Monday, July 11, 2011

I Need Your Advice


I just finished watching The Rite with Anthony Hopkins, so I am slightly freaked out. Sometimes when I watch those types of movies, I am convinced that I am somehow possessed (or the people I come in contact with are possessed). This sort of leads into a situation I am going to need some help on.

About 6 weeks ago, a female patient, mid-40s, came into my office complaining of a 6 unit anterior bridge she had placed about 3 years ago at another office. The bridge extended from tooth #6 to #11 (6 and 11 being the abutments and 7-10 were the pontics). Before she had the bridge placed, she had 2 individual crowns on 6 and 11, and a removable partial denture to replace the missing teeth 7-10. She stated she actually liked that better than having a permanent bridge. She didn't like the way the pontics looked against her tissue, and she was much happier with the pink acrylic of the removable partial. One of the abutments had recurrent caries, so something had to be done anyway.

I had given her different options all the way from implants to pink porcelain on a new fixed bridge. She didn't want to hear it. She already knew she was happy with a removable partial so she wanted to go back to that. The preparation day was without incident. I removed the fixed bridge, re-prepared the abutments, and made an impression. We had already fabricated an upper temporary acrylic partial for her to wear during lab time. At the next appointment, I tried in the restorations on 6 and 11. They looked great. Per the lab's request, I pulled the restorations in another impression so they could fabricate the partial framework on a model that included the crowns. Everything was fine so far (the possession had not taken place as of yet).

The next appointment was a framework try-in with crowns in place. The framework fit fine, and I was planning on adding Valplast® clasps on the canines to make it a little more esthetic. At her next visit, we had teeth on the framework in wax. I removed her temps on 6 and 11, and tried everything in at once. I thought it looked fantastic. I handed her a mirror, and my assistant and I stood in front of her, so we could watch her reaction. She picked up the mirror, glanced up at me with a look I had not recognized before, and screamed "GET OUT!!"

It didn't even sound like her voice. My assistant and I high tailed it out of there so she could have a moment looking at them. I walked back in, and she was steaming. She said they were too long, too wide, not even, too round, and on and on. Now, I am a very calm person. Nothing really stirs me up, but I get sensitive to people being upset with me. I told her not to worry, as this was just a try-in. We could still change things at this point. I actually decided to call my lab technician to see if he could come out and adjust her teeth at my office. We scheduled a date, and they both came to the office.

My technician brought practically everything he owned. He removed the teeth that were on the partial and placed new ones according to her liking. She was ecstatic about the look. I was a hero, and he was hero. Now we could process.

A week later she came back in so I could deliver the case. I removed the temps again, tried everything in, and the demon came out for a second time. She was about to explode with anger, saying that they were not the same teeth that were in there when we tried them in. “These are too narrow. These are too long…” I told her the lab tech would have no reason to remove the teeth he had in there and change them; they are exactly the ones she liked. She was so mad, she started crying. She said they were ugly.

Ok, here we go. Now what? I removed everything and placed her back in the temps (staying very calm). At this point, I wasn’t sure if I should call an exorcist or my lab tech. I ended up calling my lab tech for another meeting with her.

In the back of my mind, I am not sure I am ever going to be able to please her. I mean, this thing looks really good. I am not sure what my options are because I haven't been faced with this situation before. I can give her all her money back, but what is my responsibility with the crowns? Can I leave her in temps on 6 and 11 and refer her to a prosthodontist? We haven't had the next appointment with my lab tech as of yet, so there is a slim chance we can turn this around. I am just trying to figure out what to do when I decide it’s not going to work out. Stuff like this makes me want to go back to being a cook. (At least if I undercook a steak, I can always throw it back on the grill.)

Have a great week, and any suggestions are greatly appreciated.



Tom@1-800-DENTIST said...

My only suggestion is to keep a bottle of holy water handy in case she schedules another appointment.

jamie said...

wow, my knees get weak just thinking about people like this. dentistry is tough enough without having to deal with all of her other issues...and she CERTAINLY has other issues! who acts like this?

i'm not sure i have any advice to give you for this crazy lady, except perhaps just put dentistry off to the side for a moment, sit down with her and just see what is wrong. she may just be super-stressed out and be irrational. who knows. people usually act crazy for a reason. i'd try to level with her as a human being before throwing in the towel and giving her back her $$$. could that old RPD really have looked so much better? my guess is that she hardly remembers what it looks like, but has an unreal expectation of what this new one should be. good luck!

Anonymous said...

You are so screwed. If you try to please her. Take pictures, have her bring someone else to the next try in appointment as her witness and have her sign the chart saying she approves the partial. If you refer her in temps just make sure she signs a release stating she knows she has temps in and needs to finish the work somewhere else of her choosing and you are no longer responsible for her care. Just state that since you obviously are unable to satisfy her high standard and lost her trust it is in her best interest to find someone who can do what she wants and needs. You just want her to be happy. It will probably be the best money you every spent to reduce your stress level if you give it back to her. Good luck

Anonymous said...

I think Anonymous #1 has a very cogent point. This is a no win situation and the $$ are secondary, if not tertiary. Even if you get her to sign off on the completed case, I'd be awaitng further repercussions post treatment. YOU signing off on the case with a refund is probably the best outcome for YOU. Best of luck, my friend!


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