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Medical Forum / General / Dentistry / October 2005Question re bone graft
[Not sure if I am spelling "graft" correctly] I have only one tooth on the lower left bottom, #18 (basically they pulled all my other left molars when I was 16 and I have lived many years without them, not knowing what I was missing...) So now #18 tooth is too far gone to save and has to be pulled (I got 3 opinions on this) leaving me with no lower left teeth at all. So I want to get implants but cannot afford them right now. I'm hoping I can afford at least 2 at some time in the future. So the oral surgeon who is going to extract that tooth next week, also does implants and bone grafts and he is telling me that it will be much easier if I get the bone graft now, when he pulls the tooth, as opposed to getting it later, when, he says, it would be more difficult "if not impossible". And that I need the graft to be done if I am going to get implants in the future. I really don't want to spend the money or pain on having the graft done now, but if it's true what he says, that it is much better to do it now, than to wait, then I will do it, especially since he says it will only cost me $400 extra if he does it. (I know a friend of mine who paid like $3000 for two bone grafts recently, so $400 seems like a great bargain.) My question is, Is this guy telling me the truth, that the graft is better to be done now, with the extraction of #18? Why might that be? I don't even know what a graft is, but it sounds painful and I'm not looking forward to it! >From what you know, (and I realize you cannot accurately answer this without looking at the xrays) is there a good chance he is right, that I should get the graft done now? If I do get it, will I have to get the implants soon, or could I get them, say, in a year or two, and just try a partial plate for now? > [Not sure if I am spelling "graft" correctly] > [quoted text clipped - 31 lines] > implants soon, or could I get them, say, in a year or two, and just try > a partial plate for now? Many surgeons will graft the extraction socket at the same visit as the extraction. These days, they usually use graft material from some other source--either demineralized real bone, or artificial bone, or a mixture of two. It shouldn't be more painful than if the socket were not grafted. There certainly is a chance that the additional bone gained by the graft will eventually disappear. Ask your surgeon for a reasonable time frame to place the implant to get the benefit of the graft. Steve  Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > Many surgeons will graft the extraction socket at the same visit as the >extraction. These days, they usually use graft material from some other [quoted text clipped - 5 lines] > >Steve So then exactly what is the difference between doing it at the time of the extraction or doing it later? Why does he say it can't be done later, or not as easily? So most would recommend that I do it with the extraction if I plan to get the implants later? And thanks for the reply. >> Many surgeons will graft the extraction socket at the same visit as the >>extraction. These days, they usually use graft material from some other [quoted text clipped - 14 lines] > > And thanks for the reply. It is easier to maintain a boney ridge than to build one up. The alveolar bone in which the teeth are set slowly resorbs after the tooth is extracted. By packing the socket with grafting material, is makes the remaining ridge more solid. This doesn't mean it will remain forever, but it will retard its resorption. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > It is easier to maintain a boney ridge than to build one up. The >alveolar bone in which the teeth are set slowly resorbs after the tooth [quoted text clipped - 3 lines] > >Steve Thanks, Steve, that makes sense, and reinforces what my oral surgeon was saying about it being better to do it with the extraction. He just did not explain why and I did not think to ask. >> It is easier to maintain a boney ridge than to build one up. The >>alveolar bone in which the teeth are set slowly resorbs after the tooth [quoted text clipped - 7 lines] >was saying about it being better to do it with the extraction. He just >did not explain why and I did not think to ask. Of course, my question to Steve and to others is where is this documented? Where are experiments, double blind studies showing the "packed socket" is more robust than the unpacked? My theory (unproven as is this one) is that there is no difference and no resorption differential. Hey guys! Its bone! Haversian canals, osteocytes, osteoblasts, and osteoclasts ...... Blood supply ...... its a tissue. It responds to EXTERNAL stimuli. This is why some bone is more robust and other bone is less robust. Bone density studies? We got them already. We do not need any Nobel Prize wizardry here. Want to see how simple it would be to test? Radiolabeled calcium will do that in a second ... well I mean in a couple of month study! Joel >>> It is easier to maintain a boney ridge than to build one up. The >>>alveolar bone in which the teeth are set slowly resorbs after the tooth [quoted text clipped - 27 lines] > > Joel I hope Dave will comment. I've seen enough evidence that grafting works as a pre-prosthetic procedure. Most commonly I've seen it to augment the upper anterior ridge, either to aid in fixture placement or to thicken up the ridge--either to allow placement of a wider fixture or to prevent dehiscence on the labial plate. This isn't new stuff, Joel... Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } >>>> It is easier to maintain a boney ridge than to build one up. The >>>>alveolar bone in which the teeth are set slowly resorbs after the tooth [quoted text clipped - 36 lines] > >Steve This topic, much like PRP, has its usefullness but not in every case. I do not routinely graft extraction sites. I have not seen much, if any, difference in the quality of bone if I place a fixture 10-12 weeks after the extraction or if I wait until an immediate graft has incorporated in the average cases. I have been burned worse by having all the clinical and radiographic signs of a well-healed grafted socket turn out to be an illusion when the fixture is placed. Nothing worse than a fixture that wont get snug. Never had that happen when the socket was left to heal all by its lonesome. In either case, I use the longest fixture that will fit regardless of what so & so says about implant length. Sometimes those sites left to heal without a graft require alittle help when the fixture is placed. In this instance, Puros and lamellar bone membranes mean digging for the fixture at second stage, darn near everytime. The upper anterior areas can be tricky but when I get the tooth out simply, I seldom have a problem with bone volume for any fixtures 3 months down the road. Dave > This topic, much like PRP, has its usefullness but not in > every case. I do not routinely graft extraction sites. I have not [quoted text clipped - 16 lines] > > Dave Thanks, Dave! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 JOel, Myocardial matrix metalloproteinases are released in heart failure and are responsible for the breakdown of the extracellular myocardial matrix. Based on past study, the current thought is that activation of myocardial MMPs contribute to adverse LV remodelling. This contributes to the progression of heart failure disease process. To my knowledge however, drugs that block the induction and activation of myocardial MMPs have not shown any initial benefits for HF patients.... I would have too look it up in the lit however. These may have not even been tested. Enbrel, a tumor necrosis factor-alpha antagonist actaully showed increased mortality in clinical trial of HF patients. Thus blocking this proinflammatory cytokine (apparent attempt to modulate the inflammatory response) did not benefit HF patients as was hoped. -Sue >JOel, > [quoted text clipped - 7 lines] >of myocardial MMPs have not shown any initial benefits for HF >patients.... I would have too look it up in the lit however. Me too! I am a little behind with my reading ........ quite fortunately, this is a relaxed, off-the-cuff talk site so no one will hold anyone else's feet to the fire about our unresearched opinions. In person, I am a little more cautious though! Joel >These may have not even been tested. Enbrel, a tumor necrosis >factor-alpha antagonist actaully showed increased mortality in clinical [quoted text clipped - 3 lines] > >-Sue Me too. It helps to write it out. I am getting away from this research now and forgetting a lot of it. Sorry to go off topic. The MMP topic just brought back some memories of a project that I was doing with an Italian group (Luigi Padeletti et al) . Unfortunately I do not think this research was ever published outside of some of the heart failure society meetings (HFSA, ACC, ESC, etc.). Oh well, Sue I appreciate that I have sparked some kind of controversy and discussion by my question; but really, guys, all I want to know is, "Should I get the graft done at the time of the extraction or should I wait until I start work on implants?" Again, my oral surgeon says it wouild be really beneficial to do it at the time of the extraction of #19. Let me further add that I have no other teeth back there on the left bottom. Once this tooth is pulled I have to get implants, but it's a matter of when I can afford them and if I can get UCLA dental school to do them or not (they have said they MUST do the whole mouth, not just one side and I am trying to convince them to just do one side.) >From what was said early on in this thread by Steve, it sounds like doing the graft now for $400 seems to be the way to go, that it is prudent. But then the waters got muddied and now Im not sure what the consensus is. If you can, please leave out the theoretical discussion and just give me a practical opinion: should I do the graft now or not? I appreciate your time. >I appreciate that I have sparked some kind of controversy and >discussion by my question; but really, guys, all I want to know is, >"Should I get the graft done at the time of the extraction or should I ANSWER: Oh boy. That is between patient and doctor. We are just the kibbitzers in this situation so you have better listen to your doc or find one you do trust. Joel >wait until I start work on implants?" Again, my oral surgeon says it >wouild be really beneficial to do it at the time of the extraction of >#19. Let me further add that I have no other teeth back there on the >left bottom. Once this tooth is pulled I have to get implants, but it's Reaisticially, are you going to come up with $10,000 in the next three years? Are implants a pipe dream here? Joel >a matter of when I can afford them and if I can get UCLA dental school >to do them or not (they have said they MUST do the whole mouth, not >just one side and I am trying to convince them to just do one side.) For get $10K, raise the fee a bit. >>From what was said early on in this thread by Steve, it sounds like >doing the graft now for $400 seems to be the way to go, that it is >prudent. But then the waters got muddied and now Im not sure what the >consensus is. The consensus is that you are not getting implants, you may be in line for dentures in the distant future. >If you can, please leave out the theoretical discussion and just give >me a practical opinion: should I do the graft now or not? > >I appreciate your time. >>>>> It is easier to maintain a boney ridge than to build one up. The >>>>>alveolar bone in which the teeth are set slowly resorbs after the tooth [quoted text clipped - 48 lines] >either case, I use the longest fixture that will fit regardless of >what so & so says about implant length. Thanks Dave. Thanks for your expert opinion ....... Joel M. Eichen > Sometimes those sites left to heal without a graft require >alittle help when the fixture is placed. In this instance, Puros and [quoted text clipped - 5 lines] > >Dave >>>> It is easier to maintain a boney ridge than to build one up. The >>>>alveolar bone in which the teeth are set slowly resorbs after the tooth [quoted text clipped - 36 lines] > >Steve Thanks Steve. I aprpeciate your suggestion that it may be effective. Joel >>>From what you know, (and I realize you cannot accurately answer this >> without looking at the xrays) is there a good chance he is right, that [quoted text clipped - 8 lines] > There certainly is a chance that the additional bone gained by the >graft will eventually disappear. Precisely. Resorption. Joel > Ask your surgeon for a reasonable time >frame to place the implant to get the benefit of the graft. > >Steve >[Not sure if I am spelling "graft" correctly] > [quoted text clipped - 10 lines] >does implants and bone grafts and he is telling me that it will be much >easier if I get the bone graft now, Hahhhhhhh! Get a go-o-o-oo-o-o-o-o-o-o-o-od general dentist to yank it out in 15 minutes. If you are short on cash you need the treat and not THE TREATMENT! $50 or $60 ..... that's the Delta Dental fee for this! Joel >when he pulls the tooth, as opposed >to getting it later, when, he says, it would be more difficult "if not [quoted text clipped - 7 lines] >paid like $3000 for two bone grafts recently, so $400 seems like a >great bargain.) REREAD what I wrote! >My question is, Is this guy telling me the truth, that the graft is >better to be done now, with the extraction of #18? Why might that be? I [quoted text clipped - 3 lines] >>From what you know, (and I realize you cannot accurately answer this >without looking at the xrays) REPLY Oh yes I can. I have psychic powers ........ >is there a good chance he is right, that >I should get the graft done now? If I do get it, will I have to get the >implants soon, or could I get them, say, in a year or two, and just try >a partial plate for now? No good Dude, unless you are missing teeth on both sides, this wil lbe a nightmare. A unilateral removable partial denture (replacing a few teeth on one side) often does more damage than good. Plus they are iimpossible to wear. Save up for the implant instead. Joel >Hahhhhhhh! > [quoted text clipped - 3 lines] > >$50 or $60 ..... that's the Delta Dental fee for this! Not sure what you mean above. I AM getting the tooth extracted, by an oral surgeon; the cost is $10 via my Delta Dental PMI. He is a teacher at UCLA Dental school so I assume he knows his stuff. But not sure what you mean that I "need the treat and not THE TREATMENT"...? Please clarify. >REREAD what I wrote! Which part? Clarification, please. >No good Dude, unless you are missing teeth on both sides, this wil lbe >a nightmare. A unilateral removable partial denture (replacing a few >teeth on one side) often does more damage than good. Plus they are >iimpossible to wear. Save up for the implant instead. This sounds right, this is what one implant specialist was saying, that they would not do just one side. But what if I get implants on the side with no lower teeth, and then a partial on the other side where there are only a few teeth missing? Wouldn't this work? See, the problem is I just cannot afford implants on BOTH sides. >>Hahhhhhhh! >> [quoted text clipped - 6 lines] >Not sure what you mean above. I AM getting the tooth extracted, by an >oral surgeon; the cost is $10 via my Delta Dental PMI. He is a teacher REPLY Ten dollars? What about the "bone grafting"? Is that part of the ten dollars or is it extra? Joel >at UCLA Dental school so I assume he knows his stuff. But not sure >what you mean that I "need the treat and not THE TREATMENT"...? Please [quoted text clipped - 14 lines] >where there are only a few teeth missing? Wouldn't this work? See, the >problem is I just cannot afford implants on BOTH sides. >>Hahhhhhhh! >> [quoted text clipped - 9 lines] >what you mean that I "need the treat and not THE TREATMENT"...? Please >clarify. $10 plus $400 equals $410. That's a "treatment" not a treat when it comes to yanking one tooth! >>REREAD what I wrote! >> [quoted text clipped - 10 lines] >where there are only a few teeth missing? Wouldn't this work? See, the >problem is I just cannot afford implants on BOTH sides. I appreciate your replying, but honestly I must be dense because Im still not following your "treat vs. treatment" comments. I don't understand the point you are trying to make there. Let me try again: I am seeing an oral surgeon to yank #18. My regular dentist sent me to him. He is going to pull the tooth for $10 because that is my Delta Dental PMI cost for extraction. However, he - the oral surgeon - says that he will do the bone graft at the time of the extraction, for an extra $400. He also said that if I do not do the graft at the time of the extraction it will cost more, be more difficult, and possibly not even possible, to do later. My question was, Is he being truthful about the fact that it is better to do the graft at the time of the extraction as opposed to waiting and doing it later; And the reason for my question is that I'm not SURE I'm going to be able to afford the implants within say 6 months. I am going to try to but am not sure I can. Therefore, should I go ahead and get the graft with the extraction even though I'm not sure I'll be getting implants within 6 months? Someone above answered that yes, it will be better to do the graft at the time of the extraction, but it depends on WHEN I will be getting the implants. Of course, the problem is I do not know when I will be able to afford them, or if I'll fore sure be able to get them at all. I am hoping to get them within a few months, but not sure... >I appreciate your replying, but honestly I must be dense because Im >still not following your "treat vs. treatment" comments. I don't >understand the point you are trying to make there. REPLY I humbly suggest that doctors need to back up their theories with hard science, not with the "a little additive couldn't hurt so it must help" attitude. Your insurance arranged an extraction for you for $10. Common sense will tell you this cannot be a sound business model. There are costs in the dental office. Every procedure takes time. When the American public gets smart, then we will have affordable dental care. I heard you are paying $410 not $10. Is this correct? Joel Sybron Dental Acquire Synthetic Bone Regeneration Product Line from Bioplant Sybron Dental Specialties, Inc., a leading manufacturer of value-added products for the dental and orthodontic professions and products for use in infection prevention, announced today that its subsidiary Kerr Corporation has purchased the Bioplant synthetic bone regeneration product line from Bioplant Products, Inc., a privately held biomedical company headquartered in South Norwalk, CT. The acquired Bioplant product line, which generated sales of approximately $2 million in 2003, is a material used to promote the regeneration of bone in an extraction socket. In this transaction, Kerr Corporation has purchased the inventory and manufacturing equipment related to this product line, and received the exclusive license to sell Bioplant in the dental market. Utilized in tooth implant and restoration procedures, Bioplant acts as a scaffold for new bone formation. In 2004, Bioplant was the only bone regeneration product to be named a Choice Product by Reality Publishing, a leading authority on products for the dental community. "We are very pleased to add another highly differentiated product that expands our offerings for restorative procedures," said Floyd W. Pickrell, Jr., Chief Executive Officer of Sybron Dental Specialties. "Bioplant has been recognized by leading industry researchers as the premier bone regeneration product available in dentistry, yet still has relatively low awareness in the marketplace. As we leverage the breadth and experience of our sales force to educate dentists about the superior qualities of Bioplant, we believe we can generate significant growth in this product line in the future. "We believe this transaction has many similarities to our highly successful acquisition of the Safe-Wave line of disposable air/water syringes in 2000. In that transaction, we acquired a single product line, transferred the production to our own facilities, and used our sales and marketing teams to generate double-digit sales increases of the Safe-Wave products each year. We are optimistic that we can use the same strategy and produce similar results with the Bioplant product line," said Mr. Pickrell. Sybron will finance the acquisition through the existing cash on its balance sheet. The Company expects the acquisition to be accretive within the first year of operations. For more information on materials used in dentistry, click here. Posted July 23rd, 2004 >Let me try again: >I am seeing an oral surgeon to yank #18. My regular dentist sent me to [quoted text clipped - 23 lines] >able to afford them, or if I'll fore sure be able to get them at all. >I am hoping to get them within a few months, but not sure... >I humbly suggest that doctors need to back up their theories with hard >science, not with the "a little additive couldn't hurt so it must [quoted text clipped - 3 lines] >will tell you this cannot be a sound business model. There are costs >in the dental office. Every procedure takes time. I am not concerned about the business model, that is for another thread. See my thread on Dental Insurance. >When the American public gets smart, then we will have affordable >dental care. See my thread on Dental Insurance. >I heard you are paying $410 not $10. Is this correct? Yes, so what? I am paying $10 for an extraction; that price is based on my insurance which I pay $30/month for, which is $360 a year, which entitles me to get certain procedures free, such as cleaning and xrays, and most other procedures at "discounted prices". But the bone graft is not covered by insurance, nor are implants, thus the $400 charge for the bone graft. See my thread on insurance. >>I humbly suggest that doctors need to back up their theories with hard >>science, not with the "a little additive couldn't hurt so it must [quoted text clipped - 11 lines] >> >See my thread on Dental Insurance. REPLY To save $40 you are tossing away $400. Joel >>I heard you are paying $410 not $10. Is this correct? >> [quoted text clipped - 4 lines] >graft is not covered by insurance, nor are implants, thus the $400 >charge for the bone graft. See my thread on insurance. >To save $40 you are tossing away $400. > >Joel Joel, no offense, but I hope you are a better dentist than communicator. You've said about 3 times something to the effect that I am throwing away $400 but have never explained clearly why you are saying that. Again, the $400 is for a bone graft that he wants to do at the time of the extraction; says it will be easier to do at that time, than to do it later. Are you saying he is conning me, that the bone graft is a waste of money? Or are you saying he's overcharging me for the bone graft? or just that I don't need one? If you are going to say these things you should explain what you mean. >>To save $40 you are tossing away $400. >> [quoted text clipped - 9 lines] >the extraction; says it will be easier to do at that time, than to do >it later. Why a bone graft? Are you firmly committed to an implant? Do you have the funds ready to go for it? If not why not make a package deal. Basically, I used to rip out an occasional tooth for a guy down the block who was destined for dentures. I felt sorry for him, low pay, big family ..... one day he got DENTAL INSURANCE but had to go elsewhere. His co-pay, that is his portion of the payment was almost three times what I charged him for a cash on the barrelhead deal. He caught on ........ fast. Joel >Are you saying he is conning me, that the bone graft is a waste of >money? Or are you saying he's overcharging me for the bone graft? or >just that I don't need one? If you are going to say these things you >should explain what you mean. >Why a bone graft? Because I plan to get implants within 6 months. >Are you firmly committed to an implant? Do you have the funds ready to >go for it? Yes, as long as I can get them done via UCLA or USC at a reasonable price. >If not why not make a package deal. The oral surgeon has already quoted me his "bargain" price of $9000 for 3 teeth implanted. I will not pay that. UCLA peridontic school will do 7 implants for +/- $10,000. The only problem is they have not yet said they will do it, they are waiting for me to first get a crown, a root canal, and 2 partial plates "in the meantime", and I am trying to talk them out of my getting the partial plates which would only be replaced by the implants, which seems a waste of money. Not sure why they are resisting committing to doing my implants but so far they have not said yes. >>Why a bone graft? >> [quoted text clipped - 4 lines] >Yes, as long as I can get them done via UCLA or USC at a reasonable >price. REPLY I am glad you mentioned that. In Philadelphia, the University of Pennsylvania charges MORE than many dental offices charge! I know one patient who got implants at Temple University in Philadelphia for a reasonable fee, but Temple University acted like a.ses when I later questioned the treatment. The implant itself broke halfway through the metal. YUP, sounds amazing but complications happen. I have x-rays if anyone is curious. OK, these things happen., What should NEVER HAPPEN is the stronewalling of the referring doctor! So tell us what is the implant pricing structure at UCLA or USC? Or are you just pipe-dreaming? If you have not inquired, why not? Remember, its your $400 not mine! Joel >>If not why not make a package deal. >> [quoted text clipped - 8 lines] >seems a waste of money. Not sure why they are resisting committing to >doing my implants but so far they have not said yes. >So tell us what is the implant pricing structure at UCLA or USC? Or >are you just pipe-dreaming? If you have not inquired, why not? >Remember, its your $400 not mine! See, there you go again with the attitude. What gives you this idea that I am pipe dreaming? What have I ever said here that leads you to believe I am pipe dreaming? I have done all the research, I have been to UCLA, I have gotten "estimates" from both my oral surgeon and UCLA periodontal school, and I can borrow the money if I so choose. The cost of 3 implants via my oral surgeon is around $9000 depending on how much bone grafting might have to be done. The cost of 7 implants via UCLA periodontal school is around $10,000 depending... I could "afford" them, but I just don't want to spend $9000 on 3 when I should be able to get the same 3 for about $4-5000 at the dental school. BUT the dental school won't do "just 3", even though my oral surgeon and endodontist recommended that to me; they (the school) insist on doing the whole mouth, and I really do not want to do the whole mouth (7 implants) all at once, I just want to do 3, then do the others later. But so far they (the dental school) are refusing to do that, which I think is very arrogant of them. In fact the oral surgeon (private practice) said that the dental school has a very "ivory tower" unrealistic attitude about doing the implants, rather than doing what the patient wants and needs, taking into consideration the patients' finances. The oral surgeon - trained at the same school - says he WILL do just 3. The problem is he will charge me 3 times as much. (so HE isn't taking my finances into consideration, either!) So I can't win. Also (and this is the real sticking point) the UCLA dental school insists that I get partial plates on BOTH sides first, before doing the implants. This makes NO sense to me, it's just a waste of money and time and pain and hassle. Why not get just a partial on one side - at most - and start with the implants right away on one side. But they are insisting I get the TWO partial plates first. When I ask WHY, they won't answer, they only say, basically, "Because I said so" with no explanation. I find them to be very arrogant in not being willing to explain things to me or answer my questions. Meanwhile I'm stuck with the student, and when I try to get to the Director to get my questions answered (and complain about the student's attitude) I get stone-walled. UCLA dental school pricing: http://uclasod.dent.ucla.edu/patientcare/index.asp?id=248 >>So tell us what is the implant pricing structure at UCLA or USC? Or >>are you just pipe-dreaming? If you have not inquired, why not? >>Remember, its your $400 not mine! >> >See, there you go again with the attitude. What gives you this idea >that I am pipe dreaming? Simple. I have not head this: "I have consulted with Dr. X, and I have in hand a pre-treatment estimate for $1,150 for implant and crown. They suggested that when I have the tooth removed, that I have Peri-Glas, or Stere-Oss, or blah, blah, blah, introduced into the socket." Similarly, When a plumber suggests that I hook up a new vent for the future family room that I MAY build on the back of my house, that is, if I EVER GET the money, and if I EVER GET motivated to do it, well if I am not buidling the room anyway, so one can forget the EXTRA VENT. Just fix the damn toilet I tell the plumber and forget selling me extras that I do not need. Joel > What have I ever said here that leads you to >believe I am pipe dreaming? I have done all the research, I have been >to UCLA, I have gotten "estimates" from both my oral surgeon and UCLA >periodontal school, and I can borrow the money if I so choose. So how much will the implant cost? _____UCLA _____USC >The cost of 3 implants via my oral surgeon is around $9000 depending >on how much bone grafting might have to be done. [quoted text clipped - 9 lines] >whole mouth (7 implants) all at once, I just want to do 3, then do the >others later. Ahahhhhhh. That's the old one where the new butcher sells ground beef for $2.99 a pound. CUSTOMER: "WhOT?? $2.99? My old butcher sells it for $1.99 a pound!" BUTCHER: "So why not go there?" CUSTOMER: "He is out of it today." BUTCHER: "Well when I am out of ground beef I sell it for $0.99 a pound!" >But so far they (the dental school) are refusing to do that, which I >think is very arrogant of them. In fact the oral surgeon (private [quoted text clipped - 21 lines] >UCLA dental school pricing: >http://uclasod.dent.ucla.edu/patientcare/index.asp?id=248 >Also (and this is the real sticking point) the UCLA dental school >insists that I get partial plates on BOTH sides first, before doing [quoted text clipped - 8 lines] >answered (and complain about the student's attitude) I get >stone-walled. I guess you cannot understand what is going on here. UCLA could extract the tooth also. There is not huge learning curve for removing teeth! You are being played. Joel >I guess you cannot understand what is going on here. Teach me, o master. >UCLA could extract the tooth also. There is not huge learning curve >for removing teeth! They suggested I get it done at UCLA OR at my private oral surgeon, whichever is easier/cheaper. It is easier for me to get it done at my oral surgeon (closer, much easier to get to). >You are being played. Played to what purpose? Tell me, O Master. >>I guess you cannot understand what is going on here. >> >Teach me, o master. Now yer talkin' Joel >>UCLA could extract the tooth also. There is not huge learning curve >>for removing teeth! [quoted text clipped - 5 lines] >> >Played to what purpose? Tell me, O Master. >>I guess you cannot understand what is going on here. >> [quoted text clipped - 6 lines] >whichever is easier/cheaper. It is easier for me to get it done at my >oral surgeon (closer, much easier to get to). And cheaper well even if you add in the $400 ...... >>You are being played. >> >Played to what purpose? Tell me, O Master. See above ..... how many Om Shantis did you say today? >>>I guess you cannot understand what is going on here. >>> >>Teach me, o master. REPLY This is a venue for discussions about the appropriateness of squirting bone into the open socket. Dave King kind of agrees with me. This is a venue for discussing changes in mRNA and molecular biology of the healing process. But in that venue, I am often talking to myself. Its a venue for describing some slightly shady business practices which of course have no place in dentistry. Yeah that's odd I know. Better to get polyester pants, a white belt, go to dinner theater, play golf and off to the Bahamas for the winter! Hey that is NOT ODD, that's NORMAL. So be it! You asked for more ideas .... you got 'em. Joely >>>UCLA could extract the tooth also. There is not huge learning curve >>>for removing teeth! [quoted text clipped - 10 lines] > >See above ..... how many Om Shantis did you say today? > But so far they (the dental school) are refusing to do that, which I > think is very arrogant of them. In fact the oral surgeon (private [quoted text clipped - 5 lines] > HE isn't taking my finances into consideration, either!) So I can't > win. Do you understand why the school is doing this yet ? It has to do with a proper learning environment for the students, not with conforming to compromises in care dictated by patients. I am not trying to be rude here. I would be happy to discuss it further if you like. Signature/ Amatus / > >>So tell us what is the implant pricing structure at UCLA or USC? Or [quoted text clipped - 46 lines] > UCLA dental school pricing: > http://uclasod.dent.ucla.edu/patientcare/index.asp?id=248 >> But so far they (the dental school) are refusing to do that, which I >> think is very arrogant of them. In fact the oral surgeon (private [quoted text clipped - 10 lines] >compromises in care dictated by patients. I am not trying to be rude here. >I would be happy to discuss it further if you like. Yes, I understand they are insisting on doing it "the perfect way", not the practical way. But tell me: 1) why do they refuse to answer my questions (such as WHY do I need 2 partial plates instead of 1, before starting the implants)?, etc. and 2) why, when I told them, "Fine, do the entire mouth AS YOU ORIGINALLY SUGGESTED", they still will not say, "Fine, let's start", they still say "Go get the 2 partial plates and then come back" My main issue with them, is why do they refuse to explain reasons for things to the patient? Isn't explaining things to the patient also part of the learning process? Why do I need 2 partial plates before starting implant therapy? Why not just one while the other side is begun? > But tell me: > 1) why do they refuse to answer my questions (such as WHY do I need 2 [quoted text clipped - 5 lines] > SUGGESTED", they still will not say, "Fine, let's start", they still > say "Go get the 2 partial plates and then come back" There is _NO_ reason not to explain things to the patient so that the patient can understand. Communication is very important. Unfortunately, Some patients do not realize how much they themselves need to understand and ask for more details than can be explained in less than three years. The tough part is finding the right compromise where the patient is informed without being over-whelming. Personally, I do not like to work up an implant case until I have a recent set of dentures which would work well if they would stay in place. I, then, can use the this set of dentures to determine the proper placement of the implants, and the patient gets to use these appliances while the implants are healing. Signature/ Amatus / > >>> But so far they (the dental school) are refusing to do that, which I [quoted text clipped - 31 lines] > starting implant therapy? Why not just one while the other side is > begun? >There is _NO_ reason not to explain things to the patient so that the >patient can understand. Thank you. That has been my stance. > Communication is very important. Unfortunately, >Some patients do not realize how much they themselves need to understand and [quoted text clipped - 7 lines] >implants, and the patient gets to use these appliances while the implants >are healing. Thank you for FINALLY giving me an explanation. Actually the (private practice) oral surgeon I just went to today, to get #18 extracted, explained that to me. But the woman student at UCLA never explained that, after my having sent faxes and leaving messages for her to answer that question. My dentist simply told me, "They prefer that you get dentures first, to see how they fit, and sometimes you may decide you don't need the implants after all, you can just live with the partials". All the UCLA implant student/dentist had to do was say what you just said: "I do not like to work up an implant case until I have a recent >set of dentures which would work well if they would stay in place. I, then, >can use the this set of dentures to determine the proper placement of the >implants, and the patient gets to use these appliances while the implants >are healing." But until you today, no one ever answered that question. Very poor communication skills, I'd say, and I think UCLA should do better than that in teaching their students about answering their patients' questions. I'm going to call and talk to the Prof/Director about that. " Jim, I am sorry I cannot answer for them. I would not feel comfortable going to anyone that refused to answer my questions. When I was younger and literally could not afford much, I would not ask questions and simply go the cheapest.... or go without. I think you are doing things right by doing your homework before making your decision. Yet I stand by my suggestions. For something as expensive as this, as well as something that is this important to your overall health and well-being, I would at minimum, get all of these questions answered: .... in person by clinician(s) that can see you mouth. Once my questions were fully answered by someone in person, then I would decide who is going to do the work. This may indeed end up being UCLA.. or perhaps not. I am sorry I cannot give you any technical advice or make your decision for you. Maybe I am particularly anal-retentive about this, but that is how I have come to view my health now: I am repsonsible for maintaining it. I make my own choices based upon ALL of the information I can find. Finally: I pay for it. Healthcare providers help me to maintain my health... but I am ultimately the true gatekeeper. I hope this makes sense and is not insulting to either you and/or the professionals on this board. Sincerely, Sue > Jim, > [quoted text clipped - 33 lines] > > Sue Hi Jim, FFS = Fee For Service FFS means an office that does not set their fees based upon what insurance companies dictate. This does not necessarily mean that your insurance is not good for anything at a FFS office though. Most FFS offices will process your insurance and the portion that ins pays is deucted from your bill. However they simply do not set their fees based upon what the insurance company determines as UCR. (dentist here please define this acornym). I believe UCR is "usual and customary reimbursement" or something like that. I can undertsand feeling like many dentists are out to take advantage of unsuspecting patients... as there are so many ads out on the internet ...marketing TO dentists... ...like on how to become the "profitable dentist" ...or for example, the book "The profitable hygienist" These sorts adverstisement by people and companies helping dentists to become more "profitable" understandably can put some of the public ill-at-ease when it comes to gaining trust with their dental provider. Try to look past that and just realize that dentistry is a business. They make a profit just like any other business. (That is the way I view the industry today anyway). In the same token, realize there are ethical businesses and unethical businesses. Thsi does not mean that all dentists are "shysters." I hope my views do not confuse you more. These are simply my own views as nondental professional. Bottomline: Do not do anything until you are comfortable in your decision. Good luck. It is a big decision! Sincerely, Sue > However they simply do not set their fees based upon what the insurance > company determines as UCR. (dentist here please define this acronym). UCR = Arbitrary Fee Ceiling set by the insurance carrier based on the premium dollars the employer is willing to spend. Signature/ Amatus / > Hi Jim, > [quoted text clipped - 41 lines] > > Sue UCR = Arbitrary Fee Ceiling set by the insurance carrier based on the premium dollars the employer is willing to spend. -- / Amatus Thank you Amatus. I was not sure if what I was saying was entirely correct about UCR. I was just stating my layviews from what I understand after peeking in at DT. Before DT, I had no idea that there even was such a thing as UCR.... and I had never heard of FFS either. Thanks for your clarification and patience. I hope this thread is helping Jim find the answers that he needs in order to feel comfortable with his treatment decisions. Sue > UCR = Arbitrary Fee Ceiling set by the insurance carrier based on the > premium dollars the employer is willing to spend. I like it. UCR is "usual, customary, and reasonable". What is arbitrary is whether they want to define this as the 90th percentile in 2005 or 1974. Steve > -- > / [quoted text clipped - 12 lines] > > Sue SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 UCR is "usual, customary, and reasonable". What is arbitrary is whether they want to define this as the 90th percentile in 2005 or 1974. Steve LOL. The truth comes out. The insurance companies are a little behind the times! Perhaps their own fees should be adjusted to 1974 rates. :-) Sue PS About Joel. He may come across funny... but he always has the patient's best interests at heart. If anything he is more cycnical about dentists than most patients are (IMHO)... Although his cynicism seems a tad overboard to me sometimes, since he is a dentist who has many years of experience, his opinion should be taken with more than just a grain of salt. I don't think he is only just trying to make fun or argument... I think he being sincere here. (sometimes it is hard to tell) JMO. Sue PSS I fogot about JD. Joel has the patient's best interests at heart... unless you are Jan Drew. He is not very nice to Jan. >PS About Joel. He may come across funny... but he always has the >patient's best interests at heart. If anything he is more cycnical [quoted text clipped - 8 lines] > >(sometimes it is hard to tell) Sometimes it IS hard to tell, and that's the problem with him; personally I don't come here for sarcasm and cynicism, I come here for clear simple advice or information. It doesn't do a lot of good to "have the patients' best interest at heart" if you do not give them the info and advice they are asking you for. You, and several other people did give me that advice and info and I appreciate that. Thank you. Sometimes it IS hard to tell, and that's the problem with him; personally I don't come here for sarcasm and cynicism, I come here for clear simple advice or information. It doesn't do a lot of good to "have the patients' best interest at heart" if you do not give them the info and advice they are asking you for. You, and several other people did give me that advice and info and I appreciate that. Thank you. Joel... are you listening? Sarcasm is ok with us... but for patients in pain and/or in worry... not ok. Meant only in a good way to you JoelY, Sue Jim, I understand your frustration with Joel. His communication style frustrates a lot of people. He can come across too casual and humorous when a patient is seriously looking for concise and succinct answers. Here is something that you should know about Dr. Eichen however. He is very concerned about the rising costs of dental procedures. These seem to becoming astronaumically expensive for many families. Joel is currently in the process of setting up a low cost dental implant clinic (located in Philadelphia). This is the absolute truth! I just had to add that.. even though it does not impact your current situation. Please keep us updated on your progress, if you will. Good luck! Sincerely, Sue >Here is something that you should know about Dr. Eichen however. He is >very concerned about the rising costs of dental procedures. These seem >to becoming astronaumically expensive for many families. It's because JME is stuck in the 60's ... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Sometimes it IS hard to tell, and that's the problem with him; >personally I don't come here for sarcasm and cynicism, I come here for [quoted text clipped - 12 lines] > >Sue OMG I forgot that somebody is Sue! SOME BODY!! >>PS About Joel. He may come across funny... but he always has the >>patient's best interests at heart. If anything he is more cycnical [quoted text clipped - 16 lines] >people did give me that advice and info and I appreciate that. Thank >you. COMPROMISE: How about if I just listen and others can chime in and advise you ..... Joel >PS About Joel. He may come across funny... but he always has the >patient's best interests at heart. If anything he is more cycnical [quoted text clipped - 8 lines] > >(sometimes it is hard to tell) Actually you are correct. I believe in giving someone a fishing pole rather than give him a fish. Metaphor: This means give someone the tools to make future decisions ....... >JMO. > >Sue >>(sometimes it is hard to tell) > [quoted text clipped - 3 lines] >Metaphor: This means give someone the tools to make future decisions >....... What about 'bait' (and switch) ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Hi Jim, > [quoted text clipped - 41 lines] > >Sue Thank you, you have been very helpful. As to "shyster dentists" who might be on this board, or might not, I say "if the shoe fits, wear it". I have no problem with dentists making a fair profit and running their business such as to make money. I DO have a MAJOR problem with dentists pushing un-needed procedures on people. An example: One dentist I went to insisted my wife and I both needed "deep cleaning and scaling" or whatever it is called, at a cost of around $100 each. It so happened that I switched dentists and asked that dentist about it and he said "No, you don't need that". Another time my wife just had her teeth cleaned at one dentist, then we went to another dentist and that dentist said she needed to have her teeth deep-cleaned. So the only "need" was the dentist needing to make a payment on his 2nd BMW. I'm not in any way saying all dentists are crooks, many are not, and I'm sure those helpful people here (you know who you are) are not. But the fact is, many are one step above used car salesmen and it just adds another layer of fear to going to the dentist. Now you have to also fear getting fleeced. > An example: > One dentist I went to insisted my wife and I both needed "deep > cleaning and scaling" or whatever it is called, at a cost of around > $100 each. That is the typical HMO bait-and-switch tactic. The dental office only gets about $120 a year from the HMO and MUST provide all your covered services out that money. Most dental office cost $200 and hour to stay open. So, the offices in the HMO plan usually will resort to only offering non-covered procedures. If they did all the work covered by the plan, they would be out of business. I am not defending those office, since I don't believe any dental office should ever participate with a plan that is designed to make the insurance company rich, save the employer lots of money, and screw both the patient and the dentist. You are expecting good treatment through an HMO plan, and that will never happen. Signature/ Amatus / > >>Hi Jim, [quoted text clipped - 71 lines] > adds another layer of fear to going to the dentist. Now you have to > also fear getting fleeced. Jim, I am glad you have found answers to your questions. I am also sorry that you need $10,000 worth of work. That is quite a bit of tooth loss you have there. Luckily there is technology available today that is better than dentures (if you choose to purchase it). Too bad it costs more, but coming from a technology company I know all the work that goes behind these developments... and these efforts do not come free, unfortunately. (or perhpas that is fortunately for me, because that is how I make my living) I must agree with Amatus on the dental student. I don't think one can expect the same level of maturity, confidence and communication skills that a dental student posesses as compared to an established oral surgeon. One of the reasons universities charge less for the work done there is that these are only students. Oh well. Chalk it all up to doing your research and homework. Best regards, Sue >I'm not in any way saying all dentists are crooks, many are not, and >I'm sure those helpful people here (you know who you are) are not. But >the fact is, many are one step above used car salesmen and it just >adds another layer of fear to going to the dentist. Now you have to >also fear getting fleeced. I am happy ... thanks. >>Good luck. It is a big decision! >> [quoted text clipped - 5 lines] >As to "shyster dentists" who might be on this board, or might not, I >say "if the shoe fits, wear it". And I say if the shoe fits, I'll kick your a.s... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Jim, > [quoted text clipped - 33 lines] > >Sue Thanks Sue, nothing insulting about it at all. I was just looking for answers to reasonable questions, nothing more, and my UCLA dentist was refusing (or unable??) to answer it. I got my answer today at my oral surgeon (private practice), and someone on this board. I think the UCLA dental school is doing a pretty poor job of teaching their students how to communicate with patients. Makes me wonder what else they are failing to teach well... > I was just looking for > answers to reasonable questions, nothing more, and my UCLA dentist was > refusing (or unable??) to answer it. I got my answer today at my oral > surgeon (private practice), and someone on this board. I think the > UCLA dental school is doing a pretty poor job of teaching their > students how to communicate with patients. Please don't take this wrong, as I could be all wet on this one. But your tone of _voice_ in your postings has come through as an angry person. I know that newsgroup messaging does not allow raised eyebrows, slight smiles, etc, to show through, so it might not be accurate. However, if you came off as seeming angry or difficult to deal with, the dental student may not have had the life experience to deal with you. Rather than slowing down to see what lit your fuse, she may have reacted by trying to spend as little time with you as possible, therefore, not giving you any details and not returning your calls. She might have preferred you went elsewhere. I am not defending such behavior, but trying to explain where it can sometimes come from. Communication skills are learned through life experiences. Signature/ Amatus / > >>Jim, [quoted text clipped - 41 lines] > students how to communicate with patients. Makes me wonder what else > they are failing to teach well... >> I was just looking for >> answers to reasonable questions, nothing more, and my UCLA dentist was [quoted text clipped - 14 lines] >not defending such behavior, but trying to explain where it can sometimes >come from. Communication skills are learned through life experiences. I agree. I got the impression she took exception to my questions and got all defensive when all I was trying to do was get my questions answered. From my perspective I had a right to know WHY she was insisting I get partial dentures before getting implants. I was not saying she was wrong or that I would not do it, I was simply asking why. The simple answer you gave me, that it helped to see how to fit the implants, was excellent, and satisfies me. Had she said anything like that, I would have said, "Oh, I see; thank you. What's the next step?" But her not answering my question over the course of 2 very clear phone messages and 2 even more clear faxes I left for her (and her leaving me 2 messages on my phone, neither of which ANSWERED that question at all) did make me very frustrated. Since you seem to be a very reasonable and helpful person, let me ask you if you find this fax insulting or angry. (I faxed because in her first phone message in which she did not answer my questions, she said "if you can give me a more detailed message as to what it is you want to know, I'll answer your questions") So I thought a fax would be helpful to her, even though I'd already left a clear phone message: "I am writing about my appointment of [date] and I have a couple of questions. You said in your phone message you wanted a detailed message as to what I wanted to talk to you about. Hopefully this will suffice. PLEASE fax me back or call me back with a reply. If you cannot reach me please let me know when is the best time to reach you. You said I needed to get my #18 tooth extracted and partial plates before you would consider getting any implant work done. I am getting the extraction done next week. My general dentist referred me to an oral surgeon, [name], to get #18 extracted. He said several things of interest, one of which further complicates my situation. He said that he too thought I should get implants and that if I cannot afford to get both sides done, one side is better than none. He said that when he extracts #18 he could also do some bone grafting to prepare it for implants. But he also said that by choice, he would begin with the OTHER side as far as implants, as it would be easier and would give me something to chew with. He suggested that since I am accustomed to not chewing with my left side, I could withstand it a little longer until I could eventually also get implants on the other side. I was wondering if you concur that I should go ahead and get the bone graft done on the left side, now. Is there an advantage to doing so if I plan to get implants in the future? But are we even sure I CAN get implants on the left side? Frankly, if I can get them done via UCLA I would rather just have you do the bone graft too, unless there is an advantage to getting it done when the tooth is extracted. Is there? Please answer this, because I need to know before I get the tooth extracted, maybe as early as this coming Tuesday. He would charge me around $9000 to do just the implants (3) on the right side, for now. I cannot afford that, so once again I am asking you for your help. If I get a removable partial denture on the right side - where, as I understand it, a partial would work better, because there are teeth to anchor it to - and if I get the crown and possible root canal done on #30, will you then consider doing implants on the LEFT side? I can pay 3-4,000 dollars for implants on the left, but cannot afford to pay $9,000 for implants just on the right. So if I get the work done on the right side - the crown, the partial plate - then will you consider doing the implants on the left side? Then, in the near future after that, I would also get the right side implants done if I can get them through UCLA where it won't require me to take out major loans. And is there any reason I should get the bone graft now instead of later? Also, I do not understand the logic in getting a partial plate on both sides, if one side is only going to be replaced by implants in the near future? Seems like a waste of money. But I will do it if that is what you require of me in order to do the implants. Please advise. Thank you for your time." *************************** NOTE that I SPECIFICALLY asked whether I should get the bone graft at the time of the extraction or not; and that I specifically asked why the partial plates were necessary. But when she called me back she did not address either of these questions nor any other of the issues brought up. She only said "I stand by my treatment plan as I originally gave it to you". And although I told her specifically when she could reach me at home, and I know for a fact she came into work during that time so she could have called me before starting work, she chose to call me outside the times I gave her so as to avoid talking with me, and just left a message instead which did not at all address my questions. I never acted angry with her in person, raised my voice or in any way disparaged her. I am curious. Did my fax make her Justifably angry? Did I say something out of line? Do I seem like a difficult person to deal with, from this fax? She probably had PMS. Just kidding (sorry). I think she is: #1- Not as knowledgable as your oral surgeon #2- Not as confident in her communications with you (too sensitive and perhaps more easily imitidated) Just guesses though. ... and I know you were not asking me. Your fax seems reasonable enough to me... polite... and not inflammatory. I would not worry too about your demeanor. I think this may just be a matter of speaking to a "kid" versus an established professional.... JMHO -Sue >She probably had PMS. Just kidding (sorry). They all get Practice Management Software ....... >She probably had PMS. Just kidding (sorry). > [quoted text clipped - 15 lines] > >-Sue Thanks for the feedback Sue. I was beginning to think I must be a real a-hole. (I expect Joel to chime in here and say that I am.) But she isn't that much of a "kid". Remember that this is periodontal school. Correct me if I'm wrong, but aren't the people in periodontal school already practicing dentists? In any case, she appeared to be at least 30 or so... Old enough that she should know how to communicate and answer simle direct questions - or find out the answers from her prof and get back to me... >>-Sue >Thanks for the feedback Sue. I was beginning to think I must be a real >a-hole. (I expect Joel to chime in here and say that I am.) Not at all. You are an intelligent guy who has been rebuffed in the real world by too few answers, and kind of overloaded here with too much information! Joel > But she isn't that much of a "kid". Remember that this is periodontal > school. Correct me if I'm wrong, but aren't the people in periodontal > school already practicing dentists? In any case, she appeared to be at > least 30 or so... Old enough that she should know how to communicate > and answer simple direct questions - or find out the answers from her > prof and get back to me... She will still need to have any changes in treatment plan approved by "higher-ups". She may be specializing in an effort to compensate for poor communication skills in private practice. I was 30 when I graduated from dental school. Most of the students are 26-28 at graduation. Many students go directly into specialty school with out ever being in private practice (often with a 1-3 year residency in between). I congratulate you if you can tell the age of a person under 35. I find those people look so young to me now, that I cannot tell how old they really are anymore. Signature/ Amatus / > >>She probably had PMS. Just kidding (sorry). [quoted text clipped - 25 lines] > and answer simle direct questions - or find out the answers from her > prof and get back to me... > NOTE that I SPECIFICALLY asked whether I should get the bone graft at > the time of the extraction or not; and that I specifically asked why [quoted text clipped - 12 lines] > something out of line? Do I seem like a difficult person to deal with, > from this fax? Please do not consider a dental student like someone at work. It is not the same. The dental student is obligated to be the classroom during specified time periods with no excuses allowed. There are other times, when mandatory meetings must be attended. Then, there is the clinic time which is spent in many disciplines for long periods of time. During the students clinical time, they are not allowed to go to the phones to call people unless they have no patient to treat. They are expected to get all their telephone calls completed after clinic is over. It may be very difficult for this person to call you during the times you specified. It is also possible that she is avoiding you. Just keep an open mind and remember that dental school does not operate like a dental practice. Now, the student should be able to answer your questions from a scientific point of view, _BUT_ she is not allowed to change a treatment plan. Treatment plans in the dental school are determined by consultation between the student and various department heads. Often 3-4 different dentist-professors will need to sign off on a single treatment plan. This is done so that the student looks at every treatment plan from a multi-disciplinary approach. To change your treatment plan (at the school), she would have to arrange a consult with the dental specialists involved in the original diagnosis and planning of the case. It may take a week to arrange this. Things do not move quickly in the dental school. I personally prefer to see all the missing teeth replaced with a removable prosthesis prior to finalizing an implant treatment plan. With only one side being fabricated, the dentist cannot evaluate your occlusion dynamically while you function. Most patients missing back teeth for a while will have had their teeth shift. Often, the back teeth will lift (or drop if upper) searching for their counterpart to chew against. To restore your mouth successfully, would require re-shaping things to achieve a harmonious plane of occlusion. If this "plane of occlusion" is off, the implants will be subject to lateral forces greater than they can withstand. Also, having some teeth on the other side to share chewing take some of the burden off the implants during the early stages, so that healing can proceed better. I don't think your fax was rude or angry. After having been in practice for over 20 years, I would see something like that message as a warning that the patient will require higher maintenance to satisfy. That can significantly effect fees, and treatment plan. Any compromises on a "finicky" patient will surely come back to haunt the dentist later. Again, I am not trying to insult you, only passing on observations and trying to transmit what goes on in _our_ heads. Remember that above all, you are dealing with a young person who has not gotten out in the "real" world yet and lack the lifetime experiences which lead to better communication skills. Hell, there are still plenty of times where my communication skills are lacking. Signature/ Amatus / > >>> I was just looking for [quoted text clipped - 118 lines] > something out of line? Do I seem like a difficult person to deal with, > from this fax? Thanks for your honest opinion and insight into the dental student's processes. I suppose I am being defensive here, but I will say that I don't think I was high maintenance at all - and usually am not - until she refused to answer my simple questions; not even an attempt to answer them. THEN I became "high maintenance" only to demand the answers I was seeking and felt I deserved. Had she answered my questions in the beginning, it would have been over; no calls or faxes would have been ncessary. Remember, she STILL has not answered me and at this point I am going to talk to her director/prof re being re-evaluated by him or someone else. As to the process of the Treatment Plan, this is how I saw it go down. Maybe something else went on behind the scenes, but this is how I think it went: She (the student) herself made all the decisions about my treatment plan. I gathered that she is a highly regarded student and pretty much trusted to do her own thing. She told me about needing ALL the implants and I asked her if this was really required, if perhaps I could just get one side now and one side later. She said she would ask the Director. The Director was busy operating on someone and as far as I could tell he didn't even look at her plan or my mouth, he just "signed off" on what she was saying because he was too busy to examine it, and trusted her judgement. She came back and told me he agreed with her. She told me to get partial plates and at that momeny I was overwhelmed with much info re implants and bone grafts and root canals and crowns and such, and it did not occur to me at that moment to ask "WHY do I need partial plates if they are only going to be replaced soon with implants?" Thus was born the problem, as she refused to answer that question via phone or fax. Also the question about whether or not I should get the bone graft at the time of oral surgery, or get it later? NO answers. I do not object to getting partials IF IT MAKES SENSE, which now I see maybe it does. And I am even willing to consider getting ALL the implants if I have to in order to get the school to do them, as it makes more sense to pay $10k for 7 implants than to pay $9k for 3. However now I feel they see me as a "problem patient" and will not deal with me. All because this idiot woman student would not answer my simple questions and I had the audacity to keep pushing for an answer. I appreciate your feedback, and I probably am a bit high maintenance as a patient, especially when I perceive that it is the only way I can get good service. I would add however that I am not high maintenance if I see that the office conducts themselves professionally and I feel I am getting good service. But yes, I demand good professional service. If that's a problem for a dentist then I probably should go elsewhere. > However now I feel they see me as a "problem patient" and will not > deal with me. All because this idiot woman student would not answer my > simple questions and I had the audacity to keep pushing for an answer. You concerns may be valid. Remember I only get hear one side of the story. I suggest you simply contact the student and explain your dilemma, your online discussions here, and what you want to achieve. Ask, how you can work together to meet your goals. Be up-front about your problems up to now. Odds are, that will spur better and fresher communication. Signature/ Amatus / > > Thanks for your honest opinion and insight into the dental student's [quoted text clipped - 53 lines] > service. If that's a problem for a dentist then I probably should go > elsewhere. >> However now I feel they see me as a "problem patient" and will not >> deal with me. All because this idiot woman student would not answer my [quoted text clipped - 6 lines] >work together to meet your goals. Be up-front about your problems up to >now. Odds are, that will spur better and fresher communication. I was thinking more along the lines of talking with her prof/director and asking to be re-evaluated by someone else or have the director review my case with the knowledge that I have already taken the first step - getting #18 extracted, and that I already have an appointment for the root canal and crown work she recommended before coming back for implants. I really do not want to work with the original woman student unless I have to. I found her to have a very poor attitude; and I imagine she feels the same about me. Jim wrote: I really do not want |
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