Drilling for Dollar$

February 8, 2008 12:10 PM

I'm mid 40s, have had 2 cavities in my life, to date, one in my late teens and another 15 years later. My dentist from childhood retired in 1999. Since then I have consulted a dif't dentist each year, for a total of 7 dental "exams". Each one has alerted me to various work I need done to my teefs, which I declined to have done. None has ever "diagnosed" a problem remotely similar to any of the preceeding dentists. Each has found something new. The science of Dentistry is a profession exactly how? How can I ever find an honest dentist?
posted by Fupped Duck to health & fitness (35 comments total)

How can I ever find an honest dentist?

Recomendations from people you trust. (I can recommend someone here in Toronto :-)
posted by winston at 12:16 PM on February 8, 2008

The science of Dentistry is a profession exactly how?

People are willing to pay other people to fix their teeth. The fact that dentists seem to be crooks a lot of the time does not eliminate the very real need for dentists.

How can I ever find an honest dentist?

In my experience, the only way is to have a pre-existing personal relationship with the dentist that is good enough that the dentist would rather keep the relationship strong than get rich by scamming you.
posted by The World Famous at 12:19 PM on February 8, 2008

Well, it depends on two factors:
1. What was the work? Was it related to tooth decay, jaw position (i.e. corrective dentistry needed to move teeth), or periodontal concerns?
2. Was each dentist addressing the same concerns?

I have no idea why you're spreading out exams instead of buckling down and getting an exam done with an estimate of what work to be done, and then seeking out a second dentist for a second opinion. Sometimes corrective dentistry is cosmetic, but sometimes it's done to alleviate stress on the jaw joint or similar issues, and different dentists will have different approaches -- this may be why you have had different opinions.

Without knowing what sort of issues are being "diagnosed," as you put it, you're kind of leaving us in the dark as to what we're talking about.
posted by mikeh at 12:19 PM on February 8, 2008

I've had this same issue and I too am growing a distrust of dentists. Even getting recommendations doesn't seem to help. I don't WANT to be an anti-dentite, but I'm interested in the responses here.
posted by agregoli at 12:22 PM on February 8, 2008 [1 favorite has favorites]

I think you need to stop going to dentists, or just go for cleanings and assume that's all you'll ever get out of it. I'm serious. If you've only ever had two cavities and your teeth aren't bothering you, what else do you want? It doesn't sound like you need a dentist.
posted by Violet Hour at 12:23 PM on February 8, 2008

The science of Dentistry is a profession exactly how?

At age 40 you're approaching root canal territory. The dentist uses skill and science to eliminate the worst discomfort you'll ever know, associated with your teeth and eating. So far, with only two cavities, you've been lucky.
posted by Rash at 12:24 PM on February 8, 2008

You could always get a recommendation from your dental insurance representative. They're likely to hear about patient complaints and are probably more likely to favor dentists who don't submit lots of claims for reimbursement.
posted by parilous at 12:32 PM on February 8, 2008

I've tried getting referrals. It doesn't seem to help. No two dentists ever diagnose the same problems. In 2006, a dentist, who I found because I'm good friends with a long time employee of his, diagnosed a cavity on each back surface of my last molars, where prior inpacted wisdom teeth removed 20 years ago had made a "notch". Because it was under the gum line, he proposed drilling down from the top, whcih would have severely compromised the strength of the tooth and started me on the way to a crown, some time down the road when this massive filling wore out.
This year's exam not only failed to find this, but when I specifically asked him his opinion, he felt there was still just a notch, but no decay. WTF?
My understanding of the term profession, vs industry is that professions place the clients interests ahead of their own. Industries, not so much...
I'm trying hard not to conclude that the entire "profession" is one big racket. And so I'm looking for a methodology to find and work with a dentist who can be trusted to care for me teeth, rather than mine them.
posted by Fupped Duck at 12:37 PM on February 8, 2008

I'm trying hard not to conclude that the entire "profession" is one big racket.

I'm right there with you.
posted by The World Famous at 12:39 PM on February 8, 2008 [1 favorite has favorites]

I've found that staying far away from dental insurance provider lists is the best way to go. Get recs from folks you know. The insurance listed doctors seemed more likely to drill, trump up extra work, and have weird inane advice. After some ugly dentist issues, I still carry insurance but I don't use in-network dentists. After filing a claim for out-of-network reimbursement, the difference in cost is hardly noticeable.
posted by ick at 12:46 PM on February 8, 2008

I'm 38, and have never had a cavity. I had one dentist who, for 12 years, said just keep truckin' with my cleanings twice a year and flossing and I'll be fine. The new one now constantly tells me I need "planing" under the gumline and that I should have my perfectly fine, never-bothered-me wisdom teeth out to avoid stress on other teeth and bacterial buildup (which is odd, since I never had a bacterial infection before).

So yeah, it maybe be medicine, but it's one of the most subjective sorts of medicine. I understand your frustration! I finally just told mine that I wasn't having surgery, and if she could convince the insurance company that I needed 3 or 4 cleanings a year instead of two, I could address it that way, but that I wasn't paying a single dime out of pocket and it was up to her to keep my teeth as good as I'd kept them by myself. We'll see what happens.
posted by luriete at 12:49 PM on February 8, 2008

2. Was each dentist addressing the same concerns?

Thats just it. I'll spare you all the long list of contradictory and sometimes spurious diagnoses...
But employing them all I think I could easily make an empirical case for the fact that there is no science at work here, dental or or otherwise.
Having the good fortune of strong teeth, I've the luxury of waiting a year to see if their Dx is confirmed by a second opinion. And it never holds up. Not once in 7 exams.
posted by Fupped Duck at 12:52 PM on February 8, 2008

Holy cow, I feel for you, Fupped Duck. I have exactly the same problem; no dentist I've ever gone to has ever told me the same thing about my teeth. I have to be extremely firm with them about what is and is not going to happen to my mouth. Then they make derisive comments about it in front of me.

I'd be interested in the best way to approach the issue of finding a dentist, as well!
posted by LN at 12:53 PM on February 8, 2008

Keep shopping around. I finally found a good dentist after several quacks. Tip off to quacks are when they try and upsell you things like using a special light to detect oral cancer that the insurance won't cover, or when they have 12 front office people. A lot of front office people means aggressive billing and high overhead. The dentist I have now is old school and small time. The front office receptionist doubles as his assistant. He has never recommended anything but the most conservative type of treatment. He fixed a problem for under $100 when another dentist suggested an over $6,000 course of treatment and two needless extractions.
posted by 45moore45 at 12:56 PM on February 8, 2008

It doesn't require dishonesty for dentists to disagree. True, there is a broad tendency towards over-servicing (dentists will often suggest that you return every 6 months for a check, but once a year is fine), but a lot comes down to different standards of when to intervene and aesthetics. US dentists tend to be more proactive, do more 'just in case' work and have higher standards of dental beauty than (say) Australia or the UK. For example, root canals are a relatively uncommon operation in Australia. (In my immediate family, there's a total of two.) And what passes for acceptable in British teeth? Yeesh ...

A recommendation of a good dentist is the best idea, but beyond that it pays to be sceptical and ask how important any work is. Will any issue definitely develop into a problem, might develop into a problem, or is it just cosmetic?
posted by outlier at 12:58 PM on February 8, 2008

I'm right with you. I'm 30 and never had a cavity in my life. I went to the same childhood dentist up until I moved a few years ago. This dentist was almost a family friend and my dad is a doctor, so I suppose that helped. Now after I moved the dentist here suddenly finds I have holes in my teeth that need to be filled and also said I had a small cavity on one of my teeth. She recommended the work be done and I was adamant that it would not be done because I think they are quacks and I'm pregnant. I told her to stick with the cleaning.

I definitely feel your pain and unfortunately have no recommendation except to err on the side of being conservative rather than getting any work done.
posted by threesquare at 1:12 PM on February 8, 2008

You raise a good question, Fupped Duck. Up until my mid-30's I had very few cavities and most dentists I saw complimented me on what good shape my teeth were in. (I moved a lot so I saw a lot of dentists). Then when my dentist retired I started going to a dentist recommended by a friend. This one never failed to find some problem. A small cavity beginning to form, some gum issue, so on and so on. Some work I agreed to, some I didn't, but I wondered what I had done different that was all of a sudden causing problems.

I switched dentists due to an insurance change and this new dentist hasn't identified any problems yet, nor mentioned anything that the other dentist did, in fact he's giving me compliments on what great shape my teeth are in. I previously had chalked this to different degrees of aggressiveness and treatment philosophies between dentists, but maybe it was more along the lines of what you're raising.

Getting to outlier's point, this second dentist is British (I'm in the U.S.) and received his training in England, so I actually did think briefly that maybe there was a cultural thing going on and hoped that I wouldn't ultimately end up in the Big Book of British Smiles

So I don't have an answer, but one more data point in the "some dentists seem prone to find problems that others don't" group.
posted by cptspalding at 1:28 PM on February 8, 2008

nth recommendations
posted by Salvatorparadise at 1:43 PM on February 8, 2008

Past performance does not guarantee future results. Meaning, just because you've never had problems with your teeth doesn't mean you won't in the future. I fell into that trap. I kept telling the dentists, "no!" until I had a pain come on that kept me awake for three days straight. *That's* when it gets *really* expensive.

Now my question is always, "why do you want to do that and how will it help my oral health down the road?" An unsatisfactorily vague answer gets a 'no' and and an obviously stupid answer gets me a new dentist.
posted by GPF at 1:47 PM on February 8, 2008

I am 35, have never flossed in my life, brush 2x/day, go to the dentist once every 5 or 6 years (these days) and I've never had a cavity filled. I have had dentists tell me I have cavities, but when I went back to another dentist 5 years later, he didn't notice any at all.

So the last time I was at the dentist, I asked him why this phenomenon. He said something to the effect of minerals naturally occurring in your saliva fill the holes in the enamel of your teeth. Sometimes, this process fails, he told me, and you get a cavity - a rotten spot. But most of the time, nature has its own way of fixing teeth and lots of dentists fill in likely benign holes for the money. I'd never heard that theory before, and I couldn't find really anything to back it up on the internets. My wife says its horse shit. Who knows.

Although in my 20s I let 12 years go by between dental visits, and that did result in a root planing.
posted by M.C. Lo-Carb! at 1:51 PM on February 8, 2008

it's one of the most subjective sorts of medicine

What an excellent question. I know that when this has come up in discussions of medicine, people often point to "evidence-based medicine" as a way of beginning to determine what practices really create better outcomes than others. There is such a movement underway for dentristry, based on this ADA page I found by searching "Evidence Based Dentistry." Maybe you'll want to explore that concept.

We can be sure, however, that dentist disagreement has a long history. After all, they could never get more than 4 out of 5 of them to get behind the Trident thing.
posted by Miko at 1:52 PM on February 8, 2008 [2 favorites has favorites]

Several years ago, I was told that my wisdom teeth had to come out. I asked if it was because my teeth were overlapping slightly, and he said "no, not because of that." He then changed the subject. No other dentist has suggested this might need to be done, and it's been over ten years.

Not long after that, after relocating to a new town, I had a dentist fill a handful of cavities the previous dentist did not find (presumably.) She also pressured me to pull out all my metal fillings from when I was a kid, as otherwise I'd get mercury poisoning. I declined at the time.

Very recently, I found a family-operated dentistry; not only did they not want to pull my wisdom teeth or drill out my metal fillings, but the only cavity they found was a result of one of the other dentist's fillings falling out.

I think it's a lot like auto mechanics; you have some who are experienced and honest, and even they might disagree because a lot of it is about troubleshooting methods and cost/benefit ratios and preventative maintenance, and you have some unscrupulous folks who just want your cash. Telling the difference can be difficult, but the surest way I've ever found (with mechanics and dentists and lots of other folks) is to get three opinions, and don't sweat the stuff that they don't independently agree on.
posted by davejay at 1:53 PM on February 8, 2008

Also recommending a family-run sort of place with a shabby waiting room and one old lady behind the counter.

I've never tried it, but maybe 1 800 dentist has something?
posted by gjc at 2:26 PM on February 8, 2008

When I had to move, my old dentist recommended I find a dental school and see if the faculty saw patients. I have followed this advice and have been happy with it -- my dentist, because he is a professor, has the habit of explaining everything he does in excessive detail. ("See your X-ray here, see this spot, etc., etc.)
posted by Comrade_robot at 2:35 PM on February 8, 2008 [1 favorite has favorites]

I second the dental school thing, they don't have the same motivation to make money on unneeded procedures plus you are helping to train future dentists.
posted by yodelingisfun at 3:03 PM on February 8, 2008

So the last time I was at the dentist, I asked him why this phenomenon. He said something to the effect of minerals naturally occurring in your saliva fill the holes in the enamel of your teeth. Sometimes, this process fails, he told me, and you get a cavity - a rotten spot. But most of the time, nature has its own way of fixing teeth and lots of dentists fill in likely benign holes for the money. I'd never heard that theory before, and I couldn't find really anything to back it up on the internets. My wife says its horse shit. Who knows.

Oh, the benign hole-filling is definitely true. (Not sure about the saliva bit, but it sounds interesting.) Back in 2006, I went to a dentist after two years without even a teeth cleaning. My teeth weren't in pain, but I was still pretty afraid of what atrocities the dentist would find. Sure enough, they took some digital x-rays, pointed to things I couldn't see, and told me I had a cavity. I trusted them enough to make an appointment to fill the cavity -- I figured that the dentist knew more about teeth and reading x-rays than I did -- but decided to get a second opinion anyway. And then a third just to be safe. Two out of the three dentists I saw that week didn't see a cavity, so I canceled the filling appointment. It's been two years and there hasn't been any further decay where my alleged cavity was.

So yeah, there are dentists out there who'll pull out the drill for no reason other than money. And I'm now somewhat skeptical of digital x-rays; they must enhance areas that are on the verge of possibly being problematic. The two other dentists I saw both used old-school x-rays and said they couldn't see a thing -- and this is after I said I had been told I had a cavity. They could've easily pitched to me that I pay them to fix the "cavity" instead of the first dentist.
posted by phatkitten at 3:11 PM on February 8, 2008

I totally do not disagree with your conclusion. However, I don't think it's isolated to dentistry, but US medicine in general.

First, there is little incentive for preventative medicine in the US, but there is a high incentive for curative medicine. Doctor's are paid to treat problems, not to keep problems from occurring. But, also Dentistry is a bit worse because the doctors that diagnose are also the ones that treat.

If I go to my family doctor with symptoms, there is little incentive for him to diagnose me with an expensive problem that only a specialist can cure (unless he's colluding with the specialist). However, I go to my dentist there's a lot of incentive because he's also the one to treat the problem.
posted by brandnew at 4:04 PM on February 8, 2008

How can I ever find an honest dentist?

One suggestion is to look for a family-oriented practice--a place that has an old play cube in the waiting room. A dentist that treats both adults and children might be less conditioned to "upsell," as their treatment of children's deciduous teeth is usually far less aggressive.

Another thing to check out in the waiting room are the posters and ads up on the wall. The shady dentists I've encountered all had advertisements for LumineersTM, whitening treatments, etc, plastered everywhere. The good dentists may have had some of those posters, sure, but they also had a presence of posters warning against oral cancer, and brochures on smoking cessation. This suggests a concern with actual dental health as opposed to just expensive vanity treatments.

The two best dentists I have had come from dental "families." My best childhood dentist has a daughter in dental school; my current dentist is the son & brother of dentists. Perhaps these people are more likely to view dentistry as an honorable profession (instead of a moneymaking racket) since they inspired or were inspired by family members to continue the profession in the family line.


(These markers are based on the small sample size of my own experience; if you want a recommendation for south St. Louis or Washington Heights in Manhattan, send me a MefiMail.)
posted by neda at 4:29 PM on February 8, 2008 [2 favorites has favorites]

I asked my child's dentist to give me the name of his dentist. Now I go to my child's dentist's dentist. It is the only pain-free dentist I've ever worked with. I am so glad I asked.
posted by mamaraks at 7:06 PM on February 8, 2008

I agree with Neda; my dentist has posters encouraging regular flossing, not expensive treatments. Also, my dentist has a network of specialists he refers people to for major issues; he has a periodontist he sends people to for "gum-scraping," and he even has a guy that does nothing but root canals. This leaves him free to do the basics, like crowns and fillings and regular cleanings, which is what he enjoys anyway, and he isn't likely to refer people for special treatments unless they really need them.

Coincidentally, my dentist (who is also my uncle) agrees with ick's advice to steer clear of insurance provider lists.
posted by infinitywaltz at 8:11 PM on February 8, 2008

a family-run sort of place with a shabby waiting room and one old lady behind the counter.

Eh. Mrs Jones with never a cavity in her life went to such a place recommended by her college where the old coot found several teeth that "needed filling". She believed him. Once out of college she found another dentist who did nothing to her teeth but thought the old boy had probably invented the need.

Seconding mamaraks. Ask your old dentist who tends/tended his teeth. Or his assistants.
posted by IndigoJones at 3:20 PM on February 9, 2008

This will not help you [but maybe it'll help someone else]:

1. I have the same problem; there does seem to be a lot of bad dentists out there, and if it's not the dentist, it's their front office.

2. Could you please update the tags to include at least, "dentist"?
posted by RikiTikiTavi at 10:47 AM on February 11, 2008

Interesting thread.

I'll pitch in my related anecdote. When I was a kid, my family had the same dentist for close to twenty years. My parents and siblings all went to him. We even visited his family's home for dinner, and played with his same-aged kids a few times.

For years, he told my mom, my brother and me that our teeth were perfect. I've never had a cavity (I'm now 35). My mom has had very few cavities. Same with my brother. My dad's not so lucky.

Anyway, our dentist always told my mom, my brother and me that we'd most likely never need any serious work if we kept up with regular check-ups, flossed and brushed. Teeth were straight... No problems in sight... Keep up the good work!

Then, out of no where, my brother and I needed braces and our wisdom teeth pulled, my mom needed braces, and my dad needed $10K of various work on his teeth. WTF dentist?
posted by syzygy at 10:09 AM on February 12, 2008

Then, out of no where, my brother and I needed braces and our wisdom teeth pulled

Yeah, brushing and flossing does nothing to prevent your teeth from being crooked or your wisdom teeth from coming in and messing things up. Same with your mom's braces.
posted by The World Famous at 10:41 AM on February 12, 2008

The World Famous, That's certainly true, but the dentist had told us repeatedly and explicitly that neither I, my mother nor my brother would need braces because our teeth were straight (which I mentioned in my comment).

Had nothing to do with brushing or flossing.
posted by syzygy at 10:32 AM on March 7, 2008