Ageism in dentistry? OFF TOPIC

[Sylvain VAN DER WALDE]

Hello all.

This is no belated April fool's joke. I went to the dentist last week to have a small white filling done _privately_. This dentist is the owner of the practice (2 associates, as far as I know). He should be very experienced, and should have been able to do that job "with his eyes shut". Well, that filling dropped out soon afterwards. His associate (who has gone back to Sweden where they both trained) did a very similar white filling some time ago, and it's still intact. The hole in the tooth was very shallow, and I was extremely surprised (but said nothing) when he just cleaned the cavity and did not enlarge and/or deepen it. I was therefore not surprised (_strictly the truth_) when it dropped out. I must add that I've had a number of unfortunate incidents with some other local dentists where treatment had to be repeated two or three times. I've had to ask for my money back twice, and regret that I didn't do so another two or three times. A pattern has finally emerged (so I believe) with this latest incident. I would be very grateful for any comments.

Thanks in advance.

Sylvain.

[Jon]

[e-mail] declared for all the world to hear...

Don't post it to this group?

[The Natural Philosopher]

Well its like teh very expensive service my landrver had, where I asked tehm to change tey brake fluid, as its nearly ten years old and at that age its probably half water..

They maybe did or didn't. They said 'you need new rear brake pads soon, shall we do it'? I said 'no leave it for now. The vehicke was returned to me with pathetic brakes. They had 'accidentally' not bled the brakes properly.

This is the same place that years ago took a look at my XJS back axle and said that they would have to charge me £2500 fr a new one. I took it to a 'bloke I know' and he fixed the oil seal for 3£10 and it was still fine 30000 miles later when I sold it.

There are ways of ensuring a steady stream, of patients, if you are a clever dentist, just as there are ways of ensuring a steady stem of car repairs, if you are a smart mechanic.

[Bob Eager]

Unless he plans to DIY his teeth from now on? :-)

[Jon]

Ah! If that was the case then surely he would not have visited said dental practise in the first place?

[Derek Geldard]

New systems and materials are being produced all the time. You wouldn't want your treatment to be retricted to what he was taught in dental school would you.

Nowadays white plastic composite fillings actually bond to the tooth material. the prep doesn't need to be undercut for retention, this is "a good thing". OTOH the cavity has to be meticulously prepared, etched, dried etc.

Maybe the prep got contaminated with saliva.

The dentist should re-do the filling FOC.

DG

[Andrew Mawson]

Well I recently saw (repeated again) the Mr Bean film where he did precisely that. Having knocked out the dentist he proceeded to try to fill his own teeth !

AWEM

[mike]

If you were "extremely surprised" that he didn't enlarge the cavity, maybe you should have asked why.

If you knew he should have enlarged the cavity, you should either have advised him or gone to a better dentist.

So are all the dentists in your area bad or do you keep going back to ones that you know are bad?

Would you care to share with us what you think this pattern is?

That there's a conspiracy of bad dentists in your area? That your oral hygiene is so poor, no one can help?

[Andy Hall]

How long did it take him and what did you pay?

Certainly the cavity should be cleaned, but should not, with modern materials need to be deepened or enlarged particularly.

The old fashioned mercury amalgam filling materials required this and also required that the tooth be undercut such that the filling material sits packed under an undercut sloping wedge. In other words, these materials required mechanical retention to stay in place.

Modern materials do not. They bond to the tooth material. The procedure, in outline, is

- for the old filling material plus any decay to be removed

- sterilisation of the area and rinsing.

- etching of the bonding surface (IIRC, an acidic substance is used for this), followed by rinse

- thorough drying of the area and maintenance of dryness during the filling procedure. Sometimes a thin rubber sheet is located around the tooth to achieve isolation from the rest of the mouth.

- application of filling material, shaping, curing with an intense light source. Deeper fillings built up in layers.

- checking of bite and minor grinding away of filling material if needed.

The two most critical parts are the etching and drying. If this is skimped or not done properly, the material may well detach.

Any but the most simple of fillings should take the best part of an hour or even more if done properly.

I don't really believe that there's a conspiracy, or ageist policy as there is in the NHS.

It becomes a simple commercial transaction. You buy a service. They do it. Properly. If they don't, then they fix it FOC. If you are not happy, go elsewhere.

[Sylvain VAN DER WALDE]

Interesting! But I will try to get it confirmed.

I hope not. His assistant was supposed to be taking care of that. Mind you, they were having a discussion, and I think that he was taking more notice of her than myself.

He will. I have another appointment tomorrow. This never was a concern of mine.

Sylvain.

[Sylvain VAN DER WALDE]

Easier said than done. A matter of discretion, probably.

Again, easier said than done. I'm reluctant to make quick (snap) decisions. I prefer to take my time, as I did before writing the first message.

I believe that most of them are dishonest. I couldn't even get decent treatment on the NHS.

It's in the subject line. What else?

I expected helpful comments, not pathetic ones. So you think that you're clever. Believe me, you're not.

Sylvain.

[Andy Hall]

Derek's right on that point. However, it would be very difficult to prove that the preparation had not been done properly unless you went to another dentist, had the fallen out piece of filling lab testted and all the rest of it.

The two realistic options are to ask the same dentist to repeat the work or to obtain a refund and go elsewhere.

If the payment was by credit card and the amount over £100, you could also bring the card company into the equation to help force the issue if it were necessary. However, under those circumstances, I think that I would be thinking refund and not repeat treatment.

Was she prettier? :-)

Even so, there is no excuse not to concentrate and do the job properly.

[Sylvain VAN DER WALDE]

I don't think that the preparation itself took long (he did very little). The curing of the synthetic filling took the most time. He didn't even bother to finish the exterior of the filling properly (he left a ridge). Cost = £70.00.

You're the second poster who's stated this. If true, I will need to bear this in mind, when I see him tomorrow.

Very interesting and illuminating. I can't be sure of what he did or didn't do exactly that first time. The second appointment is for 30 minutes. The cavity (part of the tooth broke) is on the side of the tooth, underneath a gold inlay. A similar filling was done by his associate some time ago, and it's still intact. That dentist made a very good impression on me. I have good perception and can usually tell if people have applied themselves or not.

I'd very much like to believe that.

They frequently don't. That's the problem.

They will.

I have, several times. I'm tired of doing so. If things don't go well a second time, I will make a formal complaint. I already have the required phone number and website.

Thanks for your useful comments.

Sylvain.

>

[Andy Hall]

It shouldn't be. He should explain every step of the treatment if you ask. You don't need to feel shy about it - you are the customer after all.

This would be a little surprising - i.e. if there were a geographical factor wherein all dentists in a give area were dishonest. I've never had problems at all, and neither has anyone I know. had you though about going a bit further a field? I go about ten miles to see mine, but that's because I've had the same one and his carefully chosen successor for a number of years and it's worth it not to change.

You would wait a long time for that. Proper dental treatment isn't available on the NHS because in most areas, dentists would make a loss providing it. Frankly, I think it's better that way.

I agree that that was a little unfair. Even with the best personal commitment to oral hygiene, the reality is that some people have better mouth chemistry, teeth and gums than others for a whole variety of reasons.

[Andy Hall]

There's no excuse for that. It's the work of a few minutes to check bite with a piece of special paper that you bite on and which marks the high spots - bit of work with the Dremel and that's it.

£70 doesn't seem very high, although may depend on where you are. IIRC I paid nearly £100 last time, but it does vary based on difficulty and time taken.

You could just ask him what the procedure should be as he does the work. No need to be awkward about it - just ask for information because you're interested. One obvious question is why did the material come out this time.

This should not be difficult.

I have a restored section to one lower incisor (tooth 1 in dentist-speak), which is literally on the side of the tooth. If you think about that one, there is no real way to mechanically support it to any degree. The first time this was done was about 25 years ago and it lasted about 5 years before breaking away. The early non-mercury fillings were OK but didn't last. There were then substantial improvements which have continued over the years. Anyway, the current one has been there for 20 years, no trouble at all.

Well, put it this way.... you won't find better treatment by going for NHS dentistry. It's not possible for the required time to be taken to do a decent job.

I think that that would be my next action. Once is reasonable. Twice no.

If there is a risk that a treatment is going to be marginal and could fail, the dentist should tell you ahead of time.

[Andrew Gabriel]

If we're referring to the quartz/resin filling material then I can confirm that too. I had a long chat with my dentist about it when the material first came out. There are (or at least were) other white cosmetic filling materials which can be used in areas where large forces are not an issue, such as in small areas of front teeth. I don't know the properties of those.

The boundary between the resin and real tooth is more vulnerable to attack than the boundary between a mercury amalgam filling and tooth (which is perhaps not what you'd expect given the former is bonded and the latter isn't), but that should not be an issue for some time even if you didn't care well for your teeth.

[mike]

Nothing in your posting supports that accusation. What have you told us? That you "believe" most dentists are dishonest. That you like his partner. That you continue to patronise bad dentists. How does that make them ageist?

Ask more questions and don't keep going to dentists who are no good... sounds like pretty good advice.

We can all see what your judgement is like.

[Bob Eager]

Yes....it can't even 'judge' the correct newsgroup for posting!

[Derek Geldard]

That happens frequently !

We had an office secretary who had originally trained as a dental assistant from school. The work was stultifyingly boring, cleaning the surfaces in the surgery and autoclaving instruments.

They actually told them at college their only chance of having a decent standard of living was to get off with the dentist.

I've been away, how did it turn out ? I hope it got sorted for you.

If you are still concerned or just curious FWIW you could make a similar posting to sci.med.dentistry. A fascinating newsgroup, loads of real dentists post on there, many from the US, but that's not significant.

All very approachable / helpful

Did the dentist perform the operation using a rubber dam to seperate the prep in the tooth from the tounge, saliva etc, it's a thin 4" square of rubber (Like toy ballon rubber) stretched across a wire frame, with the tooth in question poking through a hole) ?

If so it's a good sign.

In 50 years of quite extensive NHS treatment I never encountered one once. Since I went private 10 years ago the dentist has used one every significant treatment episode.

DG

[Sylvain VAN DER WALDE]

I swallowed the filling.

He is going to repeat the work. But I feel that this simple job should have been done properly the first time.

It's a matter of principle, more than anything else. I'm fed up moving from one dentist to another. There's too much dishonesty and lack of integrity.

She had her mask on all the time. I could only see her brown eyes. :)

Sylvain.