How aggressive should I be with my dental work?
May 11, 2011 8:22 PM   Subscribe

Please help me navigate a new dentist!

I’ve moved recently and was forced to find a new dentist. My old dentist was great – he’d yell at me for not flossing enough but never found any cavities. I went to a new dentist and the news is less rosy; he wants to fill two cavities (very small ones) and put a crown on one of my molars. On my way out the receptionist gave me the projected bill for the additional work and commented that I didn’t need much done. I disagreed, but she assured me that I had comparatively little work to do.

I have two questions:
1) Is this a reasonable amount of work to need done? I’m 32 and brush and floss twice a day. So far I’ve managed to get by with only 2 fillings. I recognize that my old dentist may have been more conservative, but getting a crown seems like a big deal. The receptionist's comment really put me on edge, so I'm going to get a second opinion. Maybe I’m just old and I don’t realize it yet?

2) My second question is more important. How aggressive should one be with dental work? I don’t want to put off work if it needs to be done, but at the same time I’m reluctant to have permanent work done that will degrade//break/hurt over time. Once a cavity starts, is it better to nip it in the bud? What sort of long-term risks am I facing with the crown?
posted by Hermes32 to Health & Fitness (5 answers total) 2 users marked this as a favorite
So, this happens a lot when people go to see new dentists: the dentist they've had for years said everything was fine; new dentist finds all kinds of cavities. (And then, usually, the person gets ticked off, feels he's being unnecessarily forced into a lot of dental work, and there are bad feelings all around.)

As I understand it, this happens because your previous dentist has had a consistent, years-long relationship with your mouth. Through x-rays and regular checkups, the dentist has been able to keep tabs on your cavities. If your dentist noticed any pre-cavity (or small cavity or decalcification or whatever) areas on your teeth that weren't immediately troublesome and haven't progressed in a while, he probably made a note to follow up the next time you were in the office, and fix it if/when it looks like it will start to cause problems.

When you go see a new dentist, they don't know your personal mouth history. They don't know if those tiny cavities are something new that has cropped up in the last month or something that has been sitting in your mouth in the same non-progressing state for years. Erring on the side of caution (i.e. assuming that these are new, potentially aggressive cavities), the new dentist pushes for fillings.

There are, of course, personal differences between dentists (some are surely more proactive than others) as well as the dental technology they might have (apparently, there's some sort of laser or something these days that you can point at a tooth to very accurately determine underlying issues) that might cause them to react to small problems in different ways. But in general, the above is what happens.

If I were you, I'd call your old dentist and ask his opinion on these small cavities of yours. Are they ones you've had for a while that he's been keeping an eye on? Or are they new? He should be able to give you some idea of the immediate necessity of dental work.

Anecdotally, there have been a lot of things in my mouth that have been sort of "wait and see" cases. I'm related to my dentist, so he's got no reason to either push unnecessary dental work on me or not do what's absolutely best for my teeth. Every mouth is different. Call your old dentist and see what he says.
posted by phunniemee at 8:58 PM on May 11, 2011 [2 favorites]

Yeah, this happened to me the last time I got a new dentist. My "necessary" work was to the tune of $900 so I balked and got a second opinion. The next dentist looked at my xrays, looked at my teeth, and said my mouth looked fine. Then the NEXT appointment, after he'd had 6 months to think on my teeth, he recommended 4 new fillings and drilling out one of my old ones to replace it. At that point I thought, well, this guy didn't take the immediate dollar sign opportunity; he waited on it and thinks it looks worse. So, I let him do the work. Weirdly, the one place my old dentist thought was a precavity didn't look weird to the new dentist at all.

Dentistry: basically more art than science, feels like.
posted by troublesome at 10:32 PM on May 11, 2011

I like phunniemee's advice, and that may well be the case here, but sometimes? The dentist is just bad.

When my nice dentist retired, I went to his horrible replacement for several years. Not only was he dismissive of my tears during our appointments ("Oh, it doesn't hurt that much"), he told me I should have all my wisdom teeth out because they had cavities that were too hard to fix. When I asked if there were other options, because I didn't like the idea of mouth surgery, he was so weirdly aggressive about it that I never went back to him, or to any other dentist, for almost a decade.

(Note: this is not a great idea.)

When I finally decided to get myself together a couple of years ago, I found a very nice dentist who specialises in pain-free dentistry. I asked him about my wisdom teeth, figuring they must've been awful if they had cavities ten years ago, and he said they were fine.

"They don't have cavities?" I said, surprised.

"No, not at all," he said, and showed me the x-rays we'd just taken.

I recently had another check-up, and there's still no problem with my wisdom teeth. If I'd listened to the bad dentist, I would've had dental surgery for no reason.

If you're not comfortable, find another dentist.
posted by Georgina at 11:03 PM on May 11, 2011 [2 favorites]

To answer your 2 questions:
1)Each mouth is so different that what seems to be a 'reasonable' amount of work in one mouth might be completely inadequate in another and completely overboard in another still.
It is not unreasonable to begin by asking your current dentist to explain a little further why he/she thinks that the crown or each of the fillings is necessary. This should give you an idea of whether the treatment is preemptive or based on a deteriorating situation and should give you an answer to question 2).
If you don't like what you hear, a second opinion is warranted.
2) Tooth decay, once it takes hold in the dentin (the inner part of the tooth analogous to the meat of an apple), will not heal on its own, and will progress until it starts to cause pain or abscess the tooth. So taking care of cavities when they are small ensures that the filling will be smaller with less surface area to break down over time.
A crown is a big deal, and you should be comfortable with the reasons for it, and the dentist should explain the material he is going to use and its durability in your mouth. Long term risks with a crown should not be an issue as long as the factors that lead to the crown in the first place are addressed in the restoration.
IAADBNYD naturally.
posted by OHenryPacey at 7:36 AM on May 12, 2011

I called my old dentist and it turns out the tooth-to-be-crowned was something that he had been watching and suggested that I get taken care of.

posted by Hermes32 at 7:02 PM on May 16, 2011

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