Dr. Hall,
Thanks so much for this wonderful site and your expertise, Dr. Hall. I feel like I can get an unbiased opinion from you since you are not going to be doing the dentistry work I need. I’ve been going to a holistic dentist whom I think has many good things going in her practice, and have wanted to stick with her despite noticing years ago some lack of care about my experience. I should have listened to my instincts and not returned, regardless of the fact that she is the only truly holistic dentist in my town.
I went to have a half metal crown replaced with all porcelain, as well as replace a mercury filling with ceramic, and fill another very small hole. She said my original crown was big but did not elaborate. She used the newfangled computer – CAD/CAM technology – to make a scan of my old crown and teeth and send it to a computer where it told her what size and shape of crown was needed for the replacement, which she made in her office on the spot. This “technology” gives you the new permanent crown in 30 minutes and there’s no need for a temporary one while another outside lab makes it. It all sooouuunds good and I trusted her. In hindsight, the first alarm bell was that she cemented the new crown in without even fitting it first to see if it felt right. After that, my bite felt off, so she did some sanding and sent me on my way.
It was obvious soon afterward that things were definitely not right but I didn’t know what. I went back the next week and she said the molar in front of the crown was hitting way too hard and proceeded to sand that tooth, which previously had no problems. My bite was so off that she also sanded 2 of my front teeth that were crooked and banging on each other now. I asked her what to do if my teeth still felt off. She said I needed to go to an orthodontist. This was very upsetting to me as I did not want to feel forced to immediately start a $6600 ortho treatment to make my teeth feel normal.
Another alarm bell went off that day when her assistant was doing half the work on my teeth, and I didn’t know her, or what her credentials were. She is not even listed on their website. She did not do the sanding on the pinhole filling correctly, either, and after 2 sandings that side still is off, as well.
I have had a second opinion already and it is obvious with the bite scan they did, that the crown is way too small/high and that that whole side of my teeth are not even meeting when I bite down. The front teeth are even getting sore from chewing. The second dentist said I would need to replace the crown with a bigger one, and add material to the front molar that they sanded unnecessarily, OR I could fix it and my other crooked teeth with Invisalign.
I have numerous questions about which is better, but have for sure decided not to go back to the first dentist and to also try and get my money back.
I also do NOT recommend getting the CAD/CAM technology crowns because it is up to the computer and dentist to “decide” what size of tooth you “should” have and is not based on reality. The old-fashioned way of using impressions to fashion a crown, which matches your original tooth pretty exactly seems to be the obviously smarter way to go. I would much rather put up with a temporary crown for a few weeks, then get it totally wrong and suffer until I can get Someone to fix it.
I would love your opinions on this.
Thank you so much,
Lisa from California
(See Dr. Hall’s answer below.)
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Lisa,
You’ve had quite the awful experience! Thanks for sharing this.
First, the question that you implied but didn’t ask directly—are you better off with a dentist who isn’t holistic but has more competence? I would say that you are. There aren’t many dentists who you could say are totally holistic in their thinking, but there are a number of them who are willing to accommodate patients with holistic concerns. That was how I was in my practice. While I did not personally subscribe completely to the holistic thinking, I had respect for those who did and was willing to accommodate them with their needs as they perceived them. I was mercury-free and nickel-free for starters. Then, they would bring me long lists of dental materials that would indicate that they were sensitive or not sensitive to those materials, and I accommodated all those requests. My holistic patients understood my philosophy and referred their friends to me, and they would come from a hundred miles away to see me. That to me is much better for your health that a dentist who may totally subscribe to holistic thinking but nearly ruins your mouth, as yours has done.
Then, about the care you received. I think your dentist violated the standard of care and is at risk of losing a lawsuit over this. So yes, I would press for a complete refund and if you don’t get cooperation, I’d talk to a lawyer. This could take quite a bit of work to repair your bite, and meanwhile there has been quite a bit of suffering.
While you have had problems with this crown made with the new CAD/CAM computer technology, many dentists are producing excellent work with it. The two principal companies making this technology are CEREC and E4D. The optically scanned impressions actually have a higher degree of accuracy than the physical impressions, since under certain conditions physical impressions can stretch or tear. The crowns made by this system are metal-free ceramic crowns and so are very biocompatible. You have been a victim of the old computer principle, “garbage in–garbage out.” To build a quality crown, this technology needs a skilled dentist directing it, and yes, the crown should have been tried in and adjusted to your bite before it was cemented. That’s pretty basic. Impressed with this technology, about 15 years ago I traveled to Tucson where I had a highly skilled colleague who had a CEREC machine and had him make me a CEREC crown for a lower molar. It fit perfectly and I have had no trouble at all with that crown since.
You need a highly skilled and honest dentist fixing the damage that you have suffered. I hope you are now in good hands. I’d be interested in hearing the follow-up on your case.
– 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.
Dr. Hall,
Thanks so much for responding to my letter! I Really appreciate your input and expertise. I’m glad to know that you think the CAD technology for in house crowns is good and that it just depends on who’s doing it.
I’ve decided to go to a dentist who does the computer scanning of the teeth, but sends the info out to a lab to create the crown. I’ll wear a temporary for a bit, but I’ll get to see if the size corrects the situation before the permanent one is cemented in, which I’m tending to think is better than cementing in the permanent one on the same day. This dentist thinks the in house creation of the crown is not quite there technology wise.
My original dentist told me to fix the bite/crown problem by going to an orthodontist. I went to the one she recommended and he was not confident he could fix the situation. How ironic. Because of this I decided to get a new crown. I’m hoping my tooth will survive this work again alright and we won’t have to add material to the front molar where the dentist sanded it. Hoping for the best.
Thanks again,
Lisa