Dr. Hall,
In November 2009 I had a crown put on my number 8 front tooth. My tooth was slanted from sucking my thumb when I was little, and this was to fix that.
About 3 weeks after my crown was put on my tooth was really sensitive to hot and cold. I was told that was normal for the first few weeks. About 4 months later my tooth was hurting so bad that I had to go to the ER! The next day my face swelled up and I was out of work for 5 days. When I went to another dentist, they told me that my tooth was infected and that I would need a root canal and a new crown. I was like WHAT??? how could this happen? She told me that I had an open margin and it was from the crown not being placed properly.
I called the first dentist, who did the crown, and I told the secretary the situation. I told her that i deserved my money back because for his mistake i have to pay for another crown and a root canal!! she said that once the crown was in my mouth it was my responsibility!! I said even if it was a failed job???
Is he liable for this? Shouldnt he pay?? I have seen the xray and the open margin is huge! ! If he we re to have taken xrays at the end of the job he would have seen the open margin and knew it had to be redone.
At the time I was making payments on the crown and paid a little more than half. After I found out about his mistake i told the office i was not paying the balance . About three months later I got a notice saying he was suing me for the balance! I couldnt believe it ! I of course filled a countersuit and when I went to the small claims court his lawyer told me if i drop the counter claim then the dentist would “forgive my debit”. I said NO I want the money that I paid him and his lawyer said “Well he is not willing to do that.” The case now has to be handled by the superior court because civil court can’t deal with things like this.
My question is should this guy have fixed his mistake? Because of him I was in the most extreme pain I was ever in, I had to miss days of work, I had almost a dozen appointments ( emergency room, doctors and dentist visits), my face swelled up so bad that I could barely see and I had to get a new crown and a root canal . Please let me know what you think!
Thanks!
– Sarah from Massachusetts
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Sarah,
You have quite the story!
I have to qualify this because I can’t judge this without seeing. But just going from what you’re telling me, yes, your former dentist is liable for violating the standard of care. The most important thing to check when a new crown is being seated on a tooth is to run the explorer around the margins and make sure there is a good fit to the crown. Usually a dentist won’t take an x-ray before seating a crown, but they always need to run that explorer completely around the margins of the crown and check for any open margins. But having the x-ray you have is good documentation showing his negligence.
The problem, though, in many cases like this is that the dollar amounts involved make it impractical to involve lawyers and to go to trial. But here are a couple of things you can do to increase the pressure on this dentist to refund your money:
1. Threaten to complain to the dental board. Not as serious as a malpractice suit, this is still something that the dentist is strongly motivated to avoid.
2. Have the new dentist help you. A call from one dentist to another, verifying that there was indeed a problem with the work, can be very persuasive. In a trial, you HAVE to have an expert opinion of a dentist to back up any claim of negligence. Your word isn’t good enough.
3. Have a lawyer write a threatening letter. Rather than pay for an entire malpractice case, just having a letter from an attorney can get the dentist to take your complaint more seriously.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Questions about the integrity of mynewsmile.com listings
Dr Hall:
When dentists send you pictures of their work, how do you know the photos haven’t been retouched? Also, since they pay to be included on your site, have you ever turned a dentist down because his work wasn’t good enough? Thanks.
– Mark from Massachusetts
Mark,
Actually, most of the dentists who approach me about being listed on mynewsmile.com are turned down. I have a whole file folder full of those requests. And sometimes it’s kind of awkward because I know the dentist, but if their work doesn’t measure up, I simply won’t list them.
You’ll notice that other sites that list dentists just list them – they don’t say they recommend them, they just list the name. But on mynewsmile.com, the wording specifically says that these cosmetic dentists are recommended. You don’t find that kind of wording on other dental directories. So I’m sticking my neck out to do that, and I need to have assurances that their work is good enough for me to put my name behind them.
As far as dentists altering the photos – I have never had an incident where I suspected that. In most cases when I turn down dentists, the dentist thinks their work looks great. So they wouldn’t even know how to retouch the photos to make them meet my standards. If they were artistic enough to make the photos look good, they would be artistic enough to make the cosmetic dentistry look good. Plus, I don’t rely on the photos alone, but I also use other credentials and reputation among other cosmetic dentists. I have had a couple of examples where the photos looked okay, but, reports from other cosmetic dentists who were familiar with the dentist’s work told me that their work was inconsistent, so I turned them down.
I also listen carefully if any mynewsmile.com visitor has a complaint about the work of any of our member dentists. I have had only three complaints. In the case of two of them, the complaints didn’t hold up under scrutiny. In one of those cases, the woman I think must have been surprised that I took her complaint seriously, and when I said I wanted to investigate it, she said that she had made a bigger deal of it than she should have and that she was actually pretty happy with the work. In the third case, the issue was easily resolved.
I hope this helps.
Dr. Hall
Links:
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
I have a high resistance to novocain
Dr. Hall
I am a fairly young female who has extensive dental problems mainly due to having a high tolerance for novocain. Therefore, making every trip to the dentist horrifyingly painful. After a while I just got discouraged and stopped going. Now I am older and what to take full control of my dental hygiene. I have 5 or more teeth that need to be extracted but haven’t done so cause I immediately want them replaced with preferably implants. My goal is to have heathly teeth with a beautiful smile. Since I live in New York, do you recommend I out-source to another state to keep the cost as low as possible?
– Nina from New York
Nina,
Manhattan has some of the best cosmetic dentists in the country, but it is also a very high fee area. Yes, if you want to save money and don’t mind travelling, there are excellent cosmetic dentists in either New Jersey, or on Long Island.
Interestingly, over the years when I have looked, I haven’t found a cosmetic dentist I wanted to recommend in any other boroughs of New York City except Queens. So apparently really good cosmetic dentists have no interest in locating in Brooklyn, for example.
But I wanted to address your high tolerance for novocain. This is nothing more than a higher level of anxiety when you’re getting dental work, and what you need is not more novocain but some type of relaxant. I know this subject very well, because I had a special interest in treating this type of patient, and the question I asked to find out if people needed a little nitrous oxide or possibly an oral sedative was, “How does novocain work for you?” In every case, where a patient had what they felt was a high resistance to novocain, using a little nitrous oxide, or perhaps an oral sedative before the appointment took care of the problem, and the novocain worked fine.
I also know this subject well because I am one of these patients also. I’ve had some very stressful experiences in the dental chair as a patient, so I tend to get anxious when I have any work done and the novocain wears off very quickly on me, unless I have some nitrous oxide. You can read about this in an article I wrote for Dental Economics about dental fear.
So look for a dentist who has nitrous oxide available. That could mean a world of difference to you for your future dental care.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Cement left around my new crown
Dr. Hall
Is it common for a dentist to leave cement in a mouth that had a crown? My gums were hurting from the temporary crown. After the permanent crown was put on he said in a few weeks my gums would heal. They didn’t. I finally took tweezers and anything else I could find and pulled out a piece of cement under my gums. NOW my gums are healing. I felt instant relief after extacting this piece of cement. A 7 week ordeal.
– Mona from Texas
Mona,
This is a “no-no”, for a dentist to leave cement around a crown, and it will cause gum inflammation until it is removed.
I wouldn’t assume that you got all the cement but would make an appointment with the dentist, explain what happened, and say you want it checked carefully for any residual cement. If cement is left in there long-term, it can contribute to irreversible gum disease.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
After my wisdom teeth were extracted, I can’t feel my tongue
Hi Doctor Hall,
I had my lower wisdom teeth extracted about three months ago. Since the surgery I can no longer feel my tongue. In my understanding lingual nerve damage usually effects either one side or the other.
My mouth is also severely dry. This is very perplexing to the doctors and I have received many second opinions – none of which have amounted to answers. Do you have any insight on this? An allergic reaction to the injection medicine? Any answers or new avenues you could reveal would be most helpful. Thank you!
Jenny from Louisiana
Jenny,
The lingual nerve, which is the nerve that goes to your tongue, runs along the inside of your jaw close to your wisdom tooth. Its course varies somewhat from person to person, so a dentist is wise to keep any incisions of tissue that are over the wisdom tooth well toward the cheek side (called the buccal side) of the tooth.
Lingual nerve damage after the extraction of a wisdom tooth can be either because the nerve is severed by the incision of the dentist, or because it is compressed and traumatized either during the surgery or as a result of the swelling afterward. If the nerve is severed, there is little hope that it will grow back. If it is slightly bruised, it can recover within about a month. If it is badly bruised or crushed, it can take it about a year or more to heal.
There are two lingual nerves. One goes to each side of your tongue. If your entire tongue is numb, that means that both lingual nerves were damaged.
As far as your dry mouth, there isn’t anything during the actual wisdom tooth extraction that I believe would cause that. There is no way it could be an allergic reaction to any injections, because those medications have been long since totally eliminated from your body. So how can you still be having an allergic reaction to something that isn’t there? There are a couple of possible explanations.
One is that it could be related to the numbness in your tongue. Taste sensations provoke salivary flow. Since your taste sensations have been numbed, it seems reasonable to think that you would have reduced salivary flow.
However, when you say that your mouth is “severely dry,” that leads me to think it is burning mouth syndrome. Stress can also cause a reduction in saliva flow, and that persistent extreme dryness in the mouth can lead to a burning sensation, which gives this syndrome its name. This syndrome is poorly understood, and I have received a number of communications from patients who have told me it has perplexed their dentist and it took going to a specialist to have it diagnosed.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
How should my crowns come together?
Dr. Hall,
I am 59 years old, and have had 8 previous crowns. 2 weeks ago a new dentist fitted 2 new crowns (one porcelain and one gold) to my upper rear left adjacent molars.These are the permanent crowns, not temporaries. These new crowns are at least one mm or more distant from touching the opposing lower teeth (which are also crowned). I read that crowns should slightly touch opposing teeth. I also need another crown on the other side of my mouth, but need to know if my dentist made a mistake. Thank You very much!
– Mark from Colorado
Mark,
Yes, dental crowns should touch their opposing teeth. But, if they are made correctly, there are more rigorous demands than that. It matters where they touch. The study of how your teeth come together is called “occlusion,” and there are textbooks and entire courses that study occlusion.
How your upper teeth meet your lower teeth is important for proper jaw function. If your jaw is properly aligned, you should be able to clench together and all your teeth will meet at the same time. Then, when you slide your teeth from side to side, there are two acceptable patterns of occlusion. One is called canine-protected occlusion. In that type, when you grind your teeth to the side, only your canine teeth touch. These teeth have especially long and sturdy roots and are equipped to take this sideways stress.
The other acceptable pattern is called group function. In group function, all of the posterior teeth have the same slope and when you grind your teeth to the side, they all touch evenly.
One way some dentists use to check the bite is to put a thin strip of plastic between your back teeth, about 0.05 mm thick and about the width of one tooth. No matter where you put it on the back teeth, you should be able to clench your teeth together and prevent the strip from being withdrawn.
When you have back teeth that don’t come together all the way, over time they may drift together and touch. But even though they may touch, there is a strong chance that they won’t touch correctly, and they could throw your bite out of alignment. A poorly aligned bite is one of the contributing factors in TMJ disorder.
I hope this is helpful.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Seems like this “cosmetic” dentist is in over his head
Dr. Hall,
I recently replaced my four veneers, two on each side of my front teeth. A few things did not come out as I wanted, but I was willing to overlook them because I just wanted to be DONE with this!!!!
The things I was willing to overlook:
1. When my dentist tried my two canine teeth on; they were too bulky and stuck too far out. So he polished the right one; this created a dark spot on the tooth. This was obvious, so he immediately agreed to replace it.
2. My left canine teeth still sticks out more than the others. But again, I was willing to overlook it because I felt too greedy asking for a perfect smile.
Before proceeding to cement my veneers the dentist showed me what they would look like and all look well. But later that day at night I noticed that my veneers looked darker; they looked grey! In day light my veneers look fine, but in artificial light they’re noticeably darker than my two front teeth. This is very noticeable especially since I whitened my two front teeth prior to the procedure. I immediately called my dentist to explain what happened. He told me he couldn’t do anything about it. He also stressed the fact that he showed them to me and I said it was fine. And this is true, but he showed them to me during day light- the windows were open and there were no artificial lights on. Had I known that the shade could change with different types of light, I would’ve asked him to close the windows and turn the lights on. But I never knew to do that, especially because my old veneers never changed in color depending on the light.
Please advise me what to do???? I can’t be stuck for 10 years with this problem. I’m extremely self-conscious about it and don’t even want to smile in public. Please help!!!! Thank you!
– Evelyn from California
Evelyn,
I’m not getting a lot of good vibes here about your “cosmetic dentist.” I’m wondering how you came to pick him.
The problem with your canine tooth concerns me. When it was tried on it was too bulky, so he polished it back and discovered that made a dark spot on the tooth. I’m sorry, but it sounds like he is learning as he goes. And so you are accepting that these two teeth are too bulky and are going to just live with it. Any dentist who has much passion at all for cosmetic dentistry would never tolerate that in a result but would do it over until it looked beautiful and you loved it.
The color problem you have is called color metamerism. Under one light, the porcelain matches your natural teeth. Under another light, they don’t. Apparently this is another surprise for your dentist who doesn’t appear to be aware of this principle. Excellent cosmetic dentists learn all these things.
It isn’t true that your dentist can’t do anything about it. He can replace the porcelain veneers. But if it were my front teeth, I wouldn’t let him do that but would try to get a refund. It seems like he is in over his head.
I’m guessing here, because I can’t see your case and don’t know your dentist, but what you are telling me leads me to believe that you asked the wrong dentist to do this artistic work for you. 98% of dentists are engineering types. They like to fix things, but they aren’t artistic and they have little passion or feeling for appearance-related dentistry. When I talk to a dentist, there is one question whose answer will tell me a lot about whether or not the dentist is an excellent cosmetic dentist, and that is, “What do you do if the patient doesn’t absolutely love what you did?” The really good cosmetic dentists won’t hesitate – they will send the case back to the lab if the patient has any doubt at all about how it looks. In fact, they will tell me that usually they are more demanding about the appearance of the work than the patient. That’s the kind of dentist you need.
I see from your city that you are about half an hour from an excellent cosmetic dentist that I recommend. I believe this office will give you a free consultation appointment just to take a quick look and verbally explain what some of your options might be. That’s what I would do.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
My teeth are crumbling, and what if I can’t afford any other treatment but dentures?
Dr. Hall,
I am considering getting full dentures. I was told I had little enamel left on my teeth about 13-14 yrs ago and since have had two pregnancies in which I vomited every day (sometimes multiple times a day) during my entire pregnancy. Since the birth of my last child 8 yrs ago my teeth have literally started crumbling like powder, cracking and I have a lot of visible cavities.
I had a tooth removed last week because it had already started falling apart and I cracked it in two blowing up a float for my child and I flat out had enough. Five of my teeth are literally down to the gum line now and one crown and post have fallen out. My dental insurance only covers $1000 a yr and it doesn’t take much to use that up so if you are wondering why I have not had all this fixed as it happened when you run out of insurance in March it is hard to get anymore done with insane cost of cosmetic dentistry. It will only cost me $1400 out of my pocket to get upper dentures (I am still debating on lowers as they are not as bad as the uppers) but I was quoted about $4000-$5000 out of pocket to get root canals and crowns or bridges. I do not qualify for any loans or assistance to get this done so dentures appear to be the only option.
I have read just about everything you have on this site and am really irritated at your comments about people’s care or lack of care for their teeth as you do not know what some have gone through. I also had meningitis as a baby and was put on a lot of meds (I have other health issues due to this but my teeth are the worst). I would love to have an awesome cosmetic dentist fix my teeth right but unless you or they intend to do it for free I think you need to stop being so condescending about what people should do and/or what caused their teeth to become bad in the first place. In case you are wondering I have brushed after every meal and snack since I was a kid and flossed at least once a day as well as rinsed with a mouthwash but it has done me no good except to ensure fresh breath.
– Wendi from Alabama
Wendi,
It sounds to me like you’ve almost completely decided what you want to do, so I don’t know that you need much help here, but I’ll offer some. I was also intrigued by your comments and wanted to respond to them.
I think you’re trying read things into my website that aren’t there if you come away from reading it thinking that I would condemn someone like you in your situation. I don’t know where you would get that. Yes, I’m going to tell people to take care of their teeth when they can. To do otherwise would be negligent. But I rarely criticize patients who write to me with their problems. And then there are always things that can happen that are difficult or even impossible to deal with, which sounds like what you have experienced.
About the cost of dental care—yes, it can be expensive. I think it will help you to understand that the overhead to run a dental practice is very high. It can run into hundreds of dollars an hour. And some insurance plans, including government programs, discount their coverage so much that a dentist will lose money on every case. In my practice, I would see some patients with these programs that caused me to lose money, but I had to limit my participation or I would end up turning my entire practice over to that and wouldn’t be able to deliver the quality care I wanted to.
If your finances are really limited, it may be that dentures are your only option. I saw a number of patients in your situation and did my best to help them as much as I could. But don’t expect me to sugar-coat your situation. There are troubles ahead when you get full dentures. They will reduce your chewing efficiency, and there is a great deal of dissatisfaction out there with people who have dentures. In addition, your jawbone will begin to shrink and within about twenty years or so, you will have to deal with facial collapse. But let me try to be helpful, and share some ideas that may be helpful for your situation, because you are in a difficult situation.
Losing your lower teeth is much more serious than losing your upper teeth, and an upper denture is much easier to adjust to and to use than a lower. An upper denture is held in place with suction, so it is considerably more stable than the lower denture, which rests and kind of floats on your lower jaw and is held in place by your tongue and cheeks. Additionally, if you have lower teeth chewing against an upper denture, it may help the lower teeth to last longer. So if you are looking for the most economical solution and you can keep your lower teeth, any amount of time you can keep them will delay facial collapse. And there is much more satisfaction with upper dentures than with lower ones.
Also, any teeth that can be saved for any amount of time will delay the bone resorption. Sometimes the crowns of the teeth can be cut down and the roots of teeth can be retained and this will also delay the bone resorption.
I hope that you can find a sensitive and caring dentist who will take care of your needs and take the time to discuss your options.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.