Wednesday, January 04, 2006

Dodgy restoration dodgy boss


Mr L came to me today complaining about "swollen gum and toothache". He said his gum swelled up so much he could no longer wear his partial denture but the swelling had gone down before he could get in. Intially I thought he had gum infection as he moved his finger along his gingivae to show me where the swelling was. Just when I was about to give him a lecture about him wearing his P/- 24/7 he said he thinks a piece of filling fell out from 21 that's why it hurts. The filling was actually intact, it was done by my boss just 2 months ago but the tooth turned out to be non vital and TTP so I took a radiograph. Holy moly! My boss had shoved the composite right into the pulp chamber! This wasn't the first time I'd to fix up some shady work done by my boss. I was pissed by the way he treats the patients but because he's been nice to me so far I helped him cover up and just patch things up quietly. I dunno what happened to that tooth initially, it might have been a carious exposure and RCT inevitable, but he could have at least tell the patient what happened and discuss treatment options with him instead of making him pay for the restoration which would have to be removed anyway for RCT.

There was another time when I'd a patient with deep carious lesion close to pulp but no symptom. I didn't want to jump straight into RCT since there was no pain. I thought I would give the pulp a chance to lay down secondary dentine so I left a thin layer of infected dentine behind and restored the tooth with Fuji VII. I told her to come back asap if she starts getting pain but if not we'll wait for 6 months and see how it goes. 3 months later she came back with a composite restoration in place and unbearable continuous dull throbbing ache that kept her up all night. She actually came back 2 months after she had the temporary because the tooth started to hurt when she bites down but because I was travelling she saw my boss who despite the dull ache replaced the temporary with a composite restoration just because the cold test is positive. Hullo any tooth with more than one root would give positive result unless the tooth is looooooooooooong dead. So my poor patient spent $100+ on a useless filling, put up with 1 month of pain and ended up having that tooth pulled out anyway.

Then there's this time when his patient came back the next day complaining about sharpness in her new filling. My boss wasn't around so I'd to see her. She said the filling was very sharp at the back and asked if I could polish that for her but when I looked at it jesus christ there was a big hole in the filling itself. The 10 mins quick polish appointment the front desk squeezed in between my normal schedule turned into a 30 mins replacement appointment. My next patient wasn't too happy about it and decided to go walkabout. I never see him again.

I really dunno what my boss is up too. He charges the lowest fees in the whole country (when Veteran Affairs pay more than the fees you charge you know something is VERY wrong here) but on the other hand he seems to be doing dodgy things to make patients pay more. I think I'm probably one of the endangered species of dentist who still tell patients the truth (except when I'd to cover up for other ppl boooohooooo I don't lie I just don't tell them everything). If the decay is reversible I would tell the patient so and wouldn't jump into picking up the drill even though I would only get paid if I do. I would make heaps more bling if I practice dentistry like most other dentists but who cares bling is not everything at least my conscience leave me alone and I can sleep at night.

4 Comments:

Anonymous Anonymous said...

hey, good for you dear!!
i know dentists in Asian countries who place PLASTIC crowns, and i mean PPLLASSSTTTIICCC crowns for anteriors.. and they big, juicy swelling periodontium. no, they don't do anything about the perio condition. all they care about is getting the quick cash.
it just defies my teachings in the school that "Eradicate all underlying problems before placing any restorations"
Yea right..
Maybe they are dodgier elsewhere..
I don't know.. speechless

5/1/06 12:11 pm  
Blogger Dr. Mommy, D.D.S. said...

thanks for your comment and glad you like my site! yeah, i know what you mean about seeing stuff your boss does and you're like "WTF???" that's why i really hate working for someone else and can't wait to go into private practice for myself. then you won't have to answer to anyone else or explain anyone else's mishaps.

like this one time this guy came in around september, my boss had done a crown on him in july, and i see a radiolucency on the distal root of the lower right first molar (here we call it #30) i saw the guy's radiograph from july when he came as an emergency and saw huge caries to the pulp and was like, man, this tooth should have had RCT way back then. so then try explaining why the crown failed and why my boss didn't do that from the beginning and now he needs a $700 RCT after just spending $1000 for a crown. ugh! man, it's not easy...

good luck, i'll keep checking your blog!

12/1/06 10:42 am  
Anonymous Anonymous said...

Don't ever give up your ethical standards.
Be true to yourself and the profession.
A retired dentist

12/1/06 9:57 pm  
Blogger Rachel said...

Hi ! I'm also a dentist down under :) I am lucky to have a very good r'ship with my boss and he has always been upfront with patients. He charges the same as VET affairs and tries to keep things affordable for people. His motto is "if you are ethical, the finances will take care of themselves." I have been practicing for 4 years now and the more I see it, the more I realise that taking short cuts is defintely not the way to go ! It will come back and bite you in the end. Your boss will probably miss you when your gone.

I feel bad for you that your boss is so dodgy. Hope that you can find a better one sometime and help ease the stress and frustration.

21/1/06 4:54 pm  

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