Dentist visit from hell
March 5, 2011 6:03 AM   Subscribe

I'm highly upset. Against my initial instincts, I allowed a dentist to put three fillings in my mouth last Monday. Almost a week later, my mouth is STILL hurting. I've been told by others this is not normal. Beyond that, I found out after the fillings were put in place, they were amalgam. I had assumed they would be composite since my other filling was composite (put in by another dentist years ago). I need advice.

Something told me, "don't do it. Don't go back there." I went to this dentist once about a year ago when they supposedly found all these fillings I needed. Previously however, every dentist who saw my teeth complimented me on how great they were. So I took this as a red flag that this new dentist was one of those shysty types. After changing insurance companies though, I went back this last time because they accetped my insurance and the location was convenient for me. I thought, "well, fillings are pretty standard, can't imagine how they'd mess that up." *sigh*

Anyway, so I come home and open my mouth in the mirror right after leaving the dentist, and see all this silver and I almost fainted! I called them and they said they would replace them and I'd pay the difference becuase my insurance doesn't cover composite for back molars, only visible teeth. I tell them I'd call them back. Now, to compound the issue my mouth is aching like crazy and I'm getting headaches on the side of my face that the fillings are on. I am soo frustrated.

The dentist who put my fillings in was a young guy, not the main dentist at the office (ie the one who's name is on the building), and this in itself made me nervous. Beyond that, I didn't find him all that friendly and I just didn't get a good vibe off of him at all. But I let it slide, and I'm paying the price now.

This is what I want to do: go back, let them fix their mess, insist that the main doctor be the one working on my mouth, get my records, and go find another dentist. I have been given a few referrals from others, so I will try my luck elsewhere and hope there is no permanent damage to my mouth.

My questions: 1) Should I go back or just cut my losses? 2) What insurance covers composite for back molars, in the GA area? The only one I can find so far is Aetna, and they're still very high. I was under the impresion that EVERYONE wanted composite now. I didn't know it was even a question of amalgamm vs. composite anymore. (And I still haven't figured out why this bootleg dentist didn't even ASK me which I preferred.) 3) What do I do if I have permanent damage to my mouth? Do I have any legal recourse?
posted by GeniPalm to Health & Fitness (21 answers total)
It is odd that they did amalgam fillings without asking, they're rare in the United States these days for aesthetic reasons. (Even though amalgam is mechanically slightly superior). Anyway, any dentist can replace an amalgam filling with a composite.

The important issue though is the pain that isn't going away, that could potentially be much more serious. What did they say about that?
posted by atrazine at 6:14 AM on March 5, 2011

I am not a dentist, but something like this happened to me once. The pain came from the fact that the fillings were too "tight," whatever that means. I went back in to the nutty dentist, she "loosened" the fillings, and the pain went away on the spot.

I ran for the door and never went back.
posted by vincele at 6:22 AM on March 5, 2011

Response by poster: Atrazine, I haven't told them yet about the pain. I just really noticed yesterday where it was coming from. I kept getting these headaches on the side of my face and for some reason (duh) only yesterday did I put two and two together.
posted by GeniPalm at 6:22 AM on March 5, 2011

I was under the impresion that EVERYONE wanted composite now

Many folks can only afford what their insurance pays for, and some of us don't care about the type of filling on back teeth, so no, not everyone wants or needs composite.
posted by crankylex at 6:25 AM on March 5, 2011 [12 favorites]

Both dentists I have visited in the last 3 years have offered me a choice in filling types. Without insurance the price difference was around $20.
Dentist #1 announced that I had 4 cavities which needed to be fixed ASAP. He seemed a bit seedy to me so ditched out and a year later I went to Dentist #2.
Dentist #2 found 1 single cavity to fill. He told me that the other teeth were "pre-cavities" which needed to be watched closely. Could it be possible that your previous dentists saw these pre-cavities and did not mention them? My Dentist #2 only broached the topic when I asked about my now missing 3 cavities.
If you have pain for an extended period you need to call and go back right away. One of those teeth may now need a root canal. Did your young dentist place any medication in the tooth before placing the filling?
posted by phytage at 6:29 AM on March 5, 2011

Response by poster: Crankylex, you are right, some people don't care, but I thought it was standard that dentists ask you before-hand your preference since composite is so much more popular these days.

Phytage, you were smarter than me. I wish I had ditched this office the first go-round. Yes, I think it's possible those previous dentist may have seen pre-cavities or something. This young guy did use medication before filling the tooth, but during the process I winced when he was doing one tooth, he went to the next, then came back to that same tooth, without adjusting anything. I should have known something then!
posted by GeniPalm at 6:36 AM on March 5, 2011

Response by poster: Sorry to keep responding, I know this site is not built for comstant feedback, so this will be my last response. I just called and spoke with the answering service or the on-call dentist or something. I explained my situation and she told me that it's probably because the bite is too high, that I should call Monday to make an appointment and have them readjust the bite of the teeth or something. I will call Monday, but not only will they adjust the bite. They will replace these fillings and I will throw up the deuces. Can't wait.

Thanks for your responses. I really needed the feedback.
posted by GeniPalm at 6:43 AM on March 5, 2011 [1 favorite]

GeniPalm, that is what I meant, the bite was too high. Not too tight. That fixed the pain for me. I hope it works for you.
posted by vincele at 6:51 AM on March 5, 2011

My dentist explained to me that a lot of fillings are done these days as very early-early preventative measures. In other words, the economy has hurt dentists, too. They need to pay mortgages and anything that looks like it might result in a cavity will get a filling.

Another anecdote, another dentist I had took the liberty of filing down a tooth, because he thought it was too tall and putting pressure on a tooth he had filled. He never asked me if he could file a perfectly healthy tooth. The pain didn't even get better after he filed. Needless to say I dumped that dentist.

Tldr; if 3 dentists tell you that your teeth is great and one dentist wants to do work, he's probable late on his mortgage payment.
posted by ttyn at 7:20 AM on March 5, 2011

Sorry about the insane grammar/spelling. This topic makes me really angry and my phone-typing can't keep up.
posted by ttyn at 7:22 AM on March 5, 2011

On amalgam vs. composite... a large number of my composite fillings (from different dentists, even) have fallen out after a year or two. Amalgam is better for certain surfaces, apparently.
posted by underflow at 7:48 AM on March 5, 2011

My both the dental insurances that I've had- Lincoln and Guardian have covered composite in molars. However, in my experience, the composite don't last nearly as long. I had some fillings as a kid that were amalgam. They lasted about 20 years before needing to be replaced. Two different dentists ended up making composite replacements over the course of about 3 years. The life span of those fillings was about 5-7 years. At the second replacement, I decided to go back to amalgam. I don't think it's really that noticeable, and I would much rather have fewer dental numbing/drilling experiences.
posted by kimdog at 7:55 AM on March 5, 2011

I had assumed they would be composite since my other filling was composite (put in by another dentist years ago).

So you assumed incorrectly… how does that make it the dentist's fault? If they had used composite you could accuse them of trying to pad your bill.

I took this as a red flag that this new dentist was one of those shysty types

The word you are so desperately grasping for is shyster, and if your dentist is Jewish I would highly suggest not repeating it in his company.

To address your actual problem, if you had work done on the tops of the teeth (the face that does the chewing) and you're feeling tooth pain afterward it's highly likely that you need to have your bite looked at. What that means is, sometimes they don't smooth down the filling enough, which creates high spots that can cause serious pain when you're chewing food. I've had this happen to me and I remember thinking that I was going to need root canal the pain was so excruciating. Just a couple of passes with a dremel and I was right as rain. I never could have believed something so minor could cause to much pain, but that's teeth for ya'.
posted by Civil_Disobedient at 7:57 AM on March 5, 2011 [15 favorites]

If you don't want amalgam on cosmetic grounds, sure, get composite, but amalgam is better-lasting. I'm glad I don't have composite, seeing other people having their composite filling break up after a few years; some of my amalgam is 50+ years old and still good.
posted by anadem at 9:08 AM on March 5, 2011 [1 favorite]

Response by poster: Civil_disobedient, since you asked, I'll answer even though I said I wouldn't respond anymore. Maybe I wasn't clear the first time. If I'm a dentist and I see a patient has a composite filling, I'm going to at the very least assume he/she likes that and before I decide to fill their mouth with silver, I'm going to ask if he/she has all of a sudden changed their mind about composite. Similarly, if I wanted to do composite, I would deem it my duty to let the person know before-hand the cost. To me, this is basic customer service 101.

And I wasn't "grasping" for any word, I used the word I wanted. And the word I used was appropriate how I used it. You can save your grammar lesson for someone who gives a dang.

But thanks for your [related] advice, and same to all the others. I thoroughly appreciated it.
posted by GeniPalm at 9:24 AM on March 5, 2011

"What insurance covers composite for back molars, in the GA area? The only one I can find so far is Aetna, and they're still very high. I was under the impresion that EVERYONE wanted composite now. I didn't know it was even a question of amalgamm vs. composite anymore."

Many people will only get what their insurance will cover and like you are discovering it is mostly expensive plans that universally cover composite fillings because they are both more expensive and also less durable. Also I'm not a dentist but both of the dentists I've put this question to have told me that amalgam fillings are stronger so they are sometimes the best choice for large cavities. Putting in a composite in some cases can result in a significant risk of the tooth breaking requiring a crown.

I'll also confirm that very minor height problems in fittings can result in excruciating pain that just won't go away until 30 seconds in the chair adjusts for even pressure. Gum are bizarrely sensitive considering the abuse they get. I had a wisdom tooth extracted that required the tooth be broken for removal. This procedure went fine but left a tooth chip smaller than a grain of table salt embedded in my gum that started being so painful after a couple days I though I had a raging infection or something. My dentist picked it out in a few seconds and the pain subsided immediately.
posted by Mitheral at 10:19 AM on March 5, 2011

You have to ask yourself a few questions. Where do you stand on cost versus health benefit? Is your provider qualified/experienced in doing all types of fillings?

I come from the perspective that I'd rather pay more out of pocket than compromise on health - but that's a question of means as well as priorities. This article is a good rundown on the types of fillings available. FWIW, I opt for gold fillings in my back molars, but that brings us to the second question: unfortunately, great numbers of dental care providers don't have any experience doing gold fillings. And no, not every filling type is the same - you do need experience. For example, I have a special filling in the back side of one of my front teeth (invisible when I smile) - it's a "gold leaf" filling - it is a rare provider who knows how to do these (I had a professor of dentistry and instructor at USC do it for me), and the costs are commensurate. What may happen is that a dentist will try to talk you out of a gold filling because they are not experienced enough and it's the case of "let me sell what I have in the shop, not what's the best for the customer".

Remember: every time you do a filling, you are weakening the tooth, because you need to have the cavity cleaned out and in the process enlarged. Therefore, the more infrequently you do it, the better. So try to make your fillings last - and gold fillings are still the best, with some porcelain ones coming close (though costing just as much). That puts cost in perspective, as well as health - because it may be not quite as expensive to do gold if it lasts 3-4 times as long. Fillings don't last forever, but I have yet to replace my gold leaf I had done back in 1985 - it's still perfect.

Trust is a key thing. Don't go to a dentist whom you don't trust, or who fobs you off on his incompetent or inexperienced assistants. I always demand the best, and if I sense I'm not getting it, I walk out the door.
posted by VikingSword at 11:27 AM on March 5, 2011

It is very interesting to read about how amalgam fillings are longer-lasting. Just this week I got a filling. The dentist asked if I wanted "tooth-colored" or "metal-colored", and when I asked him what the difference was, he said just that the "tooth colored" ones were cosmetically better but a bit more expensive (with insurance) - he didn't mention the strength/durability difference at all. Kind of wishing I'd gotten the stronger kind now.

About your pain - definitely go back to them and say, what's this pain about and what will you do to alleviate it? Ask them to spell out their plan before letting them in your mouth. (And if it's unsatisfactory or involves a lot more work, cut your losses and try another dentist.)

I also agree with vincele that it might be because the filling is "too high" - the bite surfaces might not align properly. When you had the filling done, did the dentist put a piece of (what looks like) carbon paper in your mouth and have you bite-bite-bite on it? That is the usual thing to do, have a couple of rounds of bite-bite-bite (which marks the filling surface so they know where the bite should be), and then drilling/shaping of the filling surface so it matches up with its mate's surfaces.

One more distant possibility - could you be having pain from the site of the novocaine injection? It could be that the inexperienced guy put the needle in a bad spot?
posted by LobsterMitten at 1:18 PM on March 5, 2011

Amalgam fillings are specifically better able to withstand the kinds of stresses that are placed on a molar during chewing. So for a front tooth it doesn't usually make much difference, but for a back tooth it can be a better choice. It also depends on how big the hole is and where in the tooth the filling is, but for some fillings composite is really inferior and a good dentist wouldn't use it.

I have a couple of composite fillings because they're visible when I smile and they're on the side, so not involved in chewing. But none of that meant the dentist assumed anything about what I wanted in my back teeth because they're totally different teeth and cavities. And actually, nearly all my back teeth are filled with silver and no one ever notices. I currently have a huge ugly grey temporary crown on a premolar and no one sees that either. People are surprised when I point out what's in my mouth. So I can see why a dentist wouldn't even consider that someone would care what those teeth back there look like, they just really aren't that visible in day to day life.

Different types of material are suitable for different types of fillings, and all the stuff about 'oh I already have composite so they should have assumed I'd want more' makes no sense to me. Your dentist used the material which was best suited to the filling he gave you. If you do insist on changing them, you at the very least need to discuss with the dentist how this is going to affect the tooth in the future. You may be lining yourself up for regular replacements every few years as it gets damaged by your chewing, something which is not good for the underlying tooth.

The alignment of your bite is also very important for overall tooth and jaw health. Under your teeth there are stretch receptors that measure the direction and size of force going through your teeth and bones (they're pretty common around your body). These are involved in all kinds of things like appetite control (chewing harder foods sends a stronger signal to your brain that you're eating, helping to trigger satiety), and jaw bone density (all bone grows to provide support in the direction of mechanical stress). If a filling is made too low so that it's not putting pressure on the other tooth you can experience bone loss under the two teeth, making them become loose. This is one reason why dentists don't like pulling random teeth from the middle of your jaw. So it's pretty common for a dentist to err on the side of making it a touch too high to start with then shaving it down if necessary, so that it definitely makes contact and still provides the strongest filling (building it up is difficult, plus you wouldn't notice if it's too low). Sure it's better if they manage to get it perfect but my (very very good) dentist told me that it's quite difficult to get right because they don't know how it's going to feel inside your jaw - some people are more sensitive than others. So going back to get it checked is the right thing to do, it can easily be fixed if it is too high, and they shouldn't charge you for it. And having to do this isn't unusual and doesn't make this guy a bad dentist at all.

So your dentist gave you a filling that was specifically designed to be strong, hold your tooth together for a long time, and maintain the best overall tooth and jaw health that was possible. None of that makes him bad in any way, and your anger is misplaced. He should have discussed with you what kind of filling he was using and told you to come back if it was uncomfortable, and you should definitely bring that up with him. But calm down on all the composite vs amalgam stuff because no one was trying to screw you, and you have no reason to think this guy was anything but a really good dentist who cares about your teeth.
posted by shelleycat at 2:27 PM on March 5, 2011 [4 favorites]

I am not a dentist, but I know a lot about dentistry and it sounds like, as shelleycat says, this dentist used amalgam because it's a molar and amalgam is stronger for molar-type biting. Especially if this was replacing another filling, the new filling is likely bigger and the tooth structure somewhat weaker, so it's not a matter of just 1.) noticing it was composite before, and 2.) putting in the same thing. There are other issues here. As for the pain, as others have suggested, you likely need what they call an occlusal adjustment, a very minor fix to get the bite right. Go back and have that done (and voice your concerns), instead of assuming all sorts of negative things.
posted by FlyByDay at 8:17 PM on March 5, 2011

Aside from all the above reasons for using amalgam back there, here's another. (I'm not a dentist. I used to manage a dental office.)

Packing resin composite and packing amalgam require different finesse. If your young doc has done 600 amalgam fillings in molars, but only 6 resin composites in molars, s/he may not be comfortable (yet) putting resin composite into your mouth.

And ya, the amalgam lasts longer, generally.

Third, I just had an enormous (deeeeeeep!) Distal Occlusal filling on the upper left side about a month ago. It was much deeper in real life than it appeared on the radiograph. The tooth still hasn't quite settled down from all the banging around near that nerve.

So in addition to asking about having the bite profile checked, as the doc if it was a deep cavity, or superficial.

Finally, as I usually say, whether your dentist is trying to rip you off or not doesn't matter a whit if you feel taken advantage of. Do this doc, and youself, a favor and find a dentist that you like, respect, and trust.
posted by bilabial at 6:34 AM on March 6, 2011

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