How can I resolve a dispute with my orthodontist?

November 12, 2007 10:47 AM

Do I have any recourse if my orthodontist has been carrying out a bogus treatment plan for the last year?

I am a 31 year-old woman with two baby teeth in the front top of my mouth. They are loose, and I have decided to replace them with implants. My dentist recommended pre-implant braces, and referred me to an orthodontist.

The orthodontist gave me a 1-year treatment plan for braces, for the sole purpose of making room for the implants. Towards the end of this year (about a month ago), he referred me to a prosthodontist. The prosthodontist told me that my treatment plan was not ideal, and recommended that the orthodontist move my teeth in the exact opposite direction he had been moving them for the last year! A second prosthodontist agreed.

The orthodontist is willing to defer to the prosthodontists. However, he still wants to charge me $135 per month for the additional 7 months it will take to move my teeth in the opposite direction.

Was it my ortho's responsibility to get a prosthodontic consult beforehand? I have paid $3500 and spent a year in braces and I am farther from my implant goal than when I started. I do not think I should have to shell out any more cash (although the extra time is unavoidable). Do I have any recourse? Any suggestions for how to approach the orthodontist without destroying our relationship, since I will have to see him for the next 7 months?

posted by pizzazz to health & fitness (11 comments total)

don't Americans sue doctors for this shit all the time? it seems to me it's worth a try.
posted by matteo at 10:49 AM on November 12, 2007

I mean: "I have paid $3500 and spent a year in braces and I am farther from my implant goal than when I started" sounds like negligence
posted by matteo at 10:50 AM on November 12, 2007

I have baby teeth also (I am over 40) and my last quack of a dentist wanted to yank them out and do a bridge. Her estimate was over $6000. I went to another dentist because I did not want them extracted, I wanted them to be fixed as long as they were viable teeth. It was less than $100 for that.

In my conversations with both of these dentists, there was never any mention made of having to do anything to the baby teeth to get them ready--they were just going to yank them out full steam ahead and replace them. I really don't see why in your case you need to be moving teeth around that are just going to be extracted and replaced. The whole thing sounds like a scam, not just the last part of it. I think you should go outside of that little pool you have been working with and get another opinion. I notified my insurance carrier of the extravagant $6000 estimate and treatment plan and told them I wanted to see another dentist because I did not believe my teeth were to the point of extraction. I went to another dentist and the cost was covered. If your insurance is covering a portion of what you are doing now, they might allow you to see someone else for an initial consultation and cover it because it might save them a lot of money, too.
posted by 45moore45 at 10:54 AM on November 12, 2007

Well, was what the orthodontist did wrong or was it what he/she thought was the best treatment plan at the time? If it's the latter, you might just have to chalk it up to personal experience and pay for the additional 7 months.

I do think when shelling out your own money for expensive dental treatments, there should be an element of personal responsibility in getting second opinions and making sure your specialist knows what he or she is doing.

To me, The prosthodontist told me that my treatment plan was not ideal does not scream "the orthodontist fucked up!". I would think that except in the case of actual fuckups, not simply an "unideal" plan, would you really have the right to insist on free follow up service. I mean is this really just "not ideal" or does the orthodontist have to undo the past year's worth of work??

Also, if you think your orthodontist screwed you over or made a huge mistake, why on earth would you let them continue to work on your teeth??
posted by tastybrains at 10:56 AM on November 12, 2007

Dental specialists depend on referrals, so your best recourse is to express your displeasure to your primary dentist. Make it clear that you will find a new primary dentist if the situation does not get worked out. No matter what, you're a short-term customer of the orthodontist, but you represent a long-term income stream to the primary dentist who, in turn, is a long-term producer of leads for the orthodontist, so it's in their interests to find a solution you'll accept.
posted by backupjesus at 11:17 AM on November 12, 2007

Look, first of all, medicine isn't a perfect science, no matter how much you'd like it to be. The cost you've already paid and the time you've spent have absolutely nothing to do with whether you'll have to pay for it in the future. You can't go around getting free services from doctors or getting your money back just because what they do doesn't produce the results you want.

Second, everything hinges on what you mean by the word "bogus." Now, I don't know where you are, althought the near-litigious way you frame the question indicates to me that you're in the US, like I am. However, if you are, I can tell you that, in order to have legal right in this matter, you'll have to have evidence that the orthodontist was willfully negligent in putting together the treatment plan. It doesn't sound to me like he was. It doesn't sound to me like he made any mistake at all, except that he disagreed with two other doctors about how to proceed.

Third, some suggestions: (1) Get a second opinion before embarking on a costly, year-long treatment plan. (2) Get dental insurance.
posted by koeselitz at 11:39 AM on November 12, 2007 [1 favorite]

To answer some questions:

- Was what the orthodontist did wrong? It is difficult to get one medical professional say that another one is "wrong", but both prosthodontists expressed surprise at my treatment plan.

- If you think your orthodontist screwed up or made a huge mistake, why on earth would you let them continue to work on your teeth? I think my orthodontist is technically proficient in moving teeth around, but doesn't have the broader understanding of the mechanics and energetics of mouth movement to make good decisions on where to move them. I feel comfortable having him execute the plan of the prosthodontist (who I trust).

- I really don't see why in your case you need to be moving teeth around that are just going to be extracted and replaced. Because the baby teeth are small, the rest of my teeth moved around, leaving my teeth evenly spaced, but with gaps. The orthodontist just wanted to close the gaps and make room for adult-sized implants. This seemed reasonable to me. However, in addition to the spacing, the order of my teeth was affected. My canine teeth are not in the canine position. The baby teeth are there instead. Nevertheless, the orthodontist wanted to put the implant in the canine position. The prosthodontists said implants should not go there because they would end up absorbing a lot of the sheer force involved in chewing, and it would be better if a natural tooth (which can provide feedback to the jaw) were doing that. I didn't know that last part when I signed up for treatment, and apparently neither did the orthodontist.
posted by pizzazz at 11:47 AM on November 12, 2007

Just a data point -- I have two baby teeth, and every dentist I've had has agreed that there is no reason to pull them while they're still hanging on. When they fall out, I'll get implants, no pre-implant orthodontics necessary.
posted by desuetude at 11:56 AM on November 12, 2007

I think my orthodontist is technically proficient in moving teeth around, but doesn't have the broader understanding of the mechanics and energetics of mouth movement to make good decisions on where to move them.

I think those two things are more related than you think. And it's hard for me to imagine that your orthodontist is now just a glorified, expensive technician for your prosthodontist. He's still going to need some "broader understanding" of the way the mouth works. If you don't think he has that, go elsewhere.
posted by grouse at 12:57 PM on November 12, 2007

this doesn't answer the question, but i also have weird shark teeth (extra sets--my baby canines, upper and lower, never fell out), and this info may be helpful for you. when i was 17, my dentist realized that i had some extra teef. the babies. he said i should pull them out and let the adults grow in. i said what will happen if i do not. he said, potentially nothing. as an awkward and vain 17-year-old i did nothing. then maybe 5 years later, what happened was that my adult canines started growing in through my gums, above the still-present baby teeth. which was lovely. headaches and my other healthy adult teeth starting to get crooked because they were being pushed out of the way. no dental insurance, though, so i did nothing. finally i had the insurance. new dentist says i can't leave the adult teeth up there because nasty things can happen and they can get infected in the gums and then there's jaw surgery and bone grafts and things. so, they ripped out my baby teeth. and are now pulling down the reticent adult with a lovely bracket/chain/bar combo. in a few weeks it will be down enough to put full braces on me. after a year or so i will be normal.

my point is that if they had just pulled those babies when i was 17, none of this would be happening. the adult teeth would have grown into the right spot. instead, i'm spending thousands of dollars ($8k?), tons of tortuous time, and get to look like a brace-face teenager to boot, just in time for my 30th birthday.

anyway, if you're just getting some implants put in, i don't know why they don't just yank those baby teeth and start the process for the implants. i've heard, though, that they're way more expensive than braces (upwards of $20k/tooth), and that there is a long prep period where they have to let the jaw prepare itself for the screws (again with the bone grafts).

teeth suck.
posted by apostrophe at 7:43 PM on November 12, 2007

Thanks to everyone for taking the time to advise me.

I agree that I should have been more proactive in figuring out what should be done with my teeth. I've learned a valuable (and costly!) lesson not to trust the guy in the white coat. However, I still think this particular orthodontist lacked sufficient knowledge of implant dentistry to handle my case on his own. A responsible practioner would have acknowledged this.

For the record, I was never looking to sue. (I guess my anger at my orthodontist really came through!) I was thinking more of filing a complaint with some consumer body. Looks like I'll have to settle with complaining to my dentist, as backupjesus suggested.

Unfortunately, it's too costly for me to start treatment elsewhere. I do have dental insurance, but am not covered for this because my condition is congenital.

Yes, apostrophe. Teeth suck.
posted by pizzazz at 8:38 PM on November 12, 2007