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Medical Forum / General / Dentistry / December 2005crown replacement - does this make any sense??????
i recently broke an old crown on a molar, and am in the process of getting it fixed i liked and trusted my old dentist but because of insurance reasons i had to get a new dentist and i'm not sure this new dentist has my best interests at heart - i think he may be cutting corners on me to save himself costs, but i'm not sure and am curious what people up here think as per usual crown proceudres he drilled down the existing tooth to prep it for the new crown, took impressions etc but instead of then fitting me with a temporary crown for the interim 2 weeks while the new crown is being made, he said "this will be easier for you than a temporary crown" and simply filled in the remaining stump of my tooth with white dental cement stuff so what i have now is my stump of a tooth, the hollowed center with some cement in it, my gums very raw around the outside of the tooth, pain while chewing both occasionally from the tooth itself and even more so from food that keeps hitting the gum area around my tooth which is already mashed up somewhat from the procedure chewing is difficult and i am having trouble eating, the tooth is sensitive to hot/cold & sometimes pressure while eating food keeps getting stuck in the gap between the crownless tooth and the tooth in front of it, making the area more & more sore shouldn't i have a temporary crown protecting all that? protecting the tooth itself??? giving me something to chew on? protecting the already super sensitive and cut gums next to the tooth? and isn't a purpose of a temporary crown also to keep the gumline down until the actual crown is ready????? are there any circumstances where NOT putting on a temporary crown makes sense?? if in my place, what would you do in this circumstance? grin and bear it? go back & ask that a temp crown be put in, but in doing so risk alienating the dentist & having him treat you with disdain & not really care about doing a good job from then on, or even worse, perhaps HURT YOU ON PURPOSE in order to make the point of "i told you it would be better to not have a temporary crown put in!!!" i'd like to trust this dentist and give him the benefit of the doubt but this is all weighing heavily on my mind thanks for any opinions > I liked and trusted my old dentist but because of insurance reasons I > had to get a new dentist This is what happens when you go to the office "preferred" by the insurance carrier. Why do you think the insurance plan prefers this office ?  Signature/ Amatus / >i recently broke an old crown on a molar, and am in the process of > getting it fixed [quoted text clipped - 47 lines] > > thanks for any opinions > > I liked and trusted my old dentist but because of insurance reasons I > > had to get a new dentist > > This is what happens when you go to the office "preferred" by the insurance > carrier. Why do you think the insurance plan prefers this office ? Sorry i wasn't clear on this point, but actually it is a little more complicated than just the insurance reasons, but it isn't simply a case of an insurance plan telling me to go to this guy instead of my previous dentist. - I am not currently working and lost my group dental coverage which my old dentist participated in - My crown broke 2 days b4 thanksgiving and i was in agony with eating problems, my tongue was getting cutup by the rough surface of the crown, the tooth itself was extremely sensitive to hot/cold etc etc etc - I actually tried to get an appointment with my old dentist but he could not see me for over a week!!! So i decided to try to find a new dentist, one that could hopefully see me last week. And at the same time also decided to get new dental coverage to help me defray the costs that i would be incurring . So i joined a discount dental plan in my area, and went to a dentist nearby who could see me the quickest, who was a member of the plan. I am still not sure what to do about my existing situation but i am not particularly happy with this dentist & will try a different dentist in the plan next, as i need other dental work done as well. Not having dental coverage I have neglected my teeth (bad move). This all leads into the topic of "how to choose a new dentist?", and i do have recommendations for others that are actually in the plan, and i did try them first last week, but again, because of the holidays all were either closed or backed up!!! So i went with this guy simply because he was available, and in general I assumed that most dentists are honest, competent, trustworthy, etc. Which leads me to ask - Amatus' comment of " Why do you think the insurance plan prefers this office?" suggests that insurance plans will steer you towards substandard dentists!! Ones that cost less, work less thoroughly, cut corners, or something of that nature - am i naive in thinking that that should not be the case? > So I joined a discount dental plan in my area, and went to a dentist > nearby who could see me the quickest, who was a member of the plan. Mistake > Which leads me to ask - Amatus' comment of " Why do you think the > insurance plan prefers this office?" suggests that insurance plans will > steer you towards substandard dentists!! Ones that cost less, work > less thoroughly, cut corners, or something of that nature - am I naive > in thinking that that should not be the case? IF you think the insurance carrier prefers these offices for any reason other than saving themselves a lot of money, you are being fooled. If it costs the body shop $350 to buy new parts for your car and the average mechanic takes three hours at $30 an hour to install them, but your insurance carrier sends you to someone ho will do it for $85, would you be suspicious ? Signature/ Amatus / >> > >> > I liked and trusted my old dentist but because of insurance reasons I [quoted text clipped - 43 lines] > less thoroughly, cut corners, or something of that nature - am i naive > in thinking that that should not be the case? amatus wrote: IF you think the insurance carrier prefers these offices for any reason other than saving themselves a lot of money, you are being fooled. <<< i don't think that applies to my case - but i understand your point i joined a discount dental "plan"; it is not "insurance" per se dentists in the plan agree to charge the patients a "discounted rate" for the work, i think they call it the "PPO" rate? the plan itself doesn't pay the dentist directly for the various tasks? i don't understand how it works, perhaps the dentist gets some sort of stipend from being a member of the plan, or makes $$ primarily from attracting new patients he would not otherwise get, then profits more off certain procedures than others etc all i know is that the plan has something like 1500 participating dentists in my area; and at least a few of them are ones used by people i know who are happy with their dentists, so i had hoped this dentist would be in that category but perhaps i made a mistake in choosing this dentist simply because his office was open for business last friday and was able to see me - i naively gave him (& all dentists) the benefit of the doubt and assumed all would be good/honest/trustworthy/etc until proven otherwise as a patient i am stuck between a rock and a hard place - i cannot afford the cost of dental procedures without some kind of offsetting price discounts or insurance reimbursements - i have to use a dentist who participates in some kind of plan accessible to me i don't see this as a situation of an insurance carrier sending me to someone who charges much less to do the same work though which seems to be the point you've made i guess i am naive and don't understand the ins/out of insurance, dental plans, good dentists, bad dentists, dentists who cut corners, dentists who care about their patients, who don't care about them, what financial pressures the dentists are under themselves etc i'm just a patient!! > I joined a discount dental "plan"; it is not "insurance" per se Sorry, but that is even worse. Google backwards for Ameriplan on this NG. The plan does not pay out one cent to anyone. The plan simply keeps all the money. They only provide a list of doctors who agree to accept the ridiculous fee in exchange for being on the list. Study the list very carefully, and you will find that the 1500 listings are actually the same names repeated 20-30 times. I am in a major metropolitan area, and there are only about 4-5 offices here participating despite the advertisement of having hundreds of participating dentist in this region. Of those 4-5 offices, I would never refer a breathing patient to any of them. Signature/ Amatus / > amatus wrote: > [quoted text clipped - 39 lines] > > i'm just a patient!! Amatus wrote: Sorry, but that is even worse. Google backwards for Ameriplan on this NG. The plan does not pay out one cent to anyone. The plan simply keeps all the money. They only provide a list of doctors who agree to accept the ridiculous fee in exchange for being on the list. Study the list very carefully, and you will find that the 1500 listings are actually the same names repeated 20-30 times. I am in a major metropolitan area, and there are only about 4-5 offices here participating despite the advertisement of having hundreds of participating dentist in this region. Of those 4-5 offices, I would never refer a breathing patient to any of them. <<<<<< Thanks again for your time. That plan truly sounds like a ripoff all the way 'round! The plan I joined is called "Aetna dental access". I believe it is basically the same thing as their "dental "insurance" that is offered via group employment plans like I used to belong to, EXCEPT that there is no "insurance" part. The client (me) simply gets access to the dentists' negotiated plan rate with Aetna, and unlike insurance I don't get any coverage beyond that, that is that Aetna doesn't pay anything towards any of the procedures to help my own expense outlay. Not to put anyone on the spot - and perhaps legally you cannot comment - but is this plan considered "bad" from the dentists' viewpoint? That is, are their PPO rates so low that you lose money? > Not to put anyone on the spot - and perhaps legally you cannot comment > - but is this plan considered "bad" from the dentists' viewpoint? That > is, are their PPO rates so low that you lose money? I wouldn't say they are bad. I'd say they may be disasterous! If a dentist charges $800 for a crown (full fee) and has a reasonable overhead, the office profit may be $300-$350. If a discount is given and the total fee is only $650 (often less with many plans), then the dentist's profit has been cut in half. Would you feel good taking a 50% pay cut for certain clients/jobs? I wouldn't do it myself unless I was going bankrupt (and even then I would be looking for better ways to combat the problem). I want to be proud of my work and I want my patients to be proud to have me as their dentist (instead of trying to figure out how to shave another $10-$50 off of my material and lab fees). I suspect you'll get a '$650 crown' (if you're lucky). You won't get an '$800 crown' at a discount price. You're not buying a microwave or TV. JMO, Dartos > If a dentist charges $800 for a crown (full fee) and has a reasonable > overhead, the office profit may be $300-$350. If a discount is given > and the total fee is only $650 (often less with many plans), then the > dentist's profit has been cut in half. I figure it costs me $650 in overhead costs and lab fees to make a single PFM type crown of high quality. Signature/ Amatus / > >> Not to put anyone on the spot - and perhaps legally you cannot comment [quoted text clipped - 20 lines] > JMO, > Dartos >I suspect you'll get a '$650 crown' (if you're lucky). You won't get an >'$800 crown' at a discount price. You're not buying a microwave or TV. > >JMO, >Dartos A 'microwave' crown; heats your food as you chew ! Clever idea ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Thanks again for your time. That plan truly sounds like a ripoff all > the way 'round! Your plan is the same. > The plan I joined is called "Aetna dental access". I believe it is > basically the same thing as their "dental "insurance" that is offered > via group employment plans like I used to belong to, EXCEPT that there > is no "insurance" part. Your plan is NOT an insurance ! It is a list of offices which have agreed in the past to accept the discounted fees. >The client (me) simply gets access to the > dentists' negotiated plan rate with Aetna, and unlike insurance I don't > get any coverage beyond that, that is that Aetna doesn't pay anything > towards any of the procedures to help my own expense outlay. exactly > Not to put anyone on the spot - and perhaps legally you cannot comment > - but is this plan considered "bad" from the dentists' viewpoint? That > is, are their PPO rates so low that you lose money? yes Signature/ Amatus / > Of those 4-5 > offices, I would never refer a breathing patient to any of them. > -- > / > Amatus _________________________ I understand your reluctance to refer a breathing patient to them. But some dentists have a variety of interests. If any of those guys are forensic dentists, you could easily refer the other type of patient to them, and still have a clear conscience. ;-) - dentaldoc We are not trying to chastise you. Many dental consumers are, for lack of a better term, ignorant when it comes to picking dental insurance and dentists. Someone once said, "sometimes you get what you pay for, and sometimes you get less". IOW's if there is a *big* price break for dental services, there is going to be something missing. Service? Quality? Safety? Comfort? All of the above? Someone may still sell you Spam® for a caviar price, but you absolutely cannot buy caviar for a Spam® price. IMO, you would be better served dealing with a dentist that you know and trust. Budget what you can to deal with your dental problems. The money you are spending for your 'discount plan' is just money up in smoke with nothing good to show for it. :-( Dartos > i don't see this as a situation of an insurance carrier sending me to > someone who charges much less to do the same work though which seems to [quoted text clipped - 6 lines] > > i'm just a patient!! IMO, you would be better served dealing with a dentist that you know and trust. Budget what you can to deal with your dental problems. The money you are spending for your 'discount plan' is just money up in smoke with nothing good to show for it. <<<< Yup, I am afraid that I am learning a very painful (& expensive) lesson. Thanks for your comments. Hi bytor, Hi bytor. I am a fellow dental patient. Read some of the previous recent threads I started about dental "insurance", especially "Is this a dental insurance thing?" and "How does one find a good dentist?" You may also be interested in my thread that I just started "Is this dentist a con artist?" We'll see what responses I get to this. As a fellow dental insurance patient, I totally understand how you feel. These dental plans seem to attract the worst dentists, who are basically willing to do whatever they have to do to make a buck. Seems to me that they are accepting a deal with an insurance plan to offer certain services for certain prices, but then they find out they can't make money by sticking to the plan so they find ways to extort money out of you or cut corners, to make up for it. In your case, I think this is clearly a case of cutting corners, and as Dr. Bornfeld stated "Vital tooth should be temporized--period." If I were you, I'd go back to the dentist and say, "A friend of mine who is a dentist in another state told me I should get a temporarty crown for this tooth. Would you be willing to give me one?" But he'll probably want to charge extra for it even though he shouldn't. If he charges you, you should say, (just my opinion) "Isn't that normally part of the price quoted?" You might even want to say you were told that it should be included and it should be done. If he knows you are talking to other dentists he may be afraid of getting in trouble for cutting corners. That's what I would do, anyway. I'll tell you what this fellow patient thinks: Dental plans are a big con. Whether the dentists agree to join, KNOWING they'll have to use bait-and-switch techniques and cut corners to make a buck, or whether they get into it not realizing this and then later realize it and become dishonest with their patients to make ends meet, is debatable and known only to that dentist. But it is clear to me that I have had "bait and switch" used on me and I've been sold things I don't need, as a result of these plans. As I stated in another thread, I believe some governmental body or the ADA or someone should run "stings" on these dentists and find the ones who are being dishonest and cutting corners etc., and take their dental licenses away. Many of the good dentists here in this group would not be opposed to that, in principle, I don't think. Because if one is a good dentist one need not worry about it. Of course no one wants the government breathing down their necks, and I understand that. But when we have dentists ripping people off like used car salesmen, then they are inviting regulation and oversight. As a patient, people like you and I are starting to see "behind the curtain" and realize these plans are a big rip off. My wife and I - and others I know of - were told we needed "scaling" or deep cleaning, when we really did not. This is yet another of the scams they use to charge you for things that the insurance plan will not cover. Today I was told my crown would cost much more than the insurance price, because he refuses to use the lab the insurance co. uses and so therefore the price is much higher. Bait and switch. These dental plans should all be investigated and regulated by the government. And this comes from a person who is basically a Libertarian. But sometimes we need government regulation on matters that affect the public health. You are lucky to have found this group, with good dentists who will help you figure things out. > Hi bytor, > [quoted text clipped - 64 lines] > You are lucky to have found this group, with good dentists who will > help you figure things out. I should point out that I have participated for many years in PPOs and union welfare funds. I've cut out the poorest ones as their fees progressively fall further and further behind reasonable fees. But in my competitive market I feel I have to accept some of these. I use the same labs for these patients as for my private paying patients; I do not give preferential scheduling to my private patients. When I feel I can no longer provide a good ethical service for a given fee, I explain to my patients why I must drop off the panel, and then I do it. I think it is unfair to paint all PPO dentists with the same brush. I feel very differently about HMO plans, which I think are cynically constructed. Steve > I should point out that I have participated for many years in PPOs and >union welfare funds. I've cut out the poorest ones as their fees [quoted text clipped - 9 lines] > >Steve I respect you and your sense of justice and fairness to your patients, and in no way meant to paint all PPO dentists as bad. It's just that, in general, it seems that most dental insurance plans are bad. Some of my bad dentists were also part of the PPO plan I had at one point, so I tend to lump it all in together, just due to my experience. If I can get the Delta PPO plan, do you think it would be worthwhile for me to do so, or am I still generally better off to just go to pay-for-service regular office visits? Guess I'm still not clear on the exact difference between the PPO plans you speak of and what I have which is Delta Care PMI. I just know that every dentist I've been to on either plan has either been a bad dentist, or a bait-and-switch dentist, or both. I was debating whether or not I should go back to the Delta PPO plan because it is about $30/month, and only a $1000 maximum benefit. If you mulitply that out, it means that I pay $360 and get a possible $640 benefit. Not much incentive. And if I get just a couple cleanings under the plan then it is not even worth the money I pay in. >> I should point out that I have participated for many years in PPOs and >>union welfare funds. I've cut out the poorest ones as their fees [quoted text clipped - 31 lines] > $640 benefit. Not much incentive. And if I get just a couple cleanings > under the plan then it is not even worth the money I pay in. I haven't followed about the Delta PMI. I assume you are calculating the benefit for the particular treatment you would get, and obviously if you know at the beginning of the year that your benefit will be $640 for a $360. premium, that's good for you. This is the thing about dental insurance--no one would expect to consistently draw more in benefits for any other type of insurance than they pay in premiums. I have UFT patients who pay $30-$40 a month for hospitalization, major med, dental, optical, etc. and complain about it. Obviously if you don't expect to have dental expenses, dental "insurance" isn't worth purchasing. Some folks have to buy a package of benefits incl. dental, and I can understand the annoyance if they don't think they are going to use it. But while dentistry is expensive and I can fully understand that someone may have difficulty affording it, I am amazed how many feel they "can't" go to the dentist because they have no insurance. These often are folks with new cars, computers, video games. I'm not ragging on you, Jim. But understand dental benefits for what they are not--they're not insurance. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 "Guess I'm still not clear on the exact difference between the PPO plans you speak of and what I have which is Delta Care PMI." ______________________ In a nutshell: PMI is an HMO. It is NOT a PPO. The dentist in PMI gets a few paltry bucks a month whether he does any work for you or not. Since he gets the same pay for seeing you, as he gets for NOT seeing you, why should he want to do any work under the HMO terms? There is no incentive in the plan. True, for some types of treatment he can charge you a small sum, but this usually will not even cover expenses. The only way for him to make a penny more than he already gets for NOT working, is to charge you EXTRA for any treatment he actually performs. This is because any co-pay he gets from the HMO for extra work is usually so small that it won't cover expenses. If the HMO dentist won't even be paid for his expenses by keeping to the HMO rates, then HOW will he get the extra money that is absolutely necessary to keep his bills paid? You already figured this out! A PPO is very different: The dentist actually gets paid according to the services performed. This is basically the same as payment by a private patient. The only difference is that the PPO sets the fee. If a dentist finds the PPO fee to be too low, he doesn't join that PPO. If he finds the PPO fee adequate for his expenses, then he has reason to join. Remember that different dentists, even in the same town, can have greatly varying expenses. A PPO fee schedule that is adequate to pay the expenses of one dentist may be entirely too little for another. I hope you read the comments by Dr. Bornfeld regarding the PPO concept. His viewpoint is accurate and is shared by many fine dentists. Best regards, - dentaldoc Thanks much for the explanation, Bill. It's probably been explained to me before, but I got confused about the various plans. Now I totally get the difference. My only comment is that PPO's, it seems, CAN also be bad because IF the dentist finds - after joining up with the PPO plan - that the plan does not cover his fees, then he is in the same position as an HMO dentist is in, having to cut corners or sell the patient "upgrades" or things he doesn't need (like scaling, in some cases) in order to make ends meet. I ran into this when I had the Delta PPO plan, before. The dentist tried to sell my wife and I both scaling when we had just had our teeth cleaned 6 months earlier and told we were fine, and then asked another dentist a month later (when we figured out the guy was a con artist and we probably didn't need scaling) and he confirmed what I suspected, that we did not need scaling. Okay, maybe it's a judgement call, but I got the distinct impression we were being conned by the dentist who wanted us to get scaling. Also, regardless of whether the dentist is a PPO dentist or even a non-insurance dentist, there is still the greed factor which can make him want to sell things one does not need like scaling, or upgrades to materials or whatever, in order to make more money. I guess what worries me is that as bait-and-switch techniques and selling things patients don't need becomes a "standard mode of operation" among dentists, as a result of these "insurance" plans, then that leads to more and more dentists being about as trustworthy as a used car salesman. I apologize for disparaging "dentists" in this fine group here, but I feel that out in the field, at least here in L.A., there are many more greedy used-car salesman type or just plain bad dentists than there are good, honest ones. I may start doing all my dental work at USC, if my implants go well, simply because at least there I know there is no cheating going on, and the work is being overseen to some extent. The only problem is, it is a hassle to fill out the paperwork and one has to be there for 3-4 hours for each appt.. > Dental plans are a big con. No, just the managed care plans and discount plans. Dental care is not like medical care and the same type of plan does not work in both situations. Signature/ Amatus / > Hi bytor, > [quoted text clipped - 64 lines] > You are lucky to have found this group, with good dentists who will > help you figure things out. thanks for your comments jim misery loves company (just kidding) i will read your other threads! > Which leads me to ask - Amatus' comment of " Why do you think the > insurance plan prefers this office?" suggests that insurance plans will > steer you towards substandard dentists!! Ones that cost less, work > less thoroughly, cut corners, or something of that nature - am i naive > in thinking that that should not be the case? You are correct in thinking "that should not be the case". However... The simple fact its that "good" dentists who have been around long enough to enjoy a good reputation and build up a good practice generally don't have to sign up for those "plans" to fill up their schedules. So what type of dentist is likely to sign up to work for a huge discount? What do you think? Remember, the dentist gets no money from the operators of those "plans". For your premium, you are simply buying a list of dentists who have signed up to work for a discounted fee. It is entirely possible that you might find a great young dentist who is "practice building" by using those plans to attract new patients. That said, other possibilities exist. Vaughn > i recently broke an old crown on a molar, and am in the process of > getting it fixed [quoted text clipped - 47 lines] > > thanks for any opinions I'm surprised Amatus didn't say "What's a Temporary?" (he generally prepares and delivers Cerec-restorations same day. If this is a tooth that has a vital pulp, a temporary crown definitely should be placed. While a temporary can be made to prevent the gum from creeping up the root surface, ideally the tooth shouldn't be prepared more than maybe 1/2 mm under the gum anyway, so preventing reattachment is not a primary reason for a temporary. Sometimes a tooth prepared for a crown will actually drift significantly between visits, esp. if there is a lapse in treatment, and a temporary crown will prevent or minimize this. However, in a back tooth that has had root canal and where cosmetics is not an issue, I occasionally will dispense with a temporary. It is difficult to make the edges of a temporary crown as smooth as the permanent crown anyway, and esp. if the gum is in poor shape the rough edge sometimes slows down the healing. I would want to know why the gum is so cut up. It is sometimes necessary to work under the gum somewhat and the gum can get inflamed during the preparation and impression phase, but it really shouldn't be severely traumatized, or something is wrong. If you are in discomfort, you should tell the dentist of your concerns. His response will be telling. If you get the sense that he is retalliating for some slight, RUN--do not walk to another dentist. Not to lecture, but I always shake my head when a patient has a good dentist and HAS to change because of insurance. If the second guy is a bum (not saying he is) you know what you should do. Steve > I'm surprised Amatus didn't say "What's a Temporary?" I did not think the temporary was a big of an issue as was the potential crappy care form a "preferred" office. Signature/ Amatus / > >> i recently broke an old crown on a molar, and am in the process of [quoted text clipped - 75 lines] > > Steve Thanks for the feedback. This is a back molar - never had root canal though. I will discuss the situation with the dentist, & try to gauge his response. He did not previously offer me an explanation for not putting on a temp crown, he simply said "this will be easier for you" and I did not argue with him about it. I trusted him. It is not working out well though. Discussing this further with friends & relatives, they all feel that he simply did what was easier for HIM. I dunno and don't want to assume anything but I leaning towards that being the case. > Thanks for the feedback. > [quoted text clipped - 9 lines] > he simply did what was easier for HIM. I dunno and don't want to > assume anything but I leaning towards that being the case. Vital tooth should be temporized--period. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Steve wrote: Vital tooth should be temporized--period. <<<<< What does "temporized" mean? That it should be covered/protected by a temorary crown? (sorry if this is a very stupid question!) Thanks > Steve wrote: > [quoted text clipped - 5 lines] > > Thanks No, I'm sorry. Yes, I meant a temporary crown. Occasionally a patient will report that a temporary crown has fallen off between visits, and if the tooth is not too sensitive and the patient finds it difficult to get down to the office to recement it I advise them to leave it off or get a temp. cement from a local pharmacy to recement it. However, when the patient is in the office for the preparation and impression for a crown they are numb, and there is no way to predict how sensitive to hot/cold/touch the tooth may be once the anesthetic wears off. Under the circumstances not providing a temporary crown for a tooth with a vital nerve is foolhardy, and possibly inconsiderate. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Steve wrote: Under the circumstances not providing a temporary crown for a tooth with a vital nerve is foolhardy, and possibly inconsiderate. <<<<<< Thanks for your input - that is what I've come to think but was trying to give the dentist the benefit of the doubt. In view of my current discomfort (and various comments) I am going to ask him about this, but as I said in other posts, I am somewhat fearful that *if* he did intentionally skimp on this because he just doesn't care about my welfare and was simply looking to save himself time or material costs, that his reaction will be one of intentional misdirection, disdain, irritation, anger etc - no one likes being found out that they were deceitful and human nature can get ugly in this type of situation. I am at his mercy though. I can't afford to waste the $400 I already put into this & go somewhere else for help. I will do my best to frame my request in this matter sensitively. Wish me luck.... > Steve wrote: > [quoted text clipped - 16 lines] > my best to frame my request in this matter sensitively. Wish me > luck.... He would be a really big fool to react angrily. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Unless the treatment is for an Inlay rather than a crown, in which case there are specific cement-type temporaries made specifically for that application. Signature/ Amatus / > Steve wrote: > [quoted text clipped - 16 lines] > my best to frame my request in this matter sensitively. Wish me > luck.... Thanks for the feedback. This is a back molar - never had root canal though. I will discuss the situation with the dentist, & try to gauge his response. He did not previously offer me an explanation for not putting on a temp crown, he simply said "this will be easier for you" and I did not argue with him about it. I trusted him. It is not working out well though. Discussing this further with friends & relatives, they all feel that he simply did what was easier for HIM. I dunno and don't want to assume anything but I leaning towards that being the case. > i liked and trusted my old dentist but because of insurance reasons i > had to get a new dentist Clarification: for insurance reasons you *chose* to get a new dentist. Lots of insurance plans are rip offs (for everyone except the insurance company) and the participating dentists sometimes don't practice the way you would like. They are not going to work for free, so they do what they have to do to make a profit too. Sorry, Dartos dartos wrote: Lots of insurance plans are rip offs (for everyone except the insurance company) and the participating dentists sometimes don't practice the way you would like. They are not going to work for free, so they do what they have to do to make a profit too. <<< wow - i think i am understanding things now- i am totally naive despite the fact that i am a patient - in need of the correct by the book treatment and expecting to get that - you're saying that dentists take into consideration what insurance or dental plan coverage that you have b4 they work on you, balance in their minds something like "well i can save myself 10 minutes work and $25 worth of materials by cutting this or that corner since this guy has a plan that doesn't pay me as much, who cares if he is in discomfort, can't eat right, screws up his gums, the crown won't fit right later", etc etc etc???? i'm going to be sick :-( sounds like i would have been better off not enrolling in a plan and paying full price, no matter what dentist i would be seeing but even then there are still good/bad dentists (?) and i just can't accept all this....i think that someone who would cut corners because of what payment he is getting is basically dishonest anyways & probably cuts corners with ALL HIS PATIENTS to make larger profits - i think a "good" dentist would be someone who manages to treat his patients in the best possible way, yet still earn enough to keep his business going etc and i don't mean to criticize or insult any dentists reading this either - i think there are load of "good" dentists out there i think the key is that you either care about your patients or you don't > despite the fact that i am a patient - in need of the correct by the > book treatment and expecting to get that - you're saying that dentists [quoted text clipped - 4 lines] > much, who cares if he is in discomfort, can't eat right, screws up his > gums, the crown won't fit right later", etc etc etc???? You still have it wrong. Dentists who participate in these cheap plans will mostly incorporate a bait-and-switch tactic to make money off procedures not listed in the plan. Otherwise, they cut so many corners that there is no quality of care. Did you read my earlier statement about the body shop ? Signature/ Amatus / > dartos wrote: > [quoted text clipped - 35 lines] > i think the key is that you either care about your patients or you > don't Amatus wrote: You still have it wrong. Dentists who participate in these cheap plans will mostly incorporate a bait-and-switch tactic to make money off procedures not listed in the plan. Otherwise, they cut so many corners that there is no quality of care. Did you read my earlier statement about the body shop ? <<<< Yes, but i still am not sure how much of that example truly applies here. First, let me backup & say that i appreciate your (Amatus) comments (and everyones' comments). I really appreciate your time. What started as a thread to inquire about whether what was being done in my specific case regarding not being given a temporary crown and wondering if that was kosher, has morphed into a discussion on the issues surrounding dental "plans", costs, money issues as they relate to what type of care a patient can expect to receive. Things I, and most uninformed members of the public, never think about! This is very eye opening for me, as NONE of this is even hinted at in the least possible way by either the plans themselves or by the dentist when i was there - no one told me, "oh you have such and such plan so you are not going to get the type of care that most people get". Is it possible that perhaps Amatus may be thinking of some other type of "plan" than what i have though????? Because i don't see what i have as some kind of huge cut rate thing that the dentist should be cutting corners. It's not like I am getting some amazing gigantic bargain here that I can tell. As far as i understand things (& i COULD BE WRONG but this is what i understand): - without any coverage at all to get a new crown would cost about $850 - with the "discount plan" i am in the crown costs me $640, which is supposedly the agreed upon "PPO" rate that the dentist uses as per negotiations with the plan itself - what he gets out of being a member of this plan is unknown to me, if it does not pay him in some way to do this then why is he a member? - with my old group insurance plan, the dentist would be charging the same negotiated "PPO" rate of $640 for the crown - that is the $$$ that he collects, BUT i then get additional "coverage" through the "insurance" payout so that they pay something like $200 towards that cost, so that the amount out of my own pocket is less then what i pay now So in relation to the plan i am in now vs. the plan i used to be in through work, the dentist gets the same amount of $ either way (?) Of course, if i had no insurance, then the dentist would make more per each procedure, since he then charges "full price". As far as what dentists get out of participating in these plans i do not know - do they get some kind of stipends? discounts on gear? larger client base to offset the costs? i haven't seen any bait & switch type behavior (yet). I am not trying to disparage anyone's right to make a living, but i do think i am entitled to each respective dentist's best efforts - and if this dentist is purposely cutting corners because he feels he is not making enough $$$ off me, then i think he does not have my best interests at heart, & that makes him a "bad dentist"!!!! I just spoke with a friend who works in a dental office - she told me that the dentist she works for ACCEPTS NO INSURANCE PLANS OF ANY KIND!!!! That he has builtup his client base & reputation to such a degree that he has patients willing to pay "top dollar", and the only "discount" he gives is for people who pay ca$h! What I gather from this point about the dentist my friend works for, and this whole discussion, is that dentists who participate in various insurance or discount plans AGREE to accept lower payments for their work, and some of them in doing so compromise the quality of their service to offset their own cost/balance sheet. I thought that my previous dentist did great work. No complaints after 15 years. I never got a crown from him with no temporary one installed during the 2 week wait period. He accepts GROUP based insurance plans only. The plan I was in through him is the same company I am going through now with this non-insurance "discount" plan so i believe that his payout would be the same either way. I never suspected him of cutting corners. I don't know why he won't accept any non-group plans, and guess that perhaps there are bad cutrate ones that Amatus alluded to that are more trouble than they are worth, thus he won't bother with any at all?? I don't know. Or there is more to this whole thing than I understand. I still think a large part of this comes down to how honest, thorough, good, caring, etc a dentist is. He is either the type to cut corners or not. If he has to do cut rate work because he is not being paid a fair rate he should be honest about that and say so, not "this is easiest for you" and leave me with no temp crown. If he told me something like "your plan is paying me less than what it costs to get the materials. I can't give you the proper care, you should either go somewhere else, or drop out of that plan, we are both being ripped off, etc etc" I would respect that. I'm still not sure what is what in my case though. Maybe he is cutting corners to maximize profits because he is a greedy bum and doesn't give a damn about me or any other patients. Maybe he is cutting corners because he is losing so much money that he is going out of business thanks to the insurance plans etc. Maybe he just wanted me out the door quicker so he could hit the golf course earlier. Maybe he is just a bad dentist period and doesn't know what he is doing. Or maybe cutting corners is not an issue at all, perhaps he is a great dentist, he has my best interests at heart and not having a temp crown is really "easier for me" like he said, although I am suffering this way now and wondering what truly is what. Sorry for rambling. I hope this discussion and my experience proves helpful to anyone else, either patient or doctor. >What started as a thread to inquire about whether what was being done > in my specific case regarding not being given a temporary crown and > wondering if that was kosher, has morphed into a discussion on the > issues surrounding dental "plans", costs, money issues as they relate > to what type of care a patient can expect to receive. Things I, and > most uninformed members of the public, never think about! The reason I re-directed the discussion into one about your discount plan is because there is potential for bigger problems than this one temporary. > This is very eye opening for me, as NONE of this is even hinted at in > the least possible way by either the plans themselves or by the dentist > when i was there - no one told me, "oh you have such and such plan so > you are not going to get the type of care that most people get". Did you expect the plan to tell you that the offices which sign up for the plan are either the offices which will bait-and-switch you inot higher cost items, or offices which will cut corners beyond what any "normal" dentist considers accepable ? > Is it possible that perhaps Amatus may be thinking of some other type > of "plan" than what i have though????? Because i don't see what i > have as some kind of huge cut rate thing that the dentist should be > cutting corners. It's not like I am getting some amazing gigantic > bargain here that I can tell. A lot of offices have an 80% overhead (some are as low as 60%). If the plan forces a 25% discount, what do you think will happen ? > - without any coverage at all to get a new crown would cost about $850 I charge about $960 > - with the "discount plan" i am in the crown costs me $640, which is > supposedly the agreed upon "PPO" rate that the dentist uses as per > negotiations with the plan itself - what he gets out of being a member > of this plan is unknown to me, if it does not pay him in some way to do > this then why is he a member? He joins the plan either expecting patient s to refer him lots of regular paying clients, he expects to make money selling you stuff which is not covered, or he joins out of stupidity. Personally, I do not know of a single dentist in this area which will accept that kind of a fee for a crown, except the bait-and-switch offices (who never fabricate the type of crowns listed by the plan, so they can then charge more than the "normal" fee). > - with my old group insurance plan, the dentist would be charging the > same negotiated "PPO" rate of $640 for the crown - that is the $$$ that > he collects, BUT i then get additional "coverage" through the > "insurance" payout so that they pay something like $200 towards that > cost, so that the amount out of my own pocket is less then what i pay > now That sound odd. How much is the office being paid for the $850 crown in this case ? > So in relation to the plan i am in now vs. the plan i used to be in > through work, the dentist gets the same amount of $ either way (?) nope > Of course, if i had no insurance, then the dentist would make more per > each procedure, since he then charges "full price". yup > As far as what dentists get out of participating in these plans i do > not know - do they get some kind of stipends? nope > discounts on gear? nope > larger client base to offset the costs? Some office hope for this, but if the office loses $20 on every crown they insert, how many crowns must they insert to make a profit ? >i haven't seen any bait & switch type behavior (yet). That is good. I am surprised the office is willing to insert a listed crown type. But, then again, he is cutting corners pretty significantly. Betcha, he sends the impression to a lab in Indonesia and cements it no matter how bad it fits. > I am not trying to disparage anyone's right to make a living, but i do > think i am entitled to each respective dentist's best efforts Well, I would agree fully that you deserve the best care the dentist is capable of. - and if > this dentist is purposely cutting corners because he feels he is not > making enough $$$ off me, then i think he does not have my best > interests at heart, & that makes him a "bad dentist"!!!! You have been paying some attention to what we are saying. > I just spoke with a friend who works in a dental office - she told me > that the dentist she works for ACCEPTS NO INSURANCE PLANS OF ANY > KIND!!!! That he has builtup his client base & reputation to such a > degree that he has patients willing to pay "top dollar", and the only > "discount" he gives is for people who pay ca$h! A lot of offices will offer 5% discount to patients who pay the full fee up front and then the pateint waits 3-10 weeks fo rthe insurance check to arrive. > What I gather from this point about the dentist my friend works for, > and this whole discussion, is that dentists who participate in various > insurance or discount plans AGREE to accept lower payments for their > work, and some of them in doing so compromise the quality of their > service to offset their own cost/balance sheet. Remember that a dental office, just like a hospital or a physician office is a business that will only be around next week if the office makes thier overhead and some amount of profit for the person who owns it. > I thought that my previous dentist did great work. No complaints after > 15 years. I never got a crown from him with no temporary one installed > during the 2 week wait period. He accepts GROUP based insurance plans > only. The plan I was in through him is the same company I am going > through now with this non-insurance "discount" plan so i believe that > his payout would be the same either way. Just because AETNA is collecting the premium in both cases does not make the plans in any way similar. IN the case of the discount plan, AETNA is make guaranteed money as they only collect the money and sell you a list of dentists silly enough to accept the discounts (at the time they collected the name). They do not pay out any of that premium dollar to anyone else except their stock-holders. The type of insurance plan you want is an indemnity plan. Or, in other words, a plan which allows you to go to any dental office you choose. The insurnace willhopefully pay enough to make the dental treatment afordable, but not totally free. 100% coverage is horendously expensive to buy. > I never suspected him of > cutting corners. I don't know why he won't accept any non-group plans, Maybe he does not accept the cheap trashy plans because he won't cut corners ? > and guess that perhaps there are bad cutrate ones that Amatus alluded > to that are more trouble than they are worth, thus he won't bother with [quoted text clipped - 6 lines] > fair rate he should be honest about that and say so, not "this is > easiest for you" and leave me with no temp crown. It is below standard of care to not use a temporary for a full crown. He cannot say that. If you are getting an inlay, a cement type temporary may be appropriate. > If he told me something like "your plan is paying me less than what it > costs to get the materials. I can't give you the proper care, you > should either go somewhere else, or drop out of that plan, we are both > being ripped off, etc etc" I would respect that. You have to figure out why he is in the plan. > I'm still not sure what is what in my case though. Maybe he is > cutting corners to maximize profits because he is a greedy bum and [quoted text clipped - 7 lines] > is really "easier for me" like he said, although I am suffering this > way now and wondering what truly is what. I think you are smarter than that. Signature/ Amatus amatus said: I think you are smarter than that. <<< actually no! i think i am VERY STUPID! i've been took :-( wasted $100 to join this "plan" & getting substandard dental care as a result (if i am understanding things right) wasted almost $400 so far on this dentist hurt myself physically in the process, have a tooth that has pressure builing up in it all week from the cement he put it in, can't eat right because of not having a tooth there doing it's thing, no temp crown, hurting my gums, will be getting a poorly made idonesian crown that won't fit, etc etc afraid to go back to this dentist after reading through the various comments not sure what the hell to do now plus already being very financially stretched, i can't afford much of anything else, i have very little, or no alternatives, left to me Getting ripped off and being stupid don't necessarily go hand in hand. Especially when you are not an expert on the subject at issue. (at least I hope not, or I'm stupid too!) One of the KC TV stations recently did a little expose' on mechanics. About 50% of the shops they took a car to tried to sell them parts and services that they did not need. Many used hard sell tactics like: "I won't be responsible if you have an accident" or "You could break down in rush hour tomorrow". The other half did the routine maintenance only and often commented on how well the auto had been taken care of. As a dentist, I would like to believe that my profession has a better percentage of honest care givers than mechanics. (and one TV spot doesn't mean that 50% of all mechanics are theives) When it comes to those taking shady insurance plans, they may be worse. I don't know what advice to give at this point other than to say you should be glad this wasn't brain surgery. Once this problem is resolved, I think I would revisit my 'old trusty' dentist of the last 15 years and work with him as best you can afford. Bargains in health care usually aren't. :-( Dartos > actually no! i think i am VERY STUPID! > [quoted text clipped - 18 lines] > plus already being very financially stretched, i can't afford much of > anything else, i have very little, or no alternatives, left to me Bargains in health care usually aren't. <<<< right, big eye opener & painful life lesson for me here it never occured for me for one second to try to figure out how these plans work, to consider that participating dentists operate below cost with those patients & that therefore equates to the problems mentioned here like cutting corners, baits & switches, the overall type of dentist who predominately may be in one of these plans, the financial pressures involved even on a good dentist who signs up perhaps not knowing what he is in store for thus having to compromise his services as a resultt, etc etc etc (& what i think i am going through) - bad all the way 'round i *assumed* that the "PPO" rates i was being given access to were the same thing that dentists charge/get paid for/have no problems with as with any other type of dental insurance plan (i explained my thinking on that above, which i now understand to be incorrect), and didn't really think about ANY of this whatsoever what a mess thanks for everyone's time I have one last question regarding this - not the dental plan stuff but something physical relating to my tooth. When i first saw this dentist (last friday), prior to him actually working on the tooth to prepare it for the crown (this monday), i asked him to do something to give me some temporary relief over the weekend in the meantime, something to help desensitize from heat/cold, protect it from being smashed up during eating, and also smooth it somewhat to stop my tongue from getting ripped up by it. I asked for some type of "temporary cap". His reponse was that he could not put on something like that because that involves driilling first, and he would be doing that on monday, and he could not do that today. Instead he put some kind of whiteish cement in the tooth, which helped smooth over the sides, and yes, it did somewhat reduce the sensitivity to hot/cold, and also offer some protection. HOWEVER - i noticed within 5 minutes that after the cement was in that I had a sensation of pressure on/in the tooth, not incredibly painful, but not comfortable either. I beared with that over the weekend and it eased up somewhat on Sunday. When I went in on Monday he asked me how things went, I explained about the pressure but that the cement did help me in regards to my tongue/hot/cold/etc & , he asked me if I had "pain", I said that it was not that "painful" but was uncomfortable. He then did his thing drilling/prepping the tooth for the crown, then told me he would fill it back up with cement rather than give me a temp. crown because "that will be easier for you". Which led to this whole thread starting..... But....here's my question now....I have noticed again the "pressure" sensation in my tooth. Building up over the last 2 days more and more. Could the cement be pressing on something inside there, or perhaps expanding outwards causing the sensation, stressing the outline of the tooth? Or something else going on? It is not a pleasant sensation and borders on pain, but is not like "big" pain. Is this something I should mention again? Or is this possibly normal for this type of situation. Regardless of the dental plan vs. quality of care issue, I think I need to try to work with this dentist for the time being, at least to gauge what might happen next, I need to go back & ask about getting a temp crown and mention this pressure feeling as well, but it might help me to know also if this is something i really really need to stress (or not), and what responses he might have to indicate he is helping me out vs. jerking me around. Thanks again. > I have one last question regarding this - not the dental plan stuff but > something physical relating to my tooth. [quoted text clipped - 46 lines] > > Thanks again. Can't say without examining you, unfortunately. It could be that the temporary filling is slightly too high, or it could be a problem with the nerve. This should be mentioned to the dentist and the cause of the discomfort determined before proceding further, IMO. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thanks for sharing your story. Maybe it will help someone else avoid getting in the same fix. I wish that cases like yours were the only rip offs in dentistry. It would be easier to deal with. Unfortunately there are bad dentists who charge a fortune for crappy work, dentists that prey upon false medical claims, and others who just aren't very good. Even so, the vast majority of dentists are doing a pretty good job. The bad apples get all of the attention. Dartos > what a mess > > thanks for everyone's time >Thanks for sharing your story. Maybe it will help someone >else avoid getting in the same fix. [quoted text clipped - 9 lines] > >Dartos From a previous post: "No apple butter (or sauce) this year. Just eating, baking, and pie." Curious that. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com bytor, don't beat yourself up about it. I am a pretty savvy consumer, and I also did not know what was going on with these plans, and it took me a long time to catch on. I thought I was "just having bad luck" as far as just finding greedy, con artist dentists. Being in L.A. where there is a lot of that kind of thing going on - in every field: mechanics, computer repair, you name it - I just figured it was coincidence. Of course now I realize it is because of these plans. And it is hard to know for SURE how much of it is just running into bad or dishonest dentsts as a result of bad luck. For example, Dr. Bornfeld says that he is as PPO dentist and not all PPO plans are bad; and I have faith that he is not a bad dentist, in fact that he is a good one. But my experience was that a PPO dentist did a bad root canal on my wife causing her to need an apicoectomy, and he did a bad root canal on me causing me to lose my tooth. I can't prove it, but I was told this by several dentists who looked at the xrays. But of course others made excuses for him, saying "it's not malpractice, though". In any case, I did not want to sue, though I did get the dentist's insurance to at least pay us back for the bad root canal on my wife. Anyone can get cheated when it is not their area of expertise. I know many people at my job who are still using these HMO dental plans and they too expect it to be "legitimate" and get good care. Almost NO ONE knows how bad these plans are because they are called "insurance" and we expect them to be at least as good as our medical HMO's. There needs to be more magazine and internet articles and media exposure of this. So just accept that you got into a bad thing due to never having known how these things work, and now do what you can do get things made right and get back on track with your old dentist or a new one that is good. Being fooled twice in the same way would be stupid; being fooled once is just part of life in the 21st century. Good luck! > One of the KC TV stations recently did a little expose' > on mechanics. About 50% of the shops they took a car > to tried to sell them parts and services that they did not need. > Many used hard sell tactics like: "I won't be responsible > if you have an accident" or "You could break down in rush > hour tomorrow". What do you say to those patients who won't get a root canal done when it is time, and insist on waiting until it wakes them up at 02h00 AM, or Friday evening at 20h30, just when you're getting ready to go to the show with your wife? Even if you would qualify that is 'scare tactics' as per the KC TV exposé, I, for one, am up front with the patient: *OK, it's your choice, and so here's a prescription to tide you over the weekend, because that is when it'll hit you.* My quality of life is bad enough. If they won't support me when it is time, I don't feel obligated to come in at those hours on the weekend either for them. JMO SP SignatureTake out the TRAASH to reply Obligated? No way. What you can do is add an emergency fee onto any after hours visit. Mine is $100 in cash and then whatever the treatment cost is added on. Most of the time, that makes the problem less serious and it can wait till I'm open on a regular day. If not, I get paid a decent wage for coming in on off hours. Dartos > My quality of life is bad enough. If they won't support me when it is > time, I don't feel obligated to come in at those hours on the weekend > either for them. > > JMO > SP > Obligated? No way. > [quoted text clipped - 8 lines] > > Dartos That sounds reasonable. Most of my patients here (due to the fact that there is an overabundance of dentists) feel I should be like the conrner convenience store: open at all hours and no added fees. One lady actually told my assistant the other day that _I_ should be paying _her_ for her extraction, since I took something _out_ of her mouth.... thanks SP Thanks SP SignatureTake out the TRAASH to reply > What do you say to those patients who won't get a root canal done when > it is time, and insist on waiting until it wakes them up at 02h00 AM, or > Friday evening at 20h30, just when you're getting ready to go to the > show with your wife? When a patient refuses needed treatment, I simply tell them that "I am NOT going to take time out of my weekend to fix an emergency that you refused to deal with during working hours. However, If we are working through your treatment plan, and you have an emergency, then you can call me at any time of the day or night and I will come to the office to help you. The choice is yours." Signature/ Amatus / > >> One of the KC TV stations recently did a little expose' [quoted text clipped - 21 lines] > JMO > SP >> What do you say to those patients who won't get a root canal done when >> it is time, and insist on waiting until it wakes them up at 02h00 AM, or [quoted text clipped - 7 lines] >of the day or night and I will come to the office to help you. The choice >is yours." Rarely get weekend calls. The only times I remember coming in after hours was for a post extraction bleeding problem (once). And perhaps one or two very good patients in a bind. Can only remember less than a handful of times since at this location. (18 yrs) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Rarely happens to me either. But, when it happens to patients who follow through on treatment plans and try their best to be good people, I always drop what I am doing and drive over to the office for them. New patients are told they will need at least $150 cash to get me to open the office at this time. The drug seekers will opt out at that point. Patients who were told to get the treatment done, but refused until it hurt, get a prescription called in to the pharmacy of their choice. Signature/ Amatus / > >>> What do you say to those patients who won't get a root canal done when [quoted text clipped - 23 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com > Rarely happens to me either. But, when it happens to patients who follow > through on treatment plans and try their best to be good people, I always > drop what I am doing and drive over to the office for them. This goes without saying; a patient that *walks the walk* deserves the best. >New patients > are told they will need at least $150 cash to get me to open the office at > this time. The drug seekers will opt out at that point. Yes... they always seem to want a *prescription* to tide them over until the (nonexistant) inflammantion goes down ('Cuz ya know, Doc, I'm a hard one to freeeze...') >Patients who were > told to get the treatment done, but refused until it hurt, get a > prescription called in to the pharmacy of their choice. Again, 100pc reasonable in my estimation. I don't lord it over them, but that is the attitude. Thanks SP SignatureTake out the TRAASH to reply > Rarely get weekend calls. The only times I remember coming in > after hours was for a post extraction bleeding problem (once). > And perhaps one or two very good patients in a bind. OK... How do you handle those symptomatic teeth that have radiographic lucencies and need Endo? If you one-step those teeth, they're gonna HURT, it seems to me. Personally I avoid that by leaving these teeth open till there is no pain on biting. I know, however, that all-a youse want to do one-shot Endos... Thanks SP SignatureTake out the TRAASH to reply >> Rarely get weekend calls. The only times I remember coming in >> after hours was for a post extraction bleeding problem (once). [quoted text clipped - 8 lines] >Thanks >SP Usually bring the pt in for Dx. Place IRM if possible. (no anesthesia, no prep, just put it in there) Rx AB & pain meds. Do endo next visit. I never leave teeth open. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Usually bring the pt in for Dx. > Place IRM if possible. > (no anesthesia, no prep, just put it in there) > Rx AB & pain meds. Big 10-4 on the Dx, WB! 73s, SB Steve > Do endo next visit. > [quoted text clipped - 4 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Usually bring the pt in for Dx. >> Place IRM if possible. [quoted text clipped - 4 lines] > >73s, 73s ? >SB -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>Usually bring the pt in for Dx. >>>Place IRM if possible. [quoted text clipped - 6 lines] > > 73s ? Old CB term for "bye-bye!" Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>>Usually bring the pt in for Dx. >>>>Place IRM if possible. [quoted text clipped - 10 lines] > >Steve 10-4 Good buddy. (heard that that gb term fell out of favor) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > I never leave teeth open. I agree with my sister. Signature/ Amatus / > >>> Rarely get weekend calls. The only times I remember coming in [quoted text clipped - 23 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com >> I never leave teeth open. > >I agree with my sister. Your legs are another matter though. 8-[] -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Does this color scrubs make my butt look big ? Signature/ Amatus / > >>> I never leave teeth open. [quoted text clipped - 7 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com > Does this color scrubs make my butt look big ? There is no correct answer to this. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Does this color scrubs make my butt look big ? > > There is no correct answer to this. > >Steve Oh, butt there is ! ;-) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com You are just avoiding the issue because you think my butt IS too big. :-( Signature/ Amatus / > >> Does this color scrubs make my butt look big ? > > There is no correct answer to this. > > Steve > You are just avoiding the issue because you think my butt IS too big. :-( I heard tings. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Does this color scrubs make my butt look big ? Yes. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Usually bring the pt in for Dx. > Place IRM if possible. [quoted text clipped - 9 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com OK.... I understand... I try to avoid AB. That's why I leave 'em open. Thanks SP SignatureTake out the TRAASH to reply >> Usually bring the pt in for Dx. >> Place IRM if possible. [quoted text clipped - 13 lines] >Thanks >SP Bad idea to leave teeth open, you just invited Bergey's Manual into the canal spaces. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com In general, I agree. However you can run into some that if you close them up, the patient blows up (like a balloon). I've had two cases like this in the last month. One I did close (though I was wavering on the issue) and the patient's swelling increased dramatically. The second, I drained, prescribed ABs, and lef |
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