Wanted: An honest dentist
Three exams in 13 months bring startlingly different results. What's up with that?
This post comes from Lynn Mucken at MSN Money.
My dental problems began about 10 years ago. Not problems with my teeth or gums; problems with my dentists.
I had strolled into the office for my semiannual cleaning and checkup. The receptionist, in that cheery receptionist way, greeted me with, "Doctor has a new associate. Do you mind if she does your checkup?"
The associate took the usual five-minute look, then asked, "Would it surprise you to find out you have three cavities? One of them will require a root canal."
Yes, it would surprise me.
I had not had a cavity in the 20 years I had been coming to that office. It was nothing but scraping, buffing and every few years a replacement of a deteriorating filling.
She waved an X-ray in front of me and pointed at a dark spot. "We shouldn't wait on this."
I told her I had to check my schedule before making an appointment. Three weeks later I was sitting in the chair of my wife's dentist. "There's a couple fillings we need to watch," he said as way of diagnosis. And cavities? "Nah. You're not a cavity kind of guy."
Fast-forward a few years. I had moved to San Diego and been going to a dentist recommended by a co-worker of my wife. No cavities in 18 months and three visits with him either, although he seemed distressed by the grayness of my teeth. (Apparently I am the only person in this town without whitened teeth.) However, I then turned 65, and he didn't accept my Medicare supplement.
I walked a couple of hundred yards up the street to another dentist, went through the usual routine and waited for the news. "We have some crown problems here," she said before waving an X-ray at me and walking away. I was ushered into another office, where a pleasant young woman explained the spreadsheet she slapped in front of me.
It was like choosing a car wash. The deluxe version would require a "core bldup amal/plas" and a "cerec-blue blck post" on teeth 5 and 13. Only $1,696 after insurance. Also offered were cheaper treatments on the same teeth: "lava posts" instead for $792.50, "bio 2000 posts" for $537.50 and "PFG posts" for just $336.50. I told her I would think about it.
Off I went to another dentist. Here they said I had to have a root canal and crown on No. 31 and a "perio scale and root pin and anti-microbial irrigation" on No. 32. All for just $3,050 out of my pocket. Post continues after video.
I said I would think about it, but I must have looked a little dubious, because they immediately asked me to sign a form verifying that I had "refused treatment."
What now? I have seen three dentists in the past 13 months. One said everything was fine, the next one diagnosed problems on upper teeth on both sides, and the third found problems only on the back two teeth on the bottom right. What would another opinion do besides add to my confusion?
Are these dentists -- and which ones -- incompetent? Are they crooks? Was all this just differences of opinion among professionals?
I've done most of what advice sites recommend in picking a dentist:
- Word of mouth. It worked once for me, so maybe I go back to that dentist and negotiate prices.
- Check state records. I did. None of my dentists in California had had complaints filed against them.
- Look at patient review sites. Did that on the last two dentists. For the first, there were 34 reviews on Yelp.com, about evenly split between positive and negative, with almost half of the negatives focusing on customer service. For the last dentist, there were five reviews, with the four negatives dealing entirely with the office help. Given that review sites on pretty much everything from apartments to mechanics run 80% negative, these results didn't cause any red lights to go on.
I thought about filing complaints with the state dental board (see list for all states), but I figure that it would be almost impossible to get sanctions imposed over a diagnosis.
Maybe I'll just keep looking, while remembering the words of Jay W. Friedman, a highly honored retired dental surgeon who has campaigned against needless root canals and unnecessary removal of wisdom teeth. He wrote the "Complete Guide to Dental Health: How to Maintain Your Dental Health and Avoid Being Overcharged and Overtreated."
"The average dentist is well intentioned and capable of providing adequate dental care," Friedman wrote. "By training and the imperatives of marketplace economics, however, the dentist is more than likely to provide too much care."
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Well obviously the latter two took marketing classes. Many dental offices are now just like car dealerships and electronic stores. Up sell up sell. It seems to be about the dollar. Dentistry has gone from keeping teeth just healthy to pushing things you may need. Or selling procedures that aren't 100% necessary but may enhance the life of a tooth or your smile.
Believe me I know I am an old fashioned dentist. If it isn't broke why mess with it is my motto. that's probably why I will never be uber wealthy.
I think the thing that frustrates me most is how many patients don't care about their mouth, and think that they don't play a part in keeping their teeth healthy. They feel it is fully the dentists job to take care of their teeth. I often hear patients come in complaining of how terrible the last dentist they saw was because he did several fillings, and now they are all falling out. I then find out that they drink about 10 mountain dews a day and brush about 1 time a week. Many times I will refuse to work on them unless they commit to change their habits. If I don't proceed that way, I become the "terrible dentist" to everyone they talk to. I find it insane when a person will drop $20,000 for a boat that they may use 10 times a year, but refuse to spend $2,000 or $3,000 for needed dental work, for something they use several times a day and plays a part in their overall health.
As for advice in finding a good dentist, just remember the fancier the office is, or the more "spa" features they offer, the money for the mortgage or rent payment has to come from somewhere. Many of the big national chains I have seen are run as a big corporation, and profits are usually stressed.
If I were looking for a dentist, I would seek one out that has a nice, but modest office. Look at what type of car he drives, (Porsche or Chevy). Ask questions about why treatment is needed. If you get a funny feeling that you are getting taken, look elsewhere.
I finally went to her because I had a terrible toothache. She sent me to a dental surgeon for a root canal and then she did a crown. She told me my other crown needed to come off and be replaced because they only last 5 years. Well, thankfully she wasn't able to remove the old crown - the new one she put on only lasted a year and a half. It broke and I had to go to a dentist in a foreign country where I'm now living. He told me the first crown, a porcelain one, is in good shape and shouldn't have to be changed. the one she put on is made out of acrylic and isn't good for anything but temporary use. So not only did my "friend" do shoddy work on her supposedly good friend, but either she lied to upsell or she doesn't know her dentistry very well. My new dentist, an American but trained in another country, did a good job replacing the crown with a permanent porcelain one, did a small filling and a cleaning for less money than in America. So I wonder what happened to the quality of medical care in the USA.
I could not agree more. I spent ten years looking for an honest dentist. Fortunately I finally found one. Prior to that, the story was always the same. I would go to a new dentist for a checkup and cleaning. I would be told that I had a problem with tooth "17". Told them I would check my schedule and call for an appointment, never did. Six months later I go to a different dentist for a checkup and cleaning. This time tooth 17 is fine, but 5 and 6 need work. Next time, different dentist, different story again.
My conclusion is that either most dentists are dishonest, or my teeth have an amazing ability to repair themselves.
We are on our third dentist here in Naples Florida.
The last one we parted company with was an office of the "Towncare Dental" corporation.
Towncare has bought up quite a number of offices here in FL and they run it like a corporation, as opposed to a healthcare provider.
Maximizing profits is put above patient care and they hire young dentists fresh out of school (willing to accept beginning pay I imagine) and obviously school them in how to get the most money out of each patient.
We finally found a dentist that puts patient welfare ahead of profits and have had to fight tooth and nail with the previous dentists to be refunded overcharges that both put on our bill.
I am a Bachelor of Science hygienist with 31 years of experience, most coming from excellent dental practices. The scope of treatment that is available is anywhere from, "nothing hurts so that means nothing is wrong" to "your whole mouth needs reconstructing".
I have seen patients who have had "dental cleanings" every 6 months, have no pain, and are told they are ok when they actually have severe cases of periodontal "gum" disease. I have seen patients who have been told they have several cavities or need major restorative work who in my and my doctor's opinion don't.
For a consumer to be happy, the answer lies in finding a dentist whose practice reflects his or her perceived needs. For example, there are those who want "if it ain't broke, don't fix it". These folks usually have amalgam "silver" fillings that are greater than the amount of tooth structure that remains. I have seen them have an abcess that is deteriorating the bone as it becomes larger, but because it doesn't hurt and they are not swollen, they refuse to address it.
On the other side of the spectrum, I have seen a patient who is told they need 8 crowns, when actually the teeth are still quite strong and have good function or a no-previous filling adult patient with prominent fissures on the surfaces of their molars and no breakthrough decay evidence on x-ray told they need teeth filled.
Somewhere out there is a dentist who will give you what you want, however, each dentist sets the guidelines of his own practice based on his or her long term expectations. Those expectations can be all "financial", all "let me tell you what you want to hear and make you like me", but hopefully they are "giving you an honest assessment of your dental health and if there are problems or needs, exploring options to take care of them. I am preventive and want my teeth and gums to be healthy and to look nice (even the ones you can't see) so I want a practice that addresses my concerns, so I would not be happy with Dr. "no hurt, no problem", nor would I be happy with Dr. "let's meet our financial goal, today".
Hopefully, by speaking with the practice's appointment scheduler, you would feel comfortable scheduling a "New Patient Exam" and can obtain this information,
Just a few comments on cost of dental care:
It is impossible to give prices over the phone. Your individual situation may be very complex where someone else may have a simple fix (example: a simple vs surgical extraction).
Medical insurance and dental insurance are very different. Medical insurance can cover many thousands of dollars of treatment. Dental insurance usually only provides a benefit of maybe$1000 to $2000 per year, with many exclusions about which the consumer is not educated. These benefits are the same as they were when I started practicing 31 years ago, so they cover very little if you have major dental problems.
I also compare my medical itemized statements to dental ones. In medical offices I have been charged for "sterile tray set up", "vein puncture", "extended office visit" where a "3-surface amalgam" charge includes the injection for anesthesia, preparation of the tooth to remove the decay, applying a base to protect the nerve, and placing the actual filling, all done from a sterile set up with no office visit charge. Because medical insurance covers most of a physician's procedure, people don't get upset. If you only want the dentistry that your dental covers, you will not get very much dental work from any office. Dental insurance does not perform based on your needs, t only performs based on what plan your employer purchased.
I am rather amused at the attempt to make a dental office appear somewhat shady by saying, "..they immediately asked me to sign a form saying I refused treatment." That is standard procedure bud. As required by law, this is a liability there must be documentation of a dental professional letting you know what the situation is and what can be done to treat it. Much of this can be attributed to the fact we live in a world where people enjoy suing eachother.
I brought that fact up to him and he said "all the reason to hurry more".
I asked her doctor about it. He said doing that kind of major work while the chemo was in process and her condition was fragile was just plain stupid and dangerous. And anyway, the teeth weren't hurting or causing trouble. They lasted the two years with no trouble.
Just for fun I asked the dentist how long the work would take. He "estimated" about 10 hours altogether, over a period of 3 weeks.
This kind of greedy, unprofessional activity certainly taints the whole business.
One of my first jobs was for an orthodontist in high school. Years later one of my university jobs was at The University of Michigan School of Dentistry. From my first orthodontist who was on the state licensing board, he said that after the 8 years of school before specialty, they need to go in with someone before setting up a new practice because it is so expensive starting out. Our town was good at referring new in town patients to the new dentists to help them get started. Dentistry used to be cheap before dental insurance came to be and before the prices of gold and silver went up. The bands that we put on the kids's teeth in our office was white gold. I cannot imagine what the cost would be now if they used the same things. When I worked for the u, I just didn't see the doctors out to gouge anyone, nor growing up either. My dentist was my godfather. When his son began practice we were switched to him except for my brother who had a more complicated mouth. I don't like going to the dentist because I can't keep up with the cost of dentistry. I went the other day because delay causes fractures and breaks, and I had a choice, removal or if I wanted to save it root canal. At the price of gold I'll opt for a partial once all is addressed rather than canal and crown. The cost was $211. -too bad they don't discount cash customers. I've seen the comments that someone went to 50 dentists before getting the extractions desired. It is because you really never get away from dentistry. As the mouth changes, you'll need adjustments, or more dentures. The risk of fractures (jaw) are greater as those bones thin. And believe it or not, most dentists are not out to rob you blind. The cost of dentistry has just gotten expensive-rent, utilities, equipment, supplies, dentist, hygienist, insurance billers, their liability insurance. You try to run a business -if you are not a dentist chain and see what your prices are 4 years of college, 4 years of dental school and if a specialist 2-4 years of specialty school. (Same for physicians, same for PharmD pharmacists). I do not understand how someone can feel that someone as educated as these individuals tend to be do not realize that some things cost money.
Another thing to consider in the differentiation in your type of care. There tends to be the question which is somehow worded like this,"Are you happy with your teeth (smile)?" Prices may vary in the response to that, it might be that one person wants the glam mouth, another wants nothing done except what is absolutely the bare essential. (no whitening,try to fill, rather than canal and see if it works and so on).
in 1987 I had all of my teeth removed, and following that, I returned to the same dentist , ONLY to be ushered into an office, where some lady I had never seen, set up her tools on a tray and sat down to clean my TEETH! I smiled and she still did not get it!
I said EXCUSE me you are going to CLEAN what? My teeth are no longer in my mouth...she was really embarrased and left.
I have had my teeth completely destroyed by dentists and assistants. Since I was 9, they put in braces and partials, following the removal of my teeth at the ripe old age of 6! I had dentures for a LONG time and they just butchered my mouth over the years. I found one decent dentist that made the plates that I still have today. My wife had 3 sets made and they were terrible!
It's sad that some are so interested in their wallets only .not your health!
OMG thank you for this article. I've been to at least 6 (maybe more) dentists from hell in Jupiter, Florida, and i'm hoping they read this article. I went to a dentist to replace a very small filling in my tooth. he said that i needed a crown at a cost of $1,500. the pain from the procedure didn't go away for several days. i went back to see him, he said i needed a root canal on the same tooth and it would cost me another $3,500. I told him to just pull the tooth and he wouldn't charge me but would refund my money. However, the receptionist was unwilling to give me the money. i just stood there and waited to let them know i meant business. they are bottom feeders, scum bags, etc etc.
There's nothing we can do about this. It's like they know they can get away with it. And if we keep going from dentist to dentist we still have to go through the same procedure of having x-rays, it's very unhealthy.
Ahh, yet another dentally undereducated person writing about dentistry as if they're professionals in the field. Yes, dentists' opinions vary based on their training and if they are young or old. One dentist will be more aggressive in treating small problems before they get worse and other dentists like to "watch" cavities get worse. Some dentists will recommend to get fillings and some will recommend crowns instead. It all depends on what that dentist's philosophy on dentistry is. Old dentists sometimes have failing eyesight but continue to work while misdiagnosing most patients. Some dentists just aren't very good at their profession and are not good diagnosticians. And then there are the others who do rip patients off. Like every profession, everyone is human and some do a good job while others aren't that good, some people are decent humans, and some are dirtbags. The object of every business is to make money, this should not surprise people at all. Most dentists do enjoy their work and their patients or they wouldn't do it every day.
I would say the majority of dentists out there are honest and reliable and recommend treatment the patients do need. Whether the patient perceives their need in the same way or not. We had a lady in our office just the other day with teeth falling out due to periodontal disease insisting that there was nothing permanently wrong with her teeth, this was as she was holding her tooth that had fallen out of her mouth of its own accord and due to bone loss. Most patients don't know and refuse to believe the negative things a dental professional will tell them about their teeth. However, this is the job of a dental professional, to educate the people with low dental IQ's. Prices of treatments will vary from place to place, it depends on location and demographics of the area. If this patient wanted to really find out what was wrong with her teeth, the x-rays will usually tell all. If a tooth needs a root canal, it will generally be obvious on the x-ray. I'm guessing that the patient isn't a dental professional and therefore cannot read x-rays so she'd have to rely on the dental advice of the dentist. But to get varying treatment plans in different dental offices in different locations, that's to be expected.
I agree that it is difficult to find a dentist that a patient will trust because many patients are distrustful by nature, some patients are in denial about the state of their teeth and about 75% of people have some form of periodontal disease or another. 60% of the population doesn't go the dentist at all. Most dental problems are caused from some kind of neglect by the patient, either they don't brush and floss as instructed or they haven't been to a dentist in years. I'm always surprised when a patient is surprised when they have dental problems after 10-15 years of neglect, but that is common to hear at a dental office.
I find it sad that these websites that most people get their news from allow "bloggers" to go and post about anything they want as if they are experts on subjects while most of the articles I read are written by the average Joe who usually knows little to nothing on the subject they're sharing their undereducated viewpoint on. I guess actual news reporting on well researched topics is a thing of the past. Sad indeed.
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