[Didi]

Hello,

In December 2007 I underwent anterior crown replacement of teeth 5,6,7,8,9,10. At this time the dentist also suggested I install veneers on teeth 3, and 4 and 11 and 12. The front six crowns that I had prior to this procedure had been in place for over 25 years without any problems, root canals, cracked teeth, sensitivity, jaw pain, etc.

The only reason I replaced the crowns was a dentist told me since I had insurance and the crowns were old and somehwat discolored, I should replace them now. The crowns were somewhat discolored and were the old porcelain over metal type which with a small amount of gum recession, resulted in some of the metal showing.

Unfortunately the crown replacement did not go well. When I got home and the novacaine wore off, I noticed my smile was drastically altered. I was extremely unhappy with my appearance and felt that the crown replacement "aged" my face. My smile seemed collapsed and my teeth were not visible when my mouth was in a semi-smile or relaxed state. Additionally, 3 of 6 permanently cemented crowns dislodged within the first week on 3 different occasions.

When I visited the dentist (not the one who did the work) who owned the practice for crown reattachment after dislodgement, he acknowledged that my teeth were shorter than before and suggested I speak to the dentist who performed the work.

The dentist (DR.X) stated that she took my previous overjet of 6mm down to 1mm and subsequently, the teeth were shortened as well. I was completely distraught and complained also about the left teeth, 8, 9, 10, veneers 11 and 12 were shorter than the left side. I also visited two other dentists who agreed with me regarding the teeth "running up hill".

The dental office agreed to a full refund but Dr. X would not allow release of my tooth "preps" to my new dentists. She did release the mold of my original crowns but not the "preps". The other dentists were hesitant to perform the work without the preps, so I felt I had no other choice but to let this same dentist replace the crowns one last time.

On the advice of the other dentists, before I had Dr. X perform the work again, I paid an additional $1700.00 extra to have a "mock up" temporary made to wear for a few weeks to make sure I new what I was buying/getting before the next set of crowns were permanently installed. The mock up appeared compositionally much more inline with what I had before. The overjet was back and the tooth length seemed satisfactory.

Unfortunately, something happened between the mockup and the final installation because when the novacaine wore off and I smiled, the teeth still were slightly shorter on the left, my bite was extremely tight (making me look old and scrunched in the face) and the teeth are still not long enough. I have learned since then there are really no laws governing who can call themselves a cosmetic dentist.

I am now at a loss as to what to do. I detest my appearance, I look worse than before I began after undergoing two full anterior crown replacements and the replacement of two of the four original veneers. I have exhausted all of my insurance as Dr. X billed both of my insurance companies for all of my benefits allocated for 2007/2008 (even though all of the original work was performed in 2007 - which I later learned is considered to be insurance fraud).

One additional thing, tooth number twelve, a tooth that had never had a crown or any problems in 51 years, became extremely sore after the installation of the first set of veneers. I complained to the dentist at the time but she indicated that the tissue was probably bruised or swollen and the tooth would calm down. When she replaced that veneer with the second veneer, I told her the tooth was still very painful and she said the tooth looked cracked. This was after the second installation.

Also within 10 days of the second crown installation, I developed extreme pain in tooth number 8. I had an emergency root canal (extemely painful) and had to endure 3 rounds of antibiotics to quell the infection. What amazes me is that I never had trouble with any of the crowns or had never had a root canal prior to this work. I now have endured 3 root canals, two after the dentists removed my original crowns, and the one described above. I have also never had a cracked tooth and tooth twelve is now cracked with a veneer covering it.

I really wish I would have stuck with my original crowns. This whole ordeal has been depressing and frustrating. As a professional who is engaged in public speaking, it has been extremely humiliating when coworkers I have known for over 20 years ask what has happened to my mouth. Additionally, I am in a great deal of pain each day in my jaws which I have never had before. My questions are as follows:

I need to get some relief from my tight bite: Did the placement of veneers on teeth 3 and 4 and 11 and 12 change my bite? Since I bite mostly on my back teeth and these teeth are the furthest back in my mouth of all the ones altered, I figured that may be contributing to my tighter bite. Also the porcelain crowns are of thinner material than my original crowns, could this be responsible for a tighter bite? Do you have any recommendations for what I can do about this?

I feel that my only option is to have all 12 teeth replaced once again (this would be the third time) but I do not know who to trust. I visited two dentists who claim to be "LVI", Las Vegas Institute of Cosmetic Dentristy graduates. While it seems from the before and after photos in their offices I visited, that the dentists do great work, I am concerned that part of their training includes courses in revenue generation. Even though these two LVI dentists I visited were in different states, their routine was the same: Consult with an aesthetic consultant first before actualling seeing the dentist, consultant took photographs immediately and pointed out what was wrong with my mouth, and both quoted prices that seemed higher than usual. (One said I needed a full mouth restoration at $50,000.00 and the other said they could correct my situation with restoring the whole upper arch at a cost of $28,000.00.

Please help me. I am desperate. I am currently paying $300.00 a month for the next few years for the dental work that has already been done. I don't know what to do. Is it dangerous to replace these crowns once again? The first replacement was in December 2007 and the second replacement was in early April 2008. As I mentioned, I have jaw pain, a cracked tooth (which I believe may be attributed to the veneer installation), asymmetrical front teeth, and an extemely tight bite. How do I find a dentist that is skilled and knows the basics in crown replacement and tailoring the tooth size, shape, length, and overjet to one's face? How do I find a dentist that will not over charge me?

Please help me. I currently live in Colorado and if anyone knows of a dentist who is certified and skilled in Cosmetic Dentristy and not out to overcharge the patient, please forward me to a website or help me some how figure out what I can do next. Thanks so much for listening and for any advice that anyone can offer to me. Didi

[Bryanna]

Hello Didi,

I read your post a few days ago, but had to make sure I had time to sit and write my reply. I can understand your concerns and I agree that things did not go as they maybe should have. However, there are alot of issues with your situation that you may or may not be aware of. I will do my best to acknowledge them one issue at a time as if we were sitting and having a conversation. First let me tell you that your case type is commonly seen in dental offices who perform whole mouth reconstructive dentistry. I am very familiar with this type of dentistry....... hopefully I can enlighten you and be of some help to you! To make this easier, your quotes will be in brackets <<>>. My reply will follow.


<<In December 2007 I underwent anterior crown replacement of teeth 5,6,7,8,9,10. At this time the dentist also suggested I install veneers on teeth 3, and 4 and 11 and 12. The front six crowns that I had prior to this procedure had been in place for over 25 years without any problems, root canals, cracked teeth, sensitivity, jaw pain, etc.>>

Twenty five years is a long time to have the same crowns. The actual cement that seals the crown to the tooth generally has a life span of about 10-15 years and that's if the cementation was done near perfect. So even though you may not have been aware of any real physical changes, the margins of the crowns had to be leaking for quite some time. This leakage allows bacteria to get in under the crown which eventuallly weakens the tooth sometimes to the point that the nerve dies. Sometimes a crown will pop off when the cementation gives out and sometimes not. The suggestion by the dentist to place veneers on #'s 3,4,11 and 12 were for esthetics which is a standard treatment option when someone has a broad smile or wants a broad smile line.

<<The only reason I replaced the crowns was a dentist told me since I had insurance and the crowns were old and somehwat discolored, I should replace them now. The crowns were somewhat discolored and were the old porcelain over metal type which with a small amount of gum recession, resulted in some of the metal showing.>>

IMO, the dentist should have told you about crown history just as I have. Perhaps she did tell you in a way that seemed matter of fact and you didn't think too much of it because you were not experiencing any discomfort at the time?? In actuality, the discoloring of the crown is one physical sign that the crowns are wearing out. Of course, most people out of the dental field would not suspect that the crowns are breaking down on the inside as well.
The porcelain to metal crowns are still used in many dental offices on patients who have certain types of bite discrepancies. But most of the time all porcelain crowns made from zirconium or something of that resiliency can be used anyplace in the mouth. The gum recession was also an indication that the crowns had leaky margins. When the gum pulls away from a crown, a gumline filling or a natural tooth, it is usually due to either a sensitivity to the material that the crown or filling is made from or a buildup of plaque. Gum recession occurs as a defensive mechanism to a chronic irritant. It can also occur over time if the person brushes too aggressively and repeatedly injures the gum tissue or the persons bite is unbalanced which causes an unnatural wear pattern on the teeth causing them to shift away from the gum tissue.

<<Unfortunately the crown replacement did not go well. When I got home and the novacaine wore off, I noticed my smile was drastically altered. I was extremely unhappy with my appearance and felt that the crown replacement "aged" my face. My smile seemed collapsed and my teeth were not visible when my mouth was in a semi-smile or relaxed state. Additionally, 3 of 6 permanently cemented crowns dislodged within the first week on 3 different occasions.>>

What did the temporary crowns look like?? Did she have them professionally made by a dental lab or did she make them herself chairside?? Professional temps are meant to resemble the size and shape of the permanent crowns so the patient gets a good idea of what they will look like. In the temporary stage, the patient and dentist can tweak the esthetics and fit so that the permanent ones can be ordered to fit well into the patients bite and will hopefully be to the patients liking. There is no reason for having a crooked smile or one that was drastically different from the original unless the teeth needed to be shortened/changed because of misaligned bite issues. Did she mention any of that to you? Crowns that are permanently cemented are just that, permanently cemented until the bonding agent in the cement wears out. If the crowns came off after a few weeks, then they were either not cemented on properly, the crowns did not fit the prepped teeth properly or the crowns did not fit into the bite properly. Once maybe........ three times, no way!!!

<<When I visited the dentist (not the one who did the work) who owned the practice for crown reattachment after dislodgement, he acknowledged that my teeth were shorter than before and suggested I speak to the dentist who performed the work.>>

Typical situation where one dentist does not want to step on another ones toes. They all have their own way of doing things and sometimes they do crappy work and sometimes they just go about it in a different way. He was not about to engage in any real discussion about this with you without the other dentist being present.

<<The dentist (DR.X) stated that she took my previous overjet of 6mm down to 1mm and subsequently, the teeth were shortened as well. I was completely distraught and complained also about the left teeth, 8, 9, 10, veneers 11 and 12 were shorter than the left side. I also visited two other dentists who agreed with me regarding the teeth "running up hill".>>

Did she talk to you about changing your overjet?? If not, then she should have before she made such drastic changes. She sure had to cut your natural teeth down alot to shorten your overjet by 5 mm's. And to boot, she didn't make them straight across! Here is where you had some risks to the health of your teeth that should have been explained to you in the beginning. Number one, any time you drill into a tooth you risk killing the nerve in the tooth from the trauma of the high speed drill. Secondly, your 25 yr old crowns had to be leaking for several years which predisposed the teeth to a weaken state in comparison to other teeth that have never been crowned or filled. Thirdly, the severe cutting down of the tooth structure may have been too much trauma for these teeth to undergo and you ended up with irreversible pulpitis.

<<The dental office agreed to a full refund but Dr. X would not allow release of my tooth "preps" to my new dentists. She did release the mold of my original crowns but not the "preps". The other dentists were hesitant to perform the work without the preps, so I felt I had no other choice but to let this same dentist replace the crowns one last time.>>

She may not have kept the modeled preps because they would have shown the severity of the prepped teeth and that would not be in her favor. Other dentists were hesitant to take on your case for a few reasons.....One, they may have claimed to have no idea what was under those new crowns, but they absolutely had a good idea because they've all done it at some time themselves and were not going to touch those teeth with a ten foot pole. Two, if the teeth are prepped too far down, reprepping them can kill the nerve and they did not want to be blamed for that happening. Three, crowns ideally should have some solid tooth structure to be cemented onto. However, my guess is she had to do some major composite build ups to make the reprepped teeth larger. This build up is ok to a point, but if too large it doesn't allow much tooth structure for the crown to be cemented onto. If the buildups are done properly, the crowns fit well and are cemented properly and the bite is near perfect, then they should stay on ok.

<<On the advice of the other dentists, before I had Dr. X perform the work again, I paid an additional $1700.00 extra to have a "mock up" temporary made to wear for a few weeks to make sure I new what I was buying/getting before the next set of crowns were permanently installed. The mock up appeared compositionally much more inline with what I had before. The overjet was back and the tooth length seemed satisfactory.>>

These are the temporaries that I spoke of earlier. In large cases like yours, this step is imperative!! IMO, she should have paid for these herself and most likely you got charged more than what the lab fee was on these. Usually they double the amount of the lab fee for mock up temps when they are to be worn as a cosmetic test.

<< Unfortunately, something happened between the mockup and the final installation because when the novacaine wore off and I smiled, the teeth still were slightly shorter on the left, my bite was extremely tight (making me look old and scrunched in the face) and the teeth are still not long enough. I have learned since then there are really no laws governing who can call themselves a cosmetic dentist.>>

Did she cement your new crowns with permanent or temporary cement?? Generally, in large cases like yours, the new crowns are cemented with a temporary cement so the patient can wear them for about 2 weeks so they can critique them. Then any changes can be made before they are permanently cemented or if all is well, they can be permanently cemented on after the two week period.

<<I am now at a loss as to what to do. I detest my appearance, I look worse than before I began after undergoing two full anterior crown replacements and the replacement of two of the four original veneers. I have exhausted all of my insurance as Dr. X billed both of my insurance companies for all of my benefits allocated for 2007/2008 (even though all of the original work was performed in 2007 - which I later learned is considered to be insurance fraud).>>

I am SO sorry you have gone through such an ordeal and now you're unhappy with your new crowns. I am not doubting you one bit when you say that they are not what you were expecting and alot of the work was due to miscalculations by Dr X....... to put it politely.

My guess is the new crowns are alot lighter or brighter (whiter) than your old ones. Correct? They are also full porcelain without the metal substructure, correct? Full porcelain crowns/veneers in a light white shade when there are many in a row can sometimes exaggerate even the slightest imperfections. I am not justifying or making light of the difficult experience you have been through nor that the teeth may not be angled properly. I am just saying that you were use to seeing yourself a certain way for 25 yrs and your darker, metal to porcelain crowns are completely different in appearance than what you have now. You also have extended your smile line with 2 veneers on each side which totally change the perception of your smile. And please take this comment gently from one middle aged woman to another........... your skin tone/texture is not what it was 25 yrs ago and the brightness of the porcelain may be something that you'll need to get use to. Sometimes, and this may or may not be your case, the shade chosen for the crowns/veneers is much lighter than natural teeth would be at middle age. Very often this is what people want no matter how unnatural looking it may be. Did Dr X discuss shade color with you......... she should have.

As for the insurance part of this.... depending on the insurance company, some allow payment to be made on the prep date of crowns/veneers and others will only pay upon insertion date. You would have to ask your ins companies which way they pay out.

<<One additional thing, tooth number twelve, a tooth that had never had a crown or any problems in 51 years, became extremely sore after the installation of the first set of veneers. I complained to the dentist at the time but she indicated that the tissue was probably bruised or swollen and the tooth would calm down. When she replaced that veneer with the second veneer, I told her the tooth was still very painful and she said the tooth looked cracked. This was after the second installation.>>

Tooth #12 could have had a hairline crack in it which didn't cause any symptoms prior to the first veneer and when she prepped for the veneer it cracked further and you developed symptoms. OR, the veneer didn't fit properly in your bite and when you bit down, you cracked the tooth. Chances of her initially cracking the tooth while prepping for the veneer are slim because there is minimal prepping for veneers ....... unless she prepped those teeth too severe too!!

<<Also within 10 days of the second crown installation, I developed extreme pain in tooth number 8. I had an emergency root canal (extemely painful) and had to endure 3 rounds of antibiotics to quell the infection. What amazes me is that I never had trouble with any of the crowns or had never had a root canal prior to this work. I now have endured 3 root canals, two after the dentists removed my original crowns, and the one described above. I have also never had a cracked tooth and tooth twelve is now cracked with a veneer covering it.>>

If you have read any of my posts with regard to root canal therapy you will see that I am not a proponent of root canal treatment. Of course the only alternative to a root canal is extraction and I can certainly understand why you would be hesitant to remove your front tooth. However, from a health standpoint, root canaled teeth are not healthy teeth because they harbor numerous types of bacteria inside the tiny microscopic canals that can never been cleaned out. The vitality of these teeth is removed when the nerve is removed. This could be compared to cutting off the circulation of a finger or toe. No circulation means death of tissue which is never a healthy situation anyplace in the body. When you need to readdress these root canaled teeth, perhaps your dentist at the time will discuss the options available to you which currently are:

1)Retreat the tooth with another root canal which serves to accomplish nothing different than the first root canal
2)An apicoectomy which is a surgical procedure which again accomplishes the same end result as a second root canal
3) Extraction and replacement of the teeth with either something removable or dental implants.

<<I really wish I would have stuck with my original crowns. This whole ordeal has been depressing and frustrating. As a professional who is engaged in public speaking, it has been extremely humiliating when coworkers I have known for over 20 years ask what has happened to my mouth. Additionally, I am in a great deal of pain each day in my jaws which I have never had before.>>

Your original crowns were failing after 25 yrs. Sooner than later you would have experienced discomfort due to decay or worse. Who knows what was going on underneath them but your situation probably did not have to end up as extreme as it has. If the teeth underneath the old crowns were healthy and they had been prepped conservatively, you may or may not have had any problems with infected teeth requiring root canal treatment. But truely, only Dr X knows the answer to that question. Even old radiographs would not show decay through metal to porcelain crowns unless it was very extensive. But xrays will show the relation between the gumline and the edge of the tooth.

<<My questions are as follows:
I need to get some relief from my tight bite: Did the placement of veneers on teeth 3 and 4 and 11 and 12 change my bite? Since I bite mostly on my back teeth and these teeth are the furthest back in my mouth of all the ones altered, I figured that may be contributing to my tighter bite. Also the porcelain crowns are of thinner material than my original crowns, could this be responsible for a tighter bite? Do you have any recommendations for what I can do about this?>>

It is not unusual for new crowns/veneers, especially 9 in a row, to feel tighter than the old ones you had before. But they should not be uncomfortable. Do the gums looks puffy or red along the gumline? Is there any pain, tenderness or a lump along the bony ridge where you had the root canals done? Do you develop alot of plaque along the gumline? Any of these things will cause inflammation to occur and the result would be a tight, uncomfortable, painful feeling where the new crown work is done.
The veneers should fit properly into your bite when you open and close and when you move your jaw side to side when chewing. If you are hitting these teeth unnaturally, yes they can contribute to that feeling of a tighter bite.
The porcelain crowns are thinner than the old ones that you had but if they too fit properly, then they should feel like nothing is there.
My recommendation, have the dentist (a new one preferably) check your bite for any discrepancies.

<<I feel that my only option is to have all 12 teeth replaced once again (this would be the third time) but I do not know who to trust. I visited two dentists who claim to be "LVI", Las Vegas Institute of Cosmetic Dentristy graduates. While it seems from the before and after photos in their offices I visited, that the dentists do great work, I am concerned that part of their training includes courses in revenue generation. Even though these two LVI dentists I visited were in different states, their routine was the same: Consult with an aesthetic consultant first before actualling seeing the dentist, consultant took photographs immediately and pointed out what was wrong with my mouth, and both quoted prices that seemed higher than usual. (One said I needed a full mouth restoration at $50,000.00 and the other said they could correct my situation with restoring the whole upper arch at a cost of $28,000.00.>>

Chances are if you have your teeth prepped a third time, your teeth will die and they will all require root canal therapy or removal. There is only a very slim chance that this won't occur, but I wouldn't bet my worst enemy on it. I would bet that both of the estimates that you got to do this a third time, included automatic root canal therapy. I think you really need to weigh the risks associated with doing this a third time. I know you are very unpleased with the outcome, but at what expense are you willing to go through this again and there are no guarantees you will like their work any more than what you currently have.

Yes, a big part of cosmetic dental training is hard core marketing.... even the staff gets programmed to market the treatment. I worked with someone like this for about 3 years...... I could never bring myself to sell the BS to anyone. Sorry, I'm just being completely truthful with you.

<<Please help me. I am desperate. I am currently paying $300.00 a month for the next few years for the dental work that has already been done. I don't know what to do. Is it dangerous to replace these crowns once again? The first replacement was in December 2007 and the second replacement was in early April 2008. As I mentioned, I have jaw pain, a cracked tooth (which I believe may be attributed to the veneer installation), asymmetrical front teeth, and an extemely tight bite. How do I find a dentist that is skilled and knows the basics in crown replacement and tailoring the tooth size, shape, length, and overjet to one's face? How do I find a dentist that will not over charge me?>>

If you were my friend, my sister or me......... I would first suggest you reconsider your financial obligation to Dr X by letting her know how displeased you are and how emotionally affected you are by her work in your mouth. If she is smart, she will zero out your account and hope you don't decide to report her to the state board of dentistry. I think you have a 2 year window to file a complaint, but I'm not sure. I tell people all of the time, if you feel you have been mistreated, speak up and be heard. If the dentist/doctor is deaf to your concerns then follow your intuition. The board will look into your case by asking her for your records including all of her models for both sets of crowns/veneers. They will read her chart notes and review your radiographs and sometimes interview the other staff including any dentists. If they don't think your case is worth looking into, they will discuss that with you. They generally only investigate the ones that look pretty obvious or the repeat offenders.

I think you need to see a new dentist for the jaw pain and one who can help realign your bite. But the treatment should be conservative and not entail redoing your crowns/veneers. I would not do it a third time if it were me.......

<<Please help me. I currently live in Colorado and if anyone knows of a dentist who is certified and skilled in Cosmetic Dentristy and not out to overcharge the patient, please forward me to a website or help me some how figure out what I can do next. Thanks so much for listening and for any advice that anyone can offer to me. Didi[/QUOTE]>>

I do not personally know of any dentist in CO and I think it will be quite a task to find someone who is willing to touch her work. It may be best to try and adjust to the esthetic issues of the new crowns/veneers and have a new dentist make them more comfortable fit/shape wise. I know that is a really tough thing to do and I do respect how unhappy you are with the result. But it may be more important to weigh the risks (your health) vs the benefits (cosmetic) before allowing someone else to redo the work their way. Remember, there are no guarantees it will look any different and unfortunately, it could end up worse because there is little tooth structure to work with.

Didi, I have been extremely honest and straight forward with you because I felt that you were seeking sincerity and that's what I am here for. Over the last 30+ yrs, I have seen countless people with the same or similar situation as yours. My heart goes out to you and I do believe you have suffered needlessly. Please keep in mind that to hate your appearance will only cause you more heartache. There are people who are permanently disfigured who would give their right arm to have your crooked smile.......... please try to see the positive in your life and remember that it could always be worse.

I'm here if you need to vent or ask more questions or just want to give me feedback of what I have written......

Bryanna ~'.'~

[Didi]

Bryanna,

Thanks so much for taking the time to respond to my request for help. You were so very helpful and I certainly did not expect such a comprehensive reply. It is comforting to know that I can log on to a website and get objective advice and information from a source that does not have a vested interest in what the recommended course of action should be.

It's amazing that after my visit today with the 5th dentist I have consulted with, not one mentioned that it might be risky to perform crown replacement again. I am very disappointed in the dental profession and the regulation thereof, especially that any dentist, with little or no training in cosmetic dentristy, can adverse their services as "cosmetic".

When you addressed my concern over the insurance billing and indicated that some companies will accept the "preparation" work and the actual "installation" work be conducted in different stages. This dentist did all the prep and installation on two visits in December 2007, in other words all the work was completed in December but she billed the insurance company for 3 crowns and two veneers in December and 3 crowns and veneers in January 2008, which idoes not accurately reflect what was done.

Also, I appreciate your comments about what she should have discussed with me prior to the installation, even suggesting a mock up of what was going to be in my mouth prior to permanent installation.

She did not apprise me of any information prior......did not tell me she was altering the overjet or shortening the length of the teeth. She also did not discuss or mention anything associated with a mock up for me to wear. She made the temporaries from a mold made of my original crowns so what I wore for temporaries (the first time) only mimicked what was in my mouth prior to crown removal.

The second mock up was made upon my insistence, after visiting other dentists who said this should have been done. She only agreed to do this if I paid an additional $1700. 00 which I reluctantly agreed to pay but felt, at this point, hostage to the situation.

I have composed a letter indicating my dissatisfaction with this entire process and am asking for a total refund. I hope that I am successful with this request and, as you say, I will try to get "used to the new look" but I need the money to, at a minimum, get a prosthetic device made which will help me to relax my bite.

Do you know anything about these? A dentist that I visited today, who seemed to be more conservative, and not wanting to jump in with full mouth restoration, indicated that this may help with my tight bite.

Again, thanks so much for your comprehensive reply. You are performing a great service to all dental consumers. Your advice is greatly appreciated. I wish I could meet you! Didi

[Bryanna]

Hi Didi,

Well, you are very welcome and thanks so much for the kind words~'.'~

I am very glad that your interpretation of my reply was so positive! I know you have alot going on with your mouth and I'm sure you were hoping to get a reply that said..... hey go ahead, do it a third time! But there is no way I personally would have suggested that you do that.

There is no surprise to me when a patient is not informed about the risks of dental procedures. This is the way dentistry has been for many, many years and for the most part, people accept it this way. Fortunately, there are people who are becoming self educated and they are asking questions! There are also dentists who are challenging their antiquated education and learning what they can from outside sources on the systemic health connection between the mouth and the rest of the body. This topic is not taught in any depth in any dental school believe it or not!!

Yes it's true......... any dentist can say he/she is a cosmetic dentist. The only time they have to produce a licensure for it is when they specifically specialize in it and they are known as a Prosthodontist, etc. Otherwise, many dentists go to a seminar or two and then practice their new techniques on their patients....... yikes!! Oh I could tell you stories that would make your hair stand on end!! Then you have many of these specialists who do full mouth reconstructive dentistry..... they are usually pretty good tooth carpenters but their focus is on the esthetics, not the dental health or the patients health.

As with your case, someone specializing in cosmetic dentistry would redo your crown work, but at what expense to you? Not just financial but at what expense to the health of your teeth and your overall well being?? Since they see the manifestations everyday from the risks they take, they automatically assume there will be issues and they deal with them as they occur. There is no preventive mindset that says hey, this is more than just tooth carpentry and esthetics.

If your dentist completed all of the work in 2007 and billed the insurance in 2008 with dates of service dates for 2008, that is definitely fraudulent billing. If she billed the insurance in 2008 for work that she completed in 2008, then that is legitimate billing practices. Some offices will do part of the dental work in one year and the rest in the second year as a courtesy to the patient to help the patient maximize their yearly dental benefits, which is fine. However, the work can only be legally billed on the dates it was completed.

I am glad that you wrote that office a letter. I would suggest that you send one letter regular mail and at the same time send a copy of it registered with return signature requested. This way they cannot say they never received it. This is how dental offices send out their collections letters to their patients! If you don't hear from them within 10 days, I would contact the office and let them know you are patiently waiting for a reply. Chances are the owner of the practice will contact you and try to negotiate a deal of some sort. If you stick to your guns, he/she will offer you some money back but will tell you they had lab bills to pay on your case and would like to deduct those lab fees from your refund. Chances are they will inflate the lab costs figuring you will not question them on it. Ask them to show you the lab bills which all offices keep or can get from the labs with no problem. Each lab bill has the date, patients name, procedure and cost to the dentist. I offer you this suggestion because this is how it's usually done from the other side of the spectrum and you have undergone permanently altering procedures that you are very dissastisfied with .......... that's putting it mildly ~'.'~

I think it would be wise to have someone fit you with a bite appliance to help alleviate some of the unnatural stress that you are feeling with that new crown work. I don't think this will cure your problems, but it could help to get you through this "crisis" period.

Thanks again for your kind words......... please do keep us posted on how you are doing!

Bryanna ~'.'~

Originally Posted by Didi

Bryanna,

Thanks so much for taking the time to respond to my request for help. You were so very helpful and I certainly did not expect such a comprehensive reply. It is comforting to know that I can log on to a website and get objective advice and information from a source that does not have a vested interest in what the recommended course of action should be.

It's amazing that after my visit today with the 5th dentist I have consulted with, not one mentioned that it might be risky to perform crown replacement again. I am very disappointed in the dental profession and the regulation thereof, especially that any dentist, with little or no training in cosmetic dentristy, can adverse their services as "cosmetic".

When you addressed my concern over the insurance billing and indicated that some companies will accept the "preparation" work and the actual "installation" work be conducted in different stages. This dentist did all the prep and installation on two visits in December 2007, in other words all the work was completed in December but she billed the insurance company for 3 crowns and two veneers in December and 3 crowns and veneers in January 2008, which idoes not accurately reflect what was done.

Also, I appreciate your comments about what she should have discussed with me prior to the installation, even suggesting a mock up of what was going to be in my mouth prior to permanent installation.

She did not apprise me of any information prior......did not tell me she was altering the overjet or shortening the length of the teeth. She also did not discuss or mention anything associated with a mock up for me to wear. She made the temporaries from a mold made of my original crowns so what I wore for temporaries (the first time) only mimicked what was in my mouth prior to crown removal.

The second mock up was made upon my insistence, after visiting other dentists who said this should have been done. She only agreed to do this if I paid an additional $1700. 00 which I reluctantly agreed to pay but felt, at this point, hostage to the situation.

I have composed a letter indicating my dissatisfaction with this entire process and am asking for a total refund. I hope that I am successful with this request and, as you say, I will try to get "used to the new look" but I need the money to, at a minimum, get a prosthetic device made which will help me to relax my bite.

Do you know anything about these? A dentist that I visited today, who seemed to be more conservative, and not wanting to jump in with full mouth restoration, indicated that this may help with my tight bite.

Again, thanks so much for your comprehensive reply. You are performing a great service to all dental consumers. Your advice is greatly appreciated. I wish I could meet you! Didi

[Didi]

Hi Didi,

Well, you are very welcome and thanks so much for the kind words~'.'~

I am very glad that your interpretation of my reply was so positive! I know you have alot going on with your mouth and I'm sure you were hoping to get a reply that said..... hey go ahead, do it a third time! But there is no way I personally would have suggested that you do that.

There is no surprise to me when a patient is not informed about the risks of dental procedures. This is the way dentistry has been for many, many years and for the most part, people accept it this way. Fortunately, there are people who are becoming self educated and they are asking questions! There are also dentists who are challenging their antiquated education and learning what they can from outside sources on the systemic health connection between the mouth and the rest of the body. This topic is not taught in any depth in any dental school believe it or not!!

Yes it's true......... any dentist can say he/she is a cosmetic dentist. The only time they have to produce a licensure for it is when they specifically specialize in it and they are known as a Prosthodontist, etc. Otherwise, many dentists go to a seminar or two and then practice their new techniques on their patients....... yikes!! Oh I could tell you stories that would make your hair stand on end!! Then you have many of these specialists who do full mouth reconstructive dentistry..... they are usually pretty good tooth carpenters but their focus is on the esthetics, not the dental health or the patients health.

As with your case, someone specializing in cosmetic dentistry would redo your crown work, but at what expense to you? Not just financial but at what expense to the health of your teeth and your overall well being?? Since they see the manifestations everyday from the risks they take, they automatically assume there will be issues and they deal with them as they occur. There is no preventive mindset that says hey, this is more than just tooth carpentry and esthetics.

If your dentist completed all of the work in 2007 and billed the insurance in 2008 with dates of service dates for 2008, that is definitely fraudulent billing. If she billed the insurance in 2008 for work that she completed in 2008, then that is legitimate billing practices. Some offices will do part of the dental work in one year and the rest in the second year as a courtesy to the patient to help the patient maximize their yearly dental benefits, which is fine. However, the work can only be legally billed on the dates it was completed.

I am glad that you wrote that office a letter. I would suggest that you send one letter regular mail and at the same time send a copy of it registered with return signature requested. This way they cannot say they never received it. This is how dental offices send out their collections letters to their patients! If you don't hear from them within 10 days, I would contact the office and let them know you are patiently waiting for a reply. Chances are the owner of the practice will contact you and try to negotiate a deal of some sort. If you stick to your guns, he/she will offer you some money back but will tell you they had lab bills to pay on your case and would like to deduct those lab fees from your refund. Chances are they will inflate the lab costs figuring you will not question them on it. Ask them to show you the lab bills which all offices keep or can get from the labs with no problem. Each lab bill has the date, patients name, procedure and cost to the dentist. I offer you this suggestion because this is how it's usually done from the other side of the spectrum and you have undergone permanently altering procedures that you are very dissastisfied with .......... that's putting it mildly ~'.'~

I think it would be wise to have someone fit you with a bite appliance to help alleviate some of the unnatural stress that you are feeling with that new crown work. I don't think this will cure your problems, but it could help to get you through this "crisis" period.

Thanks again for your kind words......... please do keep us posted on how you are doing!

Bryanna ~'.'~[/QUOTE]

[Didi]

Bryanna,

Thanks once again for reply to my questions. It means so much to be able to consult with someone with your knowledge. Do you know of any honest dentists who could take a look at my case and help me with alleviating bite issues and give me suggestions as to what lies ahead for me in the future? I am willing to travel almost anywhere.

I have been told (by every dentist) that I do have a tough case in that I have several worn teeth, a tight bite, and enamel that has broken off the outside of the tooth (I forgot what they called it) and that I should do something about it as it will keep getting worse.

Should I contact the American Dental Association or is there some governing body that can recommend some one? I really need help with possibly getting a prosthetic device. There is a prosthodontist in the Boulder, Colorado area who is about an hours drive from me. I see from his website that his is very practiced in crown replacement and dental implantation. My question is, is a prosthodontist skilled and knowledgeable about the esthetics of a smile as well as the technical aspect to crown replacement?

I am somewhat confused about the training, etc. for prosthodontists as opposed to these dentists who have attended the Las Vegas Institute (LVI) know for creating "hollywood" smiles.

Thanks for any recommendation you may have as to who I should contact to find a good dentist who can look at my case.

Thanks again Bryanna. Hopefully, with your next response, I will finally have all of my answers and can quit bothering you. Best Regards, Didi


Hi Didi,

Well, you are very welcome and thanks so much for the kind words~'.'~

I am very glad that your interpretation of my reply was so positive! I know you have alot going on with your mouth and I'm sure you were hoping to get a reply that said..... hey go ahead, do it a third time! But there is no way I personally would have suggested that you do that.

There is no surprise to me when a patient is not informed about the risks of dental procedures. This is the way dentistry has been for many, many years and for the most part, people accept it this way. Fortunately, there are people who are becoming self educated and they are asking questions! There are also dentists who are challenging their antiquated education and learning what they can from outside sources on the systemic health connection between the mouth and the rest of the body. This topic is not taught in any depth in any dental school believe it or not!!

Yes it's true......... any dentist can say he/she is a cosmetic dentist. The only time they have to produce a licensure for it is when they specifically specialize in it and they are known as a Prosthodontist, etc. Otherwise, many dentists go to a seminar or two and then practice their new techniques on their patients....... yikes!! Oh I could tell you stories that would make your hair stand on end!! Then you have many of these specialists who do full mouth reconstructive dentistry..... they are usually pretty good tooth carpenters but their focus is on the esthetics, not the dental health or the patients health.

As with your case, someone specializing in cosmetic dentistry would redo your crown work, but at what expense to you? Not just financial but at what expense to the health of your teeth and your overall well being?? Since they see the manifestations everyday from the risks they take, they automatically assume there will be issues and they deal with them as they occur. There is no preventive mindset that says hey, this is more than just tooth carpentry and esthetics.

If your dentist completed all of the work in 2007 and billed the insurance in 2008 with dates of service dates for 2008, that is definitely fraudulent billing. If she billed the insurance in 2008 for work that she completed in 2008, then that is legitimate billing practices. Some offices will do part of the dental work in one year and the rest in the second year as a courtesy to the patient to help the patient maximize their yearly dental benefits, which is fine. However, the work can only be legally billed on the dates it was completed.

I am glad that you wrote that office a letter. I would suggest that you send one letter regular mail and at the same time send a copy of it registered with return signature requested. This way they cannot say they never received it. This is how dental offices send out their collections letters to their patients! If you don't hear from them within 10 days, I would contact the office and let them know you are patiently waiting for a reply. Chances are the owner of the practice will contact you and try to negotiate a deal of some sort. If you stick to your guns, he/she will offer you some money back but will tell you they had lab bills to pay on your case and would like to deduct those lab fees from your refund. Chances are they will inflate the lab costs figuring you will not question them on it. Ask them to show you the lab bills which all offices keep or can get from the labs with no problem. Each lab bill has the date, patients name, procedure and cost to the dentist. I offer you this suggestion because this is how it's usually done from the other side of the spectrum and you have undergone permanently altering procedures that you are very dissastisfied with .......... that's putting it mildly ~'.'~

I think it would be wise to have someone fit you with a bite appliance to help alleviate some of the unnatural stress that you are feeling with that new crown work. I don't think this will cure your problems, but it could help to get you through this "crisis" period.

Thanks again for your kind words......... please do keep us posted on how you are doing!

Bryanna ~'.'~[/QUOTE]

[Bryanna]

Hi Didi,

Again you are welcome...... feel free to ask me anything about dentistry and I promise to give you a truthful answer based on my extensive knowledge and experience. I have strong opinions about certain procedures which are also based on my experience. I always feel that everyone has the right to be informed and I respect everyones right to choose the path that they feel is best for them.

I'm not sure how to phrase this next comment ..... ummm...... you asked about finding an honest dentist. Well there are plenty of "pleasant" people who practice dentistry, but often they withhold so much information from their patients so I cannot in good conscience say it will be easy to find an honest one. I hope I'm making myself clear without sounding negative. I encourage people to be their own advocate and do some research as much as possible. That's why I'm here, to help offer information and help do the research if I can. I always tell people to ask questions and make it clear to whomever is treating you that you want to be informed of all the treatment options and the benefits and risks of all procedures prior to consenting to having anything done. When a person does this, the outcome is usually much different and the dentist is more apt to share more information with you.

I had a feeling that you may have some additional dental issues other than the recrowning of your upper teeth. The enamel that has broken off, is it along the gumline or along the biting edges of the teeth?

If it is along the gumline then it is enamel that has worn away from an uneven bite and/or aggressive tooth brushing. In that case, tooth colored fillings can be placed in those areas to prevent any further wear on the enamel.

If the enamel is worn down on the edges of the teeth, this is called incisal wear and it too comes from an uneven bite and/or tooth grinding. The treatment to deal with this problem is a bit more complicated. The teeth have worn down on the edges because the bite is so tight that there is no room for normal length teeth to fit into it. To lengthen these teeth with filling material may not be long lasting because the bite will just wear the fillings off. Sometimes, these teeth are crowned to protect them from further breakdown, BUT, if the bite is not altered allowing room for the height of these crowns, then they too will wear down and/or become toothaches and/or start to wear down other teeth that are now not hitting properly.

A prosthodontist is trained in general dental procedures with additional training in cosmetic replacement of natural teeth...... crowns, bridges, dentures...... those things. Generally, these specialists are more concerned about the esthetics than the health of the teeth. The LVI dentists do not necessarily have their prosthodontic licensure but have taken extensive courses in cosmetic dentistry. Truthfully, it just all depends on how well skilled a person is and has little to do with where they got their training. Either one can make a prosthetic device for you to wear and may be able to give you options about repairing those teeth that have worn down enamel.

The only recommendation that I can offer you as far as a referral would be to go to www.iaomt.org
Here is a direct link to their dentists in CO.
http://www.iaomt.org/patients/result...eProv=Colorado

The members of IAOMT have extensive training outside of the antiquated dental schools and continually educate themselves about the affects of dental procedures (etc.) on the body. They are Integrative thinking practitioners who support the patients right to choose healthier treatment alternatives that have proven to be just as effective as the old stand by ones.

I hope this website offers you some positive results if you choose to go that route. Let us know how you are doing!

Bryanna



[QUOTE=Didi;300823]Bryanna,

Thanks once again for reply to my questions. It means so much to be able to consult with someone with your knowledge. Do you know of any honest dentists who could take a look at my case and help me with alleviating bite issues and give me suggestions as to what lies ahead for me in the future? I am willing to travel almost anywhere.

I have been told (by every dentist) that I do have a tough case in that I have several worn teeth, a tight bite, and enamel that has broken off the outside of the tooth (I forgot what they called it) and that I should do something about it as it will keep getting worse.

Should I contact the American Dental Association or is there some governing body that can recommend some one? I really need help with possibly getting a prosthetic device. There is a prosthodontist in the Boulder, Colorado area who is about an hours drive from me. I see from his website that his is very practiced in crown replacement and dental implantation. My question is, is a prosthodontist skilled and knowledgeable about the esthetics of a smile as well as the technical aspect to crown replacement?

I am somewhat confused about the training, etc. for prosthodontists as opposed to these dentists who have attended the Las Vegas Institute (LVI) know for creating "hollywood" smiles.

Thanks for any recommendation you may have as to who I should contact to find a good dentist who can look at my case.

Thanks again Bryanna. Hopefully, with your next response, I will finally have all of my answers and can quit bothering you. Best Regards, Didi

[Didi]

Bryanna,

Thanks again for answering my questions.....especially about the prosthodontist and the LVI dentists. I have an appointment scheduled with a prosthodontist on July 31st and will let you know what happens as a result of that evaluation. I plan to ask many questions, as you suggest, about the risks associated with any additional procedures. Hopefully, I will get truthful answers and, with your help, can make an informed decision.

To answer your question about the enamel on my teeth. This is occuring close to the gumline so it is probably the result of a bite issue. What I hope for is that someone can "open" my bite a bit with perhaps a few crowns on my back teeth. Some of these teeth have already lost quite a bit of enamel so it wouldn't be so upsetting to crown them. I would really like to replace these anterior crowns again as I hate my smile now. The teeth are shorter, more square, run uphill, and my smile is much more "scrunched". I am completing revisions on my letter to the original dentist and had planned, as you suggested, to send the letter "return receipt requested".

I will also let you know of the outcome as soon as I get a response. Thanks again for being a "storehouse of information" for those of us without the specific technical knowledge and experience to properly evaluate dental issues.

I will make sure to keep in touch with my results. Until then, if you have any additional advice, as always, I would be grateful for any information. Didi


[QUOTE=Bryanna;301117]Hi Didi,

Again you are welcome...... feel free to ask me anything about dentistry and I promise to give you a truthful answer based on my extensive knowledge and experience. I have strong opinions about certain procedures which are also based on my experience. I always feel that everyone has the right to be informed and I respect everyones right to choose the path that they feel is best for them.

I'm not sure how to phrase this next comment ..... ummm...... you asked about finding an honest dentist. Well there are plenty of "pleasant" people who practice dentistry, but often they withhold so much information from their patients so I cannot in good conscience say it will be easy to find an honest one. I hope I'm making myself clear without sounding negative. I encourage people to be their own advocate and do some research as much as possible. That's why I'm here, to help offer information and help do the research if I can. I always tell people to ask questions and make it clear to whomever is treating you that you want to be informed of all the treatment options and the benefits and risks of all procedures prior to consenting to having anything done. When a person does this, the outcome is usually much different and the dentist is more apt to share more information with you.

I had a feeling that you may have some additional dental issues other than the recrowning of your upper teeth. The enamel that has broken off, is it along the gumline or along the biting edges of the teeth?

If it is along the gumline then it is enamel that has worn away from an uneven bite and/or aggressive tooth brushing. In that case, tooth colored fillings can be placed in those areas to prevent any further wear on the enamel.

If the enamel is worn down on the edges of the teeth, this is called incisal wear and it too comes from an uneven bite and/or tooth grinding. The treatment to deal with this problem is a bit more complicated. The teeth have worn down on the edges because the bite is so tight that there is no room for normal length teeth to fit into it. To lengthen these teeth with filling material may not be long lasting because the bite will just wear the fillings off. Sometimes, these teeth are crowned to protect them from further breakdown, BUT, if the bite is not altered allowing room for the height of these crowns, then they too will wear down and/or become toothaches and/or start to wear down other teeth that are now not hitting properly.

A prosthodontist is trained in general dental procedures with additional training in cosmetic replacement of natural teeth...... crowns, bridges, dentures...... those things. Generally, these specialists are more concerned about the esthetics than the health of the teeth. The LVI dentists do not necessarily have their prosthodontic licensure but have taken extensive courses in cosmetic dentistry. Truthfully, it just all depends on how well skilled a person is and has little to do with where they got their training. Either one can make a prosthetic device for you to wear and may be able to give you options about repairing those teeth that have worn down enamel.

The only recommendation that I can offer you as far as a referral would be to go to Here is a direct link to their dentists in CO.

The members of IAOMT have extensive training outside of the antiquated dental schools and continually educate themselves about the affects of dental procedures (etc.) on the body. They are Integrative thinking practitioners who support the patients right to choose healthier treatment alternatives that have proven to be just as effective as the old stand by ones.

I hope this website offers you some positive results if you choose to go that route. Let us know how you are doing!

Bryanna



[QUOTE=Didi;300823]Bryanna,

Thanks once again for reply to my questions. It means so much to be able to consult with someone with your knowledge. Do you know of any honest dentists who could take a look at my case and help me with alleviating bite issues and give me suggestions as to what lies ahead for me in the future? I am willing to travel almost anywhere.

I have been told (by every dentist) that I do have a tough case in that I have several worn teeth, a tight bite, and enamel that has broken off the outside of the tooth (I forgot what they called it) and that I should do something about it as it will keep getting worse.

Should I contact the American Dental Association or is there some governing body that can recommend some one? I really need help with possibly getting a prosthetic device. There is a prosthodontist in the Boulder, Colorado area who is about an hours drive from me. I see from his website that his is very practiced in crown replacement and dental implantation. My question is, is a prosthodontist skilled and knowledgeable about the esthetics of a smile as well as the technical aspect to crown replacement?

I am somewhat confused about the training, etc. for prosthodontists as opposed to these dentists who have attended the Las Vegas Institute (LVI) know for creating "hollywood" smiles.

Thanks for any recommendation you may have as to who I should contact to find a good dentist who can look at my case.

Thanks again Bryanna. Hopefully, with your next response, I will finally have all of my answers and can quit bothering you. Best Regards, Didi

[Didi]

Hi Bryanna,

I have a question regarding a dental term that was used after I visited the 3rd LVI dentist. He said, one of the reasons that my teeth run uphill is that I have a "cant" (spelling). In other words my teeth are embedded slightly higher in the gum line on one side. Can you tell me what the actual definition and spelling are of this term? Thanks so much, Didi

[Didi]

Originally Posted by Didi

Hi Bryanna,

I have a question regarding a dental term that was used after I visited the 3rd LVI dentist. He said, one of the reasons that my teeth run uphill is that I have a "cant" (spelling). In other words my teeth are embedded slightly higher in the gum line on one side. Can you tell me what the actual definition and spelling are of this term? Thanks so much, Didi

I appreciate any infomation that you have regarding this question as the LVI dentist told me that one reason my mouth looks different is that the first dentist did not address my "cant" (teeth running uphill on the left side). My original crowns that were in place for twenty five years did not reveal my "cant". In otherwords, the first dentist must have compensatied for the cant by making the teeth on the left side slightly The dentist who performed the current work did not address the"cant".