Dear Other Endodontist In Town.

Dentists April 1st, 2009

Dear Other Endodontist In Town,

You are a nice guy and everything, but I wanted to send you a note to say that you are embarrassing me. In fact, you are degrading the specialty of Endodontics as a whole.

Vertical BitewingWhen you do work like this and tell the patient that everything is good and then the patient ends up seeing me a short time later with persistent or recurrent issues I end up having to do lots of damage control. After all, this tooth was treated by an endodontist, and he didn’t say that he had any trouble with the tooth.

In fact you did have trouble getting around the curve in the MB root. You had trouble getting the job done properly in the excessively short amount of time that you booked for the treatment. So much, in fact, that you over-instrumented the coronal aspects of all the canals and then created a strip perforation on the distal aspect of the MB root.

I have seen better work done by a dental student. Shame on you, and shame on the rest of us for allowing you to pass your specialty certification exams. A higher standard of treatment is implicit in the referral of the patient to your office.

Or maybe you were more conscientious and skillful in the past and for medical reasons you are not physically capable of doing better work now; or maybe greed has gotten in the way?

As specialists, when we fuck a tooth up, we always do a first class job — So much so that I have recommended that your patient have this tooth extracted. It is unlikely that I will be able to get around your ledged curve, fix your perforation, fix the obturation in the other canals, and leave the tooth strong for the long-term. In this case an implant is a better option than retreatment.

Stuff hits the fan in specialty offices all the time, it’s unavoidable when we see the tough cases. It’s always a good idea to be up-front with your patients and explain these complications or unexpected results to them. They usually understand that you tried your best.

They are hard-pressed to think you tried your best when those unexpected results and complications are explained after the fact from one of your peers.

Yours Sincerely,

Peri Apex, The Other Endodontist In Town.


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  • http://www.amid.com/werd Rudy

    How come the other endo won’t fix his screw up?

    And how did the patient ended up with you?

    • http://www.endodontics.ca Periapex

      Astute question.

      The office manager from the patient’s regular dental office saw this endodontist a few months ago for a fairly straight forward root canal. She had problems with the tooth after and the endodontist eventually recommended that she have it extracted.

      She ended up seeing me for a second opinion and I found some crappy work in there also…and another perforation, or hole, in the root that he created. I patched things up for her and so far she’s doing fine. I don’t know if that will continue, but at least as of today she still has the tooth.

      That office no longer refers to the other endodontist.

  • kamala

    You are very brave. Once you put it out there, someone is bound to see it and “tell” on you. :) Are you looking for a face to face?

    You have given me hope, I have a situation very similar with a general dentist, and I have stayed quiet for too long. I think we might have lunch and discuss findings in years prior. I haven’t done this before, because nobody is perfect, and I have tried to give him the benefit of the doubt.

    Let me know how this ends up.

    • http://www.endodontics.ca Periapex

      Possibly — this is one reason why I blog anonymously though.

      You are right, it is wrong of us to judge someone’s work based on a couple of cases here and there. In my situation, that is especially true because I tend to only see cases that have gone wrong for random reasons and so the case pool is inherently biased to begin with.

      However, over time I have seen a large enough pool of patients that he has either treated, or that are in treatment with him, and have heard anecdotal accounts about him from various offices that it is now impossible to ignore the harm that he could be causing patients.

      The office manager that I mentioned in my reply to Rudy above has filed a complaint against him and so, not for the first time, he is going to need to explain himself to our licensing body.

  • Isha

    Thanks for bringing this to light. It is really important that though we show mutual respect and understanding for our colleagues, that sometimes we draw a line and make a statement. The issue is not just about competency, but about ethics in a profession. Another good post!

    • http://www.endodontics.ca Periapex

      You hit the nail on the head. Thanks!

  • dr. mommy

    there’s really only two of you in your neck of the woods? i better get my ass back to school ASAP!

    • http://www.endodontics.ca Periapex

      That’s what I keep telling you.

  • Jules

    That’s crap work! Amazing how much the general public believes & puts up with, just because they are “Doctors”. The pedestal is not big enough for sheisty, shady and careless individuals… no matter what lever of doctor, dentist, oncologist, profession, ect…

    • http://www.endodontics.ca Periapex

      The problem is that the average patient has no idea if a professional (lawyer, dentist, accountant) is doing the best job they can. It’s the reason we go to professionals, they have more knowledge/experience than we do. It’s also the reason that ethics is taught to budding professionals.

      Unfortunately for too many, greed takes over and the philosophy of the job becomes, “what can I get away with?”.

  • endodontist elsewhere

    Well, it’s very difficult to put ourselves in the shoes of the other part. But I strongly believe we should. We are all able to make mistakes at some point, and the difference is to recognize them and be responsible or not. I understand this type of sittuations. It’s not the first Doctor nor the last one, who will get in the same situation in your practice.
    Around here I have some “colleagues” just about the same. And in this town we are only 5 specialists, but MANY general dentists, have their offices well known as “endodontic professionals”, and the patient
    Almost NEVER understant or even care, at the beggining of searching for treatment, if the Doctor is a PostGraduate specialist or not. And I have dealt with cases around here and always shut myself up about it
    In front of the patient because I once was a General Dentist myself, and maybe I would never claim myself as a specialist if I weren’t, but I can understand why other urge to pretend they are. I have been mad at this
    For so long, I don’t even want to worry anymore. The patients DON’t understand the difference at first, only when there is not much left to do for the tooth, and they had undergone any bad situations, and they have to come to my office
    Or other specialists offices, in order to look for some possible solution. I don’t say directly to the patient that the other one screwedd up his/her tooth but try to protect the other Doctor (without talking to him, I know I probably should, but I won’t)
    By saying there has been a lack of finishing properly some portion of the root canals o something like that, but because it seems that the Doctor worked a lot and had a hard time due to the conditions of the particular tooth.
    Well, I understand the need in your heart to speak out, because I felt the same many times, but I also believe there is a chance for screwed up professionals in every fields, and there will always be around.
    Be the best for yourself everyday, do the best, feel the best in your own place, and do it with love. I open my heart to my colleagues and wish them wellness in their jobs, but I can only change my own space and recieve with love and caring, the patients who choose to seek me regardless of what happened before in other places.
    You just do your best and worry about your own practice, that’s our contribution to the world, from my own space, what can I do? And do it. Trying to change other people’s acts and understandings isn’t worth the effort.

    • http://www.endodontics.ca Periapex

      In your comment you’ve hit on tons of issues that I deal with on almost a daily basis. Some of those issues bothered me so much when I first started practising endo that I almost looked for a different line of work.

      In the end, I started managing my office differently, implemented strict policies about referring offices and patients. I was able to weed out the problem practices so that they stopped referring to me. My stress level improved drastically. Basically, if I don’t see the bad stuff happening (that I know happens in every business) then I don’t need to turn a blind eye to it (or report it).

      It is never worth the time or effort to try to change people unless they ask for you to help them change. It’s a basic principle of the ego I think.

      Your last paragraph describes exactly the way we should all work. Do the best we can at everything that we do, all the time. Treat the patient, not your wallet. Know your limitations.

      Thanks for your comment!

  • question

    Terrible RT. I wouldn’t try this one in the first place myself, but it would be very hard to do a worse job. Perhaps he is old and needs glasses. I see now why you feel cynical towards the profession.

    • http://www.endodontics.ca Periapex

      I know that he has a microscope in his office. He needs to use it more.

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