Dentist Problems-Need Help

[brookline]

Hi everyone,
I am having problems with a dentist and would like to hear recommendations on how to proceed. Here is some background:
1. I went to see Dr. X for dental work over a period of a couple years.
2. I didn't have great enthusiasm for him at a personal level but his office took my insurance and billed the carriers competently. That put him ahead of many competitors.
3. The doctor put 4 crowns on my teeth between June 2014 and December 2014.
All of the crowns were paid for by insurance.
4. In February, one of the crowns broke and the dentist put a new one in its place without charge to me or the insurer.
5. I changed jobs and lost the dental insurance.
6. I now lack the cash to pay for dental work. (I work part-time, am contending with multiple health problems, my wife is out of work, we have two children, and only a few thousand dollars in the bank. We have huge debt and are looking to move to cheaper housing soonest.)
7. Another of the crowns broke this week.
8. Both of the broken crowns had covered lower jaw molars.
9. I asked the dentist's office whether they would replace this crown without charge as well.
10. They asked if I grind my teeth and said they would replace it for $850. (That was not the response I was seeking!)
11. They added that I should come in and see the dentist. His assistant said maybe they could put in a sturdier model crown.
12. I emailed them back saying that, before I came in, I would appreciate assurance that a replacement crown would indeed be sturdier and last. I have received no response.
13. I am told that the labs that make crowns give them warranties ranging from 2-5 years.
14. My mouth has another crown from another dentist that is at least 4 years old and doing well. It is on an upper jaw molar.
15. I went to see another dentist who showed me a Zirconia model crown that is supposed to be tough. But it didn't seem different than any of the prior crowns that Dr. X had put on.
So there is the background. What should I do? Pay another dentist out of pocket and send him the bill? Presumably suing him to collect? Go to another dentist and eat the loss? What can I do to get a crown that lasts?

[stoneage]

A crown is not supposed to break within a year or so. More like 5 to 10, depending on your dental hygiene.
If you've not been shewing bolts on a regular basis, there's more likely a mechanical problem : maybe the crown fitting and adjustment to other teeth was less than perfect.

I had a temporary crown once, and it felt weird in my mouth. the adjustment wasn't stellar to say the least. It lasted two days. Once proprely adjusted, it lasted the time it was meant to.

Did the dentist used blue strips to make sure everything was where it needed to be ?

[brookline]

Did the dentist used blue strips to make sure everything was where it needed to be ?

Hi Stoneage,
Thanks for responding. The dentist had me bite on some pieces of paper. I don't remember if he did it for each of the crowns. Is that what you mean?

[stoneage]

Yep, that's what I meant. According to google, it is called occlusion (or articulation) paper strips. They're meant to adjust dental occlusion.
If a dentist does not use multiple strips for one crown, it is a warning sign.
Some people are more prone to occlusion problems, which can lead to recurring back pains. So you actually prefer a cracked crown or two.

My second best guess is a bad ceramic batch. It is rare but not unusual.

Either way, your chewing is not responsible for it : they're designed for it !

[brookline]

Yep, that's what I meant. According to google, it is called occlusion (or articulation) paper strips. They're meant to adjust dental occlusion.
If a dentist does not use multiple strips for one crown, it is a warning sign.
Some people are more prone to occlusion problems, which can lead to recurring back pains. So you actually prefer a cracked crown or two.

My second best guess is a bad ceramic batch. It is rare but not unusual.

Either way, your chewing is not responsible for it : they're designed for it !

Thanks for explaining. What is the best way to handle my getting a new crown? Should I go elsewhere, pay out of pocket, and bill the current dentist? Just pay out of pocket and eat the cost?

[stoneage]

I hope you kept the crown !

You should come over to try and negociate with your current dentist.
He started the job, it is failing (too early ! less than a year !). He should finish it properly. I would advise you to :

- (optional) If you do not trust your current dentist, seek advisory help from another practician. Ask him his opinon about the failure. If the supporting tooth is in good shape there is no reason for the crown to break so early. Have him take pictures.

- go and see the dentist, so he can check why it failed. Be sure the dentist does not "destroy evidence" (no tools other than mirror and pick in your mouth). Let him see the broken crown, but keep it if he does not intend to ask for some insurance.

I would make sure he gets that the situation is not normal and that he should be diligent in fixing this.
I would make sure he gets I'm not sure about the other crowns still in my mouth : does he plan on charging 850 $ each if they fail early too ?
I would however accept a very small fee and flee once the job is done.

[brookline]

Thanks Stoneage!!

[stoneage]

On the "handling a medical expert" side :
- Avoid confonting them : Your view will be ridiculed or dismissed. (you know nothing Jon Snow...)
- Use "naïve questions" to make your point.

Keep us posted.

[RealPerson]

I think your dentist should stand behind his work. Crowns should not fail like that, except if you chew ice or hard candy.

Most states have a free service called peer review. This group of dentists will evaluate your situation and require the dentist reimburse you if deemed indicated. That would be a great step if your dentist just shrugs you off. You would contact your state dental association to inquire about this option. You would probably also learn a lot about your situation by going to peer review.

[brookline]

I think your dentist should stand behind his work. Crowns should not fail like that, except if you chew ice or hard candy.

Most states have a free service called peer review. This group of dentists will evaluate your situation and require the dentist reimburse you if deemed indicated. That would be a great step if your dentist just shrugs you off. You would contact your state dental association to inquire about this option. You would probably also learn a lot about your situation by going to peer review.

Hi RealPerson,
That is a great idea. Unfortunately my dentist is not a member of the Mass. Dental Society. They seem to be the only local peer review board. That said, I could try the Mass. Division of Registration if he proves unhelpful. They control dental licensing.

[brookline]

Hi everyone,
I have a couple updates to my dental situation. First, the dentist has offered to put in a temporary crown without charge. (I plan to accept that offer to buy time to determine a long-term resolution.) Second, he has proposed a solution to the problem of repeated broken crowns. My dentist believes I should put in a gold crown in place of a ceramic crown. He believes that I chew or bite with unusual force and that a gold crown would last longer than a traditional crown. Based on past history, I do not want him to do the work. Also, the cost of the crown would be $1,600. That is not a frugal-person's price! As implied by a comment above, it would make little sense to pay him $1,600 every time I shatter a crown.

That said, I am generally wary of putting a metal in my mouth. Many of you have no doubt read that mercury fillings can leach into the body and cause health problems. (The tooth where the crown fell off is grey from mercury from the former fillings.) I assume the same potential for leaching to exist with gold. (I have many existing health problems without creating new ones.) Does anyone have recommendations on how to proceed? Might a gold crown be the best option for preserving the tooth? Thanks!

[stoneage]

First, Take the temporary crown.
Second, I'd advise you to seek advice from a practician : What would he do ? Ask him for a quotation.

You could potentially use zirconium instead of gold. If I remember correctly, it is almost as solid as gold.

Were your crowns composite ?

On the plus side, If I remember correctly my chemistry class gold is not as reactive as mercury and "not that" toxic to humans.but this would be some alloy, not pure gold, so you never know.


The following IS NOT and advice :
I were you, I'd actually put in a composite, unless I thought I was really grinding my teeth or chewing hard. It is kind of a bet. It won't damage your tooth further, may last long, and is "neutral". As far as we know, you did not break other crowns yet.
I'd ask the practician to be on the safe side an lower the occlusion at this crown (lower the crown just a bit so it does not handle all the jaw pressure, if it was the case).
...And I'd accept I may break the crown within a year.

OR

I'd go zirconium if the practician says it is feasible.

God, I hate tooth problems...