Alpine & Rafetto Orthodontics

January 15, RE: Concern ID [redacted] Dear [redacted] We are writing this letter in response to "additional concerns" regarding the concern ID [redacted] Please refer to our previous letter in which we acknowledged the original concerns raised by Mrs [redacted] , stated the facts as we know them and explained the lengths we went through to accommodate her in the past in the short time we were given Furthermore, we stand by our original response dated October 29, We have had a chance to review Mrs [redacted] ' most recent letter (dated 11/20/2014), and feel we did everything we could have for her considering the time line We believe some of the comments presented by Mrs [redacted] to be unfounded and rather emotional as she is starting to stray from the true facts of the matter We assure everyone reading this complaint that the notes in our computer system are not "falsified and distorted" and cannot be changed once entered into our computer system (as they are medico-legal documents) The accusation of our office doing this or "handling our records poorly" is completely untrue and offensive We will vehemently defend our office’s ability to accurately record the events which occurred at each appointment It should also be mentioned that the scheduling coordinators do not create an entry in a patient's chart every single time they call the office, this is not in their job description as long as they leave a note on the doctor's desk to return, which they did Mrs [redacted] stated that her original lingual wire was "constructed from a type of gold material, rather than a stainless steel braid" That, in fact, is untrue, and the wires we have used since the late 1980's have been made of braided stainless steel We have never told anyone that our wires were made of gold or a gold alloy, nor have we ever used lingual wires made of gold or gold alloy As for being "told by Dr [redacted] that it was not possible" to reattach the old wire That is true, because the part of the conversation Mrs [redacted] left out of her letter was that the teeth in question had shifted, and that lingual wires are bent to fit the teeth when they are straight When the teeth shift, the wire (like any other retainer) won't fit properly and therefore be less effective Teeth that have relapsed (become crowded again), change any wire's ability to be as effective as it would have been with straight teeth In others words, lingual wires are more effective when the teeth have not relapsed (shifted) In regards to the phone records, we did not see that Mrs [redacted] attached a copy of them for reference (?) Dr [redacted] did reach out to Mrs [redacted] by phone hour and minutes after she left a message at the office He was ready to listen to her concerns and was willing to help in any way he could have even though she lived, and still does live 14-hours away (in another country - Canada) Dr [redacted] did leave a message telling her to call him back at the office, but always tells patients that if the office is closed, his contact information (cell phone, so he can be reached hours a day) is part of voice mail message, and has been since he joined the practice in August of Understanding that she might have favored Dr [redacted] in this "emergency situation requiring prompt action", Dr [redacted] was available and ready to guide her through this situation Later in the letter, she asks the question, “Do you expect a client in such a situation to wait until the next day for an appointment with the orthodontist located hour away from my home and risk swallowing the rest of the broken section during my next meal or while I’m asleep that night?” We are not sure where she was going with this question; however, had she returned Dr***’ call, he most likely would have advised her to visit the nearest orthodontist or dentist because it would have taken him close to hours to find his passport, pack his bag (complete with his orthodontic emergency kit) drive through the night, clearing customs into Canada while making his way to her place of residence for a house callWhile we understand this may have been disappointing to her to have Dr [redacted] call her back instead of Dr [redacted] , we assure you that Dr [redacted] is a competent orthodontist who would have taken time to guide her through the process of finding her a dental professional to address the problem Also of note, when Mrs [redacted] said she wanted a phone call back from “any doctor at Alpine and [redacted] ” – Dr [redacted] is the only other doctor in the practice as well as a partner Mrs [redacted] still has not addressed our concern of why there was such a time lapse (months), between the time she reported the wire being loose then cut, and her actually making an appointment to remove/replace the lingual wire Was she truly concerned or did she want to play the victim to avoid any responsibility she made have had in this matter? In regards to her last paragraph of defamation against our office, our response is simple We stand by the team we have employed, who are honest hard working people, who would never falsify or distort office notes (medico-legal documents)We stand by the products we use, in this case the lingual wires, which are used by a majority of orthodontists in the United State and Canada These wires are not faulty and do not break easilyWe have teenagers who mistreat these wires everyday and as a result these wire do not fray and rarely break These wire being discussed are industry standard (refer back our previous letter) and have been on the orthodontic market for years Finally, we live in an increasingly blameless society where certain people shy away from personal responsibility for whatever the reasonThese people seem to want everything and expect to give nothing in return, yet they buy such luxuries as cars, which do not come with a life time guarantee and no bitterness arises when it becomes time to find a replacement no matter how it has been treated in the past As we stated earlier, we stand by our original statement and will offer Mrs [redacted] the names of other Delaware orthodontists if she wants to continue her orthodontic retention checks on her visits back to the state because we will not continue to take abuse from someone who is not forth-coming regarding the facts of the matter and continues to play the part of the victim We would like to thank the Revdex.com of Delaware for giving us the opportunity to respond again If there are any further questions, or if we can be of anymore assistance, please feel free to contact our office Sincerely, [redacted] D.M.D [redacted] * [redacted] D.M.D., M.S

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below It is clearly obvious by [redacted] 's reply, that he intends to divert attention from the real issue at hand, the fact that I should be reimbursed for the defective wireI am disappointed by the failure of his office to professionally and promptly handle my complaintAs I sat in the exam chair on September 29, 2014, I was able to see the falsified and distorted office notes on their computer screen in front of meIt is very evident that his office is handling records poorly as I have records contradicting dates and details recorded by [redacted] As no agreement to get reimbursed was reached on May 10, 2013, I waited until my next trip to Delaware, September 2014, to attempt to resolve this customer service issueAt the very least, I expected to be refunded the $250.00, have the rest of the defective wire removed at no cost, and be reimbursed $in dentist fees for removing the frayed section of wireThen I would have been willing to pay the full price of $for the new removable retainer.Discrepancies in *** [redacted] 's replies:1.DISCREPANCY: [redacted] 's notes state: "There are too many variables associated with them such as the individual's bite, inclination of the teeth, biting forces, patient habits (how cautious one is with foods or objects that could cause the retainer to break or come loose), etc"In the presence of my husband and office staff, I was told on October 3, 2011, that this new type of braided wire was AS DURABLE AND EFFECTIVE as the previous wire I had worn since No mention was made of the exceptions aboveI have not changed my eating or flossing habits since 1994, contrary to what [redacted] is implyingMy first lingual wire from was a superior quality wire, constructed from a type of gold material, rather than a stainless steel braid, as I have now seenIt was for that original gold wire to need new adhesive re-applied at some point during yearsHowever, THAT PARTICULAR WIRE NEVER BROKE OR FRAYEDI did save it in hoping to have it reattached, however, I was told by [redacted] that was not possibleSo, he suggested I purchase the new braided wire for $250.002.DISCREPANCY: [redacted] 's notes state: "On 5/1/(19months later), [redacted] called the office reporting that her lower lingual retainer was loose again, and was upset because she could not find an orthodontist in Canada where she was residing, but found a dentist who clipped the wire to make her comfortable." My initial phone call to [redacted] 's office was on April 4, 2013, 9:(Atlantic Time), not May 1, 2013, as their records mistakenly sayI made it very clear to different staff members (Receptionist,Technician, and Financial) that a section of my lingual wire frayed and splintered, it did not merely come “loose” as their records stateTHIS IS AN EMERGENCY SITUATION REQUIRING PROMPT ACTIONWhat I “extracted” was one detached thread of the braided wire resting on my tongueThe last broken threads of that section of wire needed to be dealt with immediately before I swallowed themAFTER that discovery, I immediately called [redacted] 's office inquiring how to proceedI did not receive any assistance or direction after minutes of being put on hold and transferred around the officeI left a message for a Doctor to return my call as soon as possible, however, I did not hear back from anyoneBy 2:30pm that same afternoon, I finally sought the help of a local dentist in my town who safely removed the broken section and smoothed the wire3.DISCREPANCY: [redacted] 's notes state: "*** said she made "repeated phone calls"(May 2013) to the office before [redacted] called her backAccording to our records, there was only one phone call documented, but it did note she said she called a few weeks ago and was transferred to financialThe scheduling coordinators are very good at making entries into patient's charts when they callFurthermore, *** failed to call [redacted] back after he left message a on 5/1/(the day she called), because [redacted] was out of the office until 5/20/2013, when he returned her phone call." I made different phone calls as shown on my telephone billsI did indeed return *** ***' phone call on May and 2, I have phone bills to prove itAs with the April 4, 2013, call the office also failed to document this factMy final call to the office was on May 10, This is the date [redacted] and I spoke, not on May 20, 2013, as his records falsely stateDates that I phoned [redacted] 's office (as shown on attached long-distance phone bills): April 4, 9:37am (Atlantic Time) minute duration-How could [redacted] 's office staff neglect to document a call of this duration?May 1, 15:53pm (Atlantic Time) minute duration-Spoke only to staff who left a message for a DoctorMay 1, 20:39pm (Atlantic Time) minute duration-I returned *** ***'s call, but the office had closed for the night He did not leave any other number by which to contact him after hoursMay 2, 15:52pm (Atlantic Time) minute duration-I called attempting to reach any Doctor availableNo successThe staff did not follow throughMay 10, 11:25am (Atlantic Time) minute duration-I left a message with the receptionist to have [redacted] return my callWithin the hour, finally he repliedFinally, on May 10, 2013, [redacted] returned my callThe objective of my phone calls dated May 1, 2, and 10, 2013, was to seek an explanation for the wire breaking and request compensation for repair/replacement of the defective retainer, before seeking services of professional orthodonists miles from my homeThe estimated cost would have been at least $to remove the current broken wire and make a new retainer to replace itDuring that conversation, he told me that I would be better off with a removal retainer since plaque builds up with the glued retainer making it difficult to maintain healthy teethWhy did he not tell me that October 2011, before I purchased this stainless steel braided wire? 4.DISCREPANCY: Dr [redacted] 's notes state: "As stated earlier, there are orthodontic offices within miles of her address (Documents #and #3)Also of note, traditionally there are more dental offices in most areas than there are orthodontic offices in any given areaIfa search for dental offices within an mile radius of her address was done, it would probably show more than dental offices in that area where this could have been addressed in a much more timely manner, keeping in mind that it was cut by a dentist in April/May of (Document #shows a search for dentists in the *** [redacted] area)."I was not living in Newfoundland in 2013, I moved to Newfoundland September Contrary to what [redacted] says, there is no such orthodontist within miles of where I lived in 2013, only dentist, who fortunately had enough experience in orthodontic matters and knew how to safely address this dangerous situation I gave sufficient time for any Doctor at Alpine & [redacted] to return my call that day before proceeding with the local dentistUnfortunately, the Orthodontist located miles away was not able to give me an appointment soon enoughDo you expect a client in such a situation to wait until the next day for an appointment with the orthodontist located hour away from my home and risk swallowing the rest of the broken section during my next meal or while asleep that night? [redacted] still has not explained why he did not keep the rest of the retainer removed on September 29, 2014, to send to the company making and selling the wire for further examination and testingIt is obvious he diverts attention from the real issue at hand, makes claims, and incorrectly documents informationWhy did the technician tell me that this braided wire retainer is not made to last years like my original wire and compared it to the quality of refrigerators made now verses years ago? If [redacted] knows this product is of inferior quality, he should at least mention it to clients before purchasing this productCustomers expect quality products, especially when permanently affixed inside the mouth.There is nothing Dr [redacted] can say to change the documented factsWhat I want at this point is a refund of $USDThis includes: $(cost of the frayed permanent retainer) +$(dentist fees) -$(the amount discounted off the new removable retainer)$USD Total Regards, *** [redacted]

We are writing this letter in response to a concern submitted on 10/23/at 9:23:39PM, which was assigned an ID of *** Please refer to attached documents # 1-throughout our response Please note that Document # 1, which are the patient notes, should be used throughout
our response as a general timeline (Medical-Legally, these patient notes become permanent record at 11:59pm the day they were entered into our computer system)
Mrs*** *** was a patient of the practice as a child On 10/3/2011, she contacted our office stating her lower lingual retainer (a braided wire which is glued to the back of the lower front six teeth as a fixed retainer) was loose and wanted us to replace itLater that day, *** presented without the wire, and told us that she removed it We removed the remaining glue and fabricated a new one for her
On 5/1/(months later), *** called the office reporting that her lower lingual retainer was loose again, and was upset because she could not find an orthodontist in Canada where she was residing, but found a dentist who clipped the wire to make her comfortable
During this conversation she also said that the old type of wire was better and that the wire itself was not the issue but rather the glue had come off Referring to appointment notes of 10/3/2011, she presented without the wire (which she stated she pulled out) and the glue was still on the teeth This is a conflicting statement from how she presented to our office (without the wire, but only the glue remaining on the teeth) At the conclusion of this phone call she ask if one of the doctors would called her back Dr*** *** called her back at 4:20pm that afternoon and left a message *** never returned his phone call
Dr*** ** *** called her back on 5/20/upon his return to the office He understood that *** was disappointed that the wire had broke, and he presented solutions to
her Since the circumstances were out of our control, and we do not know how the retainer came loose, we were unable to reimburse her; however, *** *** did offer to repair it at no charge if it was a simple repair (meaning that if the wire was still intact and not broken, just loose from the orthodontic glue)He also stated that there is no implied warranty with these types of retainers, and strongly suggested that she see an orthodontist in her area to address the issue After some research, we have found orthodontic offices (see Documents #and #3) located within 11 miles from her address
It was not until 9/18/that *** called the office again, explaining that she would be in town and would like to seen for the repair of the lower lingual retainer, and to discuss with *** *** the differences between the old retainer and the new retainerDuring this phone conversation *** stated that she believes *** *** said that the new wire is under warranty, and that she feels she should not have to pay for a repair or a new oneThe concern here was that *** had gone months without seeing an orthodontic specialist about the broken retainerAs stated earlier, there are orthodontic offices within miles of her address (Documents #and #3)Also of note, traditionally there are more dental offices in most areas than there are orthodontic offices in any given areaIfa search for dental offices within an mile radius of her address was done, it would probably show more than dental offices in that area where this could have been addressed in much more timely manner, keeping in mind that it was cut by a dentist in April/May of (Document #shows a search for dentists in the *** *** *** area)
On 9/29/2014, *** presented with the lower lingual retainer broken between her lower left canine and lower left lateral incisorIt was at this appointment that she and *** *** discussed the old wire retainer vsthe new wire retainer vsremovable retainers*** also wanted to know why this wire was not guaranteedThere is not an orthodontist that would guarantee this type of retainer regardless of the size or type used because there are too many variables, such as the bite, biting forces, diet, and parafunctional habits to name a few
Furthermore, it was cut by a dentist, not an orthodontist (who has the know-how and skill to work with this type of orthodontic wire)This was out of our control, meaning we were not able to examine the breaking point and really analyze how it fatigued to come to an accurate conclusionIt was decided to remove the lower lingual retainer and replace it with removable type retainerA rush was put on the retainer when sending to the orthodontic laboratory so it would be fabricated and sent to our office by the patient's desired time
The removable retainer was fitted and given to *** on 10/8/At this appointment, *** questioned *** *** about her previous retainersHe told her that he had never seen what she had described and offered to describe the situation to the company from which the wires are purchased and she said that she would appreciate that (see Document #5, which is the e-mail correspondence between *** *** ** *** *** *** *** *** *** ***, and Mrs*** ***)It was also at this appointment that she accused *** *** of caring only about money, which is simply untrue; he was simply stating the laboratory and operating costs associated with wire fabrication and placement of the retainerThis cost or fee was agreed upon by both *** *** and *** at the 9/29/appointment
We were disappointed to learn of ***'s frustrationIn reading her letter to the Revdex.com, we must comment on several statements made in this letter:
(1) Mrs*** said *** *** "guaranteed this new product"It is simply not true, retainers are not guaranteed by orthodontists or the laboratories that fabricate themThere are too many variables associated with them such as the individual's bite, inclination of the teeth, biting forces, patient habits (how cautious one is with foods or objects that could cause the retainer to break or come loose), etcIn ***'s case, the first wire came loose, so she removed it herself, without any regard for having it removed the proper way or consulting an orthodontistThis left glue on her teeth for an extended period of time could act as a plaque trap for decay forming bacteriaFortunately, there was no decay to these teeth
(2) With regards to the second lingual retainer she had, *** mentioned in her letter that she "extracted the splintered piece", but told our office that she found a dentist, not an orthodontist, to cut the wireThe concern with *** doing this herself or even a dentist cutting a portion of the wire out, is that neither have the trained expertise to properly remove this type orthodontic wire in an entirely safe wayIfthis wire it not cut and polished with the proper instruments, it could cause the wire to frayIt is for this reason, we suggest to all patients, when we place the wire they should be seen in our office or an orthodontist if they are out of the state of country if there is a problem with the wireWe hold ourselves accountable for the products
we use and the services we provide, but we cannot accept responsibility for something that is out of our control like the way she or another office cut or removed this retainerWe have no idea how it was done or what was used
(3) *** said she made "repeated phone calls"(May 2013) to the office before *** *** called her backAccording to our records, there was only one phone call documented, but it did note she said she called a few weeks ago and was transferred to financialThe scheduling coordinators are very good at making entries into patient's charts when they callFurthermore, *** failed to call *** *** back after he left message a on 5/1/(the day she called), because *** *** was out of the office until 5/20/2013, when he returned her phone callMaybe *** chose to wait for *** *** to call her back in spite of *** *** reaching out to herOur phone records can be made available for verificationAs for being ''transferred to financial", this only occurs when the patient asks about the fees associated with certain procedures
(4) *** commented, "not one person in the office seemed the least bit shocked or concerned that she had splintering metal in her mouth or that they were selling this product to patients"No mention of the wire splintering was ever mentioned in the office until she approached *** *** the day he fitted the removable retainer*** saw the same technician for her appointments on 9/29/and 10/8/To say that not one person cared is completely untrueWhat goes on at a patient's appointment is typically kept between the patient and the technician (along with the doctor) assigned to him/her that particular daySo it can be said that, unless that patient was extremely vocal while in the chair, no one else in the office would know what was transpiring at that particular chair for that particular appointmentThe fact that she waited months to be seen by an orthodontist, when there were clearly offices (Documents
#and #3) within miles of her home speaks volumes of her concern for the wire in her mouth
(5) *** *** did not "have the technician destroy the wire as she removed it from her mouth" as *** has said in her letterJust as in a physician's office, it is protocol to place the used needles in a "sharp's container"; in an orthodontist's office the old, used, and broken orthodontic brackets, bands, and wires are placed in a special orthodontic container as well
(6) *** also noted that "the office is giving away free iPads to patients"The average orthodontic treatment time is monthsIn an attempt to make it more enjoyable for our patients, we typically have fun contests for our patients to participate inTherefore, it can be said that any prizes in the office are not given away, but must be earned by patient's participationPlease refer to Document #for an example contest we've had in the past
(7) ***'s statement of us "intending to make more profit by selling inferior products that could endanger patient's lives'', we hold completely and untrueWe provide and use only products that have been approved by the FDA (Food and Drug Administration) , the ISO (International Organization for Standards), the ADA (American Dental Association , and the
AAO (American Association of Orthodontists)We have not and will never use any products that could endanger the lives of our patientsThe fees that were agreed upon by *** *** and Mrs*** were heavily discounted *** *** in an effort to meet *** half-way as an offer of good faith and overcome the "victim mentality" and the blame game reduced the fee 50% if she would be satisfied and move forward Itappears that she took the reduce fee but was not genuine in her acknowledgement of moving forward in a solution oriented mannerFurthermore, they are many employees of *** *** *** Orthodontics and their family members who currently have this type ofretainer and do not feel that their lives are "endangered" The technician working with *** on 10/8/told her that her "oldest son has the same wire and it has not broken and he is not as careful with it as *** said she was with hers"
(8) As for the question, "do they care"? Yes, we doOur patient 's safety and welfare trumps everything else we do in our officeOur patients are the most important people in our office They are never viewed as interruptions to our day, but rather the purpose of it
We would like to thank the Revdex.com of Delaware for giving us the opportunity to respond If there are any further questions or if we can be of any assistance, please feel free to contact or office

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.  It is clearly obvious by [redacted]'s reply, that he intends to divert attention from the real issue at hand, the fact that I should be reimbursed for the defective wire. I am disappointed by the failure of his office to professionally and promptly handle my complaint. As I sat in the exam chair on September 29, 2014, I was able to see the falsified and distorted office notes on their computer screen in front of me. It is very evident that his office is handling records poorly as I have records contradicting dates and details recorded by [redacted]. As no agreement to get reimbursed was reached on May 10, 2013, I waited until my next trip to Delaware, September 2014, to attempt to resolve this customer service issue. At the very least, I expected to be refunded the $250.00, have the rest of the defective wire removed at no cost, and be reimbursed $30.00 in dentist fees for removing the frayed section of wire. Then I would have been willing to pay the full price of $175.00 for the new removable retainer.Discrepancies in [redacted]'s replies:1.DISCREPANCY: [redacted]'s notes state: "There are  too many variables associated with them such as the individual's bite, inclination of the teeth, biting forces, patient habits (how cautious one is with foods or objects that could cause the retainer to break or come loose), etc. "In the presence of my husband and office staff, I was told on October 3, 2011, that this new type of braided wire was AS DURABLE AND EFFECTIVE as the previous wire I had worn since 1994. No mention was made of the exceptions above. I have not changed my eating or flossing habits since 1994, contrary to what [redacted] is implying. My first lingual wire from 1994 was a superior quality wire, constructed from a type of gold material, rather than a stainless steel braid, as I have now seen. It was normal for that original gold wire to need new adhesive re-applied at some point during 17 years. However, THAT PARTICULAR WIRE NEVER BROKE OR FRAYED. I did save it in hoping to have it reattached, however, I was told by [redacted] that was not possible. So, he suggested I purchase the new braided wire for $250.002.DISCREPANCY: [redacted]'s notes state: "On 5/1/2013 (19months later),[redacted] called the office reporting that her lower lingual retainer was loose again, and was upset because she could not find an orthodontist in Canada where she was residing, but found a dentist who clipped the wire to make her comfortable."  My initial phone call to [redacted]'s office was on April 4, 2013, 9:(Atlantic Time), not May 1, 2013, as their records mistakenly say. I made it very clear to 3 different staff members (Receptionist,Technician, and Financial) that a section of my lingual wire frayed and splintered, it did not merely come “loose” as their records state. THIS IS AN EMERGENCY SITUATION REQUIRING PROMPT ACTION. What I “extracted” was one detached thread of the braided wire resting on my tongue. The last 2 broken threads of that section of wire needed to be dealt with immediately before I swallowed them. AFTER that discovery, I immediately called [redacted]'s office inquiring how to proceed. I did not receive any assistance or direction after 17 minutes of being put on hold and transferred around the office. I left a message for a Doctor to return my call as soon as possible, however, I did not hear back from anyone. By 2:30pm that same afternoon, I finally sought the help of a local dentist in my town who safely removed the broken section and smoothed the wire. 3.DISCREPANCY: [redacted]'s notes state:  "[redacted] said she made "repeated phone calls"(May 2013) to the office before [redacted] called her back. According to our records, there was only one phone call documented, but it did note she said she called a few weeks ago and was transferred to financial. The scheduling coordinators are very good at making entries into patient's charts when they call. Furthermore, [redacted] failed to call [redacted] back after he left message a on 5/1/2013 (the day she called), because [redacted] was out of the office until 5/20/2013, when he returned her phone call." I made 5 different phone calls as shown on my telephone bills. I did indeed return [redacted]' phone call on May 1 and 2, 2013. I have phone bills to prove it. As with the April 4, 2013, call the office also failed to document this fact. My final call to the office was on May 10, 2013. This is the date [redacted] and I spoke, not on May 20, 2013, as his records falsely state. Dates that I phoned [redacted]'s office (as shown on attached long-distance phone bills): 1. April 4, 2013 9:37am (Atlantic Time) 17 minute duration-How could [redacted]'s office staff neglect to document a call of this duration?2. May 1, 2013 15:53pm (Atlantic Time) 12 minute duration-Spoke only to staff who left a message for a Doctor.3. May 1, 2013 20:39pm (Atlantic Time) 1 minute duration-I returned [redacted]'s call, but the office had closed for the night.  He did not leave any other number by which to contact him after hours.4. May 2, 2013 15:52pm (Atlantic Time) 7 minute duration-I called attempting to reach any Doctor available. No success. The staff did not follow through. 5. May 10, 2013 11:25am (Atlantic Time) 2 minute duration-I left a message with the receptionist to have [redacted] return my call. Within the hour, finally he replied. Finally, on May 10, 2013, [redacted] returned my call. The objective of my phone calls dated May 1, 2, and 10, 2013, was to seek an explanation for the wire breaking and request compensation for repair/replacement of the defective retainer, before seeking services of professional orthodonists 60 miles from my home. The estimated cost would have been at least $300.00 to remove the current broken wire and make a new retainer to replace it. During that conversation, he told me that I would be better off with a removal retainer since plaque builds up with the glued retainer making it difficult to maintain healthy teeth. Why did he not tell me that October 2011, before I purchased this stainless steel braided wire? 4.DISCREPANCY: Dr [redacted]'s notes state: "As stated earlier, there are 2 orthodontic offices within 11 miles of her address (Documents #2 and #3). Also of note, traditionally there are more dental offices in most areas than there are orthodontic offices in any given area. Ifa search for dental offices within an 11 mile radius of her address was done, it would probably show more than 2 dental offices in that area where this could have been addressed in a much more timely manner, keeping in mind that it was cut by a dentist in April/May of 2013 (Document #4 shows a search for dentists in the [redacted] area)."I was not living in Newfoundland in 2013, I moved to Newfoundland September 2014.  Contrary to what [redacted] says, there is no such orthodontist within 11 miles of where I lived in 2013, only 1 dentist, who fortunately had enough experience in orthodontic matters and knew how to safely address this dangerous situation.  I gave sufficient time for any Doctor at Alpine & [redacted] to return my call that day before proceeding with the local dentist. Unfortunately, the Orthodontist located 60 miles away was not able to give me an appointment soon enough. Do you expect a client in such a situation to wait until the next day for an appointment with the orthodontist located 1 hour away from my home and risk swallowing the rest of the broken section during my next meal or while asleep that night?[redacted] still has not explained why he did not keep the rest of the retainer removed on September 29, 2014, to send to the company making and selling the wire for further examination and testing. It is obvious he diverts attention from the real issue at hand, makes false claims, and incorrectly documents information. Why did the technician tell me that this braided wire retainer is not made to last 18 years like my original wire and compared it to the quality of refrigerators made now verses 18 years ago? If [redacted] knows this product is of inferior quality, he should at least mention it to clients before purchasing this product. Customers expect quality products, especially when permanently affixed inside the mouth.There is nothing Dr. [redacted] can say to change the documented facts. What I want at this point is a refund of $192.50 USD. This includes: $250.00 (cost of the frayed permanent retainer) +$30.00 (dentist fees) -$87.50 (the amount discounted off the new removable retainer)$192.50 USD Total
 
Regards,
[redacted]

January 15, 2015   RE: Concern ID [redacted]   Dear [redacted]                 We are writing this letter in response to "additional concerns" regarding the concern ID 1[redacted].  Please refer to our previous letter in which we acknowledged the original concerns raised by Mrs. [redacted], stated the facts as we know them and explained the lengths we went through to accommodate her in the past in the short time we were given.  Furthermore, we stand by our original response dated October 29, 2014.                 We have had a chance to review Mrs. [redacted]' most recent letter (dated 11/20/2014), and feel we did everything we could have for her considering the time line.  We believe some of the comments presented by Mrs. [redacted] to be unfounded and rather emotional as she is starting to stray from the true facts of the matter...   1.      We assure everyone reading this complaint that the notes in our computer system are not "falsified and distorted" and cannot be changed once entered into our computer system (as they are medico-legal documents).  The accusation of our office doing this or "handling our records poorly" is completely untrue and offensive.  We will vehemently defend our office’s ability to accurately record the events which occurred at each appointment.  It should also be mentioned that the scheduling coordinators do not create an entry in a patient's chart every single time they call the office, this is not in their job description as long as they leave a note on the doctor's desk to return, which they did. 2.      Mrs. [redacted] stated that her original lingual wire was "constructed from a type of gold material, rather than a stainless steel braid".  That, in fact, is untrue, and the wires we have used since the late 1980's have been made of braided stainless steel.  We have never told anyone that our wires were made of gold or a gold alloy, nor have we ever used lingual wires made of gold or gold alloy.  3.      As for being "told by Dr. [redacted] that it was not possible" to reattach the old wire.  That is true, because the part of the conversation Mrs. [redacted] left out of her letter was that the teeth in question had shifted, and that lingual wires are bent to fit the teeth when they are straight.  When the teeth shift, the wire (like any other retainer) won't fit properly and therefore be less effective.  Teeth that have relapsed (become crowded again), change any wire's ability to be as effective as it would have been with straight teeth.  In others words, lingual wires are more effective when the teeth have not relapsed (shifted). 4.      In regards to the phone records, we did not see that Mrs. [redacted] attached a copy of them for reference (?).  Dr. [redacted] did reach out to Mrs. [redacted] by phone 1 hour and 20 minutes after she left a message at the office.  He was ready to listen to her concerns and was willing to help in any way he could have even though she lived, and still does live 14-15 hours away (in another country - Canada).  Dr. [redacted] did leave a message telling her to call him back at the office, but always tells patients that if the office is closed, his contact information (cell phone, so he can be reached 24 hours a day) is part of voice mail message, and has been since he joined the practice in August of 2003.  Understanding that she might have favored Dr. [redacted] in this "emergency situation requiring prompt action", Dr. [redacted] was available and ready to guide her through this situation.  Later in the letter, she asks the question, “Do you expect a client in such a situation to wait until the next day for an appointment with the orthodontist located 1 hour away from my home and risk swallowing the rest of the broken section during my next meal or while I’m asleep that night?”  We are not sure where she was going with this question; however, had she returned Dr. [redacted]’ call, he most likely would have advised her to visit the nearest orthodontist or dentist because it would have taken him close to 24 hours to find his passport, pack his bag (complete with his orthodontic emergency kit) drive through the night, clearing customs into Canada while making his way to her place of residence for a house call.. While we understand this may have been disappointing to her to have Dr. [redacted] call her back instead of Dr. [redacted], we assure you that Dr. [redacted] is a competent orthodontist who would have taken time to guide her through the process of finding her a dental professional to address the problem.  Also of note, when Mrs. [redacted] said she wanted a phone call back from “any doctor at Alpine and [redacted]” – Dr. [redacted] is the only other doctor in the practice as well as a partner. 5.      Mrs. [redacted] still has not addressed our concern of why there was such a time lapse (17 months), between the time she reported the wire being loose then cut, and her actually making an appointment to remove/replace the lingual wire.  Was she truly concerned or did she want to play the victim to avoid any responsibility she made have had in this matter?   In regards to her last paragraph of defamation against our office, our response is simple.  We stand by the team we have employed, who are honest hard working people, who would never falsify or distort office notes (medico-legal documents). We stand by the products we use, in this case the lingual wires, which are used by a majority of orthodontists in the United State and Canada.  These wires are not faulty and do not break easily. We have teenagers who mistreat these wires everyday and as a result these wire do not fray and rarely break.  These wire being discussed are industry standard (refer back our previous letter) and have been on the orthodontic market for years.  Finally, we live in an increasingly blameless society where certain people shy away from personal responsibility for whatever the reason. These people seem to want everything and expect to give nothing in return, yet they buy such luxuries as cars, which do not come with a life time guarantee and no bitterness arises when it becomes time to find a replacement no matter how it has been treated in the past.  As we stated earlier, we stand by our original statement and will offer Mrs. [redacted] the names of other Delaware orthodontists if she wants to continue her orthodontic retention checks on her visits back to the state because we will not continue to take abuse from someone who is not forth-coming regarding the facts of the matter and continues to play the part of the victim.   We would like to thank the Revdex.com of Delaware for giving us the opportunity to respond again.  If there are any further questions, or if we can be of anymore assistance, please feel free to contact our office.   Sincerely,       [redacted] D.M.D.                                [redacted] D.M.D., M.S.

Review: Additional reasons for complaint include: "A sales presentation that misrepresents the product" and "the product I purchased was defective.

In October 2011, I purchased a new lower lingual braided wire (permanent retainer) to replace the previous wire which I had worn for 17 years but came unglued. Unable to reattach that particular wire, [redacted] said that I should purchase a new wire. He informed me that the previous wire is no longer available and they are now using a new type of wire. He guaranteed that this new product is as sturdy and durable as what I previously had worn. I paid $250.00 expecting that this new wire would last another 17 years. However, in March 2013, after only 18 months, the new wire frayed and I extracted a splintered piece of metal from my mouth. Immediately, I contacted [redacted]'s Pike Creek office and was transferred from the receptionist to a technician then to someone in finance, all of whom were extremely cold and unhelpful. Being that I was out of the country, I found a local dentist who could safely remove the frayed portion of wire that same day. In addition, my teeth obviously shifted while wearing the defective wire. I left a message for [redacted] to return my call that day, but he did not call me back for several days until after I persistently called his office. I wanted answers as to why this happened and what he will do to rectify this situation. Not one person in that office seemed the least bit shocked or concerned that I had splintering metal in my mouth or that they were selling this product to patients completing treatment. I returned to their office September 2014 when back in the country, desiring a better quality retainer free of charge. The best [redacted] would offer me is half-price on a removable retainer. No refund on the broken wire. I was told by the technician that "wires made today are like new refrigerators, they just are not made to last like the refrigerators made 18 years ago!" [redacted] adds, "If the wire can last 9 months, that is good! We don't know how a particular patient will respond to this wire." That is their job, supposedly their expertise, to match up the right product for the right patient. So, this tells a patient that they intend to make more profit by selling inferior products that could endanger patients' lives. I was lied to when sold this wire in 2011, they knew full well that it would not last any longer than a couple years. Did they know it would fray? Maybe not. Do they care that it frayed? Not at all! When I brought this matter to the attention of another orthodontist in the practice, he graciously offered to contact the company selling the wire, something [redacted] never offered nor intended to do. The emailed reply from the company stated that they would need to see the wire to examine it for defects. Unfortunately, [redacted] had his technician destroy the wire as she removed it from my mouth. How will that company ever know how faulty this product is or how dangerous it can be if orthodontists do not send defective wires back for examination? Parents should definitely be aware of the potential hazard associated with this wire and no one should pay $250.00 for such. When I requested a free replacement, I was told that it costs them time and money to make a retainer. Meanwhile, the office is giving away free iPads to patients. Hardly satisfactory customer service.Desired Settlement: This particular wire should not be used in any patient's mouth. It is a hazard. I am seeking a refund of $367.00, which includes $250.00 for the first defective wire, $30.00 for the fees of the dentist removing the frayed wire, plus $87.00 for the new removable retainer that I obtained in September 2014.

Business

Response:

We are writing this letter in response to a concern submitted on 10/23/2014 at 9:23:39PM, which was assigned an ID of [redacted]. Please refer to attached documents # 1-5 throughout our response. Please note that Document # 1, which are the patient notes, should be used throughout our response as a general timeline (Medical-Legally, these patient notes become permanent record at 11:59pm the day they were entered into our computer system).

Mrs. [redacted] was a patient of the practice as a child. On 10/3/2011, she contacted our office stating her lower lingual retainer (a braided wire which is glued to the back of the lower front six teeth as a fixed retainer) was loose and wanted us to replace it. Later that day, [redacted] presented without the wire, and told us that she removed it. We removed the remaining glue and fabricated a new one for her.

On 5/1/2013 (19 months later), [redacted] called the office reporting that her lower lingual retainer was loose again, and was upset because she could not find an orthodontist in Canada where she was residing, but found a dentist who clipped the wire to make her comfortable.

During this conversation she also said that the old type of wire was better and that the wire itself was not the issue but rather the glue had come off. Referring to appointment notes of 10/3/2011, she presented without the wire (which she stated she pulled out) and the glue was still on the teeth. This is a conflicting statement from how she presented to our office (without the wire, but only the glue remaining on the teeth). At the conclusion of this phone call she ask if one of the doctors would called her back. Dr. [redacted] called her back at 4:20pm that afternoon and left a message. [redacted] never returned his phone call.

Dr. [redacted] called her back on 5/20/2013 upon his return to the office. He understood that [redacted] was disappointed that the wire had broke, and he presented solutions to

her. Since the circumstances were out of our control, and we do not know how the retainer came loose, we were unable to reimburse her; however, [redacted] did offer to repair it at no charge if it was a simple repair (meaning that if the wire was still intact and not broken, just loose from the orthodontic glue). He also stated that there is no implied warranty with these types of retainers, and strongly suggested that she see an orthodontist in her area to address the issue. After some research, we have found 2 orthodontic offices (see Documents #2 and #3) located within 11 miles from her address.

It was not until 9/18/2014 that [redacted] called the office again, explaining that she would be in town and would like to seen for the repair of the lower lingual retainer, and to discuss with [redacted] the differences between the old retainer and the new retainer. During this phone conversation [redacted] stated that she believes [redacted] said that the new wire is under warranty, and that she feels she should not have to pay for a repair or a new one. The concern here was that [redacted] had gone 17 months without seeing an orthodontic specialist about the broken retainer. As stated earlier, there are 2 orthodontic offices within 11 miles of her address (Documents #2 and #3). Also of note, traditionally there are more dental offices in most areas than there are orthodontic offices in any given area. Ifa search for dental offices within an 11 mile radius of her address was done, it would probably show more than 2 dental offices in that area where this could have been addressed in much more timely manner, keeping in mind that it was cut by a dentist in April/May of 2013 (Document #4 shows a search for dentists in the [redacted] area).

On 9/29/2014, [redacted] presented with the lower lingual retainer broken between her lower left canine and lower left lateral incisor. It was at this appointment that she and [redacted] discussed the old wire retainer vs. the new wire retainer vs. removable retainers. [redacted] also wanted to know why this wire was not guaranteed. There is not an orthodontist that would guarantee this type of retainer regardless of the size or type used because there are too many variables, such as the bite, biting forces, diet, and parafunctional habits to name a few.

Furthermore, it was cut by a dentist, not an orthodontist (who has the know-how and skill to work with this type of orthodontic wire). This was out of our control, meaning we were not able to examine the breaking point and really analyze how it fatigued to come to an accurate conclusion. It was decided to remove the lower lingual retainer and replace it with removable type retainer. A rush was put on the retainer when sending to the orthodontic laboratory so it would be fabricated and sent to our office by the patient's desired time.

The removable retainer was fitted and given to [redacted] on 10/8/2014. At this appointment, [redacted] questioned [redacted] about her previous retainers. He told her that he had never seen what she had described and offered to describe the situation to the company from which the wires are purchased and she said that she would appreciate that (see Document #5, which is the e-mail correspondence between [redacted], and Mrs. [redacted]). It was also at this appointment that she accused [redacted] of caring only about money, which is simply untrue; he was simply stating the laboratory and operating costs associated with wire fabrication and placement of the retainer. This cost or fee was agreed upon by both [redacted] and [redacted] at the 9/29/2014 appointment.

We were disappointed to learn of [redacted]'s frustration. In reading her letter to the Revdex.com, we must comment on several statements made in this letter:

(1) Mrs. [redacted] said [redacted] "guaranteed this new product". It is simply not true, retainers are not guaranteed by orthodontists or the laboratories that fabricate them. There are too many variables associated with them such as the individual's bite, inclination of the teeth, biting forces, patient habits (how cautious one is with foods or objects that could cause the retainer to break or come loose), etc. In [redacted]'s case, the first wire came loose, so she removed it herself, without any regard for having it removed the proper way or consulting an orthodontist. This left glue on her teeth for an extended period of time could act as a plaque trap for decay forming bacteria. Fortunately, there was no decay to these teeth.

(2) With regards to the second lingual retainer she had, [redacted] mentioned in her letter that she "extracted the splintered piece", but told our office that she found a dentist, not an orthodontist, to cut the wire. The concern with [redacted] doing this herself or even a dentist cutting a portion of the wire out, is that neither have the trained expertise to properly remove this type orthodontic wire in an entirely safe way. Ifthis wire it not cut and polished with the proper instruments, it could cause the wire to fray. It is for this reason, we suggest to all patients, when we place the wire they should be seen in our office or an orthodontist if they are out of the state of country if there is a problem with the wire. We hold ourselves accountable for the products

we use and the services we provide, but we cannot accept responsibility for something that is out of our control like the way she or another office cut or removed this retainer. We have no idea how it was done or what was used.

(3) [redacted] said she made "repeated phone calls"(May 2013) to the office before [redacted] called her back. According to our records, there was only one phone call documented, but it did note she said she called a few weeks ago and was transferred to financial. The scheduling coordinators are very good at making entries into patient's charts when they call. Furthermore, [redacted] failed to call [redacted] back after he left message a on 5/1/2013 (the day she called), because [redacted] was out of the office until 5/20/2013, when he returned her phone call. Maybe [redacted] chose to wait for [redacted] to call her back in spite of [redacted] reaching out to her. Our phone records can be made available for verification. As for being ''transferred to financial", this only occurs when the patient asks about the fees associated with certain procedures.

(4) [redacted] commented, "not one person in the office seemed the least bit shocked or concerned that she had splintering metal in her mouth or that they were selling this product to patients". No mention of the wire splintering was ever mentioned in the office until she approached [redacted] the day he fitted the removable retainer. [redacted] saw the same technician for her appointments on 9/29/2014 and 10/8/2014. To say that not one person cared is completely untrue. What goes on at a patient's appointment is typically kept between the patient and the technician (along with the doctor) assigned to him/her that particular day. So it can be said that, unless that patient was extremely vocal while in the chair, no one else in the office would know what was transpiring at that particular chair for that particular appointment. The fact that she waited 17 months to be seen by an orthodontist, when there were clearly 2 offices (Documents

#2 and #3) within 11 miles of her home speaks volumes of her concern for the wire in her mouth.

(5) [redacted] did not "have the technician destroy the wire as she removed it from her mouth" as [redacted] has said in her letter. Just as in a physician's office, it is protocol to place the used needles in a "sharp's container"; in an orthodontist's office the old, used, and broken orthodontic brackets, bands, and wires are placed in a special orthodontic container as well.

(6) [redacted] also noted that "the office is giving away free iPads to patients". The average orthodontic treatment time is 23 months. In an attempt to make it more enjoyable for our patients, we typically have fun contests for our patients to participate in. Therefore, it can be said that any prizes in the office are not given away, but must be earned by patient's participation. Please refer to Document #6 for an example contest we've had in the past

(7) [redacted]'s statement of us "intending to make more profit by selling inferior products that could endanger patient's lives'', we hold completely false and untrue. We provide and use only products that have been approved by the FDA (Food and Drug Administration) , the ISO (International Organization for Standards), the ADA (American Dental Association , and the

AAO (American Association of Orthodontists). We have not and will never use any products that could endanger the lives of our patients. The fees that were agreed upon by [redacted] and Mrs. [redacted] were heavily discounted. [redacted] in an effort to meet [redacted] half-way as an offer of good faith and overcome the "victim mentality" and the blame game reduced the fee 50% if she would be satisfied and move forward. Itappears that she took the reduce fee but was not genuine in her acknowledgement of moving forward in a solution oriented manner. Furthermore, they are many employees of [redacted] Orthodontics and their family members who currently have this type ofretainer and do not feel that their lives are "endangered" . The technician working with [redacted] on 10/8/2014 told her that her "oldest son has the same wire and it has not broken and he is not as careful with it as [redacted] said she was with hers".

(8) As for the question, "do they care"? Yes, we do. Our patient 's safety and welfare trumps everything else we do in our office. Our patients are the most important people in our office. They are never viewed as interruptions to our day, but rather the purpose of it.

We would like to thank the Revdex.com of Delaware for giving us the opportunity to respond. If there are any further questions or if we can be of any assistance, please feel free to contact or office.

Consumer

Response: