I want to ask my dentist in town to share the X-rays and results with a
dentist nearer to me. What is the proper way to approach this? I don't
want to ruffle any feathers, but I do want to see if the dentist closer to
me has lower prices for re-doing some ancient fillings. The dentist in
town uses a laser for small cavities. I want to see if I can have the
dentist with the laser fill the small cavities in front and do the
"cosmetic" parts of what I need done. How do I go about letting both of
these dentists know that I want to "use" each one for different things
without upsetting either one of them?

The dentist in town is extravagantly expensive, I think. I have an
appointment with his dental hygienist next month. I have an appointment
for a consultation with the dentist nearer to me in March.

Do dentists get insulted by this kind of thing? I want to handle this in
a professional manner and need a little advice about how to tell them.
I'm sort of a timid person, but I need to stand up for myself here and
insist on doing this my way.

Thanks in advance for any advice you have.

Eva

I want to ask my dentist in town to share the X-rays and results with a
dentist nearer to me. What is the proper way to approach this? I don't
want to ruffle any feathers, but I do want to see if the dentist closer
to me has lower prices for re-doing some ancient fillings. The dentist
in town uses a laser for small cavities. I want to see if I can have
the dentist with the laser fill the small cavities in front and do the
"cosmetic" parts of what I need done. How do I go about letting both of
these dentists know that I want to "use" each one for different things
without upsetting either one of them?

The dentist in town is extravagantly expensive, I think. I have an
appointment with his dental hygienist next month. I have an appointment
for a consultation with the dentist nearer to me in March.

Do dentists get insulted by this kind of thing?

in a professional manner and need a little advice about how to tell
them. I'm sort of a timid person, but I need to stand up for myself here
and insist on doing this my way.

Thanks in advance for any advice you have.

Eva

Eva Quesnell wrote:

I want to ask my dentist in town to share the X-rays and results with a
dentist nearer to me. What is the proper way to approach this? I don't
want to ruffle any feathers, but I do want to see if the dentist closer
to me has lower prices for re-doing some ancient fillings. The dentist
in town uses a laser for small cavities. I want to see if I can have
the dentist with the laser fill the small cavities in front and do the
"cosmetic" parts of what I need done. How do I go about letting both of
these dentists know that I want to "use" each one for different things
without upsetting either one of them?

The dentist in town is extravagantly expensive, I think. I have an
appointment with his dental hygienist next month. I have an appointment
for a consultation with the dentist nearer to me in March.

Do dentists get insulted by this kind of thing?

They shouldn't. You are entitled to a copy of your records (including
x-rays) and a reasonable fee for copying may be charged. You need not
explain why, and any dentist who would be insulted IMO is a fool.
I agree with Alex about the laser, BTW.

Steve


I want to handle this
in a professional manner and need a little advice about how to tell
them. I'm sort of a timid person, but I need to stand up for myself here
and insist on doing this my way.

Thanks in advance for any advice you have.

Eva

I was talking with my brother in law who is a lawyer in personal injury
and he was telling me that there was a case ruling that the original
records are the property of the patient. In fact there was a case he
mentioned where the original records were demanded by the plantif and
the doctor did not want to give up the originals.

the judge and the judge placed a "body attachment warrant" on the
doctor. I am told that a body attachment means the sheriff will
actively search for the person and take them to jail in their underwear
vs a bench warrant where they wait for the person to be pulled over for
minor traffic violation etc... This is another good reason to go
paperless and digital x-rays, this way both parties maintain identical
electronic records.
As far as I know from the dental practice act, doctor offices are
allowed to charge a moderate fee for duplication of records.
The issue here with duplicates vs originals is that when it comes to
x-rays duplicate films are not the same quality as originals and
sometimes this gets difficult because the originals deteriorate over
time due to improper fixer time. and making a duplicate of a
deteriorating original is even worse quality. Problem may arise if an
insurance company wants to re-question a benefit payment and they ask
to see the x-rays and the doctor then can not send them the same
quality x-ray as original which may contain critical detail such as
subtle decay explaining the procedure. Digital x-rays solves this
problem although it requires software and hardware and database back-up
maintenance which is still currently expensive. Therefore I do not
forsee the modest duplicating fee disappearing anytime soon.

Steven Bornfeld wrote:
Eva Quesnell wrote:
I want to ask my dentist in town to share the X-rays and results with a
dentist nearer to me. What is the proper way to approach this? I don't
want to ruffle any feathers, but I do want to see if the dentist closer
to me has lower prices for re-doing some ancient fillings. The dentist
in town uses a laser for small cavities. I want to see if I can have
the dentist with the laser fill the small cavities in front and do the
"cosmetic" parts of what I need done. How do I go about letting both of
these dentists know that I want to "use" each one for different things
without upsetting either one of them?

The dentist in town is extravagantly expensive, I think. I have an
appointment with his dental hygienist next month. I have an appointment
for a consultation with the dentist nearer to me in March.

Do dentists get insulted by this kind of thing?
They shouldn't. You are entitled to a copy of your records (including
x-rays) and a reasonable fee for copying may be charged. You need not
explain why, and any dentist who would be insulted IMO is a fool.
I agree with Alex about the laser, BTW.

Steve


I want to handle this
in a professional manner and need a little advice about how to tell
them. I'm sort of a timid person, but I need to stand up for myself here
and insist on doing this my way.

Thanks in advance for any advice you have.

Eva

couple of things.
a laser is not going to give you any kind of advantage over the modern
drill. In fact it will take longer to explode away the decayed tooth
structure.
having a second dentist treat you, you may find a considerable
difference in philosophy and the amount of work that is recommended to
be done. If you are happy with your current dentist and the only thing
that is stopping you from continuing is cost on a few fillings, you may
find that taking a chance with someone else long term this may not be
the best cost savings. There are patients that switch for this reason
end up going to a cheaper clinic to then having to return to the
original dentist or someone else with far more work and problems.

That said if you still want to visit the other office, ask them to
obtain the records for you. But my advice is to stick to one office it
makes things a lot easier for warranty purposes and you are dealing
with somebody who knows your mouth.



Eva Quesnell wrote:
I want to ask my dentist in town to share the X-rays and results with a
dentist nearer to me. What is the proper way to approach this? I don't
want to ruffle any feathers, but I do want to see if the dentist closer to
me has lower prices for re-doing some ancient fillings. The dentist in
town uses a laser for small cavities. I want to see if I can have the
dentist with the laser fill the small cavities in front and do the
"cosmetic" parts of what I need done. How do I go about letting both of
these dentists know that I want to "use" each one for different things
without upsetting either one of them?

The dentist in town is extravagantly expensive, I think. I have an
appointment with his dental hygienist next month. I have an appointment
for a consultation with the dentist nearer to me in March.

Do dentists get insulted by this kind of thing? I want to handle this in
a professional manner and need a little advice about how to tell them.
I'm sort of a timid person, but I need to stand up for myself here and
insist on doing this my way.

Thanks in advance for any advice you have.

Eva- Hide quoted text -- Show quoted text -

Forgive the top posting. I'm responding through google groups because
your original message does not show up in my dinosaur newsreader. I
could only see responses to your post.

I'm curious about your statement that the laser will take longer to
"explode" (geez, does it have to explode??) the decayed part of the
tooth. In my understanding, the laser is painless and doesn't require
numbing. Does the fact that it will take longer affect the quality of
the work done?

I appreciate your response, and I am trying to figure out which dentist
to use. My niece has gone to the first dentist since she was very
little, and he has been very good to her and has not caused her to be
afraid like I am. Maybe you can tell me what you think of his prices
-- I have an estimate here in front of me. The first item is "onlay 4
surf (porcelain) -- $1,101.00." Is this a good price? I think that
just means replace an old filling -- yes?

I'm trying to do my homework. Cost is important. I'm on early
retirement and get a small pension. I was forced out before I reached
full retirement because I was sick a lot with Meniere's Disease. OK,
sad story over -- back to basics. I want to get my teeth fixed if I
can. I am going to have numbers 21, 28, and 29 removed by an oral
surgeon the first week of February. I went to see him today, and he
gave me a price of $860. Sounds reasonable since I will be in la-la
land and won't have to go through the procedure awake. He says my
other teeth are good -- look strong -- and should be fixable. Trouble
is -- I'm looking at about $7,000 that would wipe me out. So I really
need to research prices.

Whatever advice/help you can offer is very much appreciated. This
whole thing gives me a headache. The problems are my fault -- stayed
away from dentists a long time because of fear and some bad treatment.
I found a good one -- very skilled, but not a nice man. He scared me
away again, and now I'm losing these three teeth that could've been
saved if I hadn't been so scared. Now that you've read this whole long
message (at least I hope you have), can you advise me?

Thank you, Eva

On Jan 21, 1:22 pm, "Alexander Vasserman DDS" <purple543...@yahoo.ca
wrote:

couple of things.
a laser is not going to give you any kind of advantage over the modern
drill. In fact it will take longer to explode away the decayed tooth
structure.
having a second dentist treat you, you may find a considerable
difference in philosophy and the amount of work that is recommended to
be done. If you are happy with your current dentist and the only thing
that is stopping you from continuing is cost on a few fillings, you may
find that taking a chance with someone else long term this may not be
the best cost savings. There are patients that switch for this reason
end up going to a cheaper clinic to then having to return to the
original dentist or someone else with far more work and problems.

That said if you still want to visit the other office, ask them to
obtain the records for you. But my advice is to stick to one office it
makes things a lot easier for warranty purposes and you are dealing
with somebody who knows your mouth.



Eva Quesnell wrote:

I want to ask my dentist in town to share the X-rays and results with a
dentist nearer to me. What is the proper way to approach this? I don't
want to ruffle any feathers, but I do want to see if the dentist closer to
me has lower prices for re-doing some ancient fillings. The dentist in
town uses a laser for small cavities. I want to see if I can have the
dentist with the laser fill the small cavities in front and do the
"cosmetic" parts of what I need done. How do I go about letting both of
these dentists know that I want to "use" each one for different things
without upsetting either one of them?

The dentist in town is extravagantly expensive, I think. I have an
appointment with his dental hygienist next month. I have an appointment
for a consultation with the dentist nearer to me in March.

Do dentists get insulted by this kind of thing? I want to handle this in
a professional manner and need a little advice about how to tell them.
I'm sort of a timid person, but I need to stand up for myself here and
insist on doing this my way.

Thanks in advance for any advice you have.

Eva- Hide quoted text -- Show quoted text -

I'm curious about your statement that the laser will take longer to
"explode" (geez, does it have to explode??) the decayed part of the
tooth. In my understanding, the laser is painless and doesn't require
numbing. Does the fact that it will take longer affect the quality of
the work done?

I appreciate your response, and I am trying to figure out which dentist
to use. My niece has gone to the first dentist since she was very
little, and he has been very good to her and has not caused her to be
afraid like I am. Maybe you can tell me what you think of his prices
-- I have an estimate here in front of me. The first item is "onlay 4
surf (porcelain) -- $1,101.00." Is this a good price? I think that
just means replace an old filling -- yes?

Whatever advice/help you can offer is very much appreciated. This
whole thing gives me a headache. The problems are my fault -- stayed
away from dentists a long time because of fear and some bad treatment.
I found a good one -- very skilled, but not a nice man. He scared me
away again, and now I'm losing these three teeth that could've been
saved if I hadn't been so scared. Now that you've read this whole long
message (at least I hope you have), can you advise me?

Thank you, Eva

Still, I look at it this way. Even if the pain is less, to be
totally relaxed you will want to know you will have no pain, and there's
no way to guarantee that without local anesthesia if the patient is
conscious. Once you have well-administered anesthesia, it doesn't
matter from a pain standpoint whether you're using a laser for decay
removal or a low-speed handpiece with a #8 round bur. I can equip my
operatory with handpieces for a couple of thousand bucks. The laser may
be $20-30K. There is nothing you can do on hard tissue with a laser that
you can't do with a high-speed and a low-speed air driven handpieces
more quickly and obviously more cheaply. If money is a concern, I would
go for solid, well-done restorative dentistry and skip the ray gun
razzle dazzle.
Call me an old fart--I'll pass on the laser.

Steve

I like top posting. <G

Anyway, I'm an old fart *with* a laser.

IME, (other laser 'experts' may disagree with me) 'laser anesthesia'
is a bunch of crap. Like Dr. Steve says, it is a less traumatic
method of removing decay and tooth structure, but it is *not* pain
free. Most of the time that I use it, patients are numb.

There are definitely patients who need little (and even no) anesthesia
for dental treatment. In a metro area, there are probably
thousands of people who would rather not be numbed for most dental
treatment. With a laser, these people will be very happy. They are
likely to believe it is the magic of the laser, but it is probably
more within their own nervous system. IME, most people will still need
anesthesia.

Advantages of the laser:

It does not induce cracks into the enamel as it cuts.

Patients like not feeling vibration and pressure.

I can trim soft tissue with very little hemorrhage.

The lased surface is supposed to bond better to filling material.

The laser actually destroys bacteria as it works.

Disadvantages:

Initial expense (my Waterlase was ~$50K).

It does cut slower than a bur.

It won't cut amalgam (or other metal).

It does not live up to the hype put out by the laser companies.

I love it for decay along the gum line and most restorations on
anterior teeth. I don't like it for occlusal or interproximal
decay on posterior teeth.

After all of that, I don't think your decision on which dentist
to 'trust' should come down to the laser or other pieces of
equipment.

Cost of treatment (though a very real issue) is also seldom a great
factor when determining quality of care.

As a lay person trying to judge dentists, you are at a distinct
disadvantage. Kind of like me picking a jeweler, ophthamologist,
surgeon, mechanic, or electrician.

I don't know any secrets that will allow you to make the 'right'
choice.

Best wishes,
D

I'm curious about your statement that the laser will take longer to
"explode" (geez, does it have to explode??) the decayed part of the
tooth. In my understanding, the laser is painless and doesn't require
numbing. Does the fact that it will take longer affect the quality of
the work done?

I appreciate your response, and I am trying to figure out which dentist
to use. My niece has gone to the first dentist since she was very
little, and he has been very good to her and has not caused her to be
afraid like I am. Maybe you can tell me what you think of his prices
-- I have an estimate here in front of me. The first item is "onlay 4
surf (porcelain) -- $1,101.00." Is this a good price? I think that
just means replace an old filling -- yes?


Whatever advice/help you can offer is very much appreciated. This
whole thing gives me a headache. The problems are my fault -- stayed
away from dentists a long time because of fear and some bad treatment.
I found a good one -- very skilled, but not a nice man. He scared me
away again, and now I'm losing these three teeth that could've been
saved if I hadn't been so scared. Now that you've read this whole long
message (at least I hope you have), can you advise me?

Thank you, Eva



Still, I look at it this way. Even if the pain is less, to be
totally relaxed you will want to know you will have no pain, and
there's no way to guarantee that without local anesthesia if the
patient is conscious. Once you have well-administered anesthesia, it
doesn't matter from a pain standpoint whether you're using a laser for
decay removal or a low-speed handpiece with a #8 round bur. I can
equip my operatory with handpieces for a couple of thousand bucks.
The laser may be $20-30K. There is nothing you can do on hard tissue
with a laser that you can't do with a high-speed and a low-speed air
driven handpieces more quickly and obviously more cheaply. If money
is a concern, I would go for solid, well-done restorative dentistry
and skip the ray gun razzle dazzle.
Call me an old fart--I'll pass on the laser.

Steve

Dartos wrote:


I like top posting. <G

Anyway, I'm an old fart *with* a laser.

IME, (other laser 'experts' may disagree with me) 'laser anesthesia'
is a bunch of crap. Like Dr. Steve says, it is a less traumatic
method of removing decay and tooth structure, but it is *not* pain
free. Most of the time that I use it, patients are numb.

There are definitely patients who need little (and even no) anesthesia
for dental treatment. In a metro area, there are probably
thousands of people who would rather not be numbed for most dental
treatment. With a laser, these people will be very happy. They are
likely to believe it is the magic of the laser, but it is probably
more within their own nervous system. IME, most people will still need
anesthesia.

Advantages of the laser:

It does not induce cracks into the enamel as it cuts.

Patients like not feeling vibration and pressure.

I can trim soft tissue with very little hemorrhage.

The lased surface is supposed to bond better to filling material.

The laser actually destroys bacteria as it works.

Disadvantages:

Initial expense (my Waterlase was ~$50K).

It does cut slower than a bur.

It won't cut amalgam (or other metal).

It does not live up to the hype put out by the laser companies.

I love it for decay along the gum line and most restorations on
anterior teeth. I don't like it for occlusal or interproximal
decay on posterior teeth.

After all of that, I don't think your decision on which dentist
to 'trust' should come down to the laser or other pieces of
equipment.

Cost of treatment (though a very real issue) is also seldom a great
factor when determining quality of care.

As a lay person trying to judge dentists, you are at a distinct
disadvantage. Kind of like me picking a jeweler, ophthamologist,
surgeon, mechanic, or electrician.

I don't know any secrets that will allow you to make the 'right'
choice.

Best wishes,
D

Thanks--it's good to get some perspective from a user, and better
when it's not a self-serving uncritical rave.
I imagine the thing about better bond strengths is because the laser
might not create a "smear" layer?

Steve

On Tue, 23 Jan 2007, Mark & Steven Bornfeld wrote:

Dartos wrote:


I like top posting. <G

Oh -- good. :)

Anyway, I'm an old fart *with* a laser.

IME, (other laser 'experts' may disagree with me) 'laser anesthesia'
is a bunch of crap. Like Dr. Steve says, it is a less traumatic
method of removing decay and tooth structure, but it is *not* pain
free. Most of the time that I use it, patients are numb.

So -- on a scale of 1-10, how much pain is involved with the laser? In
your experience, does a person's fear factor increase the amount of pain
they perceive?


There are definitely patients who need little (and even no) anesthesia
for dental treatment. In a metro area, there are probably
thousands of people who would rather not be numbed for most dental
treatment. With a laser, these people will be very happy. They are
likely to believe it is the magic of the laser, but it is probably
more within their own nervous system. IME, most people will still
need anesthesia.

I have no idea where I fall into these categories. I don't know if I
could take this treatment without being numb. My biggest problem is
fear. When I went to the oral surgeon -- just to talk -- they took my
blood pressure, and it was 144/71. I have never, ever registered that
high in my life. The highest reading I've ever seen, when I was rushing
to get to an appointment on time, was 120/70. My normal is 100/70 --
right where it should be. I wonder if my fear will make me think I'm
feeling more pain.

Advantages of the laser:

It does not induce cracks into the enamel as it cuts.

Patients like not feeling vibration and pressure.

I would like that part. Does this laser make a loud noise? Since I
have Meniere's Disease, one of the most distressing things for my
hyperacusis is hearing the drill sound. I have to wear an ear plug if
they work on my left side.


I can trim soft tissue with very little hemorrhage.

The lased surface is supposed to bond better to filling material.

The laser actually destroys bacteria as it works.

Disadvantages:

Initial expense (my Waterlase was ~$50K).

It does cut slower than a bur.

It won't cut amalgam (or other metal).

It does not live up to the hype put out by the laser companies.

I love it for decay along the gum line and most restorations on
anterior teeth. I don't like it for occlusal or interproximal
decay on posterior teeth.

That's exactly what I've got -- decay along the gum line on anterior
teeth. I can see these little red spots along the bottom edge of my teeth
where they meet the gum. The laser wouldn't apply to my posterior teeth
because they are the ones with old metal to be taken out and replaced.
You lose me with the technical terms occlusal and interproximal, tho.

After all of that, I don't think your decision on which dentist
to 'trust' should come down to the laser or other pieces of
equipment.

Cost of treatment (though a very real issue) is also seldom a great
factor when determining quality of care.

That's where I get lost, too. It may be that one dentist charges less,
but is more skilled at the task. An expensive dentist isn't necessarily
better than one who charges less.

As a lay person trying to judge dentists, you are at a distinct
disadvantage. Kind of like me picking a jeweler, ophthamologist,
surgeon, mechanic, or electrician.

I don't know any secrets that will allow you to make the 'right'
choice.

Best wishes,
D

Egad. How do I gain an advantage then in making this decision? There
must be a way for a lay person to choose the best dentist. I do know of
a really good one, but he's a real SOB. It's too bad because his skill
is probably the best I've ever experienced. He could give me a shot
where I barely felt it at all. That leads me to the question of skill
being measured by the way a dentist gives a shot. If he can do it
without my feeling it, does this always mean that he has more skill?
This dentist I'm considering -- the one with the laser -- uses this
vibrator. An assistant holds the vibrator on my face while he gives me
a shot. If the metal syringe touches my teeth when this thing is
vibrating, it drives me nuts! And why is he using a metal syringe? I
thought those were obsolete.


Thanks--it's good to get some perspective from a user, and better
when it's not a self-serving uncritical rave.
I imagine the thing about better bond strengths is because the
laser might not create a "smear" layer?

Steve

I do appreciate the time you've both taken to answer my questions and
address my concerns. I'm still kind of at a loss as to how to make this
decision. I want to compare prices. I do have money in my savings, but
I don't want to be wiped out. This is an awful position to be in. It's
scary and so confusing.

What is an onlay, and should it cost $1,000? I guess all I can really
do is gather as much information as I can and try to go from there.

Thanks! Eva

Thanks--it's good to get some perspective from a user, and better
when it's not a self-serving uncritical rave.
I imagine the thing about better bond strengths is because the laser
might not create a "smear" layer?

Steve

Yes, there is supposed to be no smear layer. But for SE Bond,
isn't the smear layer part of the process? IOWs, I don't know
composite bonds better with all systems (or even any). With 4.5
loupes, the surface is certainly 'rough' before etching or
'conditioning'.

D

Thanks--it's good to get some perspective from a user, and better
when it's not a self-serving uncritical rave.
I imagine the thing about better bond strengths is because the
laser might not create a "smear" layer?

Steve

Eva--

I might have top-posted too, but decided not to. Dartos (the other
Steve) should answer the bulk of your questions, since he's laser-guy.
An onlay is generally an indirect filling (IOW, it isn't formed like
amalgam or resin just placed in the prepared tooth--an impression is taken or
the tooth is scanned in a machine like a CEREC) that covers the chewing
prominences (cusps) of the back teeth.
This vibrator thing I know nothing about--sounds intriguing! Back in
dental school we had an instructor who would grab the patient's cheek,
retract and shake the living daylights out of the cheek. I figure it's some
kind of distraction technique.

As far as metal syringes, for some reason as local anesthesia
developed in dentistry we use reusable (sterilizable) metal syringes and
disposable single-dose cartridges of anesthetic, and a disposable needle.
This is probably just tradition, but it's convenient. When I was a resident
if I had to use anesthetic in the emergency room we generally used disposable
syringes and a multidose vial of anesthetic.

Steve