How should I deal with this inadequate dental care?

July 5, 2014 8:52 AM

I had some dental work done this week that I consider unsatisfactory. I'd like advice on what to do next.

Because of a highly-sensitive gag reflex, it is quite difficult to do dental work on me. Generally it’s necessary that I be sedated, using either oral ("conscious") or more frequently IV sedation, to do the work. I’ve had this done 5-6 times. The sedation is quite expensive and not reimbursed by insurance but it’s the only way I’ve found to get it done.

Yesterday I went in for a root canal, the filling of a couple of small cavities, and a deep cleaning, under IV sedation with a dentist who was new to me. The sedation felt subjectively much lighter than normal, and I was much more aware of the work being done than usual, but he carried out the root canal. However, I then became much more awake, and when I conveyed this, the dentist declined, for safety reasons, to administer more sedation, and was unable to complete the work, including putting a crown over the root canal. He told me that I needed “hospital sedation”, which I find difficult to believe since I’ve had similar, and even more extensive, work done as an outpatient before.

I’m now in a difficult position: I have a root canal with no crown, which I understand means I’m likely to lose the tooth at some point. I’m out of pocket some thousands of dollars for work that was not completed, and I’ve used up all my dental insurance for the year. In order to complete the work that was begun, it seems I’m going to have to find another dentist who can successfully administer the sedation, and pay more thousands of dollars.

Am I reasonable in thinking that I’ve been done wrong here? It’s clearly possible to sedate me, as it’s been done several times before, and if the dentist had done so successfully everything would be fine. His inability to do something that he advertises as the major focus of his practice is going to cost me a lot of money. I have not discussed this with him as I spent yesterday recovering and now we're into the holiday weekend. How should I proceed?

(Note: suggestions on how I might do without sedation are not particularly helpful. I’ve lots of experience with lots of attempts to do so, and I’m confident that sedation is what I need if I’m going to have dental care at all.)

posted by anonymous to Health & Fitness (9 answers total)

Surely the dentist will have a record of what medications were used and at what dose, and previous dentists ditto? I'd start by comparing what sort of medications you've had over the various appointments.
posted by kmennie at 9:05 AM on July 5, 2014 [1 favorite]

I've always had the root canals and crowns done in separate appointments. That is, the root canal is done and a temporary filling or temporary crown is placed by the endodontist, and then I go to my regular dentist to get the crown done.

If you paid for a crown and did not receive a crown I would ask for that money back. Find a new dentist for just the crown placement. Do that soon.
posted by sockermom at 9:13 AM on July 5, 2014 [4 favorites]

Reading your question, some questions occur to me. Why were you using a new dentist, and how did you find him? What communications occurred between you and him prior to yesterday's procedure, and what substantiation do you have of them? Did he indicate that anything unexpected occurred during the procedure, apart from the sedation issue? Is there another dentist, perhaps one of your former dentists, you could talk with to get some perspective on yesterday's experience? What is going to be your actual loss here, and when will you know for sure?

You don't need to answer these here, but they are questions that might be helpful for you to consider as you're pondering what to do. Good luck. I'm sorry you had a rotten experience; and I hope that whatever you decide going forward, your top and immediate priority is your own health.
posted by cribcage at 9:18 AM on July 5, 2014 [1 favorite]

I’m now in a difficult position: I have a root canal with no crown, which I understand means I’m likely to lose the tooth at some point.

IANADentist, but I think you're catastrophizing a bit here. As sockermom notes, it's pretty standard to receive your permanent crown some time after your root canal. (In fact, I had four separate appointments for my root canals: two with the endodontist, about 10 days apart, then two with my dentist, about three weeks apart, to set me up with first temporary crowns and then permanent ones.) These teeth received the root canals in the first place because they were knocked out of my head, so my endodontist and dentist were giving me the absolute best care to ensure that I could keep the teeth.

So yes, you need a permanent crown on your root canaled teeth at some point, and sooner rather than later, but the immediate risk is in my view pretty much nil.

I’m out of pocket some thousands of dollars for work that was not completed, and I’ve used up all my dental insurance for the year. In order to complete the work that was begun, it seems I’m going to have to find another dentist who can successfully administer the sedation, and pay more thousands of dollars.

Yes, you do need to seek out a new dentist who is a better fit for your unique needs. But I don't think it's a given that you just have to eat the money you've paid this dentist. His office should refund you the share of your payment that would have gone towards your crown. It doesn't even sound like you asked for your money back yet. Don't freak out before you've asked and been told "no." You'll likely be told "yes," and then you can carry on with your life.

It’s clearly possible to sedate me, as it’s been done several times before, and if the dentist had done so successfully everything would be fine.

I 100% get why you're frustrated - I would be, too. But every dentist (and in fact, every medical professional) has a different comfort level with using sedatives. He likely felt he was acting in your best interest by refusing to give you more sedation, and as sedation can be slightly risky, I don't think he's completely out of left field on this one - maybe he used a different drug than your previous dentists have, one which just happened to be less effective on you but could have been dangerous in increased amounts. You aren't an anesthesiologist (and neither am I), after all.

Before you castigate the man, I think you should get your dental records (from him, and from other more successful treatments) and compare the sedation you received. This will actually be very useful information for your next dentist to have, so he/she sedates you adequately and safely.

His inability to do something that he advertises as the major focus of his practice is going to cost me a lot of money. I have not discussed this with him as I spent yesterday recovering and now we're into the holiday weekend.

Sorry, but this is not obvious at all to me. You haven't even inquired about getting a partial refund for the work he wasn't able to perform. Talk to him on Monday, then see what happens.

How should I proceed?

My advice, and I know it's annoying to hear, is to try to calm down. If you call him in a rage on Monday morning, you're not going to get very far, even though you are 100% entitled to a partial refund, which you can then take to a new dentist for the crowning procedure. Try to be cool and calm and kind, and I promise you'll see better results. Ask for the refund, and see what happens.
posted by schroedingersgirl at 10:22 AM on July 5, 2014 [4 favorites]

He told me that I needed “hospital sedation”, which I find difficult to believe since I’ve had similar, and even more extensive, work done as an outpatient before.

Different places have different laws on what types of sedation you can receive without needing to have an anesthesiologist present.

If you have moved recently, the type of sedation you need might only be available to you in hospitals where you live. If dentists have hospital privileges there this is likely to be the case.

Some dentists choose not to use certain types of sedation, even where it would be legal to do so, because they are not comfortable with the types of risks posed to patients. One dentist who does this where I live is actually preferred by MD's I've talked with due to this.

In the future you need to know more about the specific names of drugs and dosages that have worked for you in the past (not just "IV" and "conscious") and see if the dentist you are considering has those available.

Talk with the dentist on Monday, they may be able to give you a refund or be comfortable giving you a second sedation to complete the work.
posted by yohko at 11:04 AM on July 5, 2014 [1 favorite]

I think you got good advice re: this root canal. One thing to do that might make future dental visits better would be to ask your prior dentists about precisely what sedatives and dosing you had in successful dental visits and this bad visit. Then you can tell other dentists, "i need z drug in z dose, or x drug in x dose for 4 hours of work. If you give me y drug in y dose, I wake up after 3 hours." Dentists who do sedation have special training (source: I work at a university that trains special dentist skills including sedation) and they know people metabolize drugs differently. You having this info will help you take control of your future dental health.
posted by holyrood at 1:27 PM on July 5, 2014 [1 favorite]

Another issue to consider in trying to understand what happened is the possibility of a shortage of a relevant drug. In recent years, there have been short- and long-term shortages of quite a few drugs, including some that might be used for dental sedation. If a preferred drug is in short supply, something else may be substituted, or dosages restricted. Find out specifically what drug(s) you had and in what doses for the procedures that worked for you and the one that didn't. Check against this list to see if any of them are in short supply. (assuming you're in the US -- I don't know if this is an issue elsewhere.)
posted by Corvid at 1:31 PM on July 5, 2014 [2 favorites]

Echoing the suggestion to go slow in concluding you were wronged. There are lots of reasons this might have happened - I think people can even respond to medications differently at different times, so it's possible he did exactly what was done before and it affected you differently. It's also possible he didn't do the same thing, for perfectly defensible reasons.

It's also possible he's a hack, of course.

If I were you, I'd focus first on getting your root canal taken care of - as others have noted, I'm not sure you're as doomed as you think, and if he is responsible, I suspect it could muddy the issue if it isn't dealt with quickly. Then perhaps a second opinion?
posted by Linda_Holmes at 2:03 PM on July 5, 2014

Just ask the dentist to finish the work you've already paid for. A good dentist will make this right. My dentist has had new crowns made up at the lab for free because they were the wrong colour. I didn't pay a cent for the subsequent office visits until the work was done right.

If you haven't received the work you've paid for just politely call and ask what it will take to get the work done. And consider going to your MD and getting ativan for appointments. Ativan + nitrous might work for you, and this is much cheaper than sedation.
posted by crazycanuck at 2:36 PM on July 5, 2014