Monday, March 30, 2015


As the time comes to write my blog, ideas swirl in my mind about what to write about. One of them was to write a blog on just funny things that happen from day to day at our office. I really could write a book on the crazy/funny things that happen inside the walls of our office. 

I decided against that blog, but I wanted to give you a taste of what that blog would have looked like. 

I had a gentleman patient who we all loved. He was in his mid-80s and he moved to Central Florida to move in with his kids. 

We got to see him quite a lot because, basically, I think he liked having something to do. 

One day he told me that our headrests did not fit his head well and that he was going to bring his own headrest. I told him to be my guest. This is what he brought—and this is real life folks; I can’t make this stuff up!

 I could go on and on.  Maybe I will give you another funny one next time.

I now will get to topic at hand. 

I have written about this in the past but it has been a couple of years. And the reason why I am writing about it again is because it keeps coming up. Overtreatment…bad treatment from another dentist and what am I suppose to do with it?

Look, I am a conservative dentist. I also am a minimalist. I feel like once you cut into a tooth, you are opening this thing up for the circle of life. You know the circle…filling, bigger filling, crown, maybe another crown, extraction, implant. (I am envisioning Rafiki holding up Simba with the music in the background.) 

I think that the longer you can put off the big stuff, the longer a tooth can go before putting on a crown and the eventual loss of that tooth.

I use composite where most people are uncomfortable using it.  I get that two ethical dentists can have two different opinions on what is the best treatment for a tooth. (Now granted, it just so happens that one treatment option that someone else thinks is “best for the patient” just happens to be a THOUSAND DOLLARS more, but I digress.)

I want to tell you a story about a patient I had.

I am a leader at my church and every week there is a prayer sheet. People write on a sheet of paper what their prayer request is and then our leadership prays for them. 

One particular prayer request was by someone who was having a bunch of teeth issues and wanted prayers for that. So I reached out to her.

She told me that she had been getting a lot of dental work done and the dentist told her she needed a bunch more work done. Then she told me she was a stay-at-home mom and her husband was presently out of work. She had money for her dental needs but the work and the costs continued to mount up.

I told her that I could take a look at what was going on in her mouth and at least give her some advice, only if she wanted.

She took me up on the offer. She came in. Here are some of her X-rays that she had sent over. 

I look at these high quality X-rays and, like you, I can see some small issues going on here. In the first X-ray, you can see some PAP associated with #19.  She was asymptomatic. I could see where they would want to do a RCT. 

I see a little decay on the distal of #12. I see a bit of decay on the distal of #13 where it looked like the enamel was nicked. I see something started on the mesial of #15. I see an E2 on the mesial of #18, probably caused by the bur during the prep of #19. (At this point, I probably would not do #18 but would do #12).

And, I am guessing that her dentist decided to the RCT first and talked to her about this. And I also am guessing that the cost of a RCT got her scared. So she went to the dentist on her insurance plan so she could save some money.

This is where things started to go wrong for her.

This is the kind of @#$% I see coming out of the corporate offices down here in Central Florida.
You see here that another dentist has taken over and did the RCT (you can tell by the quality of the x-ray).  But do you see what else he/she did?   

Yeah, they did!!! They took out the best dentistry she had in her mouth.  The crown that was PER-FECT was taken out in order to do a RCT.  Now I don’t know what you do, but what I know is that in order to do a RCT, the endodontist or general dentist puts a small hole in the crown and does a RCT and then the general dentist does an access filling. 

$950 for the RCT + $200 for the access filling, and done.

Well, not at this office. The dentist took off the perfect crown to do the RCT and, after the RCT, he/she put on this brand new piece of poop on her tooth. 

And, if you look at the pre-op X-ray, you will see the decay on the mesial of #18. Now, at my office, if I am taking off a crown and I see decay on the mesial or distal of an adjacent tooth, I take out the decay and restore it right then. This way you don’t have to do a two-surface filling that blows out the marginal ridge.

Well, not at this place. 

This dentist decided to wait and then do a MO amalgam. But it looked like the decided to shoot this amalgam in with a shotgun.

I am not bashing corporate dentistry or corporate dentists or insurance practices or insurance dentists and I don’t mean to paint them with one brush.  But, around here, I continue to see the same thing.  So for me, if it quacks like a duck, smells like a duck, poops like a duck…it usually is a duck.

Here is the thing: I would go to the place where my insurance covered more, too. But I would expect the same care. I would expect the same ability from the dentist. But, in this case, it didn’t happen. 

They are all responsible for producing a product that is going to last—a product that is ethical, a product that is fair in cost. This is not happening.

To me, there is a lot of blame to go around. I blame the insurance, I blame the dentist, and I blame the corporations.

The corporations should be responsible for educating their young dentists. Insurance companies should monitor what is going on with their providers (heck, the insurance company is paying more out doing it this way). And dentists should want to stop overtreating for the sake of making more money.

I know, I know, I know... I am not suppose to bad mouth other dentists in front of the patient, but at this point it is getting REALLY hard not to. 

I tried to remain calm and stick with the facts. Let’s get some better X-rays and see what is going on now. Let’s forget about the past.

Here is one of the X-rays I took: 

Well, you have three spots of decay. They are large, but I think we could get away with doing big fillings. 

We won’t be doing any RCTs, we won’t be doing any crowns (which, of course, her corporate dentist told her she needed). The total cost of my treatment was about $1000.

So, we did it. Here is the X-ray:

Restorations came out great.  She had no pain. Her teeth looked awesome.  She was thrilled.

Oh, you see I went ahead and smoothed out the shrapnel on the mesial of #18, which I didn’t think was healthy. 

How is going to her insurance dentist saving her money? What am I suppose to do with this? 

What the laws here in Florida say is “sit down and shut up”: A dentist is not allowed to blow the whistle on another dentist. I think this is fair but again, what am I suppose to do with this?

Am I supposed to tell the patient to blow the whistle? The problem is that she really doesn’t have a case. This dentist could probably defend this treatment. Not being that great of a dentist is not a crime. 

And, I know, I don’t know all of the facts and I am not or was not in this dentist’s shoes when he/she was doing this.  But this is smelling so much like a duck to me. 

This is your profession that this dentist is pooping on. What do you think? Am I being too hard on this person? Does this make your blood boil, too?

John Gammichia, DMD, FAGD


Anonymous said...

Hello Doc....
I have read almost all of your blog entries and it is clear you are an honest, caring kinda Dentist.
In this particular case....I agree with some but not all of your comments. But, you know if you ask 2 Dentists a question, you'll get 4 answers.
BUT your blog is about " whistleblowing ". That is where you and I are on different planets.
You are a religious I will quote you....." Let he who is without sin cast the first stone ".
You practice in Florida...I don't but I am licensed there and I pray the Lord will let me move there and continue working. My office was in downtown Manhattan from 1988 until last year.
I had to go up against the Fla board once many years ago. I am sure the experience shaved a couple of years from my life expectancy.
So....right as you may be....don't do it....don't put anyone into the meat grinder that is ANY state board but ESPECIALLY
Put your blinders on and do the good work you do. At the MOST...why not invite the Doc in question to lunch and DISCUSS what you a PRIVATE
peer review issue.
You may be surprised at the result. Believe it or not...I truly believe MOST Dentists do what they know is necessary...
any profession has some bad apples. But think about how YOU would feel/act/respond to being the victim of a " whistleblower "

Jenn and Steven said...

John, we see plenty of this here in Texas too. What's the time frame on those xrays? Her decay seemed to have progressed really rapidly. Just curious.

Anonymous said...

I like your posts but in this case I disagree. Why blame the corporations. Just blame the dentist. Nobody was holding the handpiece for him.
Ultimately it is the dentist practicing under his/her own licence. No matter how much corporate asks you to "produce" do not do it unethically. No matter what the production of the day is, at the end of the day it should be 100% ethical. That should be the mantra.
I wish all dentists practiced that way, so patients would not have to go "second opinion shopping".
The most common of which is "do you think I need a deep cleaning ?" .

Unknown said...

Thank for sharing information about whistle blowing.

Aurora Dentist

Anonymous said...

I am not a dentist, but I have been in the dental field for the last 25 years both as a chair side assistant and practice administrator. Does it have to be a dentist whistle blowing? I currently work for a dentist in Georgia that has been practicing dentistry for the last 30 years. 90% of her dentistry is below standard of care. Patients report with fillings constantly coming out because she does not etch or isolate the field, she packs composite with blood and saliva contamination present. She breaks adjacent teeth because she only uses a periosteal to elevate and extract, she believes single rooted teeth can support 4 to 6 unit bridges while crossing the canine. I could go on and on about what I witness chair side. I am truly disheartened standing beside this woman chair side and truly feel bad for the patients in her care. She is a great person which is why patients return but I am not sure she should be practicing anymore. Any advice would help...


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