Here is a question from John from New York. It’s hard to follow. Don’t try to understand all of this—I summarize his problem in the first paragraph of my answer.
had full mouth reconstruction, all crowns, one bridge, removable upper partial. No wax up done. First set temps occluded well, still original partial and not great occlusion on left side, as was with original teeth. When lower perms delivered, lost all occlusion, only 5 and 28 touched, dentist did not address issue, when upper perms delivered, occlusion worse as the six lower teeth no longer fit inside the front uppers. I could not chew and side to side was unassisted by proper mechanics. I addressed this after completion and a number of attempts to remedy the occlusion were tried by grinding down the right side, then by modifying the partial. At each step of treatment my bite got progressively worse, and at the end, all attempts to alter the partial also gave progressively worse results. If I were to place implants in 12 and 4, which would allow me to lose the partial, I would have to have 13, 11 and 6 crowns redone as they do not occlude. l have offered to pay at least the lab fees to correct the non occluding crowns, but for some reason the dentist chose to keep trying to fix the issue by modifying the partial, which also got progressively worse and is now very uncomfortable, causes pain on some teeth when chew, and because of adding material to the saddle, has a squeezing rubbery effect when bite down. I have tried to get help from two other very well qualified dentists but neither of them said they saw anything wrong, other than one who did admit that the partial was doing nothing, but did not mention that 13, 11 crowns and 12 on the partial were not occluding and that 5 and 28 were the only teeth touching. I want to fix my bite but between not wanting to pay to have at least three crowns redone and make a new partial, and hope any of the other crowns won’t need to be redone as well, and because of how my confidence has been shaken by what appeared to be the two dentists being more concerned about protecting the dentist who did the work than they were about my health and welfare, I am stuck trying to figure out what my best course would be. I’d appreciate some guidance. Thank you.
And then I understand that you are wondering if the other dentists helping you are more concerned about protecting their colleague than helping you. I also know quite a bit about that subject.
Occlusion is a complex subject
On the subject of occlusion—that is a very complicated subject. How the teeth interact with each other, with all their bumps, ridges, and pits, is complicated enough. But then you have this complicated joint, the TMJ, that allows a hinge motion, sliding back and forth and side to side—no other joint in the body does anything close to that—and dealing with it is beyond the capacity of a dentist who has merely graduated from dental school. There are high-powered institutes that are devoted to nothing more than the post-graduate training of dentists in the subject of occlusion and how it affects the TMJ and associated muscles. You need to find a dentist with a higher level of expertise to sort out your problems and fix them. As I said, I don’t know clearly what has happened in your case, but I am strongly suspicious that your dentist has gotten in over his head.
So how do you find a dentist who can sort out your occlusion? Look for a dentist trained at one of these occlusion institutes I mentioned. The two most prestigious are in South Florida. One is the L.D. Pankey Institute, the other is the Peter Dawson Academy. Both of these teach conventional occlusal theory. Another respected institute is the Las Vegas Institute. It teaches a different, functional theory of occlusion that also seems to work well in practice. There are others, such as the Texas Center for Occlusal Studies, but these three are the most popular. A dentist trained at any one of these institutes should be able to help you.
On the other issue, yes, it is very common for dentists to band together and defend each other against the interests of the patient. I get occasional flak from other dentists who tell me that my criticism of some dentists is unprofessional (see the “hate mail” category in this blog). That is their thinking. My thinking is the opposite—that the highest professionalism is serving the patient and calling out mistakes when I see them. That is why I counsel patients seeking second opinions to go outside their local area.
I see you are in a suburb of Rochester, New York. My advice to you would be to do a search on the term “TMJ dentist” in Rochester, look at the doctor bio of each dentist you find, and select a dentist who is either Pankey or Dawson trained and enjoys working with this complex field of TMJ treatment. And before you make an appointment with the dentist, ask if he or she would be comfortable going to bat for you in getting some type of refund from your family dentist to help defray the cost of fixing what he or she messed up.
And, as you have learned, it might be easiest to select a dentist across town who doesn’t know your dentist.
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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.
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