Expert: Howard Finnk, D.D.S., P.A., CEO - 7/2/2005

Question
Dr. Howard Fink,

   I would appreciate your feedback on this situation:  Dentist (A) claimes I need 3 crowns and 1 inly because the fillings are old and contracting causing tiny gaps where moisture could get in, also the walls are thin and could crack. I hire dentist (B) for his "second opinion" in which he agrees with dentist (A).  Dentist (C), after a full set of x-rays and an examination, claims that the four teeth in question do not need dental intervention because they have integrity and showing no need for crowns or inlays.  He explained that his approach is a conservative one in which only work that needs to be done will be suggested to have dental intervention.  I asked him why the discrepency. He said that it is very common for dentists to advise dental work to be necessary because these dentists want to create additional income for themselves.  

    If this is the case, then I have spent the last nine months suffering unnecessary mental stress believing that I needed to have very expensive dental work for which I cannot afford.  I am very angry that this has happened to me and for other innocent people seeking honesty from the
medical professionals for whom they depend on for their health.  This is an outrage and it is my intention to take some action in the interests of preventing unnecessary medical proceedures and mental and financial stresses because a doctor wants to create additional income for themselves.   Can you share with me some of your insights into this topic and how and where I might address a possible investigation and warrented complaint.  

                        Respectfully,

                           David

Answer
Dear David:  Sad you have such anger over your interaction with 3 different dentists.  However, it is fairly common for different dentists to look at your teeth and find different things.  Being relatively conservative myself, I probably would side with dentist number 3, as I usually do not do anything unless I sense an immediate, or near-immediate, need.  As an example, I may see a patient with an old silver filling that occupies 80% of the volume of the tooth, with the tooth having thin spines of enamel holding this large filling.  Knowing that silver fillings do not bond to the teeth, that the enamel has been overstressed over years, and there is likely leakage between the large filling and the tooth, I may recommend that this tooth receive a crown.  I prefer to schedule this procedure at the patient's convenience, rather than waiting for the tooth to break (likely on the eve of a child's wedding!).  I consider this to be good judgment.

I have not done an inlay since dental school, as I find them very expensive, without providing significant benefit over time to the patient.  For a tooth that is sound enough to accept a filling, I will place a bonded filling, which bonds and seals to the enamel, lasts a long time, looks like your tooth, and releases trace amounts of fluoride during chewing to strengthen the tooth.  Other dentists believe other things, offer you what they believe to be best for you, and may still be providing you with treatment that is well within the standards of dental care.  Rather than go after 2 dentists whom you believe gave you wrong advice, wouldn't you be better off receiving the care that you need from the dentist you trust, then get on with your life?  You decide.  dd