Wanted: An honest dentist

Three exams in 13 months bring startlingly different results. What's up with that?

By doubleace May 3, 2011 11:43AM

This post comes from Lynn Mucken at MSN Money.

 

My dental problems began about 10 years ago. Not problems with my teeth or gums; problems with my dentists.

 

I had strolled into the office for my semiannual cleaning and checkup. The receptionist, in that cheery receptionist way, greeted me with, "Doctor has a new associate. Do you mind if she does your checkup?"

 

The associate took the usual five-minute look, then asked, "Would it surprise you to find out you have three cavities? One of them will require a root canal."

 

Yes, it would surprise me. 

 

I had not had a cavity in the 20 years I had been coming to that office. It was nothing but scraping, buffing and every few years a replacement of a deteriorating filling.

 

She waved an X-ray in front of me and pointed at a dark spot. "We shouldn't wait on this."

 

I told her I had to check my schedule before making an appointment. Three weeks later I was sitting in the chair of my wife's dentist. "There's a couple fillings we need to watch," he said as way of diagnosis. And cavities? "Nah. You're not a cavity kind of guy."

Fast-forward a few years. I had moved to San Diego and been going to a dentist recommended by a co-worker of my wife. No cavities in 18 months and three visits with him either, although he seemed distressed by the grayness of my teeth. (Apparently I am the only person in this town without whitened teeth.) However, I then turned 65, and he didn't accept my Medicare supplement.

 

I walked a couple of hundred yards up the street to another dentist, went through the usual routine and waited for the news. "We have some crown problems here," she said before waving an X-ray at me and walking away. I was ushered into another office, where a pleasant young woman explained the spreadsheet she slapped in front of me.

 

It was like choosing a car wash. The deluxe version would require a "core bldup amal/plas" and a "cerec-blue blck post" on teeth 5 and 13. Only $1,696 after insurance. Also offered were cheaper treatments on the same teeth: "lava posts" instead for $792.50, "bio 2000 posts" for $537.50 and "PFG posts" for just $336.50. I told her I would think about it.

 

Off I went to another dentist. Here they said I had to have a root canal and crown on No. 31 and a "perio scale and root pin and anti-microbial irrigation" on No. 32. All for just $3,050 out of my pocket. Post continues after video.

I said I would think about it, but I must have looked a little dubious, because they immediately asked me to sign a form verifying that I had "refused treatment."

What now? I have seen three dentists in the past 13 months. One said everything was fine, the next one diagnosed problems on upper teeth on both sides, and the third found problems only on the back two teeth on the bottom right. What would another opinion do besides add to my confusion?

 

Are these dentists -- and which ones -- incompetent? Are they crooks? Was all this just differences of opinion among professionals?

 

I've done most of what advice sites recommend in picking a dentist:

  • Word of mouth. It worked once for me, so maybe I go back to that dentist and negotiate prices.
  • Check state records. I did. None of my dentists in California had had complaints filed against them.
  • Look at patient review sites. Did that on the last two dentists. For the first, there were 34 reviews on Yelp.com, about evenly split between positive and negative, with almost half of the negatives focusing on customer service. For the last dentist, there were five reviews, with the four negatives dealing entirely with the office help. Given that review sites on pretty much everything from apartments to mechanics run 80% negative, these results didn't cause any red lights to go on.

I thought about filing complaints with the state dental board (see list for all states), but I figure that it would be almost impossible to get sanctions imposed over a diagnosis.

 

Maybe I'll just keep looking, while remembering the words of Jay W. Friedman, a highly honored retired dental surgeon who has campaigned against needless root canals and unnecessary removal of wisdom teeth. He wrote the "Complete Guide to Dental Health: How to Maintain Your Dental Health and Avoid Being Overcharged and Overtreated."

 

"The average dentist is well intentioned and capable of providing adequate dental care," Friedman wrote. "By training and the imperatives of marketplace economics, however, the dentist is more than likely to provide too much care."

 

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81Comments
May 3, 2011 6:41PM
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Well obviously the latter two took marketing classes.  Many dental offices are now just like car dealerships and electronic stores.  Up sell up sell.  It seems to be about the dollar.  Dentistry has gone from keeping teeth just healthy to pushing things you may need.  Or selling procedures that aren't 100% necessary but may enhance the life of a tooth or your smile.

Believe me I know I am an old fashioned dentist.  If it isn't broke why mess with it is my motto. that's probably why I will never be uber wealthy.

Jun 2, 2011 9:39AM
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I myself am a dentist and somewhat agree with parts of this article, but disagree with others.  It tries to make dentists look like were all crooks just out for money,  but there are a few of us that don't make that the focus of our practice.  I also have had patients come to me for a 2nd opinion when they were told by other dentists that they need extensive work.  Many times, the 1st diagnosis was correct,  a few times, they are not.  I did have one patient the other day that came in after seeing one of the big national dental chains that offered free exam and x-rays.  She was told she needed 4 quadrants of deep cleaning and 9 fillings.  Her guns were in perfect shape, and I found no cavities.  Believe me when I say I was just as frustrated as she was.  I feel it gives all dentists a bad name when this happens.  I can honestly say that I have never once reccomended one procedure over another simply because one costs more.  I try to explain all options, the +and-'s and costs of each, and let the patient decide.

I think the thing that frustrates me most is how many patients don't care about their mouth, and think that they don't play a part in keeping their teeth healthy.  They feel it is fully the dentists job to take care of their teeth.  I often hear patients come in complaining of how terrible the last dentist they saw was because he did several fillings, and now they are all falling out.  I then find out that they drink about 10 mountain dews a day and brush about 1 time a week.  Many times I will refuse to work on them unless they commit to change their habits.  If I don't proceed that way, I become the "terrible dentist" to everyone they talk to.  I find it insane when a person will drop $20,000 for a boat that they may use 10 times a year, but refuse to spend $2,000 or $3,000 for needed dental work, for something they use several times a day and plays a part in their overall health.

As for advice in finding a good dentist, just remember the fancier the office is, or the more "spa" features they offer,   the money for the mortgage or rent payment has to come from somewhere.  Many of the big national chains I have seen are run as a big corporation, and profits are usually stressed. 

If I were looking for a dentist,  I would seek one out that has a nice, but modest office.  Look at what type of car he drives,  (Porsche or Chevy).  Ask questions about why treatment is needed.  If you get a funny feeling that you are getting taken, look elsewhere.



Jun 2, 2011 7:35AM
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I worked for dentists for years, and I have seen some really great ones and I have seen some REALLY BAD ones.  I have seen the really bad ones go to great lengths to make sure that Joe Public does not realize how bad they are.  Be VERY VERY Careful!  A good dentist will have a LONG STANDING STAFF that he is NOT related to, if you are seeing different or very young people every time you go in for a check up be afraid!  A good dentist will be conservative, they will catch that cavity LONG before it needs to become a root canal (IN MOST CASES, there are those exceptions but they are few and far between) if you are coming in for your 6 month check ups as you should be.  A good dentist will be happy to answer your questions and not make you feel like you are questioning their abilities, AND they will answer your questions themselves, not send a smiling young girl in to answer them for them.  A good dentist will NOT have his patient stacked on top of each other, each patient will have their appointed time and they will not feel like the dentist is rushed, if you are sitting in a packed waiting room for long past your appointment time and their is only one dentist in, get up and tell them you will reschedule!  and DO NOT let them stall you from leaving with "OH Mr. Smith so sorry we can put you in a room right now (do you really want someone who is feeling the pressure of a packed waiting room and all the operatories filled working in your mouth?)  And another word of caution,  scaling and root plaining is the dentist money maker!  any dentist that suggests that a 24 year old who has been seeing a dentist regularly needs this service you should be afraid of, I am not saying this never happens, but...this doesn't happen often.  And lastly, if you are getting information that surprises you PLEASE PLEASE go get a second opinion!  I know your insurance does not cover another exam in such a short time, BUT you only get one set of adult teeth and when they are gone...well...THEY ARE GONE!
Jun 2, 2011 8:15AM
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Thank you for the article.  I'd seen the same dentist for 20 years and always had healthy teeth.  Then my dentist opened a new clinic and started telling me I had cavities and needed expensive work.  I gave him the benefit of the doubt at first, but when, for the 3rd time, he told me I needed another round of expensive work, I couldn't take him seriously.  Most tellingly, the assistant who cleaned & scraped my teeth said they looked great and I had no problems; then the dentist came in, looked in my mouth for a few seconds & said I had cavities, and the dental assistant looked really surprised but kept her mouth shut.  This happened ALL 3 TIMES.  And during my 2nd round of work, the dentist apparently couldn't see any cavities and was starting to work on a tooth on the wrong side of my mouth.  I told him he was doing the wrong side, and he had to look at his chart to figure out which teeth he'd diagnosed as having cavities.  So on this 3rd visit, the dentist rushed me into making an appointment for more expensive work, but when I got out of the office I called back and cancelled it.  Next time I talked to my mom, she told me a similar story about the same dentist: he'd suddenly been telling her that her teeth were bad, and recently ordered several thousand dollars in painful dental work.  She went to get a second opinion and guess what?  Two other dentists told her that her teeth were fine, and were surprised that someone had ordered such extensive work.  I called the dental clinic and said I would no longer be a patient there.  I didn't see any dentists for a few years, then found another one and have had no problems, never needed anything but a standard cleaning.  My mom's teeth are great too.  I'm still upset that someone I'd known since childhood took a drill to my perfectly healthy teeth.
Jun 2, 2011 7:37AM
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All of you dishonest dentists who over charge, misdiagnose, "invent" problems in the patients months that don't exist, or take advantage of the patients in any way, you ALL will be punished eventually, and lose tenfold of what you've gained. And, this is called Karma.
Jun 2, 2011 3:58AM
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I hate to say it, but American dentistry has some problems. I had a good friend who was a dentist in the US. She told me horror stories of the up-selling that was forced on the dentists, and she kept losing positions or for whatever reason moved from clinic to clinic. She told me that chains were buying up clinics and they were in it for the money only and making dentists do unnecessary work on patients for the money.

I finally went to her because I had a terrible toothache. She sent me to a  dental surgeon for a root canal and then she did a crown. She told me my other crown needed to come off and be replaced because they only last 5 years. Well, thankfully she wasn't able to remove the old crown - the new one she put on only lasted a year and a half. It broke and I had to go to a dentist in a foreign country where I'm now living. He told me the first crown, a porcelain one, is in good shape and shouldn't have to be changed. the one she put on is made out of acrylic and isn't good for anything but temporary use. So not only did my "friend" do shoddy work on her supposedly good friend, but either she lied to upsell or she doesn't know her dentistry very well. My new dentist, an American but trained in another country, did a good job replacing the crown with a permanent porcelain one, did a small filling and a cleaning for less money than in America. So I wonder what happened to the quality of medical care in the USA.

Jun 2, 2011 9:36AM
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I could not agree more. I spent ten years looking for an honest dentist. Fortunately I finally found one. Prior to that, the story was always the same. I would go to a new dentist for a checkup and cleaning. I would be told that I had a problem with tooth "17". Told them I would check my schedule and call for an appointment, never did. Six months later I go to a different dentist for a checkup and cleaning. This time tooth 17 is fine, but 5 and 6 need work. Next time, different dentist, different story again.


My conclusion is that either most dentists are dishonest, or my teeth have an amazing ability to repair themselves.

Jun 2, 2011 7:20AM
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I live in So. Florida and have been going to the same dentist for 20 years. He happens to be extremely good and honest about any work I've had done, although he's expensive. So, about 6 months ago I went to someone else only for a cleaning, check-up and x-rays because he advertised all that for $39.00. My dentist charges $130.00, so I figured why not? Well, they did everything they said, but then the dentist came in and told me I needed about $1,300 worth of gum work. I've never had problems with my gums so I went to my regular dentist who looked at the x-rays, examined my mouth and told me that that was a total crock of you know what! I guess because this other dentist only charged $39 he had to make up for that cheap price by conning me into thinking I had infections in my mouth. I've always taken good care of my teeth, so this was extremely disconcerting. Needless to say, I will be sticking with my "old" tried and true dentist! I guess it's "patient beware" no matter what part of the country you reside.
Jun 2, 2011 11:33AM
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I am a Bachelor of Science hygienist with 31 years of experience, most coming from excellent dental practices.  The scope of treatment that is available is anywhere from, "nothing hurts so that means nothing is wrong" to "your whole mouth needs reconstructing". 

I have seen patients who have had "dental cleanings" every 6 months, have no pain, and are told they are ok when they actually have severe cases of periodontal "gum" disease.  I have seen patients who have been told they have several cavities or need major restorative work who in my and my doctor's opinion don't.

For a consumer to be happy, the answer lies in finding a dentist whose practice reflects his or her perceived needs.  For example, there are those who want "if it ain't broke, don't fix it".  These folks usually have amalgam "silver" fillings that are greater than the amount of tooth structure that remains.  I have seen them have an abcess that is deteriorating the bone as it becomes larger, but because it doesn't hurt and they are not swollen, they refuse to address it.

On the other side of the spectrum, I have seen a patient who is told they need 8 crowns, when actually the teeth are still quite strong and have good function or a no-previous filling adult patient with prominent fissures on the surfaces of their molars and no breakthrough decay evidence on x-ray told they need teeth filled.

Somewhere out there is a dentist who will give you what you want, however, each dentist sets the guidelines of his own practice based on his or her long term expectations.  Those expectations can be all "financial", all "let me tell you what you want to hear and make you like me", but hopefully they are "giving you an honest assessment of your dental health and if there are problems or needs, exploring options to take care of them.  I am preventive and want my teeth and gums to be healthy and to look nice (even the ones you can't see) so I want a practice that addresses my concerns, so I would not be happy with Dr. "no hurt, no problem", nor would I be happy with Dr. "let's meet our financial goal, today".

Hopefully, by speaking with the practice's appointment scheduler, you would feel comfortable scheduling a "New Patient Exam" and can obtain this information,

 

Just a few comments on cost of dental care:

It is impossible to give prices over the phone.  Your individual situation may be very complex where someone else may have a simple fix (example: a simple vs surgical extraction).

Medical insurance and dental insurance are very different.  Medical insurance can cover many thousands of dollars of treatment.  Dental insurance usually only provides a benefit of  maybe$1000 to $2000 per year, with many exclusions about which the consumer is not educated.  These benefits are the same as they were when I started practicing 31 years ago, so they cover very little if you have major dental problems.

I also compare my medical itemized statements to dental ones.  In medical offices I have been charged for "sterile tray set up", "vein puncture", "extended office visit" where a "3-surface amalgam" charge includes the injection for anesthesia, preparation of the tooth to remove the decay, applying a base to protect the nerve, and placing the actual filling, all done from a sterile set up with no office visit charge.  Because medical insurance covers most of a physician's procedure, people don't get upset.  If you only want the dentistry that your dental covers, you will not get very much dental work from any office.  Dental insurance does not perform based on your needs,  t only performs based on what plan your employer purchased.

Jun 2, 2011 9:58AM
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My mother's dentist insisted that she had to have $34k worth of dental work performed asap.  She was 89 and dying from cancer,  with less than 2 years to live and he knew that.
I brought that fact up to him and he said "all the reason to hurry more".
I asked her doctor about it.  He said doing that kind of major work while the chemo was in process and her condition was fragile was just plain stupid and dangerous.  And anyway, the teeth weren't hurting or causing trouble.  They lasted the two years with no trouble.
Just for fun I asked the dentist how long the work would take.  He "estimated"  about 10 hours altogether,  over a period of 3 weeks.
This kind of greedy,  unprofessional activity certainly taints the whole business.


Jun 2, 2011 9:16AM
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We are on our third dentist here in Naples Florida.

The last one we parted company with was an office of the "Towncare Dental" corporation.

Towncare has bought up quite a number of offices here in FL and they run it like a corporation, as opposed to a healthcare provider.

Maximizing profits is put above patient care and they hire young dentists fresh out of school (willing to accept beginning pay I imagine) and obviously school them in how to get the most money out of each patient.

We finally found a dentist that puts patient welfare ahead of profits and have had to fight tooth and nail with the previous dentists to be refunded overcharges that both put on our bill.

Jun 2, 2011 9:29AM
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Finally, someone is writing about this problem! My super awesome dentist retired and sold his practice. The new dentist advised me of thousands!!! of work that I needed today that I did not 6 months ago????!!!! And a root canal!!! So I went for a second opinion and guess what"? No root canal required! Now I have accidently lost a lower incisor and it is over $3000 for one bridge! Honest to god, over 3000 bucks for one lousy tooth to be bridged! It is highway robbery and I think from on now my vacations will include a dental visit in a foreign country.
Jun 2, 2011 5:46AM
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One of my first jobs was for an orthodontist in high school.  Years later one of my university jobs was at The University of Michigan School of Dentistry.  From my first orthodontist who was on the state licensing board, he said that after the 8 years of school before specialty, they need to go in with someone before setting up a new practice because it is so expensive starting out.  Our town was good at referring new in town patients to the new dentists to help them get started.  Dentistry used to be cheap before dental insurance came to be and before the prices of gold and silver went up.  The bands that we put on the kids's teeth in our office was white gold.  I cannot imagine what the cost would be now if they used the same things.  When I worked for the u, I just didn't see the doctors out to gouge anyone, nor growing up either.  My dentist was my godfather.  When his son began practice we were switched to him except for my brother who had a more complicated mouth.  I don't like going to the dentist because I can't keep up with the cost of dentistry.  I went the other day because delay causes fractures and breaks, and I had a choice, removal or if I wanted to save it root canal.  At the price of gold I'll opt for a partial once all is addressed rather than canal and crown.  The cost was $211.  -too bad they don't discount cash customers.  I've seen the comments that someone went to 50 dentists before getting the extractions desired.  It is because you really never get away from dentistry.  As the mouth changes, you'll need adjustments, or more dentures.  The risk of fractures (jaw) are greater as those bones thin.  And believe it or not, most dentists are not out to rob you blind.  The cost of dentistry has just gotten expensive-rent, utilities, equipment, supplies, dentist, hygienist, insurance billers, their liability insurance.  You try to run a business -if you are not a dentist chain and see what your prices are 4 years of college, 4 years of dental school and if a specialist 2-4 years of specialty school.  (Same for physicians, same for PharmD pharmacists).  I do not understand how someone can feel that someone as educated as these individuals tend to be do not realize that some things cost money. 

 

Another thing to consider in the differentiation in your type of care.  There tends to be the question which is somehow worded like this,"Are you happy with your teeth (smile)?"  Prices may vary in the response to that, it might be that one person wants the glam mouth, another wants nothing done except what is absolutely the bare essential. (no whitening,try to fill, rather than canal and see if it works and so on).

Jun 2, 2011 6:26AM
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    Wow I've had some really bad Dentists but nothing like some of you. I will say however while living in North Fl I was lucky enough to come across one Dentist who is amazing. He has a way of numbing where you hardly feel a thing and once he starts the work he asks about every 3 min or so how you're doing. We worked out a great hand signal where I would just give him a thumbs up if I'm good or make a sign with my fingers to show a little discomfort or if I'm feeling pain. He had no problem stopping to numb me some more if I needed it. He also didn't mind if I wore earbuds and my Ipod to block out the drill sounds. I did have a tooth that was broken due to some shoddy work by another Dentist. He had to do a mini root canal put in a post and a crown. I won't say it was fun but he was so gentle and put me at ease that it was a good of an experience as it could have been. He did it in 2 visits and after the first I had a temp crown I must have pushed it with my tongue or something because the next day it seemed to be out of line a little, you couldn't tell by looking but I could feel it. I called them that morning and they fit me right I showed up and they pulled the temp off cleaned it up and put back in place. I was in and out in less than 30 min and of course there was no charge. 
   We moved from Fl. at the beginning of the year and you would think that I would be sad to leave the sun and surf but, no the worst part leaving my Dentist. I don't work for his office and never have, He is not a friend, and I have nothing to gain by saying these things. It's just that he is an amazing Dentist and deserves to be known as one. 
  Thanks Dr. Clark 
Jun 2, 2011 8:40AM
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in 1987 I had all of my teeth removed, and following that, I returned to the same dentist , ONLY to be ushered into an office, where some lady I had never seen, set up her tools on a tray and sat down to clean my TEETH! I smiled and she still did not get it!

I said EXCUSE me you are going to CLEAN what? My teeth are no longer in my mouth...she was really embarrased and left.

I have had my teeth completely destroyed by dentists and assistants. Since I was 9, they put in braces and partials, following the removal of my teeth at the ripe old age of 6! I had dentures for a LONG time and they just butchered my mouth over the years. I found one decent dentist that made the plates that I still have today. My wife had 3 sets made and they were terrible!

It's sad that some are so interested in their wallets only .not your health!

Jun 2, 2011 7:31AM
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OMG  thank you for this article. I've been to at least 6 (maybe more) dentists from hell in Jupiter, Florida, and i'm hoping they  read this article.  I went to a dentist to replace a very small filling in my tooth. he said that i needed a crown at a cost of $1,500. the pain from the procedure didn't go away for several days.  i went back to see him, he said i needed a root canal on the same tooth and it would cost me another $3,500. I told him to just pull the tooth and he wouldn't charge me but would refund my money. However, the receptionist was unwilling to give me the money. i just stood there and waited to let them know i meant business. they are bottom feeders, scum bags, etc etc.

 

There's nothing we can do about this. It's like they know they can get away with it.  And if we keep going from dentist to dentist we still have to go through the same procedure of having x-rays, it's very unhealthy.

Jun 2, 2011 9:54AM
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This article is so "spot on". It's a racket!
Jun 2, 2011 11:03AM
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I am rather amused at the attempt to make a dental office appear somewhat shady by saying, "..they immediately asked me to sign a form saying I refused treatment."  That is standard procedure bud.  As required by law, this is a liability there must be documentation of a dental professional letting you know what the situation is and what can be done to treat it.  Much of this can be attributed to the fact we live in a world where people enjoy suing eachother.

Jun 2, 2011 3:25AM
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Thank you for writing this article. I completely agree with your findings and am hesitant to see a dentist for the same reasons. It's really a shame.
Jun 2, 2011 4:52AM
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My experience with dentists?... As an adult when I was around 25 everything was fine for two decades. I became friends with a dentist in my community in So. Cal. He was then very much your small town professional. But that soon ended when a professional office manager paid him a visit and showed how stupid he was running his office and how she could make him a whole bunch more money. His small town mannerisms soon gave way to money money money and a whole new attitude. I'm guessing his office was a lot more "professionally" run but he lost a lot of his customers because of this new chick running things. When I moved away from there I had to hunt down a new dentist for the family. I settled on one who seemed to be family oriented. But after a year or so things changed with him. Being treated for simple fillings I noticed that he seemed pretty aggressive with the drill. I could smell my teeth overheating as he worked away. Oh sure he "filled" these teeth but months later I was to learn that these same teeth now were now apparently fractured and needed to be crowned. Gee... did his aggressive behavior with the drill have anything to do with those teeth overheating and causing them to fracture? How would I go about proving that? All I know is that this guy did more crowns than anybody I'd ever known. Dentists no. #2. I dropped that last guy like a hot potato while I still had most of my natural teeth. But no. 3 wasn't any better. Last job he did for me was fixing the mess no. 2 left behind. But this guy was just as bad. He did a root canal and cap in one visit!!!!!!!!!. He was scheduled to work only that Friday of that week. Guess he golfed the rest of the time. Seems he found a little infection once he drilled out the root. No problem... just apply a little bleach for say?... ten minutes. Don't have more time so we gotta get this temp on. Away he went and he was finished in record time. Well... sort of. Two days later I was in such pain that his partner had to prescribe an emergency prescription for pain and infection. Seems he wasn't supposed to try and do all of that work in less than two visits. I was on pain killers for the next two months and anti bacterials trying to kill the infection w/o doing a major surgery. I had severe diarrhea for those two months and felt like crap. And.... it turned out he didn't get all the roots because he didn't use a 3d x-ray machine that could detect them all.. I now still have extreme sensitivity to cold and heat and learned that in order to fix his screwup I have to go back and have that major surgery done w/o exception. MO' money. I have yet to have this work done because... who can I trust? Of course dentists aren't the only one's affected by greed. I'm a plumbing professional and I see it all the time with my trade too. People being told horror stories if they don't do this or that and that it will turn into an even worse situation if they don't act immediately. Sad... pretty sad the world is coming to this. If you happen across a true professional with any trade keep him or her. They ARE gold. Like the saying goes... Buyer beware. Good luck.
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