporary?], D.D.S. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Obviously you cannot tell beyond a shadow of a doubt. However, I very, very rarely see anyone that needs every old filling replaced *now*. When they do need to be replaced, they *are* leaking (not may be leaking). They *have* recurrent decay (not may have decay). If it walks like a duck and quacks like a duck, it's usually a duck. JME, Fawks > How can you know they don't need replacement without ever seeing them? > [quoted text clipped - 5 lines] >> >>Gold on every tooth in the head??????? >However, >I very, very rarely see anyone that needs every old filling [quoted text clipped - 6 lines] >JME, >Fawks Or it could be a quack, eh ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com It is the concept that every amalgam filling needs replacement *because* it is amalgam. That is my concern. Go back to page one and re-read the thread. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > How can you know they don't need replacement without ever seeing them? > [quoted text clipped - 58 lines] >> >> I am writing on a Tablet-PC,so forgive me if the PC misreads my >> > handwriting. > It is the concept that every amalgam filling needs replacement *because* it > is amalgam. That is my concern. Go back to page one and re-read the > thread. My old mentor still has that philosophy. He still does pactice that way, except he fills _canals_ with Amalgam, not gp. His assistant takes some of the powder out so it's softer, and he pluggs it in with a plugger, a file and an Apex Locator. Blast SP SignatureFinally: take out the TRASHH > Wow - I just love all the 'run don't walk' responses without even seeing any > of the teeth/fillings in question...you guys have indicted, tried, and hung > this guys dentists without seeing one radiograph or picture! No, we've suggested he get a second opinion. Steve >>>Hi, >>> [quoted text clipped - 22 lines] > > handwriting. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Wow - I just love all the 'run don't walk' responses without even seeing any > of the teeth/fillings in question...you guys have indicted, tried, and hung > this guys dentists without seeing one radiograph or picture! Did you actually read what the original poster wrote? I am sorry but most of what the patient reported being told sounded like Grade A bull crap. If anyone told me their dentist wanted to replace all their fillings because they were old and "might" have decay underneath, I have major trust issues. I'd feel the same if my mechanic told me he was going to replace expensive parts because their might be a problem or my doctor told me he was prescribing medication to address a maybe situation. That isn't a sound diagnosis. T You are allowed to do preventive treatment....If the margins are deficient then they need to be replaced in my book. Why wait until there is a symptomatic tooth possibly needing even further treatment? Are we into supervised neglect here?? I will agree that if there is nothing wrong with the fillings then it is overtreatment to replace them unless requested by the patient for purely cosmetic reasons. BUT - you guys are basing all your recommendations on heresay and speculation. Lets see some good intraoral pics of these fillings then decide or at least state after your recommendations that you can't really say anything definite without at least a clear picture > > Wow - I just love all the 'run don't walk' responses without even seeing > any [quoted text clipped - 12 lines] > > T > You are allowed to do preventive treatment....If the margins are deficient > then they need to be replaced in my book. Why wait until there is a [quoted text clipped - 7 lines] > then decide or at least state after your recommendations that you can't > really say anything definite without at least a clear picture I understand what you say, and generally agree...but sometimes when I step in something slippery and smell that smell, I know it was a load of crap even without looking to be sure. The comments here were based on what the poster said he was told. If the story is a lie or distortion, of course our responses may also be off base. I find it alarming that you are taking people to task for responding to what was posted. Do you agree with the recommendation to ignore a patient's chief complaint and replace fillings on the theory there might be decay? I find your view of this to be much like the response of the dental community back when THAT Reader's Digest article came out. All I heard was outrage and questions about how unfair it is to judge when you haven't seen the patient. It would have made me feel a lot better if someone, anyone, said well, there are some dentists who cross the line and do the wrong things, but...and then they took outrage and explained how such behavior was the exception not the rule. Instead I heard and read what I feel were dishonest claims that suggested that ALL dentist's are beyond doing anything inappropriate or unethical. Maybe it is a function of where I practice, but you know what, I see a LOT of patients that come to me and their initial diagnosis was crap and primarily aimed at enriching the dentist, not the patient's dental health. Maybe that doesn't happen much where you are...if so, you are fortunate...but I see it enough to have a nose for crap and don't wrinkling up my nose and saying ewwww when I smell it! Off soapbox...gotta change to decaf. T > but I see it enough to have a nose for crap and don't wrinkling > up my nose and saying ewwww when I smell it! > > Off soapbox...gotta change to decaf. > > T NON... it is better like this. SP SignatureFinally: take out the TRASHH Go back and read the beginning of the thread. The office says they replace every amalgam they see and they only restore with gold. There was no diagnosis of failed margins, recurrent caries etc. It is like going in to have a Tune up on your car and being told that the mechanic cannot see the piston rings without removing the pistons, so he needs to take the pistons out to see if the rings are any good. But, he does not install any "stock" rings, so you need high compression pistons cut from billet stock with an extra slot cut in for an extra oil control ring, blue print and balance the pistons and rods, and replace the crank with a counter-balanced one. Even though the engine runs fine (the tune-up was a preventative procedure), the engine does not drip oil, gets better gas mileage than factory specs, and has great compression. He must open up the engine to check it. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > You are allowed to do preventive treatment....If the margins are deficient > then they need to be replaced in my book. Why wait until there is a [quoted text clipped - 29 lines] >> >> T I went back and re-read the first of the thread and found this: "And once the filling is removed it has to be replaced with something, and the material he is proposing to use is much less durable than the original fillings. And he won't replace them with silver/mercury amalgam fillings because he does not use them at all in his practice. I was told that gold is the only metal he uses." I believe what is being said is that he is proposing a 'less durable than original' composite type filling/build-up, not gold filling material to make an onlay or inlay. Someone has told the patient that 'gold is the only metal he uses' . The patient has taken this to mean that the fillings will be gold. As quoted though, the proposed fillings are to be most likely composed of composite or build-up (insert your favorite here). > Go back and read the beginning of the thread. The office says they replace > every amalgam they see and they only restore with gold. There was no [quoted text clipped - 54 lines] > >> > >> T Did you get to the part where the office wants to replace every amalgam filling because that is what they do whenever they see amalgam? Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >I went back and re-read the first of the thread and found this: > [quoted text clipped - 91 lines] >> >> >> >> T > I went back and re-read the first of the thread and found this: > [quoted text clipped - 10 lines] > gold. As quoted though, the proposed fillings are to be most likely composed > of composite or build-up (insert your favorite here). Some people are mis-understanding what I wrote. The dentist was not planning to use gold fillings, nor did I think he was going to use them. I only mentioned gold because when I was told that gold is the only metal he uses, I immediately knew that new amalgam fillings were not even an option with this dentist. His plan was to use resin-bonded composite fillings, which I believe I clearly stated in my original message. I want to say that I think that this dentist is a very good one. At least in some ways. Why? Because he took the time to do a very thorough examination. It cost more than other dental exams that I have had, but the price it was reasonable considering the time that was spent. I think it was money well spent because I now know what my weak spots are. The main thing that troubles me is that he never seemed interested in only fixing the tooth that is bothering me. There was always subtle (and not so subtle) pressure to submit to a lot of additional work. Maybe the additional work is needed, maybe it isn't. But is it urgent? No, I don't think so. However, the same cannot be said for treating the (probably) infected molar and gum. Dealing with them should have been his first priority. I even asked him about prescribing an antibiotic, and he wouldn't do it. I have an appointment to see a different dentist later this week. He is going to see me even though there are no full openings available this week or even next week. But he will spend ten minutes in order to assess the situation. Since he might not be able to fix my tooth this week or even the next, I asked the receptionist if it's likely that the dentist would be willing to prescribe an antibiotic and/or a pain killer to take until my next appointment. She replied, "Oh, yes. Most likely both." Harry > Go back and read the beginning of the thread. The office says they replace > every amalgam they see and they only restore with gold. There was no [quoted text clipped - 8 lines] > engine does not drip oil, gets better gas mileage than factory specs, and > has great compression. He must open up the engine to check it. Ummmm Dr S... were you by any chance a mechanic in a former life? SP SignatureFinally: take out the TRASHH I am not a master mechanic, but I can disassemble a vintage SAAB or Triumph and put it back together with no stress. I build my own HI-Po engines for my VW. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Go back and read the beginning of the thread. The office says they [quoted text clipped - 20 lines] > Ummmm Dr S... were you by any chance a mechanic in a former life? > SP >I am not a master mechanic, but I can disassemble a vintage SAAB or Triumph >and put it back together with no stress. I build my own HI-Po engines for >my VW. yeah, but can tune the twin carbs on a TR4A by ear? carabelli >>I am not a master mechanic, but I can disassemble a vintage SAAB or Triumph >>and put it back together with no stress. I build my own HI-Po engines for [quoted text clipped - 3 lines] > >carabelli Yes You just need a length of vacuum hose to listen through. I normally use a Uni-Sys as it goes faster .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. "Dr. Steve" <drsteve@no-spam.com>........... >>yeah, but can tune the twin carbs on a TR4A by ear? >> >>carabelli .........I normally use a Uni-Sys as it goes faster Yup, a confirmed techie.<VGEG> and in the morning when the barometer moved 3 points you got to do it again carabelli > "Dr. Steve" <drsteve@no-spam.com>........... > [quoted text clipped - 10 lines] > > carabelli Not really, the trick is to get the two carburetors balanced to each other. You only have to change the settings if you drive to a high elevation such as Denver. When I drove my TR-7 12 months a year, I would set the carb's twice a year (it only needed it once, but I am a bit OC). Now-a-days the TR-3A and the TR-7 get the carb's adjusted every third year. The wife's TR-6 only needs adjusting every 3 years as well. The twin carb's on the Jag never need adjustment. Today the fuel and lubricants are better, we keep the cars in better tune, we don't try to get too much life out of spark plugs, etc. The engine itself does not fluctuate as much, so the carb's don't need as much fettling. > You are allowed to do preventive treatment....If the margins are deficient > then they need to be replaced in my book. Why wait until there is a [quoted text clipped - 7 lines] > then decide or at least state after your recommendations that you can't > really say anything definite without at least a clear picture _I_ haven't... I'm STILL waitin' for the movie... SP SignatureFinally: take out the TRASHH >Wow - I just love all the 'run don't walk' responses without even seeing any >of the teeth/fillings in question...you guys have indicted, tried, and hung >this guys dentists without seeing one radiograph or picture! So, what's your point ? >> >What do you think of this? If you went to a dentist (without revealing >> >that you are also a dentist) and you were told this, what would you [quoted text clipped - 5 lines] >> .. >> Stephen Mancuso, D.D.S. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Wow - I just love all the 'run don't walk' responses without even seeing any > of the teeth/fillings in question...you guys have indicted, tried, and hung > this guys dentists without seeing one radiograph or picture! _I_ haven't... I'm waitin' for the movie... SP SignatureFinally: take out the TRASHH > Kindly help us out and lose this dentist now! > .. > Stephen Mancuso, D.D.S. > Troy, Michigan, USA Don't worry, I did. I called a few of my neighbors and found out that two of them go to the same dentist, and they both had good things to say about him. BTW, I don't think that what the dentist's assistant told me was just a simple mistake, or due to inexperience, since she told me that she has 15 years of experience, and I believe that she takes her cue from the dentist. Most likely, she didn't realize who she was talking to. I have a B.S. in biology, and my minor for my Master of Science degree was microbiology. Not that it really matters much since even my mother, a high school graduate, immediately knew that what the assistant told me doesn't make any sense. I might go back to that dentist for one of the less aggressive treatments that he suggested. But probably not. Generally speaking, if somebody lies to me or tries to feed me bullsh*t, I never go back there again. Harry Is there any way we can get a picture? Take it yourself with a digital camera and post it/them here. Just do the best you can with the zoom available. I want to see how big these fillings are. Do they replace most of the tooth or are they small fillings on the chewing surfaces of the teeth? If you do go back to this dentist, ask why each filling needs replacing. There should be a reason for each replacement or crown. He should be able tooth by tooth to be able to tell you why he is recommending treatment other than just categorically stating 'possible decay'. Maybe each of the teeth in question have very large fillings, needing re-building prior to crowning and the dentist wants to evaluate them for a while to see if they need root canals. Its really hard to say without an x-ray or picture. We are all just guessing as best we can. > > Kindly help us out and lose this dentist now! > > .. [quoted text clipped - 20 lines] > > Harry >Hi, > [quoted text clipped - 13 lines] > >Harry Goodbye. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com The below should not be construed as proper dental or medical advice. no guarantees offered as to truth or viability of this info. info subject to change given clinical info, x-rays, models relevant to case. use info at own risk. not responsible for damage to teeth, gums, health, pocketbook, or anything else as a result of using info: Dentists are very diverse in how competent they are and how aggressive they are in proposing treatment. You should always get 2nd and 3rd opinions when faced with an extensive treatment plan like this one, especially if one dentist said nothing was wrong and the other one is proposing $3,800 of stuff. You might try going to a dental school for a very objective diagnosis. I have seen dentists propose thousands of $$$ of work needed when really not much was needed at all, and dentists propose no work needed when thousands of $$$ were needed. Can't tell anything in this case without the actual data, X-rays of the case. But, be careful of dentists who ignore treating an emergency situation or who don't treat it within the first or second visit. This shows a lack of "customer service" in not addressing the immediate need, and may suggest that maybe the dentist isn't all that sophisticated, either in customer service or in the technical aspect. Some points: * Amalgam fillings are extremely durable. If they last five years, and the patient continues to take care of the teeth, they may very well last another 20-50+ years. It is also impossible to determine that amalgam fillings are "leaking" just by looking at them, or even with X-rays, unless there are really big gaps or cavities between the filling and the tooth. In general, it is rare for decay to show up again under an amalgam filling, especially if there is no X-ray or clinical evidence of decay. Now, this can and does happen, but is relatively rare and would seem unlikely in this case. *You have no way of knowing if the dentist "performed the most thorough exam" in your life, or if he was competent in performing this exam. Dentists can and do perform perfectly competent exams in 7 minutes, or incompetent exams in 1 hour. *It is absurd for a dentist to remove amalgam fillings because "they probably have decay." If he doesn't see clear clinical evidence or x-ray evidence of decay, in general he should not touch the fillings. unless the patient wants them changed into white for cosmetic reasons. *If the fillings are 30 years old, no evidence of clinical or x-ray decay, they are probably solid and will last another 30 years. Unless in relatively rare cases a tooth with an amalgam filling is structurally weak and may slowly crack over the coming years. *Also, nowadays, composite fillings have become a sophisticated technology. They are more difficult to place properly than amalgam fillings, in that the dentist must be meticulous and take his/her time in placing them to do them right. But even in back teeth they should last 5-15 years. If the dentist says 3 years max he is not up to date on technology or maybe his placement technique is not quite correct leading to early failures. *sounds odd that braces can cause crowns to break off. if there are no obvious cavities on the teeth, crowns are typically needed only if the teeth show cracks in them and would need re-enforcement with crown. or if the crowns are used to support a denture of some kind. hard to tell without models, x-rays of case. The above should not be construed as proper dental or medical advice. no guarantees offered as to truth or viability of this info. info subject to change given clinical info, x-rays, models relevant to case. use info at own risk. not responsible for damage to teeth, gums, health, pocketbook, or anything else as a result of using info. --Johnny > The below should not be construed as proper dental or medical advice. > no guarantees offered as to truth or viability of this info. info [quoted text clipped - 63 lines] > > --Johnny You sound like a nice, sensible, reasonable guy, Johnny--hope you'll stick around a while. Steve SignatureCut the nonsense to reply Basically sound advice, but I could pick on a couple of statements. I see teeth with old amalgams fracture every day. Maybe statistically this is a rare event considering how many amalgams are present in the population (or not), but it is very common in my patients. The statement on composite durability seems to place 15 year ceiling on their length of service. I have many composite restorations that had their 20th birthday last year and many more celebrating that same accomplishment this year. I think a composite that has been in place successfully for 10-15 years may very well go another 10-15. Just splittin' hairs, Fawks >> *If the fillings are 30 years old, no evidence of clinical or x-ray >> decay, they are probably solid and will last another 30 years. Unless [quoted text clipped - 8 lines] >> on technology or maybe his placement technique is not quite correct >> leading to early failures. > You sound like a nice, sensible, reasonable guy, Johnny--hope you'll > stick around a while. > > Steve > The statement on composite durability seems to place 15 year ceiling > on their length of service. I have many composite restorations that [quoted text clipped - 4 lines] > Just splittin' hairs, > Fawks Since this thread is still active, I thought I would add some more information. It has occurred to me that perhaps I did not accurately communicate my dentist's intentions. Since I am not a dentist, I may not have completely understood the nature and/or purpose of the proposed treatment. To compensate for this possibility, I thought it might be useful to post the exact wording used on the consent form that I was supposed to sign/initial and bring with me at the time of treatment. Here are the parts of the consent form that were customized to fit my particular situation: --------- "I fully understand that the teeth and their associated problem(s) that are being addressed by [the dentist] and his staff are: Removal of decay, and crack damage that we can identify & access." "I fully understand that my good faith treatment plan that I have selected is designed to address my dental/oral problems via the following procedures: Temporary foundations and resins that have a life expectancy of approx. 18 months." "I fully understand that the following are the most common risks associated with the good faith effort in addressing my dental/oral problem(s): We are temporarily treating the teeth, and we are not addressing the source of the problem(s). Damage to tooth/teeth may be greater than anticipated. When the temporary restorations begin to break down there is no 'grace period' or there will be further damage & complications." --------- NOTE: At no time was I ever told that I have cavities that need to be filled. I believe what I was told is that I have some small surface pits/stains (or something like that). That was not news to me because other dentists have said similar things in the past, saying that such tiny cavities are so minor that they are not a concern and, therefore, require no treatment. I add this because I don't want anyone to misunderstand and assume that the statement "Removal of decay" that is listed above means that I have significant, visible cavities that need to be filled. Does that help clarify things? Or does that just raise more questions? Harry >> The statement on composite durability seems to place 15 year ceiling >> on their length of service. I have many composite restorations that [quoted text clipped - 51 lines] > >Does that help clarify things? Or does that just raise more questions? Time to get a second opinion in real life. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. |
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