I'm not so sure I trust my dentist anymore

[ChrisSF]

I struggled with bulimia for about a decade, and as a result my teeth were in horrible condition and even falling out. My boyfriend referred me to his dentist who also specializes in cosmetic dentistry. I didn't have the $50K to get all the work done in one go, but he assured me that wasn't going to be an issue and I could get whatever work done now that I desired. We established a plan, including a regimen of prescription mouthwash and toothpaste to reduce the bacterial load in my mouth. Of course I wanted the teeth in front to be done first since that is what is visible to other people and I hadn't really smiled in ten years.

After a few months of excruciating dental work (root canals on nearly all my teeth) and lots of painkillers I was happy with the results. The teeth looked great and I couldn't even believe they were mine. I no longer had to suffer from abscessed teeth and debilitating pain. I haven't been able to afford to get the teeth in the back parts of my mouth done yet, but they're almost all still there.

Since I had the work done I've had repeated problems with the teeth on the top. Two of them came off while I was eating, and one of these crowns I swallowed. This all despite the fact that I've stuck to old habits and have been extremely careful about what I eat and how I chew, namely chewing on my back teeth as much as possible (despite my dentist sarcastically saying I could chew on rocks because these porcelain crowns are so strong). Since then he has lasered my gums twice, because on two of them he decided to use the old teeth to post my crowns without asking me first, and those broke (one was extremely painful), and had to use the laser when he redid the work by making his own posts. There was one time I overheard him and his assistant talking about how they used the wrong cement on one of my teeth. Now I permanently have two long teeth on the top because he took a laser to my gums and the first time he used the laser was to make my gums symmetrical, which they clearly aren't anymore. He said this wouldn't be an issue because when I smile the tops of my teeth aren't visible anyway.

Two days ago was when I swallowed one of my crowns. Every time I've had an issue with my upper teeth he says its because I need to get the posterior teeth done so all my teeth will be strong. I only started having this work done a year ago, and initially he said getting the rest of the work done over the course of a few years would be fine. Now he's pressuring me every time I see him to get the other work done. This amounts to tens of thousands of dollars.

He talks about things like bite force, saying all the pressure is being put on my front teeth despite me knowing and having told him that I primarily use my back teeth to chew food. I mostly eat soft foods anyway, just because I don't want to risk breaking any crowns. He is not a cheap dentist, and paying this kind of money I feel the quality of work should be top notch from the start. He says I'm biting at weird angles and that's why the crowns aren't staying in. I have a night guard that I use every night because he said that would help my teeth set and be stronger, but it doesn't seem to have much of an effect.

The weird thing is the bottom teeth have never had issues. It's only the top ones, and each time he talks about "re-engineering" something and it makes me extremely nervous that he's using my mouth as a laboratory experiment where he isn't sure about anything. I was under the impression this kind of cosmetic dentistry should have a straight forward procedure. Are the problems with my front upper teeth really a result of not having thousands of dollars worth of porcelain crowns on my posterior teeth, or is he just trying to cover up for his own mistakes?

 

[Bertram Boniface]

Dental work that is properly planned and done well does not fail in a short space of time - within one year.
Really good dental work should last in excess of twenty years.
Really good dental work is rare.

Treating cases like yours where there are serious problems cannot generally be done in 'bits' as appears to be what has happened in your case.

Usually, after exhaustive records taking and treatment planning, a full mouth mock up is done in wax on cast models of your teeth on an instrument known as an adjustable articulator. All the teeth to be restored are then prepared and this mock up tested in the mouth (for function and appearance) using high quality laboratory fabricated acrylic provisional crowns. Only when everything has been shown to work well are the provisional crowns replaced with the final porcelain restorations.
This does not seem to have happened in your case.

All too often this sort of piecemeal approach (without proper planning) leads to loss of control, problems, fractures and failure. More treatment is then prescribed which only serves to precipitate yet more failure. The result is a vicious spiral of more and more treatment, more and more cost and more and more failure. You are starting on this path. Stop before it is too late and question what is going on.

The fact that your dentist has just used the same laser to destroy the symmetry he first created with it, should tell you a lot. It's curious how the gum symmetry which was important at the beginning is now "not important because the tops of your teeth are not visible anyway".

The fact that he is pressuring you to have more work done at the same time that the work you have already had done is falling apart should also tell you a lot.

The fact that he is now starting to blame you for his failure (weird biting angles and not having your back teeth crowned) should also tell you a lot.

You are right to be extremely nervous.

The kind of cosmetic dentistry you describe is anything but straightforward, it is difficult, complex and requires a great deal of skill and experience.

Get your money back (the work you have had done is self evidently not fit for purpose and not of merchantable quality) and find someone competent and honest to make a new plan and do the work properly. Be prepared to start again. Do not throw good money after bad.