[NAM1]

My initial goal was 4 front teeth that fit, with a slightly higher gum line.
I need a DDS who will listen, W/O ANGER, and W/PATIENCE, to a gunshy PT who has been thru 3+yrs of grief trying to fix a prob starting 12/2005 w/a DDS whom I really liked but would not admit he was in over his head. He repeatedly tried to bond 4 teeth as well as doing 6 gingivectomies instead of recognizing a need for bone reduction. Serious inflammation resulted; as well, cords were found months later left in, contributing to the prob. I finally gave up despite assurances he could fix it. He has now left practicing after promising and failing to fix his errors.
Bone reduction has now been done; and I have been thru more mistakes and probs: including refusals to wk w/my oral surgeon and his mistakes (correctly done bone reduction, but poorly done gingv as well as corresp mistake on access tooth 11's gum). There is a gen reluctance to wk w/a type 1 DM PT; and ALL 6 DDSs HAVE DIFFERENT OPIONIONS.
The last has "personal problems" which "sometimes come into her prof life" gradually enlightened to me by the DDS' (now fmr) tech during the 2nd and 3rd of 6 unfortunately progressive (required prepd) TXs. She is potentially and unpredictably explosive in manner and I dare not return to her. I could (and can) no longer tolerate her anger. While she has in fact thankfully fixed some mistakes via provisional teeth (which I pd an additional $1000 for) described as nec for healing; and 2 + 3 addl gingivectomies, I have by far found her to be the most difficult DDS to talk or work with.
It was then inferred I was lucky to have had her accept me as a PT and I should accept whatever results she felt were an improvement.
The results at my last appt were unexpected.* She angrily told me they were acceptable, not that bad, and any further charges were mine. Exhausted, I accepted crowns 8+9 with an uneven gum line and resolved to look elsewhere for help.
*#9 had a repeat gingv 1.28.9, but the new trainee tech put in a temp that was too high and the gum line stayed with it. #8 had a repeat gingv 12.30.8, and while the same tech put in a lower temp, and the gum line has stayed with that as well. The 2 crowns were to be made alike 1.28.9; however, the difference in the gum line is now 2mm.
I would like #s 8+9 to be more alike as they are together and right in front. #s 7+10 are not "perfect" and that is fine!
Ideally, I would like to have #9 removed PRN ONLY, shaved off minimally 1mm+ (which she refused to do prior to seating), wearing a temp or #9 as a temp while the gum line comes down per past experience, and then reseated. If it can be done w/o removal, that of course is preferable.
#8 has typically been the worst area for inflammation.
None of 7 8 9 or 10 has "relaxed" per DDS' prediction.
She also has refused to address the length of all crowns, saying flatly she does not want to consider it as she likes them cosmetically as is. That's the least of probs.
I once had a DDS tell me the earlier the better for saving a crown. These 2 are still a little loose. I would prefer to work w/the crowns I have; they are well made. (I have also pd for this wk twice.)
Please help me. Is there anything I can, should or should not do while I try to find a DDS who w/wk w/this mess? I feel time is of the essence while these crowns are relatively newly done.
Thanks so much!!

[Bryanna]

Hi NAM1,

I've read your post a few times and to be honest, I am having a hard time understanding some of it. Obviously, you have some dental anxiety which is very common. You have had some very unpleasant dental experieces with difficult dentists and also believe to have had some poor dentistry not just once but several times. Is all that right so far?

I would like to try to help you, if I can, but I have a few questions first.

1) What do you mean by a DM patient?

2) Why were your 4 front teeth bonded in the first place? Had they been broken or decayed? Had they been root canaled in the past? Was the bonding done strictly for cosmetic purposes?

3) Why all the repeated gingivectomies? Did the gum tissue keep growing back? Do you have a problem with overgrowth of gum tissue due to medications?

4) Do you have periodontal disease? How is the health of the rest of your teeth?

I know this has been very difficult for you and I can hear your frustrations about the way you have been treated. It sounds like some "major" dental issues have been created by dentists who either performed poor qualtity dentistry and/or by dentists who in trying to remedy what someone else had done, messed it up or were still unable to help you achieve the proper esthetic look you were hoping for.

Before I offer you any of my personal insight into this situation, I really would need the answers to the above questions. I know you want to express how negatively you have been treated and I agree that you should not hold that in. But if possible, until we get a clearer picture of what is going on, please try to limit the personal stuff about the dentists because in this type of forum, it can be bit distracting from the pertinent issues which are your teeth. Ok...... ~'.'~

Look forward to hearing back from you........

Bryanna

Originally Posted by NAM1

My initial goal was 4 front teeth that fit, with a slightly higher gum line.
I need a DDS who will listen, W/O ANGER, and W/PATIENCE, to a gunshy PT who has been thru 3+yrs of grief trying to fix a prob starting 12/2005 w/a DDS whom I really liked but would not admit he was in over his head. He repeatedly tried to bond 4 teeth as well as doing 6 gingivectomies instead of recognizing a need for bone reduction. Serious inflammation resulted; as well, cords were found months later left in, contributing to the prob. I finally gave up despite assurances he could fix it. He has now left practicing after promising and failing to fix his errors.
Bone reduction has now been done; and I have been thru more mistakes and probs: including refusals to wk w/my oral surgeon and his mistakes (correctly done bone reduction, but poorly done gingv as well as corresp mistake on access tooth 11's gum). There is a gen reluctance to wk w/a type 1 DM PT; and ALL 6 DDSs HAVE DIFFERENT OPIONIONS.
The last has "personal problems" which "sometimes come into her prof life" gradually enlightened to me by the DDS' (now fmr) tech during the 2nd and 3rd of 6 unfortunately progressive (required prepd) TXs. She is potentially and unpredictably explosive in manner and I dare not return to her. I could (and can) no longer tolerate her anger. While she has in fact thankfully fixed some mistakes via provisional teeth (which I pd an additional $1000 for) described as nec for healing; and 2 + 3 addl gingivectomies, I have by far found her to be the most difficult DDS to talk or work with.
It was then inferred I was lucky to have had her accept me as a PT and I should accept whatever results she felt were an improvement.
The results at my last appt were unexpected.* She angrily told me they were acceptable, not that bad, and any further charges were mine. Exhausted, I accepted crowns 8+9 with an uneven gum line and resolved to look elsewhere for help.
*#9 had a repeat gingv 1.28.9, but the new trainee tech put in a temp that was too high and the gum line stayed with it. #8 had a repeat gingv 12.30.8, and while the same tech put in a lower temp, and the gum line has stayed with that as well. The 2 crowns were to be made alike 1.28.9; however, the difference in the gum line is now 2mm.
I would like #s 8+9 to be more alike as they are together and right in front. #s 7+10 are not "perfect" and that is fine!
Ideally, I would like to have #9 removed PRN ONLY, shaved off minimally 1mm+ (which she refused to do prior to seating), wearing a temp or #9 as a temp while the gum line comes down per past experience, and then reseated. If it can be done w/o removal, that of course is preferable.
#8 has typically been the worst area for inflammation.
None of 7 8 9 or 10 has "relaxed" per DDS' prediction.
She also has refused to address the length of all crowns, saying flatly she does not want to consider it as she likes them cosmetically as is. That's the least of probs.
I once had a DDS tell me the earlier the better for saving a crown. These 2 are still a little loose. I would prefer to work w/the crowns I have; they are well made. (I have also pd for this wk twice.)
Please help me. Is there anything I can, should or should not do while I try to find a DDS who w/wk w/this mess? I feel time is of the essence while these crowns are relatively newly done.
Thanks so much!!

[NAM1]

Hi Bryanna
Thanks so much for replying. I SO appreciate your help.
Sorry for the confusion. My situation is quite complex; and I can well understand why you would be confused. I think my prev icon may have indicated I am confused, as well as unhappy and frustrated! I appreciate your patience, and I will answer as clearly as I can below to your corresponding questions:

Originally Posted by Bryanna

Hi NAM1,

I've read your post a few times and to be honest, I am having a hard time understanding some of it. Obviously, you have some dental anxiety which is very common. You have had some very unpleasant dental experieces with difficult dentists and also believe to have had some poor dentistry not just once but several times. Is all that right so far?

A: Yes. I am very scared and worried. I have had several poor experiences not only with these 3 DDSs mentioned but had trouble finding a DDS who would work with either a perio or an oral surgeon with the inflammation and gum line issue.
I have also had poor luck finding a good DDS and have been thru many prior to 2005 and the current issue; and one who is capable of handling my medical issues. I have been thru many prior to 2005.
These as well as the current 6 mentioned all seem to disagree on my treatment(s) or each other. This has been most frustrating as I don't know whom to trust.

Even the last DDS (I'll refer to her as "Dr H") disagreed with the oral surgeon (I'll refer to him as Dr G") I saw who referred / recommended me to her and works with her. That is why Dr H did the last gingivectomies (11/08-12/08) instead of Dr G re-doing them as he had offered, because even Dr H said she wanted "more finesse" than she had seen, and prev seen, from the oral surgeon's results.

(Dr G did the bone reduction (successful); his single (but now 7th) gingivectomy (unsuccessful) both done 8/08.)
If I have counted correctly, total gingivectomies number apx 10 to one area or another in gum areas 7-10.

I would like to try to help you, if I can, but I have a few questions first.

1) What do you mean by a DM patient?

DM=Diabetes Mellitus. Mine is type 1, uncontrolled. My health is generally compromised, but workable with qualified professionals.

2) Why were your 4 front teeth bonded in the first place? Had they been broken or decayed? Had they been root canaled in the past? Was the bonding done strictly for cosmetic purposes?

A: The bonding was done by the first DDS (w/refer to him as Dr R) beginning the problematic inflammation accordingly. It was repeatedly done in an effort to make the crowns fit when bone reduction should have been done first to make the crowns fit. He later conceded "maybe I should have done bone reduction" after I gave up on him, went to see another DDS and found nec bone reduction to be his immediate conclusion, and then reported the info back to Dr. R. The 6 gingivectomies were done by Dr. R in the same effort to make the crowns fit, together with bonding. Both were unsuccessful. That effort was 12/05-01/08. He changed practices 2x and was unavailable for some of that time.

(#9 has had a previous root canal by a different DDS.)

3) Why all the repeated gingivectomies? Did the gum tissue keep growing back? Do you have a problem with overgrowth of gum tissue due to medications?

A: (6) gingivectomies were also repeatedly done by the same Dr R mentioned above in order to try and keep the gum line up. It was of course unsuccessful. The gum kept coming back down (growing back, I presume) and hanging over especially on #8 , and severe inflammation was the result on gum areas 7,8,9 + 10, esp on #s 7,8 & 9. Packing cords were left in on #s 8+10 which contributed to the inflammation prob. They were discoved apx 11 months later by Dr H.

THUS, the bottom line answers to your Qs 2+3 is that the original problem was caused by repeated gingivectomies AND repeated bonding done by Dr. R.

The initial gingivectomy was done by Dr R to raise the gum line and reduce a "gummy" look I've been unhappy with for years.

Medication was not an issue.

4) Do you have periodontal disease? How is the health of the rest of your teeth?

A: I do have mild perio disease and some bone loss on the bottom under a bridge this same Dr R did 2006. The bone loss may well be unrelated to his work there. I did have some problems with cosmetic bonding he did on #6 not holding. That was crowned by Dr. H.

I am largely concerned with areas 8-9 at this time. I would like to have a qualified professional possibly address not only the areas of 8+9, but possible bridges to include areas to even up the areas surrounding 7-10. #5 is chipping and may need a bridge to meet a long #6. No cavities. I do have a lot of crowns, + 2 bridges.

However, definitely first things first!

The inflammation in areas 7-10 has largely been healed.

I know this has been very difficult for you and I can hear your frustrations about the way you have been treated. It sounds like some "major" dental issues have been created by dentists who either performed poor qualtity dentistry and/or by dentists who in trying to remedy what someone else had done, messed it up or were still unable to help you achieve the proper esthetic look you were hoping for.

Before I offer you any of my personal insight into this situation, I really would need the answers to the above questions. I know you want to express how negatively you have been treated and I agree that you should not hold that in. But if possible, until we get a clearer picture of what is going on, please try to limit the personal stuff about the dentists because in this type of forum, it can be bit distracting from the pertinent issues which are your teeth. Ok...... ~'.'~

A: I mentioned the personal issues as a background / timeline (hard to avoid them acc); and to explain why I have not been able to resolve the issues with this last DDS ("Dr H"), and why I dare not return to her. I had the opportunity to keep trying with her as I felt in the past I must do; but simply can no longer. I find myself becoming physically ill even at the thot of returning to her, even to correct bite issues.

I am trying hard not tb negative. If there were an icon to indicate terrified I would use it instead of unhappy.

I look forward to moving onto a DDS who can help me.

I hope I've been enlightening and not more confusing. I know there is a lot of info over the timeline.

THANK YOU SO MUCH FOR YOUR PATIENCE AND UNDERSTANDING!!

Look forward to hearing back from you........

Bryanna

[Bryanna]

Hi NAM1,

I understand that you are scared and worried. From what you have described, your dental issues are indeed complex and I think there is more to the situation than maybe you even realize.

To begin with, having diabetes especially uncontrolled, puts you in a high risk category for periodontal disease because diabetes impairs the white blood cells which are the main defense against bacterial infections. Periodontal disease is a bacterial infection. Chronic or uncontrolled periodontal disease causes bone loss. Also, healing from gum surgery may be compromised due to limited blood flow to the surgical areas.

Were all of these dentists aware of your diabetes prior to the dental work? It is risky for someone with uncontrolled diabetes to have elective gum surgery, never mind repeated ginigivectomies. I find it beyond comprehension that your dentists performed this surgery on you repeated times.

It is possible that the gum tissue just never healed properly since the first ginigvectomy was done and subsequently there after. The reason for this could be due to your diabetes and not the actual procedure itself. As far as the dentist leaving cord underneath the gum tissue for approx 11 months.... if that were the case, you most likely would have developed a severe, painful bacterial infection in those areas. The inflammation would have been severe and infection would have set in very quickly. So I'm not sure what the dentist thought he pulled out of there, but I highly doubt it was the cord used in the preparation of your crowns or bonding.

You wrote that #9 has been root canaled. Root canaled teeth harbor alot of bacteria in them which can spread from that tooth through the bone to the adjacent teeth. This is commonly seen in the upper front teeth due to vascularity and the thin bone in that area of the mouth. This could be another reason why the gum tissue over 8 and 9 never seems to heal properly.

My suggestion to you would be to avoid any further gum surgeries. The healing of the gum tissue is compromised because of your uncontrolled diabetes and you may never get the results you are hoping for. Perhaps even worse, it is a health risk for you every time you go through the healing process from the surgery. Unless your teeth are broken down, avoid any additional crowns or bridges because they tend to irritate the gum tissue and can be more difficult to keep clean. It is imperative that your plaque level be at a minimum to avoid the progression of the periodontal disease.

There is much literature linking uncontrolled diabetes to poor oral health and vise versa. Studies show that if one of these conditions can be brought under control, the other one is more likely to do the same with proper care and nutrition.

I know you are trying to achieve a certain esthetic look with your teeth, but perhaps you should consider a more conservative approach and seek a dentist who can achieve good esthetic results without surgerizing your gums or reducing your bone any further.

I often refer people to the website IAOMT.org because the dentists and doctors who partake in this worldly organization are more inclined to think outside of the traditional box and because of that, they see the cases that no one else sees.

I really don't think I can be of any other help to you due to the fact that we are in cyberspace and your situation is very complex both dentally and physically.

We are always hear to listen and offer whatever guidance we can.......... please keep us informed on how things are going.

All the best to you...
Bryanna

Originally Posted by NAM1

Hi Bryanna
Thanks so much for replying. I SO appreciate your help.
Sorry for the confusion. My situation is quite complex; and I can well understand why you would be confused. I think my prev icon may have indicated I am confused, as well as unhappy and frustrated! I appreciate your patience, and I will answer as clearly as I can below to your corresponding questions:

[NAM1]

Hi Bryanna,

Thans so much for your reply. You are so right abt risk factors. I too have realized over the past 3 yrs how much repeat surgeries have been compromising my health.

Yes, all these Drs were very much aware of my medical and dental histories. I made it clear up front, esp since I have found an understandable gen reluctance to wk w/diabetics and compromised health issues.

There was some disc bt Dr H and her tech re whether the material found was actually cords. They disagreed; Dr H said cords while the tech thot stitches. The areas where the material was left were 8+10. #8 was by far the worst for inflammation.

There was no infectn per Dr H. She felt "provisional" (low fitting pre temp crowns) nec to reduce the severe inflammn in bt her 2 gingivectomies. She would not really elaborate on why she felt the 1st ging was nec other than "baby steps" to "just heal" the "train wreck" due to prev repeat trauma.

She had refused to rewk the crown for #9 herself, insisting another ging was instead nec when this crown was too pointed and the others were not. The gum height was not too high then. It now is. I elected not to cont w/her inc reasons previously discussed.

I am definitely not :-( wanting to have more surgery or bone reductn. What I had initially described in my 1st post was finding a qualified DDS to reduce crown #9 @ gum line to achieve a more balanced look for the 2 teeth in front.

That's my immediate goal while the crowns are still relatively new. Do you feel this is poss?

While the initial goal was for 6 front teeth tb balanced, I have given up on that. Any bridgewk I am considering is to replace old bridges while I still have insurance.

One would be to replace a bridge that inc #11 in lieu of a gum graft which Dr G has offered to redo in order to fix his error during his ging. Because of the error, #11 now shows the tooth underneath the tooth beginning that bridge. Quite honestly, not only do I not want more surgery, I'm not sure he can really do it and am apprehensive abt further error.

I do understand we r in cyberspace + your help is therefore limited w/a complex issue. I have prev been to the IAOMT site + found little real help there other than 3 names. Any receptionist feels their DDS is great.

Perhaps I don't know the correct Qs to ask. Can U help there? Since all the DDSs I have been to ALL have diff opinions I don't know whom to trust or turn to.

Any further suggestions you can offer re the above crown reduction Q + finding a DDS qualified to handle such a complex issue are greatly appreciated.

I hate to give up just (or esp) because I'm diabetic.

Thanks!
NAM

Originally Posted by Bryanna

Hi NAM1,

I understand that you are scared and worried. From what you have described, your dental issues are indeed complex and I think there is more to the situation than maybe you even realize.

To begin with, having diabetes especially uncontrolled, puts you in a high risk category for periodontal disease because diabetes impairs the white blood cells which are the main defense against bacterial infections. Periodontal disease is a bacterial infection. Chronic or uncontrolled periodontal disease causes bone loss. Also, healing from gum surgery may be compromised due to limited blood flow to the surgical areas.

Were all of these dentists aware of your diabetes prior to the dental work? It is risky for someone with uncontrolled diabetes to have elective gum surgery, never mind repeated ginigivectomies. I find it beyond comprehension that your dentists performed this surgery on you repeated times.

It is possible that the gum tissue just never healed properly since the first ginigvectomy was done and subsequently there after. The reason for this could be due to your diabetes and not the actual procedure itself. As far as the dentist leaving cord underneath the gum tissue for approx 11 months.... if that were the case, you most likely would have developed a severe, painful bacterial infection in those areas. The inflammation would have been severe and infection would have set in very quickly. So I'm not sure what the dentist thought he pulled out of there, but I highly doubt it was the cord used in the preparation of your crowns or bonding.

You wrote that #9 has been root canaled. Root canaled teeth harbor alot of bacteria in them which can spread from that tooth through the bone to the adjacent teeth. This is commonly seen in the upper front teeth due to vascularity and the thin bone in that area of the mouth. This could be another reason why the gum tissue over 8 and 9 never seems to heal properly.

My suggestion to you would be to avoid any further gum surgeries. The healing of the gum tissue is compromised because of your uncontrolled diabetes and you may never get the results you are hoping for. Perhaps even worse, it is a health risk for you every time you go through the healing process from the surgery. Unless your teeth are broken down, avoid any additional crowns or bridges because they tend to irritate the gum tissue and can be more difficult to keep clean. It is imperative that your plaque level be at a minimum to avoid the progression of the periodontal disease.

There is much literature linking uncontrolled diabetes to poor oral health and vise versa. Studies show that if one of these conditions can be brought under control, the other one is more likely to do the same with proper care and nutrition.

I know you are trying to achieve a certain esthetic look with your teeth, but perhaps you should consider a more conservative approach and seek a dentist who can achieve good esthetic results without surgerizing your gums or reducing your bone any further.

I often refer people to the website IAOMT.org because the dentists and doctors who partake in this worldly organization are more inclined to think outside of the traditional box and because of that, they see the cases that no one else sees.

I really don't think I can be of any other help to you due to the fact that we are in cyberspace and your situation is very complex both dentally and physically.

We are always hear to listen and offer whatever guidance we can.......... please keep us informed on how things are going.

All the best to you...
Bryanna

[Bryanna]

Hi NAM,

I wish there was some way I could convey to you how sincerely your situation touches my heart. I know your story well.... I've seen it too many times. The fact may be that you've had too much dentistry in the upper anterior of your mouth...... meaning the natural contour and integrity of the bone and gum tissue may at this point be compromised to the point that further gum and/or bone reduction could cause you to lose your teeth. This is the major concern that I have bases on the story that you have shared with us here.

I have copied and pasted some of your post, it is in the << brackets>>. My reply will be in CAPS.


<<Yes, all these Drs were very much aware of my medical and dental histories. I made it clear up front, esp since I have found an understandable gen reluctance to wk w/diabetics and compromised health issues>>. DENTISTS WOULD NOT BE RELUCTANT TO WORK WITH DIABETICS OR ANY OTHER COMPROMISED PATIENTS IF THEY HAD MEDICAL TRAINING. BUT DENTISTS ARE TAUGHT TO BE TOOTH CARPENTERS, NOT DOCTORS. UNLESS THEY EDUCATE THEMSELVES IN MEDICINE AFTER DENTAL SCHOOL, THEY UNFORTUNATELY KNOW LITTLE TO NOTHING ABOUT HEALTH ISSUES. MANY OF THEM DON'T THINK ABOUT THE CONSEQUENCES AND THEY JUST TREAT THESE PATIENTS LIKE ANYONE ELSE NOT TAKING INTO CONSIDERATION THAT THE TREATMENT OUTCOME MAY BE COMPROMISED. SOME DENTISTS ARE WISE ENOUGH TO REALIZE THAT THEIR LACK OF KNOWLEDGE ABOUT MEDICAL PROBLEMS SHOULD MAKE THEM RECONSIDER TAKING ON A PATIENT WHO FOR INSTANCE IS AN UNCONTROLLED DIABETIC.

Is this lack of knowledge fair to the public?? Absolutely not! Everyone has a right to proper dental care but how does someone in your shoes know where to obtain that? As you well know......... 10 different dentists looking at the same issue = 10 different opinions. How can that be????? I'll be damned if I know.

<<There was some disc bt Dr H and her tech re whether the material found was actually cords. They disagreed; Dr H said cords while the tech thot stitches. The areas where the material was left were 8+10. #8 was by far the worst for inflammation.>> IT IS POSSIBLE THAT THEY FOUND REMNANTS OF CORD UNDER THE GUM LINE SIMILAR TO TINY FIBERS. BUT NOT THE ACTUAL WHOLE PIECE OF CORD THAT WAS USED. SUTURES THAT ARE NOT DISSOLVABLE WILL GENERALLY DISINTEGRATE OVER A SHORT PERIOD OF TIME. UNLESS SOMETHING IN YOUR SALIVA PREVENTED THAT FROM OCCURING..... I GUESS ANYTHING IS POSSIBLE. THE ISSUE IS WHATEVER IT WAS, DID NOT BELONG THERE AND ITS PRESENCE INDICATES POOR DENTISTRY.

<<There was no infectn per Dr H. She felt "provisional" (low fitting pre temp crowns) nec to reduce the severe inflammn in bt her 2 gingivectomies. She would not really elaborate on why she felt the 1st ging was nec other than "baby steps" to "just heal" the "train wreck" due to prev repeat trauma.>> THE LOW FITTING PROVISIONALS WERE PLACED TO ENCOURAGE THE GUM TISSUE TO HEAL WITHOUT ANYTHING IRRITATING IT. THESE TEMPS SHOULD ONLY BE WORN FOR A SHORT TIME BECAUSE THERE IS USUALLY SOME ROOT EXPOSURE NEAR THE GUMLINE THAT IS NOW VULNERABLE TO DECAY OR INFECTION. THERE ARE TIMES THAT THE GUM TISSUE NEEDS TO BE "ROUGHED UP" FOR LACK OF A BETTER TERM TO ENCOURAGE THE IMMUNE SYSTEM TO COME TO THE RESCUE AND HEAL IT FROM A PREVIOUS INJURY OR TRAUMA.

<<She had refused to rewk the crown for #9 herself, insisting another ging was instead nec when this crown was too pointed and the others were not. The gum height was not too high then. It now is. I elected not to cont w/her inc reasons previously discussed.>> THIS SOUNDS TO ME LIKE SHE FELT THE CROWN ON #9 WAS NOT FITTING PROPERLY AND TO TRY AND ADJUST IT WOULD RUIN THE INTEGRITY OF THE CROWN. THE SECOND GINGIVECTOMY OBVIOUSLY HEIGHTENED THE GUM TISSUE TO MUCH.

<<I am definitely not :-( wanting to have more surgery or bone reductn. What I had initially described in my 1st post was finding a qualified DDS to reduce crown #9 @ gum line to achieve a more balanced look for the 2 teeth in front. That's my immediate goal while the crowns are still relatively new. Do you feel this is poss?>> I PERSONALLY FEEL THAT THE HEIGHT OF THE GUM LINE ON #9 IS NOT GOING TO CHANGE FOR THE BETTER IRRELEVANT OF WHAT IS DONE TO IT. COULD THE CROWN LOOK ESTHETICALLY BETTER? WITHOUT SEEING WHAT IT LOOKS LIKE, I REALLY CAN NOT COMMENT ON THAT.

<<While the initial goal was for 6 front teeth tb balanced, I have given up on that. Any bridgewk I am considering is to replace old bridges while I still have insurance.>> SOME THINGS THAT COME TO MIND WITH YOUR CROWNS AND BRIDGEWORK ....... ARE THEY PORCELAIN FUSED TO METAL? IF SO, IS THE METAL A HIGH NOBLE OR JUST A MIXTURE OF LESS NOBLE METALS? DO YOU HAVE ANY ALLERGIES OR SENSITIVITIES TO METAL IN JEWLERY THAT YOU KNOW OF? FREQUENTLY, PEOPLE ARE SENSITIVE TO THE MATERIALS/METALS THAT ARE USED IN DENTISTRY AND THEY CAUSE A NEGATIVE REACTION IN THE GUM TISSUE LIKE CHRONIC IRRITATION, INFLAMMATION OR RECESSION WHERE THE GUM TISSUE ACTUALLY PULLS AWAY FROM THE OFFENDING MATERIAL OR METAL. HAS ANY OF THAT EVER BEEN DISCUSSED WITH YOU? THERE ARE NON METAL, PORCELAIN TYPE MATERIALS THAT ARE CONSIDERED BIOCOMPATIBLE THAT ARE BETTER TOLERATED BY MOST PEOPLE. CROWNS, BRIDGES, AND PARTIAL DENTURES CAN BE MADE FROM THESE MATERIALS AND THEY LOOK GREAT AND WEAR TERRIFIC.

<<One would be to replace a bridge that inc #11 in lieu of a gum graft which Dr G has offered to redo in order to fix his error during his ging. Because of the error, #11 now shows the tooth underneath the tooth beginning that bridge. Quite honestly, not only do I not want more surgery, I'm not sure he can really do it and am apprehensive abt further error.>> SO DR G REMOVED TOO MUCH TISSUE IN DOING THE GINGIVECTOMY ON #11 SITE. IS THERE ANY WAY HE COULD PLACE A COMPOSITE MATERIAL AT THE RECESSION SITE INSTEAD OF REDOING THE ENTIRE BRIDGE?

<<I do understand we r in cyberspace + your help is therefore limited w/a complex issue. I have prev been to the IAOMT site + found little real help there other than 3 names. Any receptionist feels their DDS is great.>> THE IAOMT SITE IS LACKING ALOT OF HELPFUL GUIDANCE, I AGREE WITH YOU. THE REASON FOR THAT IS BECAUSE THE BIG DENTAL ORGANIZATIONS WOULD TRY TO SHUT THEM DOWN IF THEY WENT AGAINST THE TIDE TOO MUCH....... POLITICAL NONSENSE COMPLETELY. IT IS TRUE THAT MOST RECEPTIONISTS WILL TELL A CALLER THAT THEIR DOCTOR IS THE BEST..... WHEN IN REALITY THEY KNOW LITTLE TO NOTHING ABOUT HIS TOOTH CARPENTRY SKILLS!! AGAIN, HOW DOES THAT GET CHANGED..... I WISH I KNEW!

<<Perhaps I don't know the correct Qs to ask. Can U help there? Since all the DDSs I have been to ALL have diff opinions I don't know whom to trust or turn to.>> YOU ARE IN A SITUATION WHERE YOU HAVE TO FIND SOMEONE TO TRUST. THE ONLY THING I CAN TELL YOU IS TO ASK FOR ALL OF YOUR OPTIONS. MAKE YOURSELF CLEAR IN THAT YOU PREFER THE LEAST INVASIVE MEANS POSSIBLE. ANY NEW DENTIST IS GOING TO BE ABLE TO SEE WHAT YOUR DENTAL PROBLEMS ARE WITHOUT YOU REHASHING ALL THAT YOU HAVE BEEN THROUGH. I WOULD BE VERY PRECISE AND TO THE POINT..... AN EXAMPLE.... I'VE HAD X NUMBER OF GINGIVECTOMIES ON TEETH 3'S X,X,X. BONE REDUCTION ON TEETH #'S X,X,X. THIS IS MY # SET OF CROWNS WHICH INCLUDE PROVISIONALS. I AM TRYING TO ACHIEVE XXX.

<<Any further suggestions you can offer re the above crown reduction Q + finding a DDS qualified to handle such a complex issue are greatly appreciated.>> WHEN PATIENTS LIKE YOURSELF COME INTO AN OFFICE AS A NEW PATIENT, THEY HAVE ALOT TO TELL THE NEW GUY AND UNFORTUNATELY, THE DENTIST GETS HUNG UP IN THE "STORY" AND "DRAMA" OF THE SITUATION. THEY BECOME RELUCTANT TO DEAL WITH PEOPLE WHO COME IN WITH BAGGAGE BECAUSE THEY ARE AFRAID THEY WILL BECOME A PIECE OF THE LUGGAGE. THIS IS NOT MEANT TO SAY THAT YOUR BAGGAGE ISN'T REAL BECAUSE IT IS MOST DEFINITELY!! HOWEVER, TRY TO LEAVE ALOT OF IT BEHIND AND STICK TO THE PRESENT SITUATION SO THE NEW GUY CAN FOCUS ON YOUR DENTAL PROBLEM AND NOT YOUR BAGGAGE PROBLEM. DOES THAT MAKE SENSE TO YOU? I'M TELLING YOU THIS FROM LOOKING AT PATIENTS FROM THE OTHER SIDE OF THE CHAIR..... OK??

Where to look for a qualified dentist? Oh I really wish I knew! Word of mouth, family, your doctor's office??

Please keep in touch............... I wish you all the best!!!!!!

Bryanna




I hate to give up just (or esp) because I'm diabetic.

Thanks!
NAM

[NAM1]

Hi Bryanna:
Wow!
The best help yet. Thanks SO MUCH for caring.
I have talked by phone /w a 7th DDS, and of course that is a 7th DIFFERENT opinion. He is app the "fmr director for LV Institute of Advanced Dental Studies" and therefore well qualified; but who knows?
He feels POSSIBLY the crown on #9 could be reduced to balance the gum line. Of course he would have to see it first.
Dr "T" was aghast that:
1. PFM crowns were used in anterior crowns. Says they are incompatible esp w/diabetic's tissue + w/cause irritation.
2. Electrosurge was used instead of lasers. He says electrosurge allows the tissue to move (and it did move).

AT LEAST HE WAS WILLING TO TALK TO ME!! I felt the need to ask up front if this type of dentistry is w/in his realm of comfort; and he actually took the time, called me back and TALKED to me like a human being!

Dr H was extremely reluctant; and left most initial explanations to her receptionist and later issues to her (now fmr) tech. Anything Dr H explained was w/extreme irritation.

***=My Responses Below...

Originally Posted by Bryanna

Hi NAM,

I wish there was some way I could convey to you how sincerely your situation touches my heart. I know your story well.... I've seen it too many times. The fact may be that you've had too much dentistry in the upper anterior of your mouth...... meaning the natural contour and integrity of the bone and gum tissue may at this point be compromised to the point that further gum and/or bone reduction could cause you to lose your teeth. This is the major concern that I have bases on the story that you have shared with us here.

I have copied and pasted some of your post, it is in the << brackets>>. My reply will be in CAPS.


<<Yes, all these Drs were very much aware of my medical and dental histories. I made it clear up front, esp since I have found an understandable gen reluctance to wk w/diabetics and compromised health issues>>. DENTISTS WOULD NOT BE RELUCTANT TO WORK WITH DIABETICS OR ANY OTHER COMPROMISED PATIENTS IF THEY HAD MEDICAL TRAINING. BUT DENTISTS ARE TAUGHT TO BE TOOTH CARPENTERS, NOT DOCTORS. UNLESS THEY EDUCATE THEMSELVES IN MEDICINE AFTER DENTAL SCHOOL, THEY UNFORTUNATELY KNOW LITTLE TO NOTHING ABOUT HEALTH ISSUES. MANY OF THEM DON'T THINK ABOUT THE CONSEQUENCES AND THEY JUST TREAT THESE PATIENTS LIKE ANYONE ELSE NOT TAKING INTO CONSIDERATION THAT THE TREATMENT OUTCOME MAY BE COMPROMISED. SOME DENTISTS ARE WISE ENOUGH TO REALIZE THAT THEIR LACK OF KNOWLEDGE ABOUT MEDICAL PROBLEMS SHOULD MAKE THEM RECONSIDER TAKING ON A PATIENT WHO FOR INSTANCE IS AN UNCONTROLLED DIABETIC.

Is this lack of knowledge fair to the public?? Absolutely not! Everyone has a right to proper dental care but how does someone in your shoes know where to obtain that? As you well know......... 10 different dentists looking at the same issue = 10 different opinions. How can that be????? I'll be damned if I know.

<<There was some disc bt Dr H and her tech re whether the material found was actually cords. They disagreed; Dr H said cords while the tech thot stitches. The areas where the material was left were 8+10. #8 was by far the worst for inflammation.>> IT IS POSSIBLE THAT THEY FOUND REMNANTS OF CORD UNDER THE GUM LINE SIMILAR TO TINY FIBERS. BUT NOT THE ACTUAL WHOLE PIECE OF CORD THAT WAS USED. SUTURES THAT ARE NOT DISSOLVABLE WILL GENERALLY DISINTEGRATE OVER A SHORT PERIOD OF TIME. UNLESS SOMETHING IN YOUR SALIVA PREVENTED THAT FROM OCCURING..... I GUESS ANYTHING IS POSSIBLE. THE ISSUE IS WHATEVER IT WAS, DID NOT BELONG THERE AND ITS PRESENCE INDICATES POOR DENTISTRY.

***The "cords" or whatever were quite long for the spaces involved. Absolutely poor dentistry!! Even Dr H was upset at that. If they were cords, they were placed by Dr. R's ofc. If they were stitches, it happened w/ Dr. G's surgical ging which included stitches, done 8/08 and discovered 11/08. Stitches were removed 9/08 by Dr G's tech, perhaps not completely. May never know.


<<There was no infectn per Dr H. She felt "provisional" (low fitting pre temp crowns) nec to reduce the severe inflammn in bt her 2 gingivectomies. She would not really elaborate on why she felt the 1st ging was nec other than "baby steps" to "just heal" the "train wreck" due to prev repeat trauma.>> THE LOW FITTING PROVISIONALS WERE PLACED TO ENCOURAGE THE GUM TISSUE TO HEAL WITHOUT ANYTHING IRRITATING IT. THESE TEMPS SHOULD ONLY BE WORN FOR A SHORT TIME BECAUSE THERE IS USUALLY SOME ROOT EXPOSURE NEAR THE GUMLINE THAT IS NOW VULNERABLE TO DECAY OR INFECTION. THERE ARE TIMES THAT THE GUM TISSUE NEEDS TO BE "ROUGHED UP" FOR LACK OF A BETTER TERM TO ENCOURAGE THE IMMUNE SYSTEM TO COME TO THE RESCUE AND HEAL IT FROM A PREVIOUS INJURY OR TRAUMA.

***They were worn for 6 wks for "healing," then repeat ging on 7+8, w/temp crowns then placed.

<<She had refused to rewk the crown for #9 herself, insisting another ging was instead nec when this crown was too pointed and the others were not. The gum height was not too high then. It now is. I elected not to cont w/her inc reasons previously discussed.>> THIS SOUNDS TO ME LIKE SHE FELT THE CROWN ON #9 WAS NOT FITTING PROPERLY AND TO TRY AND ADJUST IT WOULD RUIN THE INTEGRITY OF THE CROWN. THE SECOND GINGIVECTOMY OBVIOUSLY HEIGHTENED THE GUM TISSUE TO MUCH.

***She said requested "30 second" adjustmt to #9 might show the metal. When I asked to wear the temp longer to possibly allow the gumline relax more, she said it would not change the pointed shape of the tooth. Conversely, she also said the gum line was "done" that way. The repeat ging was to widen the area, not heighten it, but that was the result (Dr. T was right there).

<<I am definitely not :-( wanting to have more surgery or bone reductn. What I had initially described in my 1st post was finding a qualified DDS to reduce crown #9 @ gum line to achieve a more balanced look for the 2 teeth in front. That's my immediate goal while the crowns are still relatively new. Do you feel this is poss?>> I PERSONALLY FEEL THAT THE HEIGHT OF THE GUM LINE ON #9 IS NOT GOING TO CHANGE FOR THE BETTER IRRELEVANT OF WHAT IS DONE TO IT. COULD THE CROWN LOOK ESTHETICALLY BETTER? WITHOUT SEEING WHAT IT LOOKS LIKE, I REALLY CAN NOT COMMENT ON THAT.

<<While the initial goal was for 6 front teeth tb balanced, I have given up on that. Any bridgewk I am considering is to replace old bridges while I still have insurance.>> SOME THINGS THAT COME TO MIND WITH YOUR CROWNS AND BRIDGEWORK ....... ARE THEY PORCELAIN FUSED TO METAL? IF SO, IS THE METAL A HIGH NOBLE OR JUST A MIXTURE OF LESS NOBLE METALS? DO YOU HAVE ANY ALLERGIES OR SENSITIVITIES TO METAL IN JEWLERY THAT YOU KNOW OF? FREQUENTLY, PEOPLE ARE SENSITIVE TO THE MATERIALS/METALS THAT ARE USED IN DENTISTRY AND THEY CAUSE A NEGATIVE REACTION IN THE GUM TISSUE LIKE CHRONIC IRRITATION, INFLAMMATION OR RECESSION WHERE THE GUM TISSUE ACTUALLY PULLS AWAY FROM THE OFFENDING MATERIAL OR METAL. HAS ANY OF THAT EVER BEEN DISCUSSED WITH YOU? THERE ARE NON METAL, PORCELAIN TYPE MATERIALS THAT ARE CONSIDERED BIOCOMPATIBLE THAT ARE BETTER TOLERATED BY MOST PEOPLE. CROWNS, BRIDGES, AND PARTIAL DENTURES CAN BE MADE FROM THESE MATERIALS AND THEY LOOK GREAT AND WEAR TERRIFIC.

***Dr T wants all non metal; says he hasn't used PFM in 10 yrs. The bridge w/ #11 inclusive is PFM. That's the partial reasoning used behind Dr. H's choice of PFM for crowns, and being "conservative."

***I don't know the quality of metal used in either treatment.

***No, the option of porcelain was not discussed w/me by any DDS until Dr. T, yesterday.
*** PS:
***I now recall Dr. R did try a "higher quality" crown material in an effort to make them work; it did not. Subsequently the need for bone reduction arose instead.
***Otherwise, the option of a higher quality crown was not discussed except for Dr R's sales staff, and for reasons unrelated to health.

***I am unaware of an allergy to metal; my skin is sensitive however.

***Perhaps w/my prev trouble w/ bonding, I should be careful w/that?

<<One would be to replace a bridge that inc #11 in lieu of a gum graft which Dr G has offered to redo in order to fix his error during his ging. Because of the error, #11 now shows the tooth underneath the crown beginning that bridge. Quite honestly, not only do I not want more surgery, I'm not sure he can really do it and am apprehensive abt further error.>> SO DR G REMOVED TOO MUCH TISSUE IN DOING THE GINGIVECTOMY ON #11 SITE. IS THERE ANY WAY HE COULD PLACE A COMPOSITE MATERIAL AT THE RECESSION SITE INSTEAD OF REDOING THE ENTIRE BRIDGE?

***Yes, he removed some extra tissue from #11 as the access tooth to #10's ging. He is an MD as well as a DDS, but he "doesn't do" anything else besides surgery.
Different DDSs have disagreed on whether or not #11 can be veneered. Dr. H called the idea "laughable" because it is the abutmt for the bridge. (A "Dr S" suggested veneer or recrown, that those were the only options. A "Dr E" said no veneers for me). Again, who to believe???

<<I do understand we r in cyberspace + your help is therefore limited w/a complex issue. I have prev been to the IAOMT site + found little real help there other than 3 names. Any receptionist feels their DDS is great.>> THE IAOMT SITE IS LACKING ALOT OF HELPFUL GUIDANCE, I AGREE WITH YOU. THE REASON FOR THAT IS BECAUSE THE BIG DENTAL ORGANIZATIONS WOULD TRY TO SHUT THEM DOWN IF THEY WENT AGAINST THE TIDE TOO MUCH....... POLITICAL NONSENSE COMPLETELY. IT IS TRUE THAT MOST RECEPTIONISTS WILL TELL A CALLER THAT THEIR DOCTOR IS THE BEST..... WHEN IN REALITY THEY KNOW LITTLE TO NOTHING ABOUT HIS TOOTH CARPENTRY SKILLS!! AGAIN, HOW DOES THAT GET CHANGED..... I WISH I KNEW!

<<Perhaps I don't know the correct Qs to ask. Can U help there? Since all the DDSs I have been to ALL have diff opinions I don't know whom to trust or turn to.>> YOU ARE IN A SITUATION WHERE YOU HAVE TO FIND SOMEONE TO TRUST. THE ONLY THING I CAN TELL YOU IS TO ASK FOR ALL OF YOUR OPTIONS. MAKE YOURSELF CLEAR IN THAT YOU PREFER THE LEAST INVASIVE MEANS POSSIBLE. ANY NEW DENTIST IS GOING TO BE ABLE TO SEE WHAT YOUR DENTAL PROBLEMS ARE WITHOUT YOU REHASHING ALL THAT YOU HAVE BEEN THROUGH. I WOULD BE VERY PRECISE AND TO THE POINT..... AN EXAMPLE.... I'VE HAD X NUMBER OF GINGIVECTOMIES ON TEETH 3'S X,X,X. BONE REDUCTION ON TEETH #'S X,X,X. THIS IS MY # SET OF CROWNS WHICH INCLUDE PROVISIONALS. I AM TRYING TO ACHIEVE XXX.

***GREAT ADVICE!

<<Any further suggestions you can offer re the above crown reduction Q + finding a DDS qualified to handle such a complex issue are greatly appreciated.>> WHEN PATIENTS LIKE YOURSELF COME INTO AN OFFICE AS A NEW PATIENT, THEY HAVE ALOT TO TELL THE NEW GUY AND UNFORTUNATELY, THE DENTIST GETS HUNG UP IN THE "STORY" AND "DRAMA" OF THE SITUATION. THEY BECOME RELUCTANT TO DEAL WITH PEOPLE WHO COME IN WITH BAGGAGE BECAUSE THEY ARE AFRAID THEY WILL BECOME A PIECE OF THE LUGGAGE. THIS IS NOT MEANT TO SAY THAT YOUR BAGGAGE ISN'T REAL BECAUSE IT IS MOST DEFINITELY!! HOWEVER, TRY TO LEAVE ALOT OF IT BEHIND AND STICK TO THE PRESENT SITUATION SO THE NEW GUY CAN FOCUS ON YOUR DENTAL PROBLEM AND NOT YOUR BAGGAGE PROBLEM. DOES THAT MAKE SENSE TO YOU? I'M TELLING YOU THIS FROM LOOKING AT PATIENTS FROM THE OTHER SIDE OF THE CHAIR..... OK??

***Again, GREAT ADVICE!
By the way, I'm curious...what does the "other side of the chair" mean? Are you a DDS, tech...?

Where to look for a qualified dentist? Oh I really wish I knew! Word of mouth, family, your doctor's office??

***Apparently I lost that part of the reply when trying prev and had to redo the response...I've tried the 2 fmr w/ little success (Drs E and R were examples). My MD rec Dr G; and his prev unrelated cyst removals were w/exc results; however his perio skills are not his strong suit.

***For what it's worth, those cysts were in the #9 and in-bt 10-11 areas! #9 was perhaps 6 yrs ago. #10-11 was 2006 wherein Dr R missed what I adv him I tho't was a cyst...he did an unnec RTC on #11 instead for a non-existent abcess. Unfortunately I gave him the benefit of the doubt then for 1 mistake. Dr. G then removed what was in fact a cyst there.

***Yes, more complications in my health.

Please keep in touch............... I wish you all the best!!!!!!

***I have found what may or may not be a common thread in reported "good" DDSs. They seem not to accept insurance at all. Have you found that tb true?
Dr. T does not because they restrict his TXs, labs, etc. Any coverage consideration is out of netwk, etc.

***(I even find myself listening to the counter help @ Wendys, I'm so lost! Her DDS does not accept ins either.)

***Dr T's office is closed Fridays. I w/take the wkend to decide whether to see him next week. I STRONGLY feel as you do, that re-doing all this work is too traumatic both physically and emotionally!!!

***However, if PFM material is going to irritate my tissue, I may have to reconsider and pay the 3rd time for this work which is becoming a MAJOR EXPENSE in every way. Giving what you said abt non-metal materials, what do you think?

***Trying to follow my instincts at this point is viritually impossible. My mind is mush.
Therefore, any further tho'ts you have given the current events are more than WELCOME!

***THANKS!
NAM



Bryanna




I hate to give up just (or esp) because I'm diabetic.

Thanks!
NAM

[Bryanna]

Hi NAM,

Yes, perhaps it would be wise to see Dr T. He can only understand your situation when he sees it. I should have mentioned this to you before, but previous radiographs could be very helpful if you have them or can get them before you see Dr T because it will tell the history of treatment very clearly. Even radiographs from when all of this originally started would be good. It is important for the radiographs to be of excellent quality or they will be useless. It is not uncommon for a dental office to copy radiographs that end up in very poor quality which render the copies completely useless. Some offices use a 2 film packet instead of a 1 film packet when taking xrays which means that both films are of the same quality, this is the only time when it's ok to accept "duplicate" films. Some offices only take digital xrays. This can be a problem when duplicating them because the copies generally come out undignostic unless a quality printer and paper are used to duplicate them. Digital xrays can be emailed directly to another dental office which saves the quality of the xrays. I know more to think about!!! :-(( Dr T may also suggest new radiographs...... I would not be resistant to this in the least.

With regard to DDS participating in insurance plans or not.....
I've been in dentistry for 30+ years which means I started out when there was no dental insurance and patients paid in full. My experience has without a doubt shown me that..... dentists who belong to HMO insurance plans or restricted fee schedule insurance plans, definitely skimp on their materials and sterilization practices. They get paid per quantity of dentistry, not quality. They are restricted in some circumstances to abide by the insurance companies on what they can and cannot do. If they go outside of the what the insurance has deemed their boundary of care, they either have to submit ficticious claims or risk a financial penalty. They also use inferior quality materials and dental labs because they are not being compensated well enough to make a profit on their work if they used a higher quality. The public would be flabbergasted at how the insurance run dental practices perform their dental care and the lack of sterility is beyond comprehension. But that's a whole other topic!!

Please let us know what Dr T has to say..........

Bryanna




Thanks SO MUCH for caring.
I have talked by phone /w a 7th DDS, and of course that is a 7th DIFFERENT opinion. He is app the "fmr director for LV Institute of Advanced Dental Studies" and therefore well qualified; but who knows?
He feels POSSIBLY the crown on #9 could be reduced to balance the gum line. Of course he would have to see it first.
Dr "T" was aghast that:
1. PFM crowns were used in anterior crowns. Says they are incompatible esp w/diabetic's tissue + w/cause irritation.
2. Electrosurge was used instead of lasers. He says electrosurge allows the tissue to move (and it did move).

AT LEAST HE WAS WILLING TO TALK TO ME!! I felt the need to ask up front if this type of dentistry is w/in his realm of comfort; and he actually took the time, called me back and TALKED to me like a human being!

Dr H was extremely reluctant; and left most initial explanations to her receptionist and later issues to her (now fmr) tech. Anything Dr H explained was w/extreme irritation.

***=My Responses Below...[/QUOTE]

[NAM1]

Hi Bryanna,

Have made an appt w/Dr T for 3.2.09. Hope I'm doing the right thing. Slept the best & longest I have for over 2wks after making the appt., so guess I have my answer...

Nonetheless, the only recommendation I have for Dr. T is from an on-line contact w/a Mark Birnbach DDS when researching difficult dental cases. Have U ever heard of him? He says has known Dr T for yrs & he w/be honest and qualified to answer Qs.
Otherwise, I have only the conversn Dr T & I had. He not only talked to me like a Human Being, but seemed to make sense. However, they all did @ 1 point! So? At least I'm doing something, & 5 hrs avg sleep/nite for me is a disaster in the making, guaranteed.

Have to tell U, the stories U tell re corners cut on sterilizn, material quality et all inclusive of insurance is SCARY!! I have to wonder how else I've been affected medically. The story of a Kimberly B??? being infected w/AIDS by her DDS maybe 10yrs ago? comes to mind. At one time I trusted Dr. R implicitly. I unf/fortunately am still learning way more than I ever tho't needed to know abt dentistry. But, trying to move fwd!

I do have radiographs from Dr. H, collected in anaticipn of the current events; & when trouble became evident. Supposedly printed w/quality images etc and redone to insure that. I did have the prob U mentioned w/Dr S sending me w/digital, reduced images on a plastic sheet, his ofc mgr insisting they were quality & all that was nec to tell any DDS TX. Of course they were not. Dr. H redid them, w/o mention of email poss.

Dr. T does not have email cap or I would have asked Dr H's ofc to email me rads & then fwd'd them on. Dr. H does not have to know why; they do know I w/be filing w/ Dental Bd re Dr. R. W/still ask for them by email for future ref and "my recs;" then I'll have them PRN.

Can get around Dr. H that way! Thanks for telling me abt email saving quality. Otherwise I would've taken their word that reprinting for quality purposes by receptnst did in fact work.

Dr. T's ofc has said w/re-do rads PRN.

Shall I take Dr H's notes to Dr. T (or are xrays enuf)? Her notes were often disparaging, & unf not always true. Otherwise, I'm inclined to take my own timeline as U suggested prev w/various TXs on x dates. He does know I had a prob w/her.

U didn't answer the Q re bonding. I'm presuming there are different qualities of this material as well? Dr. R's bonding on #6 was failing w/in 9 mos.

I'm hoping if the metal begins to show on #9 upon reductn it can be bonded.

FYI: Recent EOB from ins co did indicate High Noble Metal was billed for paymt. Whether or not it was really used??? I don't know. Depends on integrity of both Dr. H and the lab she used.

How much do U think HNM matters? I'd like to wk w/what I have if I can; reducing re-dos as much as poss!

Remember Dr T does not use PFM at all. That's the material used in most of my dental wk. Hopefully that doesn't mean he can't help...?

I hope 3 wks after seating is not too long to "save" the crown if nec. He didn't seem concerned @2wks.

HOPE HOPE HOPE Dr T works out!!!

Pls let me know what U think meanwhile abt above.

THANKS SO MUCH!!!
NAM

Originally Posted by Bryanna

Hi NAM,

Yes, perhaps it would be wise to see Dr T. He can only understand your situation when he sees it. I should have mentioned this to you before, but previous radiographs could be very helpful if you have them or can get them before you see Dr T because it will tell the history of treatment very clearly. Even radiographs from when all of this originally started would be good. It is important for the radiographs to be of excellent quality or they will be useless. It is not uncommon for a dental office to copy radiographs that end up in very poor quality which render the copies completely useless. Some offices use a 2 film packet instead of a 1 film packet when taking xrays which means that both films are of the same quality, this is the only time when it's ok to accept "duplicate" films. Some offices only take digital xrays. This can be a problem when duplicating them because the copies generally come out undignostic unless a quality printer and paper are used to duplicate them. Digital xrays can be emailed directly to another dental office which saves the quality of the xrays. I know more to think about!!! :-(( Dr T may also suggest new radiographs...... I would not be resistant to this in the least.

With regard to DDS participating in insurance plans or not.....
I've been in dentistry for 30+ years which means I started out when there was no dental insurance and patients paid in full. My experience has without a doubt shown me that..... dentists who belong to HMO insurance plans or restricted fee schedule insurance plans, definitely skimp on their materials and sterilization practices. They get paid per quantity of dentistry, not quality. They are restricted in some circumstances to abide by the insurance companies on what they can and cannot do. If they go outside of the what the insurance has deemed their boundary of care, they either have to submit ficticious claims or risk a financial penalty. They also use inferior quality materials and dental labs because they are not being compensated well enough to make a profit on their work if they used a higher quality. The public would be flabbergasted at how the insurance run dental practices perform their dental care and the lack of sterility is beyond comprehension. But that's a whole other topic!!

Please let us know what Dr T has to say..........

Bryanna




Thanks SO MUCH for caring.
I have talked by phone /w a 7th DDS, and of course that is a 7th DIFFERENT opinion. He is app the "fmr director for LV Institute of Advanced Dental Studies" and therefore well qualified; but who knows?
He feels POSSIBLY the crown on #9 could be reduced to balance the gum line. Of course he would have to see it first.
Dr "T" was aghast that:
1. PFM crowns were used in anterior crowns. Says they are incompatible esp w/diabetic's tissue + w/cause irritation.
2. Electrosurge was used instead of lasers. He says electrosurge allows the tissue to move (and it did move).

AT LEAST HE WAS WILLING TO TALK TO ME!! I felt the need to ask up front if this type of dentistry is w/in his realm of comfort; and he actually took the time, called me back and TALKED to me like a human being!

Dr H was extremely reluctant; and left most initial explanations to her receptionist and later issues to her (now fmr) tech. Anything Dr H explained was w/extreme irritation.

***=My Responses Below...

[/QUOTE]

[Bryanna]

Hi NAM,

Again, my answers are in CAPS.

Originally Posted by NAM1

Hi Bryanna,

Have made an appt w/Dr T for 3.2.09. Hope I'm doing the right thing. Slept the best & longest I have for over 2wks after making the appt., so guess I have my answer...
I SAY WHAT HAVE YOU GOT TO LOSE! HE'S WILLING TO TALK TO YOU AND HEARS WHAT YOU ARE SAYING..... GO FOR IT!

Nonetheless, the only recommendation I have for Dr. T is from an on-line contact w/a Mark Birnbach DDS when researching difficult dental cases. Have U ever heard of him? He says has known Dr T for yrs & he w/be honest and qualified to answer Qs.
I DO NOT KNOW DR BIRNBACH OTHER THAN FROM HIS WEBSITE. HE DID COMPLETE THE COURSE AT LAS VEGAS INSTITUTE AND SUBSEQUENTLY TAUGHT THERE. SO HE HAS SEEM THE WORST OF THE WORSE.

Otherwise, I have only the conversn Dr T & I had. He not only talked to me like a Human Being, but seemed to make sense. However, they all did @ 1 point! So? At least I'm doing something, & 5 hrs avg sleep/nite for me is a disaster in the making, guaranteed.
I KNOW HOW FRUSTRATING AND DISCONCERTING IT IS TO TRUST SOMEONE ONLY TO BE DISAPPOINTED. I WOULD KEEP THE FAITH IN DR T UNTIL OR IF HE PROVES TO BE A JERK. AT THE SAME TIME KEEP AN OPEN MIND AND ALWAYS FEEL FREE TO ASK HIM QUESTIONS IF YOU ARE NOT SURE OF SOMETHING.

Have to tell U, the stories U tell re corners cut on sterilizn, material quality et all inclusive of insurance is SCARY!! I have to wonder how else I've been affected medically. The story of a Kimberly B??? being infected w/AIDS by her DDS maybe 10yrs ago? comes to mind. At one time I trusted Dr. R implicitly. I unf/fortunately am still learning way more than I ever tho't needed to know abt dentistry. But, trying to move fwd!
I COULD WRITE A BOOK, SO COULD MANY....MANY OF MY PEERS ABOUT WHAT GOES ON IN MANY DENTAL OFFICES ABOUT CUTTING CORNERS, UNINFORMED PATIENTS AND INSURANCE FRAUD. BUT THERE ARE SOME OFFICES WHERE NONE OR LITTLE OF THIS OCCURS AND THAT SHOULD BE THE WAY THEY ALL ARE!

I do have radiographs from Dr. H, collected in anaticipn of the current events; & when trouble became evident. Supposedly printed w/quality images etc and redone to insure that. I did have the prob U mentioned w/Dr S sending me w/digital, reduced images on a plastic sheet, his ofc mgr insisting they were quality & all that was nec to tell any DDS TX. Of course they were not. Dr. H redid them, w/o mention of email poss.
GOOD. BRING DR T EVERYTHING YOU'VE GOT!

Dr. T does not have email cap or I would have asked Dr H's ofc to email me rads & then fwd'd them on.
MOST DENTAL OFFICES HAVE EMAIL CAPABILITES. I AM SURPRISED THAT HE DOESN'T. PERHAPS YOU COULD MAKE THAT SUGGESTION TO HIM!

Dr. H does not have to know why; they do know I w/be filing w/ Dental Bd re Dr. R. W/still ask for them by email for future ref and "my recs;" then I'll have them PRN.
I WOULD SUGGEST THAT YOU HOLD OFF ON TELLING DR T ABOUT THE DENTAL BOARD ACTION AT THIS TIME. SINCE HE DOES NOT KNOW YOU, HE CAN GET HUNG UP ON YOUR INTENT FOR REVENGE (FOR LACK OF A BETTER WORD HERE) AND NOT SEE IT AS JUSTIFICATION. YOU WANT HIM TO SEE YOU FOR THE PERSON YOU ARE TODAY IN SPITE OF THE LESS THAN DESIRABLE DENTAL WORK THAT YOU HAVE UNDERGONE IN THE PAST. LET HIM EMBRACE YOUR POSITIVE ATTITUDE AND NOT BE CLOUDED BY WHAT HAS HAPPENED TO YOU IN THE PAST BECAUSE HE MAY INTERPRET THAT YOU ARE DIFFICULT TO PLEASE AND BE HESITANT TO TREAT YOU.

Can get around Dr. H that way! Thanks for telling me abt email saving quality. Otherwise I would've taken their word that reprinting for quality purposes by receptnst did in fact work.
RECEPTIONISTS DON'T USUALLY KNOW JACK S**T ABOUT THE QUALITY OF XRAYS, NOR DO THEY CARE. THAT IS WHY I POSTED IT HERE SO YOU AND OTHERS COULD BE MORE INCLINED TO DEMAND QUALITY XRAYS......

Dr. T's ofc has said w/re-do rads PRN.
GOOD..... THAT'S GOOD.

Shall I take Dr H's notes to Dr. T (or are xrays enuf)? Her notes were often disparaging, & unf not always true. Otherwise, I'm inclined to take my own timeline as U suggested prev w/various TXs on x dates. He does know I had a prob w/her.
TAKE HER NOTES BUT HOLD ONTO THEM UNTIL YOU EITHER HAVE TO REFER TO THEM OR AFTERWARDS YOU CAN LEAVE HIM A COPY OF THEM. DEFINITELY TAKE YOUR OWN AGENDA WITH YOU.

U didn't answer the Q re bonding. I'm presuming there are different qualities of this material as well? Dr. R's bonding on #6 was failing w/in 9 mos. I'm hoping if the metal begins to show on #9 upon reductn it can be bonded.
SORRY I MISSED THIS ONE. YES, THERE DEFINITELY IS A VARIETY OF DENTAL MATERIALS AND SOME ARE NOT THAT GREAT. IN MY OPINION, IT IS BEST TO USE A MATERIAL THAT IS DURABLE AND AS BIOCOMPATIBLE AS POSSIBLE. DENTAL MATERIALS CANNOT BE CHEMCIAL FREE BECAUSE THEY WOULD NOT BE ABLE TO BOND TO THE TOOTH NOR WOULD THEY HOLD UP FOR VERY LONG. I HAVE A FEELING THAT DR T TRIES TO USE NON METAL RESOTORATIONS AND UTILIZES QUALITY BONDING MATERIALS.

FYI: Recent EOB from ins co did indicate High Noble Metal was billed for paymt. Whether or not it was really used??? I don't know. Depends on integrity of both Dr. H and the lab she used.
THE TYPICAL INSURANCECCODE USED FOR SINGLE PORCELAIN FUSED TO METAL CROWNS IS D2750 WHICH SIMPLY STATES HNM BUT IT DOES NOT MEAN THAT WAS THE MATERIAL USED FOR THAT PARTICULAR CROWN.

How much do U think HNM matters? I'd like to wk w/what I have if I can; reducing re-dos as much as poss!
MY OPINION IS THAT HNM SHOULD CONSIST OF AT LEAST 80% GOLD WITH ZERO PERCENT PALLADIUM. BUT ALL PORCELAIN OR ZIRCONIUM IS BEST. I WOULD ASK DR T IF HE THINKS YOU MAY BE SENSITIVE TO THE METAL ALONG THE GUMLINE.

Remember Dr T does not use PFM at all. That's the material used in most of my dental wk. Hopefully that doesn't mean he can't help...?
I DIDN'T SEE THIS UNTIL NOW..... HOW DID I GUESS HE DIDN'T USE PFM'S??? HE DOESN'T USE IT BECAUSE MOST PEOPLE HAVE A PROBLEM WITH THE METALS AND BECAUSE ESTHETICALLY, ALL PORCELAIN OR ZIRCONIUM LOOK SO MUCH MORE NATURAL. I'M SURE HE WILL WORK WITH WHAT YOU HAVE SO LONG AS HE DOESN'T THINK YOU ARE SENSITIVE TO IT. SO PLEASE ASK HIM TO BE TOTALLY FRANK WITH YOU ABOUT THAT.

I hope 3 wks after seating is not too long to "save" the crown if nec. He didn't seem concerned @2wks.
IT'S NOT TOO LONG.. DO NOT WORRY ABOUT THAT AT ALL!!


HOPE HOPE HOPE Dr T works out!!!
ME TOO...... ME TOO..... ME TOO!!!!!

Pls let me know what U think meanwhile abt above.
KEEP US POSTED....... AND KEEP GETTING THAT NECESSARY REST!!!

THANKS SO MUCH!!!
you are very welcome !! ~'.'~

Bryanna

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