Dentist Competence FAQ.

Or: Does he have the Right Stuff?

The days of seeking a dentist by personal referral are fading. Instead, there are significant incentives for seeking care at a facility that participates in your dental insurance plan. Just how good are those dentists? Are they fully qualified to render dental care? What is the nature of their training, their experience? Do they have a history of negligence, of license suspension? The curious consumer wants to know...

Q: Is there an online resource where I can find out if a certain dentist has had any complaints, lawsuits, etc. lodged against him/her?

Alternatively, are there any national, state, or local sources for such information? (The dentist in question practices in Seattle, Washington.)

I would greatly appreciate any information you can provide.

A: There is a National Practitioner Data Bank that collects such data, but it is unavailable to the public. Currently, many state dental licensing boards make such disciplinary information available. In Washington, relevant information can be found at the web site of the Washington State Department of Health; See https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx For other states, inquiries may be made through the corresponding state board of dentistry. A listing for these agencies may be found at http://www.healthguideusa.org/state_dental_boards.htm

You might also try a search query consisting of the dentist's name in an internet search engine. You never know what might turn up in public court records, many of which have been indexed by the search engines.

Q: Hi. I have recently moved to CA and had a terrible experience with a dentist acting as an endodontist with no actual certification or experience. I was butchered like a guinea pig and couldn't use that side of my mouth for three weeks. I would like to write a letter to the regulatory body that would handle investigations/complaints and prevent someone else the pain/fear that I went through. Can you help? ADA/Medical Review Board?

A: The preferred method of handling complaints with a dentist is through peer review. For information, go to http://www.cda.org/page/Peer_Review_Manual. Additionally, you may file a complaint with the Dental Board of California at http://www.dbc.ca.gov/

If all else fails, you may register a complaint with the Dental Board of California at (916) 263-2335.

Q: How do I get background information on a dentist, such as his education, patients complaints against him, references, years in practice etc.?

A: The non-confrontational questions are perfectly OK to ask of the dentist personally. A copy of the dentist's diploma, usually on display in the office, will indicate where he was trained as well as the year of graduation. If a dentist posts his license to practice dentistry, it will indicate the year it was issued. In New York, dentists are only required to post their current registration certificate, which only lists the dates of the current registration period.

Some state licensing bodies post information regarding current license status and complaint history on the Web; in New York it's at http://www.op.nysed.gov/

There are efforts underway to fully implement the National Practitioner Data Bank, to make available the complaint history of most practicing health care providers. You can imagine how popular that is among the professions!

Keep in mind that a history of a complaint is not necessarily a blot on the record of a health care practitioner. In a world where personal injury lawyers take cases on contingency, some people are prone to initiate a complaint on a whim.

Q: I recently had oral surgery done in order to remove a ruined tooth and an infected salivary gland.

The tooth had been ruined by a dentist who instead of clearing the root canal went sideways and perforated the wall causing the tooth to become unsavable. This attempt at canalling the tooth was based on the previous observation by three separate dentists that I had a tooth abscess.

The problem is that it was not a tooth abscess at all but an infected salivary gland right above the second bicuspid.

One dentist had even lanced it but to no avail. Antibiotics had done nothing!

When I went to an oral surgeon after almost two years of suffering, he immediately took a biopsy. That's how he found out that it was salivary gland tissue.

My question is this, don't they teach dentists in med school to make sure that what they think is an abscess is not in fact a salivary gland? Also, how is it possible for an expert dentist to go sideways on a root and ruin the tooth. There is a big difference it going straight up a tooth and going sideways as far as I can tell!

A: Your questions are well taken, and can certainly be appreciated by anyone who has been victimized by a difficult-to-diagnose condition. We phrase this carefully, since the difficult diagnosis is the only thing that is indisputable. Although your ordeal was unpleasant, it is all too easy to assume negligence or incompetence on the part of the treating dentists. Although we sympathize, you should know that even consummate clinicians are sometimes stymied by vague, non-specific, or misleading symptomatology. Such is the deceptively difficult job of the diagnostician.

Some things that may have contributed to the confusion:

  • There are normally no salivary glands above the second bicuspid, whether upper or lower, so none would have been expected there, much less an infected one.
  • The mouth has a very limited repertoire of symptoms for a wide variety of causes. Consequently, the nature of a problem can seldom be inferred by simple consideration of a vague pain. Additionally, there is a strong predilection for oral pain to refer to a site that is remote from its actual source; that is, the pain feels like it's coming from somewhere else.
  • Infections in salivary glands cannot be diagnosed by conventional x-rays, and dental infections only manifest in x-rays in the later stages, and sometimes not at all.
  • The oral surgeon may have seemed the hero, but he entered the scene at a late stage. Symptomatology tends to become more specific and characteristic of the actual problem as the pathology progresses. He also had the benefit of the input from the previous dentists, which, despite the negative nature of the findings, allowed him to exclude certain possibilities in the differential diagnosis. He may indeed have had a keen diagnostic eye, or perhaps he was simply at the right place at the right time.

As to the perforation during the root canal access: any dentist who has done a few root canals knows how easy it is to perforate. The difference between a good access and a perforation is not the difference between "going straight up a tooth and going sideways", as you say, but may be only a few degrees of arc of inclination. The wall of the pulp chamber is only about 2 millimeters thick from side to side. Decay at the tooth neck, aberrant tooth anatomy, or a crown on the tooth can completely eliminate the surface landmarks and reference points that are critical in gauging an angle of approach. Trust us-- we've been there, and so has almost any dentist who does root canal treatment.

This is probably not what you want to hear. However, it is too easy to react in anger when misfortune occurs; it's too easy to assess blame. Indeed, there may be some blame here, but it would be difficult to determine if this were the case, much less prove it in a court of law.

You may also not want to consider yourself fortunate, but there are those who remain in pain, with conditions that continue to be refractory to either diagnosis or control. In the end, your problem was successfully diagnosed and treated, albeit in a painful and circuitous way.

Hope this helps, at least a bit...

Q: I'm about to begin the process of being fitted with partial dentures at a local dental clinic. Thus far I've had full-mouth x-rays and an initial exam, and am slated for a number of extractions. I've also taken my wife there for an exam. The dental staff seems competent, as far as I can tell from what little has been done, but I've observed some things at their practice that have left me feeling uncomfortable.

Each time I've been there, the front office is in a state of near-chaos; customers appear to be waited on according to which one is the most vocal and upset. I waited an hour beyond my appointment to be seen, and my wife waited an hour an a half before she was even x-rayed, and the entire visit lasted some three and a half hours - for an exam and x-rays. No one bothered to inform us how late they were running. In the waiting room is a sign: "We do our best to keep your dental costs low; please forgive us any delays."

Personally, I can't see a connection, but I think I can see one reason they can't maintain a schedule. In both my wife's case and my own, the exam found extractions to be necessary, but not an emergency. Rather than scheduling another appointment to perform the extraction, the staff began preparing to perform the procedure on the spot, giving every indication that this was their standard practice. They may think this is some sort of customer service, but it's also a sure way to pitch an appointment schedule out the window.

To top it off, yesterday I received my invoice for the previous month, and I was being billed for two exams, and two x-rays, plus a full-mouth x-ray for which there was no apparent charge -- all on the same day! The worst part is I paid them on the day of the appointment. I can't decide if this is indicative of dishonesty or incompetence.

The fact that the office is in disarray may not say anything about their ability as dentists, but on the other hand, it might. I'm uneasy about entering into a six-week, multiple-thousand-dollar dance with these folks. What's your take on it?

A: You're quite correct-- the degree to which an office is (mis)managed has little to do with a dentist's competence in rendering dental service-- strictly speaking. However, mismanagement (we think the term applies here) may either reflect ineptitude in running an office, or a conscious effort on the administrator's part to cut costs at the expense of the patient's comfort and convenience. Either way, a poorly managed office will eventually impact on the quality of service.

There are several things that cut into a dental office's productivity; chief among them is patient lateness and broken appointments. A common, but inconsiderate way for a doctor to limit his exposure to down time (that is, when he is sitting around doing nothing due to patient absence) is to schedule several patients for each time slot in his schedule, and to do as much work on each patient as possible while they are in the office. This way, a doctor is productive, and the patient is the one waiting around doing the sitting. Although time is indeed money for the patient as well as the doctor, this practice shifts the loss of productivity to the patient. It really helps the doctor to implement this strategy if he doesn't much care about his patient's best interests.

We think you see where we're going with this. If your dentist doesn't care enough about your time, you certainly can't expect him to go that extra length to give you the best dentistry he can, regardless of his competence. Although your experience may have been a fluke, the "please forgive us any delays" sign is evidence that this is an intentional modus operandi. If you are inclined to discuss this with your dentist to see whether your experience was perhaps not representative of what you might expect in the future, more power to you. From where we sit, your interests may very well be better served elsewhere.

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