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Medical Forum / General / Dentistry / February 2007

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File btoken during root canal

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Cassiesmommy@gmail.com - 30 Jan 2007 23:11 GMT
Ok, I know that it happens, or at least now I do.  I went to the
dentist to have a root canal performed.  The procedure went fine until
they took an x-ray at the end (before filling it)  and found that part
of the file had broken off.  I was then told to go to a specialist
which they referred me to.  I went and he did a whole new root canal
and removed part of the file.  My problem is that I was charged and
extra $245 to have the obstruction removed.  Like I said I understand
that stuff like that happens, however I believe it is my dental
offices responsibility to reinburse me for the $245 fee since it was
the dentists doing, not mine.  I filed a greivance with the office,
however I'm not sure how good of a chance I have of being reimbersed
so I just wondered if this had happened to anyone else and if there
was any advice out there that would be helpful!!
Thanks,
Cassies mommy
Steven Bornfeld - 31 Jan 2007 03:55 GMT
> Ok, I know that it happens, or at least now I do.  I went to the
> dentist to have a root canal performed.  The procedure went fine until
[quoted text clipped - 11 lines]
> Thanks,
> Cassies mommy

    Personally, if I am unable to complete a root canal, I will not charge
the patient.  The specialist will for sure though, and I haven't seen a
fee that low from a specialist in a long, long time.
    This is not about blame--it DOES happen.  However, if I refer a patient
to a specialist they KNOW it's going to cost them.  If you are saying
the specialist returned you to your dentist to complete the root canal
and the $245 fee was to remove the broken instrument, I see no problem
with that.  The alternative would likely have been what I would do--I
wouldn't charge you, but the specialist would--and it would have been a
lot more than $245.

Steve
cassiesmommy - 01 Feb 2007 15:29 GMT
On Jan 30, 7:55 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:
> Cassiesmo...@gmail.com wrote:
> > Ok, I know that it happens, or at least now I do.  I went to the
[quoted text clipped - 27 lines]
>
> - Show quoted text -

the $245 was just to have the obstruction removed, I payed a total of
$480, for a new root canal and the fee for the removal of the file.
It may seem so low because we have military dental insurance, but the
insurance didn't cover any of the fee for the file, just the root
canal.
Mark & Steven Bornfeld - 01 Feb 2007 15:41 GMT
> On Jan 30, 7:55 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
> wrote:
[quoted text clipped - 37 lines]
> insurance didn't cover any of the fee for the file, just the root
> canal.

    So--just to be clear--the first dentist charged you for the root canal,
then the specialist charged $245 for the removal of the instrument, and
then the generalist charged you a second time for the root canal to be
re-done?

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

cassiesmommy - 01 Feb 2007 16:49 GMT
On Feb 1, 7:41 am, Mark & Steven Bornfeld
<bornfeldm...@dentaltwins.com> wrote:
> > On Jan 30, 7:55 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
> > wrote:
[quoted text clipped - 51 lines]
>
> - Show quoted text -

No, I got my money back for the first root canal, because they didn't
finish it.  I'm not angry at the dentist or anything and I'm not
trying to get extra money out of em, I just believe the $245 for
having to pay to have the file removed is something I should be
reimbursed for because it's a whole new fee added to my total dental
costs that I would not have had otherwise.
Mark & Steven Bornfeld - 01 Feb 2007 20:23 GMT
> On Feb 1, 7:41 am, Mark & Steven Bornfeld
> <bornfeldm...@dentaltwins.com> wrote:
[quoted text clipped - 61 lines]
> reimbursed for because it's a whole new fee added to my total dental
> costs that I would not have had otherwise.

    I don't agree.  Perhaps you should have been referred to the specialist
in the first place.  It would have LOOKED better (it would have
eliminated the appearance that a mistake had been made) but it would in
all likelihood have cost you more.
    There are other factors connected to this situation that may have
changed the way you were treated and explain the way you were referred
back and forth (such as the military insurance and some restrictions
related to that) and if that is the case I cannot speak to that.
    If you wound up at the end with a good, functional tooth, then comfort
yourself at least by knowing that $480 for a root canal is relatively
very low.  Furthermore, removal of broken instruments is sometimes not
possible, and some methods can put the root at risk.
    In other words, I know you're annoyed--but things might have gone(and
frequently do) much worse.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

JimSocal - 04 Feb 2007 03:00 GMT
>> On Feb 1, 7:41 am, Mark & Steven Bornfeld
>> <bornfeldm...@dentaltwins.com> wrote:
[quoted text clipped - 78 lines]
>
>Steve
Dr. Bornfeld,
I respectfully disagree with you.

I know you're a stand up guy and normally I agree with you 100%, and I
always take your advice on dental matters.

But if you went to get your car fixed, and the auto mechanic dropped
something into your gas tank (say a packet of sugar) and it had to be
removed or it would ruin your engine...

So he had to remove the gas tank to clean it, and charged you an extra
$300 for doing so...
Would that be okay?

I know dentists aren't mechanics and people aren't cars, but I see it
as the same thing:

you go to an expert service provider to get something done, that
provider makes a mistake (whether it's his "fault" or not) causing you
to have to spend more money to fix the problem that didn't exist until
he created it... then you have to pay more money to fix that
problem???!

No, in my opinion, the first dentist broke off the file, he should pay
to have it removed. Period. End of story.

It's not a matter of being "mad at" the dentist for making the
mistake. I agree with the op there - mistakes happen, and he at least
told him that he made the mistake. BUT, the mistake happened during
his service, and we have no way of knowing if it was his "fault" or
not (maybe the file had been used too many times, maybe he bought it
from a low-quality supplier, maybe he pushed it the wrong way, dropped
it or any other myriad of reasons it failed; or maybe he did nothing
at all wrong, it just happened). But the bottom line is, it happened
during his treatment of the patient, therefore it is his
responsibility to pay for making it right.

Again, with all due respect, that is how I see it.
Steven Bornfeld - 04 Feb 2007 03:29 GMT
>>> On Feb 1, 7:41 am, Mark & Steven Bornfeld
>>> <bornfeldm...@dentaltwins.com> wrote:
[quoted text clipped - 109 lines]
>
> Again, with all due respect, that is how I see it.

    That is your right.  The difference in our opinions hinges on one main
point that keeps a lot of lawyers busy, and that is the presumption
among many that a bad outcome indicates that something was done negligently.
    It is routine for instance to warranty auto repairs; it is definitely
not only not routine, but unethical to warranty a medical procedure.
The reasons are based not only on hundreds of years of medical
convention, but also an understanding that there is a difference between
blood and guts on the one hand; and nuts and bolts on the other.

Steve
JimSocal - 04 Feb 2007 05:24 GMT
. But the bottom line is, it happened
>> during his treatment of the patient, therefore it is his
>> responsibility to pay for making it right.
[quoted text clipped - 11 lines]
>
>Steve
I knew the mechanic analogy wasn't a good one, but being under the
influence of codeine and valium and pain, that is all I could come up
with. ;-)

I don't think that a bad outcome always means that something was done
negligently, I just think that in this case we can't KNOW for sure if
it was negligent, so the assumption should be that if it happened
during the procedure, the dentist is at fault because he was the one
using the file, it was in his hand when it happened.

It certainly is not the patient's fault, and yet the patient has to
pay for it?

I think at minimum, they should share in the cost of the specialist,
equally.
Dartos - 05 Feb 2007 18:00 GMT
> you go to an expert service provider to get something done, that
> provider makes a mistake (whether it's his "fault" or not) causing you
[quoted text clipped - 4 lines]
> No, in my opinion, the first dentist broke off the file, he should pay
> to have it removed. Period. End of story.

Long post to follow, but I'm not offended at your statements.  I just
don't happen to agree with them.

Let's say you have a 1955 Thunderbird that was driven until it had
120K miles, was restored once in 1980, has another 80K on it, and
needs another engine rebuilt.  The 312 V-8 has some parts that are
not available at the local auto parts store and the mechanic doing the
second rebuild doesn't know exactly what the mechanic did on the first
rebuild.

Two head bolts break off just getting the engine apart.  The carburator
jets need to be replaced, but they aren't available as new parts.  It
takes three tries to properly modify available parts to fix them.

The cam is not stock.  The cylinders are already .060 over and
you aren't sure you can squeeze another .030.  Two exhaust manifold
bolts are missing.

On and on through the rebuild, and then torquing down the last
head bolt, POP, another one goes.  Off comes the head and all of the
head bolts are re-examined, a few drilled and tapped before final
assembly.

Should the engine rebuild be the same cost as one for a 1995 Taurus?
Should the mechanic accept responsibility for parts that failed?
Should the mechanic charge extra for adapting available parts to
fit an obsolete engine?

Most mechanics would simply say, "I don't work on that kind of
project".  Dentists do it every day.

Some dental treatment is easier than others.  A small one-surface
restoration on a teenager is *usually* pretty straight forward,
but much of it is more like the above example.

Cutting out an old amalgam, remaking a crown, root canals,
and many other dental treatments can turn into big trouble quickly
without the dentist making any mistakes.  Experience, skill, and
education help the dentist reduce the chances for poor results, but
they do not eliminate them.

Dentistry has been very good at 'fixing' teeth for many years.  The
repairs usually last 10-50 years!  When something cannot be restored,
fails after a short length of service, or takes more time, effort,
and money, the patient often is upset and shocked.  "We" have worked
hard to deliver good treatment and make it comfortable and seem to
be "no big deal".  It isn't nearly as easy as it may seem.

D
JimSocal - 05 Feb 2007 21:10 GMT
>> you go to an expert service provider to get something done, that
>> provider makes a mistake (whether it's his "fault" or not) causing you
[quoted text clipped - 54 lines]
>
>D
I do understand your position and I'm willing to say maybe you are
right and maybe I am wrong.

But my feeling is that if I bring my old engine in to you, and it's
got a bad cylinder so you agree to fix it for me.
But you break off a screwdriver inside the engine and now the broken
pieces of the screwdriver have to be found and taken out, in order for
the engine to run right, it's not my responsibility to pay for the
extra time spent doing so, because it was you who broke it off. Maybe
your screwdriver was old, maybe you torqued it too much, maybe it was
a defective screwdriver, etc., none of which are your fault, really.

I think, if the mechanic was going to be honest (I know: highly
unlikely, but let's just pretend), he should not charge me for the
extra time removing the broken screwdriver from inside the engine.
(In reality, the mechanic would just charge me for more time and never
tell me about the mistake he made.)

(I realize this is not a practical and accurate analogy, I'm not a
mechanic nor a dentist; but I think you get the gist of what I am
saying.)
Dartos - 06 Feb 2007 16:16 GMT
> (I realize this is not a practical and accurate analogy, I'm not a
> mechanic nor a dentist; but I think you get the gist of what I am
> saying.)

I think the gap between our opinions comes from the idea that
dentistry is little more compicated than working on a standard
automobile.

That's why I used the analogy to an antique restoration that presented
very unique and challenging problems.

No two patients are alike.  No two cavities are alike.  No two
crowns, root canals, extractions, or denture cases are alike.

Dentist can't look up what part number to order, what the shape
and size of a filling should be.  The tools for autos are pretty
strong and you don't need magnification to see what you're doing.
Tightening bolts is a simple job of setting a torque wrench to
specifications.  Cars now even have 'computer diagnostics' to
tell the mechanic what needs repair.  (Don't get me wrong, I'm
not a great mechanic and appreciate good honest ones!)

When speaking of dentistry, we often use automobile analogies.
The truth of the profession is much different.  I never know
how deep a cavity is going to be.  I never know how wide it
will be.  How a filling is layered and cured will vary with
each restoration.  I have to pick which matrix will provide
the best form of the final filling.  I carve the filling to
shape by hand.

With a root canal, I am working blind on the deepest part of
the root.  Even with X-rays and magnification, I don't know the
*exact* size, shape, or curve of the canal.  I'm often using
reamers and files that are as small as a hair by feel.  No torque
wrench settings are available.  If I'm a 'hot dog' in a hurry,
I'll break files all of the time.  If I'm slow and very careful,
I'll only break these tiny instruments on rare occasions, but I
will break them at some time. On a car, you can't do this without
gross negligence.  On a root canal, it will happen no mater how
careful you are.

I haven't even talked about finding all of the canals, getting
them properly cleaned/shaped, and sealing them.

Unless you observed a dentist for a few weeks, it is probably
hard to get a real feel for the demands of the job.

D
Mark & Steven Bornfeld - 06 Feb 2007 18:03 GMT
>> (I realize this is not a practical and accurate analogy, I'm not a
>> mechanic nor a dentist; but I think you get the gist of what I am
[quoted text clipped - 44 lines]
>
> D

    Great explanation--thanks for taking the time to think this through and
write it!

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Newbie - 05 Feb 2007 22:16 GMT
Tolp posted for your convenience.

You said a mouthful brother.

If only I had a '55 T-bird....

>> you go to an expert service provider to get something done, that
>> provider makes a mistake (whether it's his "fault" or not) causing you
[quoted text clipped - 54 lines]
>
>D
Dartos - 06 Feb 2007 16:17 GMT
> Tolp posted for your convenience.
>
> You said a mouthful brother.
>
> If only I had a '55 T-bird....

When I was 19, I had a chance to buy a '57 for $1200.  I just didn't
have the $1200.

;-(
D
 
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