10 years and 50.000€ later
I've tried to be as brief as possible, but I know it's not a short article. There is no way to cut more from that story because it unfolds over 10 years of bad medical treatments. It means many actors, and details have to be describe to which I had to add some technical information. About those, you might find the cloud on teeth useful. Future versions will enhance the organization to ease the reading. Regarding the article itself, each chapter tells a story and each of them can be considered as bad luck. We all know bad things happen. It's life. However, when you take them as a whole, it becomes a horror story. There is more, all those stories have the same pattern which indicates, to my conviction, that they are of the systemic kind. Our health system does not work well.
The French era
1) Are that teeth? Deficit of information by rule
When you have severe dental issues, there will be a point in time where implants are your last hope. I faced that situation when I was 42. The dentist (recommended by another) had to replace two molars and one premolar by three implants. I was not satisfied by the result. The teeth were significantly smaller than what I had and still are. Technically reducing the size of the teeth may be a solution to protect the implants. However, reducing the surface by 40% is extreme. Aside from the technical solution itself, the first problem I have is that the dentist took a decision without my consent with a lifetime consequence. The second problem I have is that those teeth were bridged to reduce any potential damage due to my bruxism by distributing the force applied to all implants at the same time. I'm not sure if the technical explanation that I was given is valid, at least it made sense for me, and I adopted it. To explain the size of the teeth afterward, the dentist pointed at my bruxism as an explanation. However, the bridge was the technical solution to potential damages by my bruxism not reducing the size of the teeth. Maybe the teeth should have been reduced, but since it didn't give me that information, I couldn't make a better choice.
Another issue was that the bridge shape has a straight line (linear) which doesn't match the curve of the jaw. Since the upper jaw teeth have a curved shape, the occlusion is reduced. Here is what I learned during my slow apprenticeship. To give a curved shape to a bridge you can try to give a different angle to the implant. Very hard with many problems ahead as we will see. The other and usual solution is to use only two implants, hence the term 'bridge'. That way, the bridge can be curved.
Later, I learned that what was explained to me, about bruxism and implant was not quite correct. What matter is to have a night-guard. It's the best protection for the implants and their crowns. The dentist didn't even take care to mention night-guard. It should be mandatory for all dentists to insist on using a night-guard with patients having bruxism and artificial teeth. It should be recommended not only to protect against the wear in general but the differential wear between natural and artificial teeth, which leads to an imbalance which can later produce tinnitus.
Eight years later, a German dentist who had to assess my dental situation told me that those first implants were not considered of the best quality. I don't know if it's true, but in case it is, this might shed some light to why he chooses to reduce as much as possible the surface of the bridge. He might think about the possibility that the implants would potentially not deal well with the pressure my bruxism could apply. To sum it up, it's not always easy for a layperson to know what information is correct or not and what you've understood is exactly what have been explained to you. Whatever the difficulties, they are part of the learning curve. However, I have no doubt that dentists know pretty well what they're doing. Reducing the size of the artificial version of a tooth is no error, not respecting the curve of the jaw is no error and using three implants for a bridge instead of two is no error neither.
The free society in which we live is based on individualism, meaning you make your own decisions, and you take responsibility for them. Nobody can make those decisions for you, and you have a fundamental right to get the information needed to reach those decisions. Holding back information to avoid technical questions is not in the spirit of a free society. Do patients have difficulties with medical information? Absolutely, but it doesn't change their right and certainly doesn't allow any medical staff to take over your right to decide by yourself. Is it really that hard to have a technical conversation? In less than 40 lines, I have summed up most serious technical questions a patient and a dentist could talk about when it comes to implants, so don't tell me it's impossible.
Regarding my dissatisfaction, I've tried to have a discussion with that dentist. I hold only a few minutes before I left the room, living him alone speaking in the void. I can't remember having such a crazy conversation with any other person. It was insane, in the sense I couldn't get him to talk about what was wrong. He was certainly not crazy, which account for a sophisticate form of brutality. Let me explain. He's not anybody. He/she is the one to whom you gave your trust to make the care happen. By denying you a dialogue he/she denied you the right to have rights. No rights, no humanity. What about lawyers? We will come to that soon enough.
2) Incompetence is hard work
After the disagreement I had with my first dentist (an implant specialist), I went to a second one, its partner. I know I shouldn't have done that, and I will never do it again. The dental office was hold by the two dentists. I went to the second dentist.
He did a few composites and two crowns to which we will come back later. His main job was to make the second bridge based on implants, just above the first its colleague did. After the chirurgic, I clearly remember that he praised himself for having been able to drill my jaw in quincunx. In that context, it means a small shift so that the three implants are not aligned, and the purpose of that technic is to allow a curved bridge (remember?) to match the jaw shape. At first, I had every reason to be happy, hadn't I? It was a disaster and still is. When the bridge was mounted, we had a long week-end with my wife at Hamburg, I mostly remember acute sinus pain (most likely an infection) and during a whole year pain in left sinus. When I came back from Hamburg, he explained to me that I should have told him I had sinus problems. It's funny because at that time I was regularly checked by an ENT (ear-nose-throat specialist) because of my tinnitus, and he never suspected anything wrong with my sinus. Reality is I had no sinus issue until he put those implants.
I face another problem with that dentist. One of the crowns he mounted, fell down three times within two years. What I learnt much later is when a crown doesn't stay in place the dentist has to rework the tooth roots and make a new crown, which he didn't. This has had serious consequence, the worse I could ever imagine, and I wish nobody to go through what I live because of that crown and allow me the small outrage "fake" dentist. The dentist gave lectures to the local university and was involved in the city dentist guild, in two words a 'dangerous person' if you dare to oppose him. I did and I paid a high price, and still do.
Another issue I complained about was a metallic taste. He told me he couldn't find the source of the problem. In fact, it was the second crown that was not correctly sealed and at some point generate an infection and start leaking pus. It was about time to change my dentist. A few months before I leave, another problem arose. My gum started to shrink. He first denied it but after a few weeks, he finally recognized that my gum had a problem, but he never gave me any explanation. With what I know today, my gum was under stress due to the middle implant of the bridge he mounted, to which you can add a crown leaking pus. A regular day in my life.
The bridge interlude: three months (at least) are needed for the bone's healing, time during which I had no replacement teeth as it was the case with the first dentist. Finally, the dentist gave the green light for the bridge, and I thought my wait was over. Wrong. The first bridge broke down during the mounting. The second bridge showed heavy wear after three months due to my bruxism. Of course, a night guard should be standard protocol for people like me. However, and in that particularly case, the lack of a night-guard helped to reveal the bad quality of the porcelain. With a night-guard, the problem would have shown up much later, and it would have been difficult to prove that the cause of the wear was not natural but due to the poor quality of the porcelain.
The scanner interlude (a scanner is a 3 dimensional x-ray): To assess what implant can be used, a scanner must be done. The first dentist had its own device, but not its colleague. I had to go to a hospital to get the scan of my teeth and jaw's bone. I had to be present at the end of the day, and cash was asked to pay the bill. I got no receipt, nothing. It was pretty stupid on my part, because I had and still have a private insurance that would have taken most of the charge as it did for the former dentist. Who am I to contest the authority of a dentist and think that he may not play by the rules? I guess some people waiting in that room that day hadn't a private insurance.
The hammer and the cavity: I'll need to be technical so that you understand what the problem is. Regarding implants for the upper jaw (left and right), a dentist needs to measure your jaw bone. In case there is not enough bone, the general idea is to fulfill a small cavity located between the bone and the sinus. The technic is called the sinus lift: there are two different ways to do it. 1) to reduce the size of the cavity (what he did with a hammer (see picture below) or 2) to fill it with a biological compatible material which is considered today the best practice. From what I understand it's precisely the obsolete technic (term used by another dentist to describe that technic, not my judgment) he used that generated the problem with my middle implant and my sinus.
Regarding that problematic implant. For today, I only have troubles when I use my left side fully (eating a steak). I've been explained that the implant seems to have a small mobility but a scan apparently cannot show that kind of issue. The implant certainly made its way to the sinus at the beginning explaining the infection I got in Hamburg. That seems to be no more the case. A German dentist explained to me that my body somehow reconstructed a biological protection between the implant and the sinus. Which is why, I still can sometimes have mild pain but no infection. Explanation which correlates the fact that over time problems regarding the implant are less frequent and acute. cute.
3) Five lawyers, peace and flowers
As any regular person, I felt betrayed, and I decided to go to court. Why? When something wrong happens, the first move is to look for an out-of-court agreement. However, the unwilling of the dentist to recognize any wrongdoing made that process impossible to happen.
A few words about why incompetent people are extremely dangerous. You don't become a dentist because you are dumb, which means that you're smart enough to assess your own work. Incompetent dentists know when they're incompetent, they also know that they have to hide it. Any acknowledgement of their incompetence, even indirectly, is a threat to them, that's why they will never try to find an agreement, and they will do their best to turn the situation against you, no matter the consequences.
Lawyer #1: Luckily, we had a private insurance dedicated to legal issues. At my first call, the employee yelled at me. She considered grotesque that I wanted to file a complaint against a dentist. She hung up on me, and changed the validity date of my contract (what a wonderful world). I manage to get someone else at the phone who again was unwilling to open a file but at least, gave me the address of two of the lawyers they were working with in my city. I was done with my insurance waste of money, and that insurance was far from being the cheapest on the market.
Lawyer #2: I took an appointment. Explain my case. Agree for a new meeting the next week and got an invoice three days later. Unexpected. I send an e-mail that I would not pay because he never mentioned that I had something to pay at the first schedule and according to the law, I own him nothing. I got a short answer starting with: "With people like you...." People like me? What was he talking about? Let's put aside the law. When you engage is such a fight against a dentist, it means a big fight and lot of money (European scale). He could have integrated the cost of the first discussion into a package. He not only didn't do that, but sent me an invoice as fast as he could without notice. Only a lawyer who is not happy to have you as a client does that. You're the victim and there is biological evidence (my teeth), but you're treated like some sort of criminal trying to take advantage of a poor and harmless medical worker by abusing the system.
Lawyer #3: I manage to find by myself a new lawyer. After several weeks, not a single letter went out of hers office. She always thought up about another missing piece of information required to start an action. I know today that among the many things she asked for, one was wrong. She asked us to reconstruct the medical file by our own. She didn't put it that way, and we did not understand the game she was playing. Let me explain. A medical file is not only made of x-rays, but include all schedules and for each what medical intervention was done. Each intervention has a designation, a code used by the insurance to assess how much money back you will get. Dentists have all those information in a database managed by a professional software. It's easy for them to give those information. In fact, there is a law about medical files. Dentists/doctors can't refuse to give the data of a medical file to its owner.
Let see how well that worked out for me. We ask (my wife was involved but that another story), the dentist about my x-rays. We got in return an empty envelope. Well, in fact, there was an old x-ray, made by another dentist, which I brought him, but he refused to give or copy any information regarding his own work. What did our lawyer do, when she learnt about it? Nothing, she was not even supportive and didn't suggest any course of action. She did literally nothing. When we started to question her work, she simply sent us an invoice, and telling us she won't defend our case any further. To summarize, she never filled any complains, or sent any letter for information to my dentist. I sent her the book written by Tom Bingham "The rule of law" as a reminder of the principles upon which our justice is founded.
Lawyer #4: I called another lawyer, and the phone call lasted nearly an hour. She couldn't stop explaining how much it will cost and of course what a horrible experience it will be. The funny part was with the number of expertise I'll have to undergo. Not one, but certainly two, she told me. Being not impressed, she added maybe three, or four and each will cost at least 1000 euros. To make sure I get the message, she doubled down by telling me that there was no certainty, I would get my money back, even if I won ... what a pity, she would have made a terrific lawyer.
At that point, I gave up. The hostility against me for trying to get some justice was outrageous. One must recognize when dark forces are at work, and you can't defeat them.
Lawyer #5: A few years later, I had the chance to have an appointment with one of the top lawyer of my city. After half hour, I feel we were on the same page and took the risk to ask him about my issue with the other lawyers. He asked me a simple question. Did you have any argument with a dentist? I can't see how the question is connected to my difficulty to find a lawyer. Do you? Please don't try to explain it to me :).
On the topic of lists: I'm not fundamentally in disagreement on the existence of colored lists (black, yellow, red...), even if right now I'm probably on one of them and paying a high price. What I think about lists:
What should be done? In professional, commercial environment and medical, justice services, lists have no place, and a mediator would do a far better work. Lists damage our society. When it comes to government, I'm in favor of lists. But they must have a limited time span of activity because the risk to be use by dishonest people or organization is too high.
4) Gold worse nothing
Remember the leaking crown? Well, the infection got bigger, and I had to go to another dentist. The dentist I found explained to me that the infection was there for, at least a few weeks! The leak allowed the pus to be ejected so that the infection never got big enough to be a real problem. However, the side effect is that the infection got the time to attack the bone. It means that not only the tooth was lost, but any hope for an implant too, not enough bone was left. Don't forget, I only repeat what I was told.
The crown was made of gold, white gold. I asked him if I could get it back. He answered me that because of the infection, he had to send it for destruction. Even if he's right, there is a missing piece: the receipt of that process. You have to know that every worker who deals with gold is accountable for what happen to it, even gold dust is under control. A whole big molar gold crown goes into the trash and there is no trace? I'm not certain but to my knowledge and understanding it's not a due process. Perhaps it's really how it's done, but it shouldn't. Simply thinking that gold teeth could be stolen is unbearable because of WWII. Gold teeth faith must be traced and there is no other way.
Another crown, another story. Remember the second crown, which couldn't stop falling down? It did it a fourth time. I ask that dentist if he could put it back. He refused. In fact, he politely invited me to leave its office and never come back. I told him that the whole story was a scandal, and I will try to go to court. He answered me that I will lose. Gold really worth nothing nowadays.
5) A crown, an infection and being denied antibiotic
I went to another dentist in the same street. He glued the bad crown. And infection started; he refused to give me antibiotic and to take care of that crown. I was left alone with a serious infection.
It was not a question of right. I'm not an illegal immigrant in my own country. I'm not a criminal on the loose, never see a judge in my life. I have no contagious disease. It was not a question of money. I have enough insurance and money. It was only a question of a human being helping another human being. I couldn't get that, and that's when I understood I was no more a human being for a bunch of people. I had no right, and still have them. Guess what? I'm not agree. Why do you think I'm writing that text and bring that website alive?
6) A burin to take out 3 teeth
Another dentist, another horror story. I search another dentist and found one of the best of the best, sir. He told me that he would have not only to extract the infected tooth, but also the twos on the left and right side (collateral damage). I was not eager for that and when I told him, he told me to get lost. Obey or die, they don't care. I was running against the clock and kept a clear memory about what the last infection did to my bone and with no hope for an implant. I follow its recommendation. I was devastated.
During the surgery, I was that much anesthetized that I laugh when he started to destroy my teeth with a burin and a hammer. At the end of the operation, he left me with no analgesic for the pain, and I lived the next 36 hours in a misery. About his technic, I asked him later if the use of a burin was a standard practice. He only told me that it was his technic. From what my point of view and first-hand experience, it's a brutal technic, but who am I to dare to suggest a more human technical approach?
Of course, there were not enough bones left. Therefore, a sinus lift was needed (how convenient). This time the dentist chose the fill the cavity with bio-material, and he is the one which explained to me that the first sinus lift I had, was based on an obsolete technic.
The three teeth of the upper-jaw were replaced by two implants since I was already missing a molar on the under-jaw (remember, that famous gold crown which finished its life in a trash?). The problem arose when the crowns had to be put in. The angle of the implant was (and still is) not quite right pushing the crown a wee bit too much inside the mouth. This implies trouble for my tongue and to bite my tongue more than I would like to.
All in all, I can help myself to think that the work done by that dentist is astonishingly bad work. Forgive me my French impertinence but isn't he supposed to be the best of the best, sir? By the way, he knew the previous dentist who refused me antibiotic. In a working society, shouldn't professionals be seriously worried by the severe wrongdoing of one's colleague? You know sometimes going back to the basic questions... Well, you get the idea.
7) The angel of pain
That dentist managed to have me a breakdown in its office because I couldn't face more pain. Let start from the beginning. That dentist was in partnership with the one who made the two latest implants. You know the one with the burin. His job was to make the bridge for the two implants. It was a disaster. In that situation, three times didn't make the charm. I have today a German bridge to replace his handy work. Well, that German bridge just fell down this morning, but my point is that I had to ask someone else to do his job. By the way, I paid and my insurance paid that dentist for that job. What a wonderful world. Since then, the bridge has been redone, which means myself and the health care system have paid twice for it in one years.
The real issue here was the inlay that he tried to do for a tooth which had lost too much material because of my bruxism. An inlay is a crown-like tooth but without extracting the nerves of the tooth which keep it alive. It also means that without its crown, it's very sensible if not painful. That problem is even greater on a wearer tooth, the less material the more expose are the nerves. I remember getting my inlay the 23th December. The 24th while I was eating the inlay broke. I still feel the pain I had to endure until I could see him again which was the 27th. The words, "I'm really sorry for what happen to you" is still not in the vocabulary of dentists. He tried the put an inlay, again and again. Pain, pain and pain. At the end, I asked him to take away the nerve and put a crown. The crown was a disaster as the bridge was and to top it off, my teeth start to turn black. You don't really think he was curious about it, do you? However, I was curious and also worried. I thought my teeth were having some kind of disease (one more). Of course that was me having a panic attack. A good thorough cleaning and ending my gazed water addiction solved the problem.
I never feel so much pain in such a short time span. How can incompetent dentists inflict that much pain? Luckily, I'm an apprentice "Marathon man", running helps me to heal from the psychological scarce physical pain produces. Still, I will forever remember my breakdown in his office. How I was on the floor whining and him looking at me, emotion less. I can't understand how it's possible for people to not do their best to make sure those situations never happen, and when they do to show, at least a human face. This has nothing to do with being naive about human nature. Empathy is a natural mechanism for any human being, the lack of is a choice. This leads potentially to damage people, which will inevitably damage society: lesser quality of life, less cooperation... I do understand why he didn't rush on me during the breakdown, but after he could have said something like. 'You really suffer from what you're going through. I will do my best to alleviate the pain. Let's talk about how we can do that'. Is it really too much to ask, or inappropriate?
The German era
I couldn't go that way any further with the French dentists. What could I do? I have a strong scientific culture which goes with good analytical thinking. Putting aside the emotional part of my relation with the French dentists, I tried to identify a weakness that would help me to better choose my dentist. I came up with the hypothesis that the French dentists are solving always one problem after another (one tooth at a time) and never focus on the big picture. It doesn't mean that they can't, but it's not on what they focus first. It follows that their protocols are adapted for doing just that, to treat one problem at a time without linking the problem altogether. I decided to cross the border and sent an e-mail to several German dentists to work on a global solution. I had two answers. The first was a joke. The second seems to be really interesting. How wrong I was!
1) When the fairy tale become nightmarish
Everything started like a fairy tale. She took care of my emergencies, solved a starting crown problem and replaced it by an implant, whitened and cleaned my teeth. That was pretty much it, after then everything started to be weird. First, I lost a crown, next the tooth broke up and had to be extracted. What's weird is what she failed to do after the crown was missing. I know that because I had a similar problem 12 years ago. What she forgot to tell me, and what the other dentist didn't miss, is that the tooth was at risk. To prevent the tooth to break down, meaning to be definitively lost, the dentist can reduce the occlusion (the contact with other teeth) to protect of what remains from the tooth. This gives the dentist the required among of time needed to redo the crown's root and then the crown. She didn't think about it, didn't make any mention of any risk. She failed for what is basic dentist care.
Let's move on to the next problem. When the tooth was extracted, the bridge technic, she proposed was bad. She sold me her idea because it will be corrected when the big project would be in place. I bought the "it's only a short-term solution." When she mounted the bridge, she did an occlusion checked, which is considered as standard practice. There was a space between the bridge and the lower teeth meaning the occlusion wasn't right. She noticed it but forgot "to send me the memo" and I had to go home to evaluate how much of a disaster it was. The space was between one to two millimeters over 2/3 of the bridge. She never acknowledged the problem. Unfortunately, there is more. The bridge hold 3 days and one of its colleague had to glue it again. Unfortunately, this morning it ended up in my hand, once again. The bridge won't stop falling because of the technic used. It's a cantilever bridge. It means that one tooth is floating at the extremity of the bridge. That tooth has the same effect as a lever. Now I'm stuck with that temporary solution because she changed her mind to do a full dental reconstruction, and she didn't take care to inform me of her decision.
She makes everything not to see me again. The last time I called, I heard that they were sorry that I didn't get the memo about the previous canceled appointment. My situation of today is
I'm not advocating that a dentist should be stuck with his/her patients and swallow everything. People sometime don't get along! However, no health worker in its right mind will leave a patient in such a shape. Money is not the issue, but responsibility, handling people like human being and with the dignity that they deserve. I'm fighting a disease. I'm fighting to eat, not complaining about a missing shoe while enjoying a holiday on a luxury cruise. I'm constantly ripped off my dignity and my humanity, and despite all of that I still and firmly believe in good human relations. Here is what she or any of its colleague should have said:
"Sir, I'm sorry but I've reassessed your dental reconstruction, and I'm not the right person for that project. However, I do understand the difficulties you're going through, and I will assist you the best I can until you find another dentist. "
2) Physically assaulted and hate
I must confess that I'm psychologically tired of being treated as if I had absolutely no right. It's like a dehumanization process. The word I have in mind is helplessness. When you start feeling that way, you have to make what it takes to get out of that state of mind. I decide to share my concern with my main doctor. Let me give you some context. In France and Germany, you have to have a main doctor (referring doctor) whose work is to centralize your health information. He's a dispatcher to specialists. You have the right to choose the main doctor you want. As a European, I have to right to be treated in Germany the same way as in France (It's not that simple and there are differences between theory and practice, but for the most part, it works). He gave me the address of a dentist where, I will be humanly well-treated he said.
I went there on Friday. They took an x-ray, and I was hoping to get the large composite replacement the same day. The dentist wanted to talk (In German: Versprechung), to know me better. His friendly moot started to change when he discovered that the previous German dentist was someone he knew. He insisted to know what happened, I answered him, but only because I was a little suspicious of those many questions. He just checked the occlusion problem and found an excuse to avoid to repair my front tooth. He gave me a new appointment on Monday, but I have to pay him before any work could be done. In forty years of medical treatment that was a first. On Monday, I brook 2000 euros in cash and asked for confirmation that I had to pay before any work was done. I got the confirmation. I refused and asked for a discussion.
The discussion quickly turned into an interrogation where he wanted to know private information regarding its colleague. I refuse several times. He asked me to leave. I find its reaction extreme and asked him to replace, at least, the composite (coming to him was a 3 hours two-way trip). He refused and treated me that he will call the police. I had done nothing wrong. I told him, I would wait for the police in the waiting room. It was a pacific way to protest again that person and about his deep lack of humanity. When I passed near the outside door, he physically tried to throw me out. He missed. Tried again and again, each time more violently. My glasses flew on the other side of the hallway with another device attached to my belt. I just recall a woman's voice telling me: "I will help you" (to get back my glasses and my gear). At that moment, the violence ceased, and everybody had realized that he had gone too far. I went peacefully in the waiting room. I couldn't help to rewind the scene in my head and ask to myself what can push people to believe they can do whatever they want to you. Is that what hate looks like?
The police came. They escorted me out of the building, and that's all. Well not exactly but it doesn't change the outcome, let say they took the side of the dentist. I just learnt, that since I had no bruises, I couldn't sue him (So, I had the right to shake him, a little? I doubt the police would had interpreted the law that way in that case. What a strange law). That the witnesses don't matter (To the worker who saw the whole drama and couldn't stop saying, I saw nothing I have just one thing to say. "Ein bisschen Mut, Mann!" - Have some courage, man!). He had the right to throw me out by using physical force because of "hausrecht" -right of the house/owner (why not to release the dogs). I was lucky he didn't sue me (no kidding). I will be put in jail if I come back the same day inside the building (I should have come back just for the fun to see them written a report on that). I had no right to go to the police to file a complaint (that one is really wrong). Of course, all of these are erroneous and misleading statements, and they've all been made by the "polizei" in a country where the rule of law applies. Or does it?
I don't want to bother you with more details about my life than it is needed, but I was born in Germany and live in that very city for six years when I was a child. That story really hurt me, and I've hard time to face its reality. Nevertheless, it did happen.
What he should have done is to agree to do the composite (just that). It wouldn't have taken much time. He would have had its money right away (got the cash, remember?) and I would have been happy with that outcome. All of that couldn't happen because he didn't want to find an agreement. Brutality was his answer, psychological and physical brutality. What was that song again... O happy days...