Just Grind Them Down

A 40 years old female patient presents to your general dental practice for a second opinion. She has become disenchanted with her dentist of 12 years. She brings full-mouth radiographs dated May 3, 1982, and bite wing x-rays dated June 7, 1992. The following is the story she relates: "I went to my dentist five weeks ago with pain on the upper left. After he examined me he ground on the teeth on the upper left and it felt better when I bit down. Later the pain came back. I visited him three more times and each time he ground on my teeth and it felt better. He said I was clenching my teeth as a result of losing my job. Now it's hurting again and I want another opinion because I'm afraid my teeth are getting short.”

You look at the two-year-old bitewings and clearly see caries on the mesial of the maxillary second molar. You also see extensive bone loss distal to the mandibular right second molar. There is gross subgingival calculus on the 1982 x-rays; you see clear evidence of bone loss around teeth that are now of poor prognosis. The patient asks what you think needs to be done. When you respond that endodontic therapy is needed on tooth #15, and that you would suggest additionally that she see a periodontist. She is outraged and asks you what recourse she has.