Sunday Dental Thread: Fascinating "Teaching" Case...

[PCIntern]

Yesterday, a gentleman came to me as a new patient. He had not been to a dentist for two years, but had had extensive work performed in the suburbs. To be precise, he had wanted his amalgam (silver) fillings replaced by esthetic composites because he wanted to improve the appearance. He stated that none of the silver restorations, placed when he was an adolescent, were deemed to be failing functionally, or leaking significantly. In other words, there was no decay present at the time of their replacement.

Clinical examination revealed seven composites, and four remaining silver fillings. There were gray shadows around the margins of several of the composites. Periodontal health very good despite not having prophylaxes for two years.

Radiographic (x-ray) examination revealed significant decay between the teeth at each of the composites, three of which will require the patient to undergo root canal therapy and crowns. Distinct breakdown was occurring at the exact interface between the restorations and the tooth, indicating that there was a breakdown in the bonding at the subgingival level. There were no observations of any decay around the silver restorations.

I would surmise that the practitioner who placed the restorations did not ensure that there was a satisfactory bond and the failure for this is catastrophic. I would tell all who contemplate replacing their silver fillings with these composites to ask the dentist to please monitor these areas carefully with radiographs every six months, despite the radiation dosage. The fact of the matter is that if left unattended, more radiation will be required to diagnose and treat, and repair the affected areas.

What is interesting here is that this is a situation of iatrogenic causation (practitioner-induced), and is going to be more commonplace as more and more composites are placed in a substandard fashion.

[surrealAmerican]

1. That sounds like malpractice.

Are you or the patient obligated to report this to some sort of licensing authority?

[PCIntern]

2. No.

that is 'bad result', not malpractice.

[Ms. Toad]

7. It actually may be malpractice.

Perhaps not in isolation - but I had a dentist who certainly should have lost her license for malpractice, and one of the things she did poorly was fail to bond the composites adequately to the teeth (or fail to adequately clean the decay before filling the tooth - I'll never know which).

Aside from beating me up at every visit (I literally developed bruises after each visit to her, as well as canker sores throughout my mouth from the small lacerations that had the same source as the bruising), her work was far below standard.

Six months, two improperly bonded fillings, one root canal in tooth that was healthy 72 hours earlier (when she started banging on an adjacent tooth with had significant decay), one improperly bonded onlay (which should probably have been a crown, since the root canal was in the molar), I left her practice.

Unfortunately, that bad experience with a dentist who had been recommended to me when I needed to find a new one left me reluctant to start the search again - so it was far too long before I went to another dentist.

I found myself, about two years later, being told I needed a root canal in a second tooth because either the dentist had not properly bonded the filling - or she had failed to adequately clean the decay before filling it in the first place. Fortunately, the wonderful endodontist who did my first root canal had retired so I had to visit a second dentist to get a referral to the new endodontist I wanted to have do the root canal. Because the new endodontist required a referral from a dentist he trusted (he didn't work with the emergency dentist who recommended the root canal), I found a good dentist who was able to save the tooth without a root canal - and who replaced every bit of the original dentist's work over the next three years as it failed bit by bit because it was so substandard.

So - a failed bond may be a 'bad result' - but when a dentist repeatedly has this particular kind of 'bad results' it rises to the level of malpractice.

(I wrestled quite a while with whether I should file a complaint against the person who was very briefly my dentist - unfortunately the referral to her was made by someone I must interact with regularly on a professional basis - to whom she is related.)

[elehhhhna]

8. my friend who paid for 3 root canals and only had one

(found out 5 years later) Now, that's malpractice!

[NV Whino]

3. Thanks for posting this

I appreciate your informative posts.

[Blue_Tires]

4. thanks for the insights....

[rug]

5. Could you have posted this after I finished my Cocoa Pebbles?

[Catshrink]

6. Another great post from my favorite dentist!

:hi: