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From: Steven Bornfeld on 3 Aug 2008 18:47
a_riot wrote:
> On Aug 2, 8:23 pm, Steven Bornfeld <dentaltwinm...(a)earthlink.net>
> wrote:
>
>> There is no way to say what appropriate action is. You may or may not
>> have gotten informed consent. Of course if he was dishonest with his
>> description of the procedure it could be said that he did not obtain
>> informed consent. OTOH, how long were you sitting in that chair for him
>> to grind down all your molars before you began to get the suspicion that
>> something was amiss? Did he anesthetize all your teeth? Were you in pain?
>> Where I'm going with this is that the question of whether you granted
>> implied consent is very much up in the air.
>> What is not in the air is the condition of your teeth. You say you
>> have spoken to more than one dentist. Have they examined you? What do
>> they suggest?
>>
>> Steve
>
> Thanks for your response Steve. I realize this situation may make me
> look a little daft to put myself in this position but at some point
> you have to trust that what the dentist tells you is the truth
> otherwise you would never let anyone work on you.
>
> I was in the chair for about 20-30 minutes, not all of which was
> sanding of course, as he spent time putting paper between my molars
> and asking me to clench my teeth. There was no pain or sensation at
> all and no anesthetic was used. My teeth are not particularly
> sensitive so I couldn't even feel the grinding, I could just see and
> smell the enamel flying out of my mouth but had no way to determine
> how much was being removed (note to self, always demand a mirror to
> watch the entire procedure). I have now been examined by two other
> dentists, one that says he specializes in occlusion and a TMJ
> specialist and both are rather astounded that a dentist would go in
> and remove a lot of cusp material in an asymptomatic patient with no
> preparation such as casts, scans, measurements or even a simple wax
> imprint of my bite, in preparation to change some fillings. Seems
> like a 'scorched earth' dental policy, far beyond what was
> necessary.
>
> From my understanding now, the theory that the bite should conform to
> the "canine rise" has been out of date for a number of years,

I am not aware that it is. Most of the lectures I've attended in
recent years recommend canine rise (posterior disclusion) in large
restorative cases. When I was in school (I am vintage 1976) we were
aiming for what is called "group function" in natural dentition.
Certainly a major occlusal change should be justifiable--this may be
very tough for him to establish.


and
> having this bite thrust upon me when I had no desire to change my bite
> seems like battery to me.

I'm no lawyer, but to me this goes to the issue of consent--battery is
"unauthorized touching". This could be tough to prove.
I am assuming that you are able to bite down on your back teeth. If
you cannot, you definitely have a problem. If you can, you should speak
to one of the other specialists to see what can be done at this point.
That's more urgent than dealing with the first dentist. I'm certainly
not advising you one way or the other about that.

Good luck,
Steve


The TMJ dentist speculated that it looks as
> though he equilibrated my teeth while I was reclining in the dentist
> chair so that when he looked at my bite during the procedure, my jaw
> was too far back due to being in a reclined position, so he
> accidentally gave me this weird bite where my lower jaw has to be all
> the way back for my anterior teeth to not crash. When I sneeze, my
> lower anterior teeth just smash into the upper anterior teeth with a
> lot of force causing pain. There are so many different problems now,
> that I am not sure if he could have done a worse job on purpose.
> Since I can't feel the molars touch now, it feels like I have had them
> all extracted. I can't chew my food correctly either since most of
> the chewing has to be done by the anterior teeth but they are now
> crashing. This must be what a cat feels like after its been declawed.
>
> As far as consent is concerned, I told him that I never have had any
> TMJ symptoms during the initial consult and that I like my bite even
> if it doesn't conform to some theoretical dental ideal. He then
> justified the procedure stating that he needed to remove a very minor
> amount of enamel so that the restorations wouldn't get damaged once
> they were in. "You don't want to have to pay for restorations all
> over again in a couple years do you?" he asked. Any patient hearing
> this would not suspect that this procedure would result in a complete
> anatomical change in my bite and jaw geometry. I wasn't informed of
> any risk (TMJ symptoms), alternative procedures (nightguard, splints
> etc), or referred to a specialist (prosthodontist).
>
> In fact while he was doing the procedure, he sensed I was somewhat
> worried since I joked about trying to level a table with a saw, and
> that we all know how that ends. He reassured me by telling me some
> stupid story about a steamboat engine repairman who charged $1000 to
> repair the engine. When he showed up he just hit the engine with a
> hammer in a certain place which fixed it. The owner complained about
> the high fee for such a simple repair, to which he replied that yes
> its easy to fix but you have to know exactly where to hit it. I
> suspect this analogy was meant to assure me that the $500 fee for 20
> minutes of work was justified because of his extensive knowledge about
> where and how much to remove. When I went back to his office a week
> later, I challenged him and asked him what training he had in this
> procedure. He just said "35 years experience". I pressed him and
> asked if he had any training at an accredited dental institution to
> which he just said "yes, a lot of training". It seemed like a dodge
> to me, so I am guessing his "training" consisted of trial and error on
> many patients over the years.
>
> When I think back to other dental work that I have had which only
> consisted of mercury fillings and one crown to replace an old mercury
> filling, my occlusion must have been slightly altered every time
> something was done, but I actually never noticed as I think my mouth/
> jaw has been pretty adaptable to small changes. That's what makes me
> think he did a real hatchet job since in the past I have never had a
> problem with some minor occlusal adjustment. I now feel like I have
> someone else's mouth like I had submitted to some strange plastic
> surgery where they did a jaw transplant.
>
> This cannot be what a successful complete occlusal adjustment feels
> like.
> Your perspective is appreciated.
>
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