I recently had a full mouth reconstruction done by a very reputable prosthodontist, and although it was primarily for functional purposes, aesthetics were of great importance as well. How many people have the opportunity to have all brand new white teeth that match? It was exciting: however it was also a long and painful road. I brought in old pictures of myself to show him the color I wanted and the way my original work looked 30 years ago, and I said “this is what I want”—pretty straightforward I thought. Throughout the treatment, he kept telling me to he wanted me to be happy but sometimes when I would tell him what I wanted he would tell me I was wrong but he always said trust me—I’ve been doing this a long time.
When the first set came in, they were not anywhere close to the right color so he told me I picked the wrong color. We did three try-ins. The 3rd time I told his assistant that the top teeth looked dark, that they were darker than the bottom ones and I said that several times. Now mind you, I was trying in an unfinished set of teeth because they had their own lab to do the finishing and I had never seen unfinished crowns and bridges so I had no idea what they looked like before they were finished. Anyway, his assistant assured me that once their lab finished, they would be fine that the top and bottom teeth would match and to trust her. The bottom teeth were veneers, crowns and implants.
Now, to clarify part of the cause or my problem; every time we did a try-in, I couldn’t look at the teeth with my mouth open or see how they looked when I talked or with different expressions because the teeth would fall out which made it difficult to truly see the color or to see if the bottom and top teeth matched. So the day came to have everything put in permanently and there were 3 things I wanted to check, one being color! It turned out that one of the teeth was a little sharp. I said that and he said, “Hope, we’ve done just about all we can for you and I don’t think we’ll ever be able to make you happy; so maybe you need to find someone else to finish the job.” I was standing there unable to speak because all of my teeth would fall out, and all I wanted to do was leave—take all the teeth out and leave—but I couldn’t do that. I had no teeth and no money. I just kept thinking don’t do it just leave but how could I? I had no teeth. If I took these out, I would simply have no teeth. What was I supposed to do?
From that point, everything is a blur. I remember wanting to leave, telling the assistant that I was afraid to say anything else to him, and tears rolling down the side of my face when he started putting the bottom teeth in. Then I remember asking if they would put the top teeth in with temporary cement and she said no, that he wouldn’t do that.
Now, after all of this time, effort, and about $50,000, I have teeth that don’t match. The top teeth are darker than the bottom ones and I don’t know what to do. If it was the other way around, and the bottom ones were darker, then I could probably live with it, but it’s not. This is completely unacceptable—I have to have it fixed somehow. I personally think that he should re-do all of the porcelain over gold crowns and bridges so they match the veneers. Those are at least closer to the color I wanted. I feel so stupid for letting this happen, but I was in shock—like a deer caught in headlights but worse!
How do I go about addressing this with him? I’m very picky and the difference in color is DEFINITELY something I would have noticed, but not under those circumstances. I just froze, and I truly don’t feel it was my fault—I was under enormous duress at that moment.
As you can see, I’m very emotional and wordy which is not the way to approach this. Do you think this is something he should fix, given the situation; if so, please help me. I do not know how to communicate with him, let alone get the result I believe is fair.
– Hope from Michigan
(See Dr. Hall’s answer below.)
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So you have a very reputable prosthodontist. He is undoubtedly very good at what he does, from a technical point of view. But you have to realize that your appearance concerns are frowned on by institutional dentistry. This is a classic example of the prosthodontist mentality. You’re trying to tell him what you want. His response is: “Trust me—I’ve been doing this a long time.” In other words, he knows best, he doesn’t need your input on the appearance, and you’re a troublemaker for not just accepting that.
I have had several requests from prosthodontists to be listed on this website as recommended cosmetic dentists, and I have turned them all down except one. These are dentists thoroughly steeped in the dental school mentality that focuses on functional issues and trivializes concerns over appearance. This prosthodontist thinks it’s pandering to listen to your appearance concerns. You’re talking to a brick wall here. You’re saying, “I don’t know how to communicate with him.” That’s not the problem. He doesn’t want your input—case closed.
How to Get This Fixed
Hope—brace yourself here for some tough medicine. You’re going to have to stiffen your spine and go after this dentist. The good news is that you have excellent legal leverage here. You need to have the will to stand up to him.
I don’t believe you need to sue this dentist, but my gut tells me, as arrogant as he appears to be, that you are going to need to go to a lawyer and at least threaten to sue. You can try telling him that’s what you’re going to do and see if he will make this right for you financially, but I wouldn’t hold my breath waiting for a favorable response. What you want is for him to pay to have an expert cosmetic dentist fix the upper teeth so they look acceptable to you.
You are correct that, if there is a discrepancy in color between the upper and lower teeth, the lowers should be the darker ones. A good cosmetic dentist can get away with pushing the shade of the upper teeth maybe half a shade to a full shade whiter on the Vita scale and it will still look good. But not the other way around.
Here’s Your Leverage
What he did to you was malpractice. No, there is no suggestion here that there is any lack in the quality of the work. But he forced these teeth on you without your consent. Informed consent is a cornerstone of ethical dental treatment. You did not want these crowns on your upper front teeth put in, but he did it anyway.
I can see, by the procedures you have explained to me for his trying in these crowns, that he doesn’t care about your input. You said that the work kept falling out if you tried to look at it. Now there are try-in pastes made specifically for the purpose of holding the work in well enough that you can see how it looks. He certainly knows of these materials, but he isn’t interested in them because to him, he is trying the work in only to check the fit and to make sure he likes it. His practice isn’t geared toward taking into account anything about what you think.
I’m sure he doesn’t think he did anything unethical, and it’s not going to be easy opening his eyes to that, but a letter from a lawyer, educating him on this principle of informed consent, will certainly trigger a call to his malpractice insurance carrier. They should let him know that he is on very shaky ground, and they should be able to prevail on him to make this right for you. Again, what you want to ask for is for him to pay an excellent cosmetic dentist to take out the crowns on your upper front teeth and replace them. Here’s how you do that. First, find a lawyer who understands well this principle of informed consent. Have the lawyer write the letter explaining what he did wrong (basically, he is guilty of assault). Then, before you settle on an amount, I can recommend for you an excellent cosmetic dentist who can give your dentist a figure of how many crowns would be involved in fixing this and how much it would cost.
He may argue that he had your consent. And I’m sure that he had you sign some kind of form before starting treatment. But you did not consent to putting in these particular crowns. Yes, you let him do it, but you were under duress at the time, and consent under duress is not consent—this is a key legal doctrine. You were intimidated, not given reasonable options, and your reaction as you have described it to me indicates that this was not a voluntary consent. Your lawyer I’m sure will be able to explain the advantages of his just settling this matter rather than going to court and having to pay emotional and possibly punitive damages on top of the cost of just replacing the work.
Hope, I’m sorry I don’t have an easier path for you, but I have received hundreds of complaints similar to yours and I’ve coached many of those people through situations like this, and you are simply not going to be able to transform this dentist into a listening, caring cosmetic dentist by anything you say. In his own eyes and the eyes of many of his peers he is very good at what he does, and you’re just a peon. He has been taught that it would be wrong to listen to you.
– 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.