Question:
Which restorations are most likely to fail? And are crowns considered
cosmetic or medically necessary?
Answer:
As I read the article, I became overly filled with emotion.
Had it really been almost forty years since this technologic
development occurred? Did the time really pass that quickly?
In dental school and in my early days of practice, we still
relied on those somewhat cheezy, acrylic-processed-to-gold
crowns. Unfortunately, the facings possessed the very bad
habit of darkening horribly. They also were wont to
completely popping off far too frequently for our own taste.
Somewhere around Third and Bainbridge Streets over in Center
City Philadelphia, just a couple of blocks from South Street,
there exists a small storefront attorney who "specializes" in
personal bankruptcies for small-time debtors. These are the
same guys who are drowning in consumer debt. For $750 or so,
the attorney files the necessary papers and before you know
it, you are free and clear.
However, if you come to him with a product liability lawsuit,
let's say a class action suit against American Home Products,
the manufacturers of Phen-Fen, I am certain he would not even
know where to begin. Law is just like that. It is all so
very highly specialized.
Now if the depositions for these small time bankruptcies
routinely got up to $50,000 or more plus court costs, there
would be no personal bankruptcies either. He fills a certain
need within his community, which completely appeals to his
specialized clientele. By contrast, product liability
lawsuits run into the millions and you had better get a
lawyer who knows what the heck he is doing.
So here we are, dentists all, and we have little or no
specialization with our own general dental work. Every
patient who comes over even for a simple amalgam filling is
somehow "worked over" and convinced that he/she cannot
possibly endure even one more day without the latest in
cosmetic dentistry.
When looking at the overall oral condition, this may or may
not be warranted. It may be severe overkill. I bet that
within three or four years, many of these patients will be
out there again looking for yet another dentist and yet
another solution.
This patient will be searching for a little attention for
several new problems and several of those recurring old
problems too. This may even include several failed cosmetics
restorations. Why not just go back to the cosmetics dentist
who made you so happy only a few years back?
With dentistry, very little is written in stone. Even less of
dentistry is really permanent. You do not "get your teeth
fixed" and that is that for the next ten years. It does not
work that way.
You will need plenty of ongoing care over a lifetime. If you
borrowed the money from your family, or if you dug a little
too deeply into your nest egg to get your cosmetic work done,
what will you do the next time around? The cosmetics
dentists will not want you once your money is spent. So you
look around for some alternatives.
There are the patients that come over here almost every day
of the week with those failed or failing restorations. They
have no resources for their replacement either. This is
unfortunate for everybody.
Every patient who wants the latest and the greatest (and is
also willing to pay for the latest and greatest) may be lucky
enough to get it, or maybe not. Now this new technology is
not rocket science and it is not product liability class
action lawsuit stuff either. I am convinced that in one day,
I could teach any layman about all of the ins and outs of
cosmetic dentistry alternatives. But it is a day. Patients
want the answers in a minute, not in a day.
We dentists know about most of the alternatives ourselves.
The problem is that, just like the class action depositions,
you may not be able to afford them. Most dental offices
either "ratchet-you-up" or "spin-you-back" to the level of
care that the particular office itself is most comfortable.
Could you imagine that happening within law? Could you
imagine the problem adjusting itself to the solution that the
lawyer knows best with what needs be done?
Cosmetic dentistry is clearly NOT general dentistry. And
general dentistry is not cosmetic dentistry either. We
dentists tend to confuse our patients and possibly even
confuse ourselves about this. This is purposefully done to
market our services and make some money. It does not bode
well for this profession.
Just heard the the class action lawsuit against Heraeus Kulzer,
or what is called the Artglass scandal, due to the manufacturer's
attempt to deny a very obvious fact, is running close to $1,000
per each unit and there are some 250,000 failing units in the US !
Any crown where insufficient tooth structure remains, or is not
properly preapred WILL fail. Most of the others will not fail.
Crowns are either "medically necessary" or cosmetic. I try to define
which the patient is after, and then go along with it or not, based
upon perceived success.
