Who's responsible, myself or dentist??

Rowe

Hi folks, looking for some advice / views. I attended one of the surgeries of a well known dental chain a little over a year ago to have an old filling replaced with a white composite filling for purely aesthetic reasons.

The filling was already quite deep but had not caused me a moments pain in the 15 years that I had it. Once replaced, I had to return to the same dentist on 5 occasions over a period of 8 weeks as I was in a lot of pain with the tooth. The tooth was now very sensitive, if air reached the tooth, I was in pain, I couldn't chew anything on that side of my mouth and I should say that the tooth is a molar so essential for chewing. After 5 visits to the dentist, the condition improved somewhat but was never the same as it had been previously and I always had to be conscious of the types of food I chewed on that side of my mouth.

Over a year later I developed severe pain in this tooth and had to attend an emergency dentist a number of weeks back during the Christmas period. An Xray showed that my tooth was infected and I was prescribed two courses of antibiotics. I thought these had worked but the pain returned last week along with swelling in my jaw and cheek, so I assumed the infection was back.

In my opinion, bacteria had the opportunity to access the already vulnerable tooth when the original filling was not completed correctly and was left open to infection over the course of a number of weeks. As a result I contacted that specific dental surgery and briefed them on the position and requested that they examine me as I felt I would not be in this position had the original work been completed correctly.

Following examination very recently, I was told that I would need root canal treatment and would have to cover the cost of this but that the surgery would cover the cost of the filling that would go into the tooth after the root canal was completed. I agreed with this verbally but now feel that I've sold myself short and that I would be within my rights to request they cover a larger portion of the work if not all of it. This is due to happen in the next few days.

Does anybody have any advice on whether or not I should request they cover a larger portion of the root canal treatment or has anybody gone through a similar situation at all?

All (sensible) views welcome :-)

Thanks.

ballsymchugh

Rowe wrote: »

In my opinion, bacteria had the opportunity to access the already vulnerable tooth when the original filling was not completed correctly and was left open to infection over the course of a number of weeks. As a result I contacted that specific dental surgery and briefed them on the position and requested that they examine me as I felt I would not be in this position had the original work been completed correctly.

the tooth became vulnerable over 15 years ago which is why you needed the original filling. that's the bacteria at work there.

davo10

Rowe wrote: »

Hi folks, looking for some advice / views. I attended one of the surgeries of a well known dental chain a little over a year ago to have an old filling replaced with a white composite filling for purely aesthetic reasons.
The filling was already quite deep but had not caused me a moments pain in the 15 years that I had it. .

Who is responsible for a deep though symptomless, functioning filling being replaced with a deeper filling which is closer to the nerve?

Dianthus

There is an inherent risk to the nerve in replacing a deep filling. Even an extra 0.25mm could make all the difference between the tooth being fine and the tooth giving problems.
It's a very common conversation in dental surgeries, I would say 99% of dentists would never, themselves, actively recommend replacing an asymptomatic deep filling solely for cosmetic reasons for this very reason.
Symptoms invariably arise, then there's hassle, there's bad will, there's further treatment (root canal& crown, or extraction& then gap/ bridge/implant/denture) - basically the whole thing just snowballs into one big ongoing nightmare.
So no, it's not something dentists would market or sell to an unsuspecting patient.
*However*, if the patient themselves solicits the dentists' services, is aware the filling is deep, & prepared to take the risk anyway, the onus is on them.
Long story short, if there's a filling that's deep but not especially pretty, best leave well enough alone...don't disturb the beast!

bureau2009

Dianthus wrote: »

It's a very common conversation in dental surgeries, I would say 99% of dentists would never, themselves, actively recommend replacing an asymptomatic deep filling solely for cosmetic reasons for this very reason.

But I wonder what advice, guidance, information and recommendation the original poster received from their dentist?

And is it possible this dentist belonged to the 1% of dentists who WOULD go along with replacing a deep filling?

davo10

bureau2009 wrote: »

But I wonder what advice, guidance, information and recommendation the original poster received from their dentist?

And is it possible this dentist belonged to the 1% of dentists who WOULD go along with replacing a deep filling?

There is a distinction between a dentist actively recommending replacement of a deep filling for aesthetic reasons and going along with a patient's request to do so.

The 1% you refer to relatives to the first grouping, the second part of your quote refers to all dentists, if a patient requests a particular course of treatment and there is a benefit to it, in this case aesthetic improvement, then the dentist would have no reason to deny the patient that treatment unless he/she was certain it was to the patient's detriment.
In this case the dentist could not have been certain that a root canal would be necessary in the future any more than he could be certain that the same result would/would not occur if the original filling was left untouched.

Rowe

Hi, thanks for all of the replies.

In response to some of the points made, I can say for certain that the dentist did not warn me of the dangers of replacing the initial filling. It was only after I returned to her the second time, did she mention that sometimes these things could take some time to settle and after the fifth visit mentioned root canal treatment may be needed if things did not settle down. As I mentioned previously, the tooth setted a little and was not as sore and sensitive as it had been previously.

** However**, I couldn't use it to the same extent as I had previouly and in my opinion, the tooth was greatly exposed during the eight weeks from the time of the replacement filling until my fifth visit (because the work was not done correctly to begin with), and it was during this period that the bacteria had the opportunity to take root and create the situation where I am today with root canal treatment needed and the huge cost of this being shouldered by myself.

It is on this basis that I feel the dental surgery should cover a larger portion of the cost for the root canal treatment.

davo10

OP on what do you base your opinion that the work was not done correctly and that there was increased bacterial invasion during this 8 week period? What do you mean by "greatly exposed"?, did the filling fall out?

White fillings are bonded to the inner surface of the tooth, amalgam on the other had has no adhesive properties whatsoever.

Dianthus

There seems to be some confusion as to the source of the current infection. Bacteria arise by default when a nerve dies...because it is dead tissue.
Which leads to the question- why does a nerve die? In the main, due to either decay or trauma(accidental or iatrogenic).
So the initial insult to the nerve was the extensive decay. A further insult to the nerve was in replacing a deep (but functionally perfect) filling solely for cosmetic reasons.
I don't know what conversation was had when you requested the treatment.
It's hard to argue that you felt the work was substandard, yet returned to the same practitioner for a further 5 visits.
However, there may be other mitigating factors at play.
Write to the practice outlining your concerns& request, then take it from there.

ballsymchugh

it's important to remember that the pain the OP complains about occurred a YEAR after the initial sensitivity was dealt with. unless the dentist concerned was closely monitoring everything he/she ate and drank while overseeing his/her oral hygiene daily, then responsibility is with the patient.

Rowe

Hi Folks, no the severe pain occurred a year after the filling was replaced, however, I was in pain for weeks after the filling was replaced over a year ago.

As I previously mentioned, I feel the tooth was greatly exposed after the filling was replaced because no. 1 I never had any issue with the tooth or previous filling before this was done and no. 2, the tooth was sore and highly sensitive for weeks after the filling was replaced, it was painful when breathing, I couldn't even chew gum on that side of my mouth for weeks after - hence the reason that I reached the conclusion that the filling was not completed properly in the first place.

I returned to the same dentist 4 times after the intial visit because I felt they hadn't completed the job correctly to begin with, as I assume it isn't normal to be in pain and unable to eat for such an extended period after a filling AND I had paid for the work and certainly couldn't afford to pay for another dentist to "fix" the shabby work of the first guy!

davo10

Rowe wrote: »

Hi Folks, no the severe pain occurred a year after the filling was replaced, however, I was in pain for weeks after the filling was replaced over a year ago.

As I previously mentioned, I feel the tooth was greatly exposed after the filling was replaced because no. 1 I never had any issue with the tooth or previous filling before this was done and no. 2, the tooth was sore and highly sensitive for weeks after the filling was replaced, it was painful when breathing, I couldn't even chew gum on that side of my mouth for weeks after - hence the reason that I reached the conclusion that the filling was not completed properly in the first place.

I returned to the same dentist 4 times after the intial visit because I felt they hadn't completed the job correctly to begin with, as I assume it isn't normal to be in pain and unable to eat for such an extended period after a filling AND I had paid for the work and certainly couldn't afford to pay for another dentist to "fix" the shabby work of the first guy!

Sensitivity and discomfort after a deep filling is not uncommon, many of the readers here who have had deep fillings in the past will have experienced it. In most cases it settles down over time like yours did. It doesn't mean the filling was not done properly, it means you had a deep filling which was close to the pulp chamber where the nerve is located, a filling you requested for cosmetic reasons.

You paid for a white filling, not all future treatment necessary on a heavily filled tooth.

Rowe

Hi davo10, thanks for your feedback. The slight difference in my case, is that the tooth never really did settle down after time, it took 8 weeks for the non stop pain and sensitivity to air, cold, touch etc to stop but I honestly was never able to chew anything hard on that particular side of my mouth afterwards.

Yes I requested that the filling be replaced but I was never warned of the dangers of this and if I had received any of this info prior to having the tooth filling replaced, I simply wouldn't have gone through with the replacement, as it wasn't an essential piece of work that needed to be done.

I'm not a money grabber or somebody that tries to obtain products or services for free but I genuinely feel I wouldn't be in the situation where it's now necessary for me to fork over hundreds of euro to keep this tooth, had I been given the right advice OR had the filling been completed correctly in the first instance and the tooth not left exposed for a period of 8 or so weeks.

davo10

Rowe wrote: »

Hi davo10, thanks for your feedback. The slight difference in my case, is that the tooth never really did settle down after time, it took 8 weeks for the non stop pain and sensitivity to air, cold, touch etc to stop but I honestly was never able to chew anything hard on that particular side of my mouth afterwards.

Yes I requested that the filling be replaced but I was never warned of the dangers of this and if I had received any of this info prior to having the tooth filling replaced, I simply wouldn't have gone through with the replacement, as it wasn't an essential piece of work that needed to be done.

I'm not a money grabber or somebody that tries to obtain products or services for free but I genuinely feel I wouldn't be in the situation where it's now necessary for me to fork over hundreds of euro to keep this tooth, had I been given the right advice OR had the filling been completed correctly in the first instance and the tooth not left exposed for a period of 8 or so weeks.

But again, how do you know the filling was not done correctly and how was it exposed for 8 weeks, did it break or fall out?. By the sounds of things it's just a deep filling close to the nerve, they are sometimes sore afterwards regardless if how well they are done.

You may have a justifiable issue with the dentist for not explaining the possible side effects of the treatment but again it was not the dentist advising you to have treatment, it was you requesting an elective cosmetic treatment.

bureau2009

davo10 wrote: »

You may have a justifiable issue with the dentist for not explaining the possible side effects of the treatment but again it was not the dentist advising you to have treatment, it was you requesting an elective cosmetic treatment.

When a patient - any patient - requests an elective cosmetic treatment what responsibility lies with the dentist to explain the benefits/drawbacks of the treatment?

And isn't this an area where dentists have vastly differing approaches?

I suspect some dentists are amenable to doing crowns, veneers and replacement fillings for cosmetic reasons while other dentists have a much more conservative approach.

davo10

bureau2009 wrote: »

When a patient - any patient - requests an elective cosmetic treatment what responsibility lies with the dentist to explain the benefits/drawbacks of the treatment?

And isn't this an area where dentists have vastly differing approaches?

I suspect some dentists are amenable to doing crowns, veneers and replacement fillings for cosmetic reasons while other dentists have a much more conservative approach.

Great post, this is probably the pertinent question the OP should ask the dentist.

Yes it is vitally important that the dentist discusses the treatment, this is the basis for informed consent. However, dentists use their discretion based on the circumstances, for instance when doing a small filling it is usually unnecessary to inform the patient that the tooth may need a root canal treatment as this is unlikely to happen, when its a deep filling there is a greater chance of nerve necrosis.

Yes different dentists have different approaches based on experience and interests. Some dentists like doing cosmetic work, some do not, some like surgical procedures, some do not etc. Dentists who do a lot of one type of treatment tend to know, through experience the potential complications and advise patients prior to treatment what can happen but hindsight is 20:20 and sometimes when we think there is little chance of a particular problem occurring, thats when it happens.

There is another factor to be taken into account Bureau and that is the patient and the accuracy of their recollection. The OP is adamant that the job was not completed satisfactorily and that the nerve was exposed to bacteria for 8 weeks yet is unable to provide the basis for this opinion other than he had post treatment pain and needs root canal treatment a year later.

This filling could have been done to the highest standards and as he hasn't confirmed it fractured nor fell out, you can deduce that the nerve was not left exposed for 8 weeks. Nothing you can say is going to change his/ her mind and OP is certain that the dentist did not say anything on the day. This would be very unusual, any one who has had a deep filling will tell you that the dentist informed them that it was a deep filling and may be a bit sensitive/sore for a while afterwards. We remember what we want to remember when it suits us.

Having said all that, the OP should go back and discuss this with the dentist, her notes will confirm whether she did or didn't.

btkm8unsl0w5r4

^^^^^ This X 100, great post.

spaceHopper

From very painfull expeinece you were showing signs of an absus right after it was done, it should not have taken 5 visites to sort out or left to fester for so long. The same thing happend to me over the couse of a summer when I was 18.

When you went back with problems did they do an x-ray or check for an absus?

You can't blame the dentist for the deep filling or following infectuion, no filling will last for ever. But if they didn't check for infection then I would 100% blame the dentis for not getiing on top of it straight away.

ballsymchugh

a sensitive tooth is not a sign of an infection

spaceHopper

ballsymchugh wrote: »

a sensitive tooth is not a sign of an infection

A sensitive tooth is not always an infection but from very bitter experience I know that it can be caused by an infection and is most definitely a sign of infection which should be followed up epically if you've just been poking around in the tooth replacing a filling.

When I was 18 I went to a dentist, he was a locum my regular dentist was off sick. I'd a hot cold sensitive tooth, even cold air from cycling a bike would cause pain. He said I'd a filling that needed replacing. He gave me an injection, it didn't take he gave me a second injection and drilled out the filling, when the pain got to bad I'd stop him for a few minutes. He put in a temporary filling for some reason.

Within two days I was chewing aspirin and codeine, I couldn't eat. I went back to him, he said I's a "sensitive nerve / tooth" and put a cream on the tooth. Told me to come back in a few days for the proper filling. That didn't work and I was getting sick for taking to many pain killers.

We'd a neighbour who was a dentist so I went to him at 10 one Saturday morning he looked me over and said my gum was very pink as he believed I'd an abuses. He couldn't treat me as i wasn't his patient but he told me what to say to the other dentist, I'd an appoitment at 10:30 - ask for an x-ray. He didn't believe I'd an abuses but did the x-ray to shut me up. He was wrong, shortly after that I switched dentist! So did my whole family.

ballsymchugh

sensitivity is a pain which lasts for a few seconds and is more or less reversible. what you had doesn't sound like what i would call sensitivity.

spaceHopper

ballsymchugh wrote: »

sensitivity is a pain which lasts for a few seconds and is more or less reversible. what you had doesn't sound like what i would call sensitivity.

Correct it was a full blow absus but I went to the dentist becasue it was hot cold sensitve, even the rush of air caused by cycling a bike made it ache.

After he took out he filling and put in a tempory one it blew up. Look back on what I siad I had two injections that didn't numb me up, why? First sign of absus is it not! I went back in very bad pain, he fobbed me off with a cream on the tooth.

Look back at what happened to the OP he had a filling replaced and after that had problems which the dentist missed the signs of, they went back 5 times!

AKA their fault for not getting on top of it sooner.

There isn't much the OP can do except not go back to them ever again or write to the Medical council, nothing will happen after the first letter but it might be kept of file of more unhappy customers write to them.

ballsymchugh

keep forgetting to unsubscribe!

tooth_doc

bureau2009 wrote: »

When a patient - any patient - requests an elective cosmetic treatment what responsibility lies with the dentist to explain the benefits/drawbacks of the treatment?

And isn't this an area where dentists have vastly differing approaches?

I suspect some dentists are amenable to doing crowns, veneers and replacement fillings for cosmetic reasons while other dentists have a much more conservative approach.

This is very true, not just here but nearly all over the world. However it will depend on the good will of both the dentist and the patient as to how a complication is dealt with

tooth_doc

The clinical notes that the dentist made will show what was said/ discussed or lack of it. But op definitely needs to talk with the dentist