katakat.com bytes from a participant observer

I'd like to start off this story by stating, for the record, I have beautiful teeth. At least that's what a dental hygienist told me just last week. However, I have one problem tooth, which has taken me on such an odyssey over the past four years I really need a mental (and dental) vacation. Long ago and far away, I chipped my front tooth, #8. I was 7 years old, and it was an accident; the perpetrator will not be named, but is my little brother. Anyway, the dentist (Dr. H, who I would have for 20+ years) ground away the chipped part, and it was fine as far as I was concerned. I didn't even get it cosmetically bonded for an improved shape until about 20 years later, when I actually cared (and had insurance). Fast-forward to age 34: I'm in a new town, and have a new dentist (Dr. J). She informs me my tooth is resorbing. That's dental-speak for rotting out above the gum line. Nice. I had no pain, no discoloration. Just a bad xray. So we keep an eye on it for a few years, and then it becomes too troubling for my dentist. Still no pain or discoloration. I get sent to a periodontist (Dr. S), who recommends extraction and an implant as a replacement. I go for a second opinion (Dr. T), who recommends the same, but seems more conservative about the time frame. I go with the second opinion, who does the extraction job with his twin brother (Dr. T2). Really strange day, seeing double for real while in the chair; I was only on local anesthetic, not sedation. For future reference, I would highly recommend learning more about the dental profession before shopping around for someone to do this procedure. And I do mean SHOP around. You are the consumer, and the price tag here is about the same as for a used car. I thought I had been thorough, but evidently not. The dentist who sold me on the procedure (Dr. T) was a general dentist. They can do extractions and crowns and fluouride treatments. His brother (Dr. T2) was a periodontist, who does extractions, gum work, and implants. The fact that they flew him in from New York for the surgery should have thrown up a red flag right away. You want your periodontist to be local. Since his name was on the door, I didn't know he traveled. A lot. And I didn't know how integral a periodontist is to this whole procedure. IMHO, a general dentist (Dr. T) should not have been overseeing this procedure. By the time the bone and gum healed, the implant was placed, and an abutment and crown added, we're talking two years, 30 dentist visits, and about $5,000, of which my dental insurance covered a tiny bit. All for one tooth. So I go to my regular general dentist (Dr. J)the day after my birthday this year, 2007, and that's when the pain begins. Note that I never had pain until I started going to dentists and specialists. I'm talking pain in gums and wallet. I went because the tooth felt loose to me. Actually, it had felt that way two years previous, and the dentist who did the work (Dr. T) said it was just fine. Anyway, my regular dentist (Dr. J) pops off the crown with so much force it went flying around the exam room, ricocheting off the wall--I'm not kidding. Red flag #1. She says my gum is infected, and warns me that the implant might have "failed." She recommends the same periodontist as four years previous (Dr. S), and puts my crown back on with temporary cement. She does not tell me that "temporary" was less than 24 hours, as I find out while eating oatmeal the next morning. In fact, later I find out there are other things she didn't tell me, like how bad the infection was. She had never wanted anything to do with that tooth because I had gone to Dr. T. Red flag #2. Anyway, the perio (Dr. S) takes a (painful, stabbing my gum) look at my tooth/gum/whatever, won't say anything to me until he talks to my referring dentist (Red flag #3); the next week, he tells me the implant failed and I need to do the ENTIRE procedure over again, from extraction to crown (Red flag #4). Holy cow. I can see $7,000 and another year of pain in my future. I am not a happy camper. So I seek a second opinion, recommended by one of my karate seniors. The second opinion (Dr. P) gives me a completely different answer: it's the abutment, not the implant. And then recommends I see a prosthodontist about a new abutment and crown (that's part of what prosthodontists do). I practically dance out of the office, I'm so happy with the good news. The prosthodontist (Dr. PJ) gives me the same information as the second opinion (Dr. P): the abutment was loose. So he tightened it up, put the crown back on, and I'm good to go. Yes!! In retrospect, here's the deal: IMHO, the original dentist who oversaw the implant and crown work, Dr. Raymond Tash, did a crappy job. I do NOT recommend him. (By the way, he sold his practice in La Jolla for one in L.A. which is why I couldn't go back and have him fix things. And why would I go back if he didn't do it right the first time?) Yeah, I have a sturdy implant, but the abutment was not tightened in properly from day one. I don't think he ever checked it, and of course his brother was not around to take a look either. He did not believe my concern about the tooth feeling loose when I last saw him. The space between the abutment and the implant caused the infection I had this year. Now that the abutment is tightened, the crown does not sit properly, and should be replaced. All that, and the gum around the implant is still too thin; I had been reassured by Dr. Tash that it would turn pink and look normal, which it never did; the gum is still purple and the implant shows through the tissue. The prosthodontist recommended I have the periodontist build up the tissue so it will better stabilize the implant. And then eventually get a new abutment and new crown that fits better. Cost: probably about $4,000 all said and done, which bumps the price tag for this whole ordeal to about $9,000. Argh. At least there's no rush. I can wait. And I got my smile back!! Lessons learned: 1) Ask a lot of questions & keep a log of your experiences after each conversation. And don't just go with one opinion; get consensus. Also, if the dentist does not answer you directly, find another one. There are slews of them, and ones with bad bedside manner are not worth your time or money. They are not God. And any dentist that tells you "it's just a tooth" has no concept of reality or money. 2) Go online and learn about the different types of dentists. This was my first experience with a major tooth issue, so I had no idea beyond what general dentists do. Don't be so trusting. 3) Find out what your dental insurance will cover-- call the service and talk to an actual person, even if it means going through telephone tree hell first. Be persistent. 4) If you're not in pain, then it's probably not urgent. So if you feel like you're being pushed into procedures you're not sure about, talk to friends and family, reflect, and do some research. It might save you a lot of unnecessary pain and $$ :-) .