I have a 14-year-old son who has not had any cavities in 5 years. We went to his (new) dentist for a routine 6-month cleaning and were told he had four cavities on the top of his back 4 molars. The dentist wondered why sealents were not applied, so she pulled out his old x-rays from 6 months ago and said the molars were in at that time and she did not understand why the sealents were not applied. The molars had no decay at the exam 6 months prior. The new dentist works within the same group dental practice, but at a different location. There was a serious lack of documentation in chart of my teen son (and my other 2 sons), such that it may go to a review board. I am very angry that this dentist's failure to practice caries risk assessment and management (considered standard of care) has caused permanent damage to my son's 4 permanent molars and will cost me upwards of $500 to repair. Should the dental group be held responsible for this?

Do you remember any discussion about the importance of sealants or if you had paid for them?

Yes, if that is their standard of care, I would think the practice is liable for the fillings. As a mom, I would do everything possible to make it happen.

Flossie is our resident expert in dentistry, and I'm sure she will add something to this thread.

It's a tough call. Did your son have sealants on his 6 year molars? Have they recommended sealants on his bicuspids?

How did the dentist who diagnosed the cavities find them? By x-ray, diagnodent or just by tactile sensation? Some dentists are quick to place fillings on teeth. I'd suggest you take your son to another dentist out of that practice for a second opinion. The decay could be early enough that a sealant that contains fluoride could be placed now and the tooth may never need a filling.



The photo on the left shows a tooth with shallow pits and grooves. The grooves are stained but after x-rays were taken there was no decay in the tooth. This type of anatomy on a tooth would normally not warrant sealants.

The photo on the right shows a tooth with deep pits and fissures and this anatomy definitely warrants sealants.

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Originally Posted by Wondergirl

Do you remember any discussion about the importance of sealants or if you had paid for them?

Yes, if that is their standard of care, I would think the practice is liable for the fillings. As a mom, I would do everything possible to make it happen.

Flossie is our resident expert in dentistry, and I'm sure she will add something to this thread.

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We had talked about the importance of sealants when we started going to this group 4 years ago and they have put them on my other son's teeth at this practice. I will pull out the bill from 10/09 and see if we were charged for them. Thanks!

Yes, my has sealants all on teeth except the last 4 molars. The current dentist did not do x-rays, but recommended fillings because all 4 molars have extremely deep pits/grooves. Would a sealant with fluoride work in a situation where there are deep pits? I could try and take a picture and upload it. Would it be advisable to request x-rays to see if there is any decay in the tooth? There was no decay on the x-rays from 10/09. A second opinion might be worthwhile, although our insurance would not cover it if we went outside the group.

I did look up the group on the Wisconsin BBB and they have a rating of "F". Sigh... Unfortunately, this is the dental plan we are stuck with by my husband's employer.

Thanks Flossie!

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Originally Posted by flossie

It's a tough call. Did your son have sealants on his 6 year molars? Have they recommended sealants on his bicuspids?

How did the dentist who diagnosed the cavities find them? By xray, diagnodent or just by tactile sensation? Some dentists are quick to place fillings on teeth. I'd suggest you take your son to another dentist out of that practice for a second opinion. The decay could be early enough that a sealant that contains fluoride could be placed now and the tooth may never need a filling.



The photo on the left shows a tooth with shallow pits and grooves. The grooves are stained but after xrays were taken there was no decay in the tooth. This type of anatomy on a tooth would normally not warrant sealants.

The photo on the right shows a tooth with deep pits and fissures and this anatomy definitely warrants sealants.

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If she is recommending fillings just because there are deep grooves and NO decay or early signs of decay then yes, a sealant with fluoride would work. If she has no proof that these teeth have ACTIVE decay then she is recommending treatment that is not necessary.

No... the fillings are being recommended because he has cavities in the molars with the deep pits. No x-rays were taken. Diagnosed by exam. If cavities have already formed, would sealants with fluoride work?

It could, depending how far in to the enamel the decay is. Did the dentist use a device called a Diagnodent? I'd still recommend a second opinion from a dentist outside that practice. Just ask for an assessment for decay, don't tell them what your dentist has recommended. If it has been awhile since your son had cavity detecting x-rays ask them to be taken to check for decay between the teeth too.

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Originally Posted by flossie

It could, depending how far in to the enamel the decay is. Did the dentist use a device called a Diagnodent? I'd still recommend a second opinion from a dentist outside that practice. Just ask for an assessment for decay, don't tell them what your dentist has recommended. If it has been awhile since your son had cavity detecting xrays ask them to be taken to check for decay between the teeth too.

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I do not know if she used a Diagnodent... what does that do?

I requested the dental records. They took x-rays of those 4 teeth in Oct 2009 and there was no decay. These are teeth #2, 31, 14, 18. Should I request these be x-rayed to see the extent of decay. If the decay is only superficial to the naked eye... I would think the fluoride/sealent might work. Is that something I could request and then re-evaluate in a couple of months to see if it is working? Now tooth #14 states it had a sealant placed in 2008. Is it possible the sealant was never done on #14 or fell off? The prior dentist was very sloppy. There is no exam record for 2009. The last record is for 2008 and states moderate risk for caries -- I would think a patient with moderate risk for caries would be best served by placing sealants...

Sealants can fall off if the tooth isn't kept dry when applying it. You have the right to choose the treatment you feel is best for your child. Definitely, if you do have sealants placed, they should be assessed for decay on a regular basis.