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Hi Dr. Hall,
Should I consider leaving my current dentist? When I first met my dentist, I was amazed a how incredibly fast he could trim down a tooth for a crown. It seemed like less than ten seconds. However it now seems as though he shaved some teeth down too far. Two of his crowns have fallen out twice, and there does not seem to be much tooth left to hold them. Could it be that he was working too fast and took too much off of the existing teeth?
I am not planning on suing but I cannot afford to lose any more teeth to his crown work, and cannot afford implants at the moment. Should I seek out a different dentist? Is there any guarantee with a crown?
– Marcos from New Jersey
While there is not really a guarantee with a crown, there is a concept in dental care called the standard of care–a minimum standard that an average dentist should provide his or her patients. There may be situations where there simply isn’t much tooth left to hold the crown on, so even a dentist who is doing everything right could have problems with an occasional crown staying on. But if there are recurring problems with crowns from a particular dentist with crowns falling off, that could indicate a breach of the standard of care and the dentist could be liable.
I realize that you don’t want to sue, and I’m not suggesting that. But knowing the dentist’s liability can be used to give you a bargaining position to get things fixed correctly without having to pay another dentist to do this over.
You say that two crowns have fallen off twice, and that you could see there wasn’t much tooth left on these teeth. While I don’t know the history of these teeth, that, together with your description of how little time this dentist spent on the crown preparations, suggests to me that the teeth were prepared with too much taper. I refer you to my earlier post on this subject, The Main Reason Your Crown Probably Fell Off, where I explain the role of taper.
In over 20 years of dental practice and placing many hundreds of crowns, I never had a crown that I placed fall off. I say that not to brag but to make the point that if a tooth is properly prepared and a crown properly cemented, it will stay on. Yes, it takes more time and trouble to prepare a tooth precisely so the crown stays on, and it is also more time and trouble to seat and cement a crown with an ideal preparation, which is why most dentists compromise on the ideal preparation a little bit. It sounds like your dentist compromises a lot in the interests of speed.
So to get to the point. Yes, if I were you, I’d find a dentist who does crowns that stay on. And then I would get these two teeth fixed with crowns that stay on. It may be necessary to have new crowns made. Even if a tooth is over-prepared, there are ways to modify the preparation, either with retentive grooves, or with a buildup and possibly the use of pins, so that a crown will stay on better. Or, depending on the material in the crown, it may be possible with bonding technology to get a poorly prepared crown to stay on. I would find a dentist who can take care of this for you, and ask that dentist to help you get some type of refund, even if it’s a partial refund, from your current dentist.
– Dr. Hall
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