From 4 cavities to 0 in one visit.

July 24, 2007 5:06 PM

Shady dentists and second opinions. Any insight would be helpful.

I recently moved to a new city and have not been to a dentist in a little over a year. I found one randomly that accepted my insurance and went for a preliminary visit. They said I had 4 cavities and would need approx $400 of work to fix it all. This dentist office was not the best, they didnt seem that professional and made me sign a bunch of papers about how I wouldn't sue them if anything went wrong, basically gave me a really bad vibe.

So I didn't have anything done by them and found a new dentist upon recommendation of a co-worker. I just went to the new dentist for a second opinion so to speak, and they said I was good to go with only a normal cleaning, 0 cavities, everything looks good. They were looking at the same X-rays as the first office (which I took with me.) These guys seem more professional and the office was much nicer, but I was kind of expecting them to find SOMETHING based upon the other diagnosis. They did want to put one of my teeth on observation for a potential cavity, but said not to worry about it now.

Should I be paranoid? Should I report the other office to the insurance company if they are trying to have work done on people that they dont need?

posted by outsider to health (13 comments total)

Several years back NPR did a segment where they had the same person go to dentists across the country for a quote and quotes varied widely. Anecdotally, I've definitely had shady dentists quote me things I knew were wrong. So, I would definitely believe the dentist who was recommended and who gives you a good feeling.
posted by selfmedicating at 5:25 PM on July 24, 2007

Whether or not you have a cavity is a question about which reasonable dentists can differ.

My wife went to one dentist who said she had a cavity; a few months later, she went to another one who said she didn't.

I asked a dentist friend about this, and he says that different dentists have different thresholds at which they define something as a cavity. I asked my own dentist about it, and she agreed with my friend.

So, I wouldn't go all "whistleblower" about it.
posted by jayder at 5:33 PM on July 24, 2007

Did you ask the dentist you liked about the spots the dentist you didn't like didn't like? What did (s)he say about them?
posted by toomuchpete at 5:36 PM on July 24, 2007

I went to one dentist who gave me a long list of what needed to be done, then to a second (better, in my opinion) who disagreed with a lot of it. She looked at the same xrays and while there were areas she wants to keep an eye on, she didn't think they were at a point where they needed work. The first dentist's assistant also tried to pressure me into getting it all done immediately, while the second dentist had no problem spacing it out and said none of it was all that significant. That was definitely not the impression the first dentist had left me with.

I agree that some of it comes down to differences of opinion. I think if I were to keep trying new dentists I'd get a slightly different diagnosis each time just based on their feelings about what constitutes a cavity. But given the pushy tactics at the first place I went to, I think some of it is a bit shady. Given that you had bad feelings about your first one, I'd tend to suspect the same thing. In your position, I'd keep going to the second dentist and be extra careful to keep the problem area clean in the future.
posted by waterlily at 6:01 PM on July 24, 2007

Your insurance would love to know about a dentist doing this. Differences of opinion exist in all medical fields, but pushing for unnecessary work could easily be someone exploiting the information asymmetry to drum up cash. It's called supplier induced demand, and believe me that insurers look for it. Your report is by no means sufficient (otherwise people would use it to retaliate on dentists that they don't like), but adds to the database that they watch.
posted by a robot made out of meat at 6:28 PM on July 24, 2007

Additional: your observations of an office in need of renovation, concerns over malpractice, and unprofessional attitudes support the looking-for-business hypothesis.
posted by a robot made out of meat at 6:31 PM on July 24, 2007

i think i would be really really bugged by having to sign a form saying that i couldn't sue the dentist for malpractice. i don't think they would be enforceable anyway, but the fact that he thinks that he needs them is a pretty good indicator of what kind of dentist they are.
posted by lester's sock puppet at 7:14 PM on July 24, 2007

Although I agree with the consensus that the second dentist sounds good, $400 is not really that much dental work; probably 2-3 fillings and/or similar minor things. One crown or root canal could be several times that amount, so the first guy might well be within a diagnostic gray zone in his recommendations.
posted by TedW at 7:24 PM on July 24, 2007

Once in a new city, I went to a dentist like this once and he told me that: all of my teeth either had cavities or needed to have the fillings removed and replaced and that I had hairline cracks in all of my teeth and would need to have veneers put on them. He had a lot of expensive equipment, including a tiny camera on a stick that he put in my mouth, then showed me the footage of my teeth, magnified 1000% on a widescreen TV to illustrate how "bad" the situation was. At that magnification, my teeth did indeed look like a graveyard.

Interestingly enough, this particular dentist was located very close to a large tech business park in a city thriving from the dot.com goldrush. Presumably, he made a lot of money off of young professionals with excellent dental insurance.

I quickly got a second opinion and was told I had one tiny cavity, but otherwise, my teeth looked great and to keep flossing!
posted by pluckysparrow at 7:27 PM on July 24, 2007

According to my dentist (who is wonderful and whom I trust completely), the reason for this is as follows: a dentist's drill is a certain size (say a foot, for illustrative purposes), so the absolute smallest amount of drilling the dentist can do is a foot wide. If you have a spot of decay which is substantially smaller than that, the dentist is going to destroy a whole lot of healthy tooth for the sake of a tiny spot of decay which may or may not progress. As long as you go to the dentist regularly so s/he can keep an eye on any small spots of decay, it shouldn't be a problem to wait and fill it when it actually needs filling (which may never happen, I have a small patch of smooth surface decay which hasn't changed in nearly a decade). Some dentists like to drill and fill everything they see, others are more conservative, I don't know that either is "right", but I do know that I far prefer a conservative dentist who takes the biological cost of any work s/he does into account (you never regrow teeth, so I prefer to keep as much of each tooth intact as possible, as long as that's the healthiest thing to do long-term).

I had a terrible experience with a chain dentist, where I was told I needed $6000 worth of work, including cutting one tooth in half, two crowns and two veneers, plus four fillings, I went to see my old dentist (1500 miles away), and he fixed the minor problem at the root of the whole issue (a cavity in a tricky spot to fill) for less than $200 and a whole lot less trauma to my teeth. The bottom line is that if you're not comfortable with a dentist, find another, they should be willing to explain things to you in a way which makes sense to you, and they should not make you feel concerned about their competence or their morals.
posted by biscotti at 7:51 PM on July 24, 2007 [1 favorite]

Recently I had three 'cavities' filled. My dentist used the diagnodent to detect them. As I had heard stories and known of individuals that received very different second opinions, I asked if the fillings were necessary. The dentist said that it was ultimately my choice. The diagnodent detected the problems before I had any indication and before they were visible. The dentist had a specific number reading (from the tool) in mind that indicated trouble. Although, there was room for error if there was food in the way or buildup. Like many others have said, dentists have varying degrees by which they deem a cavity or potential cavity in need of repair. Because I was wary, the dentist said that I could use a flouride mouthwash twice daily in hopes of my teeth repairing themselves. Teeth naturally regenerate and repair. But, if the problem areas had reached the inside of my teeth, there would be no change as the flouride enables correction to problems on the outside only. The idea behind the flouride rinse is to stop the cavities from forming in the first place. I am still using the rinse, had the cavities filled (there was no improvement), and have always been very happy with my dentist and the general 'feel' of their office. If you have any uneasiness, aside from general dislike of the dentist's office, the others in this thread are right, get out of there.
posted by NotInTheBox at 5:17 AM on July 25, 2007

This old post about VitalDent has some discussion about chain dentists, and how they tend to give you a pretty hard sell on potentially unnecessary dental work.
posted by chr1sb0y at 6:34 AM on July 25, 2007

We did something similar about ten years ago, although we actually started treatment before we wised up. I didn't report the guy, mostly because I threatened to do so if he didn't settle my account.... which he did. So I lived up to my side of the bargain.

I've mentioned this dentist to friends, though, telling them to watch out for this guy.

I also mentioned the treatment to our current dentist (no records came over from the other guy, and there was another dentist in between), and after describing what happened, our current dentist correctly identified the shady guy. Apprently, he has a reputation.
posted by Doohickie at 9:31 AM on July 25, 2007