Expert: Mark Bornfeld DDS - 5/26/2007

Question
QUESTION:
Greetings,
First, thank you so much for volunteering your services to this site. People like you maintain our faith in health practitioners.

My question is the following: I recently had a crown placed on an upper molar. The first crown didn't fit, so it was replaced by a second crown. Now my tooth is extremely sensitive to cold, and feels generally strange. I noticed the dentist didn't retract the gum before taking the imprint, so I'm assuming the crown is a bit short, and the cold sensitivity I'm experiencing is due to a gap between the gum and the top of the crown.

I went back to have the sensitivity checked a few days ago. The dentist -- without looking at me -- instructed an assistent to apply some sort of hardening solution to the top of the tooth, right under the gumline. The substance was hardened with what I believe was ultraviolet light (I'm obviously not a dentist), and I was told to return in a week for a second treatment of that kind.

Not only is the tooth still equally sensitive, but the danged dentist charged me 40 dollars for the treatment that didn't work. This is the first time in my rather long life that I've been charged for a crown adjustment, or any other type of prosthesis after care.

Your opinion, please?

thanks so much.



ANSWER: Dear Dr. Olsen,

My opinion, to put it quite bluntly, is that your dentist performed sloppy work, and he's bending over backwards to avoid doing the right thing.

It is evident from your description that your dentist is assuming the sensitivity is the result of exposed tooth structure, hence the attempt at covering the area with light-cured resin. This assumption is just that, and not necessarily accurate-- there are  any of a number of other reasons for sensitivity to cold stimuli-- including improper crown cementation or over-preparation of the tooth prior to crown placement.

However, the fact that the dentist didn't use gingival retraction prior to the impression is troubling. Unless he had a specific reason for ending the crown margin above the gum line (for example, to mitigate any contribution to gum disease), the conventional placement of a crown margin is UNDER the gum. This provides better protection from sensitivity and recurrent tooth decay, and certainly looks better. Although it is possible to take an accurate impression without gingival retraction, the picture your paint is more that of a dentist accustomed to cutting corners.

My gut is telling me that a second opinion will find your crown wanting in quality. Your dentist's unwillingness to personally confront the unsatisfactory fruits of his labor during your visit speaks volumes about his (lack of) sense of accountability. It certainly raises the question of why a dentist would replace a crown if he couldn't improve on the original.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Bornfeld,
Thank you so much for your quick and frank response. I will indeed get a second opinion, hoping the work won't have to be entirely redone. In fact, I'm not sure my tooth would stand yet another session of drilling and banging.

I find it interesting that you mention over-preparation of the tooth as a possible source of sensitivity to cold since I did notice that the tooth stub seemed unusually short -- almost flush with the gum, in fact. I'd like to add that I have multiple crowns and caps as well as a couple of implants, so I'm no novice to dental procedures.

Now I'm wondering what my recourse is should the second opinion prove the crown is inadequate, considering I paid for it in full immediately.

I thank you for your sage advice, and again commend you for donating your time to a pro bono site such as this.

Dr. A. Olsen-Fazi

Answer
Dear Dr. Olsen,

Your possible recourses include:

1. Doing nothing (to my mind, not an option)
2. Appealing to your dentist's sense of fairness, and asking for a refund, credit of moneys paid toward remedial action, or something of that nature (I include this option for its comic value)
3. Litigating through the courts
4. Inquiring through your local dental society whether they provide a process for peer review of patient grievances, and having your case adjudicated through that mechanism.
You can find contact information for your local dental society at the following link:
http://www.ada.org/ada/organizations/searchlocal.asp

I wish you luck!

Mark Bornfeld DDS