What are the chances of dentists missing things to diagnose that a patient notices?

[NeverEnds]

For a few years now, I have noticed rough areas (which I can feel with my tongue) at the margins of one of my fillings. I brought this up to my dentist a few years ago and he claimed the filling is still fine. I'm not convinced.

 

[comfortdentist]

For a few years now, I have noticed rough areas (which I can feel with my tongue) at the margins of one of my fillings. I brought this up to my dentist a few years ago and he claimed the filling is still fine. I'm not convinced.

This really is easy. If it feels rough to your tongue then it is rough. Not unusual that the dentist can’t find the spot as tongues have more nerves than a dental explorer. How do I handle it? I try to get the patient to describe as best as possible where it is then I may place an instrument there and ask the patient if I’m at the spot. I’ll move accordingly. If we know I’m close but I still can’t see I’ll use a medium polisher on that spot. If that’s the spot then I’ll polish it. If not I’ll move and try again.

 

[NeverEnds]

This really is easy. If it feels rough to your tongue then it is rough. Not unusual that the dentist can’t find the spot as tongues have more nerves than a dental explorer. How do I handle it? I try to get the patient to describe as best as possible where it is then I may place an instrument there and ask the patient if I’m at the spot. I’ll move accordingly. If we know I’m close but I still can’t see I’ll use a medium polisher on that spot. If that’s the spot then I’ll polish it. If not I’ll move and try again.

Well, I should also mention that I think I can see it as well. Also, these rough areas didn't used to be there. Isn't that a sign that the filling is failing?

 

[Gordon]

Not necessarily. Things can wear unevenly between the tooth and the filling material.

 

[comfortdentist]

Not necessarily. Things can wear unevenly between the tooth and the filling material.

I actually sent a photo today of a restorative material that I placed 4 years ago to a dental materials manufacturer. The photo shows their material with a large eroded area all around it like a ditch. Why? Because the patient continues with their bad habits. The material was fine but the tooth wasn't. I'm a dentist of interest for the company.

 

[NeverEnds]

So nobody really said how often dentists miss stuff like fillings going bad.

 

[Enarete]

I think nobody can really say how often dentists miss things.. how would you want to measure that in a reliable manner? Anyway, I guess you're not really interested in statistics here, but whether your filling is failing or not. As far as I understood the replies above, a rough area do not necessarily mean that there is anything wrong with the filling but that your tooth got worn a bit, which can happen over time (and can get solved by polishing it). If the plain sensation of roughness is what bothers you but your dentist looked whether the filling is sound and 'healthy', then you might have focused on two different things.

 

[NeverEnds]

I think nobody can really say how often dentists miss things.. how would you want to measure that in a reliable manner? Anyway, I guess you're not really interested in statistics here, but whether your filling is failing or not. As far as I understood the replies above, a rough area do not necessarily mean that there is anything wrong with the filling but that your tooth got worn a bit, which can happen over time (and can get solved by polishing it). If the plain sensation of roughness is what bothers you but your dentist looked whether the filling is sound and 'healthy', then you might have focused on two different things.

But at the margin where you can rub your tongue against the edge of the filling and have it get slightly caught on it? I'm not buying that that's "wear."

 

[Gordon]

OK, what is it then?

 

[NeverEnds]

OK, what is it then?

I would guess the seal is broken from decay at the margins?

 

[geos]

I would guess the seal is broken from decay at the margins?

How is that different from “wear”?

 

[NeverEnds]

How is that different from “wear”?

If it's decay, it needs to be replaced, right?

 

[Sol]

Has your dentist shown you what they are looking at with a photo or (if the concern is decay) an xray? That might help clear things up. If you don't feel like you can trust the opinion of your current dentist then maybe its time to get a second opinion.

 

[Enarete]

I would guess the seal is broken from decay at the margins?

Not everything 'broken' or 'rough' in mouth is necessarily decay. It needs bacteria there that eat a bit of the tooth around the seal to call it decay. Anyway, I second Sol; if there is any situation where you think you have a more accurate diagnosis than your dentist, then it is time to get a second opinion.

 

[NeverEnds]

Not everything 'broken' or 'rough' in mouth is necessarily decay. It needs bacteria there that eat a bit of the tooth around the seal to call it decay. Anyway, I second Sol; if there is any situation where you think you have a more accurate diagnosis than your dentist, then it is time to get a second opinion.

Has your dentist shown you what they are looking at with a photo or (if the concern is decay) an xray? That might help clear things up. If you don't feel like you can trust the opinion of your current dentist then maybe its time to get a second opinion.

Problem with the second opinion thing is that from what I have seen, you can always find a dentist who will have a less conservative approach than others. There are dentists out there who will fill any incipient decay...heck, probably even fissures.

I have no idea what approach is ultimately wisest. The money isn't my main concern; it's the amount of pain involved, given the fact that I don't believe it's possible for my teeth to get fully numb from local anesthetic. A cavity could be really bad, but a root canal is unthinkable.