This is a narrative of my experiences with what I feel has been dental malpractice. All of the mentioned appointments took place in late Summer to early Fall of 2009. I offer as accurate an account as possible of the pertinent events and dialogue, though I wish to preserve some anonymity for myself and other dentists involved, and therefore no specific dates will be disclosed. The whole ordeal has been an expensive and painful nightmare! I will never visit Dr. Nestlerode's office again, and would discourage anyone else from going there either.
I had known for a while that one of my molars needed a crown. Although I had never met Dr. Nestlerode, I was satisfied in my decision to see him when I read on his business website that he had been practicing for a long time & that crowns were mentioned specifically as something he does a lot of. On top of that, his price was substantially lower than anticipated. The estimated total for the crown was under $800. A crown's a crown, right? I now know that even in the field of dentistry there's a broad range of quality. Next time I won't price shop, because 'you get what you pay for'!
For my first visit to Dr. Nestlerode's office, he drilled out the bad part of the tooth (decay & old filling) & placed a temporary crown on. I had had two crowns done before, so I knew what to expect. What I had not anticipated was the very uncomfortable position in which Dr. Nestlerode asked me to hold my head. My mouth was open wide, of course, but with my head tilted forward. My lower jaw was held tightly against my throat, my chin nearly touching my collar bones. After some time, it was very tiring and difficult to maintain this position! I have always thought of myself as a good patient, and I do whatever I can to make the procedures easy for the doctor. This is why I did not expect (nor deserve) the frequent chiding: "I need you to keep your head very still" ... "As I work you keep moving your head back & I need you to hold it firmly" ... "I have sharp objects in your mouth, & you could get hurt if your head is moving" ... "I need you to keep your head tilted forward. You have a very narrow mouth and it's a bear getting this drill in the right spot." I held my head and mouth as still as I possibly could in the awkward - and almost painful - position he required of me. All the while I was thinking about how much different this was from my previous experiences with dentistry - and though I'm only in my twenties, I've been to the dentist a lot in my life so far! I had practically looked forward to the visit as an opportunity to relax, but my experience was far from it. I also had to keep track of suctioning fluids as they pooled in my mouth - I was handed the suction tool because there was no dental assistant working alongside Dr. N as the procedure was done. Though it seemed tolerable at the time, I shook my head days later as I thought back on it. Working without an assistant is just one example of how this dentist cuts corners in order to attract patients with rock-bottom prices. I would rather (& DID) pay extra money & have a dental assistant in the room during dental procedures. It may be advisable for him to have an experienced dental assistant working alongside him to be a witness to any mistakes he makes & later denies. He seems to become easily frustrated & impatient, and an assistant might help him cope with these feelings in a rational manner.
Three weeks later I returned to have the temporary crown replaced by a permanent crown. For much of the duration of this visit, the same position and chiding was repeated. I'm not sure anymore what exactly was said at which visit, but both times I left his office feeling denigrated. This time, however, he felt it necessary to ask me if I knew what it felt like to have my mouth stretched. Of course, this sort of tugging pressure can be felt despite being numb. I refrained from telling him that I had given birth to two babies without medication and definitely knew what it was like to have tissues stretched. In order to have my cheek out of the way as he worked inside my mouth, I was to hold my head firmly against his pulling such that my right cheek was stretched to the max (or beyond) for quite some time. The stretching of my cheek muscles made the right side of my mouth droopy for the next couple days, which made for a very crooked smile. In fact, my mouth had been stretched so much that there was laceration, which resulted in a cold sore in the corner of my mouth that I battled with for a week or two afterward. I rarely get cold sores, by the way.
However, a cold sore was not the only lasting pain resulting from my this visit to Dr. Nestlerode: my cheek was also sore. I am certain that this pain and tenderness was caused by the additional shot of novocaine (since the first round didn't numb me adequately). Normally, before a shot, there is a topical anesthetic gel placed in the cheek for a while on the end of a Q-tip, which also contains an antibacterial agent to minimize chance of infection. Well, after Dr. N determined that my mouth needed to be numbed more, he skipped this step for the 2nd round & just (rather roughly, I might add) injected more novocaine. I believe that this injection bruised my cheekbone and/or adjacent bone/sinus passages as well as introduced bacteria into the area. For several days afterward my entire right cheek & jaw area was slightly swollen, and there was visible redness on the inside of my cheek all along where it attaches to my gums above my molars. The glands on that side of my face were swollen, particularly the one tucked underneath my jawbone. This swelling of my face and gland was noticeable to others, not just myself. My cheek felt tender & bruised, especially right along my cheekbone and in the deeper area, where the roots of my teeth are.
After the permanent crown was cemented onto my tooth, Dr. N checked my bite. Then I reminded him about my retainers, which I had mentioned at the beginning of the visit. I had asked Dr. Nestlerode to make sure that the retainers that I wear nightly would still fit. The bottom retainer did not, so he spent a long time (maybe up to 30 minutes altogether) making sure that it would fit. This entailed grinding the crown down so much that there were no "peaks" to it anymore. It looked like some kind of mushroom, all rounded off. It was truly ugly, and the color did not even match that of adjacent teeth. The texture of the crown was not smooth at all; it was more like a very fine grade of sandpaper. After repeatedly alternating checking the fit of the retainer (using a film that leaves blue marks wherever the teeth touch) and then grinding the crown and a small metal prong on the retainer, he finally gave up on that. Then he asked me to bite down on the retainer in hopes that this constant pressure, held for about ten minutes, would bend the little metal prong of the retainer enough to fit the crown. This struck me as something that would be harmful to my teeth, so after a few minutes I ceased biting down (while Dr. N was attending to a patient in another room).
I was unsure of what to do at this point. I considered simply leaving, since he apparently was unable to solve the problem of my retainers no longer fitting my teeth. I had taken for granted that it wouldn't be so much trouble, since there was only one crown involved, & all else remained the same as before. A 2nd grader could have come up with the idea of biting on wire until it bent, and furthermore, I could have just done that on my own at home! After some time he returned to find that this experiment had failed. In his frustration, he showed me a retainer that was unlike the metal and plastic framework of my retainer. The model he showed me had a lot more plastic to it which custom-fit each tooth. I didn't see why this was relevant in any way to my situation, but in a frustrated tone of voice he insisted that this is the type of retainer I should have been using. I suppose my orthodontist should have consulted with Dr. N seven years ago before giving me the retainers I wear now. After all the hassle with the retainer, he did not check my bite again with the retainers out. He seemed so frustrated with me and anxious to move on to his next appointment that I didn't want to chase him down to ask him to do so.
After wearing my retainers that night my bite was terrible: only a few teeth made contact the next morning, making chewing somewhat difficult. I wondered if I simply needed orthodontic adjustment and a new retainer. Not wanting to endure the discomfort of a terrible bite any longer than necessary, I set an appointment for the following day to see the dentist who had done my orthodontic work years ago. I trusted him completely, but for some reason I had not visited his office since he took my braces off and issued the retainers. I wanted to have him evaluate my condition, primarily my bite. I shall refer to him as Dr. L. I told him about my experiences with Dr. Nestlerode and expressed my wishes to have him see what could be done about my bite. He adjusted my bite by simply grinding down slightly on certain teeth. After having me bite down and grind on bite paper, he handed me a mirror so that I could see the blue marks that were left behind, indicating where the teeth made contact. The teeth on the left side featured blue peaks, which is desirable for a good bite, while the teeth on the right side had fewer markings. The crown itself had blue only in the very center on top! Appalling as this was, I was shocked to find out that there were more problems with the crown than just my bite. Dr. L, upon examining the crown, said that it needed to be redone because there was a long gap between the crown and the gumline. If left as it was, there would eventually be decay under the crown because of this gap. He recommended the crown be redone in order to avoid potentially having a root canal procedure necessary at some later date. His price for a crown was more than double that of Dr. Nestlerode's, but included fees for evaluation/consultation and x-rays.
I don't believe I should have to pay for a faulty crown, nor to have it fixed. I wrote Dr. N a letter to request that he pay for the crown that he had done, as well as pay for Dr. L to redo it. The total I asked for was a bit over $2,100. This letter was very straightforward, and did not include details about the laceration, infection & bruising - only the fact that Dr. L recommended that the crown be replaced. Along with the letter I sent the paperwork involving pricing, as well as an x-ray photo of the crowned tooth, which had requested be printed at Dr. L's office. In the letter I mentioned that I had consulted with an attorney, but that I hoped we could settle amicably without involving third parties. I acknowledged that Dr. N would gladly offer to redo the himself, but stated that I would prefer to have Dr. L do it instead. These two dentists spoke on the phone sometime after the letter was received, which allowed them to communicate directly about my crown. I don't know much about this conversation, only that Dr. L asked my permission before contacting Dr. N.
A month passed, and since I had not yet heard from Dr. N regarding his decision (of whether or not he would compensate monetarily for his mistakes with my crown), I called him the day before my scheduled appointment to have the crown replaced by Dr. L. In short, his answer was 'no'. He added that Dr. L's price was outrageously high and that it is ridiculous of me to expect him to pay it. He explained that during his attempts to make sure that my retainer fit, the cement holding the crown to the tooth was not completely dry, and so this offset the crown - pushed it out of place. He then told me that I should not have expected him to make sure that my retainers fit, and that no dentist should have to do such a thing. I would not have even thought to request it, except that another dentist had done it gladly enough for me in the past - a few years ago I had a crown done by a Dr. W, and afterward he made sure my retainers fit before I left his office. Dr. N also told me that, had he known what type of retainers I wore, he would never have agreed to make sure that they still fit. Well, the fact is, he DID. He did NOT refuse to check the fit & suggest that I consult an orthodontist instead. Personally, I find it hard to believe that the cement used to glue the crown to my tooth would still be wet enough to allow shifting at the bonding site after a few minutes. If this were the case, he should have had me hold still long enough to allow it to set completely - and definitely should not have directed me to bite down hard with a metal wire on top of the newly crowned tooth. So, I suspect that this explanation was not only dishonest, but also an attempt to place the blame on me. He offered to remove and re-cement the crown, insisting that the crown itself could still be used. At this point I was not polite anymore, and said: "You know what? Frankly, you couldn't PAY me enough to return to your office." He ended the conversation by telling me that I would receive a letter from him in the mail soon that more fully explained his viewpoint on the issue.
While Dr. L worked on my tooth, he explained that the crown would be destroyed during its removal. He doubted that a crown could be tapped off, remaining in one piece, without causing some trauma to the roots of the tooth. I found that opinion quite interesting, and it further justified my mistrust of Dr. Nestlerode as a dental professional. Based on my limited experience with him, he strikes me as a dishonest, defensive & vindictive person. After removing the faulty crown, Dr. L told me that there was some staining on the tooth underneath where the crown had been, clearly indicating seepage (of foods/liquids). His assistant concurred, shaking her head. After drilling a bit to remove the discolored portion of tooth, he commented on the shape of the surface of the remaining tooth: it was like a mound. I had thought that odd, too.
So, Dr. L had to redo the crown build-up. He explained that he was going to drill a bit extra in order to create a sort of platform for the crown to fit onto. This reminded me of the crown that a Dr. W did for me a few years prior. I remember feeling the tooth with my tongue before the permanent crown was cemented on, & it's upper surface had a cube shape to it. The crown fit onto it just like a Leggo piece. When Dr. L was finished with the drilling, I could feel a shallow cube-like raised portion with defined edges. Then the impressions/molds were taken and the temporary crown was put on soon thereafter.
If Dr. Nestlerode had created a raised shape on the tooth's surface, with square corners that the crown could tightly fit onto, there could have been no possibility of the gap being caused by the shifting over of a crown (because no matter how wet the glue, the shape of the tooth would have prevented the tailor-fitted crown from sliding over.
Dr. L showed me the base of the removed crown from Dr. Nestlerode's practice. It consisted of a concave base made of some sort of metal, with bits of the broken porcelain remaining atop (if it actually was porcelain, I'm not certain). On the underside of this metal was a thin layer of the blue cement that had held it to the surface of my tooth. Dr. L pointed out that there had been no cement along one edge of this metal base, and this edge correlated precisely to the gap that had allowed for leakage (and discoloration of this corresponding unprotected lateral portion of the tooth). So, this finding provided further evidence that Dr. Nestlerode's expertise & workmanship are subpar. Being impatient and unprofessional is admissible, I suppose, but the problems surrounding the buildup and cementing of the crown itself is not at all acceptable. I am glad I promptly had the faulty crown replaced by a competent and caring dentist.
I received the promised letter from Dr. Nestlerode, which echoed the information that he shared with me over the phone a few days prior. In addition to his blaming the gap on my request that he make sure my retainers fit, he mentioned my alleged problem with bruxing/grinding. He even included articles on the subject. In my opinion, this was entirely impertinent to the purpose of the letter: his refusing to take responsibility for a poor crown job. There is one point on which I disagreed with him completely: he did not "strongly suggest" that I get bruxing guard retainers. He briefly & impatiently showed me an example of such a retainer from across the room & said something that roughly communicated to me: "You should have been using this kind of retainer all along."
He used the word 'etiquette' in light of some tacit rule that I should have returned to him to adjust my bite. In his letter, Dr. Nestlerode reminded me that often patients must return to the dentist after work has been done in order to readjust the bite, because it is difficult to adjust the bite while the patient is numb. I acknowledge this, & admit that I was excessively numb. I deliberately did not return to him for justifiable reasons: my prior visits to him have been very negative; Dr. L would do a better job, & Dr. L was my orthodontist & thus had more say in the issue surrounding my now ill-fitting retainers which Dr. Nestlerode blames for ruining his otherwise salvageable crown. Besides my genuine trust in Dr. Williams (I had always had positive experiences at my dental appointments with him while growing up), the core reason that had prompted me to go to Dr. L was that I feared I would need new retainers.
In Dr. Nestlerode's letter he quite undeniably (if inadvertently) admits to doing something against his better judgement. It is clear in the letter, and was clear in my telephone conversation with him on October 12th, that he took on something that, professionally speaking, he knew was outside of his expertise. To clarify, I mean that he should have refused to try to adjust the fit of the retainer, regardless of what I requested he do, because he felt uncomfortable with the task. If he had told me to consult an orthodontist instead, I would gladly have done it without complaint. I only asked him to check the fit of the retainer after the crown because, in the past, a reputable dentist (Dr. W) offered me this very service and it worked out just fine, with no complications.
I contest his explanation as to why or when a gap between the crown & underlying tooth came to be. As a layman, I may be completely wrong in this, but I truly doubt that it would take hours (as opposed to minutes) for dental cement to set. Were this indeed the case, and the cement was truly still wet enough to allow shifting, he should not have instructed me to bite down on the metal clasp of my retainer (in an attempt to bend it) - while numb, no less! The idea seems absolutely ludicrous. It amazed me that a dental professional would ask a patient to bite down on metal - for ten minutes.
I suspect he may be lying about having paid for the advice of a lawyer in an attempt to intimidate and guilt-trip me. I cannot imagine that a reputable lawyer would have advised him to admit such fault (checking the fit of the retainer though he felt this was outside of his abilities and contractual duties). All in an effort to blame me for his mistakes
According to schedule, Dr. L replaced the temporary crown with a high-quality porcelain permanent crown (with no metal base), which not only looks & feels like a normal tooth in shape, but also matches adjacent teeth in color. Dr. Williams is very meticulous about his crowns, & he expressed great confidence in the local lab that makes the crowns for his office. His assistant added that it's in Gilbert (not China) and that they can walk in to check the place out at any time.
I informed Dr. L that I had decided not to wear my retainers anymore in order to avoid further damage to my teeth & gums due to the clenching that I habitually engaged in upon removing my retainers, & that we could readdress my orthodontic issues at some later date, if it ever seems necessary. I believe that over time my retainers have become ill-fitting, and that this is precisely the reason for my clenching: only first thing in the morning after wearing my retainers do I ever clench, in an attempt to quickly adjust the bite. Dr. L has told me that this is understandable (clenching down when the bite is slightly off). Had I known that this frequent back-and-forth shifting of my teeth was harmful, causing my teeth to be "loose" and my gums to recede, I would have sought orthodontic consultation much sooner.
Thank you for taking the time to read this, and please feel free to comment and ask questions. I wish to save other people from enduring such an awful experience as I have had with Barry Nestlerode. I wonder how it is even possible that he can remain in business with such amazingly poor bedside manners and poor quality work (that he does not take personal accountability for). I have sent all this information to the Arizona Board of Dental Examiners, to investigate his performance as a dentist and consider whether or not he is still qualified to go near anyone's mouth. They sometimes offer monetary compensation, though I would rather just see Dr. Nestlerode stripped of his licenses and privileges as a dentist. If you ever have a similar experience, go to this website: http://www.azdentalboard.us/complaint.pdf
